UW 16 Flashcards
Glazman thrombastenia
Platelet aggregation deficit
Mucocutaneous bleeding
Normal platelet count. No clumping on peripheral blood smear
Cholangio carcinoma markers vs. Hepatocellular
Cholangio carcinoma: CA 19-9 and CAE
Hepatocellular: AFP
Systemic sclerosis antibodies
Limited cutanueos: Anticentromere
Difuse: anti polymerase 3 and ScL-70 (topoisomerase 1)
Delivery management of preeclampsia
Delivery at 37 weeks.
Severe features after 34 weeks: Delivery
Induction of labor preferred over C-section
Preeclampsia with severe features
BP: >160/110
Thrombocytopenia > Creatinine > LFTs Headache or neurological symptoms Pulmonary edema
Fetal fibronectin test
Done in patients <33+6 weeks gestation to predict preterm labor.
Positive test is good predictor of preterm labor within a week and an indication for IM corticosteroid injection
Pathology of Lewi body dementia
Deposition of alpha-synuclein bodies in the substantia nigra and brain stem
Examples of primitive relfexes and what do they suggest in an adult
Sucking, roting, glabelar
Frontotemporal dementia
Startle myoclonus definition and asssociation
Myoclonus/jerk with loud auditory stimulus
Prion disease (Creutzfeld-Jacob)
Dementia with Lewi bodies
Visual Hallucinations
Fluctuating cognition (may be describes as good moments and bad moments)
Parkinsonism
REM sleep behavior disorder
Other symptoms that might suggest:
Frequent falling
Sensitivity to antipsychotics
Dementia with Lewi bodies
Visual Hallucinations
Fluctuating cognition (may be describes as good moments and bad moments)
Parkinsonism
REM sleep behavior disorder
Other symptoms that might suggest: Frequent falling Sentivity to antipsychotics syncope/near syncope autonomic dysfuntion SPECT or PET showing low dopapine transport in basal ganglia
Lewi body dementia management
Parkinsonism: levo/carvidopa
Cholinesterase inhibitor: rivastigmine for cognitive impairment
Anti psychotics for functional impeding hallucinations
FACT:
If GBS status is not mentioned on the question. Consider it unknown. What do you do?
Screening 36-38
IV penicillin if 1. GBS UTI during pregnancy regardless of treatment 2. Colonation of GBS (GU and/or rectum) 3. Hx of early onset neonetal sepsis 4. Unknown status and... ..... <37 weeks .... Intrapartum fever .... Rupture of membranes >18 hrs
Vit C deficiency pathological effect
Impaired wound healing due to poor collagen formation
Niacin deficiency
Pellagra
Dermatitis
Diarrhea
Dementia/Delusions
Livido reticularis associations
Vasculitis:
Polyarteritis nodosa, SLE
Vasocclusive
Fat embolism, Antiphospholipid sd, cryoglobulinemia
May be normal in some people specially in cold climates
Antiphosppholipid sd coagulation studies
Normal PT
Prolonged PTT
Mixing of patient blood with donor plasma will not correct PTT (unlike factor deficiency)
Elevated B2-microglobulin
Multiple Myeloma
Common dermal manifestation of Antiphospholipid sd
Livido reticularis
Specific antiphospholipid antibodies
Anticardiolipin
Antiphosphatidilserine
Anti beta2 glycoprotein
Retained product of conception
Risk and complication
No placental expulsion after 30 min
Can cause post partum hemorrhage and infection
Increased risk if 24-27 weeks, still birth, placenta acreta, previous hx
Chemo induced cardiac damege
Doxorubicin (and its family that end in rubicin): fibrosis. Not reversible
Trastuzumab: stunnin/dormant/hybernation cardiomyocytes. Asymptomatic ventricular systolic dysfunction
Hystologic finding in hypertrophic cardiomyopathy
Cardiomyocyte hypertrophy and disarray
Painless penile ulcer that has been present for a few months
Cancer (Usually SCC)
Syphilis self resolve in 2-6 weeks if left untreated
Penile Cancer
Risk factors: VPH, smocking
Presentation: chronic painless ulcer + regional lymphadenopathies
Diagnosis: biopsy
Management: Excision
Massive transfusion protocol
Packed RBC, FPP and platalets 1:1:1 ratio to avoid coagulopathy from delution of platelets and coagulation factors
Indicated in patients with hypovolemic shock that failed initial resuscitation efforts
FACT
Always stabilize the patient first.. then do imaging studies
Unstable patients cant wait for blood matching.
Give O type blood
Cortical bone loss
Primary hyperparathyroidsm
McCune albright sd
Constant activated G protein
Elevated TSH: thyrotoxicosis
Elevated LH/FSH: precosious buberty (breast and pubic hair development)
Elevated ACTH: cushing sd
Caffe aulit spots, fibrous dysplasia of the bone
Fibrous dysplasia of the bone association
McCune albright sd
Defective mineralization of osteoid
Osteomalasia/osteoporosis
Bipolar I vs II diagnosis
I:
One manic episode (need for hospitalization)
II:
Hx of hypomanic episodes (lasting over 4 days)
At least one MDD episode
Clasic triad of Hemochromatosis
Cirrhosis
Diabetes
Skin pigmentation
Found only late in the disease
Hemochromatosis
Skin Gastro M/E Cardio Endocrine Infection
Skin: hyperpigmentation
Gastro: elevated LFTs and hepatomegaly (early), cirrhosis (late), risk for hepatocellular carcinoma
M/E: arthritis, chondrocalcinosis, arthralgias
Cardio: dilated or restrictive cardiomyopathy, conduction abnormalities
Endocrine: DM, hypogonadism (low libido, impotence in men), hypothyroidsm
Infection: Yersnia, vibrio,
Asymptomatic patient with LFTs
Hemochromatosis in dxx
Hemochromatosis
Skin Gastro M/E Cardio Endocrine Infection
Diagnosis
Skin: hyperpigmentation
Gastro: elevated LFTs and hepatomegaly (early), cirrhosis (late), risk for hepatocellular carcinoma
M/E: arthritis, chondrocalcinosis, arthralgias
Cardio: dilated or restrictive cardiomyopathy, conduction abnormalities
Endocrine: DM, hypogonadism (low libido, impotence in men), hypothyroidsm
Infection: Yersnia, vibrio,
DIagnosis: genetic HFE mutation
Initial management of acute pancreatitis
Aggressive IV fluids
Pain management
Monitoring complications (infection, renal failure, ARDS)
Empiric ATB not indicated unless CT evidence of necrosis
Dxx of erectyle dysfunction
Absence of nocturnal erections:
Neurologic: diabetic neuropathy, MS, spinal injury
Cardiovascular: smocking, claudication, DM, hypertension
Nocturnal erections:
Psycologic: specific to a person, situation, sudden onsent
Hypogonadism:
Decreased libido, testicular atrophy, gynecosmastia, gradual onset, low testotorone
Endocrine: hypothyroidsm, prolatinoma
Hemochromatosis
Medications: antidepresants, SSRI, antiandrogenic medication
Clues for masotiditis
Inflammation of mastoid lowers ear
Suction splash on physical examination
How do you produce it?
What does it mean
Stethoscope on epigastric region, rock the patient back and forth at the hip
Associated with gastric outlet obstruction
Calcium-phosphorous product
Ca x PO4 = >55 risk for tissue calcification
Can cause basal ganglia calcification and symptoms of parkinsonism
Low Ca and high PO4 is seen in secondary hyperparathyroidsm
Good or bad pronostic factor of schizofrenia
GOOD: Female Late onset Mostly positive symptoms Identifiable precipitant /acute onset
BAD: Early onset (childhood, adolescence) Family hx Long duration of symptoms without treatment Presence of negative symptoms Gradual onset
Good or bad prognostic factor of schizophrenia
GOOD: Female Late onset Mostly positive symptoms Identifiable precipitant /acute onset
BAD: Early onset (childhood, adolescence) Family hx Long duration of symptoms without treatment Presence of negative symptoms Gradual onset
Auer rods
AML
Brief psychotic disorder
> 1d and <1month
Sudden onset
Return to baseline
Schizophreneiform disorder
> 1 month <6 months
Same symptos as schizofrenia.
Functional decline not requiered
Schizophrenia
> 6 month of symptoms
With funtional decline
1 month of active symptoms
Schizoafective
2 years
Mood episode (depresion or bipolar) + schizophrenia
> 2weeks episode of schizophrenia without mood symptoms
Delusional disorder
> 1 delusion >1 months without any other symptom
