random Flashcards
the 3 c’s
cryptosporidum
coccoides
cryptococcal
cryptosporidum - protozoa HIV diarrhea
coccoides - fungus (systemic mycoses), SW US
cryptococcal- opportunisitc fungus - meningitis
reasons to hospitlize patients with PNA? Curb65
- confusion
- uremia
- resp distress or pulse >125
- BP low
- > 65
also fever > 104
exudate
LDH > 60% serum
protein > 50%
ph is low
glucose may be low in empyema and TB
hospital aquired PNA
> 48 hours after admission and up until 90 days
imipenem
can cause seizures
curb 65 ICU vs inpatient
- > 2 inpatient
- >4 ICU
what are some causes of sideroblastic anemia?
lead poisoning, alcohol, isoniazid, vitamin B6 deficiency
phenytoin can cause a macrocytic anemia
imparis folate absorption, give patients folate
treat warm IgG anemia
glutocorticoids
treat cold agglutinin
rituximab, plasmapharesis,
coombs + for complement
cyroblobulins are assoiciated with?
hepatitis C, joint pain, glomeruolonephritis
paroxysmal nocturnal hemoglobinuria
episodic dark urine
pancytopenia
clots in random places
complement system is messed up
M3 PML associated with
DIC
M3 treat
ATRA
auer rods
AML
CML
neutorophils, basophils
-pruritis, splenomegaly
-chronic, accelerated and blast crisi phates. accelerated is hs increased platelets
-
CLL
smudge cell
relatively asymptomatic, may have lymphandenopahty, spleen or liver enlargement, infection, hemolysis (warm IgG)
MM
IgG or IgA
waldenstrom
IgM
- lethargy blurry vision, mucosal bleeding, bruise easily
- treat with plasmapharesis
treat ITP with
glutocorticoids depending on bleeding and platelet count
amniotic fluid embolus
DIC
arrest of labor in the active phase (>6cm)
no cervical change for 4 hours with adequate contractions or no change for 6 hours with inadequate contractions.
sodium nitroprusside –> cyanide toxicity
headache, flushing, arrhtymias, respiratory depression
lactic acidosis as decreased ATP production
small nonbleeding varices ppx?
nonselective beta blockers like propanolol
reduce SIDS
baby put on back supine
build up on conjugated bili, can get into plasma
conjugated bili is water soluble so can be found in urine
unconjugated bili is not water soluble so as long as liver is working it gets conjugate
once its conjugated the bacteria turns into urobilinogen which can be excreted in the feces, some gets into the plasma and is found in urine. This would indicated hemolysis
potassium citrate can alkanlize the urine
this helps with precipitatio of uric acid sotnes not happening!
SLE like RA has similiar joint presentation but
SLE is non-deforming
non specific symptoms of anemia
dyspnea, tach from hypoxemia
systolic murmur due to hyperdynamic circulation
What is tricheinellosis?
Endemic: mexico, china, thailand
Vector: undercooked meat like pork
larvae in stomach –> worms in intestines –> migrate to muscle
At first may have vague GI symptoms, weeks later myositis, fever, susbungal splinter hemorrhages, periorbital edema, eosinophilia and possible elevated creatine kinase.
what is winters formula
1.5x HCO3 + 8 +/- 2
carbon monoxide poisoning
bound CO -Hb is carboxyhemoglobin
- binds so tightly that its like losing blood, anemia
- pt will have headaches, N/V, abdominal discomfort, confusion and coma
- they may have a pinkish hue
- treat with hyperbaric O2
- lactic acidosis since O2 cant get to tissues
cyanide intoxication (nitroprusside or buring of rubber, plastic)
similiar presentation as CO poisoning
-treat with hydroxocobalamin or thiosulfate
methomoglobin is oxidized hemoglobin that is locked in the ferric state.
- brown blood
- side affect of benzocaine and anesthetics and nitrites and nitroglycerine and dapsone
- cyanosis, bluish discoloration of skin and mucous membranes. dyspnea, headache, confusion, SZ, metabolic acidosis
- treat wiht 100% O2 nd methylene blue
reduced thyroid uptake
- subacute lymphocytic (painless) thyroiditis
- subacute granulomatous (De Quervains) (painful) thyroiditis
- levothyroxine overdose
- iodine-induced thyrotixicosis
murmur in HOCM
- interventricular septal hypertrophy causes outflow obstruction
- crescendo-decresendo systolic murmur along the left sternal border
steroid acne
steroids can cause acne, monomorphous pink papules and absence of comedones
why do we alpha blockade of pheo?
if we beta block, then all the excess circulated catecholamines can stimulate the vascular alpha-receptors causing rapid, catastrophic increase in blood pressure.
-so we block first with an alpha blocker!
clinical manifestations of cushings
central adiposity skin atrophy and wide purplish striae proximal muscle weakness HTN glucose intolerance skin hyperpigmentation (due to ACTH excess)
Rupture of the ventricular wall
5 days to 2 weeks s/p MI, usually LAD, anterior wall
-CP, profound shock, rapid progression to pulseless electrical activity and death
heterophile antibodies
are very sensitive and specific but may be negative early in the illness of IM by EBV dont be tricked!
Lambert-eaton syndrome
- autoanitobides to voltage-gate calcium channels in the presynaptic motor nerve terminal
- proximal muslce weakness
- lung cancer, small cell carcinoma
-MG also causes muscle weakness, weakness is provoked by repetitive or sustained use of muscles, deep tendon reflexes are sually preserved.
non semininomatous germ cell tumor can be found in a large mediastimanl mass what are the markers?
AFP and B-HCG
Seminomas do not produce?
AFP
how does hyperosomal hyperglycemia syndrome cause blurry vision?
acute hyperglycemia can cause blurry vision due to myopic increase in lens thickness and intraocular hypotension secondary to hyperosmolarity
menieres disease what helps?
low salt diet
systemic HTN is the class cause of diastolic dysfunction how does it cause afibb?
chronically elevated LV diastolic pressures cause left atrial dilatation –> AF
What is senile purpura?
as we age and with sunlight and damage we get loss of elastic fibers in the pervascular connective tissue. minor abrasions that would merely stretch the skin in a young patient can rupture superficial blood vessels in the elderly. subseqent extravasation of blood leads to ecchymosis over vulnerable areas such as dorum of hands and forearms
risk factors for hypermesis gravidum
increased placental mass: twins, trophoblastic disease, abnomral uterine anatomy
tricuspid valve atresia
- cyanotic infant
- left axis deviation and small or absent r waves
- hypoplastic right ventricle
- underdevelopment of the pulmonary valve/artery
- decreased pulmonary markings
- assoc. VSD or ASD
CAH what is the order
17, 21, 11
17 - shunt away from cortisol and testosterone to aldosterone
21 - will shunt away from cortisol and aldosterone to androgens
11- will shunt away from cortisol and also and go to androgens but because it is down stream you still make 11-deoxycorticosterone which is a weak mineral corticoid like aldosterone
