uworld Flashcards
treatment of esophageal varices
- volume resuscitation
- prophylactic ABx (ceftriaxone)
- octreotide (somatostatin analogue) for splanchnic vasoconstriction
- urgent endoscopy for band ligation/sclerotherapy followed by BB prophylaxis
- balloon tamponade if bleeding uncontrollable
- TIPS or shunt surgery definitive
when to do platelet transfusion?
active bleeding AND platelet count <50,000
effects of lifestyle change in HTN tx
- weight loss most effective
- then DASH diet
- then exercise
- decreased dietary sodium
- alcohol intake <1-2 drinks/day (women/men)
OA - radiographs
- joint space narrowing
- subchondral sclerosis
- osteophytes
OA vs RA in hand
- OA: DIP joints
- RA: PIP and MCP joints
hemochromatosis arthropathy - radiographs
- squared off bone ends
- hook like osteophytes in 2nd and 3rd MCP jts
untreated hyperthyroidism can cause?
bone loss
- thyroid hormone –> osteoclastic bone resorption
- increased serum calcium and hypercalciuria
cardiovascular: thyrotoxicosis –> tachycardia, systolic HTN, increased pulse pressure, AFib
- can unmask or worsen CAD
pathophys of proptosis in hyperthyroid
- accumulation of GAGs in retro-orbital mm and tissues
- ONLY in Graves dz
tx shingles
- valacyclovir is tx of choice, but acyclovir cheaper; can combine acyclovir with steroids if severe sx
- early antiviral reduces duration of rash and pain
- also reduces likelihood of postherpetic neuralgia
tx of frostbite
- rapid rewarming with continuously circulating warm water
- debride only after rewarming complete
precipitating factors for hepatic encephalopathy
- sedatives
- hypovolemia
- infection
- excessive N load (e.g. GI bleed)
- electrolyte disturbances (e.g. hypoK - maybe from diuretics)
tx of hepatic encephalopathy
- supportive care: volume, electrolyte correction, restraints
- nutrition w/o protein restriction
- precipitating cause
- lower serum ammonia: lactulose (oral/enema) –> rifaximin if no improvement in 48 hrs
clinical presentation of alcoholic hepatitis
- jaundice, anorexia, fever
- RUQ and/or epigastric pain
- abdominal distention (ascites)
- prox mm weakness
- possible HE
lab studies in alcoholic hepatitis
- MODEST AST and ALT elevations ( 2 (usually ALT higher than AST in other liver dz)
- GGT and ferritin elevation
T99 scan (sestamibi) used for what?
myocardial function and perfusion
- normally done at rest and exercise
- decreased at rest and at exercise = fixed defect = scar tissue
- decreased at stress only = inducible ischemia, likely CAD
metformin given to pts with factors predisposing to hypoxia causes what?
lactic acidosis
empyema
- result from HEMOTHORAX, parapneumonic effusions, rupture of lung abscess, penetrating trauma, thoracotomy, ruptured viscus
- dx: CT scan
- tx: recent = streptokinase/urokinase (unless recent trauma), ABx; non-complex: chest tube drainage; complex (e.g. peel, loculated): SURGERY
malignancy induced hypercalcemia
- PTHrP production (80%)
- 125OH2 VitD production
- bone mets
- ectopic PTH production (very rare)
PTHrP
- squamous cell cancers, renal/bladder, ovarian/endometrial, breast
- activation of PTH receptor –> excessive bone resorption
excess 1,25OH2 Vit D production
- by lymphomas
- causes hypercalcemia via gut absorption
bone mets and hypercalcemia
- breast ca, MM, lymphomas most common
- cause release of cytokines that stimulate bone resorption
folic acid repletion in B12 deficient pt
- fixes Hgb (folate and B12 both cofactors for methionine synth)
- does not fix neurologic sx; can actually precipitate/worsen
B6 deficiency
- peripheral neuropathy
- pts on INH
- rare
adverse effects of inhaled corticosteroids
- most common = THRUSH
- adrenal suppression, cataract formation, decreased growth, purpura, bone metabolism issues
cutaneous larva migrans
- “creeping eruption”
- helminth A braziliense (dog/cat hookworm)
- sandboxes/beaches, esp in tropics/subtropics
- serpiginous lesions on skin
sporotrichosis
- fungal infx from sporothrix schnckii
- papule at inoculation –> ulceration/LAN
- GARDENERS
dx of DKA
- blood glucose >250
- blood pH < 7.3 or bicarb < 15-20
- plasma ketones
tx of DKA
- rapid IV admin of NS and regular insulin
- correction of electrolyte abnormalities (esp K)
- treatment of precipitating factors
- bicarb can cause cerebral edema; use only if pH < 7.1 or bicarb < 5 or severe hyperK
organophosphate poisoning
- blocks AChEsterase –> cholinergic toxidrome
- give ATROPINE and remove clothes/sources of OP
complications of chronic GERD
- Barrett’s –> adenocarcinoma
- esophageal strictures: 5-15% of patients
esophageal strictures
- causes: GERD, radiation, systemic sclerosis, caustic ingestions
- cause progressive dysphagia to solid foods; can eventually block reflux
T gondii
- HIV+ with ring enhancing lesions
- H/A, confusion, ataxia
- usually CD4 <100
- give trimethoprim/sulfamethoxazole
M avium prophylaxis
- M avium complex
- HIV+, CD4 < 50
acute acalculous cholecystitis
- most common in hosp pts with burns/trauma/TPN/fasting/ventilation
- RUQ pain, fever, leukocytosis, abnl liver panel
- complications: gangrene, perf, emphysematous cholecystitis
- dx: US; CT/HIDA more sensitive/specific
Wegener’s
- systemic vasculitis
- airway granulomas
- glomerulonephritis
- onset ~40yo
- cutaneous: nodules, palpable purpura, pyoderma gangrenosum
- dx: C-ANCA to proteinase-3 and elevated CRP
- tx cyclophosphamide
classification of pulm HTN
- assoc with resp system d/os
- due to pulm venous HTN (LV heart dz, mitral valve dz, pulm veno occlusive dz)
- from chronic thromboembolic dz
- pulm artery HTN
- d/os of pulm vasculature
clinical features of pulm HTN
- dyspnea, weakness, fatigue
- chest pain, hemoptysis, syncope, hoarseness
- RV failure late in dz
- CXR: enlgmt of pulm aa with pruning and enlged RV
- EKG: R axis deviation
DHEA vs DHEAS
DHEA: from ovaries and adrenal glands
DHEAS: adrenals only
serum albumin ascites gradient
- ascites albumin - serum albumin
- if SAAG > 1.1 = transudative
- SAAG > 1.3 = portal HTN
Winter’s formula
arterial pCO2 = 1.5[HCO3] + 8 +- 2
for appropriate resp compensation of metabolic acidosis
MEN 1
- primary hyperpara
- enteropancreatic tumors
- pituitary tumors
MEN 2A
AD
- medullary thyroid carcinoma
- pheochromocytoma
- parathyroid hyperplasia
dx: genetic test for ret proto-oncogene germline mutation
MEN 2B
AD
- medullary thyroid carcinoma
- pheochromocytoma
- marfanoid habitus, mucosal/intestinal neuromas
vaccines for chronic liver dz pts
- HAV
- HBV
- pneumococcal
- flu
- Td/TdaP
dacryocystitis
- infection of lacrimal sac
- sudden onset of pain, redness in medial canthal region
- staph aureus, GABHS
mild glomerulonephritis
- nephritic urine sediment alone
- causes: IgA nephropathy, lupus nephritis
mod to severe glomerulonephritis
- nephritic urine sediment, decreased GFR, variable proteinuria
- causes: postinfectious, lupus nephritis, MPGN, vasculitis
nephrotic syndrome
- bland urinary sediment, proteinuria > 3.5g/day, microscopic hematuria possible
- causes: MCD, FSGS, diabetes, lyps, membranous nephropathy, IgA nephropathy, primary amyloidosis
mixed cryoglobulinemia
- usually due to Hep C
- immune complex (IgM + IgG-anti-HCV + HCV RNA + complement) deposition in small blood vessels
- skin, kidney, NS, MSK involvement possible
- dx: serology, kidney/skin biopsy
- tx: treat HCV, plasmapheresis, immunosuppressants
TTP
- decreased ADAMTS13
- fever, microangiopathic hemolytic anemia, renal failure, neurologic findings possible
APLA
- anti cardiolipin antibodies
- recurrent thrombosis, pregnancy loss, neurologic findings, microangiopathic hemolytic anemia
comm acquired PNA - tx
- CURB65: confusion, uremia, tachypnea (RR>30), hypotension (BP65yo
- CURB65 > 2 –> hosp; >=4 –> ICU
- levoflox/moxiflox OR betalactam plus macrolide (e.g. amp/sulbactam)
causes of avascular necrosis of femoral head
- chronic corticosteroids
- alcoholism
- hemoglobinopathies
best test for diabetic nephropathy?
random urine microalbumin to creatinine
diabetic nephropathy and Cr clearance
initially: hyperfiltration –> increased Cr clearance
- then decline in Cr
- Cr can be relatively normal for a while; low Cr clearance usually with advanced renal damage
excess oxygen in COPD
- baseline: hypoxic drive (instead of hypercapnic drive)
- get vasodilation –> increased perfusion of poorly ventilated areas
- worsened VQ mismatch
- decreased CO2 excretion –> hypercapnea
squamous cell carcinoma of lung
- PTHrP –> hypercalcemia (sCa++mous) –> anorexia, constipation, thirst, fatigue
CMV retinitis
- yellow-white retinal opacification
- retinal hemorrhages
- HIV+, CD4 <50
ocular toxo
- severe necrotizing retinochoroiditis
- white fluffy retinal lesions surrounded by edema and vitritis
- usually accomp by encephalitis
HIV retinopathy
- benign cotton wool spots
- remit spontaneously
chronic pancreatitis
- causes: alcohol, CF, autoimmune
- epigastric abd pain, malabsorption, weight loss, T2DM
- amylase/lipase often NORMAL
- AXR or CT: pancreatic calcifications; if neg do MRCP/ERCP
- tx: pain, alcohol/smoking cessation, frequent small meals, enzyme supplementation
Ca 19-9
pancreatic cancer!
pregnant with HCV
- get HBV and HAV vaccines
- can breastfeed, have SVD, have unprotected sex
- can’t have ribavirin or IFNa (teratogens!)
FSGS: common pt groups
- AfAm, Hispanic
- obesity
- HIV
- heroin
membranous nephropathy: common pt groups
- adenocarcinoma (breast, lung): most common form assoc with malignancies
- NSAIDs
- HBV
- SLE
membranoproliferative glomerulonephritis: common pt groups
- HBV
- HCV
- lipodystrophy
- chronic bacterial infections
minimal change disease: common pt groups
- NSAIDs
- lymphoma
IgA nephropathy is associated with?
URI
crescentic glomerulonephritis
- AKI, hematuria, HTN
- assoc with AI disorders
opioid withdrawal
- sx w/in 6-12 hrs of last dose; peak at 24-48 hrs
- sx: N/V, cramps, diarrhea, dysphoria, restlessness, rhinorrhea, lacrimation, myalgias, arthralgias
- PE: mydriasis, piloerection, hyperactive bowel sounds
- tx: methadone replacement (NEVER IV MORPHINE)
cirrhotic stigmata
loss of liver function:
1) synthetic: clotting factors, cholesterol, proteins –> edema, hypocoagulability
2) metabolic: drugs, steroids –> hyperestrogenism: gynecomastia, palmar erythema, spider angiomas, testicular atrophy, decreased body hair in males
3) excretory: bile and ammonia secretion –> asterixis
also ascites, portal HTN
most common causes of chronic cough
1) post nasal drip
2) asthma
3) GERD
chlorpheniramine
H1 antihistamine
- blocks histamine release from mast cells, limits response to inflammatory cytokines
- decreased nasal discharge and cough
acute mesenteric ischemia: presentation
- rapid onset periumbilical pain
- pain out of proportion to exam
- hematochezia
acute mesenteric ischemia: risk factors
- age
- atherosclerosis, Afib, CHF, peripheral artery dz
- hypercoagulable disorders
acute mesenteric ischemia: lab findings
- leukocytosis
- elevated lactate
- elevated amylase and phosphate levels
- metabolic acidosis
acute mesenteric ischemia: diagnosis
- early mesenteric angiography
- — multidetector-row CT angiography if not avail
acute mesenteric ischemia: tx
- resuscitative
- broad-spectrum ABx
- NG tube for decompression
- surgery for infarction/perforation
therapies proven to prolong survival in COPD
- smoking cessation
- supplemental O2
- lung reduction surgery
mainstays of sx reduction in COPD
aims: decreasing resp sx, improving QOL, decreasing hospitalizations
- inhaled anti-cholinergics
- can add short acting beta-ag, inhaled steroids, long acting beta ag
should you give beta blockers to pts with reactive airway disease?
- probably not!
- may exacerbate pulmonary sx if dz is severe
dermatitis herpetiformis
- papules/vesicles/bullae
- B/L, symmetric, grouped
- EXTENSOR surfaces, upper back, buttocks
- IgA deposits, circulating anti-endomysial Abs
- commonly assoc with CELIAC DZ
- tx: dapsone + gluten free diet
common causes of priapism
- sickle cell dz
- leukemia
- perineal/genital trauma: laceration of cavernous artery
- neurogenic lesions: spinal cord injury, cauda equina
- medications: trazodone, prazosin
middle mediastinal masses
- bronchogenic cyst
- tracheal tumor
- pericardial cyst
- lymphoma
- LAN
- aortic aneurysms of arch
anterior mediastinal masses
- thymoma
- retrosternal thyroid
- teratoma
- lymphoma
posterior mediastinal masses
- meningocele
- enteric cysts
- lymphomas
- diaphragmatic hernias
- esophageal tumors
- aortic aneurysms
CEA in pancreatic cancer
- can be useful as marker for response to therapy
- not useful as screening test
isoniazid and liver injury
- idiosyncratic injury: not dose-dependent, variable latency periods
- causes hepatitis morphology on biopsy
medications causing liver cholestatic picture
- chlorpromazine
- nitrofurantoin
- erythromycin
- anabolic steroids
mx causing fatty liver morphology
- tetracycline
- valproate
- anti-retrovirals
mx causing hepatitis picture
- halothane
- phenytoin
- isoniazid
- alpha-methyldopa
mx causing toxic/fulminant liver failure
- carbon tetrachloride
- acetaminophen
mx causing granulomatous liver picture
- allopurinol
- phenylbutazone
lateral epicondylitis
- repeated forceful wrist extension and supination
- pain near lateral epicondyle, worsened by use
- degeneration of ECRB tendon
posterior interosseus nerve entrapment
weakness of extrinsic extensors of hand and fingers
management of hypercalcemia
- asyx/mild: avoid thiazides, Li, volume depletion
- moderate (12-14): no tx unless sx
- severe (>14): short term: NS + calcitonin, avoid loop diuretics; long term: bisphosphonate
sx of hypercalcemia
- anorexia
- nausea
- constipation
- polyuria/polydipsia
- dehydration
- if severe: neurologic - lethargy, weakness, confusion, stupor, coma
how to treat hypercalcemia in chronic granulomatous disorders
- corticosteroids!
- reduce calcitriol production by mononuclear cells
- not useful in acute management
causes of normal anion gap met acidosis
- diarrhea
- fistulas
- carbonic anhydrase inhibitors
- RTA
- ureteral diversion
- iatrogrenic
hyperkalemic RTA
- type 4 RTA (non-anion gap met acidosis)
- elderly pts with poorly controlled diabetes
- damage to juxtaglomerular apparatus
- mild to mod renal insufficiency
CML: stages
- chronic
- accelerated
- blast crisis
CML peripheral smear
- increased immature myelocytes
- basophilia and eosinophilia
- platelet count normal/elevated
- patients commonly anemic
bone marrow: hypercellularity with prominent granulocytic hyperplasia
auer rods
- seen in M3 subtype of APL
AML vs CML
- no fever in AML unless infx
- splenomegaly uncommon in AML
- peripheral blood smears: myeloblasts
vaccines for pts with HIV
- HiB (anatomic/functional asplenia)
- HAV, HBC
- HPV
- flu
- meningococcus
- pneumococcal conjugate (1x)
- pneumococcal polysaccharide (Q5)
- Tdap, Td
live vaccines in HIV pts
- MMR, varicella, zoster
- CONTRAINDICATED if CD4<200
risk factors for NASH
TOP 3
- obesity
- DM
- hyper TGs
others: steroids, amiodarone, dilt, tamoxifen, HAART, TPN, endocrinopathies
NASH
- impaired responsiveness of fat cells to insulin –> accum of fat in liver
- steatosis can progress to steatohepatitis and fibrosis
- hepatomegaly WITHOUT stigmata of chronic liver dz
- mild ALT and AST elevation
- dx: percutaneous liver biopsy
- tx: ursodeoxycholic acid
PBC
- jaundice, pruritus
- positive AMAbs
- portal tracts infiltrated by lymphocytes, macrophages, plasma cells, eos
- can eventually cause portal tract scarring and bridging fibrosis –> cirrhosis
test of choice for dx rotator cuff tear
MRI!
test of choice for shoulder fx/disloc/calcific tendonitis
XR!
what do you use bone scans for?
dx of: osteomyelitis, fx, metastatic dz
pemphigus vulgaris
- blistering of skin and mucous membranes
- FLACCID BLISTERS
- unknown etiology
- positive Nikolsky sign
- IgG deposits in epidermis
- tx: steroids, azathioprine, methotrexate
bullous pemphigoid
- benign pruritic disease
- TENSE BLISTERS
- IgG and C3 deposits at dermal/epidermal jct
bullous impetigo
- caused by Staph
- honey color!
- red denuded areas when removed
common causes of steatorrhea
- panc insufficiency
- bile salt-related
- impaired intestinal surface epithelium
- rare: Whipple dz, Zollinger-Ellison, medication-induced
Nocardia
- gram pos, PARTIALLY acid fast, filamentous branching rods
- immunocompromise; systemic sx, lung nodules, brain abscess
- tx for pulm nocardia: BACTRIM
- if brain involved: ADD CARBAPENEM
- long tx
Waldenstroms macroglobulinemia
- rare chronic plasma cell neoplasm
- abnl plasma cells invade BM, LNs, spleen
- excessive IgM production –> hyperviscosity (e.g. retinal v engorgement)
tx of acute exacerbation of COPD
- O2: target sat 88-92
- inhaled bronchodilators and anticholiergics
- systemic glucocorticoids
- ABx IF: 2/3 cardinal sx, mod-to-severe exacerbation, mechanical ventilation
- non-invasive pos pressure ventilation/intubation
acetylcysteine
- mucolytic
- useful in CF
Wilson’s dz
- AR
- copper in liver, basal ganglia, cornea
- liver disease in children/adols
- neuropsych dz in young adults
- low ceruloplasmin + high copper; increased urinary Cu excretion, KF rings
Mallory hyaline on biopsy
- alcoholic liver injury
- wilson dz also
Osler Weber Rendu syndrome
- hereditary telangiectasia
- AD
- diffuse telangiectasia, recurrent epistaxis, widespread AVMs (mucus membranes, skin, GI, liver, brain, lungs)
lung AVM
- shunt blood from R to L heart
- chronic hypoxemia and reactive polycythemia
- massive hemoptysis
most common locations of ischemic colitis
- splenic flexure
- recto-sigmoid junction
(both watershed areas)
mechanical ventilation in ARDS
- improves O2 and prevents alveolar collapse (via PEEP)
- arterial pO2 = measure of oxygenation
- pCO2: affected by RR and TV
- goal: decrease FiO2 to under 60, make sure PaO2>60
can pancreatitis cause ARDS?
YES! up to 15% of patients
three major mechanical complications of MI
- MR due to papillary mm rupture
- LV free wall rupture
- interventricular septum rupture
malaria
CYCLICAL FEVER - correlates with RBC lyses
- cold phase –> hot phase –> sweating stage
- anemia and splenomegaly
when to get EGD in GERD
- alarm sx (dysphagia, odynophagia, weight loss, anemia, bleeding, vomiting)
- or age > 50 with >5 yrs sx and cancer risk factors
when to get H pylori testing
- active or past PUD
- pts with dyspepsia but NOT GERD
cat scratch disease
- localized cutaneous and LN disorder
- rare involvement of liver/spleen/eye/CNS
- tx: azithromycin
cholestasis: lab findings
elevated direct bili + elevated alk phos
amebic liver abscess
- hx of travel to endemic area
- dysentery and RUQ pain
- single cyst in R lobe of liver
- E histolytica!
hydatid cyst
- E granulosus infection
- from intimate contact with dogs
common causes of hematuria
- neoplasm
- infection
- trauma
- nephrolithiasis
- glomerulonephritis
- prostatic dz
risk factors for urinary tract malignancy
- age >35
- smoking
- occupational hx
- drug exposure (cyclophosphamide)
bladder cancer most common
medications that cause ototoxicity
- aminoglycosides
- chemo drugs
- aspirin
- loop diuretics
aspirin SEs
- tinnitus
- hearing loss at higher doses
EPO therapy SEs
- worsening of HTN: more common in IV vs subQ
- headaches
- flu-like syndrome
- red cell aplasia
smudge cells on smear
CLL!
- get flow cytometry to confirm
JAK2 mutation
- myeloproliferative dz
- esp POLYCYTHEMIA VERA
what does a positive hepatojugular reflux test mean?
- reflection of failing RV
- cannot accommodate increased venous return
most common causes of hepatojugular reflux
- constrictive pericarditis
- RV infarction
- restrictive cardiomyopathy
TMJ
- pain often reported as from ear
- pain worsened with chewing
- audible clicks/crepitus possible
- radiology studies limited use
- tx: conservative –> surgical
comedonal acne
- closed or open comedones on forehead, nose, chin
- may progress to inflammatory pustules or nodules
- TX: topical retinoids, salicylic/glycolic acid
inflammatory acne
- inflamed papules and pustules
- erythematous
- TX: inflammatory: topical retinoids + benzoyl peroxide (+ topical/oral ABx if mod/severe)
nodular (cystic) acne
- large nodules, can appear cystic
- nodules may merge to form sinus tracts
- possible scarring
- TX: mod: topical retinoid + benzoyl + topical ABx; severe - add oral ABx;
- unresponsive severe cases: add oral isotretinoin
indomethacin contraindicated in?
- renal failure
- hx of GI bleeding
Beck’s triad?
assoc with cardiac tamponade
- hypoT
- distended neck vv
- muffled heart sounds
cardiac tamponade pathophys
- increased pericardial P > diastolic ventricular P
- -> decreased venous return –> decreased preload
- -> decreased SV and CO
- worsened by inspiration: increased R venous return –> septum shifted to left –> LV filling further decreased –> PULSUS PARADOXUS
HSV keratitis
- freq cause of corneal blindness
- pain, photophobia, blurred viison, tearing, redness
- recurrences precip by sun exposure, outdoor work, fever, immundef
DENDRITIC ULCERS and CORNEAL VESICLES
- clinical dx
- epithelial scrapings –> multi-nuc giant cells
- tx: oral/topical antiviral
Well’s criteria
3 pts: clinical signs of DVT, alternate dx less likely
1.5 pts: previous PE/DVT, HR >100, recent surg or immobilization
1 pt: hemoptysis, cancer
score > 4: PE likely
nafcillin and renal failure
- causes acute interstitial nephritis (eos and WBC casts in urine)
aminoglycosides: uses and SEs
- usually for serious G-neg infections
- nephrotoxic!
loop diuretics: effects
- increased Na, H, K secretion in urine
- volume contraction, increased aldosterone
drugs that cause folic acid deficiency
- phenytoin, primidone, phenobarbital
- trimethoprim
- methotrexate
–> megaloblastic anemia
MC site of mets for CRC
liver!
treatment for torsades?
MG! (if conscious, stable)
if unstable, defibrillate
- if TdP due to quinidine use: give sodium bicarb
treatment for PSVT?
adenosine
tx of hyperkalemia
- if EKG changes: calcium gluconate
- rapid intracellular shifts: beta2 agonists, insulin with glucose, sodium bicarb
- removal of K: diuretics, cation exchange resins, hemodialysis
XR findings in gouty arthritis
punched out erosions with rim of cortical bone
XR findings in RA
periarticular osteopneia
joint margin erosions
common causes of megaloblastic anemia
- folate deficiency
- B12 deficiency
- myelodysplastic syndrome
- AML
- drugs: hydroxyurea, zidovudine, chemo
- liver dz
- alcohol abuse
- hypothyroidism
pernicious anemia
- MCC of B12 defic in white people
- assoc autoimmune dz common (thyroid, vitiligo)
- shiny tongue, ataxia, loss of position/vibration
common arrythmias in post MI period
- ventricular premature beats
- VT
- Vfib: most freq cause of sudden cardiac arrest in setting of acute MI
w/in 10 minutes: immediate arrythmia, ischemia –> reentrant arrhythmia
delayed (10-60 min): from abnormal automaticity
giant cell tumor of bone
benign and locally aggressive neoplasm in young adults
- pathologic fx common
- XR: epiphyses of long bones - soap bubble appearance
- patho: sheets of giant cells
- tx: surgery!
glucocorticoids and immune effects
- diminish circulating eos
- lymphopenia
- increase BM release of neutrophils –> neutrophilia
MCC of epiglottitis
- HiB
- Strep pyogenes
post cholecystectomy syndrome
- persistent abd pain or dyspepsia following chole (can be years after)
- biliary or extra biliary causes
- lab: high alk phos, abnl AST/ALT, dilated common bile duct on abd US
PPD: treat or not?
- if PPD > 5mm: treat HIV+, recent contacts of TB+, XR changes consistent with previous TB, immdef
- PPD > 10mm: recent immigrants, IVDU, high-risk setting employees/residents, higher risk for TB reactivation, children 15 mm: treat EVERYONE
treatment for latent TB
- INH + rifapentine weekly for 3 mos (not for HIV)
- INH monotherapy for 6-9 months
- rifampin for 4 months
- INH + rifampin for 4 months
- add pyridoxine to prevent neuropathies if taking INH
tx for active TB
- INH, rifampin, ethambutol, pyrazinamide for 8 weeks
- INH + rifampin for another 4 months
tx of open angle glaucoma
- BB eye drops (e.g. timolol)
- laser trabeculoplasty as adjunct
- if continues to increase, surgical trabeculectomy
CREST
- calcinosis cutis
- Raynaud
- esophageal dysmotility
- sclerodactyly
- teleangiectasias
ideal tidal volume
6 ml/kg
SEs of beta2 agonist tx
- hypokalemia –> mm weakness, arrhythmia, EKG chg
- tremor
- HA
- palpitations
lab findings suggestive of alcoholism
- TCP
- macrocytosis
- elevated transaminases
indications for O2 therapy in COPD
PaO255
evidence of cor pulmonale
bruit in renal artery stenosis
- 85% of pts with RAS have bruit
- systolic-diastolic common
mx that cause hyperkalemia
- BBs
- ACEi, ARB, K-sparing diuretics
- digitalis
- cyclosporine (blocks aldosterone production)
- heparin (blocks aldosterone production)
- NSAIDs
- succinylcholine
- trimethoprim (block ENaC)
A1AT
- bullous changes of lungs
- emphysematous chg in lower lobes
- can also cause liver dz: neonatal hepatitis, cirrhosis, liver failure
PSVT
- re-entry in AV node is most common mechanism
- abrupt attacks, HR 160-220
- vagal maneuvers increase vagal tone and decrease AV conduction
- can also use adenosine
Wegener’s
- granulomatosis with polyangiitis
- upper airway: nasal discharge, oral ulcers, sinusitis
- lower airway: dyspnea, cough, hemoptysis
- renal: insufficiency, micro hematuria, RBC casts
- systemic: fever, weight loss, fatigue
- CXR: nodular densities, alveolar/pleural opacities
- test for ANCA
aortic dissection
- risks: HTN, Marfan, cocaine
- > 20 mmHg BP variation bw arms
- complications: stroke, AR, Horner’s, MI, pericardial effusion/tamponade, hemothorax, lower-extremity weakness, abdominal pain
- dx: CXR - mediastinal widening; best test is chest CT or TEE
- tx: labetalol (if HTN)
- ascending aorta: need surg; descending aorta: medical management only
flash pulm edema
- usually 2ary to acute MI
- give furosemide: decrease preload and increase venodilation
common causes of aortic regurg
- Marfan, syphilis –> aortic root dilation
- post-inflammatory: rheumatic heart dz, endocarditis
- congenital bicuspid valve
clinical features of aortic regurg
- diastolic decrescendo murmur
- widened pulse pressure
- collapsing/water hammer pulse
- heart failure signs/sx
- increased LV size –> apex close to chest wall –> uncomfortable awareness of heartbeat
amiodarone and lungs
- pulmonary toxicity!
- chornic interstitial pneumonitis, organizing PNA, ARGDS
- related to cumulative dose
CHADS2 score
for anticoag in Afib
- CHF, HTN, Age>75, DM, stroke/TIA (2 pts)
- score 0: no anticoag or aspirin
- score 1: anticoag or aspirin
- score 2+: anticoag
AAA risk factors
- age, smoking, family hx, white, atherosclerosis
- risk factors for expansion/rupture: large diameter, rate of expansion, current cig smoking (biggest
massive PE
- PE complicated by hypoT and/or acute RH strain
- syncope possible
- JVD and RBBB possible
- causes cardiogenic shock and CNS effects
- can confirm with CT pulm angio if time allows
- give resp, hemodynamic support; fibrinolysis
tx for stable angina
- BB
- CCB (addl to BB or alternative)
- nitrates (acute or long-acting)
preventive: aspirin, statin, smoking cessation, exercise/wt loss, BP and DM control
lidocaine
- 1B anti-arrhythmic drug, good for variety of ventricular arrhythmias
- DON’T use as prophylaxis for Vfib in MI pts – increases risk of asystole!
- decreases freq of ventricular premature beats and risk of Afib
complications of PEEP
- alveolar damage
- tension PTX
- hypoT (if high P)
PEEP in ARDS
- mainstay of therapy
- levels up to 15 may be needed
pulsus parvus et tardus
assoc with aortic stenosis
Light criteria for pleural effusion
exudative pleural effusion IF 1+ of:
- p/s protein ratio >0.5
- p/s LDH ratio >0.6
- pleural LDH >2/3 ULN for serum LDH
causes of primary adrenal insuff
- autoimmune
- infections (TB, HIV, fungal)
- hemorrhagic infarction
- metastatic ca
dx of primary adrenal insuff
- ACTH and cortisol with high dose ACTH stim test
- primary: low cortisol, high ACTH
- 2ary/3ary: low cortisol, low ACTH
MC 2ary tumors in HL patients
- 5x risk of 2ary malignancy
- lung, breat, thyroid, bone, GI
- if got radiation/chemo tx: increased risk of leukemia or non-HL
