Notable Dx That I Cant Remember Flashcards
Measles
Cough coryza conjunctivitis with fevers
Descending MP rash and koplik spots in bucca
NPS and serology, urine test
Complications: PNA, AOM, diarrhea, resp failure, encephalitis, death, blindness, deafness, ID
Sx management conservative
Rubella (3 day fever)
Viral, mild URTI with mobile form rash
Symptom management
MS
Immune mediated demyelinating disease in CNS
Can be progressive or relapse/remitting
Genetic factor, DM1, RA, SLE, post EBV, low vitamin D are risk factors
Start with vision problems, optic neuritis, muscle weakness, tingling, balance issues, bladder issues, dizziness
Long term fatigue, cognitive dysfunction
MRI and LP Dx
Tx steroids, plasmapheresis, beta interferons, disease modifying agents
Myasthenia gravis
Autoimmune, peripheral motor nerve
Droopy eyelids, diplopia, face droop, slurred speech, progressive weakness, ocular myasthenia
NCS, CT/MR chest, ab test (not Firstline)
Treat with pyridostigmine, steroids, immunosuppressants, surgery (thymectomy)
Hemicrania continua
Unilateral continuous HA >3mo with episodic exacerbation and agitation and autonomic symptoms
Complete response to indomethacin
Hypercalcemia
Stones, bones, groans (abd pain, NV, constipation), overtones (psychosis, fatigue, memory loss, delirium). Also polyuria/polydipsia, muscle weakness
Complication cardiac arrhythmia and dehydration
Mostly from cancer or high PTH
check serum phosphate, albumin, creatinine, PTH, vitD, SPEP
Tx IV bisphos, calcitonin IM/sc, IVF
Hypocalcemia
Fatigue, cramping, weakness, perioral/distal extremity parasthesias, myoclonic jerks.
Laryngospasm, tetany, aLOC, seizure, arrhythmia, long QT, rickets
Caused by CKD, vitD deficiency, impaired PTH action, sepsis
Trousseau sign: BP cuff cause limb spasm
Chvostek sign: facial muscle contract by tapping below zygomatic arch
ALP, Mg, Phos, Cr, 25-hydroxyvitamin D, PTH
Calcium gluconate IV
HyperK
In CKD, rhabdo, tumor lysis, DKA (falsely elevated), adrenal insufficiency, digoxin toxicity
Muscle weakness/paralysis, palpitations
Peaked T waves, long PR, flat P, wide QRS, brady, VT
If K>6.5, get ECG
Tx:
IVF (Give RL as NS worsens)
Ca gluconate, Ca bicarb push (in cardiac arrest), insulin in DKA, ventolin nib or IV, digibind in dig tox, stop offending med
Nocturnal enuresis
Incontinence in >5yo
Mechanisms: small bladder, nocturnal polyuria, sleep arousal difficulties
Common cause: constipation, delayed development, ADHD, OSA, DM, diabetes insipidus, hyperthyroidism, trauma, maltreatment, bullying
Urinalysis and culture
Voiding diary
Good voiding practices, avoid fluids before bed, avoid caffeine, address constipation, positive reinforcement
Alarm therapy, desmopressin, anticholinergics (oxybutinin)
Sickle cell anemia
Autosomal recessive, African origin most common
Precipitated by hypoxia, dehydration, infection, acidosis, cold, pregnancy, alcohol
Normocytic, normachromic anemia, hemolysis and splenic sequestration. Abnormal cells, more fragile and die faster
Hemoglobin electrophoresis
Associated dactylitis, pain crisis, priapism, hyphema, leg ulcers
Complications: acute chest syndrome, sequestration crisis, acute stroke, aplastic crisis
Management for asplenia: vaccinations, additional pneumovax, prophylactic penicillin 3mo-5yr, avoid suckling conditions, good hygiene, folate supplements
DDx scrotal pain
Testicular torsion: prepubertal, acute onset, surgery in 6 hours or if not certain US Doppler. Negative cremasteric
Testicular appendage torsion: blue dot sign, use NSAIDS for Tx
Epididymitis: pubertal, insidious onset, UA can be positive, present cremasteric, positive prehn, give abx (doxy)
HSP: check BP and blood on UA, abdominal pain, prepubertal
Initial hernia: surgical emergency if strangulated
Exam: Abdominal (flank tenderness, bladder distension), pelvic, groin (epididymis, spermatic cord, swelling, erythema, testes lie/height
Inv: UA, US, G/C urethra swab, WBC
PRES
HA with wishes, visual change, focal neuro, aLOC
Temporal and parietal lobe
Lithium toxicity
Causes: medication, dehydration, AKI,
Signs: Tremors, nystagmus, hyperreflexia, seizures, aLOC,
Sx: NV, diarrhea, gait disturbance, blurred vision, muscle weakness
Can cause hypothyroid, CKD, nephrotic DI, tremor, ataxia
IVF, HD if >3.5, monitor lytes and cr
CRPS
Complication of # wks or months out from injury in women 40-50s mostly
Pain in previous injured limb more prolonged than expect
Pain sensory changes, color change, motor stuff, temp change
Sx management, patient education, psychological intervention, medical therapy analgesic and neuro agents, nerve blocks, pain clinic
TB
Mycobacter tuberculosis
Night sweats, weight loss, fatigue, chronic cough, hemoptysis
CXR, tuberculin skin test/mantoux, acid fast bacterial sputum
Rifampin, INH, pyrazinamide, ethambutol
