Medicine Basic Conditions/First AID Flashcards
Superior Vena Cava Syndrome
- compression of SVC by tumor or thrombosis
- Facial edema, SOB, hoarseness, arm or neck swelling
Difference between SVC syndrome and RSHF
No lower extremity edema!
Mmneomic for tumors that metastasize to bone
BLT w/ Mayo, Mustard, Kosher Pickle
Breast, lung, thyroid
multiple myeloma
kidney (renal cell) and prostate
Tumor Lysis Syndrome electrolyte abnormalities
Hyperuricemia
Hyperkalemia
Hyperphosphatemia
Hypocalcium (due to phosphate binding)
Tumor Lysis Syndrome Treatment
NaBicarb Infusion
Allopurinol
Uricase
Neutropenic Fever in Adults
> 38.3C/101F
ANC <500
Most common type of lung cancer…
Non-small cell lung cancer
includes adeno-, squamous
PTHrp w/ what cancer
Squamous
Small Cell Lung Cancer - important point about therapy
resection not part of treatment
Thymoma Associations
myasthenia gravis
pure red cell aplasia
Nasopharyngeal Carcinoma association
EBV
Courvoisier’s Sign
palpable gallbladder
pancreatic cancer
CA 19-9
monitoring of treatment for pancreatic cancer
AFP
screening for hepatocellular carcinoma
Testicular cancer age range
peak at 15-35
>60
Mmneomic for tumors that only metastasize to brain
lots of bad stuff kills glia
Lung, Breast, Skin (melanoma), Kidney (RCC), Gastrointestinal
Normal Plasma Osmolality=
250-290
Central DI Treatment
desmopressin (nasal, oral, injection)
Nephrogenic DI treatment
sodium restriction
thiazide diuretic
Tretinoin
use at night due to sun sensitivity
Benzoyl Peroxide
use during day since it can stain sheets, clothing
Bronchiectasis Differential
CF, PCD Ig Def ABPA Non-TB mycobacterium Autoimmune Post infectious
Cushing Disease Workup
- overnight low dose dexamethasone test
ACTH level utility in Cushing Syndrome workup
low = adrenal tumor or hyperplasia
not malignancy or pituitary
Adrenal Tumors, lab workup
high cortisol
low ACTH
Cushings laboratory abnormalities
metabolic alkalosis
Hypokalemia
leukocytosis
Pheochromocytoma - definition
usually located in adrenal medulla but can be extra-adrenal secreting catecholamines (Epi and Nori)
Diagnosis of Pheochromocytoma
urine metanephines, VMA, HMA if low pre-test
plasma metanephrines if high pre-test
Pheochromocytoma Treatment
alpha blockade (for HTN) prior to beta blockade (HR)
Pheochromocytoma Symptoms
HTN, HA, sweating, palpitations, anxiety/doom
Nephritis vs Nephortic Syndrome Pathophysiology
inflamm of glomeruli vs abnornmal glomerular permeability
CAP Treatment - Adult, outpatient
Macrolides or Doxy
5-14d
CAP Treatment if morbidity or antibiotics w/in last 3 months
Fluoroquinolone
Macrolide + Beta Lactam
Cause of primary hyperaldosteronism
adenoma > hyperplasia > carcinoma
Primary hyperaldosteronism symptoms
Na retention, Hypokalemia, HTN, metabolic alkalosis
Diagnosis of hyperaldosteronism
plasma aldo : plasma renin >30
Addisions Disease lab abnormalities
hyperkalemia
hypoglycemia
Carcinoid Tumors
secrete serotonin
most often in appendix
Carcinoid Tumor Diagnosis
urine 5hiaa
Carcinoid Syndrome Symptoms
flushing, diarrhea, sweating,
hypotension, wheezing
Treatment of idiopathic pulmonary fibrosis
oxygen
no evidence for steroids, but often used
lung transplantation
ACS Free Wall Rupture
2 weeks after; fatal.
Hemopericardium, tamponade,
Intervention: pericardiocentesis
ACS Papillary Muscle Rupture
produces MR
Ventricular pseudoaneurysm
can lead to free wall rupture
Ventricular aneurysm
new onset HF after MI
3d-months
death from ventricular arrhythmias
Dressler’s Syndrome
fever, mailase, pericarditis, pleuritis
Treat with ASA (first line) or ibuprofen
Chronic Bronchitis
sputum + cough x 3 months for 2 years
Hydatid Liver Cysts
Echinoccoccus
dog, sheep frmers
resection + mebendzole
Amebic Liver Bascess
Entamoeba histolytica
IV flagyl
Primary Biliary Cirrhosis
anti-mitochondrial antibodies
Causes of Dilated Cardiomyopathy
1) CAD
2) Alcohol, thiamine def
3) hypo or hyper thryoidism
Electrical alternans
cardiac tamponade
SAH
ruptured berry/sacular aneurysm
thunderclap headache
SAH - diagnostic workup
non contrast CT
LP –> xanthochromia (yellow color of CSF from RBC lysis)
Miliary TB
widespread TB by hematogenous spread
Nephrolithiasis type of stones
calcium oxalate»_space; cal phos
Nephrolithasis symptoms
flank or abd pain +/- groin pain
urinary frequency
hematuria
Nephrolithasis treatment
increase fluid intake
thiazides or KCl (citrate is inhibitor of stone formation)
Plain Xry and nephrolithiasis
will only see radiopaque/calcium stones
Nephrolithiasis- stone size and passage
typically pass if less than 5mm
Nephrolithaisis- medical expulsive therapy (MET)
tamusolin
nifedipine
Valve associated with diastolic rumble
porcine mitral valve
Pericarditis pain
worse w/ supine
better w/ leaning forward
Lowering of BP in HTN emergency
no more than 20-25% in first hour
160/100 over 4-6 hours
Medications for HTN emergency
nitroprusside
labetalol
Cor pulmonale
RV hypertrophy with eventual RV failure
due to pulm diseases
Angiodysplasia of Colon
dilated veins in submucosa of colon
bleeding, often stops spontaneously
association w/ aortic stenosis
Ogilvie’s Syndrome
radiography evidence of large bowel obstruction but no mechanicl obstruction
often recent surgical or medical illness
Level with clinical jaundice
greater than 2
Biliary Dyskinesia
motor dysfunction of sphincter of Oddi
Chronic Pancreatitis Diagnosis
CT is image of choice, ERCP gold standard
lab levels not elevated
Diffuse Esophageal Spasm
non cardiac chest pain
corkscrew esophagus on barium swallow
diagnose w/ esophageal manometry
Sweet Syndrome
acute febrile neutrophilic dermatosis
fever, rash
FUO in Adults
temp of 38.3/101 multiple times in period over 3 weeks
IRIS can occur w/
HIV
PCP
TB
ADEM
acute disseminated encephalitis
usually 7-14d following resp illness
normal JVP
6-8 cm H20 (sternum is 5cm)
Diagnosis Criteria for DKA
BG >250
ph <7.3
bicarb <18
+ serum or urine ketones
Potassium in DKA
intracellularly depleted
DKA - when to switch to dextrose fluids
Glucose 200 in DKA
250-300 in HHS
Initial Insulin management in DKA
bolus of 0.1U/kg
then continuous
DKA - don’t start insulin if K is below what
3.3
DKA: when to transition to subcutaneous insulin
tolerate PO DKA resolved (2 of 3) - AG <12 - Bicarb >15 - ph >7
Differential for Headache-
migraine vs meningitis vs subdural venous thrombosis
Blood Pressure Treatment of Aortic Dissection and Aneurysms
Esmolol (beta-blocker first to prevent reflex tachy w/ nitroprusside)
nitroprusside
Contraindications to succinylcholine in intubation/paralysis
hyperkalemia
disorders w/ intracellularly depleted K –> rhabdo, muscle disorders
Vitamin B12 and related labs
B12 defiency: increased methylmalonic acid and homocysteine
Folate defiency: increased homocysteine
Tumor Lysis Diagnosis
metabolic abnormalities and one of the following:
acute renal failure
cardiac arrhythmia
seizure
Febrile Neutropenia in Adult
> 101F or >100.4 x 1 hour
ANC <500 or anticipated decrease
Most Common Causes of SVC
non–small-cell lung cancer, small-cell lung cancer, lymphoma, and metastatic lesions.
Treatment of SVC Syndrome
raise the head of the bed
dexamethasone (4 mg every 6 hours), although benefit is unclear
supplemental oxygen for dyspnea
if airway compromise, call anesthesia and surgery
placement of intravascular stent (can be done to relieve symptoms before tissue diagnosis is known)
SVC Syndrome evaluation/imaging
CXR, CT w/ contrast
Causes of Hypercalcemia in Malignancy
increase in osteoclastic bone resorption
humoral hypercalcemia of malignancy (HHM) — caused by systemic secretion of parathyroid hormone (PTH)–related protein (PTHrP)
secretion of the active form of vitamin D (1,25-dihydroxyvitamin D [1,25(OH)2D]) by some lymphomas
ectopic secretion of authentic PTH (rare)
Malignant Spinal Cord Compression- Most common malignancies
prostate cancer
lung
breast
Spinal Cord Compression- Imaging
MRI!
Most Common Brain Mets
Lung, RCC, melanoma, colon
High reticulocyte count, THINK
hemolysis or acute blood loss
BCR-ABL1 fusion t(9,22)
CML
Acute GVHD
maculopapular rash, liver dysfunction, and/or diarrhea, because the main targets of the attack are the skin, liver, and gastrointestinal (GI) tract.
Chronic GVHD
ash or sclerodermatous skin changes; sicca syndrome; obliterative bronchiolitis; liver dysfunction, including cholestasis and bile duct degeneration; diarrhea or upper GI symptoms; and joint, muscle, or fascia tightnes
Single Solid Pulmonary Nodule 6-8mm
repeat CT in 6-12 months
