UW 4 Flashcards
Method to control confounding
Matching
- Neighbors
- Age
- Race
Presentation of Amniotic Fluid Embolism
During or shortly after delivery
Cardiogenic shock
DIC
Hypoxemic Resp failure
LLQ pain unresponsive to Abx and elevated WBC count - what is next best step
Abdominal CT scan for diverticulitis with possible complication, such as abscess
AIHA in CLL patients - intra or extravascular?
Extravascular
- Spleen and RES and extravascular
Hyperactive/tinkling bowel sounds?
Mechanical bowel obstruction
Treatment to remove K+ from body
Dialysis
Cation exchange resins (Kayexalate)
Diuretics
CMV v HSV retinitis
CMV = painless
Fundoscopy - fluffy granular retinal lesions near retinal vessels, hemorrhages
HSV = keratitis, conjunctivitis, eye pain, rapid visual loss
Fudoscopy - widespread, pale, peripheral lesions, central necrosis of retina
Who gets a tetatnus-diphtheria toxoid
Individuals w severe or dirty wounds who received booster > 5 years ago
Individuals w minor clean wounds who received booster > 10 years ago
Who gets Tetanus Immune globulin
Individual w severe/dirty wound
AND
Unclear/incomplete immunization Hx
Pt w clean or minor wound + unimmunized, uncertain or < 3 tetanus toxoid doses
Tetanus toxoid-containing vaccine only
Clubfoot Presentation
Equinus and varus of calcaneum and talus
Varus of midfoot
Adduction of forefoot
TX for clubfoot
Immediate Stretching Manipulation Serial plaster casts, malleable splints, taping Surgery if poor results b/t 3-6 months
Presentation of medial meniscus injury
Forceful torsion of knee w foot planted
Popping sound + severe pain at time of injury
McMurray sign +
Bucket handle tear leads to locking of knee joint during terminal extension
Presentation of ACL injury
Hx of forceful hyperextension injury to knee or noncontact knee injury during deceleration
Effusion Rapidly after injury
Lachman’s test, anterior drawer test, pivot shift test
Presentation of PCL injury
Dashboard injury
Foreceful posterior -directed force on tiba w knee flexed at 90 degrees
Tension Pneumothorax TX
Immediate needle decompression in 2nd or 3rd IC space in MCL
or
5th IC space in MAL
Suspected Tension pneumothorax - do needle decompression and continue to remain unstable - next step ?
FAST to look for pericardial tamponade
Next step in tension pneumothorax after needle decompression
Chest tube placement in 5th IC space in MAL to maintain lung expansion
Cerebral Palsy Presentation
A group of syndromes characterized by non-progressive motor dysfunction
Most commonly spastic diplegia = hypertonia and hyperreflexia, equinovarus presentation (feet pointing down and in)
Intellectual disability
Leading risk factor in cerebral palsy
Prematurity before 32 weeks
Management of Cerebral Palsy
Physical, occupational, speech therapy
Baclofen, botulinum toxin
Intraventricular hemorrhage in newborn
What is it?
Risk factors
Bleeding into the germinal matrix
Premature
LBW infants
Presentation of Intraventricular hemorrhage
Pallor Cyanosis HypoTN Seizures Focal neuro signs Bulging or tense fontanel Apnea and bradycardia
Management of hyponatremia with moderate sx’s - confusion, lethargy
Hypertonic saline in first 3-4 hours to raise Na to > 120
Management of hyponatremia with severe sx’s - seizures, coma
Bolus of hypertonic saline until sx’s resolve
Conivaptan - Vasopressin antag
Management of hyponatremia in asymptomatic or mild sx’s - forgetfulness, unstable gait
Fluid restriction
Oral salt tablets
Loops if Uosm > 2x Serum osmolality
Best indicator of severity of TCA intoxication
Duration of QRS complex
- predicts chances of seizures and vent arrhythmias
TCA overdose Presentation
CNS depression HypoTN Hyperthermia Anticholinergic effects - Dilated pupils - Dry flushed skin - Intestinal ileus QRS Prolongation = vent arrythmias
TX for TCA toxicity
Sodium bicarb shortens QRS
Decreases likelihood of arrhthmia
Diabetic mononeuropathy of CN III
Type of nerve damage
Ischemic, so only somatic nerve fibers are affected
Parasympathetics not affected so light and accommodation reflexes are normal
Presentation of Secondary Raynauds
Older, > 40 Male Asymmetric attacks Tissue ischmeia features - numbness, ulcers ANA and RF
Causes of primary adrenal insufficiency (Addison’s)
TB AI Infxn Hemorrhagic infarction Mets cancer
Acid base of Addison’s
Aldosterone deficiency
- Non AG hyperkalemic, hyponatremic Metabolic Acidosis
Presentation for Androgen Insensitivity
XY Karyotype
External genitalia = female
MIF secreted by testis - prevents female internal organ development
Presentation for 5 alpha reductase deficiency
XY Karyotype
No conversion of Testosterone to DHT
Female external genitalia
Virilzation @ puberty
Presentation of Mullerian Agenesis
XX karyotype
Primary Amenorrhea
Blind ended vaginal pouch
Little/no uterine tissue
Tea and toast diet
Folic Acid Deficiency
Strict vegetarians + Anemia
B12 deficiency
Most common finding on cervical radiography in cervical spondylosis
Osteophytes
Presentation of cervical spondylosis
Chronic neck pain
Limited neck rotation and lateral bending
Glucose 6 phosphatase deficiency
Von Gierke's - type I glycogen storage dz 3-4 months old Hypoglycemia Lactic Acidosis Hyperuricemia Hyperlipidemia Doll-like face, fat cheeks Thin extremities, short stature, protuberatn abdomen Normal spleen and heart
Acid maltase deficiency
Type II glyocgen storage - Pompe’s
Floppy baby first few weeks of life
Macroglossia, difficulty feeding, heart failure
Presentation of acute massive PE
Syncope
Hemodynamic collapse
Pt with malignancy presents acutely w dyspnea, chest pain, tachycardia, hypoxia, clear lungs -DX?
PE
What cardiac changes do we see w acute massive PE
Acute RV dilation and failure b/c of RV outflow obstruction and increased pulmonary vascular resistance
Hypokinesis of RV free wall and sparing of apex
What 2 signs indicate increased risk of death in PE
- RV Dysfunction
2. Elevated BNP and troponin
What does recurrent pneumonia in same anatomic region suggest?
Causes?
Bronchial obstruction
- Bronchogenic carcinoma
- Carcinoid dtumor
- Foreign body
- Bronchial stenosis
When do we do bronchoscopy
- Masses documented by CT
- Negative CT +high suspicion for endotracheal obstruction
- Central mass on CT
Workup for CT scan with peripheral lesion
CT-guided BX
Cortisol and ACTH in Primary adrenal insufficiency
Low Cortisol
High ACTH
Cortisol and ACTH in 2/3 adrenal insufficiency
Low Cortisol
Low ACTH
Calculation for NNT
1/ARR
MCC nontraumatic Subarachnoid hemorrhage
Ruptured saccular or berry aneurysm
Non-contrast CT shows acute bleeding in cisterns
Systemic blastomyosis findings
skin and bones
Ulcerated skin lesions
Lytic bone lesions
Presentation of Type III glycogen storage
Deficiency?
Deficient in glycogen debranching enzyme
Hepatomegaly, hypoglycemia, hyperlipidemia, growth retardation
High LFTs
Fasting ketosis
Prussian blue stain means what
Presence of hemosiderin
Found in urine during hemolytic episodes
Pathophys of oxidative stress in G6PD
Hemoglobin oxidized to make methemoglobin, denatured globin, sulfhemoglobin
- These form insoluable masses = Heniz bodies that attach to RBC membrane, decrease pliability, and promote RBC removal in spleen
Colorectal cancer surveillance in pts with UC
Begin colonoscopy 8 years after Dx, maybe longer if Left colon
Repeat every 1-2 years
Presentation for spinal cord compression
Motor and sensory loss
Absent rectal tone
Urinary retention
What tracts are affected in spinal cord compression
- Descending CS = LE weakness/loss of rectal tone
- Ascending sensory ST -sensory 2 segments below level of lesion
- Descending autonomics in reticulospinal tract = urinary retention/bladder flaccidity/bladder shock
Management of spinal cord compression
- Immediate neurosurgical evaluation
- Neuroimaging while awaiting - MRI
- High dose glucocorticoids
Criteria for Insomnia
At least 3 nights/week for 3 months
Adjustment disorder w depressed mood
Marked distress out of proportion to stressor
Sx’s within 3 months of onset of stressor
Myasthenia crisis
Presentation
TX
Life threatening, caused by Infnx
Diaphram weakness causes respiratory distress
TX: Intubate if declining respiratory status. Steroids and IVIG or Plasmapharesis
Presentation of unilateral cervical lymphadenitis
TX
Rapidly enlarging, fluctuant cervical LNs
Children - MCC = strep or staph
TX: I&D + Clindamycin