Endophthalmitis - MCC - Definition - Key PE Finding in Eye - W/U (2) - Tx (2)

- MCC: s/p cataract surgery - Definition: infection within the eye (vitreous) - Key PE Finding in Eye: Hypopyon (~severe uveitis) - W/U (2): Cx + Gram Stain of Vitreous - Tx (2): intra-vitreous Abx ---> vitrectomy

3 Transplant Rejection - Timing - Paph - Tx

1. Hyperacute - Timing: minutes - Paph: pre-formed antibodies --> vascular occlusion --> ischemic/necrosis 2. Acute - Timing: weeks-months - Paph: Host CTL against graft --> perivascular lymphocytic vasculitis - Tx: Immunosuppresion/steroids 3. Chronic - Timing: months-years - Paph: non-self MHC are viewed by host CTLs as self MHCs presenting foreign peptides ---> Fibrosis - Tx: none, irreversible

Charcot Joint - MCC (2) - Paph - XRay Findings (3) - Management

- MCC (2) = DM + B12 - Paph: xProtopathic/epicritic --> increase trauma - XRay Findings (3): effusion, osteophytes, loose fragments - Management: underlying conditions + low weight-bearing device

Heat Stroke - Criteria (4) - Paph - Tx

Criteria 1. Temp >104 (40) 2. Collapse 3. CNS Dysfunction 4. End Organ Damage (ARF, Rhabdo, Nose Bleeds) Paph: elevated central temperature = inability of hypothalamus to regulate body cooling Tx = rapid cooling with ice water immersion

Renal Papillary Necrosis - 3 Populations - UA will show _____

Populations 1. Sickle Cell 2. DM 3. Chronic Analgesia Users (HA Patient with Gross Hematuria) UA will show UNCHANGED RBC

Medicine 3 Flashcards by No Name

Management of Asx Lymphadenopathy?

If ≤1.0 cm + No Symptoms = OBSERVE (even if multiple and painless)

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Hemochromatosis patients @increase risk for infection with (3)?

Listeria
Vibrio Vulnificus
Yersinia

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Patient with persistent respiratory complaints and known viral URI comes with purulent cough, hemoptysis. CXR with many small thin cavities. Dx?

Acute Necrotizing PNA with Pneumatoceles (Staph Aureus complication of viral URI)

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Endophthalmitis

MCC
Definition
Key PE Finding in Eye
W/U (2)
Tx (2)

MCC: s/p cataract surgery
Definition: infection within the eye (vitreous)
Key PE Finding in Eye: Hypopyon (~severe uveitis)
W/U (2): Cx + Gram Stain of Vitreous
Tx (2): intra-vitreous Abx —> vitrectomy

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4 Anterior Mediastinal Masses

- Teratoma (and other Germ Cells), Terrible Lymphoma, Thymoma, Thyroid

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5 Germ Cell Tumors

Seminoma (xAFP, aka dysgerminoma in women), Chorio (hCG), Endodermal Yolk (AFP), Teratoma, Embryonal

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2 Stromal Tumors

Leydig + Sertoli / Granulosa + Theca

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3 Transplant Rejection

Timing
Paph
Tx

Hyperacute
- Timing: minutes
- Paph: pre-formed antibodies –> vascular occlusion –> ischemic/necrosis
Acute
- Timing: weeks-months
- Paph: Host CTL against graft –> perivascular lymphocytic vasculitis
- Tx: Immunosuppresion/steroids
Chronic
- Timing: months-years
- Paph: non-self MHC are viewed by host CTLs as self MHCs presenting foreign peptides —> Fibrosis
- Tx: none, irreversible

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Charcot Joint

MCC (2)
Paph
XRay Findings (3)
Management

MCC (2) = DM + B12
Paph: xProtopathic/epicritic –> increase trauma
XRay Findings (3): effusion, osteophytes, loose fragments
Management: underlying conditions + low weight-bearing device

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Heat Stroke

Criteria (4)
Paph
Tx

Criteria

Temp >104 (40)
Collapse
CNS Dysfunction
End Organ Damage (ARF, Rhabdo, Nose Bleeds)

Paph: elevated central temperature = inability of hypothalamus to regulate body cooling

Tx = rapid cooling with ice water immersion

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(T/F) In Sheehan’s postpatum necrosis:

Aldosterone level is low
Na is low, K is high

FALSE; recall the zona glomerulosa is ACTH independent (AngII dependent).

Bottom Line: primary adrenal failure = xAldosterone, but secondary adrenal failure = normal Aldosterone

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Paph of Malignant Hyperthermia

Autosomal dominant inheritance of abnormal Ca cells in myocytes; increase risk with halothane/succinylcholine

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Patient with primary hyperAldo is given spironolactone for control of aldosterone. Develops gynecomastia. Next step?

Switch to eplerenone (selective mineralocorticoid antagonist)

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Tx of Warm (3) vs. Cold (1) AIHA

Warm: steroids –> rituximab –> splenectomy

Cold: warm them!

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Describe Heinz bodies. When should you measure G6PD enzyme activity level in a symptomatic patient?

Heinz Bodies = ferrous –> ferric state

G6PD levels in ACUTE attack are NORMAL b/c all the abnormal RBC are hemolyzed; measure 120 days later

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MCC risk factor for aortic dissection?

Systemic HTN

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Rx approved for treatment + prophylaxis of secondary amyloidosis?

Colchicine

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Acromegaly

Screening Test
Diagnostic Test

Screening: IGF1 b/c if low rules out acromegaly

Diagnostic: Glucose load GH suppression test (just like how saline load suppression for hyperAldo and dexamethasone suppression for Cushings)

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Triad for Disseminated GC infection?

Think PST

Polarthritis
Skin Rash (PAINLESS vesicopustular lesions)
Tenosynovitis

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____ worsens wafarin vs. _____ inhibits warfarin.

___ Increase risk for warfarin induced skin necrosis

Acetaminophen worsens Warfarin (increase bleeding)

Spinach (VitK = replenish clotting factors) antagonizes Warfarin

Protein C deficiency increases risk for necrosis

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Renal Papillary Necrosis

3 Populations
UA will show _____

Populations

Sickle Cell
DM
Chronic Analgesia Users (HA Patient with Gross Hematuria)

UA will show UNCHANGED RBC

Beta blocker toxicity triad + treatment?

Bradycardia + AV Block + Wheezing —> Glucagon

McMurray’s Sign

Palpable, audible snap with fingers in jt groove @knee on extension while giving tibial torsion; sensitive for MEDIAL meinsicus tear

4 Classes of Rx –> Esophagitis (BANS)

Bisphosphonate
ABx (Doxy)
NSAID
Supplements (KCl, Fe)

Patient with signs of hyperthyroidism has non palpable thyroid. Next step? Confirmatory test for exogenous vs. thyroiditis?

next step = radioactive uptake (if low = DDx Exogenous vs. Thyroiditis) * thyroiditis = increase thyroglobulin in serum b/c damaged cells * exogenous = low throgobulin

Next best step in patient with progressive proximal muscle pain / weakness. CPK is elevated?

TSH

Diagnostic test in lactose intolerance?

H+ Breath Test | - Lactose = increase lactic acid in GI tract = increase H+ out

Osteosclerosis - 2 Populations - Rinne + Weber Tests

Populations = AI process in mid-age women vs. Paget's disease Rinne Test: AC

Tick-borne Paralysis - P/w - Next best step

P/w: ASYMMETRIC ascending paralysis (≠GBS, no prodrome); occurs 2/2 neurotoxin released from tic Next step = find tick, it goes away

Factorial Design Study Defintion

≥2 experimental interventions (3 different anti-HTN Rx) AND ≥2 end points (SBP and serum K)

Rx Indicated and Contraindicated in Prinzmetals

``` Indicated = CCB CI = beta blocker (worsen's vasospasm) ```

MC Middle Ear Pathology in AIDS

EFFUSION 2/2 obstructive lymphomas/lymphadenopathy; think retracted NON inflamed TM

4 Criteria for HCV Treatment*** 2 Contraindications to HCV Treatment 2 Rx for Treatment

4 Criteria 1. ≥18 2. HCV RNA in Serum 3. Biopsy with evidence of chronic hepatitis (fibrosis) 4. Compensated liver disease (INR

Trichinosis: Bug, Transmission, 3 Phases (with Triad in 3rd Phase)

``` Bug = Trichinella (roundworm vs. Cystercercosis/Taeina = pork tapework) Tx = Eating undercooked pork (vs. Cyster = eating eggs in poop) ``` Phases 1. Larva enter GI tract (GI complaints) 2. Larva Migration (Systemic Hypersensitivity) = Splinter Hemorrhage 3. Larva Enter Skeletal Muscle = Triad of All Phases * Myositis * Periorbital Edema * Eosinophilia (Don't confuse with taenea solium = cystercisosis)

Review 3 PPx Measures in HIV Patients @____CD4 Counts

1. CD4

(T/F) A negative FOBT at visit excludes GI bleed.

FALSE, still get a colonoscopy if it's an older ANEMIC person.

Patient with inferior MI infarct is started on Nitro drip. Found to be hypotensive. Next 2 steps?**

1. Stop NITRO (CI in RV MI, Aortic Stenosis, PDE-I use) 2. Start IVF **Recall, IVF are the mainstay of RV Infarct management b/c the body is preload dependent

When to start DM screening?

ADA recommends @45 in asymptomatic patients***

Classification of AFibb

1. Paroxysmal: recurrent (≥2x) terminating within 7 days 2. Persistent: >7 days duration 3. Longstanding Persistent: ≥1 year duration 4. Permanent: persistent without plans for rhythm control

Adult with epiglottitis has all immunizations?

GAS

DDx Thyrotoxicosis with low RIUS? (4)

1. Subacute Granulomatous Thyroiditis (DeQuervain's PAINFUL) 2. Subacute Lymphocytic Thyroiditis (Painless) 3. Iodine Induced Thyrotoxicosis 4. Exogenous levothyroxine

What does struma ovarii produce?

Thyroid hormones (≠TSH)

MCC PNA in NH Residents?

Still Strep Pneumo!!! This is why we give PNA vaccine >65

What three ∆Lytes cause QT Prolonagation?

HypoK HypoCa HypoMg

EKG ∆ with: - HypoK (4) - HyperK (2)

HypoK - T Wave Flattening - U Waves - increase QT Interval - PVCs HyperK - Tall peak T waves - Prolongation of QRS complex

Pt with generalized LE swelling, pain and linear streaks of erythema. Dx? Tx?

Dx = Cellulitis | Start Nafcillin

How often to screen for lipids after 35 / 45 ?

q5 years

3 Most important factors for patient survival in sudden cardiac arrest?

1. Adequate Bystandard CPR 2. Prompt Rhythm Analysis 3. Defibrillation NOT time to cath lab

MC Complication of Radiactive I131 for Grave's?

HYPOTHYROIDISM (not worsening of optho or hypoPTH (surgery)) Note, corticosteroids before and after RI131 can decrease optho consequences

AEIOU Indications for Dialysis

1. Acidosis (refractory metabolic acidosis

HOCM murmur increases on intensity with _______ and decreases on intensity with ________. What other murmur does this and why?

HOCM increases with valsalva (decrease VR = decrease LVEDV = increase obstruction) and decreases with squatting (increase afterload = increase LVEDP/distention) MVP does the same * decrease VR = decrease LVEDV/distention = decrease strain on chorda tendinae = easier to prolapse * increase VR = increase LVEDV/distention = increase strain on chorda tendinae = hard to prolapse, keeps valve shut

Most effective way of preventing UTI in neurogenic bladder?

Intermittent cath / diapers