wild brilliance cases Flashcards
chronic cholecystitis can be due to
food allergy
biliary dyskinesia can be due to
lack of exercise - causing sludge and stone
what does WBC in post-prostate exam urine suggest
inflammation of the prostate
what herb is very specific for pelvic pain, esp accompanied by anxiety
piper methysticum (kava)
foeniculum vulgare
fennel
carminative: relieves flatulence
trifolium pratense
red clover
phytoestrogen and anticancer
often, the root cause of chronic pelvic pain syndrome is _____ which is best treated by ___
- increased intestinal permeability : food intolerance triggering inflammation and causing urothelial permeability
- removing the triggers and healing leaky gut
levofloxacin
antibiotic - floroquinolone
chron’s disease medications
budesonide and mesalamine oral medications
what is associated with ileal chrons disease more than chrons of the colon
cigarette smoking
centella asiatica
GOTU KOLA
immunomodulator and antifibrotic
artemisia annua
wormwood
antimalarial and antiparasitic
lobelia inflata
indian tobacco
strong spasmolytic
alkaloids:
wet cough
do not use with dry cough , hypertension, pregnancy or lactation
what has been showed to decrease vitamin D activation
obesity
herbs that help with glucose control
-cinnamon
-panax quinquefolius
(american ginseng)
-gymnema
-vanadium : elemental: diabetes
insulin sensitizing
berberine
high CRP and high ferritin
increased systemic inflammation
bells palsy/facial nerve palsy
dropping in the corner of the mouth, facial asymmetry, eyebrow droop, loss of forehead and nasolabial folds, tearing, inability to close the eye and hold lips together, difficulty eating and talking, facial muscle atrophy
worry of new onset intermittent tinnitus
acoustic neuroma,
early and small could be missed on MRI
where do acoustic neuromas most commonly occur
internal auditory canal of temporal bone
-can compress facial nerve
what do trigenimal nerve palsies typically cause
loss of sensation
signs of otitis media - hearing loss, fullness in ear
hypoglossal nerve palsy
rare and cause tongue to deviate to side of lesion
tongue atrophy
severely impaired speech
ramsay hunt syndrome
conplication of shingles
affects facial nerve
painful red rash with fluid filled blisters in and around one ear
hypericum perforatum
st johns wort
- antiviral
- herpes simplex virus
treatment for patients with idiopathic bells palsy
corticosteroids
both sides of brain control what part of face
upper
right side of brain controls what side of face
left lower side
left side of brain controls right lower side
lower motor lesion of facial nerve impairs
upper facial function
what type of paralysis is classic for upper motor lesion
spastic paralysis
what is the criteria used to diagnose IBS
ROME III
abdominal pain at least 3d/mon in the past 3 months associated with change in stool form and frequency with onset more than 6 months prior to diagnsosi
frewuent bloatinf and loose stools
food intolerance usually associated
what is testing for Chrons disease
colonoscopy
what is helpful for infectious diarrhea
geranium : astringent
lactoferrin: iron binding protein
IBS-D
foeniculum (fennel) : carminative/spasmolytic
topical heat to calm gut
centella asiatica (pennywort)
relaxing/anxiolytic adaptogen
lomatium dissectum
immune stimulating antimicrobial
taraxacum
dandelion
bitter hepatic herb
what diseases are associated with type I diabetes
dermatitis herpetiformis: autoimmune skin condition
which is associated with CELIAC disease
what is the LONG acting form of insulin
insulin GLARGINE (LANTUS)
rapid acting insulin in 10-20 mins
insulin ASPART AND LISPRO
use before a meal : lasts 3 hours
regular insulin
short acting effect after about 30-60 mins, and lasts about 5 hours
SULPHUR remedy
skin rashes : worse after bathing
worse after warmth of bed , esp at night
worse from scratching, itching and burning of the eruptions
people are confident in communication, direct answering and good eye contact
what other diseases is dermatatitis herpetaformis associated with
SLE
sarcoidosis
type I diabetes
what to avoid with dermatitis herpetaformis
wheat and gluten
omeprazole
PPI
what do you see in stool with E. COLI o157:h7 infection
bloody stool
recent travel to mexico
salmonellis : sudden onset with self-limited duration
proteinuria on urinalysis with infection
infecgtion involved kidneys and requires antibiotic
rose-colored papules on chest
biopsy and culture to isolate
s. typhi vs
s. paratyphi
what to avoid in infectious gastroenteritis
anti-diarrheal because it will back up the toxins and could be lethal (toxic megacolon)
LOPERAMIDE
anti diarrheal
AMPICILLIN
used often when cause is not known
active against a wide range of bacterial groups, including Staphylococcus aureus, Enterobacteriaceae, and anaerobic bacteria.
CEFTRIAXONE
broad spectrum
gonorrhea , PID, meningitis
allium sativum
antimicrobial
can assist in speeding recovery
rumex
laxative and can worsen diarrhea
Pancytopenia
low counts for all three types of blood cells: red blood cells, white blood cells, and platelets
usually due to bone marrow problem
bone marrow biopsy next step
myelodysplastic syndrome
dysfunctional blood cell production in the bone marrow, leading to low levels of red blood cells, white blood cells, and platelets
anticancer
fasting would be most likely to offer the greatest benefit for immune modulation and protection against the progression of his disease.
what is a potential adverse side effect of having the patient suddenly stop taking high-dose oral prednisone
adrenal failure
high-dose prednisone causes feedback response from the adrenal glands to reduce endogenous production of cortisol. sudden withdrawal of prednisone can leave the pt with low cortisol level
ulcerative colitis/proctitis diagnostic
sigmoidoscopy/colonoscopy with biopsy
ulcerative colitis/ proctitis
inflammatory condition -prednisone would suppress inflammatory process
mitral valve stenosis
reduced cardiac output with left ventricular hypertrophy
blood backs up into lungs and causes pulmonary hypertension
rheumatic fever
strep antibodies
hx of arthritis
heart valve disorder
patient with an atrial septal defect
congenital disorder involving left to right shunt with volume overload on the right side of the heart
usually asymptomatic untiol age 20 when signs of pulmonary hypertension can develop
cardiac exam findings: split S2 and systolic murmur
cardiac temponade
emergent condition involving effusion into the pericardium= diminished ability of heart to fully expand and contract
sxs: low blood pressure, jugular venous distension, diminished heart sounds
Ricinus communis oil-
what is it?
castor oil
purgative laxative when taken internally, and historically has been used in cases of gastroenteritis to expel undigested food that is causing inflammation or discomfort. Now it is usually used topically in the form of castor oil packs over the liver, pelvis, or intestines to reduce inflammation and pain. Ricinus oil topically could be helpful for this patient if administered in this way.
diverticulitis treatment
ciprofloxacin in combination with metronidazole is commonly used to treat the infection that is causing inflammation and pain in diverticulitis.
sucralfate
ulcer medication
zolpidem
(ambien)
o Nonbenzo hypnotic
o Undergoes hepatic oxidation by CYP450 thus rifampin shortens the half-life
o SE: nightmares, agitation, anterograde amnesia, HA, GI upset, dizziness, daytime drowsiness
Valsartan
angiotensin receptor blocker
angiotensin II receptor blocker (ARB). It works by blocking a substance in the body that causes blood vessels to tighten.
combined with HCTZ
ARB Tx HF, DM neph AE: hyperK, photosens, cough| Ksparing duiret, ACEI, Preg D
diverticulitis diet
rich in soluble fiber, and free of nuts and seeds, is best for prevention of diverticulitis in people with known diverticulosis. Immediately after diverticulitis, a low fiber diet is best for one month until inflammation is totally resolved.
bells palsy
sudden onset, unilateral facial drooping, and no other systems affected
ACONITUM
Anxious restlessness with a subjective sensation of burning of the face indicates Aconitum. Aconitum can treat sudden-onset neurological conditions, such as numbness, after exposure to cold wind.
IBS HERB
Mentha x piperita
Peppermint leaf tea or capsules can be very helpful as a gentle carminative botanical for people with IBS.
Hypothyroidism
fatigue, digestive irregularity, and weight gain, it is essential to rule this out as a possible cause.
A spinal cord injury is said to be complete if:
‘complete’ if it includes loss of motor and sensory function at the level of S4-S5. Many clinicians consider a spinal cord injury to be complete if there is total loss of function below the level of injury, but the official definition is that of loss of function at the lowest possible level of the spinal cord.
A neurologic examination to define the level of the neurologic injury must include:
Neurological testing must include motor and sensory testing, bilaterally, in upper and lower extremities. Voluntary control of rectal muscles measures function of S2-S4.
Tanacetum parthenium
FEVERFEW
MIGRAINES
Some have reported oral ulcers or contact dermatitis with its use. This has mostly been in people who have chewed the fresh leaves.
Giant cell arteritis (temporal arteritis)
type of vasculitis that affects the large vessels that supply the face and eyes.
associated with polymyalgia rheumatica, which causes the aching pain in his shoulders and hips
Early recognition and treatment of temporal arteritis is critical to prevent which complication?
monocular or binocular blindness due to ischemia
BELLADONNA headache
rush of blood to his head, making him feel hot and flushed, and the pain is throbbing in character. It is worse from jarring motion, from stooping, and worse at midnight and 3 pm.
definitive diagnosis of tempral arteritis or giant cell arteritis
biopsy of the temporal artery, showing inflammation associated with vasculitis.
medication most increase risk of colorectal cancer
Cyclosporine
is an immunosuppressant agent and can diminish the body’s ability to fight infections, and can increase the risk of cancer due to immune dysregulation.
Studies supported by the National Cancer Institute and the National Institutes of Health demonstrated that calcium intake of 1200 mg or more can decrease risk of
developing colon polyps, but calcium supplementation has NOT been shown to cause decreased risk of colon cancer in human studies
biggest risk factor for colorectal cancer?
Cigarette smoking increases a person’s risk of colorectal cancer by about 20%. A low-fiber diet that is high in saturated fat or processed food is also a risk factor
small mass on the posterior wall of the rectum at the very limit of your fingers reach. It is non-tender and somewhat mobile
adenomatous polyp is most likely, and common. An internal hemorrhoid is likely as well, but an external hemorrhoid would have been painful on examination. A rectocele can be present in women; it is from a weakened area in the vaginal tissue, allowing the anterior aspect of the rectum to bulge into the vaginal wall.
screening recommendations for CRC
fecal occult blood test (FOBT) should be performed annually or a colonoscopy should be performed every 10 years. Colonoscopy can screen for both adenomatous polyps and cancer; FOBT can only screen for likelihood of cancer. Positive FOBT screening must be followed with a colonoscopy.
Causticum
often be very sympathetic and care deeply about justice, similar to some cases of Phosphorus, Carcinosin, or Staphysagria. Causticum symptoms are aggravated by cold wind, especially in neurological complaints.
carbamazepine
anticonvulsant. It works by decreasing nerve impulses that cause seizures and nerve pain, such as trigeminal neuralgia and diabetic neuropathy.
**must not be used in patients with a history of bone marrow disease. It is unsafe during pregnancy, and must not be taken within 2 weeks of taking MAOIs. This drug typically causes much more fatigue and sleepiness than insomnia or restlessness.
Wolff-Parkinson-White SYndrome
arrythmia causing tachycardia
slurred upstroke of QRS (delta wave) is characteristic sign of condition
low blood pressure and pallor
*seen in infancy, childhood , or young adolescence
*
digitalis purpura
cardiac glycoside
positive inotrope: increasing pumping strength of heart
negative chronotrope: decreasing heart rate
can promote AFIB and anterograde signal conduction
dont use in WPW! wolf parkinson white
vagus nerve stimulation to reduce tachycardia
massage carotid sinus to slow heart rate
Amiodarone (class III antiarrhythmic k+ blocker)
unstable tachycardia in emergent situation
90% effective for treating narrow complex arrhythmias
digoxin contraindicated in
wolff-parkinson-white
favors antegrade signal conduction and can INCREASE RISK OF V-FIB
diet that increases risk of appendicitis
low fiber
high fiber and veg are protective
acute appendicitis
positive psoas sign= retrocecal orientation
Asthma is often associated with elevations in
eosinophil count. There is also usually decreased FEV1, increased residual lung volume, and hyperinflated lungs on chest x-ray.
FUROSEMIDE is a
loop diuretic
furosemide and aspirin interaction
If aspirin is taken with furosemide, the two drugs compete for elimination in the kidneys. This can lead to higher blood levels of aspirin, and potential aspirin toxicity.
CHF
Symptoms of dyspnea on exertion, B-type natriuretic peptide (BNP) elevation, and prolonged QRS
evaluate the severity of the congestive heart failure, an echocardiogram and chest X-ray are helpful diagnostic tools.
Pagets disease of the breast
always associated with underlying ductal carcinoma
itching, burning plaque surrounding the nipple, with serosanguinous discharge, especially unilaterally, skin dimpling, and firm lymph nodes
next step to confirming Pagets disease
mammogram with image-guided biopsy
Phenelzine
MAOI antidepressant
avoid tyramine-containing foods, such as cheese, red wine, beer, and chocolate, because of the associated potential for hypertensive crisis with this drug-nutrient interaction
Pagets disease of the bone
osteitis deformans
causes an increased rate of bone turnover in localized areas, leading to elevated ALK PHOS, increased localized bone density, and bony enlargement. This disease is entirely separate from Paget’s disease of the breast, despite being named by the same physician.
high risk HPV
16 and 18
major risk factor for cervical dysplasia
smoking
nutrition for prevention and treatment of cervical dysplasia
folic acid
vitamin A
CIN I follow- up?
low grade dysplasia
HPV testing should be performed to determine presence of high-risk or low-risk HPV.
If high-risk HPV is found: a colposcopy should be performed.
With low-risk HPV: start treatment, and a pap or thin prep should be repeated in 6 months to evaluate efficacy of your treatment and to rule out development of further dysplasia.
Anti-HPV botanical for women with cervical dysplasia
THUJA : can be used internal and external
C/I pregnancy
centella
gingko
adaptogen and alterative
Arctostaphylos uva-ursi
urinary antiseptic primarily for alkaline UTI
phenolic glycoside called arbutin, which converts to the antiseptic compound hydroquinone in an alkaline environment.
Dioscorea
antispasmodic
analgesic
Serial beta-HCG
if pregnancy is still viable, should triple within 3 days
bleeding during first 20 weeks of pregnancy
25%
HSV-6 causes
ROSEOLA INFANTUM
rash usually lasts 24-48 hours
& then resolves without complication
COXSACKIE VIRUS A16 CAUSES
hand foot and mouth disease
PARVOVIRUS B19 causes
ERYTHEMA INFECTIOSUM
PARAMYXOVIRUS causes
measles and mumps
melissa officianalis
viral infections, as well as anxiety, IBS
can block thyroid antibodies from binding to the thyroid gland, and also inhibit binding of TSH to thyroid cell membranes, which leads to less production of circulating thyroid hormones.
Hyperthyroid herbs:
Melissa
Lithospermum
Leonurus
Lycopus
Roseola infantum
fever and 3 days of general malaise, then the fever rapidly resolves (phantom/ghost), and a light pink lacy rash appears on the trunk
common in infants 9–12 months of age. Febrile seizures may occur in some children with a high fever
Erythema infectiosum (5th disease)
blotchy pink rash on the cheeks, occurring in 5–7-year-old children mostly; this rash will also resolve spontaneously.
Measles
presents with a fever and the 3 Cs: cough, coryza, and conjunctivitis. Measles also classically has Koplik’s spots on the oral mucosa and a maculopapular rash spreading from the head downward.
Rubella
causes a mild fever, malaise, and a less intense version of a measles rash. The primary concern about rubella is the possibility of a pregnant mother contracting the illness, because it can result in birth defects in congenital infections.
Pathognomonic sign for pyelonephritis
white blood cell casts in urine
lower uti: WBC without casts
casts= kidney
RBC casts in urine
glomerulonephritis
Fatty casts
nephrotic syndrome
waxy casts
chronic renal failure
most common tx for pyelonephritis
CIPROFLOXACIN
broad-spectrum AB
Trimethoprim/sulfamethoxazole (TMP/SMX)
commonly used for UTI
do not use in sulfa allergy
Phenazopyridine
urinary analgesic
can be used for painful UTI
