UW Notes 4 Flashcards
What is the shape of cystine renal stones?
How do you diagnose cystinuria?
hexagonal opaque
diagnose with urine cyanide nitroprusside test
what’s the difference between acute otitis media and otitis media with effusion?
AOM is acutely inflammed and can/likely have effusion
otitis media with effusion is not acutely inflammed
what is the time frame for PCI s/p MI?
12 hours since symptoms started
90 minutes door (aka medical contact) to balloon time.
or 120 minutes door to thrombolytic therapy
why is it that small for gestation babies can have hypoglycemia? AND hyperglycemia?
hypoglycemia because they’re small with little glycogen store.
hyperglycemia because they have insufficient insulin
If pt is brain dead. who do you need permission from before removing support?
no one
If you’re worried about pancreatic cancer how do you evaluate it?
CT scan. If there’s obstructive chole then you can do an US first
can LMWH cause HIT?
yes
Sx of thrombocytopenia + thrombosis of A &V
ADHD is associated with what other psych disorder?
oppositional defiant
ankylosing spondylitis. you do an xray to test for it even though it might not show anything at first… but why don’t you do a HLAB27 to start with?
only few people with HLA b27 have ankylosing spondylitis; but almost al AS patients have HLA b27
what med is used to treat pericaditis?
ibuprofen
what are the two options for bioplar longterm maintenance therapy? which is preferred when?
lithium is the standard. but Valproate is preferred when pt’s RENAL function is bad
is goodpastures nephrotic or nephritic?
nephritic
nitroprusside can precipitate what poisoning? what are the sx?
cyanide poisoning. it can precipitate seizure, AMS, coma, actic acidosis
what is spinal shock?
it is where spinal injury initially result in flaccid paralysis. This will change over the next days into UMN defect
what are the recommended vaccines for an older person with HIV?
influenza, hepB, varicella if CD4>200; Td q10y; and PCV13/PPSV23
There’s an increased incidence of what with erythromycin in infants?
pyloric stenosis
class IC, like flecainide, are “use dependent”. In faster heart rates they can’t dissociate as well from the Na channels… what change can be seen on ECG?
widenened QRS complex
Odds ratio is calculated for case control studies; Relative risk is calculated for cohort studies. Odds ratio is a a good approximation of relative risk when what is true?
when disease is rare the RR is a good approximation of OR
antithyroperoxidase antibodies are seen in what disease?
Hashimoto
orchipexy for cryptochidism removes chances of hernia and torsion but does not remove chances of waht?
lowered sperm count and cancer
what should you do if pt develops tardive dyskinesia while on antipsychs?
wean to a lower dose.
If you NEED it then you switch to CLOZAPINE
young person with kyphosis, high arch, hammer toe, ataxia. what is this?
Freidrich’s ataxia.
cardiac and resipiratory problems are most common.
what are the quad findings in Trisomy 21?
betahCG high, inhibin A high, estriol low, AFP low
What are the quad findings in Edward syndrome Trisomy 18
beta hcg low, inhibin A normal, estriol low, AFP low
what does high AFP in quad screen mean?
abd wall defect, neurotube defect, or multiple gestation
what is the Epo level like in Polycythemia vera?
Epo is low. Epo is upstream activator of JAK2… thus jak2 mutation will constitutively activation RBC synthesis… and Epo will be suppressed via neg feedback
what are three saline resistant metabolic alkalosis etiologies?
Cushing’s
primary hyperaldosterone
severe hypokalemia
what should you give to step pneumo meningitis pt other than abx
dexamethasone
empiric tx for meningitis
cefipime, vanco, +/- ampi
Secondary amyloidosis (AA)… what is the treatment?
colchicine
what are the sx of amyloidosis ?
hypertrophy of heart, 4th heart sound, palpable kidney, hepatomegaly
What are some complications from pos pressure mechanical ventilation?
ARDS, pneumonia, pneumothorax
kidney stone in a pregnant person. how to dx?
US
what organism is the most common in CF children for pneumonia? treatment?
staph aureus. vanco IV
what is the empric abx treatment for
floroquinolone (moxi); OR ceftriaxone + azithromycin
boy with gout
lysch nyhan
pt with Guillain barre… what test should you do to assess breathing?
Spirometry
what condition is most strongly associated with stroke
hypertension
how do you treat myesthenia crisis?
you do plasmaphoresis; also ABCs
what is the biggest cause for cerebral palsy?
prematurity (intrapartum hypoxia accounts for a small number)
abortive migraine treatments? name 2
prochlorperazine, tryptans
prophylactic migraine treatment?
propranolol
immunoCOMPETENT person with ring enhancing lesion. what is it?
brain abscess.
if associated with sinusitis–>think viridans strep
Rh incompatibility could be a huge deal. However, ABO isn’t. why?
ABO incompatibility usually only cause very mild disease in infants. They can develop some neonatal jaundice and can be treated with photothreapy
Simple cystitis UTI can be treated empirically and no cultures are needed. what are the drug choices
SMX-TMP for 5 days; nitrofurantoin for 3 days, or fosfomycin single dose
What is complicated UTI/cystitis? and how should you treat it?
pregnancy, immunocompromised, caused by procedure, hospital acquired, diabetes, chronic kidney disease
you need a culture before abx… which should be floroquinolones
what is the treatment of choice for SCFE?
surgical fixation
who should get meningococcal vaccination? age and population?
age: 12 and booster at 16
group: college dorm, military recruits, and subsaharan african
Light’s criteria is used to do what? what is it?
it’s used to determine exudate versus transudate. fluid/serum protein >0.5; and fluid/serum LDH >0.6 is exudate
what’s the acid base disturbance associated with Conn’s syndrome?
metabolic alkalosis
baby with mousy odor
PKU
what deficiency caues abnormal taste?
zinc. along with alopecia, poor wound healing
wallenberg syndrome is blockage of what vessels? x2
PICA or vertebral art
TB can cause adrenal insufficiency via infiltration. What pH problem can develop?
metabolic acidosis due to decreased aldosterone–> decreased rid of K and H
nephrotic syndrome in the presence of organ enlargement (liver/kidney)
amyloidosis
Hypothyroidism can cause what effects on lipids? sodium? creatinine and liver enzymes?
it can cause hyperlipidemia, hyponatremia, and asymptomatic elevation of creatinine and liver enzymes
schizophrenia CT head findings?
enlarged ventricles decreased cortical volume
define hypertensive urgency?
hypertensive emergency?
malignant hypertension?
urgency is BP >180/120
emergency is any sx + the BP
malignant HTN is BP + retinal exudates, hemorrhage, papilloedema
what are some long term sequelae of meningititis?
hearing loss cognition loss seizures mental retardation spasticity/paresis
primary biliary cirrhosis. what is the treatment?
ursodeoxycholic acid
how do you diagnose avascular necrosis of the fem head?
MRI
3 features of wernicke’s encephalopathy?
confusion
nystagmus
ataxia
why can IV acyclovir be associated with renal failure? what should you do to prevent this?
it can cause crystal precipitation.
you should aggressively hydrate to prevent
immunecompromised people can get invasive aspergilosis of the lungs. Sx include fever, hemoptysis, chest pain. What does it look like on Xray?
nodule with surrounding ground glass opacity
What are the signs of felty syndrome? what is this associated with?
Felty is arthritis, spenomegaly, and neutropenia.
it’s associated with severe rheumatoid arthritis
renal tubular acidosis type 1 is where and what’s the defect?
it’s distal tubule; decreased excretion of H
renal tubular acidosis type 2. where is it and what’s the defect?
proximal tubule decreased reabsoprtion of bicarb
what are some ototoxic drugs?
aminoglycoside
loop diuretics
asprin
chemo agents
when should babies regain their birthweight?
by 2 weeks
features of wiskot aldrich?
thrombocytopenia, eczema, and recurrent infections
chronic granulomatous diseae is defect in NADPH oxidase enzyme leading to inability to kill catalase positive organisms. how to dx?
dx via dihydrorhodamine test or
nitroblue tetrazolium test
what’s the most accurate method of estimating gestational age?
1st trimester US
cutaneous larva migrans is caused by what?
hook worm
hypercalcemia that’s NOT related to parathyroid is msot likely due to what
malignancy
Immediate anticoagulation in a pt with renal disease…what med should you use?
heparin is preferred; NOT LMWH
what do you use to encourage weight gain in cachexic patients?
progestrone analogs
pulseless electrical activity should be treated how?
Chest compressions with vasopressors
what are the 5Ts and 5Hs that can cause PEA?
hypovolemia, hypoxia, hyper/hypokalemia, hypothermia, hydrogen ions (acidosis)
Trauma, Thrombosis, Tension pneumo, Tamponade, toxins
exertional heat stroke definition
Temp >104 and encephalopathy
skin TB test. how big does the indurated area have to be to be psoitive if the pt is HIV+
5mm
NAFLD is associated with what condition?
insulin resistance
systemic sclerosis antibody?
anti topoisomerase I
pt without vaccination for hep B is exposed, what should you do?
immunoglobulin AND vaccinaion immediately
scabies treatment?
Ivermectin or permetherin cream
allergic rhinitis treatment?
intranasal glucocorticoid spray
what meds should you hold for a stress test?
for 48 hours: betablockers, calcium channel blockers, nitrates, vasodilators
for 12 hours: hold caffeine
mechanism of diphenhydramine?
antihistamine and anticholinergic
what are appropriate treatments for asymptomatic bacteriuria in pregnancy?
cephalexin, amoxicillin, nitrofurantoin
type 4 renal tubular acidosis is characterized by what
hyperkalemia with non anion gap metabolic acidosis, and moderate renal insuff
croup has cough bronchiolitis does not. how do you treat croup?
steroids and racemic epi
asplenia predisposes to what kind of organisms?
encapsulated. strep pneumo, hemophilus, neisseria
hyperpigmentation occurs with what kind of adrenal disease?
primary adrenal insufficiency ONLY. not secondary. pigment is due to over production of ACTH
lung nodules of what size are worrisome for malig?
> 2cm
parvo 19 in adults involve 1 or many joints
many
how should ticks be removed?
with tweezers
what diseases are carried by ixodes?
lyme, babesiosis, anaplasmosis
criteria for prophylaxis in lyme disease
attached tick, >36 hours or engorged, endemic area, prophylaxis started within 72 hours of tick removal, no doxy contraindication (<8, preg, or lactating)
sensory defects followed by allodynia…where is the stroke?
thalamus
what allows the confidence interval to narrow?
increased sample size
how does HIT present in pts s/p subQ LMWH?
necrotic patches of purple and red on abd
what meds other than isotretinoin can cause pseudotumor cerebri?
tetracyclins
growth hormone
what’s the mutation in CML?
BCR-ABL 9:22
what class of drugs can you use to treat CML
imatinib; tyrosine kinase inhibitors
HIV linear esophageal ulcers (AKA YOU HAVE TO DO endoscopy to see it)
CMV esophagitis
what are the 4 emergency contraception methods?
Copper IUD
Ulipristal
Levoprogestrel
Oral contraceptive pill
B6 (pyridoxine) deficiency can cause sideroblastic anemia. Why?
because it inhibits protoporphyrin synthesis.
you can see “dimorphic RBC population’ of normochromic and hypochromic
microcytic anemia. how can you tell if it’s thalassemia versus iron deficiency?
iron deficiency will have increased RDW >20;
thalassemia will have normal RDW
what’s the treatment for atropic vaginitis? what’s the treatment for lichen sclerosis?
atrophic is low dose topical steroids;
lichen is high dose topical steroids
Dopamine inhibits prolactin. What two things stimulate prolactin?
serotonin and TRH
painless bloody stools in infants
milk protein colitis; or it could be meckles
mets to the brain… what’s the most likely source?
lung…then melanoma, colon, breast
pt in stable vtach. tx?
amiodarone
torsade de ponte tx?
magnesium sulfate/ defibrillation
sinus bradycardia. tx?
atropine
torsade depointe due to quinidine?
sodium bicarb
sx of babesiosis
fatigue, malaise, fever, hemolytic anemia and jaundice.
treat with atovaquon + azithromycin or quinine
do blood smear to visualize maltese cross
pregnant person got rubella vaccination on accident. how do you treat
expectant management
methemaglobinemia tx
methylene blue
cyanide poisoning treatment?
sodium thiosulfate
ethylene glycol treamtnt?
fomepizole
the triad findings of hereditary spherocytosis
splene enlargement, jaundice, negative coombsn, also elevated mchc
what blood abnomrlaities are associated with mono?
autoimmune hemolytic anemia and thrombocytopenia
major side effects of cyclosporin?
nephrotoxicity, hyperkalemia, hypertension, gum hypertrophy, hirsutism, tremor
major toxicity of azathioprine
diarrhea, leukopenia, hepatotoxicty
mycophenolate toxcity
marrow suppression
heat can damage what vitamin?
folate
what’s mech of flutamide?
androgen receptor blocker
social anxiety treatment if it’s performance related? if it’s not performance related?
performance related–>propranolol
performance unrelated–>behaviroal therapy; SSRI
galactose 1 phosphate uridyl transferase deficiecy sx?
hypoglycemia, cataracts, jaundice, failure to thrive
galactokinase deficiency sx
only cataracts
tca antidote?
sodium bicarb
cluster HAprevention and tx?
prevent with lithium, verapamil, ergotamine
tx of bartholin cyst w/o infection?
observe
euthyroid sick syndrome is characterized by what?
low T3 level normal T4 and TSH
subclinical hypothyroidism is characterized by what?
low T4 level, normal TSH
how to diagnose lactose intolerance?
breath hydrogen test, increased stool reducing agents, and increased stool osmotic gap
factor V leiden mechanism?
increased resistance to fantithrombin C
criteria for long term O2 therapy
Hct >55%, Sat O2 <89%, PaO2 <59
measles…what kind of precaution is needed?
airborne (neg air pressure)…not droplet
what marker in Hep b remains present during the window period? what are the two ebst tests for new hep B diagnosis?
HBc antibody IgM will be positive in the window period there fore Core IgM and surface antigen is the best.
how do you treat botulinum poisoning?
horse derived antitoxin antibody for passive immunity
how many percent is in 1 SD, 2SD, and 3SD?
68%, 95%, 99.7%
criteria for actue liver failure?
marked elevated ast/alt; encephalopathy; synthetic dysfunction
you suspect spinal cord compression. what should you do first? what should you do to image?
Give steroids; THEN do MRI
hyponatremic patient…what’s the highest rate you can go up by?
0.5 meq/L/hour
myastheniua gravis can be brought on by infections and what drug?
floroquinolones
renal cyst filled with fluid…what do you do?
observe.
most common congenital cyanotic disease… egg on string? Single S2
transposition of great vessel.
acute bronchitis treatment?
symptomatic only.
typically Abronchitis is >5 days of coughing that easily mobilizes sputum
Lyme treatment in preg or lactating?
amoxicillin
patient presenting with pyelo…what’s first, second? when do you image?
first collect urine, second give abx empirically. Image if they don’t improve in 2-3 days
what does CMV viremia look like?
pneumonitis, gastritis, hepatitis
most common opportunistic organisms associated with transplants
CMV, PCP
splenomegaly and elevated alk phos with nonspecific symptoms in CD4<50? prophylaxis drug?
MAC infection; prophylax with Azithromycin
patient with PCP should be started on TMP-SMX at CD4 <200 and steroid should be added when?
if PaO2 is lower than 70
name the live vaccines?
MMR, varicella, rotavirus, nasal influenza
name the toxoid vaccines?
tetanus, diphtheria
name the killed vaccines?
hep A, polio
kids should be vaccinated according to their what age?
chronological
back pain in third trimester is because of?
increased lordosis and increased laxity of pelvic joints
if there’s one brain metastasis, but the patient is functioning well what should you do?
resect it?
what should you do after a kid was exposed to varicella but currently has no sx?
vaccinate as prophylaxis
