UW 12 Flashcards
Treament for septic arthritis
Gram +
Gram -
No bacteria but elevated WBC
Gram +: vanco
Gram -: cephalosporin3rd
Negative mycroscopy: vanco + cephalosporin if immunocompromised
Nephrotic sd. associations:
Focal segmental
African american, hispanic, obesity, HIV, heroin
Nephrotic sd. associations:
Membranous nephropathy
Heb B, Hep C
SLE,
NSAIDs,
Adenocarcinoma (lung, breast)
Nephrotic sd. associations:
Mebranousproliferative glomerulonephritis
Hep B and C
Lipodistrophy
Nephrotic sd. associations:
Minimal Change
NSAIDs
Lymphoma
More common in children
IgA nephropathy hx
Hematuria that follows URT infection
Pathognomonic finding in Focal segmental glomerulosclerosis
Partial sclerosis limited to a segment of the glomerulus
Painless hematochezia in infants (5
Meckel diverticulum (most common)
Intestinal hemangioma (if >5 cutaneous hemagiomas) Intestinal polip: children 2-10 Lymphonudular hyperplasia (inflamed tissue): milk-indiced colitis
Juvenile Myoclonic epilepsy
Clinical features:
Absence seizure
Morning myoclonus
Generalized tonic-clonic seizure
Diagnosis:
EEG: bilateral polyspike and slow-wave activity
Treatment:
Valproic acid
Avoid triggers (alcohol, sleep depravation)
Lenox-Gastaux sd
Severe seizure type accompanied by intellectual disability
Psycogenic non epiletic seizure
Seizure-like event
Usually witness
Return to baseline is immediate (no post ictal state)
Presystolic accentuation of MS murmur
Due to atrial contration in patients with sinus rhythm
Can not be heard in patients with FA
FA clue: tachycardia with irregular rhythm
How does severity of Mitral regurge affect its murmur
It gets earlier as it gets more severe
Moderate: late diastolic murmur
Severe: early or mid diastolic murmur
Etiology of bacterial meningitis in eldery and treatment
S. pneumonia
S. meningitidis
Listeria
Vanco+cephalosporin+ampicillin
Etiology of bacterial meningitis in general
S. pnumonia
S. meningitidis
H. influenzae
GBS
<1 m: GBS, E. coli, listeria: ampicilin + cefotaxime or genta
1-3: S. pneumonia, S. meningitidis, H. influenza: vanco + cefotaxime
Adults: S. meningitidis, S. pneumonia: vanco + ceftiraxone or cefotazime
Old people: vanco+ampicilin+ 3rd cephalosporin
Factitious disorder vs. malingering
Factitious: primary gain. Want medical procedures
Mallingering: secondary gain
miss work, make money
Against medical procedures
Herpangina
Oral vesicles in uvula, soft palate and tonsilar pillars usually associated with Cosackie A virus
Herpes gigivostomatis presents with oral ulcers in the anterior mouth (bocal mucosal, hard palate, gingival, tonge)
Neutrophils in B12 deficiency
Hypersegmented
Myelodisplastic Sd
Epidemiology:
Hematopoietic stem cell neoplasia
Increased risk with age and chemo/radio hx
May transform to leukimia
Manifestetions
Cytopenias: anemia, leukopenia, thrombocytopenia
Hepatosplenomegaly, lymphadenopaties (RARE)
Diagnosis:
Ovalomacrocytosis
Neutrophil hyposegmentation, hypogranulation
Treatment
Tranfusion for symptomatic cytopenias
Chemo
Stem cell transplant
Common manifestations of pancoast tumor
Shoulder pain Horner sd (ptosis, miosis, enophtalmos and anhidrosis)
Symptoms of C8 - T2 invation
Intrinsic hand muscle weakness
Paresthesias of 4th and 5h digits, mideal arm and forearm
Supraclavicular lymphadenopathy
Weight loss
Clues for malabsorption
Bulky, foul smelling, floating stools
Weight loss (loss os muscle, subcutaneous fat, fatigue)
Pallor, fatigue (iron)
Bone pain, fracture (vit D)
Easy brusing: vit K
Hyperkeratosis: vit A
Painless diarrhea: celiac disease
Abdominal pain: think pancreatic origin
Bloody diarrhea: UC
Other: cystic fibrosis
Epidural abscess
TRIAD OF: Localized back pain, fever, level of neurologic deficits
Starts with fever and pain and then may present with shooting pain (radicular pain) to progress to paresthesias and paralysis
Management of spinal metastasis
Corticosteroids to reduce edema
Cutaneous manifestations of Granulomatosis with Polyangytis
Pyoderma gangrenoso: inmune system dysregulation or vascular occlusion causing necrosis
Leukocytoclastic angiitis: purpura on the lower extremities with ulceration
Granulomatosis with polyangitis is a necrotizing vasculitis
Interventions that improve survival in COPD patients
O2
Smocking cesation
Managment of COPD excacerbation (7)
Oxygen (goal is 88-92)
Bronchodilators (B2 agonist and Anticholinergics=ipratropium)
Corticosteroids
ATB if >cardinal symptoms (dysnea, cough, increased baseline sputum production)
NPPV (non invasive positive pressure ventilation)
Intubation if NPPV fails
Oseltamivir if influenza
Indicationf for oxygen therapy in COPD
O2Sat: <88% CO2: <55mmHg
O2Sat: <89% CO2: <59mmHg:
cor pulmonale, right heart failure, polycithemia
O2 can worsen hypercapnia. O2Sat is: 90%-93%
Things to remember about boderline personality disorder
Very brief periods of paranoia also called transiet psychotic effect
Screaning for breast cancer
Mamogram for women every 2 years for patients 50-74
Genetic counseling and testing for women with high risk family history
High risk family history:
>2 1st degree relative with breast cancer, 1 <50yoa
3 or more 1st and 2nd degree relative with breast cancer
1st and 2nd with breast and ovarian cancer
1st and 2nd with bilateral breast cancer
Male relative with breath cancer
Askenazi jew with 1st and 2nd with breast or ovarian cancer
Painful vs painless myopathy
Proximal muscle weakness
Paiful: thyroid and statin
Painless: cushing
Chrons vs. UC dxx of diarrhea characteristics
UC: bloody, lower abdominal pain, tenesmus. Toxic mega colon
Chrons: watery, low grade fever, weight loss,
Etiology of Impetigo
S. aureus (most common)
S. pyogenes
Management of DKA
Fluids: 0.9%, switch to Dextrose 5% when glucose <200
Insulin: IV infusion until…
Patient able to eat. Glucose <200. Anion gap <12. Bicarb >15.
Potasium: IV if K <5.5
Others
Bicarb if pH <6.9
Phospaphate if <1 and there is cardiac dysfunction or respiratory depresion
CML vs Leukemoid reaction
Leukocyte cout
LR: >50000 CML: often >100000
Cause:
LR: Severe infection CML: BCR-ABL fusion
LAP score
LR: High CML: low
Netrophil precursor:
LR: More mature (Matamyelocites>myelocytes) CML: opposite
Absolute basophilia:
LR: not present CML: present
CML: thrombocytosis and anemia are common
Recomendations to prevent gout attacks (7)
Weight loss to BMI <25 Low fat diet Decreased seafood and meat intake Protein intake from vegetable and low fat dairy products Avoidance of alcoholic bevarages Avoidance of diuretics
Indications for lowering serum urate in Gout (5)
Repeated and disabling attacks Tophi suggesting chronic disease Xray evidence of chronic gouty disease Uric acid kidney stone Renal insuficiency
Medications for gout
Xantine oxidase inhibitors
Allopurinol (prefered)
Febuxostat (for patients that can not tolarate hallopurinol)
Niacin and thiazide dirutics can lead to hyperuricemia
Changes of location on auscultation of aortic regurge
Valvular AR: best heard on ULSB
Due to aortic root dilatation: heard on the right side too.
