Uworld Misc. Flashcards
Arrhythmia ️Assoc. With digitalis toxicity
A-tach with av block
Usually it is rare for both of these to occur at the same time so this is pretty diagnostic
Initial Tx for Hypovolemic Hypernatremia and correction rate
Isotonic saline
Can use hypotonic saline once the patient is hemodynamically stable and euvolemic
Correction rate: .5meq/dl/hr without exceeding 12 in 24 hrs
This is done to prevent cerebral edema
Hairy cell leukemia
B cell neoplasm associated with BRAF mutations
Clinical: Pancytopenia (infections, anemia, ️Bleeding)
Splenomegaly
Dx: BM biopsy
Tx: chemo
Isolated increased ALK phos in a patient with an enlarging cap size
Paget’s disease
Vasospastic angina
Hyperreactivity of ️coronary smooth muscle leading to transient myocardial ischemia
Presents in young patients (<50) who are smokers but lack other RFs for heart disease; have recurrent chest discomfort
️Occurs at rest and during sleep; resolves spontaneously
Diagnosis: ST elevations with exertion however, ️coronary angiography shows no CAD
Tx: CCB (preventative), nitroglycerin (acute)
Earliest renal abnormality in diabetes patients
Glomerular hyper filtration
ACEIs help prevent this and therefore reduce chances of developing diabetic nephropathy
Warm agglutinin AIHA
Caused by drugs (usually penicillins), viral infxns, AI disorders (lupus), and immunodeficiency or Lymphoproliferative states
Ss: Normocytic Anemia with hemolysis
DAT (+) with anti-IgG or anti-C3
Tx: corticosteroids, splenectomy if necessary
Serum osmolality calculatio
[2 X (Na)] + [(glucose)/18] + [(BUN)/2.8]
Hemodynamic measurements in hypovolemic shock
RA pressure (preload) (pulmonary capillary wedge) ⬇️
Cardiac index (output) ⬇️
SVR (Afterload) ⬆️
MvO2 ⬇️
Cavernous sinus thrombosis
Can occur following infections of the facial skin, sinuses, and orbit ➡️ life-threatening CST and intracranial hypertension
Develop low grade fever, headache, and periorbital edema alongside CN II, IV, V, and VI pansies
Tx: Broad spectrum antibiotics and reversal of cerebral herniation if necessary
IgA nephropath
Gross ️hematuria following a URI that happens within 5 days of the infxn
⭐️ Common in young adult men ages 20-30
Ss: Recurrent gross ️hematuria
Extrarenal manifestations of ADKPD
Cerebral aneurysm
Hepatic or pancreatic cysts
Mitral valve prolapse
Aortic regurgitation
Colonic Diverticulation
Ventral or inguinal hernia
Dx: Abdominal US
Cauda equina syndrome
Bilateral and severe radicular pain
Saddle anesthesia
Asymmetric motor weakness
Hyporeflexia
Late onset bowel and bladder dysfunction
Conus medullaris syndrome
Sudden onset of severe back pain
Perianal anesthesia
Symmetric motor weakness
Hyperreflexia
Early onset bowel and bladder dysfnxn
Tx for tachyarrhythmia with hemodynamic instability
Synchronized cardio aversion
Disseminated histoplasmosis
Found in Midwestern US in soil contaminated by bird or bat droppings
S/s: Systemic (fevers, malaise, chills)
Weight loss/ cachexia
Cough, dyspnea
Mucocuatenous ulcers and papules
Lymphadenopathy, hepatosplenomegaly
Dx: Pancytopenia, increased LDH and ferritin
***Urine/serum Histoplasma antigen
CXR: Reticulonodular opacities
Tx: Ampho B in hospital
After improvement, oral itraconazole is continued for 1 year for maintenance therapy
Earliest finding in macular degeneration
Distortion of straight lines to where they start to appear wavy in the affected eye
ADKPD extrarenal complications
Hepatic cysts (most common)
Valvular heart disease (mitral valve prolapse or aortic regurg.)
Colonic diverticula
Abdominal/inguinal hernia
***INTRACRANIAL BERRY ANEURYSM
HIV patient with painful swallowing and substernal burning
HIV esophagitis
Occurs when CD4 <100
Etiologies: Candida, HSV, CMV
Tx: Empiric treatment with oral fluconazole; if they do not respond, THEN GET ENDOSCOPY
Pseudotumor cerebri
Idiopathic Intracranial HTN
Patients present with a headache that is pulsatile and awakens the patient at night, transient vision loss, pulsatile tinnitus (whooshing sound in the ears) and diplopia
S/S: Papilledema, peripheral visual field defects, CN VI palsy
RFs: Overweight
Isotretinoin, tetracyclines, hypervitaminosis A
Tx: Stop medications
Weight loss
Acetazolamide for idiopathic cases
Hidradenitis suppurativa
Also known as acne inversa
Occurs in intertrigous areas and is due to a chronic inflammatory occlusion of folliculopilosebaceous units preventing keratinocytes from shedding epithelium
RFs: DM, smoking, obesity, skin friction
S/s: Painful, solitary, and inflamed nodules that can progress to abscesses that open with purulent or serosanguineous drainage
Can lead to sinus tracts, comedones, and scarring with lymphedema
Test for lactose intolerance
Lactose hydrogen breath test
-Increased breath hydrogen level after ingesting lactose =» POSITIVE
Test to always include in Hep B testing
Anti-HepBc
This is the one that is positive during the window period
Patient with sudden visual loss and S/s suspicious for GCA
Give High dose steroids
Wait for the temporal artery biopsy
Toxic Shock Syndromew
Patient who has had a tampon in OR had a recent nasal packing
Followed by:
Rash Fever Hypotension Diarrhea Thrombocytopenia Skin desquamation including palms and soles
And 3 of the following systems: GI involvement (vomiting/diarrhea) Muscular (myalgia, elevated CK) Renal (Elevated BUN/Creatinine) Heme (Thrombocytopenia) Liver (Elevated transaminases) CNS (altered mentation without focal signs)
Tx: Fluids, broad-spectrum anti-Staphylococcal abs
Trichinellosis
Patient eats undercooked meat (usually pork) and develops acute GI illness; corresponds to larvae invading SI and developing into worms
2-4 weeks later:
Larvae encyst into muscle and cause myositis, subungual hemorrhages, periorbital edema, and eosinophilia
Classic triad: Periorbital edema + myositis + eosinophilia
Prevention of calcium kidney stones
Decreased sodium intake
=» Will enhance calcium excretion
NMS tentrad
MSC
Rigidity
Fever
Autonomic dysregulation (tachycardia, hypertension, tachypnea)
Tx of uric acid stones
Hydration
Alkalinization of the urine (Potassium citrate usually)
Low-purine diet
If absolutely necessary: Allopurinol (but only helps if there’s hyperuricemia)
Initial therapy for aortic dissection
IV BBs (labetalol, propanolol, esmolol)
Decrease the HR, contractility, and SBP
Wedge shaped infarct on chest CT scan
Think PE
Periinfarction ventricular arrhythmias
Phase 1a - Acute ischemia causing heterogeneity of conduction with areas showing marked slowing and delayed activation
Phase 1b - Occur 10-60 minutes following infarction and represent abnormal automaticity
Primary polydipsia
Patients present with hyponatremia, decreased serum osmolality, and decreased urine osmolality and a normal BP
Common in pts. with psychiatric conditions
Giant cell tumor
Eccentric and lytic area of epiphyseal bone (soap bubble)
Benigh and locally aggressive skeletal neoplasm seen in YOUNG ADULTS
S/s: Pain, swelling, decreased ROM, pathologic fracture
Tx: Surgery
Arsenic poisoning
Binds to sulfhydryl groups and interferes with enzyme activity regulating cellular respiration
RFs: Pesticides, contaminated well water, pressure-treated wood (antiquing)
S/s: Stocking-glove neuropathy
Hyporeflexia
Distal weakness
Hyperpigmentation of the skin
Hyperkeratosis of the soles and palms
Horizontal striation of the fingernails (DIAGNOSTIC)
Pancytopenia
Tx: Dimercaprol
Patient with an increased T4 but normal TSH
Suggestive of a euthyroid state; look for possible causes of increased TBG such as estrogens, hepatic dysfnxn, or tamoxifen
Isolated systolic hypertension
Systolic pressure >140 with a diastolic of <90
Path: Increased stiffness of the aorta and arterial walls in elderly patients reduces the abilities of the arteries to dampen systolic pressure
Tx: Lifestyle modifications and same pharmacologic therapy
Thyroid lymphoma
Presents as a rapidly enlarging, firm goiter assoc. with upper airway compressive symptoms; can have systemic B-sx.
- **Arises w/ preexisting Hashimoto’s thyroidits
- Suspect if patient has a positve TPO-antibody test
*When patients raise their arms, the mass will compress the subclavian and right internal jugular veins between the clavicle causing JVD
Dx: Core biopsy
Pemberton sign
Patient raises their arms up and get JVD due to compression of a lymphoma against the left subclavian and right internal jugular veins
Shy-Drager Syndrome
“Multiple System Atrophy”
- Parkinsonism
- Autonomic dysfnxn (postural hypotension, abnormal sweating, loss of bowel and bladder control, impotence, decreased salivation)
- Widespread neurologic signs (cerebellar, LMN)
**Consider when a Parkinsonian patient has signs of autonomic dysfnxn
Tx: Salt supplementation, fludrocortisone, a-agonists
Painless thyroiditis
Patient has increased T4 and decreased TSH
May have positive anti-TPO
Tx: BB (just to control symptoms of hyperthyroid phase)
Clubbing pathology
Megakaryocytes become entrapped in distal fingertips after bypassing the lungs (due to some pathology) and released PDGF and VEGF
=»CT hypertrophy and capillary growth
Scleroderma renal crisis
Increased vascular permeability, activation of the coag cascade, and increased renin secretion
=» Malignant HTN, RF (increased labs), and microangiopathic hemolytic anemia/DIC
Typically happens within 5 years of diagnosis
Paroxysmal nocturnal hemoglobinuria
AI hemolytic disorder characterized by intravascular and extravascular hemolysis and hemoglobinuria
Path: Lack of glycosylphophatidylinositol anchor that connects proteins CD55 and CD59 to RBC surface which normally inhibit complement activation
Clinical: Hemolysis, cytopenias, hypercoagulability
Dx: Flow cytometry to detect CD55 and CD59
*Sx. usually appear in pts. 40s
Malignant (necrotizing) otitis externa
Severe infxn of the external auditory canal and base of the skull usually caused by Pseud.
Most pts. are old, have poorly controlled DM, or immunosuppressed
S/s: Unrelenting ear pain worse at night, purulent drainage, sense of fullness, conductive hearing loss, granulation tissue and edematous external canal on otoscopy
Tx: IV ciprofloxacin
Middle mediastinal mass
Suspect bronchogenic cysts
Anterior mediastinal mass
Suspect thymoma
Patient with pain, itching, red streaks on their left arm that are palpable
Suspect Trousseau’s Syndrome
Hypercoagulable disorder associated with occult malignancy (usually pancreatic; can also be lung, prostate, stomach, colon)
Path: Tumor releases mucins that react with platelets to form microthrombi
***Patient’s with this should get a CT to find malignancy
Patient who received topical anesthetic and becomes hypoxic
Suspect methemoglobinemia; topic anesthetics cause the iron component of Hgb to be oxidized
Patients will have O2 sats that appear normal BUT this is because the O2 sat only measures the PaO2
S/s: Headache, lethargy, AMS, seizure, respiratory depression
Tx: Methylene blue
RFs for acute urinary retention
Male
> 80
Hx of BPH
Hx of neurologic disease
Recent surgery
Anticholinergics, opioids
Tx: Foley cath, urinalysis
Toxic megacolon
Caused by UC or C.diff infxn
S/s: Fever, tachycardia, hypotension, BLOODY diarrhea, abdominal distension,
Radio: Lead pipe
Tx: Supportive, Steroids if UC, surgery if unresponsive
Management of suspected esophageal perforation
Water soluble contrast esophogram
Suspect if recent endoscopy, esophagitis, ulcer, or heavy retching
Histoplasma capsulatum
Found in the Ohio and Mississippi river valleys in contaminated BAT DROPPINGS
***SUSPECT IN PTS WHO CAVE DIVE OR HAVE CHICKENS
S/s: Fever, chills, myalgias, DRY COUGH, HILAR LYMPHADENOPATHY
Dx: Histoplasma antigen urine testing; tissue diagnosis will reveal granulomas with budding yeasts
Botulism
Can be obtained from canned foods OR aged seafood (“cured”)
S/s: Blurred vision, diplopia, facial weakness, dysarthria, dysphagia, progresses to =»> Descending muscle weakness with possible diaphragmatic failure
Dx: Toxin in blood
Tx: Equine serum antitoxin (horse antitoxin)
First-time seizure in an adult
Run:
BMP, CBC, glucose, Ca2+, Mg2+, Renal and hepatic fnxn tests
AND DRUG SCREEN
-Possibly even consider an EKG
Patient with history of treated Hodgkin’s Lymphoma presenting with cough, hemoptysis, chest pain, and dyspnea
Likely a secondary malignancy developed after chemo or radiation therapy tx
BB OD
Bradycardia, AV block, hypotension, diffuse wheezing***
Tx: Secure airway, IV fluid boluses, IV atropine, IV glucagon
Consider IV calcium, EPI
K+ sparing diuretics
Spironolactone, amiloride, triamterene
Associated neoplasms with Lynch Syndrome
Colorectal cancer
Endometrial cancer (prophylactic hysterectomy after childbearing is complete is recommendation)
Ovarian cancer
Associated cancers with FAP
Colorectal cancer
Desmoids and osteomas
Brain tumors
Associated cancers with vHL Syndrome
Hemangioblastomas
Clear cell renal carcinoma
Pheochromocytoma
Vertebral osteomyelitis
Usually chronic and insidious
Will have tenderness to percussion over affected vertebrae
***Leukocytes can be normal as well as temp
***Usually will still have increased Platelets and ESR
Tx: Long term IV abs
Lead toxicity (3 manifestations)
- GI- abdominal pain, constipation
- Neuropsych- Forgetfulness, neuropathy, weakness in a stocking-glove distribution
- Hematologic- Microcytic anemia with basophilic stipling
* Also see HYPERURICEMIA
Drugs to start on RA patients
NSAIDS and MTX (or sulfasalazine, hydroxychloroquine, azathioprine)
***PTS NEED MTX to prevent progression of diseae
-Test them for Hep B, C, TB, and pregnancy
Dermatofibroma
Firm, small, hyperpigmented nodules that have a “dimple” when pinched
Typically follow a bug bite or minor trauma
Tx not required
MCC of pneumonia in IV drug abusers
Staph aureus
Septic embolism
Occur in pts with tricuspid endocarditis (think IV drug abusers)
Imaging may show pulmonary septic emboli seen as abscesses, infarction, or cavities typically in the lung periphery
Extraglandular features of Sjogrens
Raynaud phenomenon
Arthralgia
Interstitial lung disease
Idiopathic Intracranial HTN
Classic pt is an overweight woman of childbearing age possibly on OCPs, tetracyclines, or Vitamin A
-Pts. may have an empty sella, although, this is not diagnostic
Pts have an elevated opening pressure on spinal tap
Tx: Stop offending meds; weight loss and acetazolamide for idiopathic cases
Ichthyosis vulgaris
Chronic, inherited skin disorder characterized by diffuse dermal scaling caused by mutations in the filaggrin gene
Skin appears as “plated” much like reptile scales
*Symptoms often worse in the winter
Tx: Lotion, coal tar, topical retinoids
Work up for suspected Zenker’s
Contrast esophagram
Chronic prostatitis
Often a diagnosis of exclusion; presents as pain the perineum, pelvis, or genitalia with irritative voiding symptoms
-Urine is sterile; may have increased WBCs
Tx: Tamsulosin (a-blocker), antibiotics, finasteride
Tx for cutaneous larva migrans
Ivermectin (antihelminthic)
Patient who is vomiting up blood and you think is a risk for aspiration
INTUBATE; this will block off her airway and not allow her to aspirate while you get an upper endoscopy
Ludwig angina
Cellulitis of the submandibular space arising from a dental infxn; infxn is usually polymicrobial and spreads deep into the teeth roots
S/s: Fever, chills, malaise, local compressive symptoms such as drooling, mouth pain, muffled voice, and potential airway compromise
Tx: IV abxx (Bactrim, clindamycin); possible removal of tooth
Panendoscopy
Esophagoscopy + bronchoscopy + laryngoscopy
Also called a triple endoscopy
Amiodarone ADRs
Cardiac: Bradycardia, heart block, QT PROLONGATION
Pulm: Interstitial pneumonitis (infiltrates on CXR)
GI: Elevated transaminases
Ocular: Corneal microdeposits that are blue-gray; optic neuropathy
Derm: Blue-gray skin discoloration
Neuro: Peripheral neuropathy
Pt with signs of inferior MI and symptoms get worse with sublingual nitrogylcerin
Suspect RV MI
Give pt. IV bolus and avoid venodilation; otherwise, treat like normal MI
Patients who cannot produce sputum for a sample should undergo what
BAL
Patient who is presenting with signs of heart failure after placement of a pacemaker
Suspect tricuspid regurg. (or some other right heart problem)
-Pacemakers pass thru the SVC into the RA
Pneumococcal vaccines and their differences
PPSV23: capsular materials from 23 serotypes that induces a T-cell INDEPENDENT B-cell response
-Recommended to adults >65 and people <65 with predisposing conditions (IC, lung disease, cirrhosis, DM)
PCV13: Capsular polysaccharides that induces a T-cell dependent B-cell response
-Recommended for infants and children
EEG in cVJD
Sharp, triphasic, and synchronous discharges
Pts. present with myoclonus and rapidly progressive dementia
Carcinoid syndrome
Neuroendocrine tumors found in the distal SI, colon, and lung with metastasis to the liver; only become symptomatic with metastasis because histamine, serotonin, and VIP are inactivated by the liver
S/s: Flushing, cyanosis
Diarrhea, cramping
RIGHT SIDED HEART LESIONS (insufficient tricuspid)
Bronchospasm
Niacin deficiency (dermatitis, diarrhea, dementia)
Dx: Elevated 24 hour urine 5-HIAA; CT: echo
Tx: Octreotide and then surgery
Baker’s Cyst
Occurs due to extrusion of synovial fluid from the knee into the gastrocnemius or semimembranosus bursa thru a communication typically from chronic inflammation (osteoarthritis)
***CAN RUPTURE; following strenuous exercise, pt. will present with tenderness and swelling of the calf resembling a DVT and will show ecchymosis distal to the medial malleolus
US will r/o DVT
Psoriatic arthritis
Presents as morning stiffness and swelling of the DIP joints; may also have dactylitis (SAUSAGE DIGITS) and nail involvement
Nails may be pitting showing onycholysis (Separation of the nail bed)
Low risk cardiac chest pain patients
Men <40
Women <50 with atypical chest pain and no RFs
If patient is low-risk and has a normal EKG, do not do further work up on chest pain
Hypokalemia
S/s: Weakness, fatigue, muscle cramps, flaccid paralysis, hyporeflexia, rhabdomyolysis, arrhthmias
EKG =» Broad T-waves, U waves, ST depression, and PVCs
Putamen hemorrhage
Sudden contralateral hemiparesis and hemianesthesia with conjugate gaze deviation towards the side of the lesion
*Internal capsule containing the corticospinal and somatosensory fibers in the PLIC is damaged
Noninvasive Positive Pressure Ventilation
Ventilator support delivered via facemask allowing for CPAP or BiPAP
Decreases the work of breathing, improves alveolar ventilation
Indications: COPD exacerbation not responding to normal tx., cardiogenic pulmonary edema, Acute respiratory failure
CIs: ARDS, severe acidosis, cardiac arrest, encephalopathy, GI bleed, agitated, high aspiration risk
MC missed lesion on colonoscopy
Angiodysplasia
Think this if a patient has painless GI bleed with a recent negative colonoscopy
Lambert-Eaton Syndrome
S/s: Proximal muscle weakness, autonomic dysfnxn (Dry mouth), CN involvement (ptosis), diminished DTRs
PE Management
Step 1: Supportive care with O2 and fluids
Step 2: Assess CIs for anticoagulation (bleeding, hemorrhagic stroke)
Step 3: Wells Criteria
Wells Criteria for PE
+3 = Signs of DVT, alternate diagnosis less likely than PE
+1.5 = Previous PE or DVT, HR >100, Recent surgery or immobilization
+1 = Hemoptysis, cancer
> 4= PE likely; Heparin BEFORE further testing
Causes of constrictive pericarditis
Tuberculosis (in endemic areas)
Cardiac surgery
Radiation therapy
Viral
Idiopathic
Constrictive pericarditis
S/s: Fatigue
Dyspnea
Peripheral edema, ascites
Increased JVP
Pulsus paradoxus, Kussmaul's sign
Dx: EKG shows low-voltage QRS
Imaging shows pericardial thickening with possible calcification
JVP tracing shows prominent x and y descents
Sensorimotor polyneuropathy and differences in symptoms
Small fiber injury =» Pain, paresthesias, allodynia (“Positive sx.”)
Large fiber injury =» Numbness, loss of proprioception and vibration sense, decreased DTRs (“Negative sx.)
Tx for testicular tumor
Radical orchiectomy FOLLOWED by platinum based chemo if necessary
Mitral stenosis
Presents as dyspnea, orthopnea, and hemoptysis
May see afib, thromboembolisms, and voice hoarseness from recurrent laryngeal nerve compression after LAE
PE: Mitral facies (pink-purple patches on cheeks), LOUD S1, opening snap, mid-diastolic rumble
Dx: CXR shows pulmonary blood flow redistribution to upper lobes
EKG shos “p mitrale” (notched p wabes), RVH
Echo shows MV thickening with possible calcification, decreased mobility
Patient presenting with acute limb ischemia following an MI
Perform an echo; need to identify if there is a thrombus along with immediate anticoagulation
Pts. with candida esophagitis will also have what
Oral thrush
Criteria for LTOT
Pulse ox <88% on RA
Resting PaO2 <55
PaO2 <59 or SaO2<89% in patients with cor pulmonale, RHF, or Hcrt >55%
-O2 will greatly enhance these patients’ survival
Cerebellar degeneration
Gait probs
Truncal ataxia
Nystagmus
Intention tremor
Dysmetria
Dysdiadochokinesia
First tx of PACs
Stop smoking, caffeine, alcohol, and stress
Acute interstitial nephritis
Maculopapular rash, fever, arthralgia following an acute drug exposure
Labs: AKI, pyuria, hematuria, eosinophilia, urinary eosinophils
Tx: Discontinue drug, steroids if unstable
Diseases leading to secondary pseudogout
Hyperparathyroidism
Hemochromatosis
Hypothyroidism
Renal tubular acidosis
Patients present with non-anion gap metabolic acidosis in t he presence of preserved kidney fnxn; patients may be hyperkalemic if the problem is in the collecting tubule
Seen in patients with poorly controlled diabetes due to hyporeninemic hypoaldosteronism from longterm damage to the juxtaglomerular apparatus
Causes of normal anion gap metabolic acidosis
Diarrhea
Fistulas
Carbonic anhydrase inhibitors
RTA
Iatrogenic
Patient’s with a likely PE
GET A CTA; FUCK THE DDIMER
Bronchogenic carcinoma
Common with asbestos exposure; may see pleural plaques alongside other typical lung cancer signs
Intracranial HTN
Patients present with a headache worse at night, N/V, and AMS changes
Can also have focal neurologic symptoms such as vision change, unsteady gait, and seizure
Symptoms worsen with maneuvers that increase intracranial pressure such as leaning forward, Valsalva
Myasthenic crisis
Patient presents as a 30-40 year old woman with generalized and oropharyngeal weakness alongside respiratory insufficiency
Can be brought on by infxn, surgery, pregnancy, childbirth, aminoglycosides, FQNs, BBs
Monitor in ICU; intubate if necessary
Bath salts intoxication
Amphetamines
S/s: Severe agitation, combativeness, psychosis, delirium, myoclonus, increased BP and HR
***HAS A VERY LONG DURATION; can last from days to weeks
Pt who presents as an MI with a new onset of a holosystolic murmur at the apex
MI with papillary muscle displacement =» acute mitral regurg.
Pramiprexole
Dopamine agonist used for Restless Leg Syndrome
If patients have comorbid insomnia, chronic pain, or anxiety, can try Gabapentin insetead (Ca2+ channel ligand)
Interstitial cystitis
“Painful bladder syndrome”
Patients present with bladder pain when it is full and relief with voiding; patient’s have increased urinary frequency and urgency along with dyspareunia and pain on pelvic exam
Dx: Normal urinalysis, pelvic pain with other causes ruled out
Tx: Avoiding triggers, amitriptyline, NSAIDs
Differentiating ALF from acute hepatitis
Presence of hepatic encephalopathy
Uncommon complication of mono
AI hemolytic anemia along with thrombocytopenia
Hydroxychloroquine ADRs
Retinopathy
Pts. should have annual eye exam while on this drug
Prerenal AKI
Causes: Volume depletion, displace intravascular fluid (sepsis, pancreatitis), renal artery stenosis, afferent arteriole vasoconstriction (NSAIDs),
S/s: Increased serum creatinine, decreased UOP, BUN >20:1, FeNa <1
Tx: Fluid replacement
Tx of afib in stable pts.
BBs, diltiazem, digoxin to control rate
Acute erosive gastropathy
Development of severe hemorrhagic lesions after the exposure of the gastric mucosa to agents that reduce blood flow; decreased blood flow and mucosal injury allow acids and proteases to injure the stomach and vasculature
***Think this if a patient develops hematemesis and epigastric pain after ingesting Aspirin and Cocaine
Acetaminophen intoxication protocol
<4 hours since administration? =» Administer activated charcoal while obtaining acetaminophen levels
N-acetylcysteine administered based on the nomogram
Hyperthyroidism
S/s: Anxiety, insomnia, palpitations, heat intolerance, increased perspiration, weight loss, goiter
PE: HTN, tremors, hyperreflexia, PROXIMAL MUSCLE WEAKNESS, lid lag, A-fib
Chronic findings can include muscle atrophy
Patient with bone lesion and recurrent infxn
MM
Alcoholic hepatitis
S/s: Jaundice, anorexia, fever
RUQ pain
Abdominal distension
Proximal muscle weakness (due to muscle wasting)
Possible hepatic encephalopathy
Labs: AST:ALT >2
Increased GGT, Br, and INR
Leukocytosis
Fatty liver
Increased ferritin
Ferritin as an APR
Increased
Membranoproliferative glomerulonephritis, Type 2
Caused by IgG abs against C3 convertase causing persistent complement activation and kidney damage
Antibodies are called “C3 convertase”
EM: Dense deposits with the glomerular basement membrane
Mixed cryoglobulinemia
Presents as palpable purpura, proteinuria, and hematuria
Other nonspecific symptoms: Arthralgia, hepatosplenomegaly, hypocomplementemia
Confirm with test for circulating cryoglobulins
***F/U: Test for HCV as these two usually COEXIST
Wallenburg Syndrome
Lateral medullary infarction possibly due to intracranial vertebral artery occlusion
Vestibulocerebellar: Vertigo, falling to side of lesion, diplopia, nystagmus, ipsilateral limb ataxia
Sensory: Loss of pain and temp. in ipsilateral face and contralateral body
Autonomic: Ipsilateral Horner’s, hiccups, lack of autonomic respiration
Ipsilateral bulbar muscle weakness (dysphagia, hoarseness, aspiration)
First step in managing liver cirrhosis
Screening endoscopy to identify varices and determine risk
Management of cirrhosis
Variceal hemorrhage: BB or ligation (ligation preferred if varices are large)
Ascites: Na restriction, diuretics, abstinence
Encephalopathy: ID underlying cause, lactulose
Deficiency associated with carcinoid syndrome
Niacin
Increased tryptophan =» serotonin conversion; less niacin and tryptophan
Disseminated MAC
Presents with fever, cough, abdominal pain, diarrhea, night sweats, weight loss, and SPLENOMEGALY AND ELEVATED AP
-indicates hepatosplenic involvement)
Tx: Azithromycin
TTP
ADAMTS13 deficiency leads to formation of small vessel thrombi due to long chains of vWF accumulating on the endothelial wall
Dx: Hemolytic anemia, thrombocytopenia, possible renal failure, neurologic change, and fever
Tx: Plasma exchange
Sporotrichosis
Infections occur in gardeners via direct inoculation; a papuler forms at the site that ulcerates and drains an odorless and nonpurulent fluid
=»Later, several proximal lesions develop along the line of lymphatic drainage
Tx: Oral itraconazole
Management of stones <1cm
Hydration
Analgesics
a-blockers (Tamsulosin)
MCCo acute epididymitis in pts. >35 years
E. coli
ADRs of cyclosporine
Nephrotoxicity- azotemia, hyperuricemia, hyperkalemia
HTN- can tx w/ CCBs
Neurotoxicity- Headache, tremors, visual probs
Glucose intolerance
Infxn
Malignancy- SCC
*****Gingival hypertrophy
*****Hirsutism
GI probs
Autoimmune adrenalitis
Presents with symptoms of primary adrenal insufficiency (hyperpigmentation, hyponatremia, hyperkalemia, fatigue, weakness, GI probs)
Can occur as an isolated disorder or in association with other AI syndromes
S3 sound
ken-tuc-KY
Typically a sign of Left Ventricular failure
Senile purpura
Ecchymosis, skin fragility, and consistent bruising due to loss of elastic fibers in the perivascular CT
Minor abrasions can rupture superficial vessels and lead to large ecchymoses
-Labs normally appear normal
Best test to diagnose brain tumors
MRI with gadolinium
Double duct sign
CT finding with a carcinoma of the head of the pancreas in which we see compression of the pancreatic and common bile duct
=»Intra and extrahepatic biliary duct dilatation with a nontender, distended gallbladder
Complications of primary biliary cholangitis
Xanthelasmas (due to hyperlipidemia)
Malabsorption (fat-soluble deficiencies)
Hepatocellular carcinoma
Osteoporosis, osteomalacia (not due to deficiencies; Ca and Vit D can be normal so pathophysiology is unknown)
Tx of bacterial endocoarditis w/ acute stroke
Just IV fluids and antibiotics; do not anticoagulate
Leukomoid Reaction
Reactive process to acute infxn
LAP score: High (>20)
PMN precursors: Late phases
Basophilia: Not present
Exam for suspected chronic pancreatitis
Abdominal CT
Raynaud’s Phenomenon workup
CBC
Metabolic panel
Urinalysis
ANA, RF
-If positive for ANA, get antitopoisomerase-1 abs for systemic sclerosis
ESR and C3, C4 levels
Zinc deficiency
Alopecia
Pustular skin rash (perioral region and extremities)
Hypogonadism
Impaired wound healing
Impaired taste
Immune dysfnxn
Causes: Malabsorption, bowel resection, poor intake, paraenteral nutrition
Patient who has just gotten out of ophthalmic surgery and presents with a fever, swollen eyelid, edematous conjunctiva, and exudates in the anterior chamber
Postoperative endophthalmitis
Occurs within six weeks of surgery and is due to an infection of the eye; viterous humor can be sent for gram stain and culture
Tx: Intravitreal antibiotics
MCC of gross painless lower intestinal bleeding in adults
Diverticulosis
Hyponatremic patients who are presenting with severe neurologic manifestations
Treat with hypertonic saline; still correct at <8meq/L for first 24 hours to prevent osmotic demyelination syndrome
Hallmark of prolonged and recurrent seizures
Cortical laminar necrosis; MRI shows cortical hyperintensity suggestive of infarction
Tumor lysis Syndrome
Patients present with N/V, diarrhea, muscle cramps, seizures, tetany, CARDIAC ARRHYTHMIA, and AKI
HAllmarks: Hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia
Tx: IV fluids (flush kidneys), allopurinol
Mechanism of ACEI dry cough
Inhibits the metabolism of kinins and substance P
=» Kinins irritate bronchi with increased prostaglandin production
Also, inhibition of ACE activates the arachidonic acid pathway
=»Increased thromboxane =» Bronchoconstriction
Clinical features of multiple sclerosis
Optic neuritis
Internuclear opthalmoplegia
Fatigue
Heat sensitivity
Numbness, parasthesia
Paraparesis, spasticity
Bowel, bladder dysfnxn
MRI: Lesions disseminated in space and time (usually found in periventricular, juxtacortical, intratentorial, or spinal cord areas)
CSF: Oligoclonal IgG bands
CSF in MS pts
Oligoclonal bands
S4 Sound
TEN-nes-see
Indicates a stiff, left ventricle which occurs in the standing of longstanding hypertension or restrictive cardiomyopathy
Sound is made by blood striking a stiffened left ventricle
Mechanical Complication of acute MI timeline
Acute: RV failure (Kussmaul’s sign)
3-5 days: Papillary muscle rupture (severe pulmonary edema, new holosystolic murmur)
3-5 days: Interventricular septum rupture (shock, chest pain, new holosystolic murmur, biventricular failure)
5 days-2 weeks: Free wall rupture (shock, chest pain, JVD, distant heart sounds)
Disseminated gonoccocal infxn
Presents as a purulent monoarthritis OR
Triad: Tenosynovitis, dermatitis (erythematous papules/pustules), and asymmetric MIGRATORY POLYARTHRALGIAS
Dx: Blood cultures can be negative, synovial fluids show PMNs
Tx: IV ceftriaxone, empiric azithromycin/doxy, joint drainage for purulent arthritis
Reactive arthritis
Cant’ see, can’t pee, can’t climb a tree
Look for STD history
Tx: NSAIDs
Patient who has arthritis of the hands, wrists, and knees with joint effusion BUT also has kids
THINK ABOUT PARVOVIRUS B19
MCC of primary adrenal insufficiency
Autoimmune adrenalitis
Pulmonary empyema
Patients have frank pus or bacteria in a cavitary space; usually an IC pt.
Pleural fluid: ph<7.2, decreased glucose, WBC >50,000
Tx: Abs and drainage
Anserine burisitis
“Pes anserinus”
Localized pain and tenderness over the anteromedial tibia distal to the joint line
Patients are usually fat and obese diabetic females
Tx: NSAIDs, symptoms usually go away in a few weeks
Amyloidosis
Can be primary or secondary to chronic inflammation (RA, TB, osteomyelitis, IBD, malignancy, vasculitis)
S/s: Proteinuria, nephrotic syndrome
Restrictive cardiomyopathy (heart is concentrically thickened)
Hepatomegaly
Peripheral neuropathy/Autonomic neuropathy
Organ enlargement (macroglossia)
Waxy, thickened skin that easily bruises**
Extrahepatic manifestations of chronic HCV
Mixed cryoglobulinemia syndrome
Membranoproliferative glomerulonephritis
Porphyria Cutanea Tarda (photosensitive vesicles and bullae erupt on skin with sun exposure, lesions scar forming hyperpigmented areas)
**Always order HCV testing if a pt. has this
Lichen planus
Highest RF for stroke
HTN
Patients with steatorrhea may present with what deficiencies
Fat soluble vitamin deficiencies
Vit D= Low Ca2+, Low PO4, and increased PTH
Best tests for Cushing Syndrome
Low-dose dexamethasone suppression test
RBC transfusion thresholds
<7 = always
<8= Cardiac sx., oncology patients in treatment, heart failure
8-10= Symptomatic anemia, ongoing bleeding, ACS, noncardiac surgery
Complication of aortic dissection
Cardiac tamponade
Acromegaly effects
Local tumor effect: Visual field defects, headache, cranial nerve defects
MSK: Gigantism, protruding jaw, arthralgia, myopathy, skin tags, carpal tunnel syndrome
Cardiac: Concentric hypertrophy, HTN, mitral/aortic regurg,
Pulm/GI: OSA, colon polyps, diverticulosis
Enlarge organs = Tongue, salivary glands, liver, spleen
Endocrine: Galactorrhea, decreased libido, DM, hyperparathyroidism, hypertriglyceridemia
**Effects are due to increased IGF-1
Patient with periodic headaches and HTN who presents with severe HTN after anesthetic admin.
Suspect pheochromocytoma
BBs can also cause these exacerbations
Epidermal Inclusion Cyst
Dome-shaped, firm, freely movable cyst or nodule with a central punctum (pore-like opening)
Represents epidermis lodging in the dermis; can intermittently produce discharge; only needs tx. if signs of infxn develop
Characteristics of uncomplicated parapneumonic effusion
Caused by movement of fluid from pneumonia into visceral pleura
Fluid analysis: ph>7.2
Decreased-normal glucose
WBC <50,000
Gram stain (-)
EXUDATIVE
-Differs from empyema because no bacteria are present
Tx for acute sciatica
- Trial of NSAIDs
- Muscle relaxant/short-term opioid
* Don’t need MRI unless patient has progressive deficits, cauda equina, or signs of epidural abscess (IV drug use, fever)
Aspirin allergy
ALSO GOES FOR NSAIDs
Globus sensation
Sensation of foreign body in the throat; occurs when swallowing saliva and is assoc. w/ anxiety
Patients do not have pain, dysphagia, or dysphonia; just the sensation of something in their throat
Crescendo-decrescendo murmur along the left sternal border with no radiation
HCOM; indicates the presence of interventricular septal hypertrophy
S/s: Syncope, dyspnea, chest pain
Spinal cord compression management
Immediate IV glucocorticoids (decreased vasogenic edema caused by an obstructed epidural venous plexus)
Emergency MRI
Neurosx. consult
Patients with steatorrhea may present with what deficiencies
Fat soluble vitamin deficiencies
Vit D= Low Ca2+, Low PO4, and increased PTH
Best tests for Cushing Syndrome
Low-dose dexamethasone suppression test
RBC transfusion thresholds
<7 = always
<8= Cardiac sx., oncology patients in treatment, heart failure
8-10= Symptomatic anemia, ongoing bleeding, ACS, noncardiac surgery
Complication of aortic dissection
Cardiac tamponade
Acromegaly effects
Local tumor effect: Visual field defects, headache, cranial nerve defects
MSK: Gigantism, protruding jaw, arthralgia, myopathy, skin tags, carpal tunnel syndrome
Cardiac: Concentric hypertrophy, HTN, mitral/aortic regurg,
Pulm/GI: OSA, colon polyps, diverticulosis
Enlarge organs = Tongue, salivary glands, liver, spleen
Endocrine: Galactorrhea, decreased libido, DM, hyperparathyroidism, hypertriglyceridemia
**Effects are due to increased IGF-1
Patient with periodic headaches and HTN who presents with severe HTN after anesthetic admin.
Suspect pheochromocytoma
BBs can also cause these exacerbations
Epidermal Inclusion Cyst
Dome-shaped, firm, freely movable cyst or nodule with a central punctum (pore-like opening)
Represents epidermis lodging in the dermis; can intermittently produce discharge; only needs tx. if signs of infxn develop
Characteristics of uncomplicated parapneumonic effusion
Caused by movement of fluid from pneumonia into visceral pleura
Fluid analysis: ph>7.2
Decreased-normal glucose
WBC <50,000
Gram stain (-)
EXUDATIVE
-Differs from empyema because no bacteria are present
Tx for acute sciatica
- Trial of NSAIDs
- Muscle relaxant/short-term opioid
* Don’t need MRI unless patient has progressive deficits, cauda equina, or signs of epidural abscess (IV drug use, fever)
Aspirin allergy
ALSO GOES FOR NSAIDs
Globus sensation
Sensation of foreign body in the throat; occurs when swallowing saliva and is assoc. w/ anxiety
Patients do not have pain, dysphagia, or dysphonia; just the sensation of something in their throat
Crescendo-decrescendo murmur along the left sternal border with no radiation
HCOM; indicates the presence of interventricular septal hypertrophy
S/s: Syncope, dyspnea, chest pain
Spinal cord compression management
Immediate IV glucocorticoids (decreased vasogenic edema caused by an obstructed epidural venous plexus)
Emergency MRI
Neurosx. consult
Patients with steatorrhea may present with what deficiencies
Fat soluble vitamin deficiencies
Vit D= Low Ca2+, Low PO4, and increased PTH
Best tests for Cushing Syndrome
Low-dose dexamethasone suppression test
RBC transfusion thresholds
<7 = always
<8= Cardiac sx., oncology patients in treatment, heart failure
8-10= Symptomatic anemia, ongoing bleeding, ACS, noncardiac surgery
Complication of aortic dissection
Cardiac tamponade
Acromegaly effects
Local tumor effect: Visual field defects, headache, cranial nerve defects
MSK: Gigantism, protruding jaw, arthralgia, myopathy, skin tags, carpal tunnel syndrome
Cardiac: Concentric hypertrophy, HTN, mitral/aortic regurg,
Pulm/GI: OSA, colon polyps, diverticulosis
Enlarge organs = Tongue, salivary glands, liver, spleen
Endocrine: Galactorrhea, decreased libido, DM, hyperparathyroidism, hypertriglyceridemia
**Effects are due to increased IGF-1
Patient with periodic headaches and HTN who presents with severe HTN after anesthetic admin.
Suspect pheochromocytoma
BBs can also cause these exacerbations
Epidermal Inclusion Cyst
Dome-shaped, firm, freely movable cyst or nodule with a central punctum (pore-like opening)
Represents epidermis lodging in the dermis; can intermittently produce discharge; only needs tx. if signs of infxn develop
Characteristics of uncomplicated parapneumonic effusion
Caused by movement of fluid from pneumonia into visceral pleura
Fluid analysis: ph>7.2
Decreased-normal glucose
WBC <50,000
Gram stain (-)
EXUDATIVE
-Differs from empyema because no bacteria are present
Tx for acute sciatica
- Trial of NSAIDs
- Muscle relaxant/short-term opioid
* Don’t need MRI unless patient has progressive deficits, cauda equina, or signs of epidural abscess (IV drug use, fever)
Aspirin allergy
ALSO GOES FOR NSAIDs
Globus sensation
Sensation of foreign body in the throat; occurs when swallowing saliva and is assoc. w/ anxiety
Patients do not have pain, dysphagia, or dysphonia; just the sensation of something in their throat
Crescendo-decrescendo murmur along the left sternal border with no radiation
HCOM; indicates the presence of interventricular septal hypertrophy
S/s: Syncope, dyspnea, chest pain
Spinal cord compression management
Immediate IV glucocorticoids (decreased vasogenic edema caused by an obstructed epidural venous plexus)
Emergency MRI
Neurosx. consult
Effect modification
External variable positively or negatively impacts the effect of a risk factor on a disease of interest
*However, if you remove the variable, there is still risk in the group with one factor
Confounding
Exposure-disease relationship is obscured by an extraneous factor associated with exposure and disease
*If you remove the RF, there is no difference between two groups
Lacunar stroke
Occlusion of the deep penetrating arteries of the brain; particularly susceptible to HTN, DM, hyperlipidemia, and smoking
Path: Microatheroma formation and lipohyalinosis leading to small vessel occlusion
Erlichiosis
S/s: Flu-like illness, neurologic symptoms (confusion)
“RMSF without the spots”
Labs: Leukopenia, thrombocytopenia, elevated LFTs, elevated LDH
Dx: Intracytoplasmic morulae in monocytes
Tx: Doxycycline
First line tx. of chemotherapy-induced nausea
SSRI
Caustic ingestion
S/s: Hoarseness, stridor (laryngeal), dysphagia, odynophagia (esophageal), epigastric pain, bleeding (gastric)
Tx: Secure airway, remove contaminated clothing, CXR if respiratory probs, EGD
Systolic anterior motion of the mitral valve
Associated with HCOM; contacts the thickened interventricular septum causing LVOT obstruction
Patient who recently had a drug eluting stent placed and has an MRI
Think medication noncompliance
Cardiac myxoma
S/s: Constitutional (fever, weight loss, Raynaud’s),Heart failue, arrhythmia, embolization
Dx: Echo
Tx: Surgery soon (decrease risk of embolus)
Tubulointerstitial nephritis
Usually due to analgesic use
Patients may have poluria and steril pyuria
Glucocorticoid-induced myopathy
Patients have proximal muscle weakness and atrophy but no pain due to inflammation caused by catabolic breakdown
Will also see signs of glucocorticoid excess
Felty Syndrome
Advance RA with splenomegaly and neutropenia
Pleural effusion exam findings
Decreased breath sounds
Decreased tactile fremitus
Dullness to percussion
May be a mediastinal shift away from effusion
Pt with an acute STEMI and pulmonary edema
Make sure to give Lasix
Tophaceous gout
Tumors in the soft tissues that can ulcerate and drain a chalky material
Patients don’t even need microscopic examination for gout crystals; this is pathagnomic
Most common glomerulopathy with HIV
Focal segmental glomerulosclerosis
Bilateral trigeminal neuralgia
Think MS as this is usually a unilateral condition
Bethanechol
Cholinergic agonist used to treat urinary retention
Hyposthenuria
Found in patients with SCD OR Sickle Cell Trait; presents as a patient who cannot concentrate urine or reabsorb water; usually will be young in the question stem
-RBCs get caught in the vasa recta impairing countercurrent exchange
Tx for syphilis patients who have SEVERE penicillin allergies
Doxycycline
Supravalvular aortic stenosis
Congenital LVOT obstruction causing a systolic murmur; usually heard in the first intercostal space
**Patients have differential blood pressures in the two arms
Hypertensive nephropathy
2nd leading cause of ESRD
Decrease in renal blood flow and GFR =» hypertrophy and intimal medial fibrosis of the renal arterioles
Can see microscopic hematuria and proteinuria
Patient with renal issues who suddenly develops severe retroperitoneal pain, fever, and gross hematuria
Think RVT due to antithrombin III loss
HIV screening indications
Once between the ages 15-65
Treatment for TB
Treatment for another STD
Annual: IVDU, MSM, prostitutes, partners of HIV positive, homeless, prison
Additional: Pregnancy, exposure
Solitary brain mass in HIV patient
CNS lymphoma; is usually ring-enhancing
Multiple ring enhancing lesions in HIV pt.
Toxoplasma
Patient who becomes alkalotic after being treated for fluid overload
Think loop diuretics
The increased Na+ delivery to the DCT causes K+ and H+ to be secreted
Pt with AKI due to postrenal causes
Catheterization
Do bladder scan first to see but if it’s inconclusive, jump to this
Medications associated with SIADH
Carbamazepine
SSRIs
NSAIDs
Pt. with COPD exacerbation and has a seizure
Due to acute cerebral vasodilation
Use O2 with a goal of 90-93%
NaHCO3 mechanism in TCA OD
Na+ increases the serum pH and extracellular sodium =» decreased avidity of TCA for cardiac sodium channels
-This helps to prevent QRS widening
Charcot joint
“Neurogenic arthropathy”
Presents as patients with large, deformed joints that lack sensation and have lost neurologic input; patients can have DJD and loose bodies on joint imaging
-Patients only have mild pain tho due to the loss of neurologic input
Causes: Diabetes, syringomyelia, spinal cord injury, B12 deficiency, tabes dorsalis
=»Patients damage feet unknowingly
Tx: Manage underlying conditions; weight bearing assistance
Secondary amyloidosis
Seen with chronic inflammation, chronic infections, IBD, malignancy, and vasculitis
S/s: Proteinuria w/ nephrotic syndrome possible
Cardiomyopathy
Hepatomegaly
Peripheral neuropathy
Macroglossia
Waxy thickening and easy bruising of skin
Management of frostbite
Rapid rewarming in 37-39 degree water
Analgesia and wound care
Thrombolysis in severe, limb-threatening cases
“Water hammer pulse”
Aortic regurgitation
Vasovagal syncope
“Neurocardiogenic syncope”
Triggered by emotional or painful stimuli and is associated with prodromal sx. (dizziness, nausea, pallor, diaphoresis); pts. rapidly regain consciousness
Tx: Reassurance, avoidance of triggers, ***Counterpressure maneuvers (leg crossing, tensing arm muscles) that involve raising the SVR
CT imaging on pyelonephritis
Persistent clinical symptoms after 48-72 hours of therapy, history of kidneys tones, or unusual findings (gross hematuria, obstruction)
Pressure ulcers
Suspect over any bony prominences (sacrum, ischia tuberosities, malleoli, heels, 1st or 5th metatarsal heads)
Serous otitis media
Conductive hearing loss that presents with a dull tympanic membrane that is hypomobile
Aspirin Toxicity
RESPIRATORY ALKALOSIS
THEN
ANION GAP METABOLIC ACIDOSIS
pH is relatively normal, however, the pCO2 and HCO3 will both be decreased
Vessel that supplys the inferior wall of the heart
RCA
Protein C resistance
Factor V Leiden
Splenic abscess
Patients present with fever, leukocytosis, and LUQ pain; possibly can have left-sided pleuritic chest pain with a left sided effusion
RFs: Infxn, hemoglobinopathy, IC, IV drug use, trauma
Tx: Abs and splenectomy
**HIGHLY ASSOC. W/ LEFT-SIDED ENDOCARDITIS
Meniere Disease
Increased volume and pressure of endolymph in the inner ear due to defective resorption
Triad: Low frequency tinnitus w/ a feeling of fullness
Episodic vertigo (may have N/V, lightheadedness)
Sensorineural hearing loss (usually worsens with time)
Tx: Restrict Na+, caffeine, nicotine, alcohol
Benzos or antiemetics for acute sx.
Diuretics for long term management
Management of hypercalcemia
- Normal saline
- Calcitonin
- (Long term) bisphosphonates
Hepatic hydrothorax
Pleural effusion due to small defects in the diaphragm that occurs when PERITONEAL FLUID passes thru
***MORE COMMON ON THE RIGHT
S/s: Dyspnea, cough, pleuritic chest pain, hypoxemia
Tx: Na+ restriction, diuretics
Prevalence studies are what kind of study?
Cross-sectional
Pneumonia breath sounds
Represents consolidation of a lung
Increased crackles
Increased tactile fremitus
Dullness to percussion
No mediastinal shift
Cyanide toxicity
Causes: Combustion of carbon and nitrogen material (wool, silk), industrial exposure (mining metals), or sodium nitroprusside
S/s: Skin- Flushing, cyanosis CNS- Headache, AMS, seizure, coma CV- Arrhythmia Respiratory- Tachypnea followed by respiratory depression, pulmonary edema GI- Pain, N/V Renal- Metabolic acidosis (LA), RF
Type of cardiomyopathy assoc. w/ amyloidosis
Restrictive cardiomyopathy
Antiparkinsonian drug that is dangerous in pts. w/ glaucoma
Anticholinergics (trihexyphenidyl)
These can ppt. ACG
Granulomatosis with polyangiitis Diagnostic findings
anti-PR3, anti-MPO
Biopsy:
Skin-leukocytoclastic vasculitis
Kidney- Pauci-immune GN
Lung- granulomatous vasculitis
Tx: Corticosteroids and immune modulators (MTX, cyclophosphamide)
Pancoast tumor
S/s: Shoulder pain
Horner cyndrome
C8-T2 neurologic involvement (weakness of intrinsic hand muscles)
Weight loss
Enlarged supraclavicular lymph nodes
SVC syndrome
MS
S/s: Fatigue
Episodes of numbness, paresthesia, bowel/bladder dysfnxn, heat sensitivity, optic neuritis
Symptoms may worsen when a patient moves to a hotter area
Uhthoff phenomenon
MS patients experiencing increased frequency of episodes after they move to a hotter region
Adhesive capsulitis
“Frozen shoulder”
Patients have decreased passive and active ROM in the shoulder joint with a gradual increase in severity but NOT a lot of pain
-Can be due to chronic inflammation, fibrosis, or contracture of the capsule
Felty Syndrome
triad
RA
-including vasculitis with necrotizing skin lesions
Neutropenia
Splenomegaly
*Also have anti-CCP, elevated ESR
Mechanism of cyanide poisoning
Inhibits cytochrome oxidase a3 in the mitochondrial electron transport chain blocking the production of ATP
=»Increase in anaerobic metabolism and metabolic acidosis
Follow-up of a CXR with a new mass
Chest CT
Hypertrophic Osteoarthropathy
Digital clubbing accompanied by sudden-onset arthropathy affecting the wrist and hand joints
-Can be due to underlying lung disease (cancer, TB, bronchiectasis, COPD)
Initial study: CXR (rule out cancer)
Things to rule out in patients presenting with pseudogout
- Hyperparathyroidism
- Hypothyroidism
- Hemochromatosis (get iron studies)
Progressive Multifocal Leukoencephalopathy
JC virus reactivation typically in an IC host
S/s: Slowly progressive confusion, paresis, ataxia, and seizure
Dx: MRI of brain shows multiple white matter lesions with NO enhancement or edema
-Virus lies dormant in kidneys and lymphoid but reactivated w/ CD4 <200; moves to CNS and lyses oligodendrocytes
Medications to hold prior to cardiac stress test
48 hrs: BBs, CCBs, Nitrates
-If vasodilator, dipyramidole as well
12 hrs: Caffeine
Chikungunya fever
Patient who is from Central or South America (or recently traveled) and presents with high fever, SEVERE ARTHRALGIA, lymphopenia, thrombocytopenia, and increased LFTs
Other S/s: Headache, myaglia, conjunctivits, maculopapular rash
Tx: Supportive
Anemia that develops with antiepileptics
Folic acid; due to impaired absorption
Tx for hepatic encephalopathy
Lactulose
Tx for Lyme Disease in kids and pregnant women
Amoxicillin
Treatment of cachexia
Progesterone analogues (megestrol acetate)
Corticosteroids
- These increase appetite, cause weight gain, and improve well being
- Megestrol acetate preferred due to decreased side effects
Takayasu Arteritis
Asian female who presents with constitutional signs of fever and weight loss as well as with arterio-occlusive sx. (Claudication, ulcers in the upper extremities)
PE: Blood pressure discrepancies
Pulse deficits
Arterial Bruits, especially in the upper extremities
Dx: elevated ESR, CRP
CXR: widened mediastinum, aortic dilatation
Ct/MRI: thickening of aortic walls and narrowing of vessel lumen
Tx: Glucocorticoids
Invasive aspergillosis
Triad of fever, chest pain, and hemoptysis in an IC pt.
⭐️CXR: Pulmonary nodules with halo sign
Can also have cell wall bio marks (Galactomannan, beta-D-glucan)
Tx: Voriconazole plus caspofungin
Post-streptococcal AGN
Preiorbital edema, hematuria, and oliguria
Patient will have ️Decreased c3
Systemic sclerosis subtypes
Limited cutaneous:
Scleroderma on the head and distal upper esophagus
Vascular manifestation (Raynauds, cutaneous Telangiectasia, pulmonary hypertension)
CReSt
Anti-centromere abs
DIFFUSE CUTANEOUS:
More internal organ involvement as well as the skin (renal crisis, myocardial ischemia and ️fibrosis, interstitial lung disease)
Anti-Scl-70 (anti-topoisomerase-1) and anti-RNA polymerase III
Tx for variceal hemorrhages
Volume resuscitation
IV octreotide
Antibiotics
Urgent endoscopy to evaluate for balloon tamponade
First thing to do with hyperkalemia
STABILIZE THE MYOCARDIUM
Give calcium gluconate
Patient who has had a gastrectomy years ago and is now presenting with signs of anemia
IF deficiency; suspect Vitamin b12 deficiency
Most common vaccination to give to people traveling abroad
Hepatitis A vaccine
Patient who still has a tick attached and it just happened recently
Remove tick; follow-up closely
Evaluation of hyperthyroidism
- Measure TSH, T3, and T4
- If primary, evaluate for signs of Graves (goiter, ophthalmopathy)
- If none, do a radioactive iodine uptake scan
- If it is low, evaluate serum TBG
High? =» Thyroiditis, iodide exposure
Low? =» Exogenous
Cervicofacial actinomyces
Patient with dental infxn or facial trauma who is IC, DM, or malnourished
S/s: Nonpainful, indurate mass; sinus tracts with SULFUR-LIKE GRANULES
-typically affects the mandible
Dx: FNA; culture shows GPR that are slightly branching
Tx: Penicillin; surgery if invasive
Management of cancer pain
Mild= NSAIDs
Moderate= Weak opioids and NSAIDs
-Codeine, hydrocodone, tramadol
Severe = Strong, short-acting opioids
- morphine, hydromorphone
- consider adding long acting if this does not provide relief
pH effects on Ca2+
Increased= dissociation of H+ from albumin =» increased calcium binding to albumin =» decreased serum level
Decreased ph= association of h+ to albumin =» decreased calcium binding to albumin =» increased serum level
Ice pack test
Ice pack applied over eyelid that is droopy =» relief in ptosis CONFIRMS MG
*Cold temperature inhibits the breakdown of Ach in the NMJ
Ventilation goals with ARDS
Low-tidal volume ventilation to decrease the likelihood of overdistending the alveoli
-decreases the work on the lungs
Provide oxygenation by increasing the FiO2 and PEEP
-prevent SpO2 <88%
Patient who presents with widespread molluscum contagiosum
Test for HIV or other immunodeficiency
Tx for variceal hemorrhages
Volume resuscitation
IV octreotide
Antibiotics
Urgent endoscopy to evaluate for balloon tamponade
