More Misc Flashcards
Definition of AKI:
- Serum creatinine increase of 0.3+ in 48 hours
- Serume creatinine increase of 150% of baseline in 7 days
- Urine volume <0.5 mL/kg/hr
RBC casts
acute glomerulonephritis
Muddy brown or epithelial casts
ATN
WBC casts
AIN or pyelonephritis
Narrow waxy casts
chronic ATN/glomerulonephritis
Broad waxy casts
ESRD
Fatty casts “maltese crosses”, oval fat bodies
nephrotic
eospinophils
ATN
MC form of AKI
Prerenal
Define acute tubular necrosis:
prolonged or severe ischemia caused by a prerenal condition, it eventually leads to an intrarenal processes
Define tubulointerstitial nephritis
inflammatory of allergic response in interstitium with sparing of the glomeruli and blood vessels
MCC of tubulointerstitial nephritis
drug hypersensitivity
Tx tubulointerstitial nephritis
prednisolone x 1-2 weeks
TINU syndrome
interstitial nephritis + uveitis
BUN/Cr ratio: prerenal
> 20:1
BUN/Cr ratio: intrarenal
<10:1
BUN/Cr ratio: post-renal
early >20:1 and late <10:1
MCC of ESRD?
DM
CKD Stage 1
> 90
CKD Stage 2
60-89
CKD Stage 3
30-59
CKD Stage 4
15-29
CKD Stage 5
<15 or dialysis
Glomerulonephritis AKA
nephritic syndrome
What kidney disease is associated with cola colored urine?
nephritic
MCC AGN worldwide?
IgA neuropathy (Berger’s)
Young male presents within 24-48 hours after URI or GI infection with symptoms of nephritic syndrome?
IgA nephropathy (Berger’s)
Dx of IgA nephropathy (Berger’s)
+ IgA mesangial deposits on immunostaining
Tx Berger’s
ACE +/- corticosteroid
Post-infectious glomerulonephritis MC after?
GABHS
2-14 year old boy with facial edema 3 weeks after strep with scanty, cola-colored/dark urine?
Post-infectious glomerulonephritis
Dx of post-infectious glomerulonephritis
increased ASO, low serum complement
kidney failure + hemoptysis
Good pasture’s disease
nephritic syndrome gold standard
renal biopsy
Nephrotic CM
heavy protienuria (>3 g/d), hypoalbuminemia, hyperlipidemia, edema
MCC of nephrotic syndrome in kids
minimal change disease
MCC overall of nephrotic syndrome in adults?
DM
gold standard for nephrotic syndrome
24 hour urine protein collection
Tx nephrotic syndrome
ACE/ARB, loop for edema, statins for hyperlipidemia
Others in house have head cold?
bronchiolitis
CXR bronchiolitis
hyperinflation, patchy atelectasis
Bronchiolitis tx
no tx
Barky cough
croup
MC infection of middle respiratory tract in kids
croup
Laryngitis in older kids
croup
viral or bacterial? croup
viral
When are symptoms worse with croup?
night
Westley croup severity score?
Level of consciousness, cyanosis, stridor, air entry, retractions
Steeple sign
Croup
Tx mild croup
observe –> antipyretics, vaprizer, fluids
Tx croup with stridor at rest or signficant discomfort
oral dexamethasone x 1 dose OR
racemic epinephrine for resp. distress
Whoop coughing
pertussis
Dx pertussis
Pertussis PCR
tx pertussis
Azithromycin
Extrinsic causes of pleural effusion are called?
transudative
Intrinsic causes of pleural effusion are called?
exudative
Transudative causes of pleural effusion?
liver disease/cirrhosis, cardiac disease/CHF, renal disease/chronic renal failure
Exudative causes of pleural effusion?
malignancy, pneumonia, TB, PE
Initial test for pleural effusion?
x-ray
Tx for pleural effusion?
thoracocentesis
Thoracocentesis procedure:
insert 1-2 intercostal spaces below height of effusion; not below 9th rib
Do you go above or below rib in thoracocentesis?
above
Thoracocentesis: pale yellow
usually transudative
Thoracocentesis: yellow-green
RA
Thoracocentesis: blood or red
malignancy or asbestosis
Thoracocentesis: brown, anchovy psate
amebic liver abscess
Thoracocentesis: black
aspergillus infection
Thoracocentesis: putrid odor
anaerobic abscess
Blunting of costophrenic angles
pleural effusion
3 d’s of endometriosis
dysmenorrhea, dyschezia, dyspareunia
MC site for endometriosis?
ovary
Triad of endometriosis
pelvic pain; fixed and firm adnexal mass; tender nodularity in cul-de-sac and uterosacral ligaments
Endometriosis: US
ground glass appearance of implants
Tx: endometriosis
OCPs, medroxyprogesterone acetate; NSAIDs
MC type of benign ovarian tumor
epithelial
MC type of epithelial ovarian tumor
Serous
Best modality for assessing ovarian tumors
US
PROM definition:
at least 1 hour prior to active labor (at or after 37 weeks gestation)
Prolonged PROM:
18+ hours before onset of labor
Dx PROM:
avoid digital vaginal exam; sterile speculum exam and confirmation via nitrazine test (detects pH –> alkaline if amniotic) and fern test (detects salt crystals in amniotic fluid)
MC site of ectopic
Fallopian tube (specifically ampula)
Serum HcG should increase by at least
66% every 48 hours in the first 6-7 weeks after day 9
Progestrone in pregnancy
> 25 normal
<5 abnormal
Diagnosis of ectopic
US
When is ectopic suspected on US?
suspected if gestational sac is not seen within uterine cavity with serum HcG around 1200
Medical tx of ectopic
methotrexate (if stable and ectopic <3.5 cm)
surgical tx of ectopic
lapartomy (unstalbe0, laparoscopy (stable)
Define intrauterine fetal demise
fetal demise after 20 weeks, but before labor onset
Define premature labor
Of a viable infant >20 weeks to <37 weeks
uterine contractions: 4 per 20 minutes or 8 per 60 and cervical changes (2 cm dilation or 80% effacement)
cause of neonatal morbidity and mortality
premature labor
Greatest RF of premature labor
previous pre-term labor
Meds for preterm labor
magnesium sulfate
MCC of acute pelvic pain
ovarian ruptured cyst
Pusus paradoxus is seen with ?
cardiac tamponade
pulsus paradoxus:
exaggerated >10 mmHg decease in SBP with inspiration
Cardiac tamponade tx:
pericardiocentesis
ortho hypotension tx
fludrocortisone +/- midodrine
hypovolemic shock: I
15% blood loss –> pulse and SBP normal
hypovolemic shock: II
15-30% –> tachy (>100) and SBP >100 mmHg
hypovolemic shock: III
30-40% –> tachy, decrease SBP (<100), confusion, decreased urine output
hypovolemic shock: IV
> 40% –> tachy, decreased SBP, lethargy, no urine output
Only shock where we do NOT give large amounts of fluids
cardiogenic
Tx for cardiogenic shock
dobutamine, epinephrine
Warm shock
septic
MC type of distributive shock
septic
only shock with increased CO
septic shock
distributive shock tx
zosyn + ceftriaxone or imipenem; vasopressors
Analphylactic shock tx
Epi 0.3 IM of 1:1000 repeat q 5-10 min
If cardiovascular collapse, give epi 1 mg IV (1:10,000)
-Airway, diphenhydramine 25-50 mg IV, ranitidine, IV lfuids
What type of shock is associated with a biphasic phenomenon?
anaphylactic
Shock: brady and hypotension
neurogenic
MC route of osteomyelitis in childlren
hematogenous
MC organism for osteomyelitis
s. aureus
osteomyelitis organism pathognomonic for SCD
salmonella
MC site of osteo in kids?
hip
If x is normal, osteo is unlikely
ESR
Most sensitive test for osteo?
MRI
Gold standard for osteo?
bone aspiration
tx: acute osteo in <4 mo y/o
nafcillin or oxacillin + 3rd gen ceph
tx: acute osteo in >4 mo old: MSSA
nafcillin or oxacillin or cefazolin
tx: acute osteo in >4 mo old: MRSA
vanco or linezolid
Duration of tx for osteo:
4-6 weeks; with 2 weeks IV
SCD (salmonella) osteo tx
3rd gen ceph or FQ
MC organism of septic arthritis
s. aureus
MC site of septic arthritis
knee
Definitive test for septic arthritis
arthrocentesis
Arthrocentesis in spetic arthritis
WBC >50,000 (primary PMN)S; >2000 in prosthetic joint
Cell count >2000
Septic arthritis: gram + cocci
nafcillin
Septic arthritis: gram - cocci or gonococcus
ceftriaxone
Septic arthritis: gram - rods
ceftriaxone + anti-pseudomonal
Septic arthritis: no organism seen
nafcillin or vanco + ceftriaxone
Compartment syndrome MC after fx of
long bone
Earliest indicator of compartment syndrome
pain on passive stressing
Compartment syndrome pressure?
> 30-40 mmHg
Delta pressure compartment syndrome
DBP - measured compartment
<20-30 = compartment syndrome
What is chronic mesenteric ischemia?
atherosclerosis of GI tract
Chronic mesenteric ischemia impacts what site most?
splenic flexure
CM chronic mesenteric ischemia?
chronic dull abdominal pain after meals (“intestinal angina”); weight loss
Test for chronic mesenteric sichemia?
angiogram
Tx chronic mesenteric ischemia?
bowel rest; surgical revascularization
Acute mesenteric ischemia mc d/t
embolus
CM acute mesenteric ischemia
severe abdominal pain out of proportion to PE; poorly localized pain; N/V/D
Test for acute mesenteric ischemia?
angiogram
Tx acute mesenteric ischemia?
surgical revascularization
Ischemic coliits is a form of?
mesenteric ischemia limited to the colon
Ischemic colitis mc d/t
hypotension or atherosclerosis involving SMA
ISchemic coliits is MC at
watershed areas
Ischemic colitis CM
LLQ pain with TTP, bloody diarrhea
Epiglottis MC d/t
HIB
RF for epiglottis in adults
DM
3 ds of epiglottis
dysphagia, droooling, distress
definitive dx of epiglotitis
laryngoscopy
thumb sign
epiglottitis
tx: epiglottitis
airway, supportive; dexamethasone
Abx: ceftriaxone
ARDS is mc d/t
sepsis
3 components of ARDS
1) severe refractory hypoxemia = hallmark
2) bilateral pulmonary infiltrates on CXR (resembles CHF)
3) absence of cardiogenic pulmonary edema/CHF –> PCWP <18 (if >18, cardiogenic pulmonary edema)
ARDS: mild hypoxemia ABG
PaO2/FIO2 200-300
ARDS: mod hypoxemia ABG
PaO2/FIO2 100-200
ARDS: severe hypoxemia ABG
PaO2/FIO2 <100
Tx: ARDS
CPAP, PEEP
MCC of encephalitis
hsv-1
MC area of brain involved in encephalitis
temporal
CSF of encephalitis
lymphocytes, normal glucose, increased protein
Tx encephalitis
supportive care, seizure prophylaxis
-Valacyclovir if HSV or unknown
Epidural hematoma MC after
temporal bone fx –> middle meningeal artery disruption
Hematoma associated with brief LOC –> lucid interval –> coma
epidural
Convex/lens shaped hematoma
epidural
Hematoma that does NOT cross suture lines
epidural
Hematoma d/t tearing of cortical bridging veins
subdural
hematoma d/t temporal bone fx
epidural
hematoma d/t middle meningeal artery disruption
epidural
hematoma d/t blunt trauma “contre-coup”
subdural
Concave (crescent shaped) hematoma
subdural
hematoma that can cross sturues
subdural
Tx of subdural hematoma
evacuate if massive or 5+ mm midline shift
thunderclap headache
subarachnoid
MC d/t berry aneurysm rupture
subarachonid
shows xanthochromia on LP
subarachnoid
intraparenchymal bleed
intracerebral
hematoma that we do NOT perform LP on
intracerebral
MC cause of GBS
campylobacter jejuni
DTR in GBS
decreased (LMN lesion)
CSF in GBS
increased protein with normal WBC
Tx GBS
plasmapheresis best if done early
HA worse with straining; tinnitus; visiual changes
pseudotumor cerebri
pseudotumor cerebri associated iwth what palsy
CN 6 (abducens): lat rectus muscle weakness –> limit of abduction (entropion)
Dx pseudotumor cerebri
CT scan –> LP
tx pseudotumor cerebri
acetazolamide
NPH
dilation of cerebral ventricles with normal opening pressures on LP
Classic triad of NPH
dementia, gait disturbance, urinary incontinence
Gait in NPH
shuffling gait “magnentc”
MRI/CT of NPH
enlarge centricles
LP of NPH
pressure normal
Test that helps confirm NPH
lumbar tap test: removal of up to 50 cc of CSF –> improvement 30-60 min after
TOC of NPH
ventriculoperitoneal shunt
Brain changes in AD?
cerebral cortex atrophy
Meds for alzheimers?
donepezil, tarine, rivastigmine, galantamine
-Memantine
RF for vascular dementia?
HTN
Frontotemporal demenita associ with
marked personality changes
Pick bodies assoc w/
frontotemporal demensia
visual hallucinations –> type of dementia
diffuse lewy body
MC type of stroke
ISchemic
MC type of ischemic stroke
middle cerebral
