UW 13 Flashcards
Acute vs Chronic leukemias
They may look similar but Acute leukemia present with much obvious severe symptoms.
Pallor/Fatigue due to anemia
Bleeding do to thrombocytopenia
Ages: ALL: <13yoa AML: 13-40 CML: 40-60 CLL: >60
Tear drop cell
Beta thalasemia and myelofibrosis
Findings in Lymphocytic leukemia
Acute: lymphoblast
Chronic: Smudge cell
CLL presentation
Lymphadenopathies (cervical, supraclavicular, axilary) Hepatosplenomegaly Mild anemia and thrombocytopenia Often asymptomatic Severe lymphocytosis and smudge cells
Management of Urge incontinence
Life style modification and bladder training fisrts
Antimuscarinics (Oxybutinin) if trainning fails (SE: dry mouth, constipation, sedation)
Mirabegrom if oxybutinin not tolerated
Diagnosis of widening mediastinum
Stable patients: CT angiogram
Unstable patients: surgery or transesophageal ecorcardiogram
Aortography (via femoral artery) no longer routinely used
Nail changes in hyperthyroidsm
Onicolisis and clubbing
Eye changes on hyperthyroidsm
Lid lag: allows for visualization of the sclera on downward gaze
Endocrine changes in hyperthyroidsm
Hypercalcemia (increased bone turnover)
Hyperglycemia
Menstrual irregularities
Symptoms of cataracts
Gradual loss of visual acuity
Halos, glare around light
Myopic shift (attenuates the difficulty in close vision in patients with preexisting presbyopia)
Usually ok indoors
Risk factors for cataracts (6)
Age >60 DM Glucorticoids Smoking HIV Chronic sun light exposure
Drusen (eye finding)
White or yellow spots usually found in cluster around the central retina due to age related macular degeneration.
Patients have difficulty with reading in both day and night. Does not cause excesive glare
Flame hemorrhages (eye)
Hypertensive retinopathy
Associated with monocular acute vision acuity and field defects, headache and other neurological symptoms
Mycroaneurism (eye)
Diabetic retinopathy
Medications that improve survival in patients with Left ventricular dysfunction
ACEI/ARA II
B-blockers (metoprolol, carvedilol, bisoprolol) (pindolol, acetobulol should be avoided due to intrinsic sympathomimetic activity) Atenolol has not been studied
Aldosterone antagonist
Hydralazine and nitrates combined
Contraindications for Bblockers in heart failure
Bradycardia
2nd and 3rd degree AVblock
Symptomatic hypotension
Asthma or reactive airway disease
Endocrine effects of primary hypothyroidsm
Low T3/T4 stimulates TRH secretion
TRH stimulates TSH and prolactin (headache and galactorrhea)
Elevated prolactin suppress FSH, LH and stroges
Carpal tunnel sd managment
Splint
Corticosteroid injection
Surgery
Tocolytics (name, MAO and SE)
Pg 348
Viral examthems dxx (7)
pg 427
Viral examthems where fever is not the prodminant feature
Rubella: low grade fever, lymphadenopaties (especially posterior cervical) maculopapular rash from head to toes
Parvo: low grade or absent. Slapped-cheek rash. Rash starts at the arms and spreads to chest and legs. Worsen with fever and sun exposure
High fever and rash that appears once fever is gone
Roseola ifantum (Herpes 6 and 7)
Rash begins on trunk and spreads to face and extremities
OCPs cancer correlation
Decreased risk of Endometrial and ovarian
Increased risk of breast and cervical cancer. (Risk normalizes after 10years of stopping OCPs
Drugs that prolong QT
ABCDE
antiArrythmics (IA, III): sotalol, ibultilde, amiodarone quinidine, procainamide antiBiotics: macrolides antiCychotics: antiDepresats: TCAs antiEmetics: Ondasetron
Normal duration of QT
<0.44sec or 440msec in men
<0.46 or 446 in women
Normal duration of PR
0.12-0.2 or 120 to 200msec
Normal duration of QRS
<0,12 or <120msec
Managment of Torsades
Magnesium
Cardiovert if unstable
IV isoproterenol and temporary peace maker if Magnesium is no effective
Correct K
Withdraw offending drugs
Sings and symptoms of alcohol withdrawal
Tremor
Hypertension, tachycardia
Agitation
Malaise, nausea
Delirum Tremens
Alcoholic hallucinations
12-24hrs since last drink
VIsual, auditory and tactile
Delirum tremens
48-96hrs since last drink
Autonomic instability ( hypertension, tachycardia)
Disorientation, agitation
Hallucinations
Postoperative fever
0-6 hrs: transfution, anesthesia, tissue manipulation
24hrs-1w: nosocomial infections, SSI1 (GAS or C. perfringes), DVT, PE, MI
1w -1M: Nosocomial, catheter, SSI2 (not GAS not perfrignes), C. difficle, drug fever, DVT, PE,
> 1m: viral infections, indolent organism
S. coag - is the most common organism for catether infections
Indication that an infection is from the catether when it comes to culture
Culture taking from the catether grows bacteria faster than other blood taken from a peripheral site at the same time
Efavirenz side effects
Used in HIV treatment is a reverse transcriptase inhibitor
Side effects in up to 50% of patients Dizziness Insomnia Vivid or bizarre dreams Depression Anxiety
Polyarteritis nodosa
Necrotizing vasculitis that presents with nodular rash, aneurysm formation and hematuria
Clinical presentation of abdominal aortic anurysm
Asymptomatic
Abdominal, back or flank pain
Diagnosis of placenta previa
Abdominal ultrasound (high false positive rate) and then TVUS
Cocaine use disorder tratment
Psycotherapy and 12 steps groups
Migrane treatment (abortive vs. maintainace)
Abortive: Triptans Ergotamine Antiemetics NSAIDs (naproxen) Acetaminophen
Maintaince: Topiramate Valproic acid Beta blocker TCAs
Sumatiptan MOA
Serotonin agosnist: Vasoconstriction
5-hydroxytryptamine
Only one dose in 24hrs and do not mix with ergotamine
Treatment of Kawasaki disease
Aspirin
IV inmunoglobulin within 10 days of fever onset to prevent coronary art. aneurysm formation
Albumin to creatinine ratio
> 300 mg/g is abnormal, reflects albumiuria
