UW 7 Flashcards
Most common source of symptomatic pulmonary emobolism
Proximal deep veins - iliac, femoral, popliteal
When is dystonia seen with AP tx?
4 hours - 4 days
What is dystonia?
Muscle spasms or stiffness
Tongue protrusion/twisting
opisthotonus/oculogyric crisis
Tx for dystonia?
Diphenhydramine
Benztropine
Tx for Slipped capital femoral epiphysis
Surgical Pinning of slipped epiphysis
Placental abruptio Management
2 large bore IV lines
Urethral catheter
Ensure blood products available
Proceed with vaginal delivery if both mother and fetus are stable
MCC of acute unilateral cervical lymphadenitis in children
Staph aureus
Mallory-Weiss is rupture of?
Submucosal arteries of distal esophagus and proximal stomatch
Esophageal varices
Dilated submucosal veins at GE Junction that can rupture
Common cause of non traumatic avascular necrosis of femoral head
Chronic steroid use
- Progressive hip or groin pain w/out ROM, normal films
Dx test for avascular necrosis of hip
MRI
Acute onset dyspnea w wheezing and prolonged expiration
Bronchoconstriction
Triggers for bronchoconstriction in asthma patient
ASA
Beta Blocker
Complication of compartment syndrome?
Volkmann’s ischemic contracture
What is Volkmann’s contracture?
dead muscle has been replaced with fibrous tissue
Dull tympanic membrane that is hypomobile in an HIV pt?
Non-infectious effusion
- serous OM
- auditory tube dysfunction from HIV LA or lymphoma
- Conductive hearing loss
Otosclerosis
Conductive hearing loss
bony overgrowth of stapes
Middle aged individuals
Cherry red macula
Neimann Picks
Tay Sachs
Neimann-Pick’s Presentation
Deficiency
Hypotonia HSM Cervical LA Protruding abdomen Cherry red spot Def of spingomyelinase
Tay Sachs Presentation
Deficiency
Hyperacusis Mental retardation Seizures Cherry red macula NO HSM or Cervical LA Def - Hexosaminidase A
Gaucher’s Presentation?
Deficiency
HSM Anemia Leucopenia Thrombocytopenia Def in glucocerebrosidase
Krabbe’s Presentation
Deficiency
Hyperacusis
Irritability
Seizures
Def galactocerebrosidase
GBS PPX for unknown GBS status
Delivery < 37 weeks
Duration of membrane rupture > 18 hours
Prior Hx of delivery of infant w GBS sepsis
Best next step if decreased fetal movements?
Non-stress test
Suspect fetal compromise
When is NST done in pregnancy?
High-risk pregnancies starting at 32-34 weeks
Loss of perception of fetal movements in any pregnancy
What is a reactive NST?
In 20 minutes - at least 2 accelerations of fetal HR - at least 15 beats/min above baseline - Lasting 15 secs each 20-2-15-15
MCC of non reactive NST
Fetal sleep cycle
Next step if non reactive NST
Vibroacoustic stimulation
Next step if late deceleration on each contraction in contraction stress test
Delivery
What is Intrauterine fetal demise?
Death of fetus in utero after 20 weeks gestation and before onset of labor
IUFD presentation
Disappearance of fetal movements
Decrease/stagnation in uterine size
Fetal heart sounds not heard
Next step in management if IUFD suspected
Real Time US
Coagulation studies
Causes of IUFD
Hypertensive disorders DM Placental/cord complications Antiphospholipid syndrome Congenital anomalies Fetal Infxn - TORCH, Listeria
When do we do serial b-HCG monitoring
Molar Pregnancy
What should be done in stillbirths?
Autopsy of fetus and placenta w/parental permission
Trichomonas v. Bacterial vaginosis
Trich - green/yellow d/c and pH > 4.5, vaginal and vulvar inflammation
BV - off white d/c w/fishy odor
pH > 4.5, absent vaginal inflammation
Candida - thick cottage cheese dc, vaginal inflammation
Normal pH 3.8-4.2
Enoxaparin (LMW Heparin), fondaparinux, Rivaroxaban CI in what group?
Renal Insufficiency (GFR < 30mL/min/1.73m2)
Which pts should metformin be avoided in and why?
Acute renal failure
Hepatic failure
Sepsis
Increase risk of developing lactic acidosis
MCC of Infective endocarditis in IVDA
Staph aureus
MCC of infective endocarditis in prosthetic valves, intravascular shunts, prosthetic joints
Staph epidermidis
Red eye with leukocytes in anterior chamber
Anterior uveitis
Child abuse management
- Complete exam w/ removal of clothes
- Secure child’s safety - hospitalization
- Report to child protective services
Eikenella corrodens Presentation
Gram - anaerobe
Normal human oral flora
IE w/poor dentition/periodontal
Streptococcus gallolyticus
Strep bovis biotype I
Colonic neoplasia and IE
Enterococcus faecalis
IE w/ nosocomial UTIs
Mets to brain - Incidence
LBMC Lung Breast Melanoma Colon
Multiple brain lesions in both hemispheres with edema surrounding
Mets to brain from
Lung
Melanoma
Brain mets that present w solitary lesion
Breast
Colon
Renal cell
Presentation of Gliobastoma multiforme
Solitary mass w central necrosis and vasogenic edema
Arises from w/in brain parenchyma
When is atheroembolism commonly seen
Complication of cardiac cath and other vascular procedures
MC complication of atheroembolism
Skin
- Blue toe syndrome
- Livedo reticularis
- Gangrene, ulcers
