UW3 Flashcards
What do you do if a HC worker has a +PPD but a negative CXR?
tx w/ INH
How do HC workers get C.diff?
spores!
Pulsus Paradoxus
Pulsus paradoxus is a sign that is indicative of several conditions, including cardiac tamponade, constrictive pericarditis, chronic sleep apnea, croup, and obstructive lung disease (e.g. asthma, COPD).[1]
52 yo male w/alcoholism, unable to move lower extremities for 4 hrs, swelling of lower extremities, bladder cath shows small urine + positive blood by dipstick. dx?
Rhabdomyolysis = death of muscle fibers = releases contents into blood.
key: m swelling, weakness, ARF & blood or myoglobin on dipstick
other sx: ab pain, NVF, tachy, conf, dehydra, CK elevation
tx for prostatitis?
- If uropathogen = bactrim or FQ
* if STI = Ceftriaxone or Azithromycin
why hypoglycemia with T1 DM?
Low blood sugar happens when a person with diabetes does one or more of the following:
●Takes too much insulin (or an oral diabetes medication that causes your body to secrete insulin)
●Does not eat enough food
●Exercises vigorously without eating a snack or decreasing the dose of insulin beforehand
●Waits too long between meals
●Drinks excessive alcohol, although even moderate alcohol use can increase the risk of hypoglycemia in people with type 1 diabetes
bronze diabetes association…
hemochromatosis! = check ferritin levels
Kallman Syndrome
delay/absence of signs of puberty along with an absent/impaired sense of smell
Old lady comes into the ER after she fell and broke her hip. she has elevated na and glucose along with an elevated leukocyte count. what should be the first thing you give her?
NS ! dont give insulin! she doesnt need it! shes not acutally hyperglycemic she is only dehydrated. hence the elevated Na.
premature venticular contractions originate from….
ventricles = purkinje fibers!
normal: SA - AV- BoH - ventricles
Sx of Pagets dz?
elevated alk phos, increased bone remodeling/turnover imbalance. joint/bone pain, bowing deformity of bone, hearning loss dur to narrowing of auditory foramen.
tx: bisphosphonates
Patient with what ur almost positive is a DVT. What test do you do? D-dimer, CT angio, anticoag or compression US. Why?
US! = must confirm dx!
No: ddimer bc this will not confirm, CT bc she has no sx of PE yet, anticoagulant bc u need to confirm dx
Pt with ESRD was given EPO now has microcystic anemia. tx?
boost in RBC production has decreased Fe stores = give Fe
pt tests positive for Hep C ab. next step?
test for hep C RNA ! need to know if this is a chronic infection or a infection that they previously cleared
Pt with frequent watery stools for 10-12 days, nocturnal bm w/cramping, hypoK, met alk. +melanosis coli w/pale lymph folicles. dx? tx?
laxitive abuse! stop
side effects of methamazole
1st trimester teratogen, cholestasis, agranulocytosis, hepatic failure
What to do in someone who gets stuck by a hepB+ person but they are not vaccinated?
hep B Ig + vaccinate now and continue on regular vac schedule. if already vac do nothing
What is a Charcot joint? causes?
joint that gets beat up due to decrease sensation caused by: B12 def, 3 syphilis, DM, PN dmg, SC injury, Sryingomyelia.
sx: DJD, osteophyles, loose bodies, decrease in cartilage, deformites.
HIV STD screening via..
p24 antigena nd Ab testing
leading cause of urinary incon. in elderly?
UTI
Proximal M weakness in legs w/difficulty climbing stairs. no other sx? dx?
polymyositis = biopsy to show endomysial infiltrate w/pathcy necrosis. can also check CK, AST for elevation
when do you stent bilat or unilat renal artery stenosis?
only have you have tried 3 antihypertensive drugs without success
adult male w/RBC in urine, fever, fatigue + varicocele. test? dx? why?
do ab CT to look for RCC. increase pressure in gonadal vein due ot obstruction will cause varicocele.
Pt on long term steroids for sarcoidosis has pain in hip that radiates to the groin. Pain on abduction and internal rotation. Dx? Tx?
Avascular necrosis of the femoral head.
Dx MRI! X-ray will look normal
Tx: replace hip
Drugs to help with Parkinson’s TREMOR.
Anticholinergic! Like benztropine and trihexyogebidyl. No idea why but it does
What would you see with alveolar hypoventilation in PH PaCO2 and PaO?
Low PH, high PCO2 and low PO
Acne tx hierarchy
Topical benzoyl peroxide > topical clindamycin or erythromycin > topical vit A derivatives > ORAL minocycline or doxycycline > ORAL vit A
Basically try all topics first then do oral
Acute exacerbation of multiple sclerosis treatment?
High-dose IV methylprednisolone if no improvement then do plasma exchange
Signs of liver cirrhosis
Esophageal varices, splenomegaly, ascites, caput medusa, jaundice, Adema, ecchymosis, increase in estradiol(telangectasias, Palmer erythema, testicular atrophy, gynocomastia), decrease in binding globins(decreased T3/4 but normal TSH), decreased albumin , increased lipoproteins
What types of memories will always require work up?
Diastolic and continuous murmurs
36 hours after ingestion of cured fish patient develops blurred vision, diplopia, facial weakness, dysarthria, dysphasia, muscle weakness and respiratory failure. Cause?
Ingestion of botulism toxin either through improperly canned foods or age seafood. Treat with equine serum heptavalent botulinum antitoxin
Why do you see hypocalcemia in patients with liver failure?
About 45% of total blood calcium is bound albumin and other plasma proteins. Liver failure will cause hypoalbuminemia thus reducing the total blood calcium
How does hypothyroidism cause hypertriglyceridemia?
Decreases lipoprotein lipase activity causing hypertriglyceridemia
What is the most common cause of interest cerebral hemorrhage in children?
AV malformation
RA, splenomegaly and neutropenia(1800) dx?
Felty syndrome
Which type of dilated cardio myopathy can be reversed?
Alcoholic cardiomyopathy. If the patient stops drinking there will be an improvement or normalization of left ventricular function overtime
Women with onset of anxiety fatigue insomnia. She take OCP only and has normal TSH and elevated T4. Dx?
High estrogen decreases TBG catabolism causes thyroid to increase T4 production to maintain euthyroid.
What is electrical alternans? When would you see this?
Alternating QRS height on ECG. Indicates pericardial effusion. Caused by flooded swinging around in pericardial sac.
Tx of frostbite vs systemic hypothermia
Systemic hypothermia = warm IVF
Frostbite = rapid rewarding with warm water
What reflexes are still present in brain death?
Deep tendon reflexes
What reflexes are still present in brain death?
Deep tendon reflexes
Pt is dx with mono. What should you recommend?
Avoid contact sports for 3 weeks = during this time they are at increase risk of splenic rupture
Na > ? Require hypertonic IVF? Between what do you do fluid restriction?
Na >120 give hypertonic saline
Na 120-130 do fluid restriction
Or is describing headaches with eye pain. What can you do for him now to relieve his pain?
100% O2
Physiologic, Parkinson’s, cerebellar, essential tremor comparison
—Essential: hand tremor relieved by alcohol. Tx: BB
—Parkinson’s: resting tremor that decreases with movement and increases with distraction = BG shit tx: benztropine(antichol)
—
Pt on dialysis is bleeding from cath after blood is drawn. Why?
chronic renal failure can cause hyperuremua which disrupts platelet function = trouble clotting
MC extrahepatic manifestations of hepC
Cryigobinemia, membranous glomeruneohritis, PCT
56 yo male w/Rsided weakness. speaks with short sentences w/difficulty. Has difficulty writing and repeating words but can follow and read find. dx?
Broca’s Aphasia = frontal lobe dmg
“broca talks & wernicke listens”
what drug can you give to prevent recurrent kidney stones to a patient who also has low Ca?
Thiazide diuretics! = will passivly increase Ca reabsorption
IVDU w/pain on palpation of L3/4. dx?
vertebral osteomyelitis! = spine = MC place for staph A OM in IVDU
a Hct of what corresponds to Hb?
Hct 21% = Hb<7
