Misc Flashcards
What is POTS syndrome?
Postural orthostatic tachycardia syndrome. It is manifested by a rise on heart rate of greater than 30 beats per minute or by a heart rate of greater than 120 within 10 minutes of being in the upright position symptoms usually include position dependent headaches, abdominal pain, lightheadedness, palpitations, sweating, and nausea. Most patients will not actually pass out but some may if they are unable to lie down quickly. This condition is most common in white females between 15 and 50. They are often hard-working, athletic and otherwise in good health. There is a high correlation between PO TS and chronic fatigue syndrome. There is no single etiology but it is thought to have a genetic predisposition and is often incited after a prolonged viral illness. It also has a component of deconditioning. Recommended initial management is encouraging adequate fluid and salt intake, followed by initiation of regular aerobic exercise combined with lower extremity strength training. Then the use of beta blockers.
List the common types of seafood poisoning and it discuss which one needs more than supportive care
Ciguatera, neurotoxic shellfish poisoning, paralytic shellfish poisoning, and scombroid fish poisoning.
Only scombroid poisoning the cars more than supportive care it is a pseudo-allergic condition resulting from ingestion of high levels of histamine and sairine. Symptoms occur within minutes to hours and include flushing of The skin, oral paresthesias, pruritis, urticaria, nausea, vomiting, diarrhea, vertigo, headache, bronchospasm, dysphagia, tachycardia, and hypotension. therapy should be the same as for allergic reactions and anaphylaxis and will usually lead to resolution of symptoms within several hours.
What are the common clinical features of Wegener’s granulomatosis?
How is it diagnosed?
It typically presents with severe upper respiratory tract findings. These may include paranasal sinus pain and drainage, purulent or bloody nasal discharge, with or without nasal mucosal ulceration. Nasal septal perforation may follow which leads to saddle nose deformity. Serous otitis media may occur as a result of eustachian tube blockage and it may lead to hearing loss. Lung involvement may lead to shortness of breath and hemoptysis. CXR findings may include nodules, infiltrates and areas of cavitation. In about 77% of patients, Wegener’s presents with renal disease, with mild glomerulitis with proteinuria, hematuria, and red blood cell casts. it may also cause eye and skin lesions as well as neuropathy.
ANCA antibodies are found in about 85% of patients with Wegener’s granulomatosis. However the only definitive way to confirm a diagnosis is by biopsy of the affected tissue.
What is Wilson’s disease?
What are its clinical manifestations?
Wilson disease is also called hepatolenticular degeneration. It is due to a genetic abnormality which causes abnormal cellular copper transport. It leads to the accumulation of copper in several organs, most notably the liver brain and cornea.
It causes liver disease in about 20 to 80% of patients, neurological symptoms in about 20 to 70% of patients, and the psychiatric symptoms in 10 to 100% of patients.
The majority of patients present between ages five and 35. Findings and symptoms vary with the organs affected and the degree of damage. They may include Kayser Fleischer rings, abdominal pain, jaundice, hepatomegaly, cirrhosis and upper G.I. bleeding, hemolytic anemia, dysarthria, gait abnormalities, tremor, Parkinsonism, drooling, cerebellar ataxia, cognitive impairment, depression, personality changes, impulsiveness, irritability, inappropriate behavior, bipolar disorder, psychosis.
Common ocular abnormalities in Wilson disease
Kaiser Fleischer rings and sunflower cataracts
Common symptoms and findings in iron overload
Weight-loss, joint pain, type two diabetes, fatigue, and a bronze tone of the skin.
What is the classic triad found in hemolytic uremic syndrome?
Acute renal failure, microangiopathic hemolytic anemia, and thrombocytopenia.
What is the preferred treatment for upper extremity deep venous thrombosis?
Low molecular weight heparin subcutaneously for at least five days, followed by oral warfarin for three months.
What is the treatment for calcium oxalate kidney stones?
A low-sodium diet with restricted protein and increased fluid. Oxalate restriction also reduces stone formation. Oxalate containing foods include spinach, chocolate, tea and nuts. Potassium citrate should be taken at mealtime to increase urinary pH and urinary citrate.
What is the treatment for ethylene glycol poisoning and when should it be given?
The antidote fomepizole should be given. It should be given when there is a plasma ethylene glycol concentration of greater than 20 mg/dL, a history of ingesting toxic amounts of ethylene glycol within the past few hours , a high osmolal gap of greater than 10, plus at least two of the following: arterial pH of less than 7.3, serum bicarbonate of less than 20 mmol per liter, or urinary oxalate crystals.
If treated early hemodialysis may be avoided, but one severe acidosis and renal failure have occurred hemodialysis is necessary. Afflink like all is rapidly absorbed, and use of ipecac or gastric lavage is therefore not effective. Activated charcoal is also ineffective, as it only binds small amounts of ethylene glycol.
What goals should be set for a patient who has chronic pain?
- reduce incidence and severity of symptoms
- improve function
- Foster patient self-management
What factors predispose a patient toward opioid abuse?
A family history of substance abuse including alcohol, illegal drugs or prescription drugs. A personal history of substance abuse including the same things. Age between 16 and 45. History of preadolescent sexual abuse. Psychological diseases that include ADD, OCD, bipolar disorder, schizophrenia and depression.
What nonpharmacologic and alternative treatments have been shown to be effective for diabetic neuropathy and postherpetic neuralgia?
Diabetic neuropathy has been shown to respond to percutaneous nerve stimulation, acetyl-L – carnitine, magnetic therapy, and imagery.
Postherpetic neuralgia has been shown to respond to geranium oil and imagery.
Neither has been shown to respond to acupuncture, St. John’s wort, or spiritual healing.
What is PENS?
A combination of TENS with electroacupuncture. It has been shown to be effective for neuropathic pain.
Which foods have proteins that cross react with latex proteins and should be avoided in latex allergy?
Avocados, bananas, chestnuts, and kiwi.
What conditions are associated with an enlarged tongue?
It may be found in developmental conditions such as down syndrome, maybe caused by a tumor such as hemangioma or lymphangioma, metabolic disease such as primary amyloidoses, or endocrine disturbances such as acromegaly or cretinism.
What conditions cause a bald tongue?
Xerostomia, pernicious anemia, iron deficiency anemia, pellagra or syphilis.
What is pellagra?
Vitamin B3 (thiamine) deficiency
What vaccines should patients receive after they get a splenectomy?
Definitely pneumococcal and meningococcal vaccines. Haemophilus influenza type B vaccine should be considered as well.
What is severe hyperkalemia? What are its possible treatments?
Sodium bicarbonate, glucose with insulin, and albuterol. Total body potassium cab be lowered with sodium polystyrene sulfonate, but this takes longer than these other methods. In the most severe cases acute hemodialysis can be started.
What is osmotic demyelination? When does it occur?
It is a process that occurs when hyponatremic is corrected to rapidly, outpacing the brain’s ability to recapture lost organic osmolytes. It can usually be avoided by limiting correction of chronic hyponatremia to less than 10 to 12 mmol per liter in 24 hours and to less than 18 mmol per liter in 48 hours.
What is the treatment for acute mountain sickness or high-altitude cerebral edema?
Management of choice is a combination of descent and supplemental oxygen Often a descent of only 500 to 1000 m will lead to the resolution of acute mountain sickness. Simulated dissent with a portable hyperbaric chamber is also effective, but descent should not be delayed while awaiting helicopter delivery. If descent and/or administration of oxygen is not possible, medical therapy with dexamethasone and or acetazolamide may reduce the severity of symptoms. Nifedipine has also been shown to be helpful in cases of high-altitude pulmonary edema where descent and or oxygen are unavailable.
What conditions can cause SIADH?
CNS tumors, various infections such as meningitis and pneumonia, and drugs. The drugs include amiodarone, carbamazepine, SSRIs, and chlorpromazine.
How is the diagnosis of Marfan syndrome made?
The criteria are complex. If both aortic root dilatation or dissection and ectopic lenses are present a diagnosis of Marfan can be made unless another genetic condition that causes these is present. There is a genetic mutation of a gene called FBN1 that can be tested for. If it is present and aortic dissection or dilatation is also present a diagnosis of Marfan is made. If ectopic lenses are present without anyone aortic problems, there must be a diagnosis of a gene defect associated with Marfan’s for a diagnosis of Marfan’s to be made. If aortic problems are present, ectopic lenses absent and the FBN one status is negative or unknown, the diagnosis of Marfan because it requires systemic findings up with a score of more than seven points. These findings are variously waited into regards to point number but they include: the wrist sign which is that the patient can encircle his or her wrist and overlaps the thumb and little finger, the thumb sign which is that the tip of the thumb protrudes from a clenched fist, pectus carinatum, pectus excavatum or chest asymmetry, hind foot deformity, pes planus, pneumothorax, dural ectasia, Protrusio acetabulae, reduced upper to lower segment ratio, increased arm to height ratio, scoliosis or thoracolumbar kyphosis, reduced elbow extension, typical facial features, skins striae, myopia of greater than 3 dpt, and mitral valve prolapse.
What other diseases are associated with celiac disease?
About 7% of type one diabetics have celiac disease. A number of other autoimmune syndromes have been associated with celiac disease, including thyroid disease and rheumatoid arthritis.
Which GFR’s are associated with which stages of chronic renal disease?
Stage I there is a GFR over 90, stage II GFR from 60 to 90, stage III GFR from 30 to 60, stage IV GFR 15 to 30, and Staige V GFR less than 15.
What are the blood-pressure goals in patients with chronic kidney disease?
Chronic kidney disease stages one through four with proteinuria greater than 1 g per day goal should be less than 125/75. Chronic kidney diseases stages one through four with proteinuria of less than 1 g per day, goal should be less than 135/85. chronic kidney disease stage 5 should be less than 140/90.
According to ATLS, how can a patient’s minimum systolic blood pressure be assessed?
If only the patient’s carotid pulse is palpable, this is stolid blood pressure is 60 to 70. It’s carotid and femoral pulses are palpable the systolic blood pressure is 70 to 80. If carotid, femoral and radial pulses are all palpable the systolic blood pressure is above 80.
What are the features of Ménière’s disease?
Spontaneous episodes of vertigo lasting minutes to hours with associated tinnitus hearing loss and ear fullness.
