UW2 Flashcards
Pt w/recent travel to Southeast Asia a yr ago. Now has nonpainful nonparticipating skin lesion on upper arm that began 2 months ago. Numbness and tingling in fingers + thickened tender lunar nerve at elbow. Dx? Tx? How do you dx?
Dx w/ full thickness skin biopsy of lesion = leprosy
Tx: dapsone and rifampin
Why do blood transfusion pets experience parethesias?
Hypocalcemia! Whole blood contains citrate anticoagulant this causes ca & mg to chelate reducing plasma levels causing parethesias
Tx of essential tremor
Tremor regardless of movement.
Tx: Propanolol > pirimidone/toprimate > benzo
Tx of pagets of the bones?
Optimize vitamin D and calcium intake and then add BISPHOSPHONATES
37 F from Cambodia w left sided weakness 2h, progressive exertions dyspnea, nocturnal cough, occasional hemoptysis, episodes of palpations and irregular hearts beat. Dx? Explain…
Sweetie probably had rheumatic fever when she was younger causing mitral stenosis leading to increased left atrial pressure causing dilation resulting in episodes of a fib causing her stroke
Cause of trigeminal neuralgia
Compresssion of trigeminal nerve root
PML sx (JC virus)
Slowly progressive confusion, ataxia, seizures, white matter lesions of the brain WITHOUT enhancements or edema
Vs toxo = ring enhancing lesions with edema
Pt that is in ICU after trauma. Hypotension tx w/aggressive IVF and vasopressin. What are they at risk for?
NE induced vasodpasm causing ischemia and necrosis of digits
What is spare eye injury?
Immune mediated injury to one eye after trauma to the office at five. Do to uncovering of hidden antigens. Presents as. PeriLimbal flush, uveitis papillary edema, blindness, floaters
Strongest RF for stroke?
HTN
Small vessel lipohyalinosis of the brain?
Aka fucking hyalin thickinging of a microatheroma in a small artery of the brain that has the potential to cause a stroke
Side effects of elevated Ca in MM?
Fatigue, depression and CONSTIPATION
Can you get HIT with enoxaparin?
Yes!! This is LMWH!! It will increase ur risk of thrombosis
Pt tx for asthma exacerbation and recovers. Next morning has trouble moving arms and weakness + tremor. Dx?
Pt received b2 agonist for asthma to and likely reduced serum K levels by driving them into cells causing hypokalemka
CT scan of Alzheimer’s brain would show…
Diffuse cortical and subcritical atrophy that is disproportionally greater in the temporal and parietal lobes
Car crash in elderly shows weakness in upper Body > lower (usually) dx?
Central cord syndrome I fix the upper body more than the lower body because the CST fibers in the cervical spine or closer to the central canal. May also see loss of PIT.
Common side effects of methotrexate?
Oral ulcers, acute rise in serum transaminases, alopecia, pulmonary tox, bone marrow suppression(anemia, leukopenia, thrombocytopenia)
Antibiotics used for acne?
Minocyclin or doxycycline(teeth discoloration, GI stuff, phototoxicity, inhibition of bone grows in children)
Melancytic Nevis vs melanoma
Melanoma will have: ABCDE = asymmetry, uneven boarders, color variability, >=6mm diameter and evolve in size. Nevis will not have that shit.
Pt w/stiff neck, shoulders and hips for the last 3 months that last 1-2h in the morning. No other sx. Elevated ESR. Tx?
Polymyalgia Rheumatica!!! Tx w/ LD prednisone
What is Kussmauls sign? When would you usually see it? Tx?
Increased JVD with inspiration usually a sign of RV failure. Seen with RV infarct(2,3,aVF). DO NOT GIVE BB. For RV infarct you need to increase preload = IVF bolus
Person with BPH is given amitriptyline for somthing. 8 days later has abdominal pain. What could of happened?
Anticholinergic fx of amitrypt caused urinary retention! Due to dec detrusor contraction and preventing urethral sphincter relaxation
Sx of cyanide toxicity with nitroprusside.
Used to tx HTN emergency. Look for pt that initially improved with nitro and followed by acute neurological changes(AMS, coma, seizures) in a pt w/ renal insufficiency.
TB tx plan? When do you stop INH?
4 drugs for 2months(INH, RIF, EMB, PZA) then 2 for 4m(INH and RIF)
— stop INH when live enzymes >100. Mild elevations are okay! <100
How do you treat myasthenic crisis?
- Intubate
2. Stop ACh-inhibitors
Males prolactinoma vs testicular dz?
Both: decreased libido, dec body hair, dec testosterone and sperm count
Testicular: increased LH/FSH
Prolactinoma: dec LH/FSH
PH, GLU & WBC assoc with bacterial invasion of pleural space?
PH < 7.2 = anaerobic
GLUcose < 60 = consumption
WBC > 50,000 = high protein due to cell destruction!
This is an infection! But gram stain usually beg due to low bacterial count. Tx w/ abx + drainage
PH, GLU & WBC assoc with sterile exudate of pleural space?
PH >= 7.2
GLUcose >= 60
WBC <= 50000
Gram stain neg to w/ abx prophylacticly
MC vein to get a PE from?
Thigh! (Iliac, femoral and poplitea) calf veins usually go away on their own
What is the Jarisch-Herxheimer reaction?
6-8hr are initiating syphillis tx presents with fever, chill, myalgias an rapid progression to 2nd syphillis! This is due to destruction of the bug and will resolve in 48hr. Tx by giving support
Test with the highest sensitivity for HF?
BNP
> 400 = HF
Can steroids cause myositis?
Yes!!! cK and ESR will be normal!
Drug for gastroparesis? What do they use in the hospital for acre exacerbation?
Metoclopramide
IV erythromycin for acute
What is Aspirin exacerbated respiratory distress(AERD)?
Person taking asa develops. Asthma chronic rhinosinusitis with nasal polyps, bronchospasms or nasal congestion, physical exam shows gray nasal masses.
Tx by removing polyps
Looks like PCP but doesn’t show up on tox screens and lasts a lot longer…..drug?
Bath Salts
Pt w/fever, HA, confusion some icterus and rev smear shows fragmented cells. Platelets are low(44). Dx? Tx?
TTP = PLASMA exchange
*do not exchange platelets they will just get destroyed
Vomiting will cause……acidosis/alkalosis? why? How will urine be different?
metabolic alkalosis due to excessive vomiting up Cl = increase aldo = NaCl absoption, Na ab and H exc = worsens alkalsos + low serum Cl makes bicarb exc difficult.
urine = Low Cl and Na bc body is trying to replace this! with other diseases like ACTH, primary aldo, cushing you wont see low urine Cl
Diarrhea will cause….acidosis/alkalosis? what are you losing in stool?
Metabolic Acidosis! Losing: Na, Cl, K, HCO
why is there an increased risk of athrosclerosis with neophroic syndrome?
decrease protein means the liver starts throwing all sorts of crap into the blood stream including lipids = accelerating atherosclerosis. Also increased risk of coagulation due to loss of Antithrombin 3
Patiented with B12 deficiecny are at an increaed risk of….(what cancer?)
gastric cancer
What is the most common nephrotic syndrome in the overall population? #2?
FSGS =1
membraneous =2
Which Nephrotic syndrome is associated with adenocarcinomas of the lung & SLE?
membraneous nephropathy
which nephrotic syndrome is associated wtih heroin used, HIV, obesity?
FSGS
when is the answer frontrotemporal dementia?
when shit involves behavior more. like the lady is now eaing shit or big personality changes
What live vac can you give to a person with HIV only if CD > 200?
MMR
Acalculous cholecystitis
Seen in acute inflammmatuin of gallbladder in absence of stones. Hospital patients who are very ill(trauma, burns, intubation, shock,etc) tx like normal
Milk-alkali syndrome
Sx? Tx?
Caused by excessive calcium carbonate use(like someone taking ca for osteoporosis) resulting in hypercalcemia(stones,moans, ab overtones) = constipation, neuro sx, polydip, polyuria, AKI, metabolic alk, hypo P & Mg
Tx: stop agent, IVF + Furosemide
Common places to find pseudogout?
Knees and ankles
Alcoholic cerebellar degeneration vs wernicke encephalopathy
Both >10 yrs if alcohol use that dmgs purkinje cells in the cerebellar vermis = loss of trunca coordination w/ wise gait and postural instability(abnormal heel and shin but normal finger nose)
Wernicke will have all ^ and oculomotor dysfunction(horizontal nystagmus) and encephalopathy
Tight control of A1C will decrease —
Microvascular(nephropathy and retinopathy)
When would you see clinic jerks with suncopal episode?
Prolonged cerebral hypoxia
Hypo—
Na
Pulses parvus & tardus vs bounding pulses.
Which do you see with AS ? Which with AR?
Bounding pulses with aortic regurgitate
Pulses parvus & tardus(decreased amplitude and upstroke) with stenosis
What drug should be avoided in glaucoma?
Atropine! Anticholinergic
Vitiligo is associated with what AI disorder?
Hashimoto thyroidiitis, graves
Common sx of graph vs host
Macular papular rash and forming palms, soles, and face. Intestines may have blood part of diarrhea, abnormal liver function test. Basic pathophysiology mech involves host major and minor HLA antigens by donor T cells and a consequent cell mediated response
What drug class can cause hyponatremia and SIADH in elderly?
SSRI
