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312 Cards in this Set
- Front
- Back
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Sx/Mnemonic for SLE
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Discoid Lupus
Oral Ulcers Photosensitivity ANA Malar rash Immunologic Neuro changes ESR Renal Dz Arthritis Serositis Hematologic changes |
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What sx differentiate drug induced SLE from non-drug induced form
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renal and cns involvement
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pulmonary sx in SLE
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pleuritis
pneumonitis pleural effusion pulm htn |
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describe joint involvement in sle
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joint swelling, symmetrical non-deforming small joint involvment
non-erosive |
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lab findings in drug induced sle
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+anti-histone AB, - anti-dsDNA
-anti Sm ab |
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Behcet's syndrome
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arthralgias, fatigue, oral/genital ulcers (painful)
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Felty's syndrome
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cytopenia in setting of sero-positive nodular RA
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medications that can cause di-sle
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hydralazine
procainamide quinidine etanercept methyldopa inh |
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pathogenesis of systemic sclerosis
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fibroblast activation to produce excesss collagen
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skin manifestations in systemic sclerosis
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thickening
pigmentation changes digital pitting ulceration telangiectasia |
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Pathophysiology of digital pitting in systemic sclerosis
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2/2 vascular injury --> raynaud's
vascular injury is 2/2 proliferation of the intimal layer |
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course of skin thickening in systemic sclerosis
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thickens for ~2 yrs before atrophy occurs
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tx of raynaud's
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ccb
dipyrimadole nitrates |
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gi manifestations of systemic sclerosis
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dysphagia (2/2 dysfxn of smooth muscles of esoph)
decreased pressure in LES --> GERD dysmotility --> pseudo-obx |
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tx of gi dysmotility sx in systemic sclerosis
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npo
ngt pain control |
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pulm sx in systemic sclerosis
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interstitial lung dz
pulmonary arterial htn |
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tx of interstitial lung dz in systemic sclerosis
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cyclophosphamide
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tx of PAH in systemic sclerosis
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coumadin
O2 vasodilatory agents (endothelin receptor antag) sildenafil |
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si/sx/imaging findings of interstitial lung dz
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dry cough
dyspnea late basilar crackles honey-combing on ct |
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if a pt is + anti-Scl70, what are they at increased risk for
|
difffuse cutaneous systemic sclerosis
ild |
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what are systemic sclerosis pts with ild at an increased risk of
|
lung ca
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cardiac complications in systemic sclerosis
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CMP
pericarditis arrhythmia 2/2 myocardial fibrosis |
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renal complications in systemic sclerosis
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renal crisis that resembles malignant htn
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tx for renal crisis in systemic sclerosis
why is this tx effective? |
ace-i - captopril is fast-acting and is the mainstay (keep using even if cr worsens, andn continue even if pt is on hd 2/2 renal crisis)
crisis caused by increased levels of renin levels, so ace-i are effective |
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examples of endothelin receptor antagonists
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bosentan
epoprostenol iloprostenol |
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describe use of steroids in systemic sclerosis
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not often used b/c process is not inflammatory, but are occ used 2nd line for joint pain
steroids can induce renal crisis in scleroderma |
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pathophys of takayasu arteritis
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idiopathic granulomatous dz of the aorta and its vessels
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physical exam findings in takayasu arteritis
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bruits
tenderness when palpating arteries decreased pulses aortic insufficiency |
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normal presentation of pt with takayasu
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constitutional sx
arterial insuff |
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relationship btwn gout and sickle cell
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scd pts have high incidence of gout b/c high rbc turnover and renal dz --> hyperuricemia
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esr in pts with fibromyalgia
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low
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si/sx polymyalgia rheumatica
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pain
morning stiffness in axial joints and prox muscles (shhoulder and hip girdle involvement) no weakness/joint swelling |
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which lab is usually elevated in pts with polymyalgia rheumatica
|
ck
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which dz is associated with polymyalgia rheumatica
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40-50% pts with giant cell arteririts --> pmr
10-15% with pmr have gca |
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tx of polymyalgia rheumatica
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steroids
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when to tx for giant cell if bx of temp art has not been done
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if there are no visual sx, then it is ok to start steroids after bx is taken; do not have to wait for results
if there are visual sx, then can be tx immediately, should not aversely affect the bx results (even if givn up to 2 wks) |
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Describe what happens in subclavian steal phenomenon
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subclavian artery is blocked and the blood flow is retrograde through the vertebral artery to supply the subclavian art distal to the stenosis
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which rheumatologic condition can be associated with subclavian steal
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takayasu arteritis
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what is a potential gi complication resulting from gi dysmotility in systemic sclerosis
tx? |
bacterial overgrowth
abx - cover for anaerobes, gnr, and gut flora (cipro is a good choice) |
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t or f esr is always elevated in giant cell arteritis
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f: 10-24% have lor or nml esr
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malignancies that are associated with ra
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large b cell
NHL (44x greater than general public) |
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what is the imaging study of choice to dx ra
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xr, even though earlier joint damage can be seen on mri/us earlier than plain films
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what is rheumatoid factor
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IgM ab vs IgG
|
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what is anti-CCP AB
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reflects an IgG rxn to altered synovial membrane peptides, this indicates an increased severity in RA
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what is the association btwn ra and heart dz
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pts w ra have increased premature ath in pts with poorly controlled dz for greater than 6 wks
2x more likely to have mi than general population 70% increased risk of stroke |
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what happens to joints in ra (eg what is seen on imaging)
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pannus (proliferative mass of inflammatory vascular tissue that erodes bone/cartilage)
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DMARDs used in mild RA
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hydroxychloroquine
sulfasalazine MTX +folate |
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what defines mild RA
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5-10 joints involved, mild fxnl impairment
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how to treat severe ra
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DMARDS (MTX is best) + TNF-alpha antagonist
(adalibumab, etanercept, or infliximab, ex) |
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ex of TNF-alpha antagonist
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adalibumab, etanercept, or infliximab
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si/sx of Adult onset Still's Dz
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Arthritis, arthlagias and myalgias in 100% pts
Daily high fevers Salmon colored rash elevated LFTs, LDH, ferritin Serositis Splenomegaly Sore throat |
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tx of Adult onset Still's Dz
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NSAIDS usually work
Steroids and immune modulating agents if sx are lifelong |
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Dz course of Adult onset Still's dz
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can be self-limited, chronic, or intermittent
Chronic dz is associated with severe reactive arthritis |
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Sx of Parvovirus B19 infx in an otherwse healthy adults
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(very similar to RA sx):
symmetric polyarthritis of wrist, MCP, PIP, and similar joints in feet rash possible, not common |
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course of adult Parvovirus B19 infection
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sx resolve in 1-2 mos, helped w NSAIDS
if last longer than 2-3 mos, then dx of RA |
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what should be prescribed to pts who are on steroids long-term
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any pt who is on prednisone for >3 mos should be on Ca, vit D, and bisphosphonate to prevent bone loss
calcitonin may be helpful in pain management for acute vertebral fx |
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name of drug that is a synthetic recombinant PTH
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teriparatide
|
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when should teriparatide be used
contraind? |
severe osteoporosis tx
contraind in paget's hypercalcemia, h/o bone malignancy or radiation use for <2 yrs |
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what is the upper limit of uriate that will cause uric acid to precipitate out
|
6.7 mg/dl
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side effects of colchicine
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neuropathy and myopathy in pts with liver or kidney dz
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is colchicine used to treat or prevent gout
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both!
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is allopurinol used to treat or prevent gout?
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prevent
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potential side effect of allopurinol
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Steven-Johnson syndrome (if rash develops, STOP!)
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what is livedo reticularis and when do you see it?
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painless, net-like rash on extremities
seen in SLE |
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describe arthritis assoc with SLE
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non-erosive, polyarticular, affecting large and small joints
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Jaccoud's arthropathy
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hand deformity that is similar to RA, but reversible and non-erosive
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other than arthritis and arthropathy, what other joint MSK c/o might a pt wth SLE have
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AVN (5-10%)
fibromyalgia |
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Most common renal manifestations in SLE
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Glomerulonephritis (--> casts, dysmorphic RBC in UA)
Interstitial nephritis Renal vein thrombosis |
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Neuro/psych manifestations of SLE
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Sz
encephalitis CVA Transverse Myelitis Psychosis Aseptic meningitis Demylenating dz HA and cognitive dysfxn |
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what is shrinking lung syndrome, findings on CXR
when do you see it |
diaphragmatic dysfxn --> restrictive lung dz
CXR: lungs clear, elevated hemidiaphragm seen in SLE |
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Libman-Sachs Endocarditis
complication? |
non-infx masses near valve edge (usually mitral or tricuspid)
can --> infx |
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Heme findings in SLE
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mild cytopenias
~15% can have Coomb's + hemolytic anemia |
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complement levels during SLE flare
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C3 and C4 are low b/c complement is activated
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which blood test is has + prognostic value for lupus nephritis
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ds-DNA
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Tx of SLE
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NSAIDS, low-dose steroids, hydroxychloroquine
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what are the benefits of hydroxychloroquine
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it's non-steroidal
lowers cholesterol anti-thrombotic |
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side effects of hydroxychloroquine
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irreversile retinopathy, pts must have annual eye exams
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when can MTX be used in SLE
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if there is joint involvement
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What meds can be added to tx severe SLE
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high dose pulse steroids
cyclophosphamide azathioprine mycophenolate |
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manifestations of neonatal lupus syndrome
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rash
congenital complete heart block |
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how is neonatal lupus syndrome prevented
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keep pts on hydroxychloroquine during pregnancy
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what are the major causes of death in SLE
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infx and CAD
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lab findings of TB infiltration in liver
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isolated alk phos
ast/alt wnl |
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elevated alk phos + unexplained pruritis
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primary biliary cirrhosis
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pathophsy of pbc
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autoimmune destruction fo small and medium sized bile ducts -->progressive fibrosis and esld within 5-10 yrs
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tx of pbc
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ursodeoxycholic acid to slow progression of dz
transplant as definitive tx |
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sx of pbc
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progressive jaundice
steatorrhea hld xanthomas osteoporosis/osteomalacia (secondary to decreased absorption of vitamin d) |
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which dz has elevated anti sm muscle ab
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autoimmune hepatitis
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when is anti HBcAb elevated
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windown period of acut infx when HBsAg is low but HBsAb (an IgG) is not produced yet
after many yrs of chronic HBV after HBsAg titers are not detectable Several yrs after recovery from HBV |
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what add'l labs to order if HBcAb is elevated
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repeat test, and if repeat is +, get anti HBc IgM titer, check LFTs
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how long can HBc IgM titers be elevated
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up to 2 yrs after infx
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what is the utility of checking HBcAg
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none, it is never present in serum, only in infected hepatocytes
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what do LFTs look like ina pt with autoimmune hepatitis
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elevated AST/ALT
nml-ish alk phos nml bilirubin +ANA +anti sm-muscle AB |
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when to treat asx subclinical hypothyroidism
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if anti thyroid ab present (b/c will likely become overtly hypothyroidism)
abnml lipid profile sx of hypothyroidism ovulation or menstruation dysfxn TSH >10 (?) |
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in dka, what is the timing to switch a pt to sub q insulin when there blook sugar has normalized
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30-60 mintues before insulin infusion is stopped
otherwise, dka can occur again |
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what is the best way to manage dm during elective c/s
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pt should take nml dose of insulin the night before surgery, then start insulin drip + D5 NSS and keep bl glucose <160
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what do LFTs look like ina pt with autoimmune hepatitis
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elevated AST/ALT
nml-ish alk phos nml bilirubin +ANA +anti sm-muscle AB |
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when should incidental thyroid nodules have fna
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if >1cm, fna
if <1cm, get u/s annually |
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when to treat asx subclinical hypothyroidism
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if anti thyroid ab present (b/c will likely become overtly hypothyroidism)
abnml lipid profile sx of hypothyroidism ovulation or menstruation dysfxn TSH >10 (?) |
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in dka, what is the timing to switch a pt to sub q insulin when there blook sugar has normalized
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30-60 mintues before insulin infusion is stopped
otherwise, dka can occur again |
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what is the best way to manage dm during elective c/s
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pt should take nml dose of insulin the night before surgery, then start insulin drip + D5 NSS and keep bl glucose <160
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when should incidental thyroid nodules have fna
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if >1cm, fna
if <1cm, get u/s annually |
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of the following, which is the most common complication of hypothyroidism
HLD HTN Ascites Glossitis Angina |
HLD
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schmidt syndrome
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polyglandular autoimmune failure type ii
= addison's, type I DM, autoimmune thyroid dz |
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clinical picture of mody
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+ fam hx
modest hyperglycemia no ketoacidosis |
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what happens to blood sugar in delayed gastric emptying
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post-prandial hypoglycemia b/c the peak insulin level does not correspond with the the food absorption
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tx of choice for hyperthryoidism in pregnancy
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PTU
if pt remains symptomatic or cant' tolerate tx, then surgery |
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methimazole in pregnancy
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do not use --> teratogenic (causes aplasia cutis)
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complication of hyperthyroidism during pregnancy
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thyroid storm is common if thyroid dz is not controlled. added stress of labor is a trigger
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men I syndrome
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hyperparathyroid
zollinger ellison syndrome prolactinoma (pancreatic tumor, pituitary tumor, pth elevated) |
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what lab value should be monitored in medullary thyroid ca
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calcitonin (the tumor produces calcitonin)
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what triglyceride level warrants tx
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>200
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moa of erythromycin for diabetic gastropathy
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acts on motilin receptors of gi tract
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tegaserod
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serotonin agonist used to tx constipation in ibs
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moa of erythromycin for diabetic gastropathy
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acts on motilin receptors of gi tract
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clinical presentation of subacute lymphocytic thyroiditis
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painless nodule/goiter
sx <2 mo hyperthyroid sx occur b/c T4 is released from inflamed gland sx are usually transient, but if severe, tx with beta blocker |
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tegaserod
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serotonin agonist used to tx constipation in ibs
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moa of erythromycin for diabetic gastropathy
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acts on motilin receptors of gi tract
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clinical presentation of subacute lymphocytic thyroiditis
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painless nodule/goiter
sx <2 mo hyperthyroid sx occur b/c T4 is released from inflamed gland sx are usually transient, but if severe, tx with beta blocker |
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who gets lymphocytic thyroiditis
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pts on interferon, amiodarone, or IL-2
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tegaserod
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serotonin agonist used to tx constipation in ibs
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clinical presentation of subacute lymphocytic thyroiditis
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painless nodule/goiter
sx <2 mo hyperthyroid sx occur b/c T4 is released from inflamed gland sx are usually transient, but if severe, tx with beta blocker |
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who gets lymphocytic thyroiditis
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pts on interferon, amiodarone, or IL-2
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who gets lymphocytic thyroiditis
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pts on interferon, amiodarone, or IL-2
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causes of subclinical thyrootoxicosis
|
med induced (levothryoxine)
nodular thyroid dz graves thyrotoxicosis |
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how to manage asx subclinical thyrotoxicosis
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if pts are asx, recheck tsh b/c they have a high chance of normalization
therefore, no need to to tx if not having sx |
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conns syndrome - what is it, how to dx
|
primary hyperaldo
dx with aldo:renin ratio if >30, then hyperaldo (but aldo level must be >15) |
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tx of graves dz
contraindication to this tx |
radioactive iodine UNLESS there is a large retrosternal goiter --> inflammation from tx --> airway compromise
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how can opttic nerve inflammation be managed in graves dz
|
can give radioactive iodine, but should give steroids as well, to prevent worsening opthalmoplegia
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major side effect of methimazole and ptu
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agranulocytosis
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what medications inhibit t4->t3 conversion
|
beta blockers
ptu steroids amiodarone |
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what is thyroid lymphoma associated with
|
hashimotos thyroiditis
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tx of thyroid lymphoma
|
radiation and chemo
|
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are oral medications effective in preventing diabetic retinopathy
|
no
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how long to tx pt with first dvt if first dvt with underlying risk factor
|
3 months
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dx of toxic thyroid nodule
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increased focal uptake on scan
si/sx hyperthyroidism |
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presentation of somatostatinoma
|
gallstones (secondary to somatostatin inhibiting gallbladder wall contraction)
malabsorption and dm secondary to inhibition of pancreatic secretions |
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rash assocaited with glucagonoma
how to pts present |
necrolytic migratory erythema
rash that clears from center present with mild dm and rash |
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cells that a somatostatinoma arises from
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delta cells in pancreas
|
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dexa scan t score interpretation
|
>1 nml
-1 - -2.5 osteopenia <-2.5 osteoporosis |
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management of thryoid nodule
|
1. check tsh
2. if elevated, do fna, if low do thyroid scan 3. if scan shows hot nodule, observe, otherwise surgery |
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electrolyte abnormalities seen in rhabdo
|
hyperkalemia
hopyocalcemia hyperphosphatemia (2/2 cell breakdown) |
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things that can cause rhabdo
|
cocaine use
etoh use severe trauma/exertion |
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how to manage rhabdo
|
once adequate hydration has been given, alkalinize the urine
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how to manage hyperkalemia with rhabdo
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k will likely correct itself as renal fxn improves, but check ekg for arrhythmias and manage accordingly
no need to treat hyperk if no arrhythmias |
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appearance of paget's dz of bone on ct
|
cotton wool appearance on ct
|
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lab abnormalities in paget's dz of bone
|
nml ca
elevated alk phos |
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common problem associated with paget's dz of bone
|
hearing loss, etiology unknown but likely from bony overgrowth --> compression of cn 8, or involvement of cochlea
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tx of paget's dz of bone
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calcitonin and bisphosphonates
|
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t or f: ergonomic keyboards are useful in management of carpal tunnel syndrome
|
false
|
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what is first line dmard in sle, what if that is not effective
|
mtx
if innefectivce, then start etanercept or infliximab |
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what is the #1 cause of mi in sle
|
premature cad
|
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how do steroids lead to osteopenia/osteoporosis
|
decreased intestinal absorption of ca
increased ca excretion in urine |
|
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screening procedure for bone health in pts on steroids
|
if on steroids >3 mo, get baseline dexa, then repeat annually
|
|
|
clinical features of lumbar spinal stenosis
|
appears in 50 yo
pain is less with seating, worse with spinal extension, decreased flexion in spine |
|
|
lumbago
|
self limited back pain ~2 mo
|
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how to dx spinal stenosis with imaging
|
mri
|
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best screening test for sle
|
ana
ds-dna ab is + often, but only has 70% sensitivity |
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definition of mixed connective tissue dz
|
+anti RNP, plus 3 clinical features of sle, polymyositis, and/or scleroderma
|
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#1 cause of death in sle
|
renal failure
|
|
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clinical features of hemochromatosis
|
liver dysfxn
central hypogonadism dm arthropathy skin pigmentation |
|
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association of dermatomyositis
|
usually related to solid tumors/malignanncy
|
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how to dx sjogrens
|
first test for anti ro/la, then if positive and want to confirm dx,
bx minor salivary glands, will see focal collection of lymphocytes |
|
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tx for renal failure in sle
|
for types 1 or 2: no tx
steroids for types 3,4,5 if steroids don't work, tx with cyclophosphamide |
|
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how to dx types of renal failure in sle
|
bx
|
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t or f: levls of anti dsDNA and complement levels correlate with severity of sle
|
true
|
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what dz is assoc with reiter's syndrome
|
chlamydia
|
|
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which medication is first line tx for gout
|
indomethacin
colchicine has too many side effects |
|
|
clinical presentation of ankylosing spondylitis
|
back pain and am stiffness impmroved with exercise
sx > 3 mo decreased flexion in l-spine |
|
|
how to dx ankylosing spondylitis
|
plain film of si joints, if xr negative and clinical suspicion strong, check ct
|
|
|
associated lung probles in ankylosing spondylitis
|
pulmonary fibrosis
restrictive lung dz 2/2 decreased costo-vertebral joint movement |
|
|
t or f: there is decreased life expectancy in pts with ankylosing spondylitis
|
false, life expectancy not decreased
|
|
|
best way to dx osteonecrosis of hips
|
mr
|
|
|
carpal tunnel syndrome has increased association with what other things
|
trauma
dm rheumatoid arthritis hypothyroid acromegaly pregnancy menopause esrd fibromyalgia obesity |
|
|
tx of papillary ca of thyroid
|
near total thyroidectomy, then do radioactive therapy
|
|
|
blood sugar complications in pts with chronic pancreatitis
|
dm, but also increased risk of hypoglycemia b/c there is an attack on alpha and beta cells in the pancreas
|
|
|
contraindications to metformin
|
renal failure
chf alcoholism |
|
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contraindications to thiazoladindiones (glitazones)
|
class 3 and 4 chf
|
|
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contraindications to exercise in dm
|
bs >250
no weightlifting if retinopathy present |
|
|
thyroid complication associated with angiography
|
thyrotoxicosis b/c the high iodine load can act as a substrate
|
|
|
tx for sulfonylurea overdose that doesn't respond to d5
|
octerotide - a somatostatin analog that inhibits insulin release
|
|
|
complications with calcium as it relates to gastric bypass surgery
|
--> malabsorption and can require vitamin d and calcium supplements
in vit d deficiency, the phosphate level decreases before ca does low vit d --> high pth --> loss of po4 in the urine |
|
|
tx of diabetic neuropathy
|
tca (but contraindicated in chf/heart dz)
gabapentin |
|
|
how long does it take for gabapentin to work for neuropathy
|
6 weeks
|
|
|
benefits of ace-i in dm
|
slows progression of renal dz
decreases insulin resistance (unknown if arb's have similar effecT) |
|
|
what BP medications may increase the risk of dm developement with prolonged use
|
betablockers
hctz |
|
|
tx for a non-secreting pituitary tumor
|
trans-sphenoidal surgery
radiation is not a good option, b/c takes awhile for effects and --> hypopit |
|
|
what changes in blood cell lines do you see in adrenal failure
|
eosinophilia
|
|
|
how to dx adrenal insufficiency
|
cosyntropin stimulation test
|
|
|
how to manage levothyroxine doses in pts with h/o thyroid ca, now in remission
|
adjust levo dose to suppress tsh to 0.1-0.3, even lower if there were distant mets
|
|
|
can dx of dm be made with 1 abnml glucose level
|
yes, but only if there are overt si/sx of dm at the time of the reading
|
|
|
after how many wks on steroids does a pt need steroid taper to avoid adrenal insuff
|
> 3 wks
|
|
|
increased risk of which malignancy in acromegaly
|
colon ca, should get colonoscopy q 3-5 yrs
|
|
|
tx of prolactinoma with visual sx
|
dopamine agonist (bromocriptine or cabergoline)
tumore decreases in size rapidly, no surgery is needed sx will resolve more quickly than the mri will |
|
|
men 2
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medullary thryoid ca
pheochromocytoma hyperparathyroidism |
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what must be done before surgery in a pt with pheo
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alpha-blockade 10-14 days before surgery
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apathetic thyrotoxicosis
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seen in elderly
p/w apathy, depression, weight loss |
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pattern of uptake on nuc med scan: subacute thyroiditis
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decreased uptake of radioactive iodine
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pattern of uptake on nuc med scan: toxic multinodular goiter
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incresaed diffuse iodine uptake
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pattern of uptake on nuc med scan: painless thyroiditis
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decreased uptake
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pattern of uptake on nuc med scan: post-partum thyroiditis
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decreasd uptake
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pathophys of sx in thyrotoxicosis in the setting of subacute thyroiditis
implication for tx |
sx result from release of pre-formed thyroid hormone
therefore, will not respond to anti-thyroid medications |
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tx for subacute thyroiditis
|
nsaids
b-blockers rarely, prednisone is needed |
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course of subacute thyroiditis
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thyrotoxic phase x wks, hypothyroid x months
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suppurative thyroiditis
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non-thyrotoxic
overlying skin is erythematous u/s may reveal abscess |
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tx of suppurative thyroiditis
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abx and possible surgical drainage
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which medications can displace thyroid hormones from tbg
|
asa
lasix heparin (only in vitro) |
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when to tx paget's dz
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if bone dz is unbearable
involvement of weight bearing bones neurologic sx hypercalcemia chf |
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how to tx paget's
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bisphosphonates
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pseudopseudohypoparathyroidism
ca? po4? pth? |
nml
nml nml |
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vitamin d deficiency
ca? po4? pth? 25-D? |
low
low high low |
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hypoparathyroidism
ca? po4? pth? 25-D? |
low
high low nml |
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pseudohypoparathyroidism
ca? po4? pth? D-25? |
low
high high nml |
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action of pth
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increases bone resorption
decreases p04 reabsorption and increases ca reabsorption in kidneys ultimately, increases ca and decreases po4 |
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actions of vitamin d
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incresaes bone resorption
incresaes po4 and ca reabsorpion in kidneys omcreases ca and po4 absorption in gut overall: increased ca and po4 in serum |
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overall action of pth
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increased ca and decreased serum po4
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how often should thryoid hormone levels be checked during pregnancy
|
q2-3 mo
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how does levothyroxine level need to change in a person starting coc
|
increase dosage
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how to dx celiac dz with blood tests
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anti-tissue transglutaminase
anti-endomysial antibodies |
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phases of post-partum thyroiditis
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1. thyroitoxicosis a x wks post partum
2. hypothyroid phase x months 3. 80% recover, 20% have permanent hypothyroidism |
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how long will a single subq steroid dose stay in the body and continue to have effects
|
5-7 days
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euthyroid sick syndrome
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seen in hospitalized pts who get low t3, nml t4 and tsh
if pt is severely ill, then low t3, t4, and tsh |
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how to tx euthryoid sick syndrome
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do not givec thyroid hormones
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when should a pt with osteoporosis be suspected to have multiple myeloma
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if they don't respond to bisphosphonates, then you should check SPEP and UPEP
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side effect in utero of methimazole
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aplasia cutis
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indication for parathyroidectomy in pts with hyperparathryoidism
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ca >10.5, or very high po4 and not responding to conservative management
PTH >1000 Bone pain, pruritis calciphylaxis soft tissue calcification |
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sx of carbon monoxide poisoning
|
throbbing HA
nausea dizziness malaise can eventually lead to sz, syncope, coma |
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how ot dx CO poisoning
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carboxyhb levels
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sx of ethylene glycol toxicity
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tachypnea, agitation, slurred speech, confusion, flank pain , ataxia, nystagmus
--> coma |
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what lab test will confirm organophosphate poisoning
|
plasma cholinesterase levels
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sx of organophosphate poisoning
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excess salivation
miosis |
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tx of organophosphate poisoning
|
atropine
pralodxime |
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tx of ethylene glycol toxicity
how does it work |
fomepizole
it's an inhibitor of ADH and prevents the formation of toxic metabolites that would ordinarily form with the breakdown of ethylene glycol |
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what about using ethanol to tx ethylene glycol?
|
don't use it with fomepizole b/c it will prolong the half life of etoh
fomepizole is a more potent inhibitor of adh and will give better results |
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what is the first step to tx of heat stroke
|
evaporative cooling
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should you give anti-pyretics in heat stroke
why or why not? |
no, they won't work b/c the problem is not a new hypothalamic set point
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drug of choice in hypertensive emergency
how does it work |
nitroprusside
dilates the arterioles and veins |
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complication associated with nitroprusside
|
cyanide toxicity esp in pts with renal failure
|
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sx of cyanide toxicity
|
tachycardia, lactic acidosis, change in mental status, coma, sz
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how to tx dry chemical exposure
|
first brush off as much as possible with hands, then rinse with copious amts of cold water x15-30 mins
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how to tx liquid chemical exposure
|
wash off with water first
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cardiac issues associated with hypothermia
|
bradycardia
pvc |
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sx of salicylate intoxication
|
tinnitus
restlessness n/v/abd pain decreased consciousness fever metabolic acidosis hyperventilation w/o subj feelings of sob arf transient hepatotoxicity coagulopathy encepalopathy non cardiogenic pulmonary edema |
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tx of asa o/d
|
gastric lavage
activated charcoal alkalinzation of urine to enhance urinary secretion |
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adverse rxn to metoclopramide
how to tx |
acute dystonic rxn inhigh doses
benadryl, then benztropine if benaddryl doesn't work |
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how to tx organophosphate poisoning
|
atropine - to reverse nicotinic receptors
pralodoxime - activates cholinesterase |
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medication to reverse opioids
|
naloxone
|
|
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medication to reverse bz
|
flumazenil
|
|
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indication for carotid endarterectomy
|
>70 % stenosis in carotid artery on same side where tia occurred
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how to manage tia with <30% carotid stenosis
|
asa or other anti-platelet medication
|
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infections associated with gbs
|
campylobacter
cmv ebv hsv |
|
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what % of gbs pts will develop respiratory failure
how to monitor if this might occur |
25-30%
check bedside vital capacity |
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tx of gbs
|
ivig and plasmapheresis (steroids don't do anything)
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how does botulism present differently compared with gbs
|
botulism is a descending paralysis, starts with cranial nerve neuropathy
|
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sx associated with dominant temporal lobe impairment
|
homonymous upper quadrinopsia
impaired language fxn --> aphasia |
|
|
sx asssociated with non-dominant temporal lobe impairment
|
homonymous upper quadrinopsia
impaired perception of complex sounds |
|
|
sx associated with dominant parietal lobe
|
geistmann syndrome (acalculia, finger agnosia, agraphia, r/l confusion)
|
|
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sx associated with non-dominant parietal lobe
|
construction apraxia
can't copy simple designs difficulty dressing confusion |
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|
tick paralysis
|
from neurotoxin secreting tick
sx develop 5-6 days after exposure --> ascending paralysis in hours to days |
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how to tx tick paralysis
|
remove the tick, sx will resolve in several hours
|
|
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argyll robinson pupils - what is it, when is it seen
|
no ligh rxn, seen in dm and neurosyphilis
|
|
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pathology of alzheimers dz
|
extracellular deposit of amyloid beta protein
|
|
|
common labs for pt presentign with dementia
|
cbc
tsh b12 ua |
|
|
moa donepezil
|
cholinesterase inhibitor, increasing ACh transmission across synaptic cleft
|
|
|
other medications in addition to donepezil that have same moa and can be used to treat alzheimers
|
rivastigmine
galntamine |
|
|
when is donepezil used
|
mild-moderate dementia
|
|
|
med to tx severe alzheimers
|
nmda receptor antagonist (namenda) + cholinesterase inhibitor
|
|
|
sx of subcortical dementia
|
eps
parkinsonism lewy body dementia progressive supranuclear paly visual hallucinations |
|
|
ex of cortical dementia
|
alzheimers
|
|
|
sx of picks dz
|
(frontal lobe dementia)
behavioral changes + language impairment |
|
|
adverse effects to levadopa
|
visual hallucinations
confusion agitation if this occurs, suspect lewy body dementia |
|
|
which part of the brain is affected in parkinsons
|
substantia nigra
|
|
|
when should bp be lowered in ischemic stroke
|
if >220/120 or if there is evidence of end organ damage
|
|
|
adverse effects of carbemazepine
|
neutropenia
renal failure constipation glaucoma |
|
|
acute management of migraines
|
triptans
|
|
|
moa triptans
|
5ht agonist --> vasoconstriction, and decreased plasma extravastation
|
|
|
prophylaxis for migraines
|
beta blockers
tcas methysergide (5ht antagonist) |
|
|
si/sx of phenytoin toxicity
|
lateral gaze nystagmus (first indication)
blurred vision diplopia ataxia slurred speech --> coma can still have toxicity even if lvls are wnl |
|
|
interaction btwn phenytoin and coc
|
increases metabolism of coc
|
|
|
should routine imaging of ha be done
|
no, only do ct/mri if there are abnml sx or physical exam findings
|
|
|
how to tx acute ms exacerbation
|
steroids
|
|
|
how to prevent ms relapses
|
beta interferon or glatiramer
|
|
|
how to follow sx of ms
|
get repeat mri 3 mos after initial imaging
neurologic si/sx lag behind imaging |
|
|
how to manage medications in women with ms who would like to get pregnant
|
ifn and glatiramer are teratogenic and should be stopped several months before conception.
in the event of accidental pregnancy, TAB not indicated b/c there have been some successful pregnancies despite these medications |
|
|
riluzole
|
medication that can prolong survival with als and can delay the need for tracheostomy
|
|
|
pernicious anemia
|
destruction of parietal cells --> achlorhydria and decreased production of IF --> B12 deficiency
|
|
|
what neurologic effects are seen in b12 deficiency
|
dorsal column impairment
lat column impariement (--> brisk reflexes) LE > UE involvement |
|
|
etiology of bppv
|
calcium debris deposited within semicircular canals
|
|
|
meralgia paresthetica
|
another name for lateral cutaneous femoral nerve entrapment
|
|
|
sx of obturator nerve entrapment
|
sensory loss over medial thigh
decreased leg adduction |
|
|
what do schwann cells do
|
myelinate pns and axons of most cranial nerves
|
|
|
what do oligodendrocytes do
|
myelinate axons of cn 2
|
|
|
what cells do glial tumors arise from
|
astrocytes
|
|
|
medial medullary syndrome
|
contralateral spastic hemiplegia
contralateral vibratory and proprioception impairment tongue deviation to the side of the lesion |
|
|
effect of transfusion of prbcs in pt with renal failure, liver failure, shock or hypothermia
how to prevent this complication |
can lead to hypocalcemia
occurs b/c of inability of citrate to be metabolized into lactic acid citrate then binds calcium --> hypocalcemia deficiency is only seen if you check ionized calcium give 10% calcium gluconate for every 500 ml prbcs |
|
|
where in the brain is the abnormality in korsakoff syndrome
|
mammilary bodies
|
|
|
describe senile gait
|
walkin gon ice
wide stance, hip and knees flexed, arms flexed and extended |
|
|
spastic paresis
|
foot drags with every step
scissoring gait |
|
|
describe drunken sailor gait
|
cbl ataxia
jerky, zig-zag pattern |
|
|
describe gait seen in in distal lmn dz
|
steppage gait, foot drop
|
|
|
what does presence of rbcs in csf without xanthocrhromia indicate
|
traumatic tap
|
|
|
what happens to bilirubin in ineffective erythropoeisis
|
defective dna synthesis -> megakaryoblastic changes in bone marrow + hemolysis --> hyper bili (indirect)
|
|
|
adverse effects of valproic acid
|
increased urinary frequency
n/v/d hair loss weight gain abnml lfts |
|
|
medical tx of delirium in the elderly
|
haldol > bz
bz --> confusion/agitation |
|
|
nph on ct
|
big ventricles, no effacement of sulci
|
|
|
miller fischer test
|
test to look at gait before and after removal of csf
used to dx nph |
|
|
how to prevent cluster ha
|
lithium or ccb
|
|
|
t or false
asa is contraindicated in pts with ulcer dz in order to prevent gib |
true
|
|
|
tx of spasticity afer stroke
|
dantrolene is first line
bz and baclofen can be used but they have cns effects as well --> drowsy, not alert |
|
|
tx of superior saggital sinus thrombosis
|
heparin (even in setting of hemorrhagic infarct)
|
|
|
who gets saggital sinus thrombosis
|
pregnancy
trauma infx vasculitis |
|
|
sx of saggital sinus thrombosis
|
hemiparesis
papilledem a sz |
