UW Notes 2 Flashcards
Treatment for Croup?
Corticosteroids, then add racemic epinephrin
Supplemental O2 and intbuation if needed…obviously
alcohol consumption recommendations for women?
What is the mechanism of anemia of prenaturity?
decreased EPO and shorter lifespan of RBCs
Baby with retinal hemorrhage and enlarging head circumference… you should think what?
shaken baby syndrome
child with arthralgia, purpura/petechia, and renal issues… what do you think of?
HSP
elevated protein and normal cell count in CSF. what is this called? what is it associated with?
Albuminocytologic dissociation. Associated with Guillain Barre
max serum sodium correction rate should be…by hour? …by day?
Lithium triggers central or nephrogenic DI?
nephrogenic
Treatment of lithium induced DI?
stop lithium,
salt restriction, amiloride
when is nasotracheal intubation contraindicated?
apneic/hypopneic patients
basilar skull fx patients
when is needle cricothyroidotomy preferred?
children
5 criteria of metabolic syndrome?
- abdominal obesity (men >40; women >35)
- fasting glucose >100
- BP >130/80
- Triglycerides >150
- HDL cholesterol
what’s different about Guillain barre and tick borne paralysis
tick borne is usually hours onset, asymmetric, no autonomic dysfunction
GBS is days to weeks onset, symmetric, with autonomic dysfunction
obstructive lung dz…FEV1/FVC ratio?
meralgia paresthetica sx?
lateral fem cutaneous nerve compression at waist. paresthesia of lat thigh
neuroleptic malignant syndrome is associated with what several classes of drugs that share what property?
all are dopamine antagonists
digoxin toxicity (acute)
GI symptoms (n/v/abd pain), weakness, confusion
digoxin toxicity chronic versus acute?
more neurological/visual symptoms and less GI
What medication can induce digoxin toxicity? how should dig be managed when starting this?
amiodarone. must decrease dig by 25-50%
does pregnancy make the pt more or less hypercoagulable? why?
more because of increased fibrinogen, decreased protein S, and increased resistance to protein C
McCune-Albright Syndromic features
polyostotic fibrous dysplasia;
precocious puberty, cafe au lait spots
intrahepatic cholestasis of pregnancy…treatment?
ursodeoxycholic acid
early delivery
treatment of x-linked agammaglobulinemia (Bruton’s)
IVIG, prophylactic antibiotics
OCD…treatment?
psychotherapy
high dose SSRI
how can you provoke absence seizure? diagnosis?
hyperventilation.
EEG you’ll see 3Hz spike waves.
how to calculate anion gap? what’s nl range?
Na-Cl-Bicarb
8-12
anion gap metabolic acidosis.
alcoholic with vision loss/hyperemic optic disc?
methanol
Pellegra 3 symptoms?
what deficiency causes it?
dermatitis, diarrhea, dementia
niacin deficiency
winter’s formula is used to do what? what is it?
assess appropriate pCO2 compensation for metabolic acidosis.
pCO2=1.5(HCO3)+8+/-2
treatment for fibromyalgia
- exercise an good sleep hygiene
2. TCA antidepressants
fever, abd pain, hematuria in a nephrotic patient…dx? why?
renal vein thrombosis; due to loss of antithrombin III
renal vein thrombosis is associated with what kind of nephrotic disease?
membranous glomerulonephropathy
what’s the genetic etiology of complete mole?
2 sperms fertilizing 1 ovum without any genetic info
abx classes for Legionnaire’s disease?
fluoroquinolones, macrolides
four types of sensation categories of focal seizures?
motor: jacksonian march
sensory: paresthesia, vertigo
autonomic: sweating
psychic: de javu
dx criteria of ADHD? (x3)
- > 6 months
- in 2 settings
- prior to 12 years
which glomerulonephropathy is associated with HepB?
membranous
centor criteria for strep pharyngitis? (4)
fever
anterior cervical lymphadenitis
tonsillar abscess
NO cough
who should get oseltamivir for flu? (4)
- pregnant
- > 65
- other chronic medical problems…
- withiin 48 hours
PROM is PPROM at what time? what’s the proper management?
34 weeks. baby should be delivered
pancreatitis diagnosis; is amylase or lipase better?
lipase
aortic regurg; describe the murmur? where is the murmur best heard? what position should the patient be?
early diastolic decrescendo at the3-4th L sternal border, best when pt is leaning forward
B12 is absorbed where?
ileum
hoarding behavior disorder. what’s the treatment?
cognitive behavioral therapy
can also add SSRI
what is psychodynamic psychotherapy?
psychotherapy based on the unconscious mind
how do you assess cervical length/competency in a woman with prior cervical surgery?
transvaginal US. (way better than digital examination)
DKA diagnostic criteria? (3)
- glucose >250
2. oH low
DKA initial management?
- IVF NS
- regular insulin
- Potassium correction
- treat precipitating factor (such as infection)
how to manage threatened abortion?
reassurance. may recommend bed rest and abstain from sex.
- no need to hospitalize
Beck’s triad for cardiac tamponade
distant heart sound, JVP elevated, hypotension.
suspicious of this when pt is s/p cardiac surgery with tachy/tachypnea
early cyanotic child with L axis deviation, and decreased pulmonary markings….what do you think of?
tricuspid atresia/hypoplastic R heart
Pts with Primary sclerosing cholangitis is at risk for what cancer?
colorectal
antimitochrondrial antibodies
primary biliary cholangitis
blood on initiating urination…where’s the bleed
urethra
terminal blood upon urination…with clots
bladder/trigone/posterior urethra bleeding.
sinusoidal fetal heart tracing means what
fetal anemia
variable decelerations on fetal heart tracing indicates what
compression of cord
enuresis is a problem after what age?
5 years
Enuresis. after behavioral modification and enuresis alarms…what is the first and second line pharmacotherapy
first line: desmopressin: (SE: relapse and hyponatremia)
Secondline: Imipramine
What are the recommendations regarding PSA screening for prostate CA?
USPSTF: recommends no screening…but other societies still recommends it…so TALK TO THE PATIENT on individual basis
Why is cefotaxime preferred over ceftriaxone in neonates (NOT infants)?
because ceftriaxone displaces albumin from bilirubin…can cause kernicterus
acute limb ischemia… you should start immediate anticoagulation… and you should also perform what?
echocardiogram to assess for L ventricular thrombus
DOPAMINE RASH mneumonic of SLE?
Discoid rash Oral ulcer Photosensitivity Arthritis Malar rash Immunologic criteria Neurologic sx ESR Renal ANA Serositis Hematologic
management of postpartum blues?
monitor beyond 2 weeks. should be self limited
what acid base abnormalities are seen in Asprin overdose
metabolic acidosis
AND
respiratory alkalosis
(fever, tachypnea, tinnitius… are other sx)
Zollinger Ellison is associated with what disease? what are some sx?
MEN1; due to elevated gastrin >1,000
reflux sx, abd pain, weight loss, diarrhea, GI bleeds, jejunal ulceration, refractory to PPIs
parotid surgery complication?
facial droop 2/2 disruption of facial nerve
what’s the neurologic connection between boca’s and wenicke’s areas?
arcuate faciculus
acute therapy for gout?
indomethacin, colchicine, steroids
what is contraction alkalosis?
loss of H+ due to effects of aldosterone in effort to conserve volume
neurogenic claudication?
claudication-like pain produced in spinal stenosis.
spinal extension makes it worse
normal ankle brachial index
Gottron papules are associated with what?
dermatomyositis
psoriatic arthritis treatment?
NSAIDS, Methotrexate, TNF alpha inhibitors
what’s nl QT interval?
450
What is the autosomal recessive long QT conditions?
Jervell and Lang-Nielsen
How do you treat prolonged QT?
Propranolol +/= pacemaker
what is the autosomal dominant long QT condition?
romano ward
What classes of drugs can cause long QT?
Macrolides Fluoroquinolones antipsychotics antiemetics antiarrythmics opioids
how to treat bacterial endocarditis without heart failure?
IV antibiotics. DOn’t do surgery unless there’s heart failure
buproprion is contraindicated in what populations?
bulimia/anorexia, seizure, recent monoamine oxidase inhibitor use
What are the features of TTP?
renal failure, hemolytic anemia, thrombocytopenia, fever, and AMS
it’s like HUS without diarrhea + fever, CNS sx
what are type A and type B adverse drug events?
Type A is dose dependent
Type B is dose independent/unpredictable: SJS, NMS…etc
Tourrettes tx?
risperidone, behavioral therapy (and first gem antipsych)
post nasal drip treatment?
antihistamines
bradycardia (sick sinus syndrome). medical therapy
atropine (antimuscarinic)
asymptomatic bacturia treatment in pregnancy
nitrofurantoin x7 days
amoxicillin x7 days
fosfomycin single dose
should you give fluoroquinolones to pregnant women? why?
no, because of cartillage dysplasia
how to manage varicocele?
depend on age and fertility desires…
scrotal support, NSAIDS, surgery
new diagnosis of HTN in
chronic HTN
new dx of HTN in >20 weeks of pregnancy is called?
gestational HTN (as long as there’s no proteinuria/edema/end organ damage)
vesicoureteral reflux. how to diagnose?
voiding cystourethrogram
TCA overdose; treatment?
sodium bicarb to shorten QRS interval
What is the Dxylose test used to diagnose? How does it work? and what can it r/o?
Dxylose can be absorbed in the small intestines without pancreatic enzymes.
it is used to diagnose celiac disease since, absorption won’t occur due to damaged villi.
It r/o pancreatic causes of malabsoption
triglyceride of >1,000, hx of MI, eruptive xanthomas…abd pain. dx?
hypertriglyceridemia induced pancreatitis
What does herpangina look like/where is it? what causes it? how is it different from herpetic gingivostomatitis?
herpangina–>small vesicles on pharyngeal pillars; due to coxackie virus in the late summer time. herpetic gingivostomatitis is on the lips
smoking destroys which part of lung first? where does alpha 1 antitrypsin dz destroy first?
smoke=upper; alpha 1 antiptrypsin=lower
abortive sx; no sac is seen in the uterus or outside on US… what should you do
get beta hCG and follow to determine if it’s ectopic or if it’s completed abortion
at what bhCG level can you usually visualize gestational sac?
1,500-2,000
constitutional growth delay
pattern of growth?
testosterone levels?
bone age?
pt born normal weight; falls off until puberty (which is delayed)
testosterone is normal
bone age is delayed
mechanism of benztropine?
anticholinergic
mechanism of trihexphenidyl?
anticholinergic
most common osteomyelitis organism?
Staph aureus
how to diagnose gallstone pancreatitis?
RUQ US, possible ERCP after
When should you involuntarily commit a patient?x2
when they’re a danger to themselves/ others;
grave disability where they can’t care for themselves
Atrophic vaginitis can be associated with urinary incontinence/UTIs. What’s first line of tx for atrophic vaginitis? second line?
first line is moisturizer/lubricants; then it’s low dose estrogen
urinary incontinence 2/2 urethral hypermobility presents with incontinence when?
activity involving increased abd pressure
myotonic dystrophy has what pattern of inheritance? what’s the mutation?
autosomal dominant; CTG repeat expansion
whenever there’s postmenopausal bleeding and thickened endometrium on US…you should do what?
endometrial biopsy
incidental finding of asymptomatic endometriosis what should you do?
observation
how to treat symptomatic endometriosis?
OCP, progesterone IUD, or leuprolide (anti GnRH)
what do you see on blood smear for thalassemia?
tear drop cells and target cells
treatment for cyanide poisoning?
sodium thiosulfate
what kind of compounds can cause cyanide toxicity?
carbon and nitrogen containing compounds… like nitroprusside
symptoms of cyanide toxicity
N/V, flushing, CNS HA/confusion, arrhythmia, tachypnea followed by respiratory depression
why is ACE I contraindicated in pregnancy?
ACE I can cause fetal renal damage
informed consent. you must discuss what 4 topics?
indication, risk, benefit, alternatives
bed wetting is normal until what age. Before this age you should NOT try to prescribe any help methods
5 years
time requirement for chronic bronchitis?
> 3 consecutive months in 2 successive years
what’s the most immediate intervention in acute liver failure?
liver transplant;
renal dysfunction will develop, but dialysis should NOT be done before liver transplant
when should sclerotherapy be used in cirrhotic?
when there’s a bleeding varices
what is the definitive way to diagnose Duchene’s MD?
genetic testing; biopsy will only support the dx
pharmacotherapy for raynaud’s
CCB
CT scan can induce thyrotoxicosis…why?
acute iodine influx via contrast
Why might you see hematuria with no RBCs in a pt with heat stroke?
rhabdo
pleural effusion. what happens to breathsounds, fremitus, percussion?
decreased breathsounds, decreased fremitus (bc fluids insulate around the lung), and dull to percussion
pulmonary infiltrate/consolidation. what happens to breathsounds, fremitus, percussion?
decreased breathsounds/crackles, increased fremitus, dullness to percussion
most common cause of bacterial pneumonia in HIV
strep pneumo
conservative treatment for renal stones?
hydration, pain control, and alpha blockers (tamsulosin)
drug of choice for cat bite prophylaxis?
amoxicillin-clavulanate
arterial thrombosis versus embolus in the extremity…what’s the difference in presentation
thrombosis is slower onset
embolus is sudden…and if there’s afib then it’s obvious
acute stress disorder versus post traumatic stress disorder. what’s the difference
acute stress is 1 month
post concussive syndrome sx?
mild TBI;
HA, confusion, amnesia, difficulty concentrating, anxiety, mood alteration, vertigo
early decel’s FHT. causes
fetal head compression. normal
late decel FHT. causes
placental insufficiency
variable decel FHT. what is it? causes?
quick deceleration
atypical squamous cells of undetermined significance. what should you do if pt is 25?
under 25=repeat pap in 1 year
over 25=test HPV; if positive do colpo; if negative f/u with pap+HPV testing in 3 years
3 bacteria of bloody diarrhea
shigella, e coli, and campy
strep pharyngitis how do you test?
rapid strep. culture is gold standard
tumor lysis syndrome can have what effects on serum potassium, calcium, phosphate?
potassium and phosphate will increase
phosphate will bind calcium thus calcium will decrease
pt with appendicitis for >5 days. you should be worried about what?
appendiceal abscess
why should you not restrict calcium with renal stones?
calcium binds oxalate. therefore decreased calcium will result in more oxalaturia and possibly worse stones
what is recommended in terms of sodium and potassium intake in the face of renal calculi?
low sodium diet as calcium is excreted with sodium
high potassium diet as potassium increases urinary citrate excretion and lessens stone formation
what’s the most sensitive marker of CHF? what’s the most specific marker of CHF?
sensitivity is high with BNP
specificity is high with third heart sound
pts with high risk of thromboembolic events 2/2 afib (aka CHA2DSVASc2 score is high); then you should put the pt on prophylactic what?
anticoagulation. via warfarin or Xa inhibitors
what’s the difference between aplastic crisis and aplastic anemia?
aplastic anemia is a pancytopenia due to bone marrow failure (fanconi anemia, autoimmune)
versus
aplastic crisis is a sudden drop in red count due to things like parvo B19
total calcium in the body exist in what 3 ways?
ionized, bound to albumin (thus hypoalbuminemia–>hypocalcemia), and bound to phosphate
platelet dysfunction with uremia…what’s the treatment of choice?
DDAVP to increase von willebrand factor
DO NOT transfuse platelet because it doesn’t work +platelet count is generally normal
drugs of choice for post exposure prophylaxis to HIV? duration?
tenofovir, emtricitabine, raltegravir
start it immediately and stay on it for 4 weeks
child with first episode of UTI under
renal/bladder US
acute decompensated heart failure. what should you give the patient first?
loop diuretics and vasodilators (nitro)
then add on betablocker later on…acutely it can decrease cardiac output and should NOT be given
Meniere’s disease. triad of sx
vertigo, tinnitus, and neuro sensory hearing loss
Meniere’s treatment?
avoid sodium, caffeine, nicotine, alcohol
long term diuretics
