UW Notes 3 Flashcards
preeclampsia with severe features is >140/90 with end organ damage OR above what BP?
160/110
in pregnant person with severe HTN… given the choice between hydralazine and labetalol…what should you look at to decide which one is better?
they’re both effective in HTN emergencies… labetalol you should look at things that beta blockers could negatively affect…such as bradycardia
when is methyldopa best used in pregnant HTNsive?
chronic HTN. not for crisis
pleural plaques is a buzzword for what?
asbestosis. NOT mesothelioma
what is the best management for a hemodynamically stable pt with incomplete abortion? what if they’re hemodynamically unstable
stable: expectant management and followup OR you can give prostaglandins
unstable: do D&C
torticollis. med induced or congenital or whatever… is a type of what kind of disorder?
dystonia
where does morton neuroma occur?
between third and fourth metatarsals. often in runners with plantar pain and crepitus when palpating
upper respiratory infections/ulcers
lower repsiratory infections/ulcers
glomerulonephritis
wegener’s
granulomatosis with polyangitis.
ectopy resulting in afib usually originates where?
pulmonary veins
attributable risk percent?
(risk of exposed-risk of unexposed)/risk of exposed
(RR-1)/RR
how do you reduce chance of cerebrovascular spasm s/p SAH?
nimodipine
slapped cheek is called…?
erythema infectiosum
Legg-calve-perth. how do you treat?
bracing and observation.
if it’s very displaced–>then surgery
eclampsia seizures are usually what?
it’s usually short, generalized, and tonic clonic
what are predisposing factors preeclampsia?
previous preeclampsia
increased maternal age
maternal hx of HTN
what is buproprion good for?
its not associated with weight gain,
it has mild stimulant effect
it helps with smoking cessation
it does not have sexual SE.
narcolepsy tx?
modafinil
dysgerminoma can secrete what hormones?
LDH and beta hcg
what are the two key features of obesity hypoventilation syndrome?
- day time hypercapnea
2. obesity
acute bacterial prostatitis. how is the presentation different from cystitis? how do you diagnose? should you do urethral catheterization if there’s retention?
- more systemic sx and regional pain with prostatitis
- diagnose with mid stream catch and culture
- DO NOT catheterize through urethra. consider suprapubic cath if needed to avoid worse inflammation
presence of anti HBs, anti HBc, and anti HBe?
presence of antiHBs and anti HBc WITHOUT antiHBe?
all three=recovering
antiHBs and HBc=resolved.
normal aging patterns on sleep. Total sleep time nocturnal wakings waking in general becomes... latency? REM? slow wave?
total sleep time--> decrease nocturnal waking-->incrase waking in general -->increase and earlier latency-->increase REM-->decrease slow wave-->decrease
what class of med is fluphenazine? what is an important SE?
it’s a typical antipsychotic; an important SE is hypothermia
carboxyhemoglobinemia…what’s bound to the Hb?
carbon MONoxide
chronic macular lesion with loss of sensation…what should you be thinking of?
leprosy
You should do imaging with Type A aortic dissection. what’s preferred in renal insufficient pt? what about a normal renal function patient?
normal renal function: CTA
renal insufficient pt: transesophageal echocardiogram
what are risk factor for iron deficiency in an infant.
- prematurity
- low maternal iron store
- early introduction to cow’s milk
morbid obesity can result in anovulation due to excess estrogen. what are the FSH/LH levels?
normal
leukocytosis can be seen in Kawasaki disease. what is the predominant leukocyte?
neutrophil
Kawasaki disease treatment?
ASA and IVIG
what class of abx is most associated with renal failure?
aminoglycosides
Which type of amyloidosis is AL and AA?
AL is primary amyloidosis
AA is secondary amyloidosis 2/2 chronic inflammation
what’s a normal biophysical profile score for infants?
8 to 10 is normal
6 equivocal
fetal sleep cycle asts about 20 minutes; it can be disrupted via what test?
vibroacoustic stimulation
What is salvage therapy?
a second form of therapy when the initial treatment fails and disease recurs
when there’s maternal or fetal concerns weekly biophysical profile are done. If the BPP results in 8 how often should you f/u? if BPP shows 6 how often should you follow up?
if 8, then i’ts normal and conresume weekly f/u
if it’s 6 you need to repeat in 24 hours
if it’s 4 or lower, you need to deliver baby
infectious endocarditis with viridans strep…what is the tx?
penicillin G or ceftriaxone
firstline (2) medical therapies for BPH?
Tamsulosin and finasteride
three conditions where you can see asterixis
hepatic encephalopathy, uremic encephalopathy, CO2 retention
what is the AEIOU of urgent hemodialysis?
A=acidosis
E=electrolytes
I=ingestion (methanol/ethylene glycol, ASA, lithium, valproate
O=overload refractory to diuretics
U=uremia (sx of encephalopathy, asterixis, pericarditis, bleeding
Uric acid kidney stones…treatment?
aggressive hydration, urine akalinization via Kcitrate, low purine diet and can add allopurinol
syringomyelia is associated with trauma/tumor/infections..but it can also be associated with what congenital malformation?
Arnold chiari I
tension pneumo in a hemodynamically unstable pt…what should you do?
needle thorocostomy followed by tube thorocostomy. NO imaging unless the pt is stable.
freaking out about flying 2/2 fear of dying… is a what dx?
specific phobia
DM patient with neuropathy sx and new upper motor neuron sx…what should you think of?
spinal abscess…ask about recent illness
mediastinal mass in a young male that produces betahCG and AFP?
nonseminomatous germ cell tumor. can be locally invasive.
thymomas are associated with myasthenia gravis and what other disease?
pemphigus
common causes of osteomalacia?
- GI causes: by pass surgery, celiac sprue
- chronic liver/kidney disease (renal tubular acidosis 2)
- low vitamin D/calcium intake
pt s/p trauma with blood at urethra meatus, inability to void…what should you do?
retrograde urethrogram
malrotation-mediated obstruction and necrotizing enterocolitis both happen in very young infants and has similar sx…that’s the difference on imaging?
malrotation will show a gasless abd
NEC will show pneumatosis intestinalis.
risk factors for necrotizing enterocolitis?
prematurity, low birthweight, reduced mesenteric perfusion (congenital heart disease/hypotension)
SCID is associated with failure of T cell development…that also leads to failure of B cells to mature. What is the treatment for SCID?
stem cell transplant
Niacin causes flushing, generalized pruritis through what mechanism?
increase prostaglandin and peripheral dilation
what is the Uhthoff phenomenon?
sx of MS worsen in higher temperatures
pleural effusion that COULD be suspicious for cancer….what do you do first?
you do thoracentesis first bc it’s the easiest and allows you to figure out if it’s transudate or exudate.
bronchoscopy is good too, but will require sedation and is more invasive
Pinzmetal’s angina is usually in what kind of population…and what’s the presentation?
young female smokers, who get CP at night that spontaneously resolves. Transient ST elevation can be seen on ECG
what are the 3 hereditary germline mutations associated with pancreatic ca?
BRCA1 and 2; Peutz jeghers syndrome
besides smoking. what are two other nonhereditary factors associated with pancreatic cancer?
obesity
chronic pancreatitis
lichen sclerosis. what does the vagina look like?
normal. it doesn’t affect the vagina. only the vulva.
what does the hazard ratio signify?
ratio of event rate of treatment group/ nontretment group.
what is the mechanism of disease for membranoproliferative glomerulonephritis?
igG against C3 convertase leads to persistent complement activation –>C3 dense deposition in glomerulus. (NO igG deposition)
pts with hx of colon cancer in a first degree relative should start colonoscopy when?
10 years prior to dx time of the relative OR at 40 years of age
rheumatic fever can happen after skin or throat strep infection?
only pharyngitis
post strep glomeruloneph occurs after skin or throat strep infections? how long after does it show up?
BOTH pharyngitis and skin infections;
2 weeks after
charcot’s triad for cholangitis?
fever, RUQ pain, jaundice
how to manage pancreatic pseudocyst if asymptomatic. if symptomatic?
if asymptomatic: conservative expectant management
if symptomatic: endoscopic drainage
in patients who are pregnant/at extremes of ages/immunocompromised can get severe measles, and can benefit from vitamin A…what are the consequences of severe measles? 3
- encephalitis
- pneumonia
- blindness
what do you expect the iron store to be in thalassemia?
normal or high
which drugs are associated with decreased mortality in heart failure pts? what if the patient is African American?
ACE/ARB/aldo R blockers and beta blockers
in AAs: also nitrates+hydralazine
Mono–> should avoid contact sports for how long?
3 weeks
what is the mechanism of buproprion. what are its benefits. who is contraindicated in taking it
it’s a norepi-dopamine receptor blocker.
it does not have any weight gain/sexual SE
don’t use in seizure/eating disorder people
what are the 6 classes of antidepressants (for unipolar depression)
SSRI, SNRI, NDRI, MAOI, TCA, atypicals (mirtazapine, trazodone)
genetic abnl in Beckwith-Wiedemann syndrome. what does this genetic area code for?
mutation of the 11q15 area that codes for IGF2
beckwith Wiedemann syndrome is at an increased risk for what? so you should do what to manage these pts?
they’re at increased risk for tumors (wilm’s and hepatoblastoma), you should do serial US and alpha fetal proteins to monitor for years
what’s the mechanism of disease of TTP?
dx?
Treatment?
acquired abs to ADAMTS13 which leads to uncleaved chain of von willebrand factor–> clumps of platelets.
dx with blood smear: schistocytes
Treat plasmaphoresis and glucocorticoids
vonGierke’s deficiency? syndromic features? presentation?
glucose 6 phosphatase deficiency.
“doll like face”, thin extremities, short, protuberant abd
hypoglycemia, lactic acidosis, hyperurecemia, hyperlipidemia
enzyme deficiency in pompes’ disease?
acid maltase
manifestation of theophylline toxicity
CNS and cardiac toxicity
HA, N/V, arrythmias
what is a dangerous condition that can occur in someone with systemic scleroderma?
scleroderma renal crisis–>activation of coag cascade and renin secretion–>severe HTN; hemolysis; thrombosis
what are Burr cells associated with? what are they also called?
liver/renal disease; echinocytes
what are spur cells associated with? what are they also called?
liver disease; acanthocytes
erysipelas is caused by what bacteria?
Group A strep
kidney stone management 4 cardinal things you should address
- imaging confirmation via CT scan after KUB
- pain control NSAIDS are better than narcotics
- assessment of size: if
people often can get pneumonia after influenza illnesses; what are the most common organisms associated with this?
strep pyogenes and staph aureus
how to manage Mallory Weiss tears?
90% will spontaneously heal. if not then you have to do electrocoagulation or epiniphrine
heat stroke pt… other than giving IV hydration what should you do to cool them?
put in ice bath
you can hear a S4 in “stiff hearts” and what acute condition?
acute coronary syndrome/MI
“atrial gallop”
patient who develops infectious endocarditis with a recent history of pyelonephritis. what organism should you think of?
enterococcus
“ U Heart Tree”
whats’ the most common bacteria overall for infectious endocarditis?
staph aureus
pernicious anemia; mechanism of disease; symptoms of disease?
antibodies against intrinsic factor–>leads to macrocytic anemia 2/2 B12 deificiency.
sx of peripheral neuropathy, glossitis, neurological changes, anemia
pernicious anemia is associated with what two conditions?
intestinal type gastric cancer
carcinoid tumors
Waldenstrom macroglobulinemia is associated with monoclonal IgM expansion. what are the major manifestations?
hyperviscosity syndrome neuropathy bleeding hepatosplenomegaly lymphadenopathy
what other drug can be used to treat syph if they’re allergic to penicillin? who should be desensitized and NOT be be given penicillin anyway?
Oral doxycycline.
pregnant, neuro/ocular syphilis
calcium channel blockers preferentially dilate what vessels thus causing edema as one of the SE?
arterioles
what drug combined with calcium channel blockers can reduce the incidence of edema? (which is a SE of CCB)
ACE I/ARB causes post capillary dilation to balance out the precapillary dilation of the CCB
primary mechanism of olanzapine?
serotonin and dopamine receptor blocker
angina pectoris; first line long term therapy? contraindications?
beta blockers; don’t give to hypotensive/bradycardic pts
what is the immediate symptomatic treatment for thyrotoxicosis?
propranolol. then definitive treatment once pt is stabilized
cyclic vomiting syndrome is associated with what condition?
migraines
in a patient with aortic dissection. YOU MUST IMAGE the patient first to confirm/rule out the diagnosis… what is the preferred method of imaging in a stable patient? unstable?
stable do CTA
unstable do TEE
what is the treatment for polycythemia vera?
phlembotomy +/- hydroxyurea
growing pain is lower extremity bilateral pain that is only at night in a kid with otherwise no sx and nl activity. what is the tx?
reassurance
serious malignant otitis externa can cause what kind of symptoms? what organism causes malignant otitis externa
pseudomonas. can cause skull abse osteomyelitis/facial nerve destruction
treatment for MALToma without any metastasis
triple H pylori treatment:
Clarithromycin
Amoxicillin
PPI
nasopharyngeal carcinoma is caused by what virus?
EBV
HIV diarrhea
cryptosporidium (acid fast!)
ECG changes associated with acute pericarditis?
- ST elevation diffusely
2. PR depression
non ketotic hyperosmolar syndrome is associated with what? and what happens?
associated with recent URIs; hyperglycemia occurs with increased cortisol and catecholamine levels.
intubated patient starts getting severe respiratory infection >48 hours after intubation. what are the likely organisms?
how should you manage?
G- bacilli (pseudomonas, E. coli, klebsiella)
G+ cocci: MRSA, strep
GET pulmonary sample THEN start empiric abx
what is first stage of labor? what are the two phases of stage 1
start of contraction to 10 cm dilated. latent phase (up to 6) and active phase (rapid dilation)
If labor is arrested but there is adequate contraction (200 Montevideo in 10 mins)…what should you do?
c section
Asperin exacerbated respiratory disease. what are the associated sx?
asthma, rhinosinusitis, nasal polyps, bronchospasms, nasal congestion with NSAID/asprin use
young man with sudden onset SOB. what do you think this is? how do you treat?
spontaneous pneumothorax.
treat with O2 supplementation if it’s small. Otherwise consider needle thorocostomy/tube thorocostomy
how to treat mild hypothermia
IVF; passive warming at rate of 1-2 C/hr
Hodgkin lymphoma is associated with what renal disease?
minimal change nephropathy
penile fracture. what do you need to do to manage it?
do retrograde urethrogram THEn surgery
what’s so good about epinephrine’s mechanism of action that makes it good for anaphylaxis?
alpha 1 stim: vasoconstriction
beta 2 stimulation: bronchodilation
risk of encapsulated organism sepsis is high for how long after splenectomy? how do you mitigate infection risk?
up to 30 years;
you should give vaccination prior to splenectomy and do daily prophylactic oral penicillin for 5 years
how do you treat betablocker toxicity?
after ABCs
do Glucagon it increases cAMP
what are the signs of betablocker toxicity?
hypotension, bradycardia, wheezing, AV block.
what kind of heart damage is most associated with infectious endocarditis?
mitral regurg/prolapse
How do you treat botulism?
IVIG
a child with first time proteinuria. what should you do?
repeat the test at least 2x; could be intermittent/transient: due to exercise, stress, orthostatic…etc
why could a hep C patient get glomerulonephritis?
cryoglobulinemia. the large IgMs can get lodged everywhere (hep Sea!)
4 common causes of priapism
sickle cell
medications-trazodone, prazosin
spinal cord lesions
perineal trauma
what is contraindicated with R heart failure?
anything that reduces preload…such as nitrates
alkalosis has what effect on calcium? how?
alkalosis causes hydrogens to dissociate from albumin…. therefore the albumin will bind more dissolved calcium causing hypocalcemia
depo provera has to be administered every how often?
3 months
thiamine deficiency is very common in alcoholics. what other B vitamin are alcoholics prone to be deficient of?
folate B9!
What is the formula to assess for CO2 compensation with metabolic alkalosis?
pCO2=(0.9 x bicarb) +16 +/2
what medication slows diabetic neuropathy progression?
ACE I
restless leg syndrome is treated with dopamine Agonists (pramipexole, rolpinerol). If the patient also has comorbid chronic pain/insomnia what else could you use?
Gabapentin.
what is the mechanism of gabapentin?
binds to calcium channels
nocturnal coughing can be caused by postnasal drip and GERD. but it also can be caused by what other condition?
asthma
Neonatal polycythemia causes?
poor perfusion, maternal hypoxia, early clamping of cord/twin twin transfusion
neonatal polycythemia symptoms?
facial plethora ruddy skin/cyanosis respiratory distress hypoglycemia, hypocalcemia abdominal distension
how to diagnose hirschsprung disease?
full thickness rectal suction biopsy
delayed upstroke. pulsus tardus is due to what?
aortic stenosis
Fanconi’s anemia symptoms?
short stature, eye abnl, renal abnl, café au lait spots
pancytopenia
Diamond Blackfan anemia symptoms?
pure RBC aplsia with low reticulocyte. early onset with poor feeding
Transient erythroblastopenia of childhood sx?
young child 2-8 years with slow development of anemia sx with normocytic anemia that is very low in Hb and reticulocyte
what is a common cause of bloody diarrhea in HIV pts with CD4
CMV
pt s/p septic shock requiring pressors. develops dusky finger tips…what’s the cause?
alpha 1 agonistic properties of norepi
what is dumping syndrome? how do you diagnose and treat?
dumping syndrome occurs s/p gastrectomy/bowel surgery leading to rapid movement of foods through the upper GI system… with it draws fluids in to the bowels leading to pain, diarrhea, and electrolyte abnl.
This is a clinical diagnosis and should be treated with dietary modification
pyruvate kinase deficiency causes what?
chronic hemolysis, skin ulcers, pigmented gall stones
why can’t you test for G6PD deficicency after an acute attack
because all the severely G6PD deficient cells will have hemolyzed
Giant cell arteritis affects what sized vessels?
medium and large
what is the ocular exam finding of giant cell arteritis?
anterior ischemic optic neuropathy; pale swollen nerve with blurred margins
what reduces cardiovascular morbidity in patients >40 with DM?
statins!
which are the high intensity statins
atorvastatin and rosuvastatin
which are the medium intensity statins?
atorvastatin and simvastatin
Fish oil can do what? does it affect mortality outcomes?
it can reduce triglycerides; and no
DM patient. when should you do high intensity versus moderate intensity statin?
high: ASCVD risk >7.5% in 10 years
medium: ASCVD risk
what is leukomoid reaction?
intense leukocytosis with infections.
It has >50,000 and most will be late precursors of neutrophils (bands and metamyelocytes);
the leukocyte alkaline phosphatase score will be HIGH, so you know it’s NOT cancer
what is the first line therapy for rheumatoid arthritis? second line?
DMARD such as methotrexate (anti metabolites); then if they don’t work move on to the anti cytokines like TNFalpha inhibitors
