UW 25 Flashcards
Idiopatic thrombocytopenic purpura vs TTP
ITP does not present with hemolysis
CO2 abdominal insufflation side effect
Bradycardia and AV block due to peritoneal streching and activitation of the parasympathic system
CO2 emolism: rare. Can present as obstructive shock or end organ infarction
Renal changes in diabetic neprhopathy
Mesangial nodules (Kameitel), tubolointerstitial fibrosis
Apearence of amniotic membrane juction at the placent if monochorionic or bichorionic
Monocorionic: T shape
Fusion bi chorionic: Lambda shape
Complication of monochorionic twins
Twin-twin transfusion
Donor twin: anemia, olygohydramnios, low output heart failure
Recipient twin: policythemia, polyhydramnios, high putput heart failure
Estreogen receptor modulators
Clomiphene: antagonist at estrogen receptor in hypothalamus. Prevent normal feedback inhibition, increasing LH and FSH release. Use to treat infertility due to anovulation
Tamoxifen: estrogen blocker in breast and stimulant in endometrium and bone. Use in breast cancer ER/PR +. Can cause endrometrial cancer. Increase risk of thromboembolic events
Raloxifene: antagonist at breast and uterus, agonist at bone. Increase risk of thromboembolic events but not cancer. Use primarily in osteoporosis
Rosacea
Erythema/flushing of face +/- telangiectasias
May be pustular
Ocular: Conjunctival iperemia, lid margin telangiectasia
Avoid triggers (spicy food, wine) Sun protection Soft emolients Topical metronidazol for pustular type Laser or brimonidine (topical alpha 2 agonist) for tlenagientacic type
Fanconi sd
Glucosuria, phosphaturia, aminoaciduria
Cafe au lait spots, short stature and radial, thumb hypoplasia/aplasia
Renal tubular acidosis
Primary difect
Urine pH
Serum K
Causes
Type 1: Poor hydrogen excretion (Distal)
pH: >5.5
Serum K: normal or low
Causes: medication, autoinmune (sjrogren or rheumatioid arthritis)
Type 2: excess bicarbonate secretion (proximal)
pH: <5.5
Serum K: normal or low
Causes: fanconi sd
Type 4: Aldosterone deficiency or resistance
pH: <5.5
Serum K: high
Causes: Obstructive uropathy, congenital adrenal hyperplasia
All: low serum HCO3, hyperchloremia, growth failure
Clostridium perfringes diarrhea
Brief limited watery diarrhea and fever
Associated with undercook or unrefrigerated food
Bloody diarrhea with no fever
E. coli
Euthyroid sick sd
Normal T4 and TSH. Low T3
In the setting of a severe illness
Desmopresin
ADH analogue
Treatment of primary adrenal insufficiency
Corticosteroid: hydrocortisone, prednisone
Mineralocorticoid: fludrocortisone
Hydrocortisone has both gluco and mineralo activity, but incresing the dose if patients is having symtoms of mineralocorticoid deficiency only, would increased risk of excess cortisol side effects (cushing like symptoms)
Midrodrine
Alpha adrenergic agonist use to treat orthostatic hypotension
Uric acid stone formation physiopathology
- Excess excretion: myeloproliferative disorders, gout
- Increased uric acid concentration: hot climates, dehydration
- Low urine pH: chronic diarreha (HCO3 loss), metabolic sd/ DM
Acidic urine favor uric acid crystal formation vs urate (soluble)
Treatment is urine alkalinization (Potasium citrate)
Management of hyperglycemis
> 14:
Agressive IV fluids and calcitonin
Long term biphosponates
Avoid loop diuretics unless volume overload
12-14:
Same as above if symptomatic, If not, no treatment needed
<12
No immediate intervention needed
Avoid thiazide, lithium, volume depletion, excesive bed rest
Dobutamine MOA
beta 1 adrenergic agonist: Increases heart contractility and heart rate (decreases end systolic volume). Also causes mild vasodilation (b2 agonist) decreasing afterload
Used in patients with cardiogenic shock
Hallucinations in a patient with parkinsons
Due to disease itself or due to medication (levo/carvidopa or pramipixole)
Start reducing the dose, if meassure fails… try seconde generation antipsychotic
Paroxysmal nocturnal hemoglubinura
Complement mediated hemolysis
CD55/CD59 deficiency (RBC not protected agianst complement attachment)
Iron deficiency anemia, pancytopenia, episodic dark urine, throbosis (most common hepatic or mesenteric)
Treat with prednisone
G6PD deficiency triggers
Sell FAVA BEANS in INDIA
Sulfa drugs Fava beans Infection Nitrofurantoin Dapsone Isoniazid Antimalarials
Physical findings in endometriosis
Normal size uterus
Dysuria, pain with defecation FIxed uterus (retroverted position) Cervcal pain with mobilization Adnexal mass (endometrioma) Rectovaginal nodularity (due to tussiue in cul de sac)
ATB prophylaxis for patients undergoing clean surgery
Cardia or neurologic procedures
Covarage angaisnt skin pathogens (gram +)
Cefazoline first line
Vanco or clinda for penicillin allergic
Migratory superficial thromboflebitis
Trousseau sd
Eryhtmeatpus palpable cord-like veins
Associated with pancreas, lung, prostate, cplon
Hodking lymphoma
Bimodal presentation: 15-35 and >60
Painless lymphadenopathy
B symptoms
Pruritus
Pel-ebstein fever: 2weeks on, 2 weeks off
Excisional biopsy: red stimberg cell (owels eye) Bcell with bipolar nuclei and huge eosinophil inclusions
Treatment: adriamycin (doxorubicin), bleomaycin, vinplastine, dacarbazine (ABVD)
AVBD treatment for Hodking lymphoma
Adriamycin
Vinplastine
Bleomycin
Dacarbazine
Why is not necessary imaging before LP in infants with open fontanel
There is no risk for herniation
Empric treatment of meningitis according to age pg 224
pg 224
Elevated GGT and ALP
Suggest biliary compression or obstruction
Uterine tachysystole
> 5 contractions in 10 min
Place patient in latral decubitus
Stop oxytocin
Give tocholytics
Trearment for adult vs. infant botulism
Infant: human immunoglobulin
Adult: equine derived antitoxin
Cholesterol crystal embolism
Risk factors (2) Clinical features (7) Lab findings (5) Diagnosis (2)
Hypercholesterolemia, hypertension DM
Livido reticularis
Renal (acute or subacute injury)
Stroke, amauross fugax, plaques on retina
Intestinal ischemia, pancratitis
Laboratory findings:
Elevated creatinine, eosinophilia, hypocomplementenemia
Urine: few cells or cast, eosinophiluria
Skin or renal biopsy:
Biconvex, neddle shape cleft within ocluded vassels
Perivascular inflamation with eosinophils
Cocaine chest pain management
O2 Aspirin Bezos CCB and Nitrates are safe Do not use beta blockers
Immediate catheterization and reperfusion
Labial adhesions
Fused labia minora
Due to poor hygiene, infection or trauma
Usually asymptomatic or require treatment with estrogen
Dxx with lichen sclerous: hypopigmentation
