Medicine 2 Flashcards
MCC Adrenal Failure
- USA
- WW
- Overall
- USA = AI Adrenal Destruction
- WW = Diss TB
- Overall = Chronic Steroid Use –> Withdrawal (produces TERTIARY = CENTRAL HYPOADRENALISM with low ACTH, low cortisol and normal aldosterone)
Ortner’s Syndrome
Hoarse voice 2/2 LA enlargement; look for elevation of L primary bronchus too
Malaria
- Bug
- Reservoir
- P/w (2) and Why
- 2 Protected Populations
- Dx
- Vs. Babesiosis?
- Bug: Plasmodium (Vivax, Ovale, Malariae, Falciparum)
- Reservoir: ANOPHELES Mosquito
- P/w (2) and Why: Cyclical FEVERS + HA as leave liver –> RBC
- 2 Protected Populations: Sickle Cell (not favorable RBC) + Prior Infection
- Dx: Thick and thin blood smear with Gimesa+ stain
- Vs. Babesiosis? Caused by IXODES deer tic and found in USA NE area; causes similar presentation
Histoplasmosis
- Microbiology
- Location
- Presentation / Dx / Tx
- Micro: Histo hides in macrophages, this is why disseminated infection produces hepatosplenomegaly + palate ulcers
- Location = Ohio + MS River Valleys, caves + bats
- Fx: Diss infection as above; tx with Ampho B + Itraconazole
Blastomycosis
- Microbiology
- Location
- Presentation / Dx / Tx
- Micro: Broad Based Budding Yeast
- Location = E of MS River
- Fx: Disseminated = Pancytopenia (bone) + skin problems (warty like lesions + ulcers)
- Tx: PO Itraconazole (mild) –> Severe with Amphotericin B
Coccidiomycosis
- Microbiology
- Location
- Presentation / Dx / Tx
- Micro = Endospore spherules
- Location = SW USA
- Fx = Valley Feve
Paracoccidio
- Microbiology
- Location
- Presentation / Dx / Tx
- Micro: Captain’s Wheel Appearance
- Fx: Latin America
gluten sensitive; IgA Ab to gliadin, Dermatitis Herpetiformis. Dx gold standard = biopsy with villous flattening
Celiac
as Celiac, need h/o of living in endemic area
Tropical Sprue
SI bacterial overgrowth
the little SI bacteria are overtaken by other growth 2/2 ∆anatomy or ∆gastric motility; diagnose with jejunal aspirate >10*5 bacteria, Tx = Rifaxamin/Augmentin
Whipple dz
PAS+ cells in old white men
MCCOD in Dialysis
Cardiovascular Disease
Nasal Septal Perforation
- P/w
- 4 MCC
P/w = Persistent whistling noise
4 MCC
- S/p Rhinoplasty
- Trauma (nose picking)
- Wegener’s (ELK)
- Cocaine
MoA + ADE
- Didanosine
- Abacavir
- Indinavir
- Nevirapine
- Lamivudine
- Efavirenz
General AADE for
- NRTI
- NNRTI
- Didanosine (NRTI) = Pancreatitis
- Abacavir (NRTI) = Hypersensitivity
- Indinavir (Protease I, all end in -navir) = Needle Shaped Crystals
- Nevirapine (NNRTI) = Liver Failure
- Lamivudine = Liver Failure
- Efavirenz (NNRTI) = Vivid Dreams/Hallucinations
General AADE for
- NRTI (all end in -ine except Abacavir) = Lactic Acidosis
- NNRTI (Nevirapine, Efavirin) = SJS
Flagyl Indications (7)
GET GAP on metRo
- Giardia
- Entoamoeba
- Trich
- Gard. (BV)
- Anaerobes
- (H) Pylori
- Rosacea
Caution in Using Nitroglycerin (4)
- Aortic Stenosis
- Right Ventricular Infarct
- With PDE-I (Sildenafil; also watch PDE and alpha-blocker use)
- Hypotension
MoA Plavix
PGy-12 Receptor Blocker
MEN Syndromes and PT-adenoma vs. hyperplasia?
MEN1 = Adenoma MEN2 = Hyperplasia
Ca and PTH Levels in:
- Familial HyperCa HypoCaUria
- PseudohypoPTH (Albrights)
FHH: Mutation in Ca Sensing Receptor in PTH Gland
- Increase Ca
- Increase PTH
PseudohypoPTH (Albrights): xEnd Organ Damage to Ca
- Low Ca
- Increase PTH
How to approach Acetaminophen OD?
- Activated Charcoal ≤4 hours s/p ingestion
2. Plot Acetaminophen level @4hrs on Rumack-Matthew Nomogram
CO tox
- Risks
- P/w
- SaO2
- Tx
- Risks: space heater, garage
- P/w: Cherry Red Skin, High HCT
- SaO2: normal b/c COHb
- Tx: Hyperbaric (100%) O2
Methemoglobinemia
- Risks
- P/w
- SaO2
- Tx
- Risks: Rx (Sulfas, nitrates, dapsone)
- P/w: Chocoloate Brown Blood
- SaO2: normal
- Tx: Methylene Blue
CN Toxicity
- Risks
- P/w
- SaO2
- Tx
- Risks: nitroprusside, burning plastic
- P/w: Pink skin, burnt almond smell
- Tx: Amyl Nitrate (induce methem) –> sodium thiosulfate
(T/F) In atrial fibrillation with dilated ventricle, digoxin is treatment of choice?
FALSE. Dilated ventricle is 2/2 to atrial fibrillation, control the afibb with typical RATE control
Pulsus Bisferiens Def + 2Dz
Defined as biphasic systolic pulse with midsystolic dip. Seen in:
- Aortic Regurge
- HOCM
2 Stones that PPT in low pH and 2 Treatments
Uric Acid + Ca Oxalate
Give K Citrate + NaHCO3
2 CHF Exacerbation Protocols
What is never included?
- CHF with nl/high BP
- O2 + Lasix + Nitroglycerin - CHF with low BP
- O2 + Lasix + NorEpi Pressor
Never included = beta blocker (in acute CHF exacerbation, increase survival for chronic management)
Chondrocalcinosis - 2 DZ?
- CPPD (Pseudogout) ~ wrap around patella
2. Hemochromatosis
4 Steps in Progression of Diabetic Nephropathy
What is key treatment and why?
- Glomerular Hyperfiltration
- GBM Thickening
- Mesangial Expansion
- Glomerulosclerosis (KW Nodules)
Give ACE-I to decrease efferent arteriole constriction = decrease glomerular HTN = decrease progression of disease
3 MC Malignancies found in Malignant Effusions?
- Lung
- Breast
- Lymphoma
Chalazion
- Def
- P/w
- Management
Def: chronic granulomatous inflammation of meibomian gland 2/2 obstruction
P/w: rubbery lesion on eyelid
Mgmt: warm compresses (Same as Stye = Hodeolum) –> I+D –> BIOPSY (increase risk for conversion to carcinoma)
Gold Standard PNA Dx in Outpatient Setting
CXR (≠Sputum Culture)
4 ARDS Criteria
- New Onset
- Noncardiogenic (nl PCWP)
- B/l Fluffy Infiltrates on CXR
- ## Hypoxia (P/F Ratio)
Beck’s Triad
Underlying Physiology
Triad = JVD, Muffled Heart Sounds, Hypotension
Decrease PRELOAD
2 Neuro Signs for Immediate Back Imaging in DM?
UMN Signs or Motor Weakness
DM are at increase risk for abscess
Triad of EPO Abuse
HA, HTN and Flu Symptoms
Cystercercosis
- Bug
- Intermediate vs. Definitive Host
- Transmission
- 3 Organs
- Bug = Taenia Solium (pork tapeworm)
- Humans are only definitive host (only humans can become infected)
- Intermediate: pig (can eat eggs and not beome infected)
- Transmission: when humans eat eggs they become infected
- 3 Organs: Skeletal Muscle, Eye, Brain (Scolex)
How does insulin resistance cause NALFD?
Increase insulin resistance = increase peripheral lipolysis = increase Fatty acid delivery to liver = increase fatty oxidation = inflammation
Older patient with known presbyopia is peeing a lot and suddenly their vision gets better?
Look for New DM. Persistent hyperglycemia = corrects presbyopia
Corneal arcus in young person?
Think Familial HyperCholesterolemia
Whats the difference in Metabolic Syndrome Key Features and CAD Risk Factors (used in LDL goals too?)
Met Syndrome = SHODDy
CAD Risk = SHAFDy
- Age: >45 men, >55 women
- FMHx CAD:
What 3 things increase HDL?
Moderate Alcohol Consumption
Exercise
Estrogen
Tx of Viral vs. Allergic vs. Bacterial Conjunctivitis?
Allergic (itchiness + B/L) = Topical Antihistamines / Mast Cell Stabilizers / Vasoconstrictors
Viral (no itch + U/L + close contacts) = hand washing
Bacterial = ABx
***High Yield: Viral/bacterial are U/L and use the discharge to tell the difference. B/L = Allergic!!!
(T/F) Topical Steroids should be given on the eye?
FALSE FALSE FALSE
- Increase cataracts / glaucoma
- Worsen HSV / Fungal keratitis
Who gets UV keratitis? (3)
Treatment? (2)
UV Keratitis = welders, skiers (snow blind) and tanners
Tx = Patch the eye +/- Topical Abx
What high yield DZ is associated with CRAO?
Temporal Arteritis
What is presbyopia? What is treatment?
What is the disease associated with ∆corneal shape?
Loss of lens elasticity –> cannot accommodate (holding objects @distance to see) –> need bifocals for NEAR Vision
Don’t confuse with ∆Corneal shape = astigmatism; blurry vision regardless of distance
Massive PE Definition (2) + Unique Treatment
- PE with Hypotension
- PE with Acute Heart Strain as evidence by JVD (b/c RV dilation) or RBBB
Unique Treatment = candidate for fibrinolytic therapy
- MCC Folate Deficiency
- 3 Rx Causing Folate Deficiency
- MCC Folate Deficiency: EtOHism (Nutritional)
- 3 Rx Causing Folate Deficiency: MTX, Trimethoprim (DHFR) and Phenytoin (xIntestinal Absorption)
cANCA vs. pANCA Targets
cANCA = anti proteinase 3 pANCA = anti MPO
Casts
- Muddy Brown
- RBC
- WBC
- Fatty
- Waxy
- Epithelial
- Muddy Brown: ATN
- RBC: Glomerular Damage / Nephritic Syndrome
- WBC: AIN (PCN, Sulfa, Ceflacor) / Pyelo
- Fatty: Nephrotic Syndrome
- Waxy: Chronic Renal Disease
- Epithelial: Acute INTRARENAL Injury (Aminoglycoside)
Hypersensitivity Pneumonitis
- Definition
- P/w
- 2 Examples
- Treatment
- Def: inflammation of lung parenchyma 2/2 antigen exposure (vs. PNA = infectious inflammation)
- P/w: Fever, Cough, SOB (recurrent mini-PNA)
- 2 Examples: Farmer’s Lung + Bird Fancier’s Lung
- Tx: Avoid exposure to antigen
2 Associations with Reactive Arthritis (other than triad)
Treatment of Reactive Arthritis
Associations = PO Ulcers + Enthesitis
Tx = NSAID
3 Predictors of AAA Expansion / Rupture
- Size >5.5 cm
- Active Cig Smoking
- Rate of expansion >.5cm/6mo or ≥1.0 cm/yr
4 Fx of Legionella PNA
- PNA
- Watery Diarrhea
- HypoNa
- Elevated LFTs
Clubbing: 2/2 low O2 or 2/2 malignancy?
Depends; in cyanotic heart, pHTN, CF = chronic hypoxia. BUT, in COPD = 2/2 HOA = Malignancy
W/u Testicular Mass (1)
ULTRASOUND IS ALL THAT IS NEEDED!!!! No biopsy / FNA b/c of seeding theory. This is a cancer that you shoot (operate) first and ask questions later.
5 ∆Lifestyle for High BP?
- Weight Loss
- DASH Diet
- Regular Exercise
- Low Salt Diet
- xEtOH
