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181 Cards in this Set
- Front
- Back
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S3 gallop in hemochromatosis cause
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rapid ventricular filling in congestive failure
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MVP common in?
cause? |
youg women
panic attacks pain palpitations |
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S4 gallop in
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atrial systole agaisnt stiff LV
(HTN, also hemochromatosis) |
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aortic stenosis murmur
location? |
systolic crescendo decrescendo
2nd R intercostal space |
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S3 or S4
which is restrictive cardiomyopathy? which is hemochromatosis? |
both are S4
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stain to detect iron in myocytes or liver
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prussian blue
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use prussian blue for
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hemocrhomatosis
sideroblastic anemia |
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congo red is for
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amyloidosis
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sites to biopsy for amyoidosis
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abd fat pad or rectum
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Sudan black is used
where? to detect what? |
stool
to detect stool fat (malabsorption problems) |
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wright stain is used to detect
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blood
"blood brothers, wright brothers" |
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transferrin in hemochromatosis
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increased because packed
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ferretin in hemochromo
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increased
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TIBC in hemochromo
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decreased
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iron saturation
normal values |
iron/TIBC
>50% in men >45% in women |
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how to recognie wilson's
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chorea
psychosis paranoia NOT encephalopathy |
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best initial 2 tests for hemachromo
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TIBC and Ferritin
down and up |
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rx for hepatic encephalopathy
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neomycin/ lactulose
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most accurate diagnostic tests for hemochromo
next most |
liver biopsy
HFE gene and MRI (iron loaded liver) |
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only liver disease NOT most accurately diagnosed by liver biopsy? how to diagnose
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PSC
ERCP |
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hormonal abnormality in hemochromatosis
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hepcidin (regulates Fe absorbtion in duodenum)
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what routinely gets a swan ganz
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noone
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cause of increased pulmonary pressure
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lung disease
stenosed PA leads to RHF |
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wedge pressure =
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LA pressure
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bug that hemochromatosis pts are more vulnerable to
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vibrio bulnificus,
"you're magnificus for vulnificus" if you have hemochromatosicus |
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carriers of vibrio parahemolyticus
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fish
molluscs crustaceouns shellvish |
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peniccilamine is for
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copper
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succimer is for
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lead
mercury |
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metformin and glipizide
next step? |
pioglitazone or glargine
keep sensitizers but get ride of sulfonlyureas |
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sensitizers
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pioglitazone
metformin |
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if pt obese give what before sulfonylureas
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metformin
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contraindication to sulfonylureas
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hypoglycemia
RF |
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contraindication for metformin
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renal failure
heart failure cirrhosis (i.e., liver failure) can lead to lactic acidosis |
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metabolism of metformin
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metabolized by liver
renally excreted |
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contraindication for pioglitazone/rosyglitazone
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CHF
the heart can't glitta |
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fever and headache and focal neuro
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abscess
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fever and headach and confusion
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encephalitis
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fever and headache and maybe nothing else
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meningitis
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fever and headache and swimming in fresh water
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naegleria fowler
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fever and headach and sudden onset and loss of cnsess
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SAH
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meningitis. first step
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LP if no delay
no papilledema no focal neuro no confusion otherwise abx, then CT first |
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when can CT be first in suspected meningitis
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severe immunocompromise
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fever
headache photophbia papilledema first step |
abx to CT
vanc, ceftriaxone and steroids |
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test where only head is raised
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brudzinski
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test where pt sits up
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kernig
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layer in CNS at which meningitis occurs
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subrarachnoid
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falsely - gram stain
much increased PMN count what to detect etiology |
latex agglutination for bacterial antigens
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gram stain + is always + but gram stain - can mean
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either
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if you have gram +, treatment is
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ceftriaxone, vanc and steroids
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if not gram + treatment is
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ceftriaxone and vanc.
skip stroids |
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steroids most useful in
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strep pneumo
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most accurate test on LP fluid
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culture (but you have to wait)
never wait for results! |
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diseases where cultuer is rapid
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AIDs
syphillis TB |
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pink gram stain
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gram -
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what does it look like on gram stain - listeria
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+ rod
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what does it look like on gram stain: staph
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+ clumps like grapes
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what does it look like on gram stain: neisseria
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diplococci
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what does strep look like
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+ diplococci
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gram? h flu
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-
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gram? heisseria
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-
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gram? staph
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+
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gram? pneumo
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+
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indication for intrathecal abx
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ommaya reservoir (b/c of foreign body)
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ALL med given intrathecally
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methotrexate
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if meningitis is slightly immune compromised...
bug to cover? resistant to? how to cover? |
listeria
cephalosporins ADD ampicillin |
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most common in neonatal meningitis
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group B agalactiae
ecoli listeria |
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who gets staph meningitis?
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brain surgery pts
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what does AIDS pt get?
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cryptococccal
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what does military recruit get
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neisseria
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gram? staph
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+
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tx for staph meningitis
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ceftriaxone and vanc
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gram? pneumo
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+
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indication for intrathecal abx
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ommaya reservoir (b/c of foreign body)
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ALL med given intrathecally
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methotrexate
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if meningitis is slightly immune compromised...
bug to cover? resistant to? how to cover? |
listeria
cephalosporins ADD ampicillin |
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most common in neonatal meningitis
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group B agalactiae
ecoli listeria |
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who gets staph meningitis?
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brain surgery pts
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what does AIDS pt get?
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cryptococccal
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what does military recruit get
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neisseria
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tx for staph meningitis
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ceftriaxone and vanc
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gram? staph
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+
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gram? pneumo
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+
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indication for intrathecal abx
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ommaya reservoir (b/c of foreign body)
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ALL med given intrathecally
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methotrexate
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if meningitis is slightly immune compromised...
bug to cover? resistant to? how to cover? |
listeria
cephalosporins ADD ampicillin |
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most common in neonatal meningitis
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group B agalactiae
ecoli listeria |
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who gets staph meningitis?
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brain surgery pts
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gram? staph
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+
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what does AIDS pt get?
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cryptococccal
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gram? pneumo
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+
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what does military recruit get
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neisseria
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indication for intrathecal abx
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ommaya reservoir (b/c of foreign body)
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tx for staph meningitis
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ceftriaxone and vanc
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ALL med given intrathecally
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methotrexate
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if meningitis is slightly immune compromised...
bug to cover? resistant to? how to cover? |
listeria
cephalosporins ADD ampicillin |
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most common in neonatal meningitis
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group B agalactiae
ecoli listeria |
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who gets staph meningitis?
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brain surgery pts
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what does AIDS pt get?
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cryptococccal
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what does military recruit get
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neisseria
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tx for staph meningitis
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ceftriaxone and vanc
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if staph is oxacillin sensitivie
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switch to ox and stop vanc
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if staph is oxacillin resistant
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ceftriaxone and
vanc dapto or linezolid |
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AIDs meningitis with 250 lymphocytes
dx? tx? |
cryptococcus
amphotericin |
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5 flucytosine is for
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NEVER a single agent because org becomes resistant v. fast
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5 fluorouracil is used for which cancers
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GI
stomach FLU |
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caspofungin is used for
class? cant cover? |
neutropenic fever, candida, aspergillis
echinocandin cryptococcus |
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pentamidine is used for
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PCP active if sulfa allergic
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voriconazole is used for?
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as good as ampho, less toxicity for candida
better than ampho for aspergillis |
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pyrimethamine and sulfadiazine are for
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CNS toxo
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tx for neisseria meningitis
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cetraixone and vanc
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big risk factor for a neisseria meningitis
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no splenn
terminal complement deficiency |
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ampicillin and gentamicin is used for which meningitis
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listeria
LAG |
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best therapy for crypto
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fluconazole
fluk the crypto |
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nonblanching petechiae
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henoch schonlein/ neisseria
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meds causing HSP
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penicillin
sulfa allo pneytoing reifampin lamotrigine |
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neisseria meningitis prophylaxis
who gets it? drugs? which is best if person on contraceptives? |
v. close contacts (salivery)
cipro and rifampin cipro (rifampin has CP 450 effect on birth control) |
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why steroids in meningitis
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lowers mortality in bacterial meningitis
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indication of bacterial meningitis
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+ gram >1000 PMN
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which changes in response to therapy? antigen or antibody
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antigen
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high MCV
no neuro hypersegmented PMNs |
folate
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slight increase in MCH from reticulocytesPD
not chronic |
G6PD and hemolysisinfection
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most common cause of hemolysis in G6dapson is used for
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PCP prophylaxis in those not tolerant to bactrim
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high MCV
no neuro findigs no hypersegmented neutrophils |
liver disease
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alcohol causes it, increased serum iron
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sideroblastic anemia
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physical skin finding twith B12 deficiency
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vitiligo
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actinic keratosis progreses to
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SCC
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delusional disorder of the immune system all associated with?
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pernicious anemia
- vitiligo - addisons - hashimotos - mcgus |
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1st diagnostic test for B12
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peripheral smear (more sensitive than a B12 level!!)
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test if you ahve B12 and what is etiology
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Schillings
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problem with B12 level
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falsely normal in 30% because trancobalamin is an acute phase reactant
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typical acute phase reactants
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wbc
sed crp ferritin transobalamin |
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teardrop looking blood cells
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myelofibrosis
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tx for myelofibrosis
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tears appropriate!
supportive only (transfuse) TNF inhibitor thalidomide |
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cells that have been scrunched to pieces (schistocytes, helmet cells)
etiology |
DIC
TTP HUS |
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helmet cells
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DIC
TTP HUS evil like naziis |
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cells with a bit and with a dots
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bite out your heine
spleen bites the heiinz out in G6PD |
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megaloblastic means
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hypersegmented
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causes of macrocytic
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alcohol
B12 folate mercaptupurine hyperlipidemia |
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confirmatory test in B12 deficiency
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methylmalonic acid
(B12 transfers methyls) |
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homocystein increased in
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pernicious and folate (homo in both)
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high bili
high LDH high retics |
hemolysis
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high bili
high LDH low retics |
B12/pernicious
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why high bili in pernicious anemia
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destroyed in marrow before leaving
= extravascular hemolysis |
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what is marrow like in pernicious anemia
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hypercellular
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pancytopenia
middle age guy big spleen |
hairy cell leukemia
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purple dot in a cell
causes of it? |
howell jolly body
remnant of nuclear chromatin as a residual results from: splenectomy crohns |
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big oval cells
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B12 macro-ovalocytes
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smooth tongue
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glossitis of B12 deficiency
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fisusred tongue
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means nothing
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white stuff on tongue that does or doesn't scrape off
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scrapes candida
does not scrape off hairy leukoplakia |
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intrinsic factor low
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pernicisou anemia
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test to confirm etiology of pernicious anemia
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anti-intrinsic factor abs
anti-parietal cell abs |
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d xylose test is for
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bowel wall intact?
celiac disease |
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schollings test tell you
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old test for etiology of B12. shouldn't be used
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small bowel biopsy is most accurate test for
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celiac (flattened villi)
whilpples (bacteria) tropical sprue (bacteria) |
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bad side effect of B12 refplacement (or folate)
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hypokalemia (because the remanufacture uses up K resevers)
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most common neuro side effect of B12
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neuropathy
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how to replace B12
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IM injection
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smooth bowel
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low B12
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what is cellularity of marro in B12
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hyper
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truncal obesity
arm thinning no bone/cartilage effects |
cushings
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what disorder has fat grow
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cushings
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large bone growth abnormalities
affects skull, pelvis, long bones |
pagets
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cutaneous lesions
sandfly bite kills from hepatosplenomegaly tx |
leishmaniasis
meglumine antimonate sodium stibogluconate ampho fluc pentamidine |
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cutaenous t cell lumphoma
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mucosis fungoides
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first test for acromegaly? why?
other helpful test |
insulin like growth factor (somato medin) has longest halflife
glucose suppression |
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effect of IGF on fat
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melts it to build muscle
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increased caries in which disease
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sjogrens/sicca
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what hapens to mouth in acromegaly
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wide spaced teeth
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what happens to colon in acromegaly
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hyperplasia (not dys)
polyps are benign |
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vessels in colon
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angiodysplasi
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holes in colon
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diverticulOsis
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cause of ED in acromegaly
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increased prolactin
(cosecreted prolactin in 20%) |
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cause of carpal tunnel syndrome
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increased protein synthesis
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association of diabets w/acromegaly
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no
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therapy for acromegaly
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surgery
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therapy for prolactinomas
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octreotide (not suregery
"cut the growth medicate the prolactin" |
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use of bromocriptine
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prolactinoma
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use of octreotide
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variceal bleeding
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use of pergolide
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off marked 2/2 cardiac defects, but it's a dopamine agonist
|
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use of pegvisomant
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GH receptor antagonist
used if surgery doesn't work |
