UW 24 Flashcards
Wells criteria for pulmonary embolism (7)
3 points:
DVT
Other diagnosis less likely
1.5 points:
Tachycardia
Recent surgery/bed ridden
Hx of DVT
1 point
Malignancy (hypercoagulability)
Hemoptisis
Pancreatitis due to biliary stone surgical management
If sings of obstruction: ERCP
If medical management was succesfull: elective cholecistectomy
HIDA indication (hepatobiliary iminodiacetic acid)
Tracer for biliary secretion
Used when diagnosis is not clear with ultrasound.
If gallbladder can not be visualized it meas obstruction.
What causes butulism infants vs. adults
Infants: bacteria colonization that produces the toxin (spores)
Adults: preformed toxin
Clinical presentation of infant botulism
<12 months
First: Poor feeding, constipation, hypotonia
Oculobulbar palsy: midirasis, ptosis, absence of gag reflex,
Symmetric descending paralysis
Autonomic dysfunction: decreased salivation, fluctuating HR
Empiric ATB treatment for patients with splenectomy
Amoxicilin-clavulanic
or
Levofloxacin for penicillin allergic patients
TMP-SMX also have similar spectrum but its not used due to delay batericidal effect and resistance
Pinealoma
Parinaud sd:
Limited upwasrd gaze
Lid retraction
Pupil react to accomodation but not to light
Obstructive hydrocephalus
Papilledema, vomiting ataxia
Brain tumor in children
Craneopharingioma: most common supracellar. Optic chiasm compresion (bitemporal hemianopsia). Craneo, Cystic, Calcifications
Astrocytoma: Posterior fossa/infratentorial. Symptoms of intracraneal pressure
Medulloblastoma: arises from the cerebellar vermis or fourth ventricle. Presents with ataxia. Highly malignant but responds to radiation. Drop metastasis to central cord
Pinealoma: Parinaud sd and obstructive hydrocephalus
Pertusis presentation
Common in infants but DO NOT exclude adults with paroxysm of cough
Catharral: URI symptoms for 1-2 weeks
Paroxysmal: cough can last for 2-3 months
Convalescent: symptoms wane
Labs: leukocytosis with lymphocytosis
Treat with macrolides and close contacts too
Side effect of calcineurin inhibitors
Cyclosporin and tracolimus (via IL-2 inhibition)
Vasoconstriction (renal), hypertension
Prerenal acute kidney injury
Otitis media common organisms in children <2 yoa
S. pneumonia
S. pyogenes
S. aureus
Otocholestoma presentation
Recurrent painless otorrhea
Perly white mass or retraction pocket in the superior portion of the timpanic membrane
Associated with recurrent Otitis media
Post partum urinary incontinance
Stress incontinance
Due to weakness of the pelvic floor and streching of the pudendal nerve
Normal up to 6 weeks after birth
Reassurance +/- kegel exercise
Lead poisoning antidote
Oral succiner
EDTA
Dimecarpol
Specific contraindications of pregestin and copper IUD
Copper: Wilson
Progestin: breast cancer, active liver disease
Suprascapular nerve entrapment
Shoulder pain Weak abduction (supraspenitatus) Weak external rotation (Infraspinatus)
Crossing of the arm may produce scapular pain
Common due to backpack compression
Erlichiosis
Rocky mountain spoted fever without the spots
Tick vector (lone star), south east and south central USA
Flu like symptoms (fever, myalgias, chills)
Neurologic symptoms
Rash uncommon (,30%)
Leukopenia and thrombocytopenia
LFTs and LDH elevated
Intracytoplasmatic morula in monocytes (MEGA berry: monocytes erlichia, graulocytes anaplasma)
PCR for erlichia
Treatment:
Empiric doxy
What other screen do you do in a patient with Irritable bowel sd
If its IBS - D, then screen for celiac
If it is constipation predominate, just clinical diagnosis
Calprotectin use
To diagnose inflamatory diarrhea (infectious , inflamatory bowel disease)
Mononucleosis EBV vs. CMV
CMV is usually milder (pharyngitis, lyphadenopaties) Hepatosplenomegaly may or may not be preset
Presence of atypical lymphocyte
Negative monopost test
Positive CMV PCR
Defect in Duchene and Beker muscular dystrophy
Distrophin
Presents at age 2-3
Axial and proximal muscle weakness
EMG: polyphasic potentials and increased recruitment
Defect in Marfan sd
Fibrilin
Defect in achondroplasia
Fibroblast growth factor receptor 3
Defect in osteogenesis imperfecta
Colagen I
Causes of Galactorrhea
Pregnancy
Hyperprolactinemia
Hypothyroidsm
Chest wall, nipple estimulation (trauma, shingles, surgery)
Medication (antipsychotics, antidepresants)
Hyperthrophic pulmonary osteoarthropathy
Digital clubbing is accompanied by arthropathy (pain,) that is a attributable to a pulmonary condition like cancer, tb or emphysema
Trauma patients evaluation
ABC
FAST, Chest Xray and pelvic xrays, and cervical spine i
When is a cervical spine imaging study indicated in a trauma patient
High energy impact (car crash or fall > 3mts (10ft)
or Altered mental status Spinal tenderness Neurologic deficit Intoxication Distracting injury
(basically the same is true for any other segment of the spine)
Patient with a cervical fracture on imaging: next step
Complete spine imaging
One vertebra fracture in a patient with blunt trauma is indication for the entire spine
Management of TCAs overdose
Supportive ABCs
Activated charcoal if <2hr of ingestion
NaHCO3 for QRS widening or arrhythmia (TCAs bind to Na channels in Purkinje system and myocardioum causing >100 QRS and hypotension)
Effect of TCAs on heart (patophysiology)
TCAs bind to Na channels in Purkinje system and myocardioum causing >100 QRS and hypotension)
Sodium bicarbonate increases pH and inhibits TCAs from binding to Na channels
Aspirin intoxication management
Sodium bicarbonate alkalinizes urine and helps with excretion
Tumor associated with molar pregnancy
Teca lutein cyst
Erythema nodoso
Etiology
Pathologic findings
Evolution
Sarcoidosis
Inflamatory bowel disease
Medication (antibiotics, OCPs)
S. pyogenes infection
Septal paniculitis without vasculitis
Natural regresion
Residual hyperpigmentation
Salmonella no typhi vs. typhoideal
Non typhoideal;
Vomit, diarrhea +/- blood, fever
Poultry or non refrigerated food
Rash of dermatomyocytis
Violaceous periorbital rash
Shawal rash: rash involving the shoulder, upper chest and back
Gottron papules: papular rash with scales on the dorsa of the hands, over bony prominences
Urine low specific gravity cut off
<1.006
Suspected polyuria
Complete 24hr urine colection:
<3 L: not true polyuria
> 3 L:
…Diluted: Diabetes insipidus, polydipsia
… Concentrated: osmotic diuresis (DM, urea, saline)
DI can present with normal or elevated Na
Anysocytosis and RBW
Anysocytosis is the presence of RBC with multiple size and RBW is the quantification of that
