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75 Cards in this Set
- Front
- Back
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What are the symptoms of septic shock?
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Severe systemic response manifested by hypotension, hypoperfusion, disordered temperature regulation and derangments of organ function
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What kind of microbes most often cause septic shock?
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gram negative aerobic bacteria
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What is the primary pathogen of sepsis?
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E. coli (from genitourinary tract)
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What pathogens cause gram positive shock?
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Staph and strep species
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When you think gram positive sepsis think...
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skin and wounds
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What are the symptoms of septic shock?
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Severe systemic response manifested by hypotension, hypoperfusion, disordered temperature regulation and derangments of organ function
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What kind of microbes most often cause septic shock?
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gram negative aerobic bacteria
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What is the primary pathogen of sepsis?
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E. coli (from genitourinary tract)
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What pathogens cause gram positive shock?
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Staph and strep species
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When you think gram positive sepsis think...
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skin and wounds
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What is the mortality rate of sepsis?
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10%
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What is the mortality rate of septic shock?
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40-60%
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What is the most common cause of a bloody nipple discharge?
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an intraductal papilloma
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How do you treat Stage 1 or 2 breast cancer?
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lumpectomy and irradiation
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In whom do you see breast abscesses?
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in young women, especially if they're lactating.
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A post-menopausal woman with red, swollen breast has what?
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inflammatory breast cancer, not an abscess or mastitis
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What can tell you whether or not a thyroid cyst is malignant or not?
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radionuclide scans tell whether or not they are functional - "hot nodules" are rarely malignant. Cancer rarely works better than normal tissue
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How does thyroid cancer grow?
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slowly except anaplastic thyroid carcinoma is explosive
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When can't you use Absolute risk? Why?
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In case control studies because disease incidence cannot be assessed
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What is an odds ratio?
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another measure of risk, called odds ratio (OR)
Works for both cohort and case-control studies |
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What causes primary dysmenorrhea?
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excess prostaglandins (usually in younger women)
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What causes secondary dysmenorrhea?
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identifiable cause: endometriosis, adenomyosis, PID, adhesions, leiomyomas
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What is the tx for primary dysmenorrhea?
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NSAIDs - prostaglandin synthetase inhibitors, topical heat, OCP to induce anovulation
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What is the tx for secondary dysmenorrhea?
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treat the identifiable cause
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What is primary amenorrhea?
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no menses by age 13 without sexual development or by age 15 with sexual development
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What is secondary amenorrhea?
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no menses for 3 to 6 months
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What do you need to do for secondary amenorrhea?
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RULE OUT PREGNANCY!
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What is the most common cause of androgen excess and hirsuitism?
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excess LH from Polycystic ovarian syndrome
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How is urine osmolality measured?
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by level of ADH
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What is specific gravity?
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measures the weight of the solution compared to an equal volume of distilled water
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What does high specific gravity reflect?
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dehydration - concentrated urine
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What does low specific gravity reflect?
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dilute urine - (primary polydipsia)
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What is oliguria?
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Urine output between 100-400ml/24 hours
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What is anuria?
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urine output <100 ml/24 hours
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What are the most common causes of death in pts with acute renal failure?
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infection and cardiorespiratory complications
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What is the most common cause of prerenal acute renal failure?
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intravascular volume depletion
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How do you diagnose acute interstitial nephritis?
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renal biopsy = gold standard
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What are the indications for urgent dialysis?
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AEIOU
A: acidosis E: electrolyte disorder, generally hyperkalemia I: intoxication (methanol, salicylates) O:overload of volume (CHF) U: uremia (enchephalopathy, pericarditis) |
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What is the definition of chronic kidney disease?
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GFR <60ml/min for 3 months or more OR
Presence of high urinary albumin excretion rate of greater than 300mg/24 hours |
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What are the most common associations of chronic kidney disease?
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hypertension and diabetes
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Which stage of CKD is most common?
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CKD 3 = GFR of 30-59
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What can be used for tx of CKD?
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ACE inhibitors and ARB's both lower rates of GFR decline.
ARBs reduce the occurrence of kidney failure |
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What causes isotonic hyponatremia?
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lab artifact due to hypertriglyceridemia or hyperproteinemia (from multiple myeloma)
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What causes hypertonic hyponatremia?
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most commonly due to hyperglycemia.
Treat with volume repletion with sodium containing fluids |
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What causes hypotonic hyponatremia
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most commonly seen situation
Need to check the volume status Usually related to SIADH |
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What can happen if you correct sodium too fast?
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can precipitate severe neurologic complications, such as central pontine myelinosis (irreversible!)
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How do we treat SIADH?
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usually resolves with restriction of total fluid and free water restriction
OR Use hypertonic saline or demeclocycline (induces nephrogenic diabetes insipidus) |
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What causes euvolemic hypernatremia?
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primarily due to diabetes insipidus
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What is Central DI?
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deficient secretion of antidiuretic hormone (ADH)
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What is Nephrogenic DI?
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causes: congenital
drugs metabolic (hypercalcemia) tubulointerstitial |
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How do you treat DI?
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central: desmopressin
Nephro: treat underlying cause + sodium restriction + a thiazide diuretic |
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What are sx/EKG changes that are seen in hypokalemia?
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N/V, weakness, muscle cramps
U waves flattened or inverted T waves |
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What are the sx/EKG changes that are seen in hyperkalemia?
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weakness, nausea, parasthesias, palpitations
Peaked T waves with K+ 6.5-7.5 Sine wave if potassium >10 |
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What are some transient treatments for hyperkalemia?
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calcium chloride (stabilizes cell membrane)
insulin (drives K+ into cell) B2 agonists (ditto) |
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What are some more long term treatments for hyperkalemia?
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Diuretics (decreases total body K+)
Kayexelate (decreases total body K+ via the gut) |
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What is encopresis?
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the regular, voluntary or involuntary passage of feces into a place other than the toilet after 4 years of age
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What is soiling?
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the involuntary passage of stool and often is associated with fecal impaction
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A child with chronic constipation and soiling who had delayed passage of meconium and has an empty rectum and a tight sphincter may have what?
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Hirschsprung disease
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What is primary enuresis?
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incontinence in a child who has never achieved dryness
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What is secondary enuresis?
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incontinence in a child who has been dry for at least 6 months
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What is the spontaneous remission rate of enuresis?
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reported to be 15% per year
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What is the only lab test recommended for most children with enuresis?
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clean cath urinalysis to look for chronic UTI, renal disease, and DM
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What treatments are available to treat enuresis?
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conditioning therpy
pharmacotherapy hypnotherapy |
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What is the most widely used conditioning therapy for nocturnal enuresis?
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the enuresis alarm
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What test should be performed on all infants and children up to 6 years with a documented first UTI, regardless of gender?
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a voiding cystouretrhogram (VCUG) or radionuclide cystogram (NCG)
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What test identifies renal scars?
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nuclear renal scanning
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What is the triad that defines HUS?
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microangiopathic hemolytic anemia
thrombocytopenia renal injury |
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What is the most common manifestation of TTP in children?
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CNS symptoms
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What is revealed on peripheral smear in HUS?
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schistocytes, helmet and burr cells and fragmented erythrocytes (intravascular hemolysis)
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What does adrenarche do?
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appearance of pubic hair, oilienss of hair/skin, acne, axillary hair and body odor
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What does andrenarche not include?
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does not include breast development in females or testicular enlargment in males
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What does gonadarche do in males?
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pubic hair, axillary hair, facial hair, increased musculartiy, deeper voice, increased penile size and increased testicular volume
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What does gonadarche do in females?
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breast development, development of the female body habitus, increased size of the uterus, and menarche with regular menstrual cycles
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What is Kallmann sydrome?
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combines isolated gonadotropin deficiency with disorders of olfaction
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What is McCune-Albright syndrome?
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the most common cause of GnRH-independent precocious puberty (cafe-au-lait spots)
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