UWorld_6.6 Flashcards
Afib: 1st line tx
- unstable pt: cardioversion
- stable pt: 1. b-blockers vs. ca-chan blockers 2. anticoag based on CHADS-VASC score
Determination of need for anticoagulation in Afib
- CHA2DS2-VASc score
- CHF = +1
- Hyptertension = +1
- Age >75 = +2
- DM = +1
- Stroke (prior) = +2
- Vasc. dz = +1
- Age 65-74 = +1
- Sc (sex category) = +1 if female
- anticoagulation advised if score >= 2
Duodenal hematoma management
- occurs with blunt abdominal trauma
- bowel rest + parenteral nutrition + NG suction
- surgery considered second line if conservative tx fails
Characteristics of lateral medullary infarct
- ipsilateral loss of pain/temp @ face + contralateral loss of pain/temp @ body
- ipsilateral Horner’s syndrome (miosis, ptosis, anhidrosis)
- vertigo to side of lesion + nystagmus
- ipsilateral bulbar m. weakness ==> choking, hoarseness
- motor fxn is spared
Cause of lateral medullary infarct/wallenberg syndrome
occlusion of posterior inferior cerebellar artery or vertebral artery
Deficits in medial mid-pontine infarct
contralateral ataxia and hemiparesis
Deficits in medial medullary infarct + cause
- contralateral paralysis of arm/leg + tongue deviation towards the lesion
- caused by occlusion of vertebral or anterior spinal artery
BG goals in gestational DM
-Fasting
Newborn/fetal consequences of maternal hyperglycemia
- congenital malformations
- macrosomia
- neonatal hypoglycemia
- hyperviscosity 2/2 polycythemia`
Thyroid hormone production during pregnancy
- increased thyroid hormone production ==> increased total T4 & T3
- increased thyroxine-binding globulin
- overall: slightly elevated free T4/T3 and decreased TSH
Adenosine deaminase deficiency ==>
- impaired T cells
- viral, fungal, bacterial infections
X-linked agammaglobulinemia ==>
- impaired B cell development
- absent lymphoid tissue
- recurrent sinopulmonary and GI infections
Complement deficiency ==>
- risk for disseminated bacterial infections
- esp. w/encapsulated bacteria: s. pneumo, n. menigitidis
Impaired oxidative burst ==>
- chronic granulomatous disease
- recurrent skin & pulm infections w/catalase + organisms: s.aureus, serratia marcescens
Niemann-Pick vs. Tay Sachs
- both: AR, 2-6 mo., loss of motor milestones, hypotonia, feeding difficulties, “cherry-red” macula
- NP: sphingomyelinase deficiency, HSM, arreflexia
- TS: B-hexosaminidase A deficiency, no HSM, hyperrflexia
