UW 10 Flashcards
Common complications of parenteral nutrition
Blood stream infection: Staph aureus and epidermidis, Klebsiella, Pseudomona, Candida
Cholelthiasis if >2 weeks: due to cholestasis
Hyperglycemia
Methanol and Ethynele glycol intoxication presentation
Methanol:
Visual blurring, central scotomata
Afferent pupillary deffect
Altered mentation
Ethyline glycol: Flank pain Hematuria, oliguria (direct renal damage and crystal accumulation) Cranial nerve palsy, tetany Calcium oxalate crystals in urine
Xray clue for constrictive pericarditis
Pericardial calcification
Chronic fibrosis and pericardial calcification
Clinical presentation of pulsus paradoxus
Weak pulse that disappears with deep inspiration
Chest pain with hx of viral symptoms 1-2 weeks before
Pericarditis
Can radiate to left shoulder
Physiologic explanation of pulsus paradoxus in cardiac tamponade
Pericardial fluid pressure on heart does not allow for filling ===> decreasing cardiac output
Inspiration creates a pressure gradient that allows for increased in venous return to the right heart ==> drop in systemic pressure
Normal fetal heart rate evaluation
2 acceleration >15 bmp, that last >15sec in a 20 min interval is considered normal
Normal rate: 110-160bmp
Biphysical profile
2 points each: 8-10 reassuring, 6 equivocal, 0-2: Extremely worrisom (may consider delivery)
Test the Baby, MAN
Tone Breathing Movement Amniotic (index) Non stress test
Example of a polypeptide hormone
ACTH
Comes from cleavage of propiomelanocortin and also produces MSH (melanocyte stimulating hormone) causing hyperpigmatation in Cushing sd that could be limited to sun exposed areas, scars, palmar creases and oral mucosa
Hypercortisolism clinical manifestations
BAM CUNSHINGOID
Buffalo hump, Brusing Amenorrhea Moon facies Crazy (mood, sleep alterations) Ulcers Sking changes. (Hyperpigmentation only in C. disease) Hypertension Infection Necrosis Glaucoma Obesity/osteoporosis Immunosupresion Diabetes
Dxx Cushing disease and syndrome
If ACTH is elevated = cushing disease
bilateral adrenal hyperplasia
Pitutary tumor vs. paraneoplastic sd (lung small cell carcinoma most common)
Cortisol only = cushing sd. (no skin pigmantation) Adrenal tumor (unilateral), bening or malignant
Although obesity is a feature, the hypermetabolism state associated with malignacy can cause weight loss
Example of amminoacid derived hormones
Neuroendocrine
Epineprhine, norepi (pheochromocytoma)
serotonin (carcinoid tumors)
Arachidonic acid derivated
Leukotrienes, prostoglandins
Ecthyma gangrenosum
Skin lesion that rapidly evolve from papule to pustule to ulcer.
Associated with Pseudomona infection in inmunocomprimised patients
Labor stages
First
Latent: 0-6cm dilatation
Active: 6-10 cm (>1cm every 2hrs)
Second
10cm to delivery (30min - 3hrs 1st baby) (<30min multiparus)
Third:
Delivery to Placental expulsion
Delivery protraction vs. arrest
Active phase prolongation:
Protraction:
Cervical change slower than expected
Oxytocin
Arrest:
No change in 4hrs with adequate contractions or no change i 6 hrs with inadequate contraction
Csectio
Examples of alpha-bloquers
Non selective:
Phenoxybenzamine (for pheochromocytoma surgery)
Phentolamine
Selective:
tansulosin, prazosin, terasosin (for BPH)
A2 selective:
Mirtapzapine: antidepresive
Anticoagulation in patients with Afib
CHA(2)DS(2)VAS >2points (for non valvular AF)
Warfarin
Novel oral anticoagulant (direct inhibition of Xa)
apixaban, rivaroxaban. (Do not use in renal failure)
Imaging findings of Herpes encephalitis
Frontoteporal abnormalities
CSF analysis
pg 223
Characteristics of TB efussion
High proteins (ussually >4mg/dl)
Very high LDH
Low glucose
Low pH
Mild leukocytosis with lymphocyte predominance (not neutrophil)
Systemic symptoms may not be present or not as severe as with empyema
Empyema have a very high leukocyte concentration >50000 and neutrophile predominance
Etiology of restrictive lung disease
The lungs AIN’T compliant
Alveolar (edema, hemorrhage, pus)
Interstitial lung disease (idiopatic interstitial) pneumonias, idiopatic pulmonary fibrosis, inflamatory
Neuromuscular (myastenia, prhenic n palsy, myopathy)
Thoracic (kyphoscoliosis, obesity, ascitis, pregnancy, ankylosing spondilitis)
Spontaneous bacterial peritonitis
Common complication of patients with cirrhosis due to bacterial translocation
Suspect if patient with cirrhosis +
Fever, chills, hypothermia, hypotension
Diffuse abdominal pain
Ascitis
Diagnosed if >250 PMN in ascitic fluid
Treatment: IV antibiotics (3rd gen. cephalosporin) + albumin, fluroquinolones for prophylaxis
Associated with poor 1 year prognosis
Physiological effect of tube decompresion in tension pneumothorax
Allows for an increase in venous return
Live attenuated vaccine
Flu and polio nasal
Varicella
MMR
Yellow fever
ALS
Anterior horn degeneration
Asymetric limp weaknes
UMN and LMN sings
May present with mild CK elevation <1000
CK elevation dxx
ALS: very mild,
Korsacov syndrom
Confabulation and amnesia in the setting of heavy alcohol consumption
Temporal lobe epilepsy
Looks like an absent seizure (<20sec, no postictal state) but…
Usually in adults + post ictal state (confusion, disorientation, amnesia)
Classified as focal seizure with impaired awareness
Lupus mnemonic
DOPAMINE RASH
Discoid rash Oral ulcers Photosentivity Arthritis (not deformant) Malar rash Inmunologic criteria (anti dsDNA, anti Sm proteins) Neurologic symptoms ESR (elevated) Renal involment ANA Serositis (pleuritic pain, muffle heart sounds (pericarditis)) Hematologic abnormalities (cytopenias)
Skin findings on peripheral artery disease
Cold, thin, shiny with no hair
Complications of gastric bypass
Early:
Leak
Bowel ischemia
Late Anastomotic stricture Cholecystitis Dumping sd. Marginal ulcer
Urinary incontinance treatment
Urge type: antimuscarinic
Oxybutin, tolterodine, darfenecin, trospium
Overflow type: cholinergic agonist
Bethanecol
and beta agonist
Polymysitis/dermatomiositis
Proximal muscle weakness (dificulty climbing stairs, combing hair)
CK elevation
Positive: ANA, anti Jo
malar rash similar to SLE
Complications of hyperglycemia in pregnancy
First trimester:
Congenital heart disease, spontaneous abortion, small left colon sd, neural tube
>2nd trimester Macrosomia Organomegaly Neonatal hypoglycemia Polyctemia
All: RDS (insulin does not allow pneumocyte maturation), macrosomia, preterm delivery
Esophageal perforation management
NPO, saline, broad spectrum antibiotics, PPI
Contained perforation: trial of medical management
Not contained: surgical repair
Etiology of chronic pancreatitis
Alcoholism
Cystic fibrosis
Autoinmune
Ductal obstruction
Sings and symptoms of chronic pancreatitis
Chronic epigastric abdominal pain (comes and goes)
Malabsorption
Diabetes
Lipase may be normal
Weakness and leg cramps after intitation of thiazide diuretic
Severe hypokalemia. Think primary hyperaldosteronism
Best intial test for primary hyperaldosteronism. Treatment
Morning plasma aldosterone/ plasma renin
Aldosterone level >15 and a PAC/PRA ratio >20 is diagnostic
If tumor: resection
If hyperplasia: aldosterone antagonist
spironolactone, eplerenone
Metyrapone
Cortisol synthesis inhibitor used in patients with cushing sd awaiting for definite treatment
Glomerular vs no glomerular hematuria
Glomerular:
Usually mycroscopic
RBC cast, Dysmorphic RBC, positive blood + Proteins
From no specific symptoms to neprhotic sd
Post strep, IgA or Alport
Non glomerular Usually mycroscopic, No cast, positive blood. No proteins Sings of obstruction or dysuria Lithiasis, cancer, PKD, papillary necrosis
Renal ostedystrophy patophysiology
Renal failure===> low vitamin D production causes hypocalcemia and decreased PO4 secretion
Elevated PO4 binds to Ca forming CaPO lowering Ca even more
PTH stimulation
Increases Ca resortion ===> bone pain
Serum albumin ascitis gradient
> 1.1: portal hypertension
<1: Cancer, nephrotic sd, tb, pancreatitis
Causes of hepatic encephalopathy
Increased NH3 production/absorption:
Increased protein in diet, GI bleeding, constipation, infection
Decreased NH3 excretion/metabolism
Renal failure, diuretics, bypass hepatic blood flow post TIPS
Hepatic encephalopathy management
Lactulose: Increase NH4 formation (from NH3)
Rifaximin or neomycin (Decreased NH4 producing bacteria)
