UW 4 Flashcards
Congenital dermal melanocytosis
Blue-dark spots on lower back and buttocks
Normal. More common in Hispanics, Africans, Blacks
No treatment required
Tumor Lysis sd
labs, tx, prophylaxis
Labs: high potasium, phosphate, uric acid; low calcium
Treatment: telemetry, electrolyte monitoring/treatment
Prophylaxis: IV fluids (to avoid deposition of uric acid and calcium phosphate and prevent stones formation)
allopurinol, rasburicase, febuxostat
Structural causes of recurrent pregnancy loss (4)
Uterine fibroids, adhesion, polyps.
Cervical insificiency
Endocrine causes of recurrent pregnancy loss (4)
Thyroid (hashimoto most common)
POS
DM
Hyperprolactinemia
Hashimoto thyroiditis antibodies
Antithiroid peroxidase (antimicrosomal) Antithyroglobulin
TCAs side effects and toxicity
Anticholinergics: dry mouthn, tachycardia, urinary retention
Antihistaminic: sedation, weight gain
Antiadrenergic: orthostatic hypotesion
Overdose: seizure, coma, cardiotoxicity ( prolonged conduction through the AV node, prolonged QRS), hyperpirexia and respiratory depresion
TCAs intoxication treatment
ABCs/supportive
-sodium bicarbonate if QRS >100msec, low BP. or arrythmia
Indications for statin therapy
21-75 with atherosclerotic cardiovascular disease
21-75 LDL>190
> 40 with diabetes
> 40 with LDL 70-189 and 10 year-risk of >7.5% (high itensity) >5% low intensity
> 40 with 10 year-risk
Ototoxic medications
Aminoglicosides
High dose salicilates
Ciplastin
Loop diuretics (furosemide; especially in renal failure)
Warfarin induced skin necrosis. (
definition and management)
Due to inhibition of protein C during the first few days of Warfarin initiation.
Lesions typically occur in extremities, trunk and penis and spread over a few hours.
Stop warfarin, give protein C
Clinical features of Pagets disease of the bone
a. Asymptomatic
b. Skull (headache, hearing loss), spine (spinal stenosis, radiculopathy), long bones (bowing, fractures, arthristis of adjecent joints.
c. Giant cell tumor, osteosarcoma
Labs of Pagets disease of the bone
Elevated ALP
Normal GGT (elevates in GI pathologies)
Calcium and PO usually normal
Elevated turnover markers (PINP, urine hydroxyproline)
Treatment of Pagets disease of the bone
Biphosphonates
Anion gap metabolic acidosis + calcium oxalate crystals
ethylene glycol ingestion
forschheimer spots; assoc. w/rubella
forschheimer spots; assoc. w/rubella
HIV-assoc. kidney disease
FSGS
Intermitent explosive disorder
Inability to restrain aggressive behavior
Situation escalate rapidly, last <30min and patient feels remorse
Exclude other possible diagnosis first
Treat with SSRI
Buspirone use
Anxiolytic use in generalized anxiety disorder
Mediastinal tumor
Thyroid
Thymoma
Terrible lymphoma
Teratoma (and other germ cell tumors)
Seminoma: Elevated B-hCG, normal AFP
Non seminomatous: Elevated AFP, often B-hCG elevated too (yolk sac, ebryonal, mixed, choriocarcinoma)
Suspected ectopic pregnancy algorithm (pg 317)
+ Urine B-hCG, and clinical symptoms
Unstable=====> surgery
Stable: TVUS
a. Adnexal mass = extopic pregnancy
b. Intrauterine pregnancy
c Non diagnostic ===> messure serum B-hCG
c.1. >1500: Repeat B-hCG + TVUS in 2 days
c2. <1500: Repeat B-hCG in 2 days
Central cord sd.
Due to neck hyperextension usually in older patients
Weaknes of extremities most notable in upper body
Pain and temperture loss of sensation
UTI and asymptomatic bateriruia in pregnancy treatment
Nitrofurantoin for 5-7 days Azithromycin for 3-7 days Fosfomycin single dose TMP-SMX (second trimester only) Fluoroquinolones contraindicated
Risk of oral contraception
Hypertension Thrombotic events Hepatic adenoma Cervical cancer Stroke, MI (rare)
Congenital adrenal hyperplasia pg 365
Study
Nontreponemal test
VDRL
PRR (plasma rapid reagin)
antibody to cariolipin-lecitin-cholesterol antigen
Renal biopsy:
Effacement of podocytes foot proceces
Minimal change disease (most common nephrotic syndrome in <6yoa)
Renal biopsy:
Renal deposition of IgG along the glomerular basement membrane
Goodpasture sd.
Renal biopsy:
Longitudinal spliting of the glomerular basement membrane
Alport
Renal biopsy:
Mensangial and capilary deposition of C3 and IgG
Post infectious glomerulonephritis
Renal biopsy:
Mensangial deposition of IgA
IgA nephropathy (hx of GI or Upper respiratory infection)
