Numero 8 Flashcards
how do pts with intracranial hypertension (of any etiology) present?
headache that’s worse at night, n/v, and mental status changes (eg, decreased level of consciousness, cognitive dysfunction)
pts may also have focal neurologic symptoms (vision changes, unsteady gait) and seizures
symptoms can worsen with maneuvers that further increase intracranial pressure (eg, LEANING FORWARD, valsalva, cough)
papilledema may be seen on exam
*Cushing reflex (HTN, bradycardia, respiratory depression) is a worrisome finding suggestive of brainstem compression
in cases of intravascular hemolysis, what do haptoglobin levels do? and why?
Haptoglobin is a serum protein that binds free hemoglobin and promotes its excretion by the reticuloendothelial system (intravascular erythrocyte destruction results in free hemoglobin in the serum)
in intravascular hemolysis, the amount of free hemoglobin in the serum exceeds the binding capacity of haptoglobin, thereby DECREASING HAPTOGLOBIN LEVELS
what are important risk factors for respiratory distress syndrome in a newborn?
Prematurity and MATERNAL DIABETES MELLITUS!
others include male sex, perinatal asphyxia, and c/s without labor
what is the mechanism by which a cardiac stress test with adenosine identifies ischemic areas of the myocardium?
adenosine stimulates adenosine A2A receptors on vascular smooth muscle cells and causes coronary vasodilation and increased myocardial blood flow
**there is a several-fold augmentation of blood flow in nonobstructed coronary arteries – blood flow is also increased in stenosed coronary arteries but to a much lesser extent! – this relative blood flow difference is magnified from rest, causing a detectable reduction in radioactive isotope uptake by myocardial cells in areas supplied by a stenotic coronary artery
how do you tx vaginal candidiasis?
Oral Fluconazole
what immunologic rxn occurs within 1 hour of blood transfusion and presents with fever, flank pain, hemoglobinuria, renal failure and DIC? what is the cause?
Acute hemolytic transfusion reaction
Caused by ABO incompatibility
Dx is made by a positive direct Coobs test, pink plasma (plasma free hgb >/= 25 mg/dL), hemoglobinuria, and repeat type and cross-match showing a mismatch
What is erysipelas? what bug most commonly causes it? and what PE finding is particularly suggestive of erysipelas?
Erysipelas = a skin infection of the UPPER DERMIS and superficial lymphatic system
Most common caused by GROUP A STREP
Pts rapidly develop systemic symptoms (f/c), regional lymphadenitis, and a warm, tender, erythematous rash notable for RAISED, SHARPLY DEMARCATED BORDERS
**involvement of the EXTERNAL EAR is particularly suggestive of erysipelas as this skin lacks a lower dermis level (making cellulitis unlikely)
Postcholecystectomy syndrome is persistent abdominal pain or dyspepsia either post-op (early) or months to years (late) after cholecystectomy. When this is suspected, what studies should you get to evaluate for it?
Abdominal imaging (ultrasound) followed by ERCP (direct visualization)!!
*etiologies include biliary (retained common bile duct, cystic duct stone) or extra-biliary (pancreatitis, peptic ulcer dz) causes
when you have disseminated gonococcal infection, what does the rash usually look like?
usually vesiculopustular and rarely involves the face
an unvaccinated adolescent presents with a prodrome of mild fever, LAD, and malaise. A blanching, erythematous, maculopapular rash erupts on their face and spreads caudally within 24 hours, sparing the palms and soles. They also have polyarthralgia and/or arthritis. what is this?
Rubella!!
an unvaccinated adolescent presents with a prodrome of mild fever, LAD, and malaise. A blanching, erythematous, maculopapular rash erupts on their face and spreads caudally within 24 hours, sparing the palms and soles. They also have polyarthralgia and/or arthritis. what is this?
Rubella!!
symptoms of bland tasting food (secondary to anosmia) and recurrent nasal discharge/congestion are typical in pts with what?
Nasal polyps! -exam would reveal the presence of b/l grey, glistening mucoid masses in the nasal cavities
How do pts with Kallmann syndrome present? what is their genotype?
genotype is normal (so 46 XX in girls, 46 XY in boys) and also have normal internal reproductive organs
present with delayed/absent puberty, short stature, and anosmia (can’t smell)
FSH and LH levels are low due to gonadotropin-releasing hormone deficiency
x-linked recessive disorder of migration of fetal GnRH and olfactory neurons, resulting in hypogonadotropic hypogonadism and rhinencephalon hypoplasia
the development of a new conduction abnormality in pts with infective endocarditis should raise suspicion for what?
a perivalvular abscess extending into the adjacent cardiac conduction pathways
- IV drug abuse is also an independent predictor of periannular extension of infection
- cardiac conduction abnormalities are uncommon in pts with tricuspid valve endocarditis (more w/ aortic valve)
what enzyme is deficient in Lesch-Nyhan syndrome? also what symptoms do you see?
hypoxanthine-guanine phosphoribosyl transferase (HPRT), an enzyme involved in purine metabolism. leads to increased levels of uric acid
x-linked recessive
symptoms = self-mutilation, neuro features (mental retardation, dystonia, choreoathetosis, spasticity), gouty arthritis, and tophus formation
what enzyme is deficient in Lesch-Nyhan syndrome?
hypoxanthine-guanine phosphoribosyl transferase (HPRT), an enzyme involved in purine metabolism. leads to increased levels of uric acid
x-linked recessive
symptoms = self-mutilation, neuro features (mental retardation, dystonia, choreoathetosis, spasticity), gouty arthritis, and tophus formation
epitrochlear LAD is particularly pathognomonic for what STD?
Syphilis (secondary stage)
*sailors would routinely perform a 2-handed “sailor’s handshake” (w/ one hand on the elbow) to determine if potential partners had epitrochlear nodes prior to engaging their company
the most common cause of folic acid deficiency is nutritional due to poor diet and/or alcoholism. what are the commonly used drugs that can also cause folic acid deficiency?
Phenytoin, primidone, phenobarbital
Methotrexate
Trimethoprim (like with TMP-SMX)
the most common cause of folic acid deficiency is nutritional due to poor diet and/or alcoholism. what are the commonly used drugs that can also cause folic acid deficiency?
Phenytoin
Methotrexate
Trimethoprim (like with TMP-SMX)
how should you attempt to remove small vaginal foreign bodies in children before moving to sedation/general anesthesia for exam/foreign body removal?
attempt to remove with a calcium alginate swab or Irrigation w/ warmed fluids after a topical anesthetic has been applied
how do you tx lichen sclerosus?
Topical corticosteroids
*vs atrophic vaginitis, which is treated with low-dose topical estrogen
what is the mechanism of amenorrhea in female athletes that have a relative caloric deficit due to the amount of energy they expend in training?
hypothalamic amenorrhea
hormones levels = decreased GnRH, decreased LH and FSH, and decreased estrogen
** if they were doping with androgenic steroids, they would present with virilization, such as male-pattern baldness, deepening voice, clitoromegaly; as well as aggressive behavior and mood disorders
what antibiotic should be used as prophylaxis in cat bites? what particular organism are you trying to cover against?
Amoxicillin/clavulanate
it has activity against Pasteurella multocida (gram-neg coccobacilli) and oral anaerobes found in the mouth of cats
where is renin located and what is its role in the RAAS?
Renin is produced in the juxtaglomerular cells of the kidney in response to hypoperfusion
Renin cleaves angiotensinogen into angiotensin I (which is converted into angiotensin II by ACE in the lung. Ang II is a potent vasoconstrictor that also promotes aldosterone production in the adrenal cortex)
what is the initial management in a hemodynamically stable pt with regular and narrow complex tachycardia (QRS duration < 120 ms) at a fast rate = Supraventricular tachycardia?
IV adenosine! or vagal maneuvers (carotid sinus massage, Valsalva, eyeball pressure) – these temporarily slow conduction via the AV node and can aid in dx by unmasking “hidden” P waves in pts with A flutter or atrial tachycardia – adenosine can also terminate paroxysmal supraventricular tachycardias by interrupting the AV nodal reentry circuit
what is the initial management in a hemodynamically stable pt with regular and narrow complex tachycardia (QRS duration < 120 ms) at a fast rate = Supraventricular tachycardia?
IV adenosine! or vagal maneuvers (carotid sinus massage, Valsalva, eyeball pressure) – these temporarily slow conduction via the AV node and can aid in dx by unmasking “hidden” P waves in pts with A flutter or atrial tachycardia
