UW 11 Flashcards
What are complement levels in SLE kidney dz and post strep GN and why?
Low
Immune complexes deposit in renal glomeruli - damaging - activate complement
Goodpasture’s syndrome MOA of kidney damage
Cytotoxic Abs
Harsh crescendo-decrescendo murmur begins after S1, best heard at Left lower sternal border
HOCM
HOCM murmur intensifies with?
Valsalva - decreased preload and decreased LV filling
What is HOCM pathophys
Outflow obstruction due to hypertrophied interventricualar septum
SAM = systolic anterior motion of MV leaflets
Signs of Magnesium toxicity
Decreased DTRs
Respiratory depression
Death by cardiac or respiratory arrest
Tx of Magnesium toxicity
Immediate discontinuation
Admin Calcium gluconate
Down syndrome Quad screen
High: B-hCG and Inhibin A
Low: MSAFP and Estriol
Limb ischemia management
Immediate anticoagulation w heparin - IV bolus then continuous
Referral for emergency vascular surgery
Differ bt infectious mono (IM) and strep
Mono = HSM, generalized LA
Heme complication in IM
AIHA
Thrombocytopenia
- Cross reactivity of EBV induced abs against RBCs and platelets
- IgM cold agglutinin abs -> complement mediated destruction of RBCs
When does AIHA present after IM?
2-3 weeks after onset of sx’s
Back pain w paravertebral tenderness
Lumbago
Who is doxycycline CI in?
Children < 8 yoa
Pregnant women
PCP pneumonia - cause of hypoxia
Increased A-a Oxygen gradient from alveolar and interstitial inflammation -> V/Q mismatch
Presentation and TX of Nonallergic rhinitis
Chronic rhinitis sx’s (nasal congestion, rhinorrhea, sneezing, postnasal drainage)
Tx with intranasal antihistamine (1st G) IN glucocorticoids
Multiple System Atrophy
Shy-Drager syndrome
- Parkinsonism
- Autonomic dysfnc
- Neuro si’s
Parkinsonism pt + Orthostatic HypoTN, impotence, incontinence
Multiple system atrophy = shy drager
Familial dysautonomia
Riley-Day syndrome
- AR, Ashkenazi Jews
- Autonomic dysfnc + severe orthostatic HypoTN
Electrolyte disturbances caused by Hypothyroidism
Hyperlipidemia
Hyponatremia
Elevated creatinine kinase
Hypercholesterolemia effects in hypothyroidism
Decreased LDL receptor activity or receptors
Decreased lipoprotein lipase - hypertriglyceridemia
What should be suspected in all smoke inhalation pts
Carbon monoxide poisoning
Tx for CO poisoning
100% Oxygen nonrebreather
Pathophysiology of cardiac tamponade
Fluid accumulation in pericardial cavity - increases intrapericardial pressure above diastolic ventricular pressure = restricts venous return to heart, lowers right and left ventricular filling
- Decreased Preload, SV, CO
SBO Presentation
Vomiting
Abdominal discomfort
Mild/distal
- colicky pain, delayed vomiting, abd distension, constipation-obstipation, hyperactive bowel sounds, dilaed loops of bowel on AXR
MCC of SBO
Adhesions
- Think post op abdominal surgery in adult, appendectomy
What do occasional black or tarry stools indicate
GI bleed above Ligament of Treitz
Complications with severe burn pts
SIRS - 1st week
Infx -> sepsis, septic shock
Pneumonia
Wound infxn
Systemic Inflammatory Response Syndrome (SIRS)
Two of the four:
- Temp > 101.3 or < 95
- Pulse > 90
- Respirations > 20
- WBC > 12,000 or < 4,000 or 10% bands
Tx for Bacillary angiomatosis
Oral Erythromycin
Centrally-umbilicated dome shaped papules
Molluscum contagiosum
Bright red, firm, friable exophytic nodule in HIV pt
Bacillary angiomatosis
Indications for oxygen therapy in COPD
- PaO2 < 88%
- Hct >55%
- Cor Pulmonale
Basal Ganglia hemorrhage Presentation
Hemiplegia
Hemi-sensory loss
Homonymous hemianopsia, Gaze palsy
Stupor and coma
Cerebellum Hemorrhage Presentation
Facial weakness Neck stiffness Gaze palsy/Nystagmus Gait ataxia usually no hemiparesis Stupor/coma - brainstem herniation
Thalamus hemorrhage presentation
Hemiparesis Hemi-sensory loss Upgaze palsy Nonreactive miotic pupils Eyes deviate Twd hemiparesis
Cerebral lob hemorrhage presentation
Ass'd w seizures Contralateral homonymous hemianopsia (Occipital lobe) Contralateral plegia/paresis (frontal) Contralateral hemiparesis (Parietal) Eyes deviate away from hemiparesis
Pons Hemorrhage presentation
Deep coma
Total paralysis w/in mins
Pinpoint reactive pupils
MC site of hypertensive hemorrhage
Putamen
- Lies next to internal capsule - CL dense hemiparesis
Presentation of cerebellar hemorrhage
Occipital HA
Vomiting, dizziness
Gait ataxia
NO Hemiparesis