Third 100 Flashcards
How does TCA overdose present?
Indicator of severity? Treatment?
•Anticholinergic (dry, hot, crazy etc) as well as QRS PROLONGATION and hypotension with hyperthermia
– TCA: ThermiaTension, Cardiac (QRS), Antichol
•QRS is the indicator of severity - give sodium bicarb
Antidote for ethylene glycol poisoning? (2)
Ethanol OR fomepizole (foamy piss?)
How does beta blocker OD present?
Treatment?
Bradycardia, AV BLOCK, diffuse wheezing and hypotension
Give glucagon
How does TCAs cause QRS prolongation?
How does sodium bicarb help?
It inhibits cardiac fast sodium channels causing QRS prolongation
It increases extracellular sodium conc.
Most common cardiac congenital defect?
VSD
Cyanotic baby - list the heart defect
Truncus arteriosus (1 arterial vessel for both ventricles) Transposition of the greats (2 switched) Tricuspid atresia (3) Tetralogy of Fallot (tetra = 4) Total anomalous pulm. venous return (5 words)
List conditions with VSD in kids
TORCH, FAS, Down’s, cri-du-chat
‘Torch was (fas) down, heard cat cry or something’
- also VSD = VaSDown
Kid with conjunctivitis and pannus (neovascularization) - mcc?
Next step to diagnose?
Treatment?
Chlamydia trachomatis (trachoma) A-C
Diagnose with giemsa stain
Topical tetracycline or oral azithromycin
Baby with wheezing, relieved by neck extension
Vascular ring compressing airway
Most common cause of congenital hypothyroidism (in the USA)?
Thyroid dysgenesis
Normal CSF values?
Protein <40
Glucose 40-70
Pressure 70-180
PSP 4718
How will viral meningitis show up in CSF?
Treatment?
Normal glucose, high protein, lotsa lymphocytes
Treatment - supportive. Will resolve in 7-10 days
Describe Kawasaki disease
Konjunctivitis (bilateral, non-purulent), All-over rash, Week-long fever (5days minimum), Adenopathy (cervical, unilateral), Strawberry tongue, Aspirin (high dose), Koronary artery aneurism (complication), KIvig (treatment)
How to differentiate between NFM1 and 2?
NFM-2 must have cataracts and acoustic neuromas
Adolescent with mass in the nose, frequent nosebleeds
MCC?
Treatment?
Juvenile angiofibroma
Surgical excision by a specialist
CAH - inheritance?
How will it present?
Deficiency?
How is it diagnosed? (2 tests)
Autosomal recessive
Virilization of female or over androgenization of male.
21-hydroxylase deficiency (90% of cases) - resulting in high 17-α-hydroxyprogesterone
Test for levels of 17-α, confirm with ACTH stimulation test
Sluggish baby with large tongue and umbilical hernia
Congenital hypothyroidism
2 causes of floppy baby
- Infant botulism (remember - NOT due to ingestion of preformed toxins, toxins formed once inside)
- Werdnig-Hoffman syndrome : AR syndrome with degeneration of anterior horn cells cranial nerve motor nucleii
Mst common cause of nephropathy in kids? Adults?
Kids - minimal change disease, adults - membranous glomerulonephritis
MCD - nothing, normal biopsy
Memb. G..is - diffuse thickening of BM and subepithelial spikes
WTF is NAS?
Caused by?
Presents how?
Treatment?
Neonatal abstinence syndrome
Caused by opioid withawel (2/2 mom taking them)
Presents in the first days of life with a high-pitched cry, irritability, tremors, sweating, seizures etc.
Treatment - supportive
Who gets screened for chlamydia?
24 and younger, also those with new or numerous partners or hx of STD
Timeframe for HPV vaccine
9-26
AAA screening?
65-75 yo with hx of smoking - do abd u/s
Timeline for mammograms?
Every 2 years between 50 and 75. Nothing before or after
CDC guidelines for pneumococcal vaccine?
Once to pts 65+, but also to pts with chronic disease (heart, lung, liver or kidneys) and DM or immunosuppression.
Vaccines for newborns - according to chronological age or gestational age?
All vaccines - live and not - should be given by chronological age
Remember - a baby must be 2kg before HepB vaccine!!
Limit of viral load for contraindication of MMR in HIV pts?
200 - less than this, no vaccine (since its live and all)
Pneumococcal vaccine induces immunity how ..?
T-cell independent B-cell response
What to give for Torsades?
Magnesium sulfate (also stop offending drug)
When to give amiodarone?
Ventricular and atrial tachycardia
When to give calcium gluconate?
Hyperkalemia
Wheto give sodium bicarb?
TCA and ASA overdose
When to give atropine?
Bradycardia, asystoly and PEA
When to give adenosine?
SVT (look for WPW)
“AndThenYouSee —- WPW!)
Name 5 drugs that can cause torsades
TCAs
Amiodarone, sotalol (antiarrhythmics)
Fluconazole, mixofloxacin
Stop these when torsades show up, and give mag sulfate
How will phenytoin toxicity present?
Horizontal nystagmus, cebellar ataxia, confusion
How to calculate anion gap?
Sodium minus (chloride + bicarb)
Metabolic acidosis - what is the formula for resp compensation?
What is the name of the formula?
PaCO2 = 1.5 (bicarb)+8»_space; if this is the value of the CO2 in the ABG, there is resp comp. if not, think of resp. Alk/acid ontop of the metabolic.
Winter’s formula
High calcium with high/normal PTH - 2 top MCC?
Familial hypocalciuric hypercalcemia (look for low urine/creatinine clearance ratio) OR Primary hyperparathyroidism (this will have high urine excretion)
High calcium with low PTH?
Think of Vit. D OD, sarcoidosis, multiple myeloma, renal cell carcinoma
Aldosterone keeps water at the expense of..?
Hydrogen and potassium
Treatment for acute hyperkalemia?
- Calcium gluconate - stabillizing the heart
- Lower K+ quick : beta2agonists, glucose&insulin or sodium bicarb
- Lower K+ longterm : kayexalate
Hyperpigmentation of the skin with fatigue etc?
Addisons - look for hypokalemia, hyponatremia
What factor could affect high/low calcium?
Albumin - ad/subtract 0.8 calcm for every 1 albumin above/below 4.0
Firstline treatment of CHF
ACEI
Wheezing following NSAIDs or ASA - diagnosis?
Commonly associated with?
Aspirin Exacerbation Resp Disease (AERD)
Nasal polyps
Patient shows up with trying to lose weight and low TSH with high T3/4 - whats up?
What will thyroid look like with biopsy?
Exogenous thyroid hormone
Follicular atrophy
Pain and weakness in the hips and shoulders - diagnosis?
How to differentiate between drug-induced and inflammatory?
Treatment?
Inflammatory myopathy (polymyositis or dermatomyositis most common)
If the ESR and CK is high - this shows inflammatory
Steroids
Initial scan for diverticulitis?
CT scan
Next step with PBC patient?
Ursodeoxycholic acid
Pt presents with non-healing ulcer(s), lung issues and possibly renal problems - top of ddx?
Lab tests show?
Treatment?
Wegener’s (granulomatosis with polyangiitis)
Lab shows positive C-ANCA and elevated CRP
Treat with cyclophosphamide
Treatment for cluster headache?
100% oxygen
Pt presents with severe pIn upon the slightest touch, together with hemianesthesia - what happened?
Thalamic stroke
Treatment for Alzheimer’s?
Donepezil
Older pt with increased itching after baths, lab shows increased RBC, WBC and platelets - top of ddx?
What will labs show?
Polycythemia Vera
Normal ESR, hypercellular bonemarrow, high LAP, low erythropoetin
(LAP > ESR > erythropoetin)
Which type of lung cancer causes PTHrP?
Squamous cell (SCa++mous cell)
Pt presents with spherocytes, anemia and splenomegaly Diagnosis? Hereditary type? What should this person be on? Is there a cure?
Hereditary spherocytosis
AD
Folic acid
Yes - splenectomy
How will HIT be described?
Antibody-mediated platelet activation
Iron deficiency - think WHAT first?
Chronic bleeding - often GI
2 major macrocytic anemias - how to distinguish?
Folate and B12
B12 will have NEUROLOGIC SIGNS, methyl malonyl CoA in urine, positive Schilling test. Folate def. will not
Treatment for chemo-induced nausea?
Serotonin antagonist (ondansetron)
B12 deficiency can lead to what long-term complication?
Gastric cancer
What does a positive Coombs test mean?
Hemolytic anemia
Bone mets with neurologic symptoms - next step?
What then?
Glucocorticoids (dexamethasone FIRST)
Then MRI of spine
Patient with recurrent pulmonary and GI infections throughout life - cause?
What else might they exhibit?
IgA deficiency
Anaphylactic transfusion reactions
Sickle cell patient with sudden drop in H/H and low/no retic count - what is happening?
What can set this off?
Treatment?
What else causes a sudden H/H drop, and what is different?
Aplastic crisis (NOT aplastic anemia)
parvo B19 virus
Blood transfusion
Hyperhemolytic and splenic sequestration - retic count will be high in both, with SS also showing splenomegaly
What is the cause of warfarin necrosis?
Protein C inhibition/deficiency
Which clotting factors does warfarin bind?
Factors II, VII, IX, X, C, S (2+7=9, add 10)
Kid presents with exzema, multiple previous infections and low platelets - top of ddx?
How will the platelets be described?
Infections usually due to..?
Cause of thrombocytopenia?
Wiskott-Aldrich syndrome
Few (<50,000) and decreased volume (small)
SHIN infections
Decreased platelet production
Teen with polyps and a brain tumour - diagnosis?
Inheritance pattern?
Turcot’s syndrome - a combo of brain tumours and either FAP or HNPCC
Autosomal recessive
What will you see with Gardener’s syndrome
Look for polyps (possibly familial) and supernumary teeth with osteonecrosis of the jaw
Key words - ‘sunburst appearance’ and ‘codman’s triangle’
Treatment?
Osteosarcoma
Surgery
Treatment for elevated homocysteine?
Folate & B6 (pyridoxine)
Key words - ‘starry sky appearance’
Burkitt lymphoma
Kid with massive WBC count and positive PAS reaction
ALL
2 MCC of acquired coagulopathies in a hospital setting?
What differentiates them?
Liver disease and DIC
DIC has depressed levels of Factor VIII
Blood smear with schistocytes, low plt and high CK - diagnosis?
Treatment? What is contraindicated?
What else to keep in mind, and how to differentiate?
TTP
Treat with steroids, plasma replaceent and plasmaphoresis
Nevr give platelets!!! TTP is caused by clumping, and added plts make it worse
HUS (renal failure) & HELLP (pregnant, pre-eclampsia)
Key word : hypersegmented neutrophil
Megaloblastic anemia
Hypersegmented PMN with elevated homocysteine, normal MMA
What if the MMA was elevated?
Folate has normal MMA and high homocyst
B12 def has elevated MMA and homocyst
African american male who took quinine - now at risk for?
G6PD deficiency
Normocytic, hemolytic anemia with neurological problems and low grade fever - what will be on labs?
Diagnosis?
Next step?
Treatment?
Labs - high retic, high indirect bili
Diagnosis - TTP
Peripheral blood smear (possibly schistocytes)
Plasma exchange
Key words - anti-Jo antibodies
Polymyositis diagnosis
Key words: anti-RNP antibodies
Connective tissue disease
Kid shows with aplastic anemia, abnormal thumbs and/or skin and ear manifestations - diagnosis?
What will the ears and skin show?
Treatment?
What else?
Fanconi anemia
Ears - lowset, middle ear comp.; skin - hypopig, cafe.., freckles
Treat -stem cell transplant
At risk for cancer, AR or X-linked (chromosomal breaks)
Exposure to what causes aplastic anemia?
Benzene
Side effect from isoniazid?
Pyridoxine deficiency (give B6 for sideroblastic anemia)
What is Zoledronic acid?
Bisphosphonate
Hypercalcemia in chemo setting -
Probable cause?
Treatment?
PTHrP secretion
Treat with bisohosphonates
What is Lynch syndrome?
What else should be checked?
HNPCC
Apart from colorectal cancer, also screen for endometrial cancer
Treatment for hairy cell leukemia?
Side effects of this treatment?
Cladribine
Neuro and kidney damage
Presence of cord-like veins or red streaks on arms and/or chest -think of?
Also check?
Pt at risk for?
Migratory thrombophlebitis (Trousseau’s syndrome)
CT of chest for primary tumour (prob pancreatic or lung)
Pulm embolism!
Hard painless mass in testes - next step?
If positive, what then?
Ultrasound
If solid, hard (no hydrocele) - remove it
Recurrent infections with multiple myeloma - why the infections?
Decrease in total antibodiesand possible leukopenia (due to crowding of cells)
When seeing high calcium, think of which 2 things always?
Expand on the second one
Multiple myeloma and hyperparathyroidism
With hyperpara, think of MEN1 and 2
MEN 1 (pee, papa) - pituitary, pancreas, parathyroid
MEN2A - (vee met para) pheo, medullary CA, parathyroid
MEN2B - (vee met almal) pheo medullary CA, neuromas
Diffuse telengiectasias - think of..?
CREST or OslerWeberRandau
Pt with high plasma homocysteine levels - treatment?
Pyridoxine (B6)
Pt with multiplemyeloma - next step in diagnosis?
Serum immunoelectrophoresis (will show abnormal M-spike due to IgG Ab production)
Breast CA - how does ER/PR and Her2 expression change prognosis?
ER+ and PR+ are good prognostic factors
Her2/neu overexpression is bad
Treatment for CML?
Tyrosine kinase inhibitors (Imatinib)
What does hydroxyurea do?
Side effects?
Increases fetal hemoglobin
Bone marrow suppression
