UW 19 Flashcards
Acute intermittent porphyria symptoms
Painful abdomen Port-wine urine Precipitated: medications, stress Polyneuropathy Psychiatric symptoms
Peutz-Jegherz sd
GI hemartomatous polyps
1-5mm perioral mucocutaneous pigmented macules
Blood findings of defective prosthetic valves
Hemolytic anemia and thrombocytopenia can be found to due to mechanical damage
Rheumatoid arthritis treatment
NSAIDs (for acute pain/crisis)
First line:
Methotrexate
Others
CD 20 inhibitor: leuflonide
TNF inhibitor: rituximab
MOA of Rituximap
TNF inhibitor
Treatment for neuroleptic malignant sydrome
Dantroline or bromocriptine
Treatment of Serotonin sd
Cyproheptadine (antihistamine: blocks serotonin production)
Benzos: for altered mental status
Treatment of Bullous penphigoid vs. Pephigus vulgaris
Bullous penphigoid: topical corticosteroids (eg, clobetasol)
Pephigus bulgaris: systemic steroids +/- azathriopine, mycophenolate, IVGI, rituximab
Wilms Tumor
Embryonic glomerular structure.
Most common renal malignancy. 2-5 yoa
Asymptomatic
Palpable mass
+/- Hematuria, hypertension, absominal pain
WARG Wilms tumor Aniridia Retardation Genitourinary malformations
Neuroblastoma
Adrenal medulla tumor
Kids <2yoa
Tumor crosses mid line (vs. pheochromocytoma)
Periorbital echymosis (raccoon eyes)
Opsoclonus-myoclonus (dancing eyes and feet)
Diagnosis: catecholamine metabolites in blood, n-myc oncogene, small round blue cells on hystology
Dxx: Wills tumor
Hematuria, hypertension, WT-1 chromosome 11
Indication for systemic atb therapy of anal abscess after drainage
- Systemic illness (fever) or cellulitis
2. Diabetes or immunosupresion
Severe retinopathy of prematurity
Retinal detachment in infants born <30 weeks gestation
Causes leucokoria
Retinoblastoma red flags
White reflex
Strabismus
Nystagmus
ECG findings of pericardial efusion
Electrical alternans (QRS variation of amplitud)
Wolf-Parkinson-White treatment
Procainamide
Amiodarone
Ibutilde
(B-blockers and CCC are contraindicated)
Uterine atony management
- Bimanual massage
- High dose oxytocin, misoprostol
- Trenaxemic acid
- Carbapost (contraindicated in asthmatic patients), metergine (if not hypertensive)
- Intrauterine balloon
- Surgery
Dxx of foot pain
Stress fracture:
Arthritis
Morton neuroma
Tarsal tunnel sd
Stress fracture: localized pain, seen specially in runners, dorsal surface, 2nd, 3rd and 4th metatarsal
Arthritis: pain in the joints, not localized
Morton neuroma: pain between 3rd and 4th toe. Plantar surface, clicking sound on palpation
Tarsal tunnel sd: after anckle fractures. Burning sensation, aching and numbness on plantar surface
DIfference between intraparenchymal vs. subarachnoid hemorrhage
Intraparenchymal: focalization symptoms that worsen within a few hours. Blood is in the brain. (If hypertension: basal ganglia, av malformation in kids)
Subarachnoid: sudden headache without focalization. Blood is in between the sulci.
Patophysiology of hyper IgM sd
CD 40 ligand on T cells deficiency… prevents Ig class switching because it cant bind to CD40 receptor on B cells
CT findings of High grade astrocytoma
High grade astrocytoma = glioblastoma multiforme
Butterfly appearance with central necrosis. Serpentiginous, well defined enhancing
Vs. abseces: enhancing is thicker and diffuse
Systemic symptos of anorexia
Hypotension, bradycardia, hypothermia
Gastroparesis, constipation
Cardia atrophy, arryhtmias
Systemic symptos of anorexia
Hypotension, bradycardia, hypothermia
Gastroparesis, constipation
Cardia atrophy, arryhtmias
vs. hypothyrioidsm: diastolic hypertension
Alvarado score for apendicitis
1 point each RLQ migratory pain Fever Anorexia Nausea and vomiting RLQ rebound tenderness
2 points each
RLQ tenderness
Leukocytosis (>10.000)
Patient with 1 amenorrhe, 2nd sexual characters developed.
Amenorrhea normal <15 yoa if secondary characters are developing
Women have a rapid growth spurt right before menarche. If patient is growing “fast” then reassure
Universal screening for pregnant patients
HIV
Hep B
Syphilis
Chlamydia
Language disorder
Deficit in understanding and/or producing language
Presentation:
Limited vocabulary
Inadecuate structure
Difficulty ussing language to communicate, explain cocepts, create stories
Other symptoms:
Frustration, look for attention in other ways (biting, hitting,)
Concussion symptoms
Headache (predominant symptom) can worsen with sounds, concentrating, eye movements
Irritability, sleep disturbances
What do you need to remember about parvo19 in adults
Patients with kid contacts are at risk of viral arthitis
Fibular neuropathy
Foot drop
Impaired dorsiflexion
Preserve plantar flexion (walk on toes)
Sensory deficit on lat aspect of dorsal foot an shin
Aortic dissection and hoarness
Expansion of the intima compresess the laringial nerve
Diagnosis of aortic disection
CT angiography (for stable patients)
TEE if not stable
Diagnosis of Adrenal insuficiency
Consytropin stimulation test (ACTH analogue)
Normal response: rise in cortisol
No rise in cortisol = AI
Adrenal insuficiency labs
Hyperkalemia, hyponatremia
Eosinophilia
Normal to low glucose
Low cortisol, high ACTH
AD Polycystic Kidney disease
Presentation and extra renal features
Asymptomatic until 30-40
Flank pain, palpable mass
Hematuria
Others: polyuria (cant cocnentrate urine), hypertension, progresive renal dysfunction)
Extrarenal manifestations: Brain aneurism Colonic diverticulos Hepatic/pancreatic cyst Mitral valve prolapse, aortic regurge
Location of appendicitis in pregnant women
RUQ
Auscultation findings in pulmonary contusion
Rales or decrease breath sounds do to pulmonary edema (from hemorrhage that is later worsen by IV fluids)
Time frame of pulmoary contusion vs fat embolism
Pulmonary contusion: <24hrs
Fat embolism: 12-72 hrs
Triad of gonoccocal arthritis
Tenosinovitis
migratory Arthritis
Maculo/papular discharge
TRALI
Non cardiogenic pulmonary edema
Pulmonary infiltrates
Within 6 hrs
Acute hemolytic reaction
<1hr Fever, flank pain, hemoglobinuria, pain at catheter insertion site Low BP, tachycardia Normal O2 sat Positive coombs
Management:
Aggressive IV fluids
Management con complicated diverticulitis
Abscess <3cm: ATB
Abscess >3cm: CTpercutaneous draingage
If no improvement after a few days… surgery
Medications associated with neurotoxicity
Calcineurin inhibitors
Cyclosporin and tracolimus
Anti Jo antibodies
Polymyositis/dermato
Treatment of Bells palsy
Prednisone
Management of edema secondary to Calcium channel blockers
ACEI
When to administer Hep B vaccine in a premature baby
When it >2kg
Contraindication for faxtor Xa inhibitor
Renal failure
DVT/PE due to malignancy
Drugs related to Folate deficiency
Phenytoin
Methotrexate
Pyrimethamine
TMP-SMX
Indication for IECAs in diabetic patient
Hypertensive patien
Albumin/creatine ratio >30
