UW 15 Flashcards
Severe cancer related pain with no adequate dosing during the night
Add a long-acting opioid or extended release medication like a fentanyl patch or sustained released morphine
Elevated lactate meaning
Poor organ perfusion
New Left bundle branch block is suggestive of
Acute MI
Exercise and Cocaine hemodynamic monitoring profile
Preload, CO, Afterload
Exercise: low preload, high CO and afterload
Cocaine: normal preload and CO, elevated afterload. Normal CO is possible due to increased in contractility and HR.
How is the preload in:
Cardiogenic, Hypovolemic and septic shock
Cardiogenic: increased
Hypovolemic: decreased
Septic: decreased
Candiasis vs. Tinea on KOH
Candidiasi: Pseudohyphae with blastoconidia
Tinea: Septate hyphae
What to look for in acute gout when it comes to treatment
Look for clues of NSAIDs contraindications: anticoagulation (aspirin, clopidogrel, apixaban)
Indomethacin (fisrt line), naproxen
Colchicine: if the patient is taking anticoagulants. Do not use in eldery or renal failure
Corticosteroids: also good to use in patients with NSAIDs contraindication. Careful with diabetic patients
Z score corresponding to 95% and 99% confidence interval
95% = 1.96
99% = 2.58
How do you calculate confidence interval
mean +/- Zscore x standard error of the mean
Standard error of the mean = standard deviation/square root of the sample
Interpretation of confidence intervals
Wider confidence interval means higher variation in results
Overlapping or not in confidence intervals
If the CI of two groups do not overlap.. it means there is statistical significance
Rosacea presentations
Erythematotelangiectasic: erythema, flushing, burning, scaling
Pustular: small papules, pustules, looks like acne
Phymatous: rinophyma
Ocular: affects conjuntiva, cornea, sensation of foreing body. Common with skin manifestations not necesarily at the same time
Uveitis image
Look for irritation as close as possible to the iris.
Common with severe pain and photophobia
Diagnostic requirement for liver failure
ALT/AST >1000
INR > 1.5 (normalized value of PT)
Sings of encephalopathy (confusion, asterixys)
May also present with: anemia, thrombocytopenia, hypoglycemia, electrolyte imbalance
Renal failure can be present but it is not specific to liver failure
Specifics of liver failure due to Wilson or Acetaminophen toxicity
Acetaminophen: low bilirubin
Wilson: very low ALP
Serotonin sd. AAA
neurological Activity: clonus, tremors, hyperreflexia, hypertonia, seizure
Autonomic stimulation: fever, diaphoresis, flushing, diarrhea, midirasis
Agitation
Sings and symptoms of early diseminated Lyme
erythema migrans malaise, fatigue, arthralgias CN palsy, bells palsy, radiculopathy, lymphocytic meningitis Cardio: av block Regional lymphadenopathies
Treatment of lyme and criteria for prophylaxis
Mild/ skin : oral doxycycline or amoxicilin in <8 yoa or pregnant
Neurologic/Cardio: IV ceftriaxone
Ixodes tick
Attached for >36hr
Treatment initiated before 72hrs of tick removal
Rate of infection is >20%
Fever + painful uterine fundus (postpartum)
Decidua infection
Empiric treatment for endometritis
clynda + genta
Empiric treatment for endometritis
clynda + genta
If no improvement after 48hrs, think abscess
Fever <24 hrs post partum
Normal
Empiric treatment for Community acquired pneumonia
Outpatient:
Macrolide, oral quinilone or betalatam + macrolide
Inpatient (not MICU)
Levofloxacin IV or betalactam + macrolide
MICU
betalactam + macrolide
belactam + fluoroquinolone
Common mycoplasma pneumonia presentation and treatment
Young patient in college, prison, military
Malaise, dry cough, faringeal erythema (not exudative)
Macular/vesicular rash
Normal leukocytes, subclinical hemolytic anemia (cold agglutins)
Diffuse reticonudular opacities on xray
Treat with macrolide or resp. quinolone
Why are penicillins are cephalosporins inefective against mycoplasma
They inhibit cell wall synthesis and mycoplasma doesnt have one
Diagnosis criteria for narcolepsy
> 3 episodes of lapses into sleep/naps >3month + >1 of the following
- Catalepsy: brief loss of muscle tone precipitated by emotion (eg. laughing, exitment)
- Low hypocretin level on CFS
- Decreased REM latency
Others:
Hallucinations when falling asleep or waking up and/or sleep paralysis
Specifics: decreased sleep latency, increased REM density
3hz spike wave activity on EEG
Absence seizure
Absence seizure EEG
3hz spike wave activity on EEG
Thromboangitis obliterans
Age <45, smoker, non occlusive limb ischemia, gangrene, ulceration, thrombosis
Pulses and ankle/brachial index usually normal
Treatment: smocking sesation
Aspergillosis 4 different presentations
Allergic bronchopulmonary aspergillosis: common in asthma and cystic fibrosis. Eosinophilia, bronchiectasis. Steroids + itraconazol
Aspergilloma: usually asymptomatic. Common in patients with TB, sarcoidosis. Can cause fever, hemoptysis and cough. Solid mass in preexisting lung cavity. Itraconazol
Chronic necrotizing pulmonary aspergillosis: common in alcoholics or steroid dependent COPD patients. fever, cough, sweating. Pneumonia that does not respond to antibiotics. Vorizonazole
Invasive aspergillosis: fever, chest pain, hemoptysis. Exclusively in immunocompromised. CXR: nodules with sourounding ground glass opacities (halo sing). Voriconazol or caspofungin
Allergic bronchopulmonary aspergillosis:
Common in asthma and cystic fibrosis.
Eosinophilia, bronchiectasis.
Diagnose with skin test and specific IgG
Steroids + itraconazol
Pharmacologic treatment for bulimia vs anorexia
Anorexia: olanzapine
Bulimia: SSRI
Binge eating disorder: SSRI or lisdexanfetamine
Major differences between bulimia and anorexia
Anorexia: BMI <18.5. Distorted views over weight and shape
Bulimia: Binge eating with compensatory behaviors. Worry about weight and body shape.
Management of hypercalcemia
> 14:
Short term: IV Fluids + calcitonin, avoid diruretics unless fluid overload (patients are ussually volume depleted due to hypercalcemia induced neprhogenic diabetes insipidus)
Long term: biphosphonate
12 -14
Short term: non if asymptomatic, same as above if symptomatic
<12 or asymptomatic
No treatment needed. Avoid diuretics, lithium, volume restriction or bed rest
Mechanic valve thrombosis
Mitral or Aortic
Looks like a stenosis ==> CHF ==> Cardiogenic shock
Due to inadequate anticoagulation: INR mitral 2.5-3.5. aortic 2-3
Diagnose with eco
Anticoagulate (eg. heparine)
Thrombolitics, avoid to the max
Surgery for severe CHF
Patient with chronic cough with sputum production and +/- streacks of blood after an inciting event….
Bronchiectasis
Permanent destruction and dilation of airways
Bronchiectasis
Infantile hemangioma
May begin as a patch of telangiectasia
Progreses to a red, raised nodule at age 0-1
Regresses at 1-9 yoa (gets darker and smaller)
No treatment needed
Infantile hemangioma
May begin as a patch of telangiectasia
Progresses to a red, raised nodule at age 0-1
Regresses at 1-9 yoa (gets darker and smaller)
No treatment needed
Rett syndrom
Lost of motor and communicative skills (from 6-18months), gait disturbances, autism
Deceleration of head growth
Stereotypical hand movements
Ataxia
Phenylketunuria
Mosty odor Eczema Microcephaly Albinism Impaired cognition
Screen at birth
Tay Sachs
Hexoaminidase A deficiency. Accumulation of ganglioside
Neurodevelomental regretion staring at age 6 months
Cherry red spot on macula, no heptosplenomegaly (vs. gaucher)
Congenital syphilis
Rinorrhea
Desquamating rash in hans and soles
Bone deformities (sadle nose/ teeth later in life)
Congenital CMV
Microcephaly
Periventricular calcification
Hepatosplenomegaly
Jaundice
Rubella congenita
Catracts
PDA (heart defects)
Sensorineural deafness
Bluberry muphin rash
Management of mild sunburn
Lotions
NSAIDs
Management of threatened abortion
Vaginal bleeding with closed cervix
If fetal hr is normal and everything looks ok…
Reassurance and follow up
Need to increased folic acid dosing in pregnancy
Previous neural tube defect pregnancy
Patient taking anticonvulsants
Epstein anomaly presentation and association
Atrialization of the right ventricle
Atrial septal defect
Tricuspid valve defect
Lithium
SSRI and pregnancy
Good to go except for paroxetine wich has been associated with cardiac defects
Most common location of hypertensive hemorrahages and potential complication
Basal ganglia
Complication: Uncal herniation
Uncal herniation
IPSILATERAL CN III paralysis: dilated pupil with no response to light. Down and out
Ipsilateral hemiparesis: compresion of contralat cruz cerebri
Contralat homonimus hemianopia: compresion of ipsilateral posterior cerebral artery
Measures to prevent pulmonary complications after cardiac surgery
Stop smoking 8 weeks prior
Physical therapy prior to surgery
Wiskott-Aldrich
Xlinked recesive (male patients)
WIPE
Wiskott-Aldrich
Infections
Purpura
Eczema
Elevated IgE/IgA, low IgM Increased risk for encapsulated bacteria)
Clasic presentation: bleeding, eczema and recurrent otitis media
