UW 8 Flashcards
Causes of acute viral arthritis
Parvo B19 Hep B Hep C HIV Rubella
Parvo B19 Adult presentation
Polyarticular, symmetric arthritis Peripheral joints - hands, wrists, knees, ankles Fever Fatigue Diarrhea
Dx for Parvo B19
Anti-B19 IgM abs in serum
Within 10-15 days
Morning stiffness in RA
Lasts more than 1 hour
Risk factor for brain abscess
Cyanotic congenital heart disease - tet of fallot
Recurrent sinusitis
Presentation of medulloblastoma
HAs = morning/nocturnal
Cerebellar dysnfnc - Ataxia, incoordination
When do we do peritoneal lavage
To detect intraperitoneal bleeding in BAT when US for fast exam not available
OCPs are protective against what?
Endometrial cancer
Ovarian cancer
Reduction in benign breast disease
Risk factors with OCPs
Venous thromboembolism
HTN
Hepatic Adenoma
Stroke/MI (Rare)
Best initial test in preconception counseling w patient at risk for thalassemia
CBC
Best initial test in African for preconception counseling
Hemoglobin electrophoresis with CBC
Difference b/t Ehlers-Danlos and Marfans
ED: no tall stature, lens dislocation, pectus carinatum
Marfans: Fibrillin-1 mutation, tall, long thin extremities, joint hypermobility, aortic root dilation
Are gallstone radio-opaque or radiolucent?
Radiolucent - Cholesterol and mixed stones = majority
Confirmatory test for ALL
Bone Marrow BX
When do we do ERCP
Recurrent pancreatitis
draining pancreatic pseudocysts
PT presents with severe epigastric pain radiating to back. Next step?
Check amylase and lipase levels
THen CT
Where do we see spinothalamic tract lesions
Contralateral loss of pain and temp
Start 2 levels below the level of the lesion
Right sided lateral spinothalamic tract lesion at T10 presents with what deficit?
Left sided loss of pain and temp beg at T12
MGUS v MM
What is next best step in management in pt with monoclonal spike on protein electrophoresis
MGUS - no renal insufficiency, hypercalcemia, anemia, lytic bone lesions
Do metastatic skeletal bone survey
Pt suspected of MM - next step
Serum immunoelectrophoresis
When do we order bone scan in MM
Never.
MM causes lytic lesions in bone - not seen on bone scan
- must do skeletal survery = xray for lytic lesions
Presentation of fat embolus
Severe respiratory distress Petechial rash Subconjuctival hemorrhage Tachycardia Tachyypnea Fever
When does fat embolus occur
12- 72 hours after injury
Pt w cholelithiasis refuses cholecystectomy - TX?
Ursodeoxycholic acid
Acute otitis media in children Tx?
Oral Amoxicillin 10 days
Tx for Vaginismus
Relaxation
Kegel exercises
Insertion of dilators, fingers for desensitization
Hormones in Turner syndrome
Ovarian dysgenesis ->
LOW estrogen = unable to menstruate
Poor ovarian function = HIGH FSH bc lack of negative feedback
TX for placenta previa with stable mother and fetus at term
Scheduled C section
Causes of Immediate (w/in hrs) post-op fever (>100.4)
Prior Infxn/trauma Inflammation during surgery Malignant Hyperthermia Meds Blood products given during surgery
Causes of acute post op fever
When and what
Within first week
Nosocomial Infxn
PE
Causes of subacute post of fever
When and what
More than 1 week
Drug fever
Surgical site infxn
PE
What is SIBO
Small intestinal bacterial overgrowth
What are some causes of SIBO
Anatomic - strictures, surgery
Motility disorders - DM, scleroderma
Others - ESRD, AIDS, cirrhosis
What are si/sx’s of SIBO
Abdominal pain Diarrhea Bloating Excess flatulence Malabsorption Wt loss Anemia Nutritional deficiency
How do we Dx SIBO
Endoscopy w jejunal aspirate
Hydrogen breath test w lactulose = rapid lactulose metabolism causes early peak in hydrogen
How does serum sickness present
Young children Post Tx of viral infxn w/abx Fever Urticaria Arthralgias
What drugs MC cause serum sickness
PCN
Amoxicillin
TMP-SMX
Cefaclor
Young boy presents with URI. Treated w PCN and improves. 10 days later, fever, skin rash, fleeting joint pain in LE, urticaria, palpable LNs. MCC?
Serum Sickness
How does Rheumatic fever present?
Polyarthritis Carditits Erythema marginatum rash Subcutaneous nodules Chorea
Infective endocarditis
Fever Bacteremia Heart murmur Osler nodes - fingers and toes Janeaway lesions
Hereditary spherocytosis Presentation
Hemolytic anemia
Jaundice
Splenomegaly
Autosomal Dominant
Labs of Hereditary spherocytosis
Increased MCHC Increased osmotic fragility Spherocytes on PS Negative Coombs Abnormal eosin-5-maleimide binding test
ABO Incompatibility (isoimmune hemolytic dz of NB) and AIHA Presentation
Decreased Hb
Increased LDH
Hyperbilirubinemia
Positive Coombs
Coombs tes in Ab mediated hemolysis
Positive Coombs test
Polyarticular symmetric arthritis of acute onset and short duration + low grade fever
Viral arthritis
Viral Infxn that cause arthritis
Parvo Hepatitis HIV Mumps Rubella
What inflammatory markers may be elevated in viral arthritis?
Rheumatoid factor
ANA
Infant hypoxia that fails to improve w inhaled oxygenation
Congenital heart defect
- May need PGE2 to keep PDA patent
Congenital heart defects that depend on PDAs
Coarctation of aorta Transposition of Great arteries Hypoplastic left heart syndrome TAPVR Tricuspid Atresia
Presentation of Behcet’s syndrome
Recurrent oral ulcers + 2 of:
- Recurrent genital ulcers
- Anterior/Posterior uveitis
- Skin lesions like: Erythema nodosum, acneiform ondules, papulopustular lesions
- Retinal vascularization
- Positive pathergy test
How does Erythema nodosum present
Painful
Nodular
Areas of hyperpigmentation
