UW 2 Flashcards
What heme effect is seen with pulmonary HTN
Polycythemia - from hypoxemia, stimulates EPO
Pt with massive hemoptysis - management
- Endotracheal tube
- If bleeding persists - Bronchoscopy to localize bleeding site, provide suction to improve visualization, other interventions
If can’t localize source - pulmonary arteriography
When can external cephalic version be done
Bt 37 weeks and onset of labor if no CI
CI to External cephalic version
Ruptured membranes Hyperextended fetal head Fetal/uterine abnormalities Non-reassuring fetal monitoring Oligohydramnios Multiple Gestatino
TX for GoodPasture’s
Emergency Plasmapheresis
Management for pts with renal insufficiency and need CT w contrast
Non-ionic contrast agents
IV hydration
Acetylcysteine
Presentation of Meniere’s DZ
Vertigo Ear fullness Tinnitus Low-frequency, sensorineural hearing loss Vomiting, Postural instability Nystagmus
TX for Meniere’s
- Strict, salt restricted diet 2-3 g/day
Avoid alcohol, caffeine, nicotine - Meds - diuretics, antihistamines, anticholinergics
CYP 450 Inhibitors
Effect on Warfarin
Increase Warfarin Effect = Increase bleeding Acetaminophen, NSAIDs Abx, antifungals (metronidazole) Amiodarone Cimetidine Cranberry juice, Ginkgo, VIt E Omeprazole Thyroid hormone SSRIs
CYP 450 Inducers
Effect on Warfarin
Decrease Warfarin effect = decrease efficacy, increase thrombosis Carbamezapine Ginseng Green veggies = spinach OCPs Phenobarb Rifampin St.John's wort
Presentation of VIPoma
Watery diarrhea
Hypo or achlorhydria b/c decreased gastric acid secretion
Flushing, lethargy, N/V
Muscle Weakness/Cramps
Labs in VIPoma
Hypokalemia
Hypercalcemia
Hyperglycemia
Dx for VIPoma
VIP level >75 pg/mL
Abdominal CT or MRI - localizes tumor in pancreas
TX for VIPoma
IV hydration
Octreotide
Where does carcinoid tumor occur
Small Intestine
3 MCC of chronic cough
- Upper-airway cough syndrome/postnasal drip
- Asthma
- GERD
Pt w high risk pregnancy (HTN/preeclampsia) @ 32 weeks - Next step
NST weekly in 3rd trimester
Difference bt breastfeeding failure jaundice and breast milk jaundice
Breastfeeding failure
- First week of life
- Decreased BR elimination
- Suboptimal feeding
- Dehydration
Breast Milk
- Age 3-5 days, peaks @2wks
- High B-glucuronidase in breast milk
- Normal exam
TX for breastfeeding failure jaundice
- Optimize lactation - increase feeding frequency
2. Supplement w cow’s milk based formula if insufficient amt
Vaccinations for HIV pts at time of DX
Influenza
Hepatitis viruses
S.pneumonia
MMR in pts with CD4 > 200 + no AIDS defining lesion
Live vaccines CI in HIV
BCG Anthrax Oral Typhoid Intranasal Influenza Oral Polio Yellow fever
Presentation of Bell’s Palsy
Sudden onset Unilateral facial paralysis Affected side - Inability to raise eyebrow/close eye - drooping of mouth corner -Disappearance of nasolabial fold - Decreased tearing - Hyperacusis -Loss of taste sensatin anterior 2/3 tongue
Where do Bell’s lesions occur
Lesion Below the Pons
What does forehead muscle sparing in Bell’s pt indicate
Intracranial lesions
Brain imaging req’d
Presentation of steroid-induced folliculitis/Steroid Acne
Monomorphous pink papules
Absence of comedones
Granulosa cell tumors
Bimodal age distribution
Excessive estrogen production
Young - precocious puberty, 2 sexual traits, breast and external genitali hypertrophy, pubic hair growth, hyperplasia of uterus
Dysgerminoma
Younger women/children
Age 20 = avg
Unilateral, cause torsion
Does not secrete sex hormones
Sertoli-Leydig cell tumor
Produce androgens
Defeminization -> masculinization
Disseminated Histo presentation
CXR
Low grade fever, malaise, anorexia, wt loss LA Pancytopenia HSM Palatal ulcers CXR - hilar LA
AE of prolonged seizures or Status Epilepticus
Cortical Laminar necrosis
Otosclerosis Presentation
Conductive hearing loss
Low frequency loss
Middle aged individuals
Presbycusis
Sensorineural hearing loss
AGING
Symmetric
High frequency hearing impairment
Presentation of giant cell tumor of bone
Young adults
Pain, swelling, decreased ROM
Wt bearing joints - Distal femur and proximal tibia = knee joint
X ray findings Giant Cell Tumor of Bone
Expansile and eccentric lytic area = soap bubble appearnce
Pathology of giant cell tumor of bone
Sheets of interspersed large osteoclast giant cells
Round-to-oval polygonal or elongated mononuclear cells
First line TX for giant cell tumor of bone
Surgery
Presentation of Baker’s cyst
Swelling on medial side of popliteal fossa
Cause of osteitis fibrosa cystica
Imaging findings
von Recklinghausen dz of bone
Hyperparathyroidism from parathyroid carcinoma
Subperiosteal bone resorption on radial middle phalanges, distal clavicular tapering
Presentation of osteoid osteoma
Sclerotic, cortical lesion w central nidus of lucency
Pain worse at night, not related to activity
Which murmurs should be worked up and how
Diastolic
Continuous
Echo - TTE
Abdominal pain + hematemesis + Metabolic acidosis + tablets seen on xray
Iron poisoning
Iron pills radiopaque
Pathognomonic for Crohn’s
Non-caseating granulomas
Presentation of cholesterol embolization
Majority of cases = post angiography
Skin: feet, blue toe syndrome, Livedo reticularis, reddish/cyanotic skin discoloration
Acute Renal Failure
Labs: Increased eosinophils, low complement levels
