medicine uworld Flashcards
prolonged activated PTT in a female
could be von willebrand factor
what is the presentation of DIC
marked by abnormal activation o the coagulation cascade and fibrinolysis. thrombocytopenia and elevated PT and PTT
vitamin K deficiency
prolonged PT and INR
hypercalcemia can cause joint accumulation, what is the shape of calcium crystals in a joint
rhomboid
what are needle shaped crystals in a joint space
usually have negative birefringence and this is gout. uric acid crystals
common causes of uveitis
herpes infections, toxoplasmosis, syphillis, sarcoidosis, spondylarthritis, inflammatory bowel disease
redness of the sclera, most prominent at the junction o the cornea and the sclera. pupillary constriction and photophobia
specific presentation of anterior Uveitis
treatment of uveitis
dilated eye drops (cyclpentolate), topical glucocorticoids
pyoderma gangrensum is what
neutrophilic dermatosis often seen in inflammatory bowel disease and arthropathies. lesions develop rapidly and begin as cutaneous papule or nodule that quickly matures into a painful, purulent ulcer with violaceous borders. fever is uncommon
what is the presentation of pseudomonas bacteremia
immunocompromised individual with gangerous skin lesions
what is ecthyma gangrenosum
punched out gangrenous ulcers caused by pseudomonas
skin rash with segmented hyphae
tinea corporis
how should skin fungal infections be managed
oral fluconazole, test for HIV, diabetes and watch for systemic glucocorticoid therapy
what is the presentation of lupus nephritis
50% of lupus patients. range of presentations from asymptomatic to rapidly progressive glomerulonephritis and end stage renal disease. low C3 and C4 levels. immune complexes of ANA and anti-DsDNA deposit in the mesangium and or the sub endothelial space triggering immune response and activating complement. the subendothelial deposits cause nephrotic syndrome
chemotherapy induced diarrhea treatment
loperamide
who should be given statin
patients with an estimated 10 risk of athersclerotic heart disease >7.5-10%; LDL≥190 and those age ≥40 with DM regardless
what is the treatment for uremic encephalopathy
urgent hemodialysis
what is a cause of false positive VDLR
antiphopholipid syndrome
treatment of antiphospholipid syndrome
LMWH
what is the treatment for giardiasis
metronidazole
what is the presentation of pagets
HEARING LOSS and bone pain. this is osteoclast dysfunction with increased bony turnover
what is the cause of osteomalacia
malabsorption of calcium
what is the cause of anemia of chronic disease
increased inflammatory cytokines
presentation of hypopituitarism
low T4, low cortisol and NORMAL aldosterone.
person would have low energy, cold intolerance, low libido, weight gain/loss, fatigue, dry skin, bradycardia, hypoglycemia
what is the treatment for MAC in AIDS
macrolide based combination therapy.
what are the CD4 counts for mAC
<50
what are the manifestations of MAC in AIDS
fever, weight loss, abdominal pain and diarrhea, ALD and hepatosplenomagaly. increase alk phophs
what is the treatment for toxoplasmosis
pyrimethamine based combination therapy
what drug has been shown to reduce cravings in patients with alcoholic liver disease and help with cessation
baclophen
why do kleinfelter patients have reduced testicular volume and infertility
semiferous tubule dysgenesis
what is the presentation of pemphigus vulgaris
blisters int eh mouth and on the trunk placid bullae and ulcers, nikloski signs positive, netlike IgG. tombstone cells at the basal layer
what is the treatment for pemphigus vulgaris
agggresive wound therapy, corticosteroids
what are the antibodies directed at for pemphigus
desmosomes desmogleins 1 and 3
what is bullous pemphigoid
autoimmune blistering disease that causes pruritic, tense bullae in the flexural surfaces of the groin, and axilla.
what is hepatic hydrothorax
this is when ascitic fluid passes through the defects in the diaphragm
what is the treatment for hepatic hydrothorax
salt restriction and diuretics; chest tubes are generally avoided. definitive treatment is liver transplant
what is HIV retinopathy
no floaters or blurred vision. causes cotton wool sets and are rarely hemorrhagic. they usually resolve within weeks to months
what is the presentation of CMV retinitis
most common end organ manifestation of CMV in patients with advanced AIDS. primarily when CD4 < 100. blurred vision and floaters, sensation of flashing lights. yellow white fluffy hemorrhagic lesions adjacent to the fovea and retinal vessels.
treatmetn for CMV retinitis
valgancyclovir then start antiretrovirals 2 weeks after infection
what is a cause of vitamin B12 deficiency
PPI use due to achlorhydria and inactivated pepsin from elevated stomach pH
what are the causes of gout
myeloproliferative disorder/lymphoproliferative, tumor lysis syndrome, hypoxanthine guanine phosphoribosyl transferase deficiency, CKD, thiazide/loop diuretic
subclavian steal sydnrome
refers to the subclavian artery stealing the blow from from the vertebral because of stenotic lesion proximal
what is wernickes encephalopathy
thiamine deficiency.
encephalopathy, oculomotor dysfunction (bilateral gaze abducens palsy, horizontal nystagmus), postural and gait ataxia.
what are the causes of wernickes
alcoholism, malnutrition, hyperemesis gravidarum
treatment for wernickes
thiamine and glucose
how to treat addissons disease with hypoaldosteronism
fludricortisone
treatment for addisons
hydrocortisone for cortisol replacement and mineralocorticoid replacement for aldosterone (fludricortisone)
what type of adenoma is the worst
villous adenoma.
adenomatous polyps carry increased malignant potential and warrant enhanced colonic surveillance large polyps >1 cm and adenomas with high grade dysplasia or villous features have greater malignant potential
what type of arrhythmia does mitral stenosis put you at risk for and what type of risk does that carry
a fib
stroke risk
what is the management of hypercalcemia
IVF, calcitonin, bisphosphonates
how to calculate the number needed to treat
1/ARR.
bronchietasis
linear ateleachtasis at the base of the lungs, hemoptysis, copious sputum production with recurrent infections
how do you diagnose bronchiectasis s
high resolution CT
what is the presentation of histoplamsa capsulatumn
most common endemic mycoses in US. exposure in the midwest (ohio and Mississippi River valley) and in the northeast. granuloma and narrow based budding yeast forms.
presentation of cocidioimycoses
Arizona and chest pain, cough, fever, fatigue. CXR normal or with unilateral infiltrate with ipsilateral hilarious LAD, spherules and endospores
what is the presnetation of blastomycosis
fungal infection caused by inhaling Blastomyces dermatitidis spores. fever, cough, night sweats, muscle pains, weight loss, chest pain, and feeling tired.
what is isoniazid peripheral neuropathy caused by
pyridoxine deficiency
will have sensory and proprioceptive changes as well as stocking glove
what causes mucosa and submucosal inflammation and crypt abscesses
ulcerative colitis
what blood disorders have RBCs without central pallor and how can you tell them apart
hereditary spherocytosis and autoimmune hemolytic anemia.
positive Coombs test
What is the presentation of rheumatoid and what are the treatmetn strategies
morning stiffness lasting more than hour, pain and swelling with redness. there will be joint erosions as opposed to narrowing DMARD ASAP.
what does urobilinogen indicate
acute intermittent porphyria.
abdominal pain, hyponatremia, loss of pain and DTRs, restlessness, hallucinations, autonomic dysfunction. elevated urinary porphrin levels confirm diagnosis
when is acute rejection and what mediates it
treatment
T cell, within the first 6 months
usually asymptomatic.
high dose glucocorticoids
osteomalacia is what
impaired osteoid mineralization.
what is the cause of osteomalacia
impaired vitamin D absorption, low calcium intake
elevated alphos, elevated PTH, decreased serum calcium and phosophorus can be seen, decreased urinary calcium
what is complex regional pain sydnrome
swelling, erythema, excruciating pain with skin changes, bone changes after an accident or break
what is a sign of intracranial hypertensino
blurry vision when you lean forward
what is the presentation of infective endocarditis
oslers nodes, janeway lesions, (painful finger pads), positive rheumatoid factor, passive joint pain, low grade fever, weight loss, fatigue, dyspnea, cough, valvular insufficiency, immune-complex mediated glomerular nephritis
what is a cure for tinea versicolor
selenium sulfide lotio
what are the ECG findings for long-standing hypertension
high voltage QRS, T wave inversions
what is the treatment for small intestine bacterial overgrowth sydnrome
rifaximin.
what is the most common complication of influenza infection
secondary bacterial infection/pneumonia
what are the risk factors for male breast cancer
family history BRCA, Klinefelter, obesity, cirrhosis, marijuana use
what is 95% of the population with respect to standard deviation
2 standard deviations from the mean
what is the treatment for sporitrichoiss
3-6 months of oral itraconazole
what is a sexual SE of opioids
decreased testosterone, suppresses GnRH and LH secretion and thus causes a secondary hypogonadism
pes anserinus pain syndrome (anserine bursitis)
localizes to the medial knee and is not associated valgus stress posivity. there is usually some pain on palpation.
what is the managment for pes anserinus
NSAIDs and quadriceps strengthening
dermatofibroma
nontender, discrete, firm, hyper pigmented, usually <1 cm dimpling in the center when the area is pinched
Hawthorne effect
when people change their behavior because they know they are being watched
what is a common cause or association with carpel tunnel
diabetes
supra scapular nerve injury
common in backpackers due to compression. causes rotator cuff weakness.
what is first line therapy for bleeding ulcers
PPIs have been shown to reduce bleeding and requirements for transfusion. However, histamine blockers like famotidine have not shown the same efficacy
aplastic anemia is caused by what
acquired deficiency of pleuripotent cells
what is familial dysautonomia (Rylie-day syndrome)
autosomal recessive found predominantly in askanazi Jews, and presents at birth with feeding problems and low muscle tone. characterized by gross dysfunction of the autonomic nervous system. no tears, orthostatic hypotension.
what is the presentation of multi system atrophy
Parkinsonism, autonomic dysfunction (postural hypotension, abnormal sweating, disturbances in bowel or bladder function, impotence, gastroparesis), widespread neurological symptoms (cerebellar, pyramidal, lower motor neuron)
diagnostic requirements for acute liver failure
severe liver injury AST/ALT > 1000, hepatic encephalopathy, synthetic dysfunction INR > 1.5
best way to diagnose chronic pancreatitis
CT scan abdomen
cauda equina
lower motor neuron findings, hyporeflexia, decrease sensation, saddle anesthesia, patchy sensory loss, rectal sphincter bladder hesitancy
more gradual with more mild back pain.
does not usually cause impotence.
usually bladder retention
conus medularis
hypertonia, spasticity, hyperreflexia, positive babinski
upper motor neuron findings
sudden onset with high level of back pain
impotence is frequent
usually urinary and fecal incontinence
what’s the management for erythema nodosum
inflammatory disorders. is associated with sarcoidosis, bacets, endemic fungus, TB
the initial workup should consist of CBC, liver function, renal function, antistreptolysin O, TB skin testing, chest CXR
what is the treatment for aspiration pneumonia
clindamycin and amoxicillin
what is the presentation of idiopathic intracranial hypertension
pseudotumor cerebra maybe a history of glucocorticoid use or exposure to vitamin A. OCPs are assocaited with IIH. it is caused by impaired absorption of CSF from arachnoid villi. blindness can occur if left untreated.
what are the complications of IIH
blindness is the most severe
what is the complication of sjrogens
corneal ulceration
what are the urinary symptoms of NPH
urgency/incontinence
what is the measure of sensitivity
the number of cases tested positive out of the real number of positive cases.
measure of picking up the cases that are positive.
what endocrinological disease is associated with primary biliary cholangitis
osteomalacia due to malabsorption of fat soluble vitamins
what is antimitochondrial antibodies associated with
primary biliary cholagnitis
what are the autoimmune liver disease antibodies
anti smooth muscle and antiLMK
what is the characteristic finding for drug0-indiuced liver injury
eosinophilia
what is the presentation of isoniazid induced liver injury
characteristically lacking eosinophils. panlobar mononuclear infiltrate and hepatic cell necrosis.
what is the presentation of anabolic steroid induced liver injury
cholestasis
what is the presentation of valproate liver injury
fatty liver
what is the presentation of acetominophen induced liver injruy
toxic or fulminant liver injruy
what is the presnetaion of allopurinol liver injury
granulomatous
somatic symptom disorder
have prominent somatic symptoms such as abdominal pain, GI distress and sexual dysfunction).
illness anxiety disorder
have little to no symptoms and are preoccupied with the idea that they may be sick. despite few or no symptoms at all and negative tests.
what is conversion disorder
neurological symptoms incompatible with known disease
what auscultation findings are associated with acute coronary syndrome
atrial gallop or S4.
what is the S4 characteristic of
younger adults and children, acute coronary syndrome and ventricular hypertrophy
normal in healthy older adults
what is the S3 associated with
fluid overload/heart failure. restrictive cardiomyopathy high output states
when you decrease the sensitivity but increase the specificity what happens
the true positives decrease and the false negatives increase.
what is the presentation of legionaries
GI symptoms, atypical pneumonia, central nervous system findings such as confusion. there will be no findings on gram stain as it is an intracellular gram negative rod.
what is the treatmetn for legionaires
fluoroquinolone or macrolide.
what is the booster for tetanus
tetanus and diphtheria Td
what is the PEP for a puncture wound
depends on what their vaccination status is
if no vaccine in 5 years, then Td booster. If no Tdap in adulthood, then Tdap. If symptomatic or severe and dirty wound then TIG and tetanus toxoid.
what is the schedule for tetanus vaccine
2,4,6, 15-18 months and 4-6 years. One adult Tdap and then Td every 10 years.
what is the presentation of idiopathic pulmonary fibrosis
slowly progressive dyspnea, dry cough, and fine crackles usually with a smoking history, but not necessary. usually 50-70. restrictive pattern with decreased lung capacity and normal FEV/FVC. there will be reduced diffusion capacity
what is the presentation of B12 def and what causes the symptoms
megaloblastic anemia, increased cell turnover due to immature megaloblasts. can present with a shiny tongue, anemia, dyspnea, fatigue.
this is caused by failure of DNA synthesis because B12 is a cofactor
what are the features and presentation of chronic lymphocytic leukemia
lymphadenopathy, hepatosplenomegaly, mild thrombocytopenia and anemia, often asymptomatic. there will be severe lymphocytosis and smudge cells.
night sweats, fever, infections or weight loss also possible.
what do you do if a solitary lung nodule is found on CXR
if less than 8cm with smooth margins most likely not malignant
however, if not on previous imaging, then do CT. if less likely on CT then follow up CT for 2-3 years to monitor growth. if suspicious biopsy.
are the lungs effected in cardiac tamponade
not usually. as the right side is predominantly effected in tamponade there is a decrease propensity for the lungs to become affected by back up
what is the diagnosis of bibasilar crackles in aortic dissection.
aortic valve insufficiency
if the valve is affected the patient will have severe orthopnea, lung involvement and hypotension
what is some neurological signs of subarachnoid hemorrhage
severe, sudden onset headache. oculomotor nerve III palsy, CN II involvement can cause unilateral vision los cranial nerve IV can also be affected
cavernous sinus thrombosis presents how
typically with fever, headache, periorbital swelling, there is usually CN III, IV and VI resulting in ophthalmoplegia
what is the treatment for CNS toxoplasmosis
sulfadiazine and pyrimethamine with leucovorin
presentation of CNS toxoplasmosis
multiple ring enhancing lesions, seizures, fever, jerky movements of the extremities
what is villous atrophy
celiac
what is villous atrophy
celiac
what is initiated in atherosclosis patients
aspirin and statin
what is beta blocker toxicity
hypoglycemia, hypotension, bradycardia, seizures, altered mental status
why do beta blockers decreased glucose
prevents catecholamines from inducing glycogen breakdown
treatment of beta blocker toxicity
airway support, gastric decontamination, IVF, atropine and glucagon
labs for osteomalacia
increased PTH, decreased calcium and phoshorus
what are some causes of osteomalacia
malabsorption, celiac sprue, intestinal bypass, CKD, chronic liver disease
a fib with RVR in a hemodynamically UNSTABLE person
direct current cardio version
subacute thyroiditis
usually secondary to a viral infection. diffuse tender thyroid with goiter. there will be elevated ESR, T4, low TSH,
suppurative thyroiditis
rare. usually focal and euthyroid. tender thyroid
when is the odds ratio a good predictor of relative risk
when the incidence of a disease is low; also good when the cases and controls are good predictors or representative of the individuals in the overall population
what is a good preventative for migraine
topiramate, tricyclics, beta blockers, divalproex sodium
what are abortives for migraines
triptans, NSAIDs, acetaminophen, antiemetics (metoclopramide prochlorperazine) and ergotamine
what is associated with temporal arteritis giant cell arteritis
aortic aneurysm
Polymyalgia Rheumatica
who gets treated for TB based on skin testing ≥5mm
HIV postive, recent contacts with known TB, nodular or fibrotic changes on CXR consistent with previous TB, organ transplant recipients.
who gets treated for TB based on skin testing ≥10mm
recent imigrant, injection drug users, resident and employee of high risk setting, micro bacteriology lab personnel, higher risk for TB reactivation (DM, leukemia, ESRD, malabsorption syndromes) children under the age of 4 exposed to adults
who gets treated for TB based on skin testing ≥15mm
everyone
what is the cause finger clubbing
occult malignancy (lung), cystic fibrosis, and left to right pulmonary shunts. connective tissue proliferation at the nail bed.
why does niacin cause flushing and pruritus
due to vasodilation and the release of histamine and prostaglandin
what is the course of leukoplakia
usually progresses to squamous cell within in ten years
how do you diagnose avascular necrosis of the hip
MRI
what is the best medication for cancer induced loss of appetite
magestrol acetate (progesterone analog) medoxyprogesterone acetate DO NOT USE CANNABIS analogues. not as effective.
what is the treatment for hiv cachexia
cannaboids can be used
who is contraindicated for sildenafil
people taking nitrates or alpha blockers
what is the treatment of choice for erectile dysfunction in someone with acute coronary syndrome/cardiovascular disease
sildenafil -safe and effective. first like therapy
second line alprostadil
what is the cause of anemia in someone with chronic lymphocytic leukemia, high reticulocyte count
immune mediated hemolysis
this is warm agglutination disease more common in SLE and CLL
the positive predictive value is calculated how
number really positive/number positive from the test (this includes false positive)
what is responsible for the highest proportion of medical errors
communication failure between providers
what is the physiological defense from hypoglycemia as blood sugar decreases
decreases in insulin, increases in glucagon, increase in epinephrine, increased cortisol and growth hormone.
people with cystic fibrosis also have decreased what in their blood making them susceptible top hypoglycemia
glucagon
what is the best treatment for rosacea
avoidance of sun exposure, hot spicy foods, alcohol. topical metronidazole. second line oral tetracyclines
when does a ventricular wall rupture usually happen
5days -2weeks
when does a papillary muscle rupture occur
3-5 days after an MI
what are the labs for pagets
normal calcium and phosphate high alkphos and urine hydroxyproline
treatment for pagets
bisphosphonate
what can stop the formation of uric acid stones
potassium citrate
what is the mechanism of high altitude sickness
headache, nausea, fatigue, lightheadedness, and dyspnea due to hypoxemia that results from the low partial pressure of O2 at high altitude. hyperventilation is the most immediate and important response to high altitude. hyperventilation causes respiratory alkalosis. the kidneys respond by trying to excrete bicarb, but this take 72 hours to compensate. azetozolamide does this quicker by inhibiting carbonic anhydrase
what is associated with pernicious anemia overtime
gastric cancer
chronic hyperthyroid can result in what muscular tissue disorder
hyperthyroid myopathy. muscle weakness , especially in the proximal muscles
what is the difference between case control and retrospective cohort
case control compares risk factor frequency between cases and controls.
retrospective cohort reviews past medical records and assesses risk factors and disease incidence
where is the likely location of pure sensory stroke
thalamus. usually lacunar strokes and posterior cerebral artery branches
who gets Hodgkin’s lymphoma
15-35 and >60
what are the manifestations of hodgkins
painless lymphadenopathy, mediastinal mass, B symptoms and pruritus
what is the treatment for legionella
fluoroquinolone levofloxacin
what is the most common cause of constrictive pericarditis in developing countries or endemic areas like china, Africa, and India
TB.
what is the most common cause of pericarditis in the US
viral and radiation therapy and cardiac surgery
what are the risk factors for high output cardiac failure
morbid obesity, arteriovenous fistula, hyperthyroidism, pagets disease
what are the clinical findings of high output cardiac failure
hyperedynamic circulation, bounding pulses and increased pulse pressure, peripheral and pulmonary edema, laterally displaced PMI.
what is the cause of high output cardiac failure
reduced systemic vascular resistance. this causes increased preload. eccentric hypertrophy of the left ventricle will laterally displace the PMI. there is usually a systolic murmur due to high flow.
will vasovagal syncope have a slow pulse
yes neurocardiogenic syncope will have a weak pulse
who is at risk for anaphylaxis
people with asthma and aczema
what are the most likely causes of brain abscess
staph aureus, strep viridens, anaerobes.
usually caused by direct spread from otitis media, mastoiditis, sinusitis
treatment of Polymyalgia Rheumatica
low dose steroids; rapid and thorough relief is expected.
what is the presentation of polymyalgia
stiffness of the major joint girdles in the morning. elevated ESR, age of onset usually >50.
watch for giant cell arteritis
what is the characteristic digoxin arrhythmia
atrial tachycardia and AV block
what are the antivirals for Hep C infection
sofosbuvir-velpatasvir
what are the symptoms of chronic hep C
usually asymptomatic
what do pleural plaques suggestr
asbestosis
what is clorthalidone and what is the most likely SE
thiazide diuretic
hyperglycemia, hypomagnesemia, gout
what does pronator drift indicate (when pronation > supination)
upper motor neuron or pyramidal tract lesions
what is eplerenone
potassium sparing diuretic usd for excessive aldosterone
better used in men, less SE than spironolactone which can cause gyncomastia
what would you expect renin activity to be in someone with primary hyperaldosteronism
LOW…. thats the difference between between secondary and primary.
what is the cause of erysipelas
group A strep pyogenes
what is the presentation of polyarteritis nodosa
casuses lesions similar to erythema nodusum but is assoicated with fever, arthalgias, weight loss. renal insufficiency, abdominal pain and mononeuritis multiplex. aneurysms that look like beads on a string
what is the treatment for acute pericarditis
ibprophen and colchicine
what will the labs be for exogenous steroid use
low LH and normal testosterone because the exogenous will reduce the normal testosterone and thus the level looks normal.
what are the FSH and LH levels in klinefelters
high
what is tricuspid valve murmur for drug users
holosystolic murmur that increases with inspiration. this is tricuspid valve involvement
this is tricuspid regurg which increases with inspiration
what is the difference in esophageal findings between achalasia and systemic sclerosis
achalasia is increased LES pressure and incomplete LES relaxation. systemic sclerosis is fibrosis of the lower esophagus with aperistalsis
what is the cause of sick sinus syndrome
cardiac conduction degeneration
what is milk-alkali syndrome
essentially hypercalcemia symptoms. risk factors are thiazide diuretics. caused by excessive calcium and absorbable alkali (calcium carbonate solutions for osteoporosis).
results in hypomagnesemia, metabolic alkalosis, acute kidney injury
what is the next step if perforated viscous is suspected
upright chest and abdominal x ray which show pneumoperitoneum
disruption of lymphatics results in what clinical finding
inability to pinch the skin.
this is lymhpoedema
what is the management for syphillis in someone with penicillin allergy
doxycycline
desensitization is performed in pregnancy.
what is the source of calcium oxalate stones in a homeless person
ethylene glycol
what is the medication that treats ethylene glycol poisoning
fomepizole
what is the medication that treats ethylene glycol poisoning
fomepizole
primary hyperparathyroidism
mildly elevated calcium, normal to low phosphorus, significantly elevated PTH, kidney stones, osteoporosis, nausea, constipation and neuropsychiatric symptoms
secondary hyperparathyroidism
increased secretion of PTH due to hypocalcemia, common in chronic kidney disease, due to inadequate phosphate excretion and low vt D levels. serum phosphorus will be high and calcium will low normal
presentation of wilsons
hepatic failure, Parkinsonism, gait disturbance, dysarthria, depression, personality changes, psychosis, decreased ceruloplasmin,
treatmetn for Wilsons
d-penicillamine or Tridentine
zinc can be used to decreased copper absorption
what are the most likely causes of watery diarrhea (travelers diarrhea)
bacterial and viral are most common. cryptosporidium parvum and giardiasis are the most common for prolonged watery diarrhea
what is the cause of purulent conjunctivitis that reaccumulates after wiping
staph aureus. usually bacterial. especially if the purulence reaccumulates after wiping
what are the criteria for extubation
pH > 7.25, adequate oxygenation with minimal support. intact inspiratory effort and sufficiency mental status to protect airway
can bronchitis cause hemoptysis
yees.
what is the presnetation of thyroid storm
high fever, tachycardia, hypertension, CHF, agitation, delirium, seizure, coma, lid lag, tremor
what can precipitate thyroid storm
iodine load from contrast
what is the cause of membranoproliferative glomerulonephritis
C3 nephritic factor perpetually activates complement and causes the deposition of C3 into the membrane causing nephrotic sydnrome
what is diagnosis if someone has marfanoid habitus with neurocutaneous nodules
MEN2B
what is the treatment for strep viridans infective endocarditis
usually susceptible to penicillin. can treat with IV pen G or ceftriaxone which has easier dosing
what is the presentation of an inferior infarct involving the rt ventricle
hypotension, increased right ventricular preload.
DO NOT GIVE NITRATES
what is the presentation of inferior lead infarct involving the left ventricle/septum and papillary muscle rupture
murmur, BP okay, mitral regurg with increase LEDV and pulmonary symptoms due to blood backup
what is the def of prerenal
> 20
what is the post renal def
<15
what is the cause of sudden high frequency hearing loss
cochlear hair cell loss/damage. this is sensorineural
what do beta adrenergic agonists do to potassium
they cause a potassium shift into the intracellular space.
what is the treatmetn for seborrheic dermatitis
topical antifugals ketoconazole or selenium sulfide
reactive arthritis
urethritis, conjunctivitis, mouth ulcers, joint pain.
treat with NSAIDs
how long does it take to get lab changes from iron therapy of microcytic anemia
2-4 weeks
if someone has microcytic anemia that is not responsive to iron therapy what should you look for
thalassemia
what is the presentation of severe acute pancreatitis
can cause severe hypfotension due to intravascular permeability.
when do women get mammography
50-74 every 2 years
when do women get paps
21-65 every 3
when do you get colonscopy
50-75 every 10
when should you get a lipid if healthy
every 5 years. men starting 35 and women starting 45
what is the presentation of masked hypertensino
arteriovenous nicking in the retina, left ventricular hypertrophy. normal in office blood pressures.
what is the presntation and cause of sarcoidosis
hypercalcemia, cough with reticualr opacities in the lungs. systemic graulomatous inflammation
when do you give potassium in HHS
when the potassium is less than 5.3
blastomycoses
rib notching, cough, verucous skin lesions, cough, fever, weight loss. upper lobe lung lesions and general presentation will be reminiscent of TB and histoplasmosis
why do we give sodium bicarb to TCA OD
to alleviate depressant action on myocardial sodium channels
what is the indication for sodium bicarb treatment in TCA OD
QRS interval > 100
what is the most likely cause of death in TCA OD
cardiac toxicity
what are the SE of amitriptyline
dry mouth, constipation, urinary retention (anticholinergic), lethargy, orthostatic hypotension
If you have a patient taking amiodarone and digoxin what must be done
reduce digoxin by 25-50% or toxicity
after the clinical suspicion of acromegaly what is the next stewp
IGF levels
how to diagnose acromegaly
has to have elevated IGF, oral glucose suppression has to inadequately suppress GH and then MRI for pituitary
what are the early signs of meningitis
nonspecific fever, myalgia, muscle aches. similar to flu
what are the features of hemochromatosis
cardiomyopathy, diabetes, joint pain, hypopituitarism and secondary hypogonadism.
what is lateral medullary syndrome
vestibular nucleus vertigo, diplopia nystagmus, vomiting, ipsilateral loss of facial pain and temperature diminished gag reflex and dysphagia with dysphonia. contralateral loss of trunk and extremity pain and temperature.
what to treat Lyme disease in pregnancy
amoxicillin
what are the guidelines for FAP screening
10-12 years old begin screening with colonoscopy followed by annual once polyps are discovered.
what is the presentation of CMV colitis in HIV
frequent small volume diarrhea, hematochezia, abdominal pain, low-grade fever, weight loss
what is essential tremor
progressively worsening tremor of the upper extremities that becomes more pronounced with extension of the arms. worsens more at the end of an intended action.
no further neurological deficits and positive family history
what is intention tremor
Coarse hand tremor with a frequency of < 5 Hz
Worse with goal-directed movements
Other cerebellar signs
Dysmetria (abnormal heel-to-shin and finger-to-nose testing)
Dysdiadochokinesia(inability to perform rapid alternating hand movements)
Dysarthria, nystagmus and abnormal gait
Diagnosis
CT/MRI: cerebellar lesions
IgG in CSF if multiple sclerosis is suspected
Screen for alcohol abuse or toxic lithium blood levels
treatment for intention tremor
propanolol
what improves essential tremor.
alcohol
what are the differences between tremors
parkinson (resting), essential, intention
Parkinson’s or resting occurs at rest and has features such as rigidity and bradykinesia. this improves with movement.
essential will have a normal neurological exam except for head tremor that mild. also highly hereditary. improves with alcohol, beta blockers and primidone.
intention tremor will have other findings as well on exam. Ataxia, hypotonia, gait instability, difficulties with rapid movements, dysarthria, nystagmus
