Midterm Adult Medicine

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anemia

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reduction in the mass of circulating blood cells

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anisocytosis

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lots of RBCS of different sizes

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poikilocytosis

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variations in shapes of RBC

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schistocytes

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fragmented RBCS that appear as a variety of shapes
HEMOLYTIC ANEMIA

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target cells

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RBC with a targt like appearance
thallasemia,CLD, and spleenomegaly

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reticulocyte count

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the amoount of hg in newly circulating RBCs

a large amount of RTC means bone marrow disease

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polycythemia

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an increase in the rbc mass

HIGH BLOOD CELL COUNT

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MCV

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measurement of the avr. volume and size of a rbc

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MCHC

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% of Hb within 1 RBC= color

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pica

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cravings for non food items

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classifications of anemias

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Fe deficiency
MICROCYTIC HYPOCHROMIC

small size less color

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folic acid deficiency

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MACROCYTIC NORMOCHROMIC

decreased production

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pernicious anemia/b12 def

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macrocytic normochromic

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aplastic anemia

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bone pain tx is bone marrow transplant

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hemolytic anemia

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normochormic increased destruction

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what is the difference between pernicious anemia and other classes of b12 anemias

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pernicious anemia has b12 but can not process it because of lack of intrinsic factor

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HCT low
hgb low
MCV high
what is it?

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folate deficiency or pernicious anemia

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megoblastic(macrocytic)

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lack of intrinsic factor pernicious anemia

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dequervain stenosing tenosynovitis

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tenderness to palpation over RADIAL wrist FINKELSTEIN TEST

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dupuytrens contracture

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nodular thickening of the palmar
fascia leading to contracture

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flexor tenosynovitis
TRIGGER FINGER

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nodule of thickening of the flexor tendon,inflamation,digit looks into flexed position

idiopathic cortisone nsaids

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lateral epicondiylitis
TENNIS OR GOLF ELBOW

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increase pain while gripping,extension of wrist or supination of the forearm

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carpal tunnel

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pain/paresthesias of median nerve PHALENS OR TINNEL TEST
atrophy of the thenar muscles

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subacromial bursitis

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acute pain esp. on abduction between 60 and 100 deg.

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rotator cuff tendonitis

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continued repetitive impingement leads to irreversible fribrosis and thickening of the tendons of the rotator cuff.

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calcific tendonitis

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deposition of calcium hydrox crystals within one or more tendons of the rotator cuff. from chronic repetitive microtrauma

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shin splints

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posterior tibial tendonitis distal 1/3 of leg cx running on hard surfaces

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osgood schlatter

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paiin below knee at tibial turbecle. due to tendon separating from front of tibia pulling away a fragment of bone.

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chondromalicia patellae

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overuse syndrome of the articular cartilage of the patella. tracking of the patella
abnormal. cx stair climbing,jumping

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ligamentous ankle injuries

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most common sports injurie.anterior talofib,calcaneofib iversion

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plantar faciaitis

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pain is most severe on awakening
or rising from a sitting position

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spinal stenosis

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>60yrs bk pain radiating to butt
DX MRI
narrowing of spinal canal with compression of nerve roots cx. bulging discs enlarged osteocytes in the facet joints.

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sacroilliac joint disease

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seronegative spondyloarthopathies ex. AS,reiter syn., psoriatic arth.
DX. hla b27,ESR,

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lumbar disc herniation

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s/s lowr bk pain radiating to butt and below knee(suggests nerve root irritation) L4,L5,S1 SLR ipsilateral(same side) 95% of disc herniations

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red flags from HX or PE that suggest

FRACTURE

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s/s swelling pain with movement,deformity pt. with open unstable,irreducible or suspected compartment syndrome nerv,vascular or muscle damage

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red flags from HX or PE that suggest

TUMOR

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PAIN usual complaint. malignant tumors deep aching pain that doesnt go away with rest or at night.

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red flags from HX or PE that suggest

INFECTION

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both systemic and localized infections can cause FUO. TB and enodcarditis most common. most common local inf. is occult abcess. liver spleen kidney brain hard to find

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red flags from HX or PE that suggest

CAUDA EQUINA SYNDROME

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radicular pain and numbness in both legs.s/s may stumble,foot drop LOSS OF URINARY AND ANAL CONTROL IS A BIG RED FLAG

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Specifically, discuss when to order plain x-rays of the lumbar spine, MRI, CBC or ESR in a patient with low back pain

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MRI systemic disease or pt. having surgery. x-ray for infection,cancer,fractures,disc disorders,cauda equina syn.CBC,ESR for infection,tumor,or inflamation

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Compare and contrast the primary causes, risk factors, symptoms, and physical findings associated with the following:
ARTERIAL ULCERS

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PC smoking,diabetes,hypertension,age
SS pale base,small round with smooth wound edges. minimal drainage. over bony prominences or pressure spots ankle or below

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Compare and contrast the primary causes, risk factors, symptoms, and physical findings associated with the following:
VENOUS ULCERS

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previousDVT,obesity,trauma.decreased pain with elevation.pretibial area. lower leg. usually not ankle,foot.moderate to heavy drainage.edema. surrounding skin brown. size shallow irregular margins

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Location & risk factors for pressure (decubitus) ulcers.

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Bony prominences, coccyx, heels, shoulders, trochanters, ankles. Pressure causes ischemia, necrosis occurs. Poor nursing care, bed ridden pts.

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Method used for preventing decubitus ulcers?

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Clean dry skin, repositioning pt every 2 hours, movement

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Compare and contrast anemias causes, signs and symptoms, lab findings, complications, and typical treatment plan:
Folic acid deficiency

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pica and low serum ferritin

causes bleeding/diet

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Hereditary spherocytosis

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auto-dom diagnosed at childhood
disorder of the RBC membrane
smear shows spherocytes
complications splenomegaly
TX folic acid spenectomy

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Sickle cell anemia

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auto-dom crescent moon shape

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Acute myelogenous leukemia (AML)

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philadelphia chromosome adults

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Acute lymphoblastic leukemia (ALL)

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children good odds favorable outcome

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Chronic lymphocytic leukemia (CLL)

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>50 yo

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Hodgkin’s and Non-Hodgkin’s lymphoma

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seen in lympnodes labs=reid sternburg cells

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Inhibitors of bacterial wall synthesis
cephalosporins,penicillans

narrow spectrum blactams

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Pen v and g treats infections caused by strepococii Includes pneumococci meningicocci and spirochetes(g)and clostridium perfingens most staph and gonocci are resistant

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penicillan Intramuscular long acting forms of g

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procaine pen(g)hydrolyed rapidly
^plasma concentration for 24hrs
benzathine hydrolyzed slowly(weeks) low plasma concentration

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penicillanase resistant penicillans

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dicloxacillin,nafcillin,oxacillin
for TX of serious staph infections ex. endocarditis,osteomyelitis,skin and soft tissue infections

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MRSA methicillan resistant staphlococcus aureus

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staphloccus that are resistant are to PRPs are this
Methicillan is in the PRP family no longer used. most cephs wont work either

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extended spectrum
2 classes

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1)aminopenicillins
ex.amoxicillan ampicillan
2) antipseudomonal ex.pipericillan,ticarcillin

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aminopenicillans use

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active against strepococci,some enterococci and limited gram-bacilli
often combined with b-lactamase inhibitior

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aminopenicillins and B LAC inhibitors

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augmentin(amoxicillan and clavunate
Unasyn(ampicillan and sulbactam)
TX. infections caused by BLAC producing bacteria

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Amoxicillan uses

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RTIs otitis media,sinusitis,bronchitis,CAP

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amoxicillan clavunate(augmentin)
uses

Adult RII

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works against strains that produce penicillanase ex Haemophilus influenzaa,and some strains of strepococcus pneumonia

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amoxicillan clavunate uses

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bite wound infections because it works against pathogens causing bite wounds ex.pasteurella multocida and staph aureus

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amoxicillan uses

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prophalaxis of bacterial endocarditis in persons with heart valve defects.

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ampicillan uses

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listeria causing menningitis

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antipseudomonal pinicillins
ex.piperacillin uses

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pip usually combined with BLAC inhibitor to treat mixed infections like nosocomial pneumonia and other anaerobic organisms

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three mechanisms which bacteria resist pinicillins and other BLAC ABX

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1)inactivation by B lactamase enzymes
2)reduced affinity of PBP for ABX
3)decreased entry of drugs into bacteria through outer membrane porins

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Primary cause of bacterial resistance in penicillans and BLAC ABx

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production of b lactamases

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penicillans adverse effects

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most common cause of drug induced hypersensitivity reactions IGE hives shock

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cephalosporins 1st gen

orally administered ex. cephalexin(tx soft tissue skin)

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good against most strep mrsa
few gram- e.coli klebsiella pneumonia

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cephalosporins 1st gen cont

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cefazolin(parenterally) for more serious infections and surgical prophalaxis

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cephalosporins 2nd generation

ex cefoxitin

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similar against gram + increase against- better against HInfluenza used for otitis media

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3rd generation

ex. cefotaxime,ceftriaxone

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tx include gonococci otitis media pneumonia meningitis IA or UTI and lyme disease

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4th generation cephalosporins

ex cefepime(maxipime)

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targets PBP big gun

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VANCOMYCIN(glycopeptide ABx)

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big gun for mrsa necrotizing faciatis,endocarditis osteomylits and other pen resistant gram +organisms