Peds Flashcards
1
Q
A sickle cell patient with an episode of gross blood in urine that resolves is likely due to?
A
Renal papillary necrosis happens in SCA patients due to occlusion of renal vessels and results in gross hematuria after the glomeruli so there is no protein and no WBC and no nitries/leukoesterase
2
Q
what causes ARDS?
A
Protein leakage from capillary breakage and formation of hylaine membranes – PEEP
3
Q
When don’t you tap an unkonwn effusion
A
Tap all unknown effusions unless the patient has CHF
4
Q
what causes Vfib after MI
A
reentrant rhythm cause Vfib after MI
5
Q
what should you treat with when you hear a S3 in a patient with dyspnea?
A
think CHF and give IV diuretics, do NOT give BB
6
Q
treatment of ventricular tachycardia
A
treat ventricular tachcyardia (fusion beats), wide complex (stable), with amiodarone
7
Q
what does acidosis do to K+
A
acid shifts K+ out of cells
8
Q
What are the GLP agonists
A
exenatide and liraglutide are the GLP1 agnoists
9
Q
what effect do FLP 1 have
A
GLP1 can cause weight loss
10
Q
what second line diabetic drug causes weight loss
A
GLP1 eneatide and liraglutide causes weight loss
11
Q
what are the gliptins
A
the gliptins are DPPIV inhibitors
12
Q
what do the ligpitins do
A
gliptins are weight neutral and are used in renal insffu
13
Q
what is used in renal insuff for DM
A
you can use the glipitins (DPPIV) which are weight neutral
14
Q
what causes weight loss for diabetes
A
for diabetes the GLP agnosits cause weight loss
15
Q
What are AE of sulnyulrea
A
sulonyule cause hypoglycemia and weight gain
16
Q
what DM drug causes weight ain
A
sulfnyoluea cause weight gain
17
Q
what does DPPIV cause
A
weight neutral used in renal failure
18
Q
GLP1 agonists do what
A
the eneatides are weight los causing seocnd line
19
Q
Chemically what are key ways to tell DM2 from Dm2 diabetic state
A
DM2 has hyperosmoalr and very high omsliarty but enough insulin to not make ketones and they bicarb is is more than 18 versus les than 18 in DM1
20
Q
What are key in DKA
A
DKA has ketones and AGMA versus DM2 HHS which has higher osmolarity and and NNORMAL anion gap
21
Q
DKA what do you look for
A
DKA look for the anion gap right away
22
Q
Tx first line in HHS
A
HHS jUST GIVE IVF at first they are severely volume down and this helps correct
23
Q
what is treatment in DKA
A
DKA tx is IVF + insulin versus HHS you only need fluids first
24
Q
Most important step in HHS
A
the most improtatn step in HHS is IVF first
25
best way to slow DM nephropathy?
BP control is best way to slow DM nephroaphty
26
BP goal in CKD or Dm
below 140
27
BP goal in older than 60 with no disease
150/90
28
Earliest abnormality in Dm pnehproatphy
hyperfiltration and icnreased GFR is earliest abn in DM nephropathy
29
what happens to GBM in DM
the DM GBM THICKENS as first quatnifable chacne
30
What does A1c control do
A1c control reduces MICROvescile disease like nephropathy adn reintopahty
31
Concenrs of rhizopus
coma, cavernous sunis syndrome and coma, get CT to be sure or biopsy and treat with amphotericin B and debridement
32
What are you looking for in thryotoxicosis
in thryoidtoxiciosis there is tremor, high BP, lid lag, afib/fluttera nd Pac and high output failure
33
what are labs for secondary hyperthyroid
secondary hyperthyroid has high TSH and high T4
34
what has high TSh and high T4
High TSH and high T4 is secondary thryoid
35
what would you do if TSH and T3 are both high
high tsh and high t4 both is secondary hyperthryoid and indciates MRI of pitutiar
36
what is first step in hyperthyroidism
look at Tsh and 4
37
what is first step with high t4 and low tsh
if you have primary hyperthyroidism of high T4 and low TSH you look for s/s of graves, if none you do RAI scan
38
when do you use RAI scan
You USE RAI scan in hyperthryoidism (primary) without s/s of Graves
39
What would you use in primary hyperthryoidism so low TSH and high T4 without s/s of Graves
for primary hyperthryoidism you use RAI scan and then follow up with thyroglubolun if low to tell you exogenous hormone
40
what does thyroglobulin tell you
in primary hyperthryoidism with low uptake you look at thryroglboulin which telss you there was lysis and thyroididits or low and exogenous hormoen exposreu
41
Hyperthryoid s/s
secondary = high TSH and t4 = MRI pit, low TSH and high t4 -primary = look for graves if not do RAI scan and if low then you do exongeous for thryoditisi ersus exogenous expsoure
42
what else causes low RAI uptake with high thyroglublin
idoine toxiciosis, levothyroid OD, truma ovariss, painless thryoiditis, granulmouatusou thyroididt
43
What do PTU and MthZ both cause
Antithyorid drugs cause agrnaulocytosis
44
s/s of thyroid storm
FEVER and lid lag and tremor and hypertension and arrhtyhmi
45
what sign of thryoid toxicosis might throw you off
thryoid toxicosis oten has fever with tremor and hypertension, the fever can make you think that it i sdue to infection as it may present PP need to have high suscpitoina ndt reat with BB
46
First step in thyroid nodule on PE
Pe thyroid nodule is TSH and U/s
47
what od you do with suspcions U/S findigns on thryoid nodule exam
first step with thyroid nodule is U.S and TSH anf U/S is susicipions go ight to FNA
48
when a thyroid nodule get a FNA
get FNA with thyroid nodule if the patients have HIGH tsh (HYPOthyroid) as most cancers are cold
49
what happens in a thyroid nodule with low TSH
low TSH is hyperthyroid and means it is not likley to malignant so you do radio123 to se if hot or cold
50
When is RAI C/I
RAI can worsens severe graves opth and is C/I with Graves, but you don't need it in Gaves it is diagnostic anyway
51
what causes graves otpho
graves optho is due to retroorbibtal fibroblast sitmluation with the TSH-R stimulating Ab
52
odd presentaiotn of myopathy
myopathy can be due to hypothyroidism
53
when do you do TSH with high CK levels
do TSH with high CK levels in someoen with s/s of hypothyorid and myopathy
54
what DOES NOT work in thyroid myopathy
in thyroid myopathy ANA is no good as hypothyroid patients can have psoitive ANA so you need to do TSH and worse iw muscle bioospy
55
What does hypothyroid do to blood labs
hyptohyroid causes hyperlipidiema, hyponatremia and aysx elveations of CK
56
A patient is tired with high CK and muscle pain, low Na and hihg lipids, test?
Hypothyoridism cause high CK and unexplained myopathy with hyponatremia and elevated lipids in the blodo and sometimes hepatic issues and milkd hepati enzyme elevations
57
Subclinilca hypothyroid
mild elevation of TSHa dn normal T3/4 without s/s
58
what is the father of all thyorid cancer
papillary is the fatehr and most common of all thyroid cancer
59
hat thryoid cancer is most common
papillary (pappa) is the father (MC) of all thriod cancer
60
How does papillary spread
papillary spread lympathiccally
61
everything about papillary
papillary is LN spread, most common, radiation relate
62
what thyorid cancer is the most common adn also related to histoyr of radiation or cancer
thryoid papillary cancer spread via LN and is related to lymphoma (LN) and rdaiation and is the MC
63
Two causes of hypocalcemia that need tob ec onsidered
hypocalcmia often follows blood transfusion due to citrate in the blood
64
when does a srugical patinet get hypocalcemia
surgical patients often get hypocalcemia as they get citrate infusion with chaltes chalsium
65
Levels for low Mg
low Mg affects PTH release and K+ and lowers K+ and Ca. it causes low PO4,low PTH, low calcium and is common in alcholics
66
What can vitamin D toxicity cause
vitamin D toxicity can cause high calcium, high PO4 and low PTH
67
describe the algorithm for Cushing dx
you start with cortisol and low dose dexa and then you do acth, if acth is low you do adrenal Ct if acth is high you do MRI of pituitary right away then if there is a mass you do dexa suppression to confirm
68
how is dx of cushings confirmed comign from pituatiry
i acth is high you do an mir and then you confirm it with the dexa suppression test
69
what if actht is high in cushing sna dyou mri ptiutair and no mass?
then you do petrosal sinus smapling
70
When is high dose dexa meth used
use high dose dexa meha in acth dependent coritsol secreiotn with a + brain tumor as a confirmation and do inferior petrosal sinus samling if no mass seen
71
When do you see hyponatremia and very high urine osmo
pirmary polydipisa has low Na and very high urine osmolaityr
72
Who gest low vitamind D
kids breastfed with no prenatal care get vit D def, CF patinets and IBD who have chronic diarrhea and thos ein low sun environments or GI tract resection patinest
73
What are s/s of low vit D
gatsric resection, chronic diarrhea, hypocalcemia syx and bone pain with pseudofractures or muscle weakness and bone pain
74
Patients with MEN2A and B need what before surgery
MEN2A and B patietns often have pheo and need evaluation for urine to make sure they don'e need alpha block before B block in surgery
75
what type of acidosis is primary AI
primary AI (addison's) is no cortisol and no aldosterone = no HCO3 absorbed = low HCO3 but no foreign body = NON ANION GAP metabolic acidosis
76
Biggest risk for stroke
In general HTN is the biggest risk for stroke
77
Young person with s/s of parksinosn, next step
s/s of parkinsons you're thinking wilsons disease do LFT and slit lamp
78
What is the only drug effective in preventing restroke
all stroke patients need aspirinunless allergy as aspirin is noly agent fective in reducing risk f earlly recurrnece
79
what prevents stroke recurrent
aspirin prevents stroke recurrnts give another antiplatelety if recurrents trokes on aspirin therapy
80
When do you get lacunar strokes
lacunar strokes happen in small vessel disease
81
HTN stroke think what
HTN is leading increase in cause of alls troke and happens in lacunar small vessle dsiease
82
What dont small vessels trokes cause
mslal vessle strokes do not have cortical sgins like aphosa,a gnosia, neglact, apraxia or cahnges in mental statsu
83
HTN and lacunar strokes
mild deficits affecting in ternal capulse and pure motor dysfunction
84
common acuse of pure motor dysfunction stroke
pure motor dysfunctoin internal capusle and HTN
85
pure sensory stroke?
thalamus
86
what is the defect in lacunar stroke
HTN and lipyalinotic thickening and lucane causing limited deficitis and pure motor (internal capuse) or pure sensory thalamus
87
what is almost alwaysin volved in HTN heomrrhage
putamen is right enxt to to the internal capules and is almost alway sinvovled in HTN strokes
88
HTN strokes caue
milkd deficits and affect internal capules and putamine and lead to pure sensory and pure motor commonly or a small mixture
89
Who gest central cord syndrome
lederly get central cord syndroem
90
who is predipsoed to central cord syndrome
central cord synrome in elely with hyperextention and sponylithiss
91
Elderly person has a nexk hyperextension injru with h/o sponylosisi, what is the cysrndome
ecntral cord
92
What is centarl cord syndrome s/s
older peron with spondylotlihsis in hyperxetnsion with upper extmiry waekness adn sensation loss
93
how is acute MS treated
Acute mS with steroids
94
who si acute MS refractory to steroids treated
acute MS refractory to steroids ist reated with plasma exchance
95
when is plamsa exchange used in MS
plasma exchage in MS refractory to high does steroids
96
How is acute cluster headache treated
acute cluster headache ist reated with 100% O2
97
how is cluster headhce prophylai
prophylax cluster headache with verapamil and lithium and erogtamine
98
what else is used acutely with 100% o2in cluster headache
can use subcutanoue sumatriptan
99
what are s/s of cluster heada
retorbiratl pain adn lcarmination with horners
100
what nerve deficit is commonin cluster headq
horner is common in cluster headache
101
MC s/s in IIH
headhace and vision loss iwth diploplia and pulsailte tininus and CNVI palsy
102
what ss/a re in IIH
headhace with ptinnitus and appilledema and CNVI palsy and vision loss
103
what syx can happen in IIH
IIH you get headaceh with vision loss and CNVI palsy and visual defects
104
How is IIH diagnosed
often a Normal CT -- MRI -- then do an LP which high openin pressure
105
Complication of IIH
complication of IIH is blindness if the pressure is not treated
106
how can you remmeber the Cx of IIH is blindness
remmber th complication of IIH is blindness as many presentwith vision loss and diplopia
107
When you see CSF fluid of 1000 or more what do you suspect
CSF fluid of 1000 or more you're thinking bacterial/TB meningitis
108
what is a big feature on cell count of bacterial/TB meningitis
over 1000 cells you're thinking bacterial/TB meningitis
109
What do you suspect when normal protein and cells >100 for CSF
when you have high protein, cells over 100 and less than 100 and normal glucose = viral meningitis
110
what is the distingusiher of bacteiral versus TB meningitis
TB meningitis has really really low sugar , botherhave cell counts up to or over 100
111
cell coutns in CDF over a thousand it is?
bacterial meningitis is cel lcounts > 1000
112
HOw is GBS treated
treat GBS with IvIG and nplasmphoresis
113
what isn't used in GB tx
do NOT use steorids in GBS tx
114
What are s/s of ALS
ALS has upper and lower MN
115
what is a odd syx of ALS
ALS they get faciculations and weakness along with bulbar syx like dysphagica an dexaggerated DTR
116
oni maging what do you see in vacsular demtnin
on imaging you see putamien and white matter changes and internal capusel infarcts (white matter) white matter = axons = descending axons = white matter chagnes in vascualr dementai
117
what does AD need for diagnosis
functional impairment
118
what is seen on pathology of AD
you se nuerofibirally tangles and amyloid deposition
119
Odd sign in Pciks disease
frontotemporal deficit and they often have primary reflexes that return
