UWSA1 Flashcards
what to think of if someone drinks antifreeze
ethylene glycol poisoning
- causing a metabolic acidosis with increased anion gap
- compensatory drop in paCO2
pt taking medication for BPH and nocturnal urinary symptoms, what should you be concerned about
they could be taking an alpha-blocker in which case lookout for orthostatic symptoms which occur du e to peripheral vasodilation
what heart problem can occur after a viral illness
acute pericarditis which can cause cardiac tamponade
why is there RBC elevation in CSF of someone with herpes encephalitis
result of hemorrhagic destruction of frontotemporal lobes
how does interstitial lung disease present
- progressive dyspnea and nonproductive cough
- fine bibasilar velcro-like crackles
pulmonary fibrosis that leads to stiffening of lungs and decreased lung compliance
-FEV1 and FVC decrease proportionally so the ratio is roughly the same or may even be increased
what is the most common cause of spinal stenosis and what is the classic symptom
dx definitively with MRI of spine even tho x-ray can suggest it
cause: degernative osteoarthritis (spondylosis)
symptom: neurogenic claudication, lower extremity pain with extension of spine and flexion relieves the pain
if pt has increased pigmentation in palmar creases what do you immediately think of
increased levels of ACTH (polypeptide) b/c when POMC gets cleaved into ACTH it also stimulates melanogenesis
when to use vaginal misoprostol
used for cervical ripening (softening and thinning of the cervix) in pts undergoing labor induction
-not used for pts in spontaneous active labor
most common etiology of active phase protraction of labor when cervical dilation is slower than expected (< 1cm ever 2 hours)
contraction inadequacy is most common
-give oxytocin
how to help prevent thrombotic events in pts with a.fib
give warfarin or NOAC (rivaroxaban, dabigatran, apixaban, edoxaban)
explain pleural fluid in pt with tb
very elevated protein (always >4), lymphocytic leukocytosis, low glucose < 60
what color is the fluid in a chylothorax
turbid or milky white
-due to leakage of chyle into thoracic space from obstruction of thoracic duct
when to give what vaccinations for HIV pts with CD4 count above 200
- all pts with HIV require pneumococcal and INACTIVATED influenza
- Zoster vaccination indicated for those with no hx of disease and no evidence of immunity
- once CD4count is below 200 then treat prophylactically for opportunistic infections
most common cause of superior vena cava syndrome
malignancy
-do radiation therapy
how does spontaneous bacterial peritonitis occur
peritoneal fluid becomes infected by enteric organism that translocates across intestinal wall
- >250 PMNs on paracentesis is diagnostic
how to treat bullous pemphigoid
high-potency topical glucocorticoids
which cancers most commonly go to the brain
melanoma, lung, breast, renal
why does tension pneumothorax lead to hypotension
essentially causes superior vena cava syndrome
- high intrathoracic pressure impedes venous return by compressing the vena cava
- needle decompression causes an increase in venous return
what is the most common manifestation of temporal lobe epilepsy
focal seizures with impaired awareness
-you know its from the temporal lobe because of the associated automatisms like hand or mouth movements
all forms of poorly controlled diabetes (pre and gestational) in pregnancy have increased risk of what
fetal lung immaturity
preterm delivery
macrosomia
when you see a pt with v.tach what is the next thing to do
determine if the pt is stable or unstable
-if stable then give IV amiodarone
how to treat supraventricular tachycardia/tachyarrhythmia
-adenosine
-digoxin
(verapamil or metoprolol if adenosine doesnt work)
what to think of if a pt has weakness and leg cramps after initiation of thiazide diuretic
significant hypokalemia
what to think of if pt has persistent hypertension OR hypertension and hypokalemia (muscle weakness)
hyperaldosteronism
- primary = tumor
- secondary = mimickers
what to lookout for after a pt has gastric bypass surgery
these pts have 30-40% chance of developing symptomatic gallstones due to rapid weight loss which promotes their formation (due to increased bile concentrations of mucin and calcium)
- usually pts get ursodeoxycholic acid 6 months postop to reduce risk of gallstone development
- if pt has gallstones before the surgery some surgeons might even just take out the gallbladder at that time too
pt with CKD has low calcium and high phosphate, what do you think of if they also have bone pain
secondary hyperparathyroidism
-kidney isnt helping increase the calcium so the bone works extra hard and becomes thinner cause its giving up so much calcium causing renal osteodystrophy and associated bone pain
how to treat overflow incontinence
cholinergic agonists
how does a pt with hepatic encephalopathy present and what do you look for after
altered mentation and asterixis with EtOH abuse hx
- look for cause in hx, look for infection, electrolyte abnormalities, and evaluate for high-nitrogen states like GI bleeding and dietary changes
- give lactulose
what presentation should make you think of septic shock
fever, tachycardia, hypotension, bronchial breath sounds (or something else that could be the site of initial infection)
what to be concerned about in septic shock
its a hypermetabolic state so pts might have insufficient o2 delivery to meet metabolic demands of peripheral tissues resulting in creased anaerobic metabolism from cells leading to buildup of lactic acid –> metabolic acidosis
lichen simplex chronicus
aka neurodermatitis
- thickened excoriated plaques due to persistent scratching and rubbing
- associated with anxiety disorder
jaundice + weight loss and abdominal discomfort with fullness in RUQ
pancreatic cancer
how does acute iron poisoning present
direct injury of GI tract –> lots of abdominal pain hematemesis and green/black stool (diarrhea) from disintegrating iron tablets
- followed by shock and anion gap metabolic acidosis
- hepatic necrosis and bowel scarring/obstruction may also occur
- treat with deferoxamine and whole bowel irrigation
- acute twisting injury of the knee
- joint line tenderness
- slow-onset effusion
- sensation of instability
- locking or catching when the joint is rotated or extended while under load
meniscal tears
-can also occur from minimal trauma in older pts with chronic degeneration of the cartilage
prognosis of astrocytomas are affected by what
*these can all make prognosis worse tumor grade increased atypica mitoses neovascularity necrosis
how to treat CLL
median survival is 10 years and treatment is not necessary until advanced symptoms occur
-monoclonal antibodies against CD20 antigen are often part of the first-line treatment
serum sodium < 135
decreased intake and output of water, orthostatic lightheadedness, dry mucous membranes, poor skin turgor, tachycardia, orthostatic hypotension
hypovolemic hyponatremia
extrarenal losses have urine sodium < 20
renal losses have urine sodium > 20
decreased effective circulating volume in CHF and cirrhosis
abx prophylaxis for infective endocarditis is recommended for who
only in pts with high risk of adverse events from IE like prosthetic heart valves or previous IE
pt presents with large adnexal mass and symptoms of hyperestrogenism (precocious puberty, endometrial hyperplasia, postmenopausal bleeding)
granulosa cell tumor
right-sided adnexal fullness and firm nodularity along the rectovaginal septum with small chest pleural effusion
epithelial ovarian carcinoma
- high CA-125
- increased urinary frequency/urgency, pain, bloating, and abdominal distention
most common cancers that cause malignant pleural effusion
breast and lung cancer
-malignancy should be suspected in pts with large unilateral pleural effusions without evidence of infection
goal in management of septic shock
restoring adequate tissue perfusion through IV saline and identifying/treating underlying infection
-then start vasopressors (dopaimine, norepi) only if pt fails to respond with IV fluids
pt presents with chronic gi discomfort, malabsorption (diarrhea, weight loss), and eosinophilia
hookworm or some parasitic infection
CRAB findings in multiple myeloma
Calcium increased
Renal insufficiency (tubular damage)
Anemia (normocytic)
Bone lytic lesions and osteopenia
fragile X syndrome
CGG repeat
hypermethylation of gene and impaired transcription of protein FMRP which is important to brain development
- features of autism
- delayed milestones, seizures, macrocephaly, and hypotonia
- more typical features: elongated face, large ears, enlarged testes
- CGG repeat = Chin Giant Gonads
in a pt with psychosis what do you want to do
urine drug screen to rule anything else out
positive technetium-99m pertechnetate scan
meckel diverticulum
- ectopic gastric mucosa within 2ft of ileocecal valve
- rule of 2s
- persistent vitelline duct
what is a common cause of DIC
microangiopathic hemolysis
pt gets thoracentesis then develops quick reaccumulation of pleural effusion, has difficulty breathing, and hemodynamic instability
hemothorax
-causes decreased LV preload
nephrotic syndrome and hypoalbuminemia
FSGS
does a pulmonary contusion show on x-ray?
yes as a nonlobular opacity
-alveolar hemorrhage and edema resulta nd impair oxygen diffusion
how does a pt with parkinson disease present
small steps and festinating gait with slow speech and resting hand tremor with cogwheel rigidity on passive range of motion
- frequent falls are typical
- histology: frontal lobe atrophy with dopaminergic neuron degeneration in substantia nigra pars compacta
when is xanthochromia seen in CSF of pts
subarachnoid hemorrhage
what will the lumbar puncture findings be in someone with guillain-barre syndrome
elevated protein with normal leukocyte count
-albuminocytologic dissociation
pt presents with sudden paralysis and has a hx of injection drug use or spinal procedure
spinal epidural abscess
- most commonly with concurrent distant infection (skin or soft tissue)
- classic triad: fever, back pain, neurologic manifestations
- treatment: broad-spectrum abx (vanc + ceftriaxone) and aspiration or surgical decompression
oral vesicles on uvula, soft palate, and tonsillar pillars in child
herpangina caused by coxsackie A virus
-dx is clinical and treatment is reassurance and supportive care
granulomatosis with polyangiitis
necrotizing vasculitis
- affects upper and lower respiratory tracts and kidneys
- cutaneous manifestations are also common as the vasculitic inflammation may lead to localized ischemia and impaired wound healing
stem cell disorder primarily in older adults and those who have had previous chemo or radiation
myelodysplastic syndrome
- macrocytic anemia, leukopenia, and thrombocytopenia
- peripheral blood smear shows signs of dysplasia including oval macrocytes and hyposegmented/hypogranulated neutrophils
- bone marrow biopsy required for dx
increased symptomatic calcium… how do you treat this
calcium gluconate
how to treat COPD exacerbation
O2 with target at 88-92 bronchodilators glucocorticoids abx if needed oseltamivir if influenza NPPV if vent failure Trach intubation if NPPV failed or contraindicated
after a pt gets chemotherapy what are you concerned about
chemo can cause neutropenia putting pts at risk for systemic infections and sepsis
myxedema madness
if a pt has hypothyroidism (fatigue, weight gain, cold intolerance, myalgia, and constipation)
-also possible depressed mood
PLUS psychosis then its still hypothyroidism cause myxedema madness can be found in these pts
what is the basis of diabetic ketoacidosis in children
fatty acid breakdown in the liver causing increased ketones and acidosis
when to add K vs glucose to pt who you are treating diabetic ketoacidosis
add IV serum K if <5.3
hold if 5.3 or above
add glucose if serum glucose < 200
whatre bad prognostic factors in pts with CLL
multiple chain lymphadenopathy
hepatosplenomegaly
anemia and thrombocytopenia
what is the richter transformation
CLL/SLL transforms into aggressive lymphoma most commonly diffuse large B-cell lymphoma
if you think a pregnant pt has a PE but the V/Q scan shows a low probability then what do you do
get a CT-Angiography or LE ultrasound for further testing
-D-Dimers are NOT helpful in pregnant pts cause it changes during pregnancy anyways
*Note: in any situation where the pretest probability is low then a low D-Dimer cant actually rule out a PE
what HIV med should be used cautiously in pts with hx of psych illness (its an NNRT)
Efavirenz
they could develop anxiety, insomnia, dizziness, impaired concentration, and VIVID DREAMS
-even in previously nonanxious pts
describe the difference b/w stress, urgency, and overflow urinary incontinence
STRESS
- leaking with valsalva, cough, sneeze, laugh
- lifestyle modification, pelvic floor exercises, pessary, pelvic floor surgery
URGENCY
- sudden, overwhelming, or frequent need to void
- lifestyle mod, bladder training, antimuscarinic
OVERFLOW
- constant involuntary dribble and incomplete emptying
- identify and correct underlying cause, cholinergic agonists, intermittent self-cath
what is the next step in pts with vaginal bleeding at > 20 weeks gestation
transabdominal ultrasound to evaluate placental location
if pt has blunt thoracic aortic injury how do you treat them if they are hemodynamically unstable vs stable
unstable (hypotension, active hemorrhage): thoracotomy +/- transesophageal echo in OR
stable: CT angiography to determine vascular surgery vs open thoracic surgery repair
what is an aortography
looking at the aorta via femoral artery catheterization
migraine treatment
pt who already got a triptan or ergot derivative in the past 24hrs sholudnt get another one cause that can cause prolonged vasocontriction due to overactivation of serotonin receptors (can lead to htn, mi, stroke)
flame hemorrhages in the eye
hypertensive retinopathy
- acute monocular loss of visual acuity and visual field defects
- headaches and other neuro problems also present
increased optic cup/dic ratio
optic nerve atrophy due to open-angle glaucoma
-gradual loss of peripheral vision
glare, halos around bright light, difficulty with night driving (loss of visual acuity), myopic shift
cataracts
- progressive opacifications of lens caused by oxidative damage from smoking or sunlight exposure
- pts with DM also at high risk
after a splenectomy what can you expect to see on pts CBC
thrombocytosis
-typically platelet count normalizes after several weeks but some may have it for months or years after surgery
most common cause of sterile pyuria with associated urethritis
chlamydia
which beta blockers have been shown to improve symptoms and overall long-term survival in pts with heart failure and LV systolic dysfunction with ejection fraction < 40%
metoprolol succinate
carvedilol
bisoprolol
patient has galactorrhea but also signs of hypothyroidism, what do you think
hypothyroidism is a common cause of hyperprolactinemia, abnormal uterine bleeding can also occur
-evaluate further with TSH level
how to treat carpal tunnel syndrome
- wrist splinting
- glucocorticoid injection
- surgery for severe or refractory symptoms
first-line tocolytics depending on weeks
<32 weeks: indomethacin
maternal se- gastritis, platelet dysfunction
fetal se- oligohydramnios, closure of ductus arteriosus
32-34 weeks: nifedipine
maternal se- tachycardia, palpitations, nausea, flushing, headache
Short-term tocolytic for inpatient use: terbutaline (beta agonist)
maternal se- tachycardia/arrhythmias, hypotension, hyperglycemia, pulmonary edema
palmar xanthomas
dysbetalipoproteinemias
- defective ApoE
- palmar xanthomas show severe hypertriglyceridemia
- can also cause premature atherosclerosis
what does cholestyramine do
bile acid binding resin that helps reduce LDL levels
-might actually increase TGs
what does ezetimibe do
prevents absorption of dietary cholesterol from gut
-reduces LDL best when used with statin
how to treat raynauds
calcium channel blockers
pt has rhabdomyolysis, what do you expect to see with kidney stuff
some blood and pigmented casts due to skeletal muscle necrosis causes heme-containing myoglobin into the bloodstream
- heme pigment is responsible for renal manifestations of rhabdo
- dark red urine
- positive blood but no red blood cells
sudden onset syncope without a prodrome
arrhythmia
possibly due to TdP
what medication used to maintain sinus rhythm can predispose to Tdp
sotalol
- side effect of QT prolongation
- hypokalemia and hypomagnesemia can both lead to cardiac problems
- GIVING MAGNESIUM can prevent episodes of Tdp
