Psych/Infectious disease/Heme Flashcards
Alcohol dependence withdrawal (pharm tx)
- IV benzo
- IV fluids + suppleemnts = Thiamine/magnesium
- Avoid meds that decrease seizure threshold (bupropion, haloperidol, anticonvulsants, clonidine, BB)
Alcohol use disorder (pharm tx)
Disulfiram = First line
Naltrexone = opioid antagonist to reduce cravings and ETOH induced euphoria
Gabapentin = topiramate
ADHD (hx and pe)
Difficulty paying attention, controlling behaviors, hyperactivity
Sx onset = before age 12 and present at least 6 months
Sx must occur in at least 2 settings (home + school)
Conduct disorder, breath-holding (clinical intervention)
Family counseling w/ parents + child
Persistent depressive disorder (hx and pe)
Chronic depressed for at least 2 years in adult; 1 year child
Lasts most of day, more days than not, patient is not sx free for >2 mo at a time
Histrionic personality (FMLD)
Hey look at me - attention seeking
Hissy fits - temper tantrums
Hyperinflated - believes they are more important than others
Postparum depression (pharm tx)
SSRI
Schizoaffective disorder (FMLD)
Schizo + mood disturbance (MDD or manic)
Schizoid personality (FMLD)
Voluntary social withdrawl, loner, hermit, reclusive, isolated, anhedonia/introvert
Schizophrenia (Hx and PE)
> 6 mo of illness with 1 month of acute dx with functional decline
Decreased CNS gray matter, increased size of ventricles, increased CNS dopamine receptors
Ask about positive vs negative sx
Schizophreniform disorder (FMLD)
Meets criteria for schizophrenia but less than 6 mo duration
Tardive dyskinesia (pharm tx)
- Switch to second generation antipsychotic
- Deutetrabenazine
- Valbenazine
Ascariasis (FMLD)
Small worm load = asx
Large worm load = Vague abd pain,
High load = migrate to pancreatic duct, bile duct, appendix
Patient may c/o of cough, wheezing, hemoptysis, abdominal pain, diarrhea
Bartonellosis (cat-scratch dx) Pharm tx
Azitrho = first line
Doxy preferred if optic neuritis or neurologic disease
Chancroid (scientific concept)
STI cause by bacteria = Heamophyllis ducreyi
PAINFUL ulcer vs syphillis is painless chancre
Dengue fever (FMLD)
Biphasic fever (high then remission, then second fever)
Joint pain, HA, sore throat
Biphasic rash
Hemorrhagic fever in children
Tourniquet test - Purpura from the pressure of the tourqniuet placed on arm
Diptheria (pharm tx)
Diptheria antitoxin (horse serum) supplied by CDC + erythromycin or PCN x 2 weeks
Clinda or Rifampin are alternatives
PCR confirms diptheria
Dengue fever prevention (maint + prevention)
Pemethrin on clothes, DEET on body
HIV disease (Dx and labs)
- Antibody testing = ELISA = SCREENING
- Western Blot = CONFIRMS
HIV RNA Load = Used to monitor infectivity
HIV/AIDS (Maint + prevention)
Avoid IV drug use/sharing needles
Post exposure prophy = High risk people best started within 72hrsof incident, earlier the better
HIV/AIDS, Cytomegalovirus (scientific concepts)
MC virus in AIDS patient
CMV Retinitis if CD4 less than 50
Shigella infection (hx and pe)
Mild abd pain to severe diffuse colicky abd pain with mucoid diarrhea preceding BLOODY diarrhea, fever, N/V, anorexia
PE = Tachycardic, hypotensive, abd distention, tenderness with HYPERACTIVE bowel sounds
Lumbricoides infestation (scientific concepts)
GIANT roundworm ; MC intestinal helminth worldwide
Contaminated soil
Lyme disease (FMLD)
Hx of tick bite;
early localized= erythema migrans
Early disseminated = arthritis + HA, CN7/Facial palsy, AV heart block
Malaria (dx and labs)
Gemsa stain peripheral smear (thin and thick) parasites in RBC
Malaria (scientific concepts)
RBC disease caused by plasmodium calciparaum
Transmitted by female anophele mosquito
Sickle cell trait + thalassemia trait = Protective against malaria
Mumps (clinical intervention)
Supportive
Anti-inflammatory; Sx lasts 7-10 days
Neurosyphillis (pharm tx)
PCN IV x 10-14days
Primary syphillis (dx and labs)
- Darkfield microscopy
- Screening tests = RPR, VDRL
- Confirm = FTA- BS (fluoroscent treponemal antibody absorption)
Ramsey Hunt - (FMLD)
Triad
Ipsilateral facial paralysis (bells palsy)
Ear pain
Vesicles of auditory canal
Decreased hearing, tinnitus, hyperacusis, lacrimation in some patients
Rocky mountain spotted fever (FMLD)
Fever + HA a few days after rash
Rash = small spots of bleeding starts at ankles/wrist then palms/soles before spreading centrally over 2-3 days
Rubella (Maint + Prevention)
Generally no complications in children with rubella
Teratogenic in 1st trimester part of TORCH
Blueberry muffin rash
Schistosomiasis (FMLD)
Tropical = Swimming, wading in fresh or salt water
Pruritic rash due to cercarial dermatitis aka swimmer itch
Fever, lethargy, malaise, myalgia
Sepsis, bacterial (hx and pe)
Fever + Hypotension + Increased RR
Toxic shock syndrome (hx + pe)
Sudden onset of high fever, tachycardia, hypotension, rash like sunburn includes palms/soles
Toxoplasmosis (FMLD)
Primary infection= usually asx
Mono-like illness, cervical LAD, encephalitis and chorioretinitis if immunocompromised
TORCH syndrome
Triad:
Chorioretinitis
Intracranial calcifications
Hydrocephalus
Trichinellosis (FMLD)
Hx of wild boar, bear, or cougar hunting
Diarrhea, N/V, fever, fatigue, abd discomfort
Typhoid fever (FMLD)
Caused by salmonella (s.typhi)
Cephalic phase - HA, constipation, pharyngitis, cough
PEA SOUP STOOLS
Fever, bradycardia, hepatosplenomegaly, ROSE SPOTS
Alpha thal (Dx and labs)
- CBC = hypochromic, microcytic anemia
- Peripheral smear = TARGET cells, basophillic stipling; HEINZ BODIES in hemoglobin H dz
- Hb electro = normal
Some or all of the 4 genes that make hemoglobin (the alpha-globin genes) are missing or damaged
Anemia, hemolytic, secondary to renal failure (pharm tx)
Iron supplementation and ESA (recombinant EPO and darbepoetin alfa)
Aplastic anemia (dx and labs)
CBC, peripheral smear, Hbg electrophoresis, serology for hepatitis
Fluorescent labeled inactive toxin testing
Kidney and liver testing
Bone marrow biopsy
Autoimmune hemolytic anemia (clinical intervention)
- Warm (IgG Ab) Steroids = first line then splenectomy then immunosuppressants
- Cold (IgM) Avoid cold exposurer, Rituximab if tx is needed
Coombs (+) distinguishes between hereditary spherocytosis
Autoimmune hemolytic anemia (health maint and prevention)
Cold (IgM) = Stay away from cold temp, wear gloves
Warm (IgG) = periodic blood transfusions, splenectomy
*G6PD = avoid triggers (fava beans, napthalene)
Beta thal (FMLD)
- Beta thal - trait aka MINOR = asx, only 1 defective gene
- Beta thal Intermedia = Assoaciated with anemia, hepatosplenomegaly and bony disease
- Beta thal major COOLEYS anemia = usually asx at birth but become symptomatic at 6 mo; frontal bossing; maxillary overgrowth; hepatosplenomegaly; SEVERE HEMOLYTIC anemia, osteopenia, iron overload and pigmented gallstones
Beta thal (Dx and labs)
- CBC = hypochromic, microcytic anemia (decreased MCV); normal or increased RBC count and serum iron
- Peripheral smear = TARGET cells, teardrop cells, basophillic stipling
- Hgb electrophoresis = B thal trait (minor) = low HbA, HbA2, HIGH Hbf
- Hgb electrophoresis = B Major (cooleys) = High HgbF, increased HgbA2, little to no HgbA
Skull Xray = BOSSING with hair on end due to extramedullary hematopoeisis
Beta thal (scientific concepts)
Decreased production of beta chains leds to excess alpha chains
MC in mediterranean (greek/italian) and africans
Protein C coagulation Defect (Pharm tx)
Heparin = Anticoag for life
Protein C coagulation defect (scientific concepts)
Protein C is a Vitamin K dependent anticoagulation protein (produced in liver) that stimulates fibrinolysis and clot lysis
Increased risk of recurrent DVT and PE
Autosomal dominant inherited hypercoaguable disorder
Factor V leiden mutation (pharm tx)
High risk = Indefinitive anticoagulation; may need thromboprophylaxis during pregnancy to prevent miscarriage
Moderate risk (thrombotic event with a prothrombotic stimulus or asx) = Prophylaxis during high risk procedures
Goodpastures Syndrome (FMLD)
G + P = Glomerular + Pulmonary
Glomerulonephritis + Pulmonary hemorrhage
Goodpasture syndrome (clinical intervention)
- Steroids + Cyclophosphamide
- Plasmapheresis
Goodpastures syndrome (dx and studies)
Biopsy = Linear IgG deposits in glomeruli or alveoli on immunofluoresence, anti-GBM Ab
Goodpasture syndrome (scientific concepts)
IgG antibodies against type IV collagen of the alveoli and glomerular basement membrane of the kidney
Hemochromatosis (hx and pe)
Bronzing of the skin;deep tak color associated with insulin insufficiency
Hemochromatosis (clinical intervention)
Phlebotomy weekly until depletion of iron
Hemolytic anemia (pharm tx)
Two means of reducing antibody production
Steroids and cytotoxic drugs
Hemolytic anemia secondary to renal failure (pharm tx)
Intravascular hemolysis can produce ATN = muddy brown casts
Sx = Red/brown urine and plasma; low haptoglobin; high LSL; deteriorated renal function; fraction excretion of sodium less than 1%
Tx = DIALYSIS
Hemolytic uremic syndrome (FMLD)
Suspect in kid with GI sxs (E.coli, shigella, slamonella)
Anemia + kidney damage + petechiae/bruising
Hemophilia A (scientific concepts)
Deficiency of Factor VIII (8) Aiiiight
Affects INTRINSIC pathway = failure to form hematomas; occurs almost exclusively in males
Hemophilia A (scientific concepts)
Deficiency of Factor VIII (8) Aiiiight
Affects INTRINSIC pathway = failure to form hematomas; occurs almost exclusively in males
Hereditary hemochromatosis (dx and labs)
- Increased serium iron, increases serum transferrin; NORMAL/Decreased TIBC
- Increased LFTs,genetic testing for HFE gene, increased risk of hepatocellular carcinoma
- Liver biopsy = GOLD STANDARD = increased liver parenchymal HEMOSIDERIN
Hereditary spherocytosis (dx and labs)
- Blood smear = hyperchromic microcytic
2.Osmotic fragiltity test = POSITIVE ; Coombs = negative
Herediatry spherocytosis (FMLD)
Hemolysis leading to anemia, jaundice, hepatosplenomegaly
PIGMENTED black gallstones (calcium bilirubinate)
Hodgkin disease (FMLD)
Patient 20 or 50 - BIMODAL
Painless lymphadenopathy in upper body
Alcohol may induce lymph node pain
*Reed-sternberg owl-eye appearance
Associated with EBV
Idiopathic thrombocytopenic purpura (clinical intervention)
Splenectomy
Paroxysmal nocturnal hemoglobinuria (clinical intervention)
Eculizumab (anit-complement CD5 Ab)
Prednisone decreases hemolysis
Marrow transplant
Paroxysmal nocturnal hemoglobinuria (FMLD)
Unexplained hemolytic anemia associated sxs including fatigue, jaundice , and red/pink/black urine.
Decreased bone marrow function in some individuals may further exacerbate anemia and cause other cytopenia
Pernicious anemia (scientific concepts)
Autoimmune destruction loss of gastric parietal cells that secrete intrinsic factor leading to B12 deficiency
Polycythemia vera (dx and labs)
Screening test = Hbg >16
Hct less than 48%
Diagnostic test = Subnormal EPO and either Jak2 peripheral blood mutation or exon 12 mutation
Secondary polycythemia (FMLD)
Increased hematocrit as a response to another process
Sxs related to underlying precipitating cause (COPD) cyanosis, clubbing, HTN, hepatosplenomegaly
+/- heart murmur
Thalassemia (scientific concepts)
Inherited blood disorderr that causes the body to have less hemoglobin than normal leading to anemia and fatigue
Broken down into classifications =
4 subtypes of alpha (silent, carrier, major, Hgb H disease)
3 subtypes of beta (minor, intermedia, major)
Thalassemia (FMLD)
Microcytic anemia with normal/elevated serum iron or no response to iron treatment
Associated with severe anemia and abnormal peripheral smear for a given Hct count
Thrombotic thrombocytopenic purpura (TTP) (FMLD)
PENTAD
Thrombocytopenia
Microgangiopathic hemolytic anemia
Kidney failure
Neurlogic sxs
Fever
*Increased incidence with HIV
FAT RN
F is for fever, A is for anemia, and T is for thrombocytopenia.
R in RN is for renal dysfunction, while the N is for neurologic abnormalities.
EMTALA
Professional practice
If you work at a facility that accepts Medicare/Medicaid you are required to perform a medical screening exam on every person that comes in
No refusal
Civil penalties if you are in violation
ER must treat everyone - Anti-dumping law
Legal/ethical informed consent
Required documentation by joint commission
Provider educates patient about risks, benefits, alternatives of a given procedure, intervention, or medication
Patient must be competent to make voluntary decision about procedure or intervention and sign form
Medical informatics : medical record documentation
Accurate for biling and coding purposes
Patient care and communication: informed
Patients must be informed of risks and benefits and alternatives in all situations
Patients are allowed to ask questions about procedures and interventions before consenting to ensure they are comprehending the information we give them
