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34 Cards in this Set
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- 3rd side (hint)
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SLE, Subacute Bacterial Endocarditis, shunt nephritis & cryoglobulinemia....... these are systemic causes of Nephritic or Nephrotic syndrome? What will the C3 level be in these?
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These are all causes of nephritic syndrome with a low C3
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What 2 causes of Nephritic Syndrome are renal limited and will cause a lowered C3?
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Post-infectious GNitis, and Membranoproliferative disease (type 2 > type 1)
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What are the 4 features of nephrOtic syndrome?
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1. Heavy proteinuria
2. Edema +- pleural effusions 3. Hypo Albuminemia 4. Hyper lipidemia (high TG's) ** May be normotensive and have normal renal functions ** |
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If a child has nephrotic syndrome with normal kidney functions, how would age guide your management?
What are the 3 main treatments? In what other circumstance would you biopsy? |
if > 1yr go straight to a trial of Tx with steroids.
if < 1 yr do a biopsy first to r/o congenital causes Tx: - if severe replace the Alb & give diuretics - diet restrictions - Prednisone 60mg/m2/day (use response to this to confirm Dx) If no response after 4wks of therapy do a biopsy |
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What is the Tx for a UTI when the child is:
- < 3Mo - > 3Mo |
<3mo: Gentamycin, Cephalosporin, Ampicillin
> 3mo: Cephalosporing, TMP, sulfa's |
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What is the one blood test that can be used to help the Dx of anaphylaxis?
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Serum tryptase! BUT it must be drawn DURING the attack!
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What is the dose, route, & frequency of Epinepherine to be given during anaphylaxis?
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Epi = 0.01mg/Kg = 0.01cc/kg of 1:1000
Given IM! Can give 2nd dose w/in 4-5 mins following the return of symptoms. ** Administer while trying to secure an airway! |
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What disease would you use HLA serology tests for? Does it have +ve or -ve predictive value?
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HLA allels ar associated with Celiac disease and have a high negative predictive value. If DQ2/DQ8 alleles are --ve that excludes the Dx of celiac with 99% confidence!
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How will IgA deficiency affect your celiac serology tests (EMA/TTG)?
What other test should you do if a person is IgA deficient? |
IgA deficiency (will increase your Celiac risk) but will give you a --ve EMA & TTG, therefore in order to interpret your TTG results you should also do an IgA.
Consider IgG based tests if a person is IgA deficient. ** If IgA deficient & TTG --ve may still need a scope! ** |
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What 3 histological features are seen in people with Celiac?
What is pathognomonic? |
1. intra-epithelial L-cyte proliferaton
2. Hyperplasia 3. Atrophy (partial, subtotal, total) Pathognomic = Total atrophy |
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The Dx of depression requires a depressed mood and/or loss of interest plus 5 or more of what 7 things?
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- guilt, worthlessness
- psychomotor agitation or retardation - difficulty concentrating/making decisions - wt loss/gain - low energy/fatigue - hyper/o somnia - thoughts of death/suicide |
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Name 2 drugs that will alter the absorption of other meds?
What kind of interaction is this? |
1. Proton pump inhibitors & H2 blockers - will change the gastric pH which limits the drug's ability to dissolve
2. Ca/Mg - will complex with the drug making it impossible to absorb Pharmacokinetic! |
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What are 3 drungs that are metabolised by 2C9?
What is the reaction that is likely to occur here? |
Sulfonylureas (for DM2)
warfarin fluvastatin CYP 2C9 gets inhibited by +++ drugs (e.g. Flagyl, SMX/TMP) |
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What are the 4 A's that you should avoid with warfarin?
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1. Amiodarone
2. Anti depressants (SSRI's) 3. Abx (SMX/TMP & flagyl) 4. Analgesia (NSAIDS - esp ASA, Acetaminophen) |
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Which CYP converts codeine to morphine?
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CYP 2D6 changes codeine to morphine and is inhibited by paroxetine!
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What is the difference between pharmaco-KINETIC and pharmaco-DYNAMIC drug interactions?
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In KINETIC interactions one drug alters the [drug] of another drug, whereas in DYNAMIC, the physiologic response to a drug is being altered.
Eg: Kinetic: ↓ drug elimination causing ↑er blood levels Dynamic: one drug blocks a receptor thereby ↓effect of other drug |
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What are the "safer options" for each of the following drug classes?
SSRI's (2) Abx (3) Statins (2) *hint available* |
SSRI's: citalopram & sertraline
Abx: penicillin, cephalosporins, azithromycin Statins: pravastatin, rosuvastatin |
SSRI's (2) C & S
Abx (3) P & C & A Statins (2) P & R |
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What is the treatment for Gonorrhea?
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Cefixime 400mg STAT
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What is the treatment for Chlamydia (3 options)?
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Azithromycin 1g STAT
Doxycyclin 100mg BID x 7/7 Erythromycin 500mg QID x 7/7 |
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What is the treatment for Syphilis?
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Penicillin G!
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What happens to the ovaries during peri-menopause?
1. decrease in 3 things 2. change in something 3. erratic 4. something remains the same |
1. decrease in size, # follicles and production of inhibin
2. remaining follicles respond poorly to FSH & LH 3. erratic ovulation (lasts for 1-3yrs at onset of menopause) 4. Estradiol remains the dominant estrogen |
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Name 3/5 factors that reduce the age of menopause?
Name 3/4 factors that delay MP? |
Reduce the age: smoking, nulliparity, epilepsy, toxic chemicals, chemo/radiation
Delay menopause: obesity, MULTIparity, alcohol, high childhood IQ Do not change age of MP: OCP, age of menarche, marital status, ethnicity |
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After MP the incidence of CHD increases, thus what 3 thigns should ask women about in their diets? What about for osteoporosis?
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Omega 3's, Flavanoids & folate
OP: calories, Ca+, Vit D and protein ** alcohol intake for CA: oral, larynx, esophageal, colorectal & breast |
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Name some of the benefits of exercise during MP:
- improves (2) - protects agains (3) - may improve (2) |
Improves lipids & wt
protects against, cardiovascular disease, DM, and breast CA May improve MP symptoms and balance & bone desnisty (dec # risk) |
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What are the 6 risk factors for the vasomotor symptoms of MP?
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1. high BMI b/c of increased [estradiol] d/t aromatization in the peripheral tissue
2. Smoking 3. low SES 4. Hx of PMS 5. low physical activity 6. Surgical MP |
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What is the only direct indication for the use of HRT?
You should always use the lowest dose for the shortest amount of time. However in the notes what was the recommended dose? Of which hormone? What can be used to for peri-MP women? |
Vasomotor symptoms are the only direct indicator for the use of HRT.
Recommended dose = 0.625mg of estrogen. Progesterone is only added for Uterine protection. Low-dose OCP can be used for peri-mp women, and the usual contraindications apply (Hx of DVT, P/E, smoking, atypical migraines, liver or coronary vascular disease), and hormone-sensitive CA) |
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Abnormal Uterine Bleeding ( heavy with clots lasting >8-10days) is common in peri-MP but must be a dx of exclusion. What are 3 other Dx to consider?
What must you do if a post-MP woman has AUB? What should you keep in mind about AUB? |
Abnormal Uterine Bleeding:
1. Hothyroidism - dramatic effects on menstration when uncontrolled 2. Anatomical issues (fibroid - esp. submucosal & polyps) 3. Edometrial Hplasia or CA Any post-MP AUB demand investigations: biopsy, USS, and hysteroscopy ** important to remember that ~90% of women have 4-8 yrs of cycle changes before MP (changes in flow --> cylce length --> skipped periods) |
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In what circumstances is transdermal HRT preferred?
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When a person has high lipids b/c transdermal won't increase TG levels
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What are the 3 Xtics of post-strep GN-itis?
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1. Evidence of strep infection
2. Nephritic syndrome 3. Low complement |
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What are the 3 Xtics of post-strep GN-itis?
How is this Tx'd? |
1. Evidence of strep infection
2. Nephritic syndrome 3. Low complement Can treat the step infection but don't need to do anything about the GNitis b/c 95% will resolve on their own w/o ---> chronic disease |
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What are the 4 Xtics of substance dependance?
What are the 3 signs of substance abuse? |
Dependance:
1. Regular use 2. Physical adaptation 3. Tolerance 4. Withdrawel Abuse: 1. adverse consequences r/t use 2. Use in hazardous situations 3. Continued use despite problems r/t use |
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What are the components of the "CRAFT" questions?
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1. have you ever ridden in a Car with someone (including yourself) who was high/drunk?
2. Do you ever use substances to Relax, feel better or fit in? 3. Do you ever use substances while ALONE? 4. Do you ever FORGET things you did while high/drunk? 5. Do FRIENDS & FAMILY ever tell you to cut down? 6. Have you ever gotten into TROUBLE while you were using? "Car, Relax, Alone, Forget, Friends & Family, Trouble" |
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What are the 3 parts of the schizophrenia prodrome?
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1. Social withdrawal
2. Change in sleep-wake cycle 3. Odd thoughts |
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Define each of the following Psychotic disorders:
Brieft psychotic disorder Schizophreniform Schizoaffective Delusional |
Brieft psychotic disorder: one single episode of psychosis
Schizophreniform: < 6 mo of psychosis Schizoaffective: spectrum between schizophrenia & bipolar (hallucinations + mania) Delusional: Non-bizzare, fixed false beliefs without hallucinations (usually in mid-older age women) |
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