Step3 22 Flashcards
Synovial fluid aspirate (normal, non-inflammatory, inflammatory, septic)
WBC
PMN
Glucose
Viscosity
NORMAL:
WBC: <200, PMN: <25%
Glucose: =serum
Viscosity: high
NON-INFLAMMATORY: (osteoarthritis)
WBC: <1000, Maybe <2000, PMN: <25%
Glucose: =serum
Viscosity: high
INFLAMMATORY:
WBC: 1000-10000, PMN: <50%
Glucose: >25
Viscosity: low
SEPTIC:
WBC: 10,000-100,000, PMN: >75%
Glucose: <25
Viscosity: variable
Presentation of disseminated gonococcal infection
Tenosynovitis: typically distal extremities
Dermatitis: papules/pustules on hands and feet
Migratory polyarthralgia
OR
Purulent monoarthritis
Treat with IV 3erd gen. cephalosporin
Diagnosis of Guillian-Barre
Clinical: ascending paralysis, paresthesias, neuropathic pain, hyporeflexia, Hx or recent URT or GI infection (Campylobacter)
Supportive:
LP: >proteins, normal leukocytes
Abnormal electromyography and nerve conduction
MRI: normal or enhancement of anterior nerve roots/cauda equina
Sick Sinus Syndrome
Also know as tachycardia/bradycardia sd.
Intermittent supraventricular tachyarrhythmias (A. fib) and bradyarrhythmias (sinus bradycardia, sinus pause, sinoatrial nodal exit block
Can cause A. fib (need to anticoagulant)
Most common indication for pacemaker placement
Parkinson Plus syndrome
Rapid progression, symmetric motor signs, lack of tremor, falls early in the course of the disease, dysautonomia, lack of response to dopaminergic treatment
Progressive supranuclear palsy: gaze palsy (vertical), falls due to postural instability
Multisystem atrophy:
Dxx prerenal vs. intrinsic kidney injury
BUN/Creat FeNa Urine Na Urine Osmd Sediment
Pg 513
Clinical findings of renal cancer
Hematuria (may lead to anemia)
Flank pain
Abdominal or flank mass, firm, non-tender and move with respiration
Initiation of feeding in a patient with acute pancreatitis
As soon as the patient is hungry
Low fat, low residue diet, soft
Indications for Uric acid lowering therapy
Recurrent gouty attacks
Chronic gouty arthropathy
Tophy
Uric acid stones
Initiate after attack symptoms have resolved
Target uric acid level <6
Add colchicine or NSAIDs
Treatment for Gout
Uric acid-lowering medication:
Xanthine oxidase inhibitors: allopurinol, febuxostat
Oricosuric: probenecid (can cause formation of uric acid stones)
Urinary alkalinization: for big urate stones
Number needed to harm
NNH= 1/AR
AR= incidence of exposed group - incidence of unexposed
Silent thyroiditis and its variant
Variant: postpartum thyroiditis *within a year of birth
Elevation of thyroid peroxidase antibody
3 phases
Hyperthyroid: 1-3 m treat with metoprolol
Hypothyroid: 4-6 months
Recovery: within a year
20-30% develop chronic hypothyroidism
Polycythemia vera
Elevated RBC mass
(elevation on other types but RBC is most prominent)
Presentation
Easy bleeding/bruising, fatigue, hypertension, thrombosis (arterial and venous)
Pruritus after a warm bath
Tinnitus, visual disturbances
Hyperviscosity sd.
Intravascular hemolytic anemia (6)
MEMBRANE DEFECTS:
Hereditary spherocytosis
Paroxysmal nocturnal hemoglobinuria
ENZYME DEFECTS:
G6PD deficiency
Pyruvate kinase deficiency
HEMOGLOBINOPATHIES:
Sickel cell
HbC disease
