Step3 25 Flashcards
Compartment syndrome diagnosis
Compartment pressure >30
OR
Delta pressure < 20-30 (Systolic - compartment)
Scombroid poisoning presentation
Flushing Throbbing headache Palpitation Abdominal cramps Diarrhea Oral burning
Pufferfish intoxication
Tetrodotoxin 15-40 after ingestion
Tingling of the lips and mouth, followed by dizziness, tingling in the extremities.
Problems with speaking, balance, muscle weakness and paralysis, vomiting, and diarrhea.
In severe intoxications, death can result from respiratory paralysis.
Lead-time bias vs. length time bias
Lead time diagnoses earlier
Lenght time: diagnoses more benign, asymptomatic cases
They both show an apparent increase in survival
Adrenal insufficiency vs. hypoaldosteronism
Hypoaldosteronism; Only cortisol is low Na normal or mildly low K normal because aldosterone is present No skin changes
Clinical presentation of acute HIV infection
2-4 weeks after contact
Mononucleosis-like symptoms
Generalized macular rash
GI symptoms
Distinctive features:
painful mucocutaneous ulcers
Maculopapular rash (includes palms and soles)
Viral load: >100000
Antibodies might be negative
CD4 count: maybe normal
HEMOCHROMATOSIS
Skin M/E GI Endocrine Cardiac Infections
Skin: hyperpigmentation (bronze diabetes)
M/E: arthralgia, arthropathy, chondrocalcinosis
GI: Elevated LFTs, hepatomegaly (first), cirrhosis (late)
Endocrine: DM, hypogonadism, hypothyroidism
Cardiac: restrictive or dilated cardiomyopathy
Infections: Listeria, Vibrio, Yersinia
Arthropathy in Hemochromatosis
2nd/3rd metacarpophalangeal joints commonly affected
Also, elbows, knees
Xray: sclerosis, osteopenia, cyst, hook-like osteophyte
Joint aspiration:
Inflammatory
Calcium pyrophosphate crystals
Management of spinal epidural abscess
CBC ESR/CRP Culture MRI Biopsy Antibiotics Surgical decompression
Where do you do a biopsy on a patient with metastatic disease
Wherever is easiest
Predictors of pancreatitis severity
BUN >20 or uptrend during hospitalization
Hematocrit >40% (shows hemoconcentration due to thrid spacing)
CRP>140
Older age
Obesity
REMEMBER
No overlapping in Confidence intervals means there is statistical significance between two groups
Sarcoma botryoides
Bloody, mucoid vaginal discharge
Grape-like mass protruding from the vagina
Classification and management of lupus nephritis
Renal biopsy ALWAYS
Treat with corticosteroids
I: Mesangial: usually asymptomatic
II: Mesangial proliferative: microscopic hematuria, proteinuria
Treat with corticosteroids and cyclophosphamide/mycophenolate
III: Focal: hematuria, proteinuria, hypertension (possible nephrotic SD)
IV: Segmental: most common, poor prognosis, similar to focal
V: Membranous: nephrotic sd
VI: Sclerosing: progressive CKD with bland urinary sediment (do not treat with immunosuppresion)
How do you monitor renal disease in Lupus
Anti-dsDNA and complement levels
Vibrio vulnificus infection
Dxx with mycobacterium marinum
Mechanism
Presentation
Mechanism:
Ingestion or wound infection
Presentation: rapidly progressive <12 hrs.
Septicemia: septic shock, bullous lesion
Cellulitis with hemorrhagic bulla or necrosis
Treat with IV ceftriaxone + doxycycline (highly fatal)
Mycobacterium marinum
Ulcers and papules and it is more subacute in progression
Keratosis pilaris
Rough skin
Keratin plugs
Treat with keratolytic
Urea
Salicylic acid
Pretest probability for type 2 Heparin induced thrombocytopenia
Thrombocytopenia:
2: Drop >50% or nadir >20k
1: Drop 30-50% or nadir 10-20k
0: Drop <30% or nadir <10k
Timing
2: 5-10 days since heparin or <1 if heparin in the last 30 days
1: 5-10 days in consistent drop in platelets or <1 day if heparin the last 30-100
0: <4 days
Thrombosis
2: Confirmed
1: Suspicious/recurrent
0: Absent
alTernate
2: Not apparent
1: Possible
0: Definite
0-3= low probability 4-5= moderate 6-8= high
Management of Heparin induce thrombocytopenia
Stop heparin
Initiate direct thrombin inhibitors:
argatrovan
bivalidurin
Warfarin worsens thrombophilic state and can worsen the situation. It can be started after the thrombin inhibitors
Avoid as much as possible. List this complication as an “allergy”
Management of localized vocal cord tumors
If no invasion.. radiation can help preserve the cord
Treating strep infection prevents what?
Rheumatic fever
Peritonsilar abscess
Cervical lymphadenitis
Antibiotic has no effect in prevention of Glomerulonephritis
Medications that increase warfarin effect
Metronidazole, fluoroquinolone: reduce intestinal flora
Inhibition of CYP450 2C9: amiodarone, azoles
Acetaminophen: decreases vit. K recycling
NSAIDs: inhibit platelet function
Ginkgo biloba: increase bleeding (unknown)
Medications that lower warfarin effect
Increase coagulation factors: birth control
Induction of CYP450 2C9: SJW, rifampin, phenytoin
Vitamin ingestion; green leaf diet (excess vitamin K)
Indication for antibiotics in patients with anal abscess
Patients with:
Diabetes
Immunosuppression
Extensive cellulitis
Valvular heart disease
Management of Borderline personality disorder
Dialectical psychotherapy:
+/- Antipsychotics or mood stabilizers for mood instability and transient psychosis
+/- Antidepressant if mood disorder
Test of choice for diagnosis Chronic pancreatitis
Magnetic resonance cholangiopancreatopgraphy
Management of chronic pancreatitis
Trial of life style modifications first (stop alcohol, smoking, initiate smaller and more frequent meals, low fat)
Enzymes
Pain control (TCAs, NSAIDs, pregabaline)
