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2061 Cards in this Set
- Front
- Back
What causes S1?
|
closure of AV valves:
--mitral/bicuspid: LA->LV --tricuspid: RA-->RV |
|
What causes S3?
|
increased volume in LV (ie CHF)
|
|
Leads affected in lateral MI
|
I, aVL, V5, V6
|
|
Imagine the heart and leads superimposed
|
I is East, AvF South, aVL NE, II at SE, III at SW, aVR NW
|
|
Order of EKG changes in MI
|
1 - peaked T waves
2- ST elevation 3 - negative T waves 4 - Q waves |
|
Comment on MI pain vs Angina pain
|
not usually resolving with NTG (like it does with angina)
|
|
What is angina?
|
ischemia d/t obstruction or spasm of coronary artery
|
|
Treatment of Vtach
|
Amiodarone (because tachy with pulses to wide QRS to regular)
|
|
MI, when to start anticoagulation?
|
if presents early, if cardiac thrombus, is large arge of dyskinetic ventricle (b/c will get clot), severe CHF (b/c will get a clot)
|
|
What heart valvular lesions can produce CHF?
|
mitral and aortic valve pathology.
|
|
reflux, PUD RF (3)
|
--Certain foods
--Smoking --Caffeine |
|
Pathophysiology of stable angina
|
stable, flow limiting plaque preventing blood flow to heart
|
|
EKG stable angina
|
ST depression that is TEMPORARY, goes away when pain gone.
|
|
Stable angina pain usually lasts for
|
<20min
|
|
Achalasia pathophysiology
|
LES won't relax, likely destruction of Auerbach's plexus
|
|
Achalasia treatment
|
--pneumatic dilation
--botulinum |
|
How to treat nutcracker esophagus or esophageal spasm
|
CCB or myotomy
|
|
EKG pericarditits
|
diffuse ST elevation
|
|
Pericarditis pain characteristics
|
better leaning forward
|
|
Pericarditis on labs
|
increased ESR
|
|
Pericarditis prodrome
|
viral URI (like Coxsackie usually)
|
|
Causes of pericarditis (6)
|
--VIRAL
--Uremia (remember?) --TB (yikes!) --CA (YIKES!) --Lupus --Other AI disease |
|
How to diagnosis aortic dissection
|
CT with IV contrast
|
|
Treatment of aortic dissection
|
If ascending aorta or proximal arch involved, SURGERY.
Otherwise treat with antiHTN. |
|
Cause of aortic dissection
|
HTN (just too much pressure!)
|
|
What subpopulation gets aortic dissections?
|
Marfan's
|
|
Marfan's and heart issues
|
chronic MR, aortic dissection
|
|
Marfan's physical characteristics
|
increased arm span, arachnodactylyl, loose joints
|
|
Ehlers-Danlos characteristics
|
Joint hypermobility + skin elasticity
Pes Planus Scoliosis Velvety skin with miniscars DEGEN OF MITRAL VALVE |
|
Variant angina definition and cause
|
=Prinzemtal, angina AT rest, d/t coronary artery spasm
|
|
Treat variant/prinzmetal angina
|
NTG, CCB
|
|
Variant/Prinzmetal angina EKG
|
ST elevation (but cardiac enzymes normal)
|
|
Pathophys of unstable angina
|
disruption of a plaque that causes transient partial thrombosis and blockage to heart getting blood.
It's any CHANGE from previous stable angina |
|
Unstable angina enzymes and EKG findings
|
Enzymes NORMAL
EKG with ST depression |
|
Unstable angina pain note
|
doesn't respond to NTG initially, like an MI does. Also can start at rest.
|
|
Treat unstable angina
|
like MI
ALSO IV heparin to anticoagulate |
|
What valvular lesions can cause CHF?
|
Anything on the left (mitral and aortic valve pathology) - -- because affects what gets pumped out
|
|
mitral stenosis auscultation
|
low pitched diastolic murmur
opening snap Loud S1 |
|
mitral stenosis causes
|
congenital
|
|
mitral stenosis on CXR
|
can see elevation L mainstem bronchus
prominent pulm arteries L atrial enlargement |
|
mitral stenosis effect on lungs
|
pulmonary hypertension, can cause hemoptysis
|
|
mitral regurgitation causes
|
Rheumatic fever
Marfan's |
|
mitral regur on exam
|
holosystolic murmur
radiates to axilla Soft S1 (because closing with liquid in there). |
|
Valsalva and grip, murmurs that make them PATHOLOGIC
|
If decrease with valsalva, (less blood through there)
Increases with grip (more blood through there) |
|
aortic stenosis causes
|
Age (calcification), rheumatic fever
|
|
aortic stenosis on exam
|
systolic murmur, radiates to carotids,
EJECTION CLICK |
|
aortic stenosis, NEVER treat wieht
|
no nitates
no ACE-I |
|
aortic regur on exam
|
diastolic descrescendo
sidenes pulse pressure (b/c diastole less) |
|
mitral proplapse on exam
|
midsystolic click
late systolic murmur |
|
mitral prolapse associated with what condition?
|
panic disorder
|
|
Acute heart failure, cause?
|
papillary muscle rupture
infective endocaditis rupture of chordae tendinae MR |
|
How to recognize acute heart failure
|
young, healthy, flash pulm edema
|
|
Left sided CHF signs
|
Reduced EF
RESP ISSUES (pulm congestion, rales, dyspnea) S3 |
|
causes of left CHF
|
= systolic dysfunction
pump not working (because of ACS, HTN, viral condition) |
|
causes of right CHF
|
= diastolic dysfunction
--ventricle doesn't relax, gets stiffer, so reduced stroke volume (fibrosis, sarcoidosis, amyloidosis, hemochromatosis, HTN) |
|
Major cause of all CHF
|
atherosclerosis
|
|
Signs of right CHF
|
excess fluid accumulates in body, peripehral edema, JVD, heaptomegaly, ascites, NORMAL EF
|
|
If EF < 35%, what do you do?
|
AICD, because will go into Vtach of Vfib
|
|
BNP interpretation
|
If >500 CHF highly likely
|
|
false positive for high BNP
|
anything that stretched heart, like PE, pulm HTN, cor pulmonale, ACS, cirrhosis
|
|
anemia and CHF connection
|
anemia can cause CHF!
|
|
connection between CHF and TSH
|
hyperthyroidism can be CHF cause
|
|
Main treatment for CHF
|
Sodium restrction
ACE-I!!!! Furosemide (but no affect mortality) Digosxin maybe |
|
connection between myocarditis and CHF
|
myocarditis can be a cause
|
|
cor pulmonale definition and cause
|
RV enlargement d/t increased resistance in lungs (from COPD and chronic sleep apnea)
|
|
cor pulmonale on exam
|
(RV enlargement d/t increased resistance in lungs) - tachypnea, cyanosis, parasternal heave, loud PD
|
|
connection between PE and CHF
|
PE can be cause of CHF (esp in the young and healthy)
|
|
three kinds of cardiomyopathy
|
dilated cardiomyopathy
restrictive cardiomyopathy hypertrophic cardiomyopathy |
|
causes of dilated cardiomyopathy
|
anything that damages the myocardium, so get a large and weakened heart that can't pump
EtOH myocarditis doxorubicin |
|
who gets dilated cardiomyopathy
|
Chagas
Pregnant women Users of EtOH, myocarditis, doxorubicin |
|
genetic inheritance of HCM
|
AD
|
|
definition and cause of restrictive cardiomyopathy
|
walls are rigid, so doesn't fill well
From infiltrates! --amyloidosis --sarcoidosis --hemochromatosis --fibroelastrosis |
|
diagnosis of restrictive cardiomyopathy
|
you could do a ventricle biopsy, but usually CT or MRI of heart to distinguish between restrictive cardiomyopathy and pericarditis
|
|
treatment if unstable tachycardia
|
cardiovert
|
|
classic causes of afib
|
hyperthyroidism, EtOH
|
|
treatment of stable afib
|
slow rate with dilt, beta blocker
convert with verapamil and digoxin |
|
treatment of multifocal atrial tachycardia
|
ccb
|
|
Treatment of WPW
|
procainamide )blocks Na channels)
Quinidine (class I antiarrhythmic) |
|
What meds not to give for WPW
|
digoxin and verapamil
|
|
Treatment of VTach
|
Amiodarone
(or lidocaine) |
|
Treatment of Vfib
|
defibillation
|
|
Treat bradycardia
|
if severe, atropine
|
|
First degree heart block on EKG
|
increased PR interval (>120ms)
|
|
treatment of first heart block
|
nothing, but avoid bb and ccb
|
|
definition of third degree heart block
|
no synchrony between atria and ventricles
|
|
treatment of third degree heart block
|
pacemaker
|
|
Kinds of second degree heart block
|
MOBITZ I = WENCKEBACH
--gradual prolongation of PR interval then drop QRS MOBITZ II --p waves occasionally dropped QRS |
|
treatment of the two second degree heart blocks
|
MOBITZ I = WENCKEBACH
--pacemaker or atropine IF sx MOBITZ II --Pacemaker |
|
Connection b/w OCPs and thyroid
|
OCPs and estrogen can increase TBG so less T3 and less T4 (b/c are bound). You do need to increase the levo dose in this case.
|
|
connection between thyroid and carpal tunnel
|
seen more in hypothyroidism
|
|
connection between hypothyroid and cholesterol
|
hypothyroidism may cause hypercholesterolemia
|
|
5 causes of hypothyroidism
|
1*** Hashimoto's (AI)
2. Subacute, viral 3. Idiopathic (too much meds) 4. Sick euthyroid, transiently low b/c sick 5. Central cause (pituitary or hypothalamic problem) |
|
definition of hashimoto's thyroiditis
|
hypothyroid because AI disease.
|
|
diagnosis of hashimoto's thyroiditis
|
hypothyroid
ANTIMICROSOMAL ANTIBODIES On histology, see lymphocyte infiltration of the poor thyroid gland |
|
Hashimoto's associated with what other conditions
|
any other AI disease (pernicious anemia, vitiligo, lupus)
|
|
subacute thyroiditis, cause and exam
|
hypothyroid, acute viral infallamtion, recent URI.
Fever, TENDER LARGE THYROID |
|
treatment of subacute thyroiditis
|
NSAIDs only
|
|
danger of hypothyroidism
|
can get a myxedema coma = hypothermia and acute mental status change
|
|
definition of sick euthyroid syndrome
|
HYPOTHYROID
Caused by any illness. Thyroid isn't dysfunctional, transient decrease in T3 and T4. TSH normal. |
|
Central cause of hypothyroidism, like what?
|
from pituitary
--pit adenoma, sheehans from hypothalamus |
|
central cause of hypothyroidism in labs
|
reduced TSH and T4
|
|
diagram of here thyroid hormone comes from
|
hypothalamus with TRH
to pit releasing TSH to thyroid releasing T3 and T4 |
|
workup for thyroid nodule
|
Check TSH. If normal, do FNA biopsy.
If low, do I131 scan to see if cold or hot. Cold?FNA biopsy. Hot? ablate. |
|
thyroid nodule, if indeterminate FNA biopsy
|
6mo f/u and do it again
|
|
menstrual changes in hyperthyroidism
|
hyperthyroidism, gen hypomenorrhea!
|
|
connection between thyroid and bones
|
hyperthyroid can give you osteoporosis
|
|
pregnancy and thyroid
|
pregnancy raises TH, TSH normal. Could check free T4 I guess.
|
|
what is thyroid storm and how treat
|
when patients decompensate from very high TH levels. Treat with propanolol.
|
|
treatment of hyperthyroidism
|
PROPYLTHIOURACIL (less iodine so less TH)
METHIMAZOLE (less iodine) RADIOACTIVE IODINE SURGERY |
|
side effect of propylthiouracil
|
(for hyperthyroidism, less iodine)
agranulocytosis |
|
diagram of where cortisol comes from
|
hypothal release CRH
to pit releases ACTH to adrenal cortex releasing cortisol |
|
5 causes of hyperthyroidism
|
Graves (AI)
Plummer dz/Toxic (nodule) Toxic adenoma (1 nodule) Thyroiditis (before going hypo) Central cause (high TSH and T4) |
|
potential central cause of hyperthyroidism
|
high TSH and high T4
get MRI because pituitary adenoma possible, hyperfunctional |
|
how can hashimoto's be associated with hyperthyroidism
|
before going hypo, get a transient hyperthyroidism
|
|
What is plummer disease vx toxic adenoma
|
BOTH HYPERTHYROID
Plummer is multinodular. nodules make too much TH. Toxic adenoma is just 1 nodule. |
|
What is Grave's disease
|
#1 cause hyperthyroidism
get autoAb that activate TSH receptor to increased T3 and T4, decreased TSH. |
|
signs of Grave's disease
|
hyperthyroidism
--expoththalmosi, pretibila myxedema, nontender goiter, whole gland takes up the radiation |
|
definition of addison's disease
|
primary adrenal insufficiency (low steroids/cortisol, low mineralcorticodis), AI
|
|
cause of addison's disease
|
adrenal insufficiency, usually autoimmunie
|
|
physical exam of addison's disease
|
adrenal insufficieny
--increased skin pigmentation (increased ACTH) nausea/vomiting hypotension (no steroids) |
|
lab findings of addison's disease
|
Increased Ca
Low glucose (no steroids) Low sodium (low aldosterone) High potassium (low aldosterone) high ACTH |
|
addison's disease + some health stressor
|
ca have an adrenal crisis, see hypotension, abdominal pain, renal shutdown. GIVE steroids and fluids.
|
|
diagnose addison's disease
|
ACTH and see if cortisol increases (probably won't). But give steroids first if this is a major crisis.
|
|
if in question the patient has asthma, think...
|
probably took steroids (affect labs, adrenal insufficiency...)
|
|
primary vs secondary adrenal insufficiency causes and labs
|
primary - AI = addison's. HIgh ACTH.
secondary - taking steroids or sheehan or malignancy. Low ACTH and electrolyte balances aren't bad because still get mineralcorticoids |
|
physical exam diff between primary and secondary adrenal insufficiency
|
primary? skin hyperpigmentation (ACTH)
|
|
Cushing syndrome vs cushing's disease
|
Cushing's syndrome == increased cortisol (d/t giving steroids vs adrenal neoplasma, small cell CA)
Cushing's disease - syndrome BUT with pituitary overproduction of ACTH (pit adenoma, get MRI) |
|
Cushing syndrome and BP
|
hypertension
|
|
steroids effect on BP, glucose, bones, muscles
|
hypertension
high glucose osteoporosis muscle weakness |
|
what does ant pit make?
|
ACTH
TSH FSH/LH GH PRL |
|
what does post pit make?
|
oxytocin, vasopressin
|
|
diagnosis of cushings
|
24 hr urine collection of cortisol. NOT plasma cortisol level because always changing.
OR Dexamethasone suppression test |
|
Prolactinoma treatment
|
dopamine agonist (bromocriptine) because dopamine reduces PRL
|
|
prolactinoma presentation
|
in females: galactorrhea and amenorrhea
in males: impotence And see temporal vision loss |
|
prolactinoma labs and diagnosis
|
diagnose with MRI
See increased PRL, reduced LH and FSH. |
|
What gland is problem is low TRH, high TSH high T4?
|
pituitary gland
|
|
axis for estrogen/progesterone
|
hypothal releasing GnRH
to pituitary releasing LH+FSH to ovaries releasing E and P |
|
what is a pheochromocytoma?
|
neuroendocrine tumor in adrenal medulla, secretes catecholamines
|
|
pheo in labs
|
maybe glucose intolerance because catcholamines so high
|
|
diagnose pheo
|
24hr urine test (VMA, HVA), if positive, order abdominal CT/MRI to confirm there is adrenal mass
|
|
treat pheo
|
alpha AND beta blockers together, otherwise get major HTN
Then surgery. Can go hypotensive once out, give nl saline bolus. |
|
Conn syndrome definition
|
primary hyperaldosterone (so HTN), d/t adrenal adenoma
|
|
labs in Conn syndrome
|
= hyperaldosteronism
--HTN, HyperNa, HypoK, low renin levels. |
|
diagnose Conn syndrome
|
CT scan
|
|
causes of secondary hyperaldosteronism
|
renal artery stenosis, CHF/cirrhosis/nephrotic syndrome
|
|
labs in secondary hyperaldosteronism
|
HIGH RENIN
|
|
cause and duration of gynecomastia
|
often seen in puberty d/t excess estrogen, usually regresses in 18-24months
|
|
causes of SIADH
|
morphine
small cell cancer oxytocin (like if pregnant) |
|
SIADH labs
|
euvolemic hyponatrenemia
low levels all electrolytes d/t dilution |
|
treatment SIADH
|
water restriction
if fails, DEMCOCLYCLINE which induces opposite nephrogenic DI! |
|
treat central DI
|
ADH
|
|
cause of central DI
|
trauma, neoplasm, sarcoidosis
|
|
nephrogenic DI cause
|
medications, like lithium, methoxyflurane
|
|
treatment of nephrogenic DI
|
thiazide diruetics (paradoxical effect)
ADH WON'T HELP (kidneys won't respond) |
|
How can you tell if it is central or nephrogenic DI?
|
Give ADH, see if it works.
|
|
what is SMA syndrome
|
compression of the duodenum by the aorta and branching off superior mesenteric artery. End up with a fear of food.
|
|
pathophys of GERD
|
inapprorpriate intermittent LES relaxation
|
|
GERD and cancer
|
increased risk of esophageal ADENOCARCINOMA
|
|
diagnose GERD
|
could do endoscopy but gold standard is 24hr esophageal pH monitoring
|
|
kinds of hiatal hernia and the importance of this difference
|
sliding is where GEJ and stomach move through diaphragm. GERD.
paraesophageal is where part of stomach moves through another part in diaphragm. DANGER OF STRANGULATION. |
|
Duodenal vs gastric ulcers - common, cause, acid secretion
|
DUODENAL - most common, H. pylori, lot of acid
Gastric only 25%, NSAIDs |
|
Duodenal vs gastic ulcers, cancer risk and blood type
|
DUODENAL - NO CANCER, Type O
GASTRIC - RISK FOR CANCER (bx all), Type A |
|
Duodenal vs gastric ulcer, pain with food?
|
DUODENAL - better with food, then worse later.
GASTRIC - worse with food |
|
what is ZollingerEllison syndrome and how diagnose
|
gastrinomas, so gastric acid hypersecretion, get peptic ulcers. From pancreas.
Dx by checking gastrin level. |
|
Triple therapy for H. pylori
|
Amoxicillin
Clarithromycin PPI** |
|
what is ZollingerEllison syndrome and how diagnose
|
gastrinomas, so gastric acid hypersecretion, get peptic ulcers. From pancreas.
Dx by checking gastrin level. |
|
Quadruple therapy for H. pylori
|
Tetracycline
Metronidazole Bismuth PPI** |
|
Triple therapy for H. pylori
|
Amoxicillin
Clarithromycin PPI** |
|
staining of H/ pylori
|
Gram neg
|
|
Diagnose H. pylori
|
urease breath test
serum antibody fecal antigen |
|
Quadruple therapy for H. pylori
|
Tetracycline
Metronidazole Bismuth PPI** |
|
surgeries that COULD treat the H/ yplori if abx therapy doesn't help
|
Billroth, vagotomr (resect vagus nerve so no parasyp supply to stomach), antrectomy
|
|
staining of H/ pylori
|
Gram neg
|
|
What are the Billroth procedures
|
used for d/o of the stomach. connecting part of stomach to the duodenum.
|
|
Diagnose H. pylori
|
urease breath test
serum antibody fecal antigen |
|
what is dumping syndrome. Can happe after these stomach surgeries.
|
when foods bypass the stomach too quickly and enter small intestine undigested.
|
|
surgeries that COULD treat the H/ yplori if abx therapy doesn't help
|
Billroth, vagotomr (resect vagus nerve so no parasyp supply to stomach), antrectomy
|
|
sx of dumping syndrome
|
n/v/bloating
osmotic diarrhea because H2O enters too fast Low blood sguar because pancreas releases a lot of insulin |
|
What are the Billroth procedures
|
used for d/o of the stomach. connecting part of stomach to the duodenum.
|
|
what is afferent loop syndrome
|
obstruction of the rest of the intestinal loop after a bilroth procedure. See B12 deficiency and bilious vomiting.
|
|
what is dumping syndrome. Can happe after these stomach surgeries.
|
when foods bypass the stomach too quickly and enter small intestine undigested.
|
|
sx of dumping syndrome
|
n/v/bloating
osmotic diarrhea because H2O enters too fast Low blood sguar because pancreas releases a lot of insulin |
|
what is ZollingerEllison syndrome and how diagnose
|
gastrinomas, so gastric acid hypersecretion, get peptic ulcers. From pancreas.
Dx by checking gastrin level. |
|
what is afferent loop syndrome
|
obstruction of the rest of the intestinal loop after a bilroth procedure. See B12 deficiency and bilious vomiting.
|
|
Triple therapy for H. pylori
|
Amoxicillin
Clarithromycin PPI** |
|
Quadruple therapy for H. pylori
|
Tetracycline
Metronidazole Bismuth PPI** |
|
staining of H/ pylori
|
Gram neg
|
|
Diagnose H. pylori
|
urease breath test
serum antibody fecal antigen |
|
surgeries that COULD treat the H/ yplori if abx therapy doesn't help
|
Billroth, vagotomr (resect vagus nerve so no parasyp supply to stomach), antrectomy
|
|
What are the Billroth procedures
|
used for d/o of the stomach. connecting part of stomach to the duodenum.
|
|
what is dumping syndrome. Can happe after these stomach surgeries.
|
when foods bypass the stomach too quickly and enter small intestine undigested.
|
|
sx of dumping syndrome
|
n/v/bloating
osmotic diarrhea because H2O enters too fast Low blood sguar because pancreas releases a lot of insulin |
|
what is afferent loop syndrome
|
obstruction of the rest of the intestinal loop after a bilroth procedure. See B12 deficiency and bilious vomiting.
|
|
what is the ligament of trietz and what is its significance
|
it is at the duodenal-jejunal junction.
Upper GI bleed is proximal to it, Lower GI bleed is distal to it |
|
how to stop a diverticula bleed
|
epi injection, vasopressin, embolization
|
|
varices treatment and prevention
|
treatment - octreotide
prevent - propanolol |
|
GI bleed, what to do?
|
make sure stable, give IVF.
Endoscopies. If can't find bleed, nuclear RBC tagged scan. |
|
Diagnose diverticulosis
|
CT with IV contrast
NEVER ENDOSCOPY bc might perf. |
|
cause of diverticulosis
|
low fiber, high fat diet
|
|
osmotic vs secretory diarrhea
|
osmotic - sugar pulls in the fluid (like mild). Diarrhea stops if don't eat.
secretory - bacterial toxins like cholera has bowel secreting more fluid, diarrhea continues even if not eating. |
|
example of malabsorption d/o causing diarrhea
|
celiac sprue, crohn's
|
|
pathophys of celiac sprue
|
AI to gliadin/gluten. Pathology is villous atrophy
|
|
crohn's on blood tests
|
antiendomysial antibody
|
|
steatorrhea is d/t
|
small bowel involvement
|
|
food poisoning, what was responsible?
|
if sx <6hrs, Staph or Bacillus.
If sx>6rs, bacterial or viral. |
|
4 causes of bloody diarrhea
|
Shigella
Campylobacter Some E. coli C. diff |
|
5 infectious causes of NONBLOODY diarrhea
|
Rotavirus
Giardia Some E. coli Cholera Salmonella |
|
Exudative diarrhea is
|
inflammation in bowel muca ccuases seepage of fluid, like in IBD
|
|
Treat C. diff
|
ORAL metronidazole.
If can't do that ORAL VANCO |
|
C. diff + loperamide
|
TOXIC MEGACOLON! BE CAREFUL with that!
|
|
C. diff on stain
|
Gram positive
|
|
HUS cause
|
IN KIDS
After E. coli O57:H7 or Shigella diarrhea, the toxin damages vascular endothelium |
|
what you see in HUS
|
kids, after diarrhea, toxin damages vasculature
--ARF --THROMBOCYTOPENIA (activates all the platelets) --HEMOLYTIC ANEMIA (vasculitis breaks RBCs down) |
|
Tx of cirrhosis
|
lots of protein (bc low albumin)
If hyponatremia, give 800-1000mL/day Vit K and FFP if necessary |
|
Hep A source
|
foodborne
|
|
Hep A serology
|
AgM anti HAV
|
|
Hep B transmission
|
needles
sex perinatal |
|
If HepB + mother, what do you do for the baby?
|
HepB vaccine and HepB Ig
|
|
HepB associated with what vasculitis
|
polyarteritis nodosa
|
|
HepC serology
|
HCV AB+ = resolved infxn
HCV RNA = active |
|
complications of HepC
|
HCC
cryoglobulinemia |
|
Hep D source
|
same as HepB, usually only WITH HepB. (needles, sex, perinatal)
|
|
HepD Ag
|
chronic infection
|
|
HepD IgM
|
recent resolution
|
|
HepE source
|
food or water born (way worse in pregnant women)
|
|
drugs that can induce hepatitis
|
Tylenol
INH and other TB RIPE Phenobarbitol statin |
|
What is reye's
|
Fatty liver + encephalopathy (from giving ASA for a fever to a kid)
|
|
What is and tx for acute fatty liver of pregnancy
|
in 3rd trimester
Tx with immediate delivery |
|
AI Hepatitis, serology
|
antismooth muscle
hypergammaglobulinemia on SPEP |
|
tx AI hepatitis
|
steroids and azathioprine
|
|
Tylenol overdose mgmt
|
don't measure anything, give NAC right away.
Can give cimetidine to protect against hepatic necrosis |
|
Tylenol overdose presentation
|
2-4hrs after, n/v, pallor
24-48h after, RUQ tenderness |
|
relation between alcohol and tylenol
|
Chronic alcohol use uses up the protective glutathione, so can get worse hepatotoxicity with tylenol overdose
|
|
Acute HepB serology
|
HBsAg
HBeAg HbcAb IgM |
|
Acute HepB window period
|
HBcAb IgM only
|
|
Chronic Hep b
|
HBsAg
HBeAg HBeAb IgG |
|
Recovered from HepB
|
HBsAb IgG
HBcAb IgG |
|
Immunized against HepB
|
HBsAb IgG
|
|
If you have HBe Ab that means
|
not contagious
|
|
In anemia of chronic disease, iron, transferrin, TIB, ferritin, trans sat
|
low Fe
Low transferrin = low TIBC HIGH FERRITIN Low transsat |
|
in iron deficiency anemia
|
low Fe
HIGH transferrin HIGH TIBC HIGH FERRITIN low transferrin sat |
|
hemochromatosis genetics and pathophys
|
AR
absorb too much iron and start depositing in various tissues |
|
tx hemochromatosis
|
phlebotomy
chlate off with deferoxamine |
|
hemochromatosis men vs women
|
men symptomatic earlier because women naturally losing iron anyway with menstruation
|
|
presentation of hemochromatosis
|
Iron in:
liver - cirrhosis, HCC pancreas - DM heart - DCM skin - bronze diabetes joints - arthrtisi also infertility, amenorrhea, spooning nails |
|
dx hemochromatosis
|
DNA testing
|
|
tx portal HTN
|
sodium restriction <2g/day
Diruetics paracentesis |
|
SAAG >1.1
|
serum ascites-albumin gradient
portal HTN cirrhosis, CHF, buddchiari, hepatic vein thombosis |
|
SAAG < 1.1
|
serum ascites -albumin gradient
peritonitis, CA pancreatitis trauma nephrotic syndrome |
|
Wilson dz - genetics and pathophys
|
AR
TOO MUCH COPPER! |
|
Wilson disease blood and urine tests
|
blood - low ceruloplasmin (low because can't arry any more copper)
Urine - more copper |
|
tx hemochromatosis
|
phlebotomy
chlate off with deferoxamine |
|
diagnose wilson
|
liver biopsy, excess copper
|
|
hemochromatosis men vs women
|
men symptomatic earlier because women naturally losing iron anyway with menstruation
|
|
presentation of hemochromatosis
|
Iron in:
liver - cirrhosis, HCC pancreas - DM heart - DCM skin - bronze diabetes joints - arthrtisi also infertility, amenorrhea, spooning nails |
|
dx hemochromatosis
|
DNA testing
|
|
tx portal HTN
|
sodium restriction <2g/day
Diruetics paracentesis |
|
SAAG >1.1
|
serum ascites-albumin gradient
portal HTN cirrhosis, CHF, buddchiari, hepatic vein thombosis |
|
SAAG < 1.1
|
serum ascites -albumin gradient
peritonitis, CA pancreatitis trauma nephrotic syndrome |
|
Wilson dz - genetics and pathophys
|
AR
TOO MUCH COPPER! |
|
Wilson disease blood and urine tests
|
blood - low ceruloplasmin (low because can't arry any more copper)
Urine - more copper |
|
diagnose wilson
|
liver biopsy, excess copper
|
|
wilson disease presentation
|
hepatolenticular degeneration
KayserFleisher rings (dk rings around iris) neuro changes (bc copper in basal ganglia) Liver changes psych changes |
|
Tx Wilson' disease
|
penicillamine (copper chelator)
|
|
alpha 1 antitrypsin deficiency - genetics and presentation
|
AR
younger adult with cirrhosis AND/OR emphysema without risk factors |
|
dx alpha 1 antitrypsin deficiency
|
low blood levels of antitypsin
SPEP (CNA tests) |
|
alpha 1 antitrypsin deficiency tx
|
given alpha 1 antitrypsin
likely to need liver transplant :( |
|
liver disease and coag tests
|
PT long.
Vit K ineffective b/c liver can't use to make coag factors. |
|
tx coagulopathy in liver disease
|
NOT VIT K (can't use it)
FFP which has coag factors premade |
|
SBP diagnosis
|
paracentesis, neutrophils >250
AND can see low glucose, high protein |
|
usual cause of SBP
|
E. coli, Streptococcus
|
|
pathophys of portal HTN
|
HTN in portal vein which drains GI tract, get backup and get other tributaries to the liver so clears before getting to heart
|
|
ammonia and liver disease
|
liver clears ammonia usually, so can get high if liver damaged. Tx with lactulose (prevents absoprtion of ammonia or neomycin which kills bowerl flora so can't make the ammonia)
|
|
Tx hepatorenal syndome
|
albumin
alpha adrenergic midodrine octreotide vasopressin TIPS |
|
What is TIPS
|
connects the portal vein to the hepatic vein
|
|
glucose and liver disease
|
liver usually stores glycogen so if it isn't now... LOW GLUCOSE
|
|
Reasons to see elevated alk phos
|
biliary tract disease
paget's disease (bone formation) |
|
imagine the biliary tree
|
GB into cystic duct
then R and L hepatic ducts come together to form common hepatic duct then joins with cystic duct to make common bile duct |
|
dark urine, talk about the bilirubin found
|
it's conjugated. unconjugated won't go into use because bound to albumin
|
|
Couvoisier sign
|
jaundice
+ palpable gallbladder |
|
cholestasis can be caused by
|
meds (OCPs, sedatives, adrogens)
pregnancy |
|
Primary biliary cirrhosis and PSC causes
|
both caused by AI destruction
|
|
PBC vs PSC labs
|
PBC - antimitochondrial antibodies
PSC - antismooth muscle, pANCA |
|
PBC presentation
|
middle aged woman, maybe some osteoporosis, jaundiced
|
|
tx PBC
|
cholestyramine (bile acid sequestrant
liver transpoart ursodeoxycholic acid |
|
PSC presentation
|
with ULCERATIVE COLITIS
beaded bile duct strictures (tx same as PBC) |
|
cholangitis def and cause
|
bacterial infection superimposed on an obstructive biliary tree, usually from gallstones.
|
|
Charcot's triad vs Reynold's pentad
|
Charcot's triad: RUQ pain, jaundice, fever
Reynold's pentad: AMS, hypotension |
|
treat IBD
|
5ASA
sulfa steroids immunosuppressants surgery for UC |
|
complications of IBD
|
uveitis
ankylosing spondylitis erythema nodosum PSC if UC ALSO TOXIC MEGACOLON (UC) |
|
toxic megacolon from what?
|
cdiff + loperamide
UC/Cohn's |
|
toxic megacolon diagnosis
|
xray with dilated colon, thumprinting, emergency!!!
|
|
tx toxic megacolon
|
EMERGENCY
NPO, NGtube IVF and Abx |
|
crohns vs UC location and thickness
|
crohns - skps around, transmural
UC - rectum up, to submucosa only |
|
crohns vs UC who gets it?
|
UC gets in two spikes, 15-30yo and >60YO
|
|
crohn's vs UC cancer risk and if needs surgery
|
crohn's - no surgery (still skips), little increase CA
UC - YES CA RISK, YES SURGERY |
|
classic lesions of crohn's
|
fistulas/abscesses (b/c transmural)
cobblestoning string sign noncaseating granulomas |
|
classic lesions of UC
|
pseudopolyps
leadpipe colon toxic megacolon crypt abscesses friable mucosa |
|
diagnose achalasia
|
esophageal manometry
|
|
what is zenker's diverticulus and how present
|
outpouching in upper esophagus, foul smeeling breath, reguitation, hard time swallowing
|
|
to diagnose esophageal perf
|
ESOPHAGOGRAM, not an endoscopy, and use water soluble contrast
|
|
corkscrew esophagus seen on barium swallow, think
|
diffuse eso spasm or nutcracker esophagus
|
|
scleroderma parts
|
CREST
calcinosis Raynaud's esophageal dysmotility (apreistalsis d/t fibrosis of smooth msucle) sclerodactylyl telangiectasias, can become incompetenent LES |
|
mgmt of Barrett's esophagus
|
periodic endoscopy and biopsies
|
|
Mallory Weiss vs Borrhave
|
Boorhave is a full thickness esophageal rupture
|
|
radiolucent bank by heart border, think
|
pneumomediastinum
|
|
FAP labs and def and mgmt
|
FAP 100s of polysps __> CA.
APC gene But also risk for intestinal/gastric CA, so do an upper endoscopy too. |
|
pancreatitis labs
|
DO LIPASE!!! more specific
|
|
Grey Turner and Cullen sign
|
Grey Tuner, pancretatits, blue/black flank
Cullen: blue/black umbilicus. |
|
diffuse calcifications in pancreas means...
|
chronic pancreatitis, usualyl EtOH induced
|
|
gallbladder not involved in CHRONIC pancreatitis bc
|
gallbladder probably already removed a long time ago
|
|
cause of acute ischemic colitis
|
atherosclerotic disease
|
|
causes of pancreatitis
|
EtOH
GALLSTONES HyperTG Mumps/Coxsackie Trauma via ERCP Steroids Tiazides Azathioprine |
|
anemia and murmurs
|
can get murmurs with anemia d/t high flow
|
|
how does methyldopa cause anemia
|
Ab to RBCs
|
|
how does chloroquine cause anemia
|
via G6Pd worsening
|
|
how do sulfas cause anemia
|
only through G6Pd
|
|
chloramphenicol and anemia
|
not just anemia, but aplastic anemia
|
|
phenytoin and anemia
|
get a megaloblastic anemia
|
|
OA and anemia?
|
NO NO NO@
|
|
vit deficiencies seen in alcoholism
|
iron
folate B12 |
|
G6PD def pathophy
|
the deficiency of this enzmye means the enzyme can't eradicate free radicals in RBCs. So you get all sorts of hemolysis to certain triggers.
|
|
interpret RI
|
should be >2%, if not, the marrow isn't reponding well.
If super high, maybe there's hemolysis going on. |
|
teardrop RBCs on smear, think
|
myelofibrosis (replacement of marros with fibrous CT, get anemia)
|
|
if see bit cells on semar, think
|
hemolytic anemias
|
|
if see basophilic stippling on smear, think
|
lead poisoning
|
|
if see rouleaux formation, think
|
multiple myeloma
|
|
what is multiple myeloma
|
cancer of plasma cells (that make Ab), so get weirdo plasma cells (Ab) deposited into organis
|
|
presentation of MM
|
(CA of plasma cells, Ab)
Ab deposited everywhere, so get renal failure neuropathy anemia bone lesions lot of Ca |
|
diagnostic tests for MM
|
bone scan - see punch out lesions
serum electrophoresis - see albumin and Ab spikes |
|
See Heinz bodies, what look like and what think
|
dot inside or outisde RBC
G6D def (it's denature Hgb) |
|
Echinocytes,/burr cells - what look like and associated with
|
UREMIA!
spiky RBC |
|
teardrop RBCs on smear, think
|
myelofibrosis (replacement of marros with fibrous CT, get anemia)
|
|
if see bit cells on semar, think
|
hemolytic anemias
|
|
if see basophilic stippling on smear, think
|
lead poisoning
|
|
if see rouleaux formation, think
|
multiple myeloma
|
|
what is multiple myeloma
|
cancer of plasma cells (that make Ab), so get weirdo plasma cells (Ab) deposited into organis
|
|
presentation of MM
|
(CA of plasma cells, Ab)
Ab deposited everywhere, so get renal failure neuropathy anemia bone lesions lot of Ca |
|
diagnostic tests for MM
|
bone scan - see punch out lesions
serum electrophoresis - see albumin and Ab spikes |
|
See Heinz bodies, what look like and what think
|
dot inside or outisde RBC
G6D def (it's denature Hgb) |
|
Echinocytes,/burr cells - what look like and associated with
|
UREMIA!
spiky RBC |
|
see target cells, think
|
thalassemia
liver disease |
|
see hypersegmented neutrophils, think
|
folate
Vit B12 deficiency |
|
see Howell Jolly bodies, think and what look like
|
dot in BC (like Heinz)
asplenia or splenic dysfunction |
|
see iron inclusions in RBCs, what look like and what think
|
ring of dots around RBCs.
Think sideroblastic anemia This is d/t iron granuales that can't incorporate into Hgb |
|
see schistocytes, think
|
intravascular hemolysis
|
|
why pathology with spherocytes or elliptocytes
|
problem with the cytoskeleton, so spleen thinks they're bad so they tear them up
|
|
see polychromasia, think
|
reticulocytosis (maybe hemolysis too)
|
|
intravascular hemolysis, causes and pathophys
|
RBCs lysed in blood vessel
-d/t mech damage by heart vale -mech damage from vasculitits -paroxysmal noctural hgburina |
|
intravascular hemoysis in serum and smear
|
serum - LDH high, haptoglobin low, direct coombs negative
-smear - schistocytes, lot of Hg, l |
|
extravascular hemolysis pathophsy and causes
|
RBCs abnl or coated with Ab so liver or spleen attacks them
--AIHA --spherocytosis, membrane issues --SCD --HUS --Any antibodies against it |
|
extravasc hemolysis on serum tests
|
direct coombs maybe positive in RBC Ab involved
(so consider if blood transfusions will be helpful) |
|
examples (4) of macrocytic anemia
|
folate def
B12 def Meds (methotrexate, phenytoin) liver dz |
|
examples of microcytic anemia (5)
|
Thalassemia
(nl to high RI) Iron def sideroblastic anemia anemia of chronic disease lead poisoning |
|
hemolytic anemia labs
|
high LDH
no haptolobin (only seen with intravascular hemolysis) |
|
The correct labs for IDA
|
low iron
low ferritin HIGH TIBC low TIBC sat low TI |
|
what is a thalaseemia
|
anemia d/t defefcts in Hgb resulting from abnormal production of alph and beta globin. The units themselves are okay.
2 alpha 2 beta |
|
Hgb alpha units, how many, what race associated with problems
|
4 genes
more in africans and asians |
|
Hgb beta units, how many genes involved and what race associated
|
2 genes involved
more in mediterraneans |
|
sickle cell trait, kind of anemia and Hgb types
|
NO ANEMIA
See HbA and HbS |
|
What is hemoglobin SC disease
|
equal HbS and HbC
|
|
iron levels in thalassemias
|
NORMAL, do don't offer it as treatment!
|
|
thalassemias MCHC
|
increased
|
|
thalassemias with xrays
|
skull was hair on end appaearance because of excessive extrameduallar hematopoiesis
|
|
when become symptomatic with thalassemia?
|
depends on what kind.
alpha thal - sx at birth beta thal - sex at six months because have fetal Hgb |
|
kinds of alpha thalassemias
|
4 bad genes - hydrops fetalis
3 bad genes - HbH = Hgb Barts 2 bad genes 1 bad gene - |
|
kinds of beta thalassemias
|
2 bad genes - B thal MAJOR
- no B globin production -High HbA2 and HbF - Die without transfusions 1 bad gene = B thal MINOR - maybe occ transfusion |
|
beta thal major presentation
|
can see CHF even
thinning of cortical bone d/t expansion of marrow cavity |
|
thalassemias and malaria
|
B thal major protects against malaria
|
|
labs and smear for lead poisoning
|
labs - elevated free erythroycte protoporphyrin
smear - basophilic RBC stippling |
|
Sideroblastic anemia on iron studies
|
Fe, TIBC, ferritin all NORMAL
Low RI |
|
anemia of chronic disease, RI?
|
low
|
|
tx siderolbastic anemia
|
supporitvely, maybe pyridoxine (Vit B6)
No iron (plenty of iron, remember?) |
|
cold agglutinin disease associated w what infections
|
mycoplasma
mono |
|
cold agglutinin disease - anemia and presentation
|
it's normocytic anemia
acrocyanosis in cold exposures |
|
AIHA - kind of anemia and coombs test
|
normocytic anemia
coombs POSITIVE |
|
AIHA etiologies
|
lupus
Meds like meyldopa, Abs, INH, hydralazine mycoplasma, EBV, syphilis |
|
drugs that cause lupus
|
procainamide
hydralazine isoniazid |
|
spherocytosis genetics and how diagnose (4)
|
blood smear
fam hx (AD) positive osmotic fragility yest increased MCHC |
|
ESRD, kind of anemia and how treat
|
normocytic
give erythropoietin (usually kidney makes that) |
|
cause of aplastic anemia (and what kind of anemia)
|
normocytic
chemo/rads leukemia chloramphenicol carbamezpine sulfa |
|
iron levels in thalassemias
|
NORMAL, do don't offer it as treatment!
|
|
thalassemias MCHC
|
increased
|
|
thalassemias with xrays
|
skull was hair on end appaearance because of excessive extrameduallar hematopoiesis
|
|
when become symptomatic with thalassemia?
|
depends on what kind.
alpha thal - sx at birth beta thal - sex at six months because have fetal Hgb |
|
kinds of alpha thalassemias
|
4 bad genes - hydrops fetalis
3 bad genes - HbH = Hgb Barts 2 bad genes 1 bad gene - |
|
kinds of beta thalassemias
|
2 bad genes - B thal MAJOR
- no B globin production -High HbA2 and HbF - Die without transfusions 1 bad gene = B thal MINOR - maybe occ transfusion |
|
beta thal major presentation
|
can see CHF even
thinning of cortical bone d/t expansion of marrow cavity |
|
thalassemias and malaria
|
B thal major protects against malaria
|
|
labs and smear for lead poisoning
|
labs - elevated free erythroycte protoporphyrin
smear - basophilic RBC stippling |
|
Sideroblastic anemia on iron studies
|
Fe, TIBC, ferritin all NORMAL
Low RI |
|
tx aplastic anemia
|
stop whatever med is causing it
May be antithymocyte globulin (knock of Tcells) or BMtransplant |
|
myelophthisic anemia what is it
|
normocytic anemia
b/c myelodysplasia/myelofibrosis or malignant invasion and destruction of BM |
|
myelodyplastic issues and smera and BM biopsy
|
BM biopsy usually dry
see crazy RBC that are nucleated, giant, teardrop |
|
G6PD def, genetics, diagnosis
|
X linked
RBC enzyme assay (way after hemolysis has resolved a bit) |
|
G6PD def offending med/circumstances that can put you into hemolytic crisis
|
Fava beans
Antimalarials Salicylates Sulfas Infection |
|
what is paroxysmal noctural hemolysis
|
acquire d/o with intravascu hemolysis, recurrent thrombosis.
|
|
dx paroxysmal nocturnal hemolysis
|
flow cytometry
|
|
who gets folate def
|
alcoholics
pregnant women |
|
causes of folate def
|
alcoholics
pregnancy poor diet methotexate long bactrim tx phenytoin malabsoprtion |
|
how treat folate def
|
oral folate
|
|
vit B12 def ccause
|
prenicious anemia (Ab against gastric parietal cells)
gastrectomy, surgeries strict began chronic pancreatitis fish tapeworm |
|
Vit B12 def dx
|
Schilling test
Macrocytic anemia Low B12 |
|
what is schilling test
|
for B12 def
want to urinate out 5+% labelled B12 (if don't, impaired absoprtion) |
|
lab tests in vitamin b12 def
|
also get low Cl! No stomach acid secretion either
|
|
how treat serum B12
|
f d/t pernicious anemia, must give B12 IM because we already know they can't absorb it
|
|
When transfuse with washed RBCs
|
IgA deficiency (free of any of trace of anything else)
|
|
When transfuse with FFP
|
DIC, coumadin posioning, liver failure
|
|
cryoprecipitate, what is it
|
has fibrinogen and factor 8(can use VWD, DIC, hemophilia!)
|
|
hgb 6, what do you do?
|
transfuse on clinical grounds
|
|
emergency, what blood do you use?
|
O negative
|
|
3 kinds of transfusion reactions
|
febril reaction (Ab to WBCS0
hemolytic reacion (Ab to RBCs) Allergic reactive (rxn to component in serum) |
|
if stop peeing after transfusion
|
IVF and diurese (hemoolytic reaction)
|
|
if bleeding after transfusion, because of
|
high K
dilution (lo plt) low Ca (from chealtor) |
|
causes of DIC
|
50% OB! and preg
CA then sepsis of trauma |
|
DIC, fibrin, FDP, D dimer test
|
D dimer positive
increased FDP low fibrin |
|
loffler syndrome
|
pulmo esoinophilis (parasite?)
|
|
causes of basophilia
|
allergies
CA blood dyscrasia |
|
FVL test
|
APC (activated protein C resistance)
|
|
coag tests and what prolongs them
|
PT (extrinsic) WARFARIN prolongs
PTT (intrinsic) HEPARIN Bleeding time - PLTS BAD FUNCTION PROLONGS IT |
|
if see petechiae, this is a ___ issue
|
platelets
|
|
if cavity/joint bleeding , this is....
|
clotting factor deficiency (not platelets!)
|
|
von Willebran dz, genetics, coag tests
|
AD
PT normal PTT and BT high |
|
what is VW diasese
|
no von Willebrand factor, needed for platelet adhesion
|
|
how dx vW dz
|
Factor VIII
|
|
tx of vW dz
|
desmopressin (because increased VIII)
|
|
Hemophilia A/B genetics and problem
|
X linked
Hemophilia A = low factor 8 Hemophilia B = low factor 9 |
|
Hemophilia A/B coag tests
|
PT normal
PTT high BT normal |
|
DIC coag tests
|
High PT, PTT BT
|
|
liver failure and coag tests
|
PT hight
PTT high BT normal |
|
ITP and TTP coag tests
|
PT/PTT normal
BT high |
|
scurvy coag tests
|
all all all normal
|
|
what coag factors use Vt K
|
2, 7, 9, 10
|
|
don't give plt transfusions to
|
TTP
of HITT |
|
orgs that are spirochetes
|
treponema/syphilis
leptospira correlia (Lyme's dz) |
|
what orgs only see with darkfield microscope?
|
treponema (syphilis)
leptospira |
|
erythromycin covers
|
G+
Resp G- oral anaerobes atypicals |
|
osteomyelitis in IV drug use or sickle cell
|
osteomyelitis in IV drug use = pseudomonas
osteomyelitis in sickle cell = salmonella |
|
H influ in meningitis?
|
not so much in kids anymore since vaccination, but if NOT vaccinated, most likely cause
|
|
bacteroides type of bacteria
|
NAAERoBIC
|
|
borrelia causes what disease
|
rmsf
|
|
meds to treat lyme's disease
|
doxy amoxicillin
|
|
how to treat mycoplasma (atypical)
|
azithromycin, fluoroquinolone
|
|
which abx cover pseudomonas?
|
4th gen cephalosporin (cefepime)
aminoglycosides (gent) cipro and levofloxacin Zosyn/Unasyn/Ticar-b Carbapenems (meropenem) |
|
How treat <5YO exposed to TB, neg PPD
|
treat 3 months with INH
|
|
tx LTBI
|
INF for 6-9months
|
|
when TB no longer considered infectious?
|
if clinically improving ON TX
3 negative sputum smears |
|
TB positive with what measurements?
|
>5cm = immunocompromised, prior RB
>15mm = low risk |
|
TB therapy, how monitor
|
liver tests, supplement with B12 (pyridoxine for INH)
|
|
signs of B6 deficiency (pyridoxine), like in INH
|
cheilitis
sz sideroblastic anemia |
|
if multidrug resistant TB, what med do you add
|
streptomycin or ethambutol
|
|
impetigo and counseling patients, how to treat
|
strep/staph skin honey lesions
CANTGIOUS tx with dicloxaillin (PCN) |
|
erysipleas vs cellulitis
|
erysipelas superficial, red shiny, tender.
Cellulitis goes into subcu tissues. |
|
tx dog bites with
|
amipicilli (pasteurella)
|
|
How treat <5YO exposed to TB, neg PPD
|
treat 3 months with INH
|
|
tx LTBI
|
INF for 6-9months
|
|
when TB no longer considered infectious?
|
if clinically improving ON TX
3 negative sputum smears |
|
TB positive with what measurements?
|
>5cm = immunocompromised, prior RB
>15mm = low risk |
|
TB therapy, how monitor
|
liver tests, supplement with B12 (pyridoxine for INH)
|
|
signs of B6 deficiency (pyridoxine), like in INH
|
cheilitis
sz sideroblastic anemia |
|
if multidrug resistant TB, what med do you add
|
streptomycin or ethambutol
|
|
impetigo and counseling patients, how to treat
|
strep/staph skin honey lesions
CANTGIOUS tx with dicloxaillin (PCN) |
|
erysipleas vs cellulitis
|
erysipelas superficial, red shiny, tender.
Cellulitis goes into subcu tissues. |
|
tx dog bites with
|
amipicilli (pasteurella)
|
|
cellulitis from vibrio, tx
|
fishermen or other salf water
TETRACYCLINE |
|
Pseudmonas cellulitis, how tx
|
if DM, trauma
HUGE ABX |
|
endometritis and puerperal fever cause and tx
|
strep B
amoxicillin/ampicillin |
|
stretococcus viridians causes
|
subacute endocarditis and dental caries
|
|
endocarditis in IV drug users from
|
staph auerus
|
|
toxic shock syndrome from what org?
|
staph aureus
|
|
MRSA covered by which abx
|
vanco
coxy linezolid bactrim clinda quinupristin |
|
staph epi causes
|
IV cath infections
infectious of prestheses |
|
staph saprophyticus causes
|
UTI
|
|
if stpah aureus bacteremia, you must
|
eval for endocarditis (echo)
|
|
if you see strep bovis endocarditis, think about
|
occult GI malignancy and get colonoscopy!!!!
|
|
causes of acute and subacute endocarditis
|
acute = S. aureus
subacute - insidious onset, strep viridans |
|
What are osler nodes vs roth spots vs janeway lesions vs splinter hemorrhages
|
all for endocarditis
osler - painful nodes on fingers roth spot s- retinal hemorrhages janeway lesions - nontender on palms and soles splinter hemorrhages - under nails |
|
how long tx endocarditis?
|
4=6 weeks
|
|
how treat endocarditis
|
vanc and gent (bc sometimes G-)
|
|
who gets endocarditis
|
IV drug users
fake valves postop patient |
|
who really gets dental prophy for endocarditis?
|
MVP + audible murmur
|
|
bit by ?rabies animal, how tx
|
rabies IG
rabies vaccine EXCEPT IF NL LOOKING DOG/CAT EXCEPT IF RABBIT OR RODENT |
|
how to screen and confirm syphilis
|
Screen: RPR + VDRL
Confirm: FTA and MFA |
|
options to tx syphilis
|
PCN (duh
OR ERYTHROMYCIN if allergic |
|
three stages of syphilis
|
PRIMARY: painless chancre
SECONDARY (6w-18months), condyloma lata wart, sole/palm rash, LAD Latent phase Teritary: years later, gummas (Granulomas), neuro changes, paresis, thoracic aortic anuerysms! |
|
|
|
|
lung infection with have CF, from
|
pseudomonas
Staph aures |
|
how dx mycopllasma pna
|
positive cold agglutinin titer, + IgM against RBC
|
|
stuck with thorn or rash with gardening, ID and treat
|
Sporothrix (fungus), treat with fluconazole
See spread ni lymphatic, linear raised rash!! |
|
if aplastic crisis in SCD, from
|
parcovirus B19
|
|
spleen out, vaccinate for
|
Strep pneumo, H, inlue, N meningitidis
|
|
PNA around birts, is
|
chlamydia psittaci
|
|
fungus ball after TB
|
aspergillus
|
|
Vit B12 def and abdominal sx, think
|
fish tapeword (Diphyllobothrium latum)
|
|
bladder CA (aquam cell_ in middle east and africa), ID and tx?
|
from trematode (Schistosoma hematobium)
Dx: urine micro to see eggs |
|
fever, muslce aches, esoinophils, periorbital edema after eating raw meat
|
trichinella spiralis (Trichinosis)
|
|
mech for paralysis after honey
|
from clostridium botulinum
toxin blocks Ach release |
|
tx malignant external otitis
|
systemic Abx (antipseudomonal)
|
|
genital lesions but no abuse in kids, likely
|
molluscum (poxvirus)
|
|
goats/sheep fever, from
|
brucella (G-)
|
|
PNA by air conditioner or eatwe tower
|
Legionella (G-)
|
|
tx legionella
|
azithomycin, or fluoroquinolone
|
|
gram + stain, Gram negative stain what color?
|
G+ = blue/purple
G - = red |
|
Gram + cocci in chains
|
streptococci
|
|
gram + cocci in cluster
|
staph
|
|
Gram + cocci in pairs 9diplococci)
|
strep pneumo
|
|
gram - coccobiaccili
|
haemophilus
|
|
Gram neg diplococci
|
neisseria, moraxella
|
|
Gram neg rod that is pump with thick capsule (mucoid)
|
klebsiella
|
|
gram positive rods that form spores
|
clostridium
bacillus |
|
see pseudohyphae, think
|
candida
|
|
acid fast orgs includ
|
mycobacterium (TB), nocardia
|
|
gram pos with sulfur granules
|
actinomyces, PID
|
|
silver staining org
|
PCP and cat scrath dz
|
|
positive india ink prep
|
cryptococcus (fungus) - can cause meningitis!
|
|
how to recognize multifocal atrial tachy
|
diff P waves
RR irregular |
|
causes of multifocal atrial tachycardia
|
hypoxia
COPD low potassium |
|
how to treat prolactinoma
|
RARELY SURGERY NEEDED
dopamine agonist (bromocriptine) |
|
lab tests with Prolactinoma
|
HIGH PRL
low LH low FSH |
|
what is MELD for and what parameters
|
MELD - to predict mortality in patient with liver dz
BILI INR Cr |
|
potassium and sick kidney
|
will be high
because a healthy kidney will excrete all the extra K+ |
|
definition of oliguria
|
<500mL/day
<20mL/hr |
|
causes of prerenal ARF
|
hypovolemia
not perfusing the kidneys (CHF) sepsis renovascular HTN |
|
how to diagnose prerenal ARF
|
BUN:Cr>20
FeNa <1% |
|
causes of postrenal ARF
|
BPH
renal artery stenosis (fibromusc dysplasia) |
|
can kidney stone cause renal failure
|
not unless bilateral
OR bladder neck stone (bc other kidney an pick up the slack) |
|
causes of intrarenal ARF
|
ATN (death of tubule cells in the kidney)
IV contrast Lupus Meds GPS |
|
ATN known by
|
muddy brown casts
|
|
what meds damage the kidney
|
chronic NSAID-->papillary necrosis or ATN
cyclosporine aminoglycosides (gent) methicillin INTRARENAL ARF |
|
Goodpasture's syndrome pathophys and renal biopsy
|
path - antiglomerular basement membrane antibodies
renal biopsy - linear immunofluorescence pattern |
|
presentation of Goodpastur'es
|
young man with:
hemopytsis/dyspnea AND RENAL FILURE |
|
How tx Goodpasture's
|
steroids
|
|
Wegen's granulomatosis presentation
|
LUNG
KIDNEY (like Goodpasture's) AND SINUS INVOVLEMENT |
|
how to diagnose Wegener's
|
c-ANCA
= antineutrophilic cytoplasmic antibody |
|
RBC casts
|
glomerulonephritis
|
|
how does poststrep glomerulonephritis present
|
1-3wks after URI.
Edema, HTN, hematuria RBC casts |
|
Rhabdo connection with kidneys?
|
the muscle breaks down and plugs up the renal filtration systme.
See high CPK and CK. |
|
Tx rhabdomyoltsis
|
hydration
diuretics |
|
when is acute renal failure so bad that need dialysis
|
uremia --> pericarditis
encephalopathy metabolic acidosis if pH<7.25 CHF |
|
renal artery stenosis, when suspect
|
if young woman with inability to control HTN. (d/t fibromuscular dysplasia)
|
|
ADPKD presentation
|
HTN
hematuria BERRY ANEURYSMS in circle of Willis Liver cysts |
|
Chronic renal failure, acid/base, potassium, fluid status, Calcium, Phosphate
|
Metabolic acidosis (increased AG)
HyperK Fluid retention HypoCa and Hyperphos because imparied Vit D production so not reabsorbing Ca@+ |
|
kidneys connection to bones?
|
in chronic renal failure, can have impaired vitamin D production, bone loss leads to renal osteodystrophy
|
|
chronic renal failure AND
Anemia Symptoms Coags Skin changes Immunity |
Anemia d/t lack of EPO
N/V from buildup of toxins Bleeding with platelets not working in uremic conditions skin yellowbrown and itchy increased infection because immune system doesn't work either in uremia |
|
management of chronic renal failure
|
dialysis
water solube vitamins (which are removed in dialsis) Low phophate Phophate binders (CaCarbnate) EPO |
|
UTI, alkalotic urine, think
|
Proteus
|
|
what is urobilinogen
|
in hemolysis
in liver disease |
|
waxy casts, think
|
CKD
|
|
WBC casts, think
|
pyelonephitis
|
|
Calc FeNa
|
UNaPCr
----------- UCrPNa |
|
Pyelonephritis usually d/t
|
E. Coli
|
|
if pyelo and doesn't improve after 7whrs of abx...
|
do CT scan to look for a renal abscess (may need surgical drainage)
|
|
asymptomatic bacteruria, tx?
|
don't treat UNLESS PREGNANT (but don't use bactrim)
|
|
nephritic syndrome 3 characteristics
|
Proteinuria but <3.5g
HTN Hematuria |
|
examples of nephritic syndrome
|
poststrep glomerulonephtisis
|
|
examples of nephrotic syndrome
|
minimal change dz (no podocytes)
lupus IgA nephropathy FGFS Membranous nephropahty (spike and dome) DM nephropathy (kimmel lesions) MPN (tramtrack) |
|
nephrotic syndrome characteristics
|
Proteinuria > 3.5g
Low albumin Edema HL |
|
medicines that can cause a nephrotic syndrome
|
gold
penicillamine captopril |
|
diseases that can cause nephrotic syndrome
|
DM
HepB amyloidosis Lupus |
|
How diagnose Nephrotic syndrome
|
24h urine collection
|
|
adults with ca, which highest incidence vs highest mortality
|
incidence: prostate and breast
mortality: lung and lung |
|
#1 RF cancer
|
AGE actually
|
|
AFP tumor marker for
|
liver and testicular CA
|
|
CA 19-9 marker for
|
Pancreatic CA
|
|
CA-125 marker for
|
Ovarian CA
|
|
CEA marker for
|
colon ca
|
|
HcG marker for CA
|
hydatiform moles
choriocarcinoma |
|
B2 microglobulin marker for
|
MM
|
|
APC marker for
|
familial polyposis
|
|
Retinoblastoma inheritance
|
AD
|
|
adults with ca, which highest incidence vs highest mortality
|
incidence: prostate and breast
mortality: lung and lung |
|
#1 RF cancer
|
AGE actually
|
|
AFP tumor marker for
|
liver and testicular CA
|
|
CA 19-9 marker for
|
Pancreatic CA
|
|
CA-125 marker for
|
Ovarian CA
|
|
CEA marker for
|
colon ca
|
|
HcG marker for CA
|
hydatiform moles
choriocarcinoma |
|
B2 microglobulin marker for
|
MM
|
|
APC marker for
|
familial polyposis
|
|
Retinoblastoma inheritance
|
AD
|
|
inheritance for MENs
|
AD
|
|
inheritance fo FPC, Gardner, Turcot, Peutz-Jeghers
|
AD
|
|
what is peutz Jeghers
|
AD
perioral freckles multiple noncancerous GI polyps Increased incidence of noncolon CA |
|
peutz jeghers and risk of colon CA
|
NONE EXTRA
|
|
FPC, Gardner and Turcot
|
FPC - we know
Gardner = FPC + osteomas and soft tissue tumors Turcot = FPC + CNS tumors |
|
MEN I is
|
parathyroid
pituitary pancreas tumors |
|
MENII types
|
MEN IIa =
Thyroid (medullary CA) Pheo MENIIb Thyroid (medullar) pheo MUCOSAL NEUROMAS**** PARATHYROID** |
|
NF genetics
|
AD
|
|
NF types
|
NF type I:
neurofibromas, cafeaulait, pheochromocytomas NF Type II: bilateral acoustic schwannomas |
|
tuberous sclerosis genetics
|
AD
|
|
tuberous sclerosis is
|
(d/t bad tuberin, controls cell growth and division)
ZITS (adenoma sebaceum) FITS (sz) NITWITS (MR, glial nodules) and get ccardia rhabdomyomas |
|
Von Hippel Linau genetics and what is it
|
AD
Hemangioblastomas in cerebellum RCC |
|
Xeroderma pigmentosa genetics and what is it
|
AR
skin CA multiple areas |
|
albinism genetics
|
AD
(associated with skin CA) |
|
Bloom sydrome genetics and what is it
|
AR
short rash on cheeks little jaw INCREASED CAN RISK |
|
Fanconi anemia, what is it
|
multiple chromoscome breaks
Get lots of CA |
|
3 RF for cervical CA
|
smoking
sex high parity |
|
mesothelioma, RF?
|
asbestos
|
|
renal cell ca, RF?
|
smoking
|
|
EBV associated with what CA
|
Nasopharngeal carcinoma
Burkitt lumphoma Hodgkin |
|
H. pylori associated with CA
|
Stomach CA
|
|
HHV8 assoc with CA
|
Kaposi's sarcoma
|
|
HTLV associated with what CA
|
Adult T cell leukemia and lymphoma
|
|
acute vs chronic leukemia, what are they
|
acute = prolif of minimally differentiated cells (myeloblasts and lymphoblasts)
>20% blasts in marrow chronic: prolif of more mature diff cells (myleocytes, lymphocytes) |
|
mycosis fungoides/Sezary syndrome AKA and is it and how dx
|
= cutaneous T cell lymphoma
itchy skin rash blood smear with butt cells (cerebriform nuclei) Pautrier abscesses in epidermis) |
|
ALL, who gets it and what is it
|
CA of WBC
kids get |
|
AML who gets and dx
|
adults
auer rods |
|
AML associated with what RF
|
smoking benzee, ads, chemo
|
|
CML age and diagnosis
|
adults
philadelpha chromsome 9;22 blast crisis |
|
tx of CML
|
gleevec
|
|
CLL who gets and dx
|
adults
smudge cells CD5 |
|
CLL treatment idea
|
no teat if asx
|
|
Tx of ALL
|
induction therapy, consolidation, maintenaouce therapy
|
|
ALL and LDH and uric acid
|
high LDH high uric acid
|
|
AML and LAP
|
low LAP (leuk alk phos)
see blasts on BM bx w myeloperoxidase stain |
|
butt cells/cerebriform nuclei, think
|
mycosis fungoides/sezary syndrome
|
|
CNS B cel lymphoma, associated with
|
HIV
|
|
Hodgkin disease, what is it, sx
|
CA of B cells
cervical LAD, night sweats |
|
Hodgkin dz on smear and how treat
|
see Reed Sternberg cells (the owl eyes)
Tx: chemo ABVD |
|
Nonhodgkin lymphoma progrnosis
|
small follicular type is the best
large diffuse type is the worst prognosis |
|
Nonhodgkin lymphoma tx
|
CHEMO CHOP (vs ABCD IN HODGKIN)
|
|
Myelodysplastic syndroms associated with what, CBC findings
|
anemia
high MCV and high RDW associated with CML |
|
How to diagnose MM
|
SPEP and UPEP (Bence Jones)
|
|
what is waldenstrom disease/macroglobulinemia
|
increased B cells that interfere with RBC production
|
|
Waldenstroms presentation
|
(increased B cells)
--Raynaud's d/t cold agglutins |
|
waldenstrom's dz 3 characteristics
|
-hyperviscosity (extra B cells)
IgM spike (from the B cells) Cold agglutins --> Raynaud's |
|
most common cause of polycythemia vera
|
chronic hypoxia from lung d/o
|
|
Polycythemia vera sx, tx, labs
|
High Hg
Pruritis after hot shower tx phlembotomy |
|
polycythemia vera assoc with CA?
|
increased risk of AML
|
|
breakdown and treatment for the diff kinds of lung cancer
|
SMALL CELL CA: mets quickly, chemo or rads, no surgery
NONSMALL CELL --Adenocarcinoma --Squamous cell --Large cell CAN CURE THIS, SURGERY |
|
possible lung ca and see pleural effusion, what do you do?
|
thoracentesis and look for malignant cells
|
|
Horner syndrome and lung CA, what is it and what see
|
invasion of cervical SYMPATHETIC chain by apical tumor (Pancoast).
Unilateral ptosis, miosis, anhidrosis |
|
diaphragm and lung CA
|
can ge diaphragm paralysis d/t phrenic nerve involvement
|
|
hoarseness and lung CA
|
recurrenet laryngeal nerve involvement
|
|
8 consequences of lung CA
|
Horner's from Pancoast
Diaphragm paralysis Hoarseness SVC syndrome Cushing syndrome SIADH Hyper Ca Lambert-Eaton |
|
SVC syndrome and lung CA
|
d/t compression of SVC (carries deoxy blood from upper body to R atrium), so get edema and rendess of face and neck, neuro sx.
|
|
small cell lung CA can make (for consequences)
|
ACTH --> Cushing's
ADH --> SIADH |
|
squamous cell lung CA can make (for consequences)
|
PTHlike --> hypercalcemia
|
|
Lambert-Eaton syndrome vs MG and pathophys
|
Ab to NMJ so less Ach can go across NMH
So muscles get stronger with repetitive stimulation (because getting more across eventually) |
|
algorithim for new nodule
|
CXR, go find previous
Get CT scan if >35YO or smokes If CT not clear, PET. F/u CT scans if normal looking. If indeterminate of suspicious, do VATS biopsy for diagnosis. |
|
if see nodule and patient no smoke and <35YO, probably is:
|
d/t infecions (TB or fungi)
maratoma Collagen vasc disease |
|
most common breast CA
|
invasvie ductal carcinoma
|
|
What is Li-Fraumeni Syndrome and its genetics
|
AD
d/t mutations of p53 tumor suppressing gene so get lots of CA early on |
|
breast CA, and medicine with estrogen
|
don't give woman with h/o breast CA ESTROGEN!!!!
|
|
microcalcifications on mammography, think
|
more serious
|
|
tx DCIS
|
= intraductal carcinoma
Mastectomy or excision + rads |
|
tx LCIS
|
can become infiltrating, mastectomy and tamoxifen
|
|
invasive cancer treatment
|
if no nodes, breast conservation or chemo of endocrine
|
|
when treat breast CA with trastuzumab
|
HER2-neu POSITIVE
|
|
women under 30, want to see in breast, do
|
U/S NOT MAMMOGRAM
|
|
tx ER+ and better PR+
|
aromatase inhibitors: letrozole, anastrole
AND Tamoxifen |
|
ER+/PR+ prognosis
|
breast can, this is a good factor!
|
|
prostate CA with mets to
|
bones
lungs liver |
|
who gets prostate CA
|
blacks the most, more if fam history of it
|
|
labs for BPH
|
elevated PSA
elevated acid phosphatase only if CA has broken through the capsule |
|
tx DCIS
|
= intraductal carcinoma
Mastectomy or excision + rads |
|
tx LCIS
|
can become infiltrating, mastectomy and tamoxifen
|
|
invasive cancer treatment
|
if no nodes, breast conservation or chemo of endocrine
|
|
when treat breast CA with trastuzumab
|
HER2-neu POSITIVE
|
|
women under 30, want to see in breast, do
|
U/S NOT MAMMOGRAM
|
|
tx ER+ and better PR+
|
aromatase inhibitors: letrozole, anastrole
AND Tamoxifen |
|
ER+/PR+ prognosis
|
breast can, this is a good factor!
|
|
prostate CA with mets to
|
bones
lungs liver |
|
who gets prostate CA
|
blacks the most, more if fam history of it
|
|
labs for BPH
|
elevated PSA
elevated acid phosphatase only if CA has broken through the capsule |
|
bone lesions in prostate CA
|
vertebral metastases are OSTEOBLASTIC not osteolytic
b/c new bone growth stimulated by tumor |
|
local prostate CA tx
|
surgery and ads
|
|
tx mets from prostate CA
|
orchiectomy
androgen depletion with leuprolide, flutamide, DES RADS good NO CHEMO (doesn't help_ |
|
if painful metastatic prostate CA< do:
|
flutamide then leuprolide
|
|
colon ca mets to
|
liver and lungs
|
|
how use CEA
|
preop and postop, can periodically check it after surgery too.
NOT SCREENING TOOL |
|
tx colon ca
|
try everything: chemo, rads, surgery...
|
|
pancreatic cancer mets
|
to liver and lungs
|
|
pancreatic cancer is what kind, and physical signs
|
adenocarcinoma
wt loss, jaundice migratory thrombophlebitis (troussea syndrome) Courvoisier sign (paplpae GB) |
|
who gets pancreatic cancer
|
men
blacks diabetics |
|
name 3 islet cell tumors
|
insulinoma (b cell tumor)
gastrinoma glucagonoma (a cell tumor) |
|
insulinoma, what and where, signs
|
beta cell tumor in pancreas
secretes insulin So see Whipple's triad, hypoglyemica, CNS symptoms and glucose makes it better. |
|
cure for insulinoma
|
resect it
|
|
gastrinoma what is it, prognosis
|
ZollingerEllison syndrome is gastrinoma BUT acid hypersecretion and peptic ulcers. Ulcers are hard to treat and in weird places.
MOST ARE MALIGNANT!! |
|
glucagonoma, what is it and sx
|
high glucagon level-->hyperglycemia
migratory necrotizing skin erythema!!!!!!!!!! |
|
ovarian CA presentation
|
weight loss
pelvic mass ascites maybe even bowel obstruction |
|
ovarian enlargements, what do you think?
|
well, if young, benign.
If postmenopausal, CA until proven otherwise. |
|
treatment ovarian CA
|
debulking and chemo
|
|
most common type of ovarian CA
|
serous cystadenocarcinoma, psammoma bodies
|
|
sertoli-leydig tumor, what is it
|
secretes androgens and vitilizes! sex cord tumor
|
|
granulosa/theca cell tumor what is it
|
secretes estrogens and so can cause precocious puberty in kids
|
|
what is meigs syndrome, and how tx
|
benign ovarian fibroma, ascites
RIGHT hydrothroax. REsect! |
|
what is krukenbert tumor
|
stomach CA with mets to ovaries
|
|
magament of CIN I
|
CIN I = LGSIL
most regress spontaneously observe with Pap and colpo x 3 mo - 1 year |
|
CIN II/III tx
|
cryosurg or LEEP
|
|
high parity, RF for female cancers?
|
protective if endometrial and breast CA
but increased risk for certical cancer |
|
GB disease and the endometrium
|
turns out GB dz RF for endometrial CA! weird. maybe d/t obesity...?
|
|
what kind of tumors are uterine cancers and how spread
|
adenocarcinomas
spread by direct extension |
|
location of brain tumors in kids and adults
|
dults are supratentorial
kids are infratentorial |
|
most common intracranial tumors
|
glioma (astrocytoma)
meningiomas |
|
presenation of cranciopharyngioma
|
remnant of Rathke pouch
HEAVILY CALCIRIFIED visual distrubances, HA, vomiting like alwas |
|
most common type of testicular CA
|
seminoma (germ cell tumor of testes)
|
|
tx testicular CA
|
surgery and rads (tumors often super radiosensitive)
|
|
haloperidol and PRL
|
haloperidol is a dopamine antagonist so get more PRL made if you are taking it
|
|
esophageal CA - kinds and location
|
middle third is squamous cell
lower third is adenocarc (b/c Barrett's there) |
|
how manage Barrett's?
|
periodic upper endoscopy with biopsies
|
|
cold nodule on thyroid test ,think
|
malignancy!
|
|
increased calcitonin level, think
|
calcitonin made by thyroid parafollicular cells = anti PTH so lower Ca
indicates medullary thyroid CA |
|
bladder CA classic signs and RF
|
painless hematuria
smoker, rubber/dyte worker |
|
hepatic adenoma what is it and who gets it
|
benign tumor in women taking OCPs!
|
|
liver tumor - focal nodular hyperplasia, dx and tx
|
beningn tumor, leave it alone
CT?MIR No tx |
|
cholangiocarcinoma, what is it, who gets it
|
Cancer of the bile ducts
Patients are IBD(usually UC!), liver flukes |
|
liver tumor - angiosarcoma, who gets
|
exposure to industrial vinyl chloride
|
|
hepatoblastoma what is it
|
primary liver malignancy in children, most common
|
|
name several adrenal tumors
|
functional that causes Conn's, Cushings
Pheno Nonfunctional adenomas |
|
what is an adrenal incidentaloma
|
if <3cm
|
|
RF stomach ca
|
Japanese
smoking smoked meat H. pylori |
|
what is a virchow node
|
left supraclavicular node enlargement d/t visceral CA spread
|
|
where are carincoid tumors
|
(secrete serotonin)
small bowel appendix |
|
sx of carcinoid tumors
|
episodice flushing, cramps, diarrhea, Right heat valve damage
|
|
carcinoid tumor labs
|
increased 5HIAAA
|
|
is a carcinoid benign or malignant?
|
malignant IF having sx because that means the liver is involved
|
|
Kaposi sarcoma, from what and how to recognize
|
from HHV8
rash doesnt respond to multiple treatments |
|
CA, worried about cord compression, how treat
|
high dose steroids, then get MRI, tx with rads
|
|
RF renal call cancer
|
smoking
vHL Tuberous scloersis ADPKD |
|
tx RCC
|
chemo of nephrectomy
|
|
what is histioctosis
|
Cd1 macophages, too many. See Birbeck granules (tennis rackets)
|
|
most common CA in liver
|
METS!
|
|
oropharnygeal CA RF
|
HPV (oral sex)
Tob?etoh |
|
oropharyngeal CA sx
|
leukoplaskia, an if quit smoking/EtOh will regress. If erythroplasia (with redness), worse.
|
|
what kind of CA is orophayngeal CA?
|
squamous cell
|
|
SCC, prelim lesion, mets, tx
|
preactinic keratosis
can mets tx surgery or rads |
|
BCC growth, mets, appearance
|
slow growing
NO METS palisading cells, pearly, telangiectasis |
|
Melanoma: precursos, mets, prognosis
|
precusor dysplastic nevi
METS!!!! Clarks' levels determine prognosis |
|
need to treat hyperthyroidism but pt with pregnant
|
use PTU NOT methimazole
|
|
pt in cave, how do you know whether he has rabies or histoplasmosis?
|
first, no bat scratch or bite necessary, can be aerosolized.
second, histo will have RESP SX. |
|
risk of child having cancer
|
kind of like AR
|
|
asthma diagnosis
|
FEV1/FVC low, but gets better with bronchodilators
OR methacholine challenge |
|
definition of hypoxemia
|
O2 <85%, PaO2 < 55
|
|
theoretical causes of hypoxemia
|
V/Q mismatch
Hypoventilation Diffusion decrease High altitude Shunt |
|
hypoxemia, ex of V/Q mistamtch, A-A and response to O2
|
asthma, COPE, PE
increased A-a gradient responds to O2 |
|
hypoxemia, hypoventilation -- examples, and response to O2
|
from oversedation
responds to O2 |
|
hypoxemia, decreased diffusion -- ex, A-a gradient, DLCO and response to O2
|
interstitial lung disease
responds to O2 Increased A-a gradient reduced DLCO |
|
hypoxemicashunt - exmpls, O2, A-a gradient
|
ARDS, Labar PNA, PDA< PFO
NO RESPONSE TO O2!!!!!!! Increased A-a gradient |
|
tx of acute asthma exacerbations
|
Beta agonist
systemic steroid inhaled steroid |
|
prophylaxis for asthma
|
beta 2 agonist
cromolyn, leukotriene inhibitors |
|
obstructive vs restrictive lung disease, what are they and examples
|
obstructive: airways low volume and hard to move the air in and out: COPD, CF, asthma
Restrictive: decreased lung compliance =interstitial disease, obesity |
|
obstructive vs restrictive lung dz lung curbes
|
obstructve is concave on top, restrictive is all pushed to the left
|
|
what is DLCO, and when elevated and decreased
|
measure diffusing capacity of CO at the capillary-alveolar interface
HIGH in asthma LOW in COPD, fibrosis |
|
obstructive vs restrictive lung dz on lung function tests
|
FEV1/FVC ratio <0.75 in obstructive
normal in restrictive |
|
TLD in obstructive vs restrictive lung dz
|
TLC high in obstructive
TLC low in restrictve |
|
COPD and Co2 levels
|
can live at a higher CO2 level, so if asx don't really have to tx
|
|
prepare to intubate IF
|
CO2>50
O2<50 pH<7.30 |
|
lung hamartoma, what is it
|
forms from connective tissue, if person under 40 with pulm nodule
|
|
What is ARDSand how define`
|
noncardiac pulm edema
respiratory distress hypoxemia PaO2/FiO2>200 NOT BETTER WITH O2 |
|
How tx ARDS
|
PEEP
O2 doesn't help |
|
abx for aspiration PNA
|
try clinda
|
|
alcoholic with PNA, think
|
klebsiella (current jelly sputum) or aspiration
|
|
CF PNA, think
|
Pseudomonas of Staph aureus
|
|
COPD with PNA, think
|
H. influ or Moraxella
|
|
foreign body inhaled, where does it go?
|
RML
|
|
pleural effusion, what do?
|
thoracentsis, see if transudative or exudative
|
|
transudative pleural effusion
|
LDH<200
pleural/serum LDH<0.6 pleura/serum protein <0.5 |
|
pleural effusion, glucose nad portein significance
|
glucose low in infection, protein high in infection
|
|
On ventilators, how regulate CO2
|
RR
TV |
|
On ventilators, how regular O2
|
FiO2 and PEEP
|
|
Heberden vs Bouchard nodes
|
Both in OA
Heberden - DIP Bouchard - PIP (both d/t osteophyte formation) |
|
pannus, think
|
RA
when articular cartilage looks like granulation tissue d/t chronic inflammation |
|
RA on Xray
|
joint space narrowing
no osteophytes erosive bone changes |
|
RA in spine
|
get atlantoaxial instability
|
|
gout is d/t
|
too much uric acid, either from
1) not excreting it (diuretics, CKD, ASA) 2) making too much (psoriasis, tumor lysis, idiopathic) |
|
gouth on xray
|
tophi (uric acid deposits)
punched out smooth erosions on bone |
|
gout: which sex, diet changes
|
in men
avoid alcohol |
|
tx gout acutely
|
colchicine (antiinflamm)
NSAIDs |
|
ASA and gout
|
can be a cause! Because decreased excretion of uric acid by kidney
|
|
maintenance of gout
|
high fluid intake
probenecid allopurinol |
|
Heberden vs Bouchard nodes
|
Both in OA
Heberden - DIP Bouchard - PIP (both d/t osteophyte formation) |
|
pannus, think
|
RA
when articular cartilage looks like granulation tissue d/t chronic inflammation |
|
RA on Xray
|
joint space narrowing
no osteophytes erosive bone changes |
|
RA in spine
|
get atlantoaxial instability
|
|
gout is d/t
|
too much uric acid, either from
1) not excreting it (diuretics, CKD, ASA) 2) making too much (psoriasis, tumor lysis, idiopathic) |
|
gouth on xray
|
tophi (uric acid deposits)
punched out smooth erosions on bone |
|
gout: which sex, diet changes
|
in men
avoid alcohol |
|
tx gout acutely
|
colchicine (antiinflamm)
NSAIDs |
|
ASA and gout
|
can be a cause! Because decreased excretion of uric acid by kidney
|
|
maintenance of gout
|
high fluid intake
probenecid allopurinol |
|
gout shape and reflection
|
Needle shaped crystals
NEGATIVE BIREFRINGENCE |
|
how to allopurinol and probenicid work
|
allopruinol - blocks uric acid production
probenicid - increases uric acid excretion |
|
pseudogout diagnosis
|
rhomboid CPPD crystals
positive birefringence |
|
tx pseudogout
|
NSAIDs
colchicine |
|
septic arthritis - cause?
|
staph
gonorrhoea |
|
remember to do what in septic patients
|
blood cultures (b/c org probably got to the joing via hematogenous route)
|
|
psoriatic arthritis - where in body
|
hands and feet
RF negative |
|
tx psoriatic arthritis
|
NSAiDS
methotrexate etanercept steroids |
|
HLAB27 positive diseases
|
ankylosing spondylitis
reiter syndrome |
|
can hemophilia cause arthritis?
|
yes! tx with tyelnol.
|
|
migratory arthritis, think of
|
Lym'es disease
rheumatic fever (one of Jones criteria) |
|
SCD and arthritis?
|
yes, even avascular necrosis of humeral or femoral head
|
|
ankylosing spondyltitis presentation
|
20-40yo man
+ fam history back pain and morning stiffness may be bent over +/- UVEITIS! |
|
ankylosing spondyltitis on imaging
|
bamboo spine
|
|
tx ankylosing spondyltitis
|
exercise
NSAids RA meds |
|
ankylosing spondyltisis in labs
|
HLA-B27
ESR up anemia |
|
reiter syndrome presentation and cause
|
can't see (conjunctivits)
can't pee (arethritis) can't climb a tree (arthritis) usually after chlamydia. |
|
3 childhood arthritis
|
SCFE
LCP DDH |
|
SCFE what is it
|
fracture through the growth plat so femoral head slips.
|
|
SCFE presentation
|
waddle, foot is externally rotated (b/c sliipped fem head)
can get avascular necrosis. |
|
LCP what is it
|
defmoity of femur head, also get avascular necrosis (like SCFE) but d/t reduced blood to joint.
|
|
charcot joint - who gets and what is it
|
in diabetics and neuropathies
lack of sensation --> overuse joints, become deformed and painful |
|
Hemochromatosis and Wilson with arthritis
|
they both can be depositing their extra stuff in there
|
|
SLE - screen and confirm test
|
screen ANA
confirm w Anti-Smith |
|
SLE on CBC
|
anemia
low platelets everything can be low, actually |
|
tx SLE
|
NSAIDs
hydroxychloroquine (antimalarial but red swelling) corticosteroids immunosuppressants |
|
how tx raynaud
|
nifediipine
dilt |
|
how tx scleroderma
|
steroids
cyclophosphamide |
|
scleroderma screen and confirm tests
|
screen with ANA
confirm with anticentroemere or antitopoisomerases |
|
scleroderma presentation
|
CREST
calcinosis raynaud esophageal dysmotility (so GERD) sclerodactyly telangicetasis |
|
sjogren on labs
|
anti SSA (anti Ro and La)
|
|
dermatomyositis presentation
|
polymyositis
+ skin involvement (helitopr rash around eyes and periorbiral edema) can't get out of chair of stairclim because hits prox muscles Gottron's sign (s cales over hands) |
|
dermatomysotitis, muscle enzymes and EMG
|
CK elevated
EMG irregular |
|
how diagnose dermatomysosis
|
muscle biopsy
|
|
dermatomyositis and CA
|
increased incidence of malignancy!!!!
|
|
pANCA positive in
|
UC
Churg-Strauss PSC PAN |
|
Polyarteritis nodosoa associated with what infections
|
Hep B
cryoglobulinemia (HepC or MM) |
|
presentatino of PAN
|
fever
abdominal pain weight loss renal changles peripheral neuropathies |
|
PAN pathophys
|
vasculitis of small and med arteries. Can cause aneurysms and the breaking down of RBC screws up kidneys
|
|
dx PAN
|
biopsy
|
|
Wegener vs Goodpasures in blood
|
Goodpasture - anti glomerular Ab (type III hypersens)
Wegener's: c-ANCA |
|
goodpasture vs wegener presentation
|
goodpasutres has kidney and lung invovled
Wegener's has kidney, lung AND SINUS |
|
tx wegener
|
cyclophosphamide
|
|
kawasaki affecting the heart?
|
well, can get aneurysms, which could thrombse and cause MI. So any kid with MI, consider kawasaki
|
|
tx kawasaki
|
IVIG
ASA |
|
takayasu arteritis presentation
|
pulseless disease
women |
|
tx takayasu (large vessel vasculitits)
|
steroids
cyclophosphamide |
|
what is takayasu arteritis
|
large vessel vasculitis
get granulomatous inflammation giant cell arteritis |
|
PMR, who gets it and where
|
women > 50YO
pain no weakness in soulders and pelvis |
|
PMR ESR and muscle bx
|
high ESR
muscle bx normal |
|
Wegener vs Goodpasures in blood
|
Goodpasture - anti glomerular Ab (type III hypersens)
Wegener's: c-ANCA |
|
Wegener vs Goodpasures in blood
|
Goodpasture - anti glomerular Ab (type III hypersens)
Wegener's: c-ANCA |
|
Wegener vs Goodpasures in blood
|
Goodpasture - anti glomerular Ab (type III hypersens)
Wegener's: c-ANCA |
|
Wegener vs Goodpasures in blood
|
Goodpasture - anti glomerular Ab (type III hypersens)
Wegener's: c-ANCA |
|
goodpasture vs wegener presentation
|
goodpasutres has kidney and lung invovled
Wegener's has kidney, lung AND SINUS |
|
goodpasture vs wegener presentation
|
goodpasutres has kidney and lung invovled
Wegener's has kidney, lung AND SINUS |
|
goodpasture vs wegener presentation
|
goodpasutres has kidney and lung invovled
Wegener's has kidney, lung AND SINUS |
|
goodpasture vs wegener presentation
|
goodpasutres has kidney and lung invovled
Wegener's has kidney, lung AND SINUS |
|
tx wegener
|
cyclophosphamide
|
|
tx wegener
|
cyclophosphamide
|
|
tx wegener
|
cyclophosphamide
|
|
kawasaki affecting the heart?
|
well, can get aneurysms, which could thrombse and cause MI. So any kid with MI, consider kawasaki
|
|
tx wegener
|
cyclophosphamide
|
|
kawasaki affecting the heart?
|
well, can get aneurysms, which could thrombse and cause MI. So any kid with MI, consider kawasaki
|
|
kawasaki affecting the heart?
|
well, can get aneurysms, which could thrombse and cause MI. So any kid with MI, consider kawasaki
|
|
tx kawasaki
|
IVIG
ASA |
|
kawasaki affecting the heart?
|
well, can get aneurysms, which could thrombse and cause MI. So any kid with MI, consider kawasaki
|
|
tx kawasaki
|
IVIG
ASA |
|
tx kawasaki
|
IVIG
ASA |
|
takayasu arteritis presentation
|
pulseless disease
women |
|
tx kawasaki
|
IVIG
ASA |
|
takayasu arteritis presentation
|
pulseless disease
women |
|
takayasu arteritis presentation
|
pulseless disease
women |
|
takayasu arteritis presentation
|
pulseless disease
women |
|
tx takayasu (large vessel vasculitits)
|
steroids
cyclophosphamide |
|
tx takayasu (large vessel vasculitits)
|
steroids
cyclophosphamide |
|
tx takayasu (large vessel vasculitits)
|
steroids
cyclophosphamide |
|
tx takayasu (large vessel vasculitits)
|
steroids
cyclophosphamide |
|
what is takayasu arteritis
|
large vessel vasculitis
get granulomatous inflammation giant cell arteritis |
|
what is takayasu arteritis
|
large vessel vasculitis
get granulomatous inflammation giant cell arteritis |
|
what is takayasu arteritis
|
large vessel vasculitis
get granulomatous inflammation giant cell arteritis |
|
what is takayasu arteritis
|
large vessel vasculitis
get granulomatous inflammation giant cell arteritis |
|
PMR, who gets it and where
|
women > 50YO
pain no weakness in soulders and pelvis |
|
PMR, who gets it and where
|
women > 50YO
pain no weakness in soulders and pelvis |
|
PMR, who gets it and where
|
women > 50YO
pain no weakness in soulders and pelvis |
|
PMR ESR and muscle bx
|
high ESR
muscle bx normal |
|
PMR, who gets it and where
|
women > 50YO
pain no weakness in soulders and pelvis |
|
PMR ESR and muscle bx
|
high ESR
muscle bx normal |
|
PMR ESR and muscle bx
|
high ESR
muscle bx normal |
|
PMR ESR and muscle bx
|
high ESR
muscle bx normal |
|
PMR tx
|
steroids
|
|
PMR classic findings
|
shoulder and pelvix PAIN not wekaness
temporal arteritis neuro signs b/c vasculitits goes for the aorta Can see CHF |
|
PMR dx
|
CT or MR angiogram
|
|
Behcet syndrome, what is it
|
man in 20s with painful oral and genital ulcers.
MAybe uveitis, arthiritis, erythema nodosum. D/w SYSTEMIC VASCULITITS |
|
Behcet how tx
|
steroids (young man with oral and genital ulcers)
|
|
Paget disease of bone, what is it and who gets
|
bone broken down and regenerated
>40yo, men usually found asx on xray! |
|
paget disease calss signs
|
pelvic and skull involvement
buying bigger hats arthritis nerve deafness (skull) |
|
paget disease of bone on labs
|
AP up
Normal Ca and Phos (evens out) |
|
Paget'sdisease of bone and CA risk
|
increased risk of osteosarcoma
|
|
tx Paget's disease
|
NSAIDs
bisphosphonate (prevent loss of bone mass, etiodronate) of calcitonin (reduces Ca) |
|
what is a macule vs papule
|
macule MAT FLAT
papuled POPPED up |
|
what dz have cafe au lait spots?
|
(macule)
vHL NF McCune Albright Tuberous sclerosis |
|
pathopshy in vitiligo
|
the melanocytes don't function
|
|
where are junctional nevi and what are you worried about
|
b/w dermis and epidermis
high risk of malignant melanoma |
|
Lichen planus characteristics
|
5Ps
pruritic planar purple polygonal papules |
|
plaque vs patch
|
plaque is elevated, >0.5cm
patch is flat, >1cm |
|
what is bowen's disease
|
squamous cell CA in situ
|
|
what is nevus flammeus
|
port wine stair (Gorbachev!)
and part of Sturge Weber syndrome |
|
what all dz show erythema nodosum
|
sarcoid
cocci UC |
|
basic problem in pemphigus vulgaris vs bullous pephigoid
|
pempihigus vulgaris = loss of keratinocyte adhesion
bullous pemphigoid = breakdown between epidermis and dermis |
|
vitiligo associated with
|
other AI conditions (b/c it's aI)
|
|
roseacea dz presentation
|
see eryhtmea but not comedones
can get worse with certain foods rhinophyma late in disease |
|
tx roseacea
|
oral antibiotics actually! or topical metronidazole.
|
|
why polycythemia vera with itching after hot shower
|
abnl histamine release
|
|
contact dermatitis, what kind of reaction? and dx
|
Type Iv hypersensitivity reaction
May need to do patch teesting |
|
how to diagnose any tinea infection
|
scrape lesion and do KOH preparation
(caused by Trichophyton) |
|
tina corporis, how to recognize it and tx
|
red ring shaped lesions with raised borners.
Tx: topical or orals antifungals |
|
tinea pedias how to recognzie and tx
|
athelet's foot!
scaling web spaces between the toes that itch and bad thick nails Tx: foot hygiene, topical or oral antifungals |
|
tinea unguium how to recognize and tx
|
onychomycosis, thickened distorted nails. Tx: orals (terbinafine, fluconazole)
|
|
tinea capitis how recognize
|
scalp.
CONTAGIOUS IN CHILDREN. Sclay patches of hair loss, maybe even an inflamed gross boggy granuloma of scalp = kerion!! If do Wood's lamp and fluoresces,s it's microsporum. If doesn't, trichophyton. |
|
tx tinea capitis
|
terbinafine, fluconazole
|
|
tinea cruris, how recognize
|
jock itch
more in obese males tx topical or oral agents |
|
candidiasis in mouth and danger signs
|
patches that CAN be scraped off.
BAD if not child and no vaginal. If a man this is weird. |
|
tinea versicolor what is it how recognize
|
fungal infection by pityrosporum infection
young adults with multiple patches of tdifferent color |
|
diagnose tinea versicolor and tx
|
lesion scrapings + KOH
oral or topical imidazoles or selenium shampoo even |
|
scabies caused by and where see
|
sarcoptes scabei
burrows, flexor surface of wrists |
|
lindane, expired tx for what and the problem
|
for scabies
BUT CAUSES NEUROTOXICITIY |
|
molluscum contagiosum in microscope and how tx
|
inclusion bodies
tx with freezing or curettage |
|
treatment lineup for acne
|
topical benzoyl peroxide
topical clinda/oral tetracycline, oral erythrmycin topical tretinoin ORAL isothreinoin |
|
drugs that can cause hirsuitism
|
minoxidil (rogaine)
phenytoin |
|
psoriasis dx and tx
|
dx: sight or biopsy if needed
tx: UV light, lubricants, topical steroids, ab therapy if refractory |
|
pityriasis rosea, who gets and what see
|
ADULTS
herald patch (salmon patch on trunk) then more lesions a week later that itch. Langerhans skin cleavage lines in Christmas tree pattern |
|
pityriasis rosea prognosis and tx
|
remits spontaneously in 1-3 months
tx with reassurance. |
|
tx lichen planus
|
5 Ps
self limiting, just sx treatment (anti-itch) |
|
what drugs commonly cause rashes
|
PCN
Cephalosporins Sulfa |
|
what drugs commonly cause photosensitivity
|
chlorpromazine
compazine tetracycline |
|
erythema multiforme, what see and cause
|
target lesions
causes usually by drugs or infections (can see on palm) |
|
pemphigus vulgaris, the problem
|
blistering d/t autoab against epidermis (against desmogleins)
|
|
bullous pephigoid, ab to what
|
autoab against BM of epidermis so ballae are subepidermal so less fragile than pemphigus
|
|
erythema nodosium how recognize
|
t's tender red nodules especially over shins
|
|
pemphigus vulgaris tx
|
steroids
rituximab |
|
pemphisu vs bullous pemphighoid what see under microscope?
|
pemphigus is lacelike or fishney immunofluorescene patern
bullous pemphigoid linear immunofluorescence pattern |
|
dermatitis herpetiformis, why itch and where
|
IgA deposits everywhere, itchy papules and whales esp on elbows and knees
|
|
what is dysplastic nevus syndrome?
|
genetic condition with multiple dysplastic appear nevi
|
|
keratoacanthoma what is it and tx
|
flesh colored lesion with central crater ith crap in it. usually on face. Looks like CA but grows in 1-2 smonths! OBSERVE and will go away.
|
|
how manage a keloid
|
well don't excise it, will make it worse!
|
|
skin cancer and the bottom line on mets
|
basal cell ca - no mets
SCC - rare mets melanoma - METS |
|
BCC - how recognize and tx?
|
shiny papules that enlarges, goes umbilicated and telangiectasias
Tx: excision |
|
squamous cell cancer, precondition
|
actinic keratosis
|
|
kinds of melanoma and prognosis
|
superficial spreading melanoma (best)
nodular melanoma (worst) acrolentiginous = see black dots |
|
cause of necrotizing fasciitis
|
group A strep
|
|
causes of stomatitis (inflammation in mouth)
|
Def of B vitamins
B2, B3, B6 vitamins |
|
the different B vitamins
|
Riboflavin - B2
Niacin - B3 Pyridoxine B6 |
|
Santer's syndrome
|
asthma + nasal polyps + ASA intolerance
(so don't give ASA to pts with this!) |
|
4 types of hypersensitivity reactions and the working immunosystem part
|
Type I: anaphylactic --IgE
Type II: cytotoxic -- IgG and IgM Type III: Immune Complex medicated Type IV: cell mediated (delayed) --T cell |
|
Type I hypersens reaction, cause, examples
|
preformed IgE, release histmaine and leukotrienes
ANAPHYLAXIS ATOPY HAY FEVER HIVES ALLERGIC RHINITIS |
|
C1 esterase inhibitor deficiency, genetics and what is it
|
AD
hereditary angioedema all unrelated to allergens |
|
C1 esterase inhibitor deficiency, diagnosis and tx
|
AD
Low C4 (because all consumed) Acute Tx: like anaphylaxis Chronic Tx: androgens *increase liver production of it) |
|
Chronic Type I hypersensitivity, findings
|
elevated IgE
eosinophilia seasonal exacerbations |
|
Type II Hypersens Reaction, d/t and ex
|
preformed IgG and IgM, react with antigens
AIHA Transfusions reactions Rh incompatibitility GPS MG Graves pemphigus hyperacute transplant rejection |
|
Type III hypersens reactions d/t to and ex
|
d/t Ag-Ab complexes that usually depositied in vessels.
Serum sickness lupus chronic hepatitis cryoglobulinemia glomerulocephritis |
|
what is serum sickness
|
reaction ot proteins in antiserum from animals
|
|
Type IV Hypersens reactions d/t and ex
|
d/t sensitized T cells that release inflamm mediators.
--PPD --Contact dermatitis --Granulomatous diseases (liek sarcoid) |
|
HIV test and confirmation
|
ELISA
confirm with WESTERN BLOT TEST (PCR) |
|
What is Immune Reconstituion Inflammatory Syndrome and tx
|
In HIV
Sometimes paradoxical worsening of infections, starts after beginning HAART. Just reassure, keep on the meds! |
|
CD4 count and when to start propht
|
CD4<350, start retrovirals
Cd4<200 start PCP prophy CD4<100, MAC prophy |
|
PCP prophy
|
bactrim, pentamidine
If CD4 <200 |
|
MAC prophy
|
If Cd4<100
Azithro, Clindamycin |
|
What happens to the viral load once start HAART?
|
decreases to < 50 copies
|
|
HIV and sig of thrombocytopenia
|
Tx with zidovudine
|
|
side effect of pentamidine and what is it form
|
2nd line agent for PCp prophy
can screw up all electrolytes and glucose |
|
Once diagnosed with HIV, how often to check Cd4 count?
|
Q3-4 mo.
|
|
what live vaccine can you give if have HIV?
|
MMR
|
|
below what CD4 count do you have AIDS?
|
below 200 (so start PCP prophy too)
|
|
2 classic malignancies in AIDS?
|
Kaposi
nonHodgkin lymphoma (CNS B-cell in particular) |
|
Inida ink think
|
cryptococcus
|
|
tx CMV retinitis
|
ganciclovir
|
|
2 AIDS causes of diarrhea
|
cryptosporidium
isopsora (both protozoa) |
|
HIV and breastfeeding and birth
|
NO NO NO NO NO NO b/c can transmit through breastmilk
C-SECTION |
|
To prevent HIV transmission vertifically
|
zidoviudine in last trimester
infant same for 6 weeks after |
|
HIV transmitted to the infant?
|
Well, will be positive HIV Ab test for 6-12 months because of maternal antibodies.
Can check DNA or RNA PCR test to detect it directly |
|
HIV and hypersensitivity
|
lose type IV (skin anergy)
|
|
PCP diagnosie
|
silver stains (wright Giemsa, giemsa, silver) with sputum
if no, bronchoscopy with lavage |
|
MI, now when can pt have sex?
|
MI? no sex x 2 weeks.
MI with intervention? not x 6 wks. |
|
tx chronic constipation
|
psyllium (fiber) and hudration
|
|
reasons NOT to give bisacodyl
|
bowel stimulant, not if CRF not if HTN
|
|
how to recognize if pt presenting with PBC
|
woman with pruritis and AP
|
|
RF for Malleory Weiss
|
hiatal hernia
|
|
side effects of B12 supplements
|
low K+
|
|
what is syndeham's chorea and how treat
|
this is pt with rheumatic fever
(rdancing and laughing and moving) TX WITH PCN!! |
|
you can get ATN from
|
shock
hypotension drugs |
|
etiology of gastric vs esophageal varices
|
gastric varices can be from pslenic vein thrombosis (recurrent pancreatitis)
esophag+gastric from portal vein thrombosis |
|
what is budd chiarir
|
thrombosis of the hepatic veins (RUQ pain, jaundice)
|
|
When do only U/S breast in women's ages...
|
<30yo
|
|
cause of diverticular bleeding
|
erosion of an artery
|
|
HPV and effect on delivery
|
delivery as per normal (Herpes is a different story)
|
|
septic pulm embolism, when consider on CXR
|
if round bullet holes in CXR
|
|
presentation of lithitum toxicity and how to induce it
|
EVERYTHING from renal to skin to neuro changes
induced by thiazides! |
|
side effect of gingko biloba
|
associated with bleeding and plt dysfunction
|
|
If thinking someone has NF1, what is first move
|
to ophtho referral b/c can get gliomas of the optic nerve
|
|
if colon polyp out, what do depending on size
|
If >2cm, repeat colonoscopy in 3 months
If <2cm, nothing |
|
if adenomatous polyp on colonoscopy, how follow up
|
3 years colonoscopy
|
|
Treatment of HepB vs HepC
|
HepB supportive
HepC IFN and ribavarin |
|
tx cluster HA
|
verapamil
O2 |
|
difference between creutzfelfjakob, vascular and lowy body dementia
|
creutzfeldJakob - myoclonus nad ataxia
Vascular dementia - stepwise loss Lewy Body - parkinson like, visual hallucinations |
|
delirium in alcoholics, think
|
wernicke encephalopathy (ataxia, opthlamoplegia, nystagmus, confusion )
can progress to korsakoff |
|
how to prevent Wernicke encephalopathy
|
thiamine BEFORE giving glucose to an alcoholic
|
|
tx cluster HA
|
oxygen
verapamil |
|
why get papilledema
|
optic disc swelling from ICUP increase
|
|
pseudotumor cerebri dx and why tricky dx
|
dx elevated opening pressure
MRI negative still get papilledema, intracranial HTN, daily HA, vomiting |
|
tx pseudotumor cerebri
|
not much, weight loss, repeat LPs
|
|
possible causes of pseudotumor cerebri
|
Large Vit A
large tetracyclines steroid withdrawal |
|
dx SAH
|
nONCONTRAST ct
WORST ha OF LIFE |
|
Kallman syndrome
|
only time CNi really inovlved
anosmia + hypogonadism becuase no GnRH from hypothalamus s |
|
CN V job
|
mastication muscles
facial sensation |
|
CN V pathology
|
trigeminal neuralgia/tic douloureux
|
|
CN 7 job
|
facial expression muscles
traste in ant 2/3 tongue (vs 9) stapedius muscle |
|
how can you tell different in UMN vs LMN facial lesion?
|
UMN forehead not involved on affected side (b/c dual UMN innervation)
LMN (bell's palsy), forehead affected |
|
CN IV job
|
gag reflex
taste in posterio 1/3rd tongue |
|
CN 10 job and loss
|
muscles of palate
gag refelx taste buds see hoarseness, dysphagia, loss of gag or cough Can be affected by Pancoast tumor! |
|
CN11 and 12 job
|
11 = spinal accessory (SCM and trapeqius)
if bad, turn toward lesion and same side shoulder droop 12 = hypoglossal, lick wounds |
|
def of simple vs complex sz
|
simple = no lose consciousness
complex partial = impaired consciousness |
|
absece sz tx and dx
|
ethosuximide
valproate cx: 3hz spike and wave |
|
infantile spasms, the problem and how diagnose
|
in kids, get developmental regression
hysparrhythymia |
|
what age gets febrile sz
|
6mo - 5yrs (tx with tylenol)
|
|
tx cysticercosis and what is it
|
infx with taenia solium
CT with calcified and ring enhancing lesions Tx: niclosamide or praziquantel |
|
tx status epilepticus
|
valium = diazepam
atvia = lorazepam |
|
dangers of anticonvulsants
|
TERATOGENIC! So before starting a young woman on them, make sure not pregnant
|
|
examples of ischemic vs hemorrhagic stroek
|
ischemic = thrombosis
emobolism Hemorrhagic ICH (HTN ruptures vessel) SAH |
|
what you see in ACA stroke
|
leg paresis
|
|
what you see in PCA stroke
|
prosopagnosia (no recognize faces)
macular sparing |
|
what you see in basilar stroke
|
"locked in" syndrome
|
|
what you see in lacunar stroke
|
pure motor o pure sensory deficit
|
|
BP in strokes, how manage
|
can allow increased BP after ischemic stroke
|
|
causes of CVA
|
ischemia d/t atheroscloerosis
afib spetic emboli from endocarditits |
|
suspect stroke, what imagine?
|
noncontrast CT scan (but remember can be neg for first 24-36hrs)
|
|
sx of acute storke, CT negative, what do?
|
within 3 hours? ASA and clopidorgrel
|
|
how manage TIA
|
carotid duplex U/S
MRA to look for carotid stenosis |
|
when recommend elective carotid endarterectomy
|
carotid stenosis >70%
|
|
how LMN lesions present
|
decreased reflexes or no reflexes
fascultations |
|
examples of LMN lesions
|
GB
Bell's palsy :yme's Herpes |
|
signs of UMN leion
|
hyperreflexia
|
|
ex of UMN lesion
|
storke
TIA tumor MS head trauma |
|
signs of brainstem leion
|
CN changes
1/2 face sensory loss 1/2 body sensory loss |
|
signs of dominal frontal lobe lesion
|
broac aphasia (vs wernicke is tumorpal lobe)
|
|
what is broca vs Wernicke aphasia
|
Broca = motor = fontal (can't speak well but understands)
Wernicket = sensory aphasia = temporal = fluent speech but can't understand |
|
signs of temporal lobe lesion
|
memory impairment, agression
|
|
signs of dominal parietal lobs vs nondominant parietal lobe lesion
|
Dominant parietal lobe: can't RRR (read, write, rithmetic)
Nondominal parietal lobe: can't dress, can't copy drawakings, ignores one side of body) |
|
signs of lesion in occipital lobes
|
visual hallucinations or illusions
|
|
where do the CN come out of in brain?
|
CN 3,4 = midbraine
CN 5,6,7,8 = pons CN 9. 10. 11. 12 = medulla |
|
signs of cerebellum lesion
|
ataxia, nystagmus, tremor
|
|
signs of basal ganglia lesion
|
chorea
tremor |
|
signs of subthalamic nuclei lesion
|
hemiballisumum (flingin of extremitites)
|
|
signs of lateral vs medial medulla lesion?
|
medulla ' CN 9-12
lateral - ipsilat Hornes Medial medulla - lick wounds |
|
benign tremor genetics, age affects it, tx
|
not resting, only with intention
Increases with age tx: beta blocker AD!!!!!!!!!!!! |
|
causes of a resting tremor include
|
Parkinson
hyperthyroid, anxiety drug withdrawal/intoxication |
|
hadol and parkinson
|
haldol blocks dopamine, so side effect is parkinsonim like sx
tx anticholinergics, antihistamines |
|
parkinson disease cause, presentation
|
from deaht of dpamine cells in substantia nigra so dopamin doesn't get to basal ganglia.
slow, rigid muscles, resting tremor, shuffles/postural instability |
|
tx parkinsons
|
increase dopamine!
levodopa+carbidopa bromocriptine anticholinergics antihistamines |
|
huntington disease genetics, what is it
|
AD, huntington gene. From atrophy of caudate nuceli
|
|
huntington dz how present
|
in 35yos!
choreiform movement progressive dumbing dementia psych issues |
|
tx huntington's
|
:( maybe antipsychotics only. sad movement disorder.
|
|
what is friedreich ataxia
|
AR, degeneration of nerve tissue in the spinal cord
|
|
ALS what is it
|
degeneration of both UMN and LMN
|
|
ALS presentation
|
both UMN and LMN lesion
tx supportive maybe riluzole (die) |
|
babinski is sign of
|
upgoing toe, sign of UMN lesion
|
|
don't do LP in patient WITH
|
acute head trauma
signs of intracrnial HTN UNTIL have Ct |
|
meningitis in AIDS paitients from
|
TB
funal cryptococcal |
|
normal CSP, how much glucose, protein, opening pressure
|
50-100 glucose
20-40 protein 100-200 pressure |
|
bacterial meningitis, cells found, bluose, progein, pressure
|
>1000 PMNs
low glucose protein high pressure high |
|
viral meningitis, cells, lucose, progein, pressure
|
>100 cells lymphocytes
normal glucose normal protein normal pressure |
|
psuedotumor cerebri cells, glucose, protein, pressure
|
all normal except high pressure
|
|
GBS cells, glucose, protein, pressure
|
PROTEIN HIGH, remember!
|
|
cerebral hemorrhage cells, glucose potein, pressure
|
cells are RBC and bloody, pressure high
|
|
MS who gets it
|
women 20-40YO
northern latitudes |
|
MS d/t
|
inflammation and demyelination of CNS melin
|
|
presentation of MS
|
Lhermitte's
optic neuritis Marcus Gunn anything tempoary |
|
dx MS
|
MRI - demyelinating plaques
LP - increased IgG/oligoclonal bands and protein |
|
tx MS
|
steroids
IFN-beta glatiramer |
|
GBS dz progression
|
history of mild infection of vaccination 1 week before, sometimes from campylobacter
then symmetric, distal lower extrem weakness or paralysis and NO REFLEXES THERE |
|
GBS watch out for
|
ascending paralysis and respiratory paralysis, do IS to make sure
|
|
dx GBS
|
LP - increased protein
EMG _ nerve conduction velocity slowed |
|
cause of GBS
|
immune response to an infection (campylobacter), and body gets confused and attacks body's own nerve tissue instead
|
|
tx GBS
|
plasmapheresis IvIG
NO STEROIDS AS MAKES IT ALL WORSE |
|
albuminocyologic dissociation, think
|
GBS because high protein in CSF with normal WBC
|
|
EMG and LMN lesions
|
associated with fasciculations/fibrillations
(vs normal which is little electrical activity at rest) |
|
do you lose consciousness with stroke?
|
not usually, unless stroke in vertebrobasilar system affecting brainstem (like subclavian steal)
|
|
what is subclavian steal?
|
occlusion of the subclavian artery so get retrograde vertebral artery flow
|
|
nutritional deficiencies that can cause peripheral neuropathies
|
low B12, B6 (after INH)
thiamine vitamin E |
|
lead poisoning and extremities
|
can see wrist drop (radial nerve) or foot drop (peroneal nerve)
|
|
extremity issues in alcoholics
|
pressure paralysis = radial nerve palsy
|
|
Tinel vs Phalen sign
|
Tinel is tap on nerve and get pins and needles
Phalen is flexing the wrists together |
|
EMG, when are nerve conduction velocities slowed?
|
peripheral neuropathies
demyelinating diseases |
|
MG vs Lambert Eaton clinically
|
with MG, gets worse with reition (against AcH receptors)
with L-E, gets better (because eventually all coming out) |
|
pesticide poisoning with what sx and how treat
|
cholinergic (parasymp)
tx: ATROPINE, PRALIDOXIME |
|
aminoglycosides and anesthesia, how relatied
|
so gent and amikacin, can cause myasthenic like muscular weakness and prolong effects of muscular blockade in anesthesia
|
|
Sturge Weber, what is it?
|
angiomas in brain (AV malformations)
+ PORT WINE STAINE!!! Can get seizures and glaucoma too |
|
atropine is an
|
ANTICHOLINERGIC, so use if too much cholinergics
|
|
Tx MG
|
anticholinesterase = LONG TERM
(pyridostigmine, neostigmine) steroids plasmapheresis IvIG Thymectomy |
|
which AI dz has the thymoma
|
MG (see on CT)
|
|
what is MG
|
autoantibodies that attack AcH receptors (postsynaptic)
|
|
MG presentation
|
ptosis
diplopia muscle fatigability at end of day |
|
dx MG
|
blood test - Ach antibodies
Nerve conduction velocity and EMG Tnsilon test (edrophonium = anticholinesterase) |
|
examples of anticholinesterases
|
edrophonium
neostigmine pyridostigmine physostigmine |
|
diff between MG and L-E clinically
|
MG - fatigue increases with stimulation
L-E fatigue decreases with stimulation AND L-E has no eye inovelemement |
|
tx lambert-eaton
|
guanidine (more AcH)
pyridosytigmine IvIG |
|
L-E associated with what other diseases
|
small cell lung CA
|
|
genetics achondroplasia
|
AD
|
|
genetics Marfan
|
AD
|
|
Marfan syndrome associated medical issues
|
all
arachnodactylyl mitral valve prolapse aortic dissection lens dislocation |
|
Familial HL genetics
|
AD
|
|
APCKD genetics
|
AD
|
|
hereditary spherocytosis genetics
|
AD
|
|
APKD predisposed to what medical problems
|
diverticulosis
cerebral aneurysms aortic aneurysm MVP hernias |
|
myotonic dystrophy, genetics and clinical presentation
|
AD
muscle weakness AND CAN'T RELEASE GRIP |
|
ex of sphingolipidoses and genetics
|
AR
Tay-Sachs, Gaucher |
|
Fabry disease, what is it and genetics
|
the one sphingolipidoses that is Xlinked
|
|
Examples of mucopolysaccharidoses and genetics
|
Hutler disease
AR (but Hunter is X linked) |
|
glycogen storage diseases ex and genetics
|
Pompe disease
mcArdle disease AR |
|
cystic fibrosis genetics
|
AR
|
|
galactosemia genetics and presentation
|
AR
congenital cataracts neonatal sepsis |
|
amino acid disorders examples and genetics
|
PKU
AR |
|
Wilson disease genetics, hemochromatosis too
|
AR
|
|
Fragiele X genetics and clinical presentation
|
Xlinked recessive
mental retardation, large testes |
|
burton agammaglobulinemia genetics and what is it
|
Xlinked recessive
no make mature B-cells (no no antibodies) |
|
Wiscott-Aldrich syndrome genetics and what is it
|
eczema, low platelets, immunodef, bloody diarrhea, low IgM
Xlinked |
|
Duchenne Muscular dystrophy cause, presentation, genetics
|
from mutation in dystrophin gene on X chromosome
X linked Calf hypertrophy b/c proximal weakness |
|
Lesch-Nyhan syndrome, cause, presentaiton, genetics
|
cause is buildup of uric acid (HPRT deficiencty)
MR and self mutilation X linked recessive |
|
G6Pd deficiency genetics
|
X Linked!!!
|
|
hemophilia genetics
|
x linked
|
|
edward vs patau syndrome genetically
|
edward is trisomy 18 (e=elect)
patau is trisomy 13 (p = puberty) |
|
edward syndrome genetics and how recognize
|
trisomy 18
MR, small head, clenched fist with index fingers overlapping 3 and 4th fingers |
|
patau syndrome genetics and how recognize
|
trisomy 13
MR, deafeness, holoprosencephaly (!), cleft lip/palate, rocker-bottom feet! |
|
turner syndrome genetics
|
XO females
|
|
turner syndrome sequelae
|
female XO
aorta coarctation horeshoe kidney hypothyroidism cystic hygroma of neck |
|
turner syndrome how recognize
|
Xo
lymphedema of neck short stature webbed neck wide nipples no breast development (POF, infertile) |
|
cri du chat genetics
|
deletion on chromo 5
|
|
klinefelter genetics and how recognize
|
XXY (nondisjunction), male
tall, microtestes, gynecomastia, sterility, low IQ |
|
side effects of halogen anesthetics
|
malignant hyperthermia
|
|
side effect of halothane
|
liver necrosis
|
|
what is methoxyflurane and side effect
|
anesthetic
DI |
|
morphine side effect in GI
|
stops it
also spincter of oddi spasm so retain bile and pancreatic juices which is painful |
|
opiates side effect
|
SIADH!!!!!!!!!!!!
|
|
succ side effect
|
malignant hyperthermia
|
|
chloramphenicol side effects
|
aplastic anemia
gray baby |
|
dideoxyinosine what is it and side effect
|
DDI for HIV
pancreatitis |
|
side effect of ethambutol
|
optic neuritis
|
|
INH side effects x3
|
B6 def
lupus liver toxicity |
|
quinolones in fetus
|
cipro is a teratogen, cartilage damage
|
|
thtetracyclines on fetus
|
photosensitivity
teeth staining |
|
rifampin side effect
|
orange body fluids
|
|
what abx cause c diff
|
fluoroquinolones
clinda broad PCN broad CEPH |
|
acetazolamide side effect
|
metabolic acidosis
|
|
amiodarone side effect
|
HYPOTHYROID
pulm fibrosis |
|
ACE on fetus
|
ccan affect fetal kidneys
|
|
demeclocycline what is it and side effect
|
tetracycline
DI |
|
hydralazine side effects
|
luus
|
|
metyldopa side effects
|
hemolytic anemia
depression |
|
phenytoin side effects x 3
|
folate def
teratogen hirsuit |
|
quinine side effect
|
cinchonism (tinnitus, vertigo)
|
|
pentamidine side effect
|
screws up electrolytes
|
|
valproic acid on fetus
|
NTD
|
|
belomycin side effect
|
pulm fibrosis
|
|
cisplatin side effect
|
nephrotoxicity
|
|
cyclophosphamide side effect
|
hemorrhaic cystitis
|
|
doxorubicin side effect
|
cardiomyopathy
|
|
clozapine side effect
|
for shcizo
agranulocytosis |
|
lithium side effectx x 3
|
DI
thyroid Ebstein's heart |
|
Trazodone side effectp
|
priapism
|
|
cyclsporine side effect
|
renal toxicity
|
|
what is minoxidil
|
rogaine
|
|
oxytocin side effect
|
SIADH (bc sim structure)
|
|
gingko biloba side effect
|
bleeding and platelet dysfunction
|
|
beta blockers in diabetics, careful because
|
can mask the sx of hypoglycemia
|
|
ex of alpha 1 antagonists and side effects
|
doxazosin
terazosin can cause orthostatic hypotension |
|
diuretics that cause metabolic alkalosis and acidosis
|
thiazides = alkalosis (low K)
Loop diuretics = alkalosis Carbonic anhydrase (acetazolaminde) = metabolic acidosis |
|
thiazdes where work and what do
|
distal tubule
inhibits Na and Cl uptake |
|
thiazides on electrolytes
|
high glucose
HL LOW SODIUM LOS POTASSIUM HIGH CALCIUM |
|
thiazides and allergies...
|
they are sulfa drugs!!!
|
|
loop diuetics on electrolytes
|
also sulfa drugs
low sodium, low potassium BUT LOW CALCIUM (vs thiazides) |
|
loop diuretics where act and what mech
|
on loop of henle
inhibits NaKCl |
|
thiazides vs loop diruetics on Ca
|
thiazides retain calcium, so don't use if hight!
loop diuretics cause ca excretion, can use as tx for high Ca! |
|
drugs that cause constricted pupils
|
COPS
clonidine opiates pontine bleed sedatives (EtOH, Barb, Benzo) |
|
drugs that cause dilated pupils
|
amphetamines
anticholinergics cocaine |
|
cyanide intox, how recognize and tx
|
bitter breathe
methylene blue |
|
ethylene glycol intox tx
|
etoh
fomepizole |
|
salicylates intox tx
|
sodium bicarb
|
|
warfarin intox tx
|
Vit K
FFP |
|
opioid overdose tx
|
naloxone
|
|
lead overdose tx
|
edetate
|
|
iron overdose tx
|
deferoxamine
|
|
dignoxin overdose tx
|
fix electrolytes
digoxin ab |
|
dooper or gold overdose
|
penicillamine
|
|
beta blocker overdose tx
|
glucoagon
|
|
benzos overdose tx
|
flumazenil
|
|
Tylenol overdose tx
|
NAC
|
|
MAOI + Tyramine =
|
hypertensive crisis
|
|
MAOI + opioids =
|
coma
|
|
MAOI + SSRI =
|
serotonin syndrome
|
|
Aminoglycosides + loop diuretics =
|
ototoxicity
|
|
thiazides + Lithium =
|
lithium toxicity
|
|
2 drugs that inhibit hepatic work
|
cimetidine
ketoconazole |
|
HRT on chol
|
can increase TG
|
|
reason to give progesterone with E
|
to eliminate increased risk of endometrial CA
|
|
estrogen and chol
|
incerases HDL hol!!
|
|
Estrogen effects (side effects)
|
endometrial bleeding
breast tenderness nausea HA |
|
estrogen and pt with liver disease
|
estrogen can cause liver adenomas so don't use estrogen if pt has active liver disease
|
|
OCPs and HTN
|
OCPs are the most common cause of secondary HTN in women (stop them if women is HTNive)
|
|
Don't use OCps IF
|
smoking + >35YO
Breastfeeing liver dz HL unctonrollen HTN h/o clot SCD stroke CA |
|
how recognize alopecia areata
|
well demarcated round patches of hair loss
|
|
side effects of OCPs
|
glucose intolerance
weight gain cholelithiasis liver adenomas melasma HTN |
|
what meds interact with OCPs
|
rifampin and antiepileptics may reduce effectiveness of OCPs
|
|
OCPs and ovarian vs endometrial ca
|
reduce ovarian cancer
decrease endometrial cancer |
|
OCPs and presurgery
|
stop 1 month before and restart 1 month after
|
|
ASA vs NSAID affects on COX
|
ASA inhibits COX irreversibly
NSAIDS inhiit COX reversibly |
|
ASA can cause these bad things
|
GI upset and bleeding, uclers
GOUT! eventually tinnutis, respiratory alkalosis and metabolic acidosis |
|
NASA and NSAIDs bad effects on kidneys
|
can cause renal insufficiency, whether it be AIN, papillary necrosis, ATN)
|
|
ASA in kids?
|
NO! remember the reye's syndrome if < 15YO = encephaopathy nad liver dysunfction
|
|
ASA cannot be given to pts with
|
allergies
asthma and nasal polyps (could be sander's syndrome) |
|
preop rules for ASA and NSAIDs
|
ASA stop 1 week before
NSAIDS stop 1 day before |
|
imaging for aortic aneurysm
|
CT with contrast
|
|
aortic tear imaging
|
CT w contrast
|
|
appendicitis imaging
|
CT with contrast
|
|
diverticulitis imaging
|
CT with contrast
|
|
stroke imaging
|
CT withou contrast
|
|
brain tumor imaging
|
CT or MRI with contrast
|
|
head trauma imaging
|
CT without cntrast
|
|
intracranial hemorrhage imaging
|
CT without contrast
|
|
MS imaging
|
MRI with contrast
|
|
PE imaging
|
CT with contrast (VP scan if can't give contrast)
|
|
pulm nodule imaging
|
CXR followed by CT with contrast
|
|
def and etiology isostheniuira/hypostenuria
|
inability to concentrate urine
DI, SCD |
|
in lupus, what blood test corresponds with lupus activity
|
anti ds DNA
anti smith is for diagnosis, but doesn't correlated with lupus activity |
|
Hegar sign, Chadwick sign =
|
PREGNANCY
Hegar is softening of lower uterine segment Chadwick is darkening of vulva and vagina |
|
3 antibiotics to NOT use in pregnancy
|
NO CIPRO
NO BACTRIM NO GENTAMICIN |
|
When first feel quickening?
|
18-20 weeks
|
|
why do pregnant women get cystitis/pyelo?
|
because progesterone decreases tone of ureters and uterus compresses the ureters
|
|
lab tests in third trimester
|
glucose
UA |
|
rubella vaccine and pregnancy?
|
DON'T GIVE!
|
|
when do DM screen in pregnancy?
|
24-26 weeks
|
|
Tx BV in pregnancy?
|
is associated with preterm labor, so tx ONLY IF high risk for preterm OR if has sxx
|
|
When do a quad screen
|
15-20 weeks
|
|
when do GBS screen
|
35-37 weeks
|
|
Downs syndrome on quad screen
|
AFP DOWN (like Down syndrome)
Estriol DOWN hCg UP Inhibin UP |
|
low AFP means
|
DOWN'S (because down)
Bad dates fetal death.... |
|
high AFP thinks
|
NTD (because leaking out)
ventral wall defects |
|
when can start measuring uterine size
|
20 weeks at umbilicus
|
|
FHT when?
|
@ 10 weeks
|
|
What if measurements and LMP have a size discrepancy?
|
do a U/S.
Could just be inaccurate dates OR maybe IUGR Or maybe multiple gestation |
|
hCg levels during pregnancy
|
double Q2 days at the start.
|
|
if hcg stays same or increasing to slow think
|
fetal problems
ectoppic |
|
if hcg is rapidly increasing or doesn't come back down after delivery
|
hydatiform mole
choriocarcinoma |
|
how many lbs gain during pregnancy
|
25lbs
|
|
ESR and HgB during pregnancy
|
ESR high (so don't use)
Hgb is low because plasma voume increases sooo much |
|
relationship b/w GFR and BUN/Cr
|
CFR down if BUN and Cr up
|
|
urine findings in pregnancy
|
can have mild protein and mild glucose
|
|
electrolyes and LFTs during pregnancy
|
NORMAL
NORMAL NORMAL |
|
AP during pregnancy
|
up
|
|
BUN/Cr during pregnancy
|
DECRASE because GFR increases.
So if normal high numbers, this is renal disease. |
|
BP, HR< SV in pregnancy
|
BP down
HT up SV up |
|
TV, esidual vol, CO2 in pregnancy
|
TV up
Reduced residual (obviously) CO2 down |
|
what is a threatened abortion
|
bleeding but no dilation, no tissue out
50% have normal pregnancy |
|
what is inevitable vs incomplete abortion
|
inevitable: dilated, and bleeding, no tissue.
Incomplete: some tissue through. :( |
|
cause of painless, recurrent abotions in 2nd trimester
|
cervical incompetence
|
|
tx cervical incompetence
|
14-16weeks
|
|
signs and dx of ectopic pregnancy
|
bleeding, abdominal pain
positive hcG maybe feel an adnexal mass... U/S |
|
abortion and rhogam
|
THIS COUNTS AS A SENSITIZATION! Give Rhogam so doesn't sensitize!
|
|
transvag U/S can see pregnancy when
|
5 weeks (MUST SEE THE SAC)
or HcG >2000 |
|
Classification of IUGR etiologies
|
Maternal (smoking, lupus)
Fetal (torch, infx, congen) placental (HTN, PREEX!!!) |
|
parts of BPP (biophysical profile)
|
NonStress Test (x20min)
AFI Fetal breathing Fetal body movments |
|
how manage a subchorionic hematom and WHY
|
follow with U/S
increased risk of spont abortion |
|
interpret BPP
|
If<6, then do a contraction stress test (uteroplacental dysfunction test... give oxytocin and heart strip monitored... if late, do C-section)
|
|
def of olig and causes
|
<500
IUGR PROM postmature renal agenesis |
|
what can oligohydramnios itself cause?
|
pulmonary hypoplasia!
abnormalities b/c compression of hypoxia |
|
def of polyhydramnios and causes
|
>2000mL
DM, multip gestation, NTD, GI issues |
|
what can polyhydramnios itself cause?
|
uterin atony with hemorhage!
|
|
cuase of early decels
|
head compression (normal)
|
|
cause of variable decels
|
cord compression (Co2 can't get out, O2 can't get in)
|
|
manage variable decels
|
lat decubitus, O2
TOP OXYTOCIN bradycardia severe And if no imprvement: fetal scalp |
|
late decels cuase
|
uteroplacental insufficiency
|
|
manage late decels
|
lat decub
O2 NO OXYTOCIN TOCOLYIC fetal scalp electrode as needed |
|
example of tocolytics
|
beta 2 agonist = ritodrine, mag sulfate
|
|
no variability in heart rate, what do
|
fetal scalp pH... need to deliver!
|
|
causes of nonreactive NST
|
fetal problem
fetus asleep GA<30weeks, too early narcotics |
|
normal NST
|
accel to 156 and lasts at least 15 secods, twice in 20 minutes
|
|
how interpret fetal scalp pH
|
<7.2 = DELIVERY!!!
because the pH assess for degree of fetal hypoxia. |
|
how you know if its just braxton Hicks contractions
|
contractions are IRREGULAR
and NO cervical change |
|
difference b/w protraction and arrest disorder
|
protaction if taking too long but is changing.
arrest if no dilating in 2 hours and no descent in 1 hour |
|
if you have protaction or arrest, what do you do?
|
check position
check proportions of involved parties TRY oxytocin or cervidil (pge) |
|
first second and third stages of labor
|
first is onset of labor to full dilation
second is full dilate to birth third is birth to delivery of placenta |
|
Latent vs active phase of 1st stage of labor
|
latent is 0-3cm
active is 3cm-10cm (should follow a rate) |
|
dangers of oxytocin use in augmenting labor
|
water intoxication (bc like ADH)
hyponatremia urterin rupure or uterine hyperstimulation |
|
DO NOT AUGMENT LABOR IF
|
placenta previa, vasa previa
umbilical cord prolapse known cervical CA |
|
If mother with herpes, when give acyclovir during lpregnancy
|
during last month,k because can reduce risk of active lesions at time of labor
|
|
why don't use general anesthesia in obstretic patients
|
higher risk of aspiration
more PNA because GE sphinter is relaxed Also might cross placenta |
|
Order of labor positions
|
DFIREERE
Descent, flexion, Int rotation, extension, ext rotation, expulsion |
|
if face/brown presentation, what do
|
watchful waiting, most convert to vertex.
IF DON'T CONVERT, do a C-section |
|
significance of fetal fibronectin
|
if think someone is preterm, check.
IF VAG SECRETIONS NEGATIVE< won't deliver in 2 weeks. If it's positive, probably going to delviery and shoud do tocolysis and fetal lung maturity |
|
how manage preterm labor
|
lat decub, bed/pelvic rest, IVF< O2.
Tocolytics. |
|
contraindications to tocolytics
|
heart disease, HTN, DM
Hemorrhage Preex, chorio IUGR dilated to 4 already |
|
signs of fetal lung immaturity
|
If ecithin:sphingomyelin <2
OR NO PHOPHATIDYLGLYCEROL |
|
if PROM, what do?
|
really? ferning, pooling +blu nitrazine?
Do U/S to check AFI. If no labor in 8hours, and term, induce. |
|
cause of chorioamnionitis
|
PROM or PPROM.
tx amp and gent. Can cause nenatal sepsis! |
|
manage postterm pregnancy >42weeks
|
if unsure about dates, twice weekly BPP.
At 43 induce or C-section. |
|
prolonged gestation classically associated with what congenital anomaly?
|
anencephaly! terrible.
|
|
workup of 3rd trimester bleeding
|
U/S BEFORE YOUR PELVIC!
Fluids, O2 Labs |
|
causes of 3rd trimester bleeding
|
placenta previa
placenta abruptia uterine rupture fetal bleeding cervical/vag lesions or trauma bleeding problems |
|
RF placenta previa
|
multipartiy,
multiple gestation preior previa |
|
presentation of placenta previa and mgmt
|
U/S BEFORE PELVIC
Painless bleeding. C-section only. |
|
Placenta abruptia RF
|
HTN
polyhydramnios with rapid deompression cocaine PPOM |
|
presentation and mgmt of placenta abruptia
|
vaginal delivery!
tender painful bleeding. Be careful because bleeding could be hiding, hyperactive contracting, fetal distress... |
|
manage uterin rupture
|
immediate laparotomy + hysterectomy
|
|
cuase of fetal bleeding
|
vasa previa,
multiple gestation |
|
mgmt of fetal bleeding
|
painless... fetus looking worse.
Do Apt test, + if fetal to see which is bleeding. Do immediate C-section. |
|
What is Kleihauer-Betke test
|
quantiful fetal blood in mother's system, can use to calculate Rhogam dose
|
|
presentation of acute ischemic colitis
|
atherosclerotic history.
acute pain then bloody diarhea |
|
where is problem in acute ischemic colitis
|
in watershed areas like splenic flexure and rectosigmoid junction.
See increased WBC |
|
if CP from cocaine, mgmt
|
Benzos
phentolamine (alpha antagonist) |
|
tx graves dz
|
iodine ablation, but this might worsen ophtho problems, so give steroids too
|
|
diffuse thyroid uptake think
|
graves
|
|
if see polycythemia (high hgb), what do
|
could do EPO and if high prob from chronic hypoxia.
If LOW, prob a real polycythemia vera |
|
high PSA, chance of prostate CA?
|
25% prostate CA
|
|
elevated PSA what do
|
if >4 do biopsy
|
|
don't use colchine IF
|
renal failure (choose steroids)
|
|
dx gonococal arthritis
|
NOT JUST joint fluid, must check urethral swabs and cultures.
|
|
if disseminated gonoccoal infection (from arthritis...)
|
tenosynovitis
|
|
tx psoriasis
|
UV
lubricants topical seroids methotrexate if refractory |
|
side effect of antiparkinson medications
|
can make you psychotic, pull back.
|
|
side effect of imipenem
|
careful, increases sz risk!!
|
|
tx psoriasis
|
UV
lubricants topical seroids methotrexate if refractory |
|
side effect of antiparkinson medications
|
can make you psychotic, pull back.
|
|
side effect of imipenem
|
careful, increases sz risk!!
|
|
who and when gets hyperemesis gravidarum
|
first tri
younger women in first pregnancy or social issues |
|
when do CVS vs amnio vs Quad screen
|
CVS 10-12 weeks (chromosomes and genetics)
Amnio 14 weeks (NTD!!!!) Quad screen 15-20weeks |
|
CVS vs amnio and miscarriage rates
|
CVS slightly higher miscarriage
|
|
CVS CANNOT DO WHAT
|
NTD!! Only for chromos
|
|
when can you start having preeclampsia
|
20 + weeks (third tri)
|
|
sx of preeclampsia
|
HTN
UA with proteinuria edema oliguria HELLP |
|
what is HELLP?
|
variant of preeclampsia
hemolysis elevated liver enzymes low platelets |
|
RF for preeclampsia
|
chronic renal disease
old or young mulitple getstation NULIPARITY BLACK |
|
tx preeclampsia
|
hydralazine or labetalol
mag sulfate for sz prophylaxis |
|
eclampsia management
|
deliver regardless of gestational age
|
|
how does preex affect eh infact
|
IGUR< uteroplacental insufficiency because of vasoconstricution
|
|
can you deliver with active HPV or active Herpes?
|
HPV (flesh colored)
|
|
If preeclampsia, risk of HTN in the future?
|
NOT REALLY
|
|
if looks like preex but it's before 20 weeks, what should you consider?
|
molar pregnancy, bc gte HTN and proteinuria too.
|
|
toxic effects of mag sulfate for preeclampsia
|
no reflexes (#1)
then resp despression CND depression |
|
diabetes and IUGR
|
gestational diabetes = macrosomia
IGUR = preexisting diabetes |
|
complicaitons of DM on fetus
|
size problem
RDS NTD caudal regression CV hypertrophic interventricular septum |
|
which insulin to use in pregnanct
|
NPH, want less than 6.5 in first tri
|
|
A1 vs A2 DM
|
A1 diet controlled
A2 meds controlled |
|
baby born to DM mother glucose level
|
LOW
|
|
IgM and IgG in the new baby?
|
IgG probably from mother
IgM never normal if elevated in baby |
|
dizygotic twins IF
|
sex different
blood type different placentas are dichorionic |
|
monozygotic twins IF
|
same sex
same blood type placentas are monochorionic |
|
glucose tests 50 vs 100 g
|
50g 1 hr, + if >150
100g 3 hrs |
|
glucose goals in pregnancy
|
fasting < 95
postprandial < 120 |
|
exact pathology of the Rh problem
|
If mother Rh neg, baby Rh positive
When Rh+ RBCs leak into mother's circulation, mother form RhIgG which CAN cross placenta and attack baby |
|
when to give rhogam timewise
|
28w
within72 hours |
|
RH and sensitization
|
remember that first Rh positive infant probably wont be affected
|
|
how can you gauge the severity of fetal hemolysis in Rh disease?
|
amniotic fluid spectrophotometry
|
|
when is it too late to give Rhogam?
|
if mother is Rh negative and has a high titer of Rh antibodies
|
|
is there sensitization with ABO incompatability?
|
no, because IgG antibodies will cross directly
|
|
How to you manage a hemolytic disease with Rh situation?
|
deliver if mature
intrauterine blood transfusion phenobarbital (helps fetal liver break down bili) |
|
how manage pregnant women with antiphopholipid antibodies
|
low dose ASA
los dose heparin! WOW! normally don't use these in pregnancy |
|
examples of Gestational Trophoblastic disease
|
1) molar
2) choriocarincomia |
|
etiology of choriocacinoma
|
only de novo
OR from complete mole |
|
tx choriocarcinoma (GTD)
|
chemo (methotrexate or actinomycin D)
|
|
complete vs incomplete mole
|
COMPLETE: 46XX FROM FATHER. Sperm /o egg duplicates.
INCOMPLETE: 69XXY. Fetal tissue here! |
|
when suspect a mole
|
weird acting hcg
preeex but too early |
|
tx HIV in pregnancy?
|
can continue HAART throughout
|
|
do surgery on pregnant women?
|
yes in all acute surgical conitions. If semiurgent, wait until 2nd trimester. Can still do laparoscopy.
|
|
tx TB during pregnancy?
|
INH just as usualy, just no streptomycin (aminoglycoside)
AND git Vit B6 with isoniazid |
|
aminoglycosides on baby
|
deafness
renal toxicitiy |
|
aminopterin what is it and effect on fetus
|
immunosupp
IUGR CNS deffects clipt lip |
|
OCPs on fetus (low risk)
|
VACTERL
|
|
carbamazpine on fetus
|
fingernail hypoplasia
craniofacial defects |
|
diazepam on fetus
|
cleft lip and palate
|
|
progesterone on fetus
|
masculiniazation of female fetus
|
|
valproic acid on fetus
|
spina bifida
hypospadia |
|
wafarin on fetus
|
NEVER!
ALL MAJOR ISSUES including nasal hypoplasia |
|
ACEI or ARB on fetus
|
renal toxicity
|
|
pain tx in pregnancy
|
TYLENOL
No NSAIDS No ASA |
|
what if mom doesn't want to breastfeed, how help mom
|
tight bras
ice packs analgesia bromocriptine (low PRL) and estrogens |
|
cause of mastitis
|
staph aureus
|
|
manage mastitis
|
give abx
can keep feeding I think PCN |
|
drugs mother takes = baby can't breastfeed
|
drugs
sedatives or stimulants lithium chemo |
|
if postpartum fever from endometritis doesn't resolve with abx, think
|
pelvic abscess or pelvic thrombophelbitis, Get CT scan. Could give heparin for the phlebitis.
|
|
tx uterin atony
|
uhhhh oxyotocin!
binmanual ergot prostaglandin F2 alpha |
|
causes of uterine hemorrhage
|
uterine atony #1
retained parts @2 urtine rupture/inversion |
|
define postpartum hemorrhage
|
500+ mL blood loss or > 1000mL on a C-section
|
|
when get Sheehan
|
after postpartum hemorrhage, get hypopit because of reduced blood flow
|
|
PID and h/o IUD, think
|
actinomyces israeli
|
|
TX PID
|
outpatient: doxy (chlamydia) + Cef
inpt: azithro (chlamydia) + gent |
|
PID can progress to what emergency
|
tubo ovarian abscess, and this abscess can burst
|
|
chancroid vs chancre
|
CHANCHROID painful, Haemophilus ducreyi
chancre painless, syphilis |
|
tx chanchroid
|
this is from hameophilus ducreyi (G-)
Use azithromycin, ceftriaxone |
|
what abx cover chlamydia
|
doxy + other tetracyclines
quinolones macrolides (like azithro) |
|
gonorrhea vs chlamydia, when empiricially treat
|
gonorrhea? cover for chlamydia too.
chlamydia? don't have to cover for gonorrhea |
|
tx crabs
|
peidulosis
permethrin cream |
|
BV treat partner?
|
no
|
|
def of primary vs secondary amenorrhea
|
primary: no menses by 16
secondary: no puberty by 14, OR puverty but no menstruation for by 16 |
|
presentation of androgen insensitivity syndrome
|
phenotypically normal female but no axillary nor pubic hair... end up finding no uterus and patient is XY
|
|
workup of amenorrhea, bleeds with progesterone
|
Preg test
THEN Progesterone. If bleeds, uterus not the problem. CHECK LH: if high --PCOS. If low pit issue. |
|
when can clomiphene work?
|
ovaries working
|
|
workup of amenorrhea, doesn't bleed with progesterone
|
FSH.
High FSH: Preamture ovairan failure OR menopause. If low: hypothal not working, check brain. |
|
presentation of endometriosis
|
dysmenorrhea, dyspareunia
ALSO DYSCHEZIA MAYBE TENDER ADNEXAE!!! |
|
dx endometriosis
|
gold standard is laparoscopy, of course -- see mulberry spots, powder burns, chocolate cysts
|
|
tx endometriosis
|
1. OCP
2. Danazol (testeosteron,e but treats it), GnRH agonists 3. surgery |
|
adenomyosis, what is it and presentation
|
ectopic endometrial glands, over age 40, LARGE BOGGY UTERUS b/c infiltrated the muscle so it's no longer firm
|
|
tx adenomysosiss
|
D/C or biopsy
hysterectomy GnRH agonists |
|
DUB mostly d/t
|
anolvulatory cycles (unopposed estrogen), also PCOS
|
|
Cause of PCOS
|
androgen excess
LH:FSH >2:1... |
|
menopause labs
|
elevated FSH
|
|
sx of fibroid (leiomyoma)
|
painful or excessive menstrual bleeding
|
|
meds that can cause breast discharge
|
OCPs
Hormones Antipsychotics Hypothyroidism... |
|
fibrocystic vs fibroadenoma
|
fibrocystic: comes and goes with cycle. If over 35, RF breast CA.
fibroadeoma: mobile mass, rubbery. benign tumor. Worse with pregnancy and OCPs. No change with cycle. No RF CA. |
|
tx fibrocystic vs fibroadenoma
|
fibrocystic: nothing OR progesterone for week at the end of each month or danazol.
Fibroadeoma: exise or nothing |
|
breast mass over 35, do
|
mammorgram basically no matter what. If a cyst, aspirate it.
|
|
phlloides tumor what is it
|
potentially malignant tumor that starts out looking like a fast growing fibroadeoma.
|
|
What are BRCA1 and 2
|
nomrally tumor supressors. If mutated, increased risk of breast and ovarian cancer
|
|
when start ca and vit D
|
once postmenopausal
|
|
managment of bloody nipple discharge
|
likely intraductal papilloma, do an excisional biopsy to r/o intraductal papillary carcinoma
|
|
cause of stress incontinence
|
poor support of urethral sphincter
|
|
cause of urge incontinence
|
detrusor instability, urinary frequency and urgency. B/c of involuntary detusor muscle contractions.
|
|
tx urge incontinence
|
(detrusor instability)
blader training antichol botox limited fluid intake |
|
emergency contraeption, use
|
levonorgesterol
|
|
fibroids gorw when and can cause
|
with pregnancy or E
smaller fater menopause can cause infertility, cure by taking them out. |
|
locations of the prolapses: cystocele, rectocele, enterocele, urethrocele
|
cystocele: upper anterior vag wall. Urethrocele: lower anterior vag wall.
Rectocele: lower post vag wall enterocele: upper posterior vag wall |
|
infertility, whose fault and first step
|
2/3 femal problem
first step though is semen analysis because cheap |
|
when use hysterosalpingogram
|
radioopaque die -- structural abnormalities of uterus and tubes
|
|
time for schizophrenic vs other psychotic d/o
|
<1mo = brief psychotic d/o
1-6 mo = scizophreniform > 6mo = schizophrenia |
|
schizophrenia prognosis poins
|
negative sx worse, no precipitating factor sworse
|
|
tx schizoprhenia
|
HIGH POTENCY: haloperidol, but lot of extrapyramidal effects and nothing on neg sx.
LOW POTENCY: Chlopromazine, but lot of autonomic side effects. Also no effect on neg sx. ATYPICAL (maintenance) like risperidone, olanzapine, works on neg sx. |
|
dopamine and prolacin
|
dopamine inhibis PRL.
SO IF BLOCKING DOPAMINE, get high prolactin. |
|
side effect of thioridazine
|
retinal pigment deposits
|
|
side effect of clozapine
|
agranulocytosis
|
|
side effect of chlorpromazine
|
(with autonomic side effects_ jaundice and photosensitivity
|
|
list of extrapyramidal side effects and time line
|
(with high potency antipsychotics like haloperidol)
Acute dystonia: hours Akathisia: days Parkinsonsim: months Tardive dyskinesia: years NMS: any time |
|
acute dystonia, sx and when
|
first few hrs or days
muscle spasms or stifness. Tx with antihistmaines or antichol (benztopine, trihexyphenidyl) |
|
askathisia, when and sx and tx
|
frist few days.
Feels restless and paces and shifts. Tx. beta blockers |
|
antipsychotics and parkinsonism, when and tx
|
first few months of haldol
stifness. tx: antihistamines, anchicholingerics |
|
ex of anticholinergics
|
benzropine
trihexyphenidyl |
|
tardive dyskinesia, what, when tx
|
years of high potency antipsychotics.
--perioral movements, tongue, grimacing, limbs. STOP ANTIPSYCHOTIC AND SWITH TO ATYPicAL |
|
what is neuroleptic malignant syndrome, cause and timing
|
any time with high potency antipsychotics
OR sudden withdrawal of levodopa in parkinsonism |
|
neuroleptic malignant syndrome, presentation and tx
|
rigidity, mutism, high fever, high CPK, sweating.
STOP MED SUPPORT DANTROLENE (same as in malignant hyperthermia) |
|
carinoid tx vs serotonin syndrome tx
|
carcinoid (d/t mass): tx octreotide
serotonin from drugs, tx with 5HT anatonist like cyproheptadine |
|
bupropion side effect
|
lowers sz threshold
|
|
what is serotnin syndrome
|
d/t SSI + MAOI, delirium, tachy, diarrhea, high reflexes.
|
|
side effects TCA
|
block alpha adrenegtic too so get dizzy AND block muscarinis and lower seizure threshold,
|
|
TCA overdose does what
|
causes arrhythmias, tx with bicarbonate!
|
|
when use MAOI
|
atypical depression (if hypersomnia or hyperphagia)
|
|
MAOI+ ? = HTn crisis
|
with tyamine foods, because get a lot of NE
|
|
ex of MAOIs
|
phenelzine
traylcypromine |
|
tx bipolar d/o
|
lithium
valproic acid carbamazpine |
|
how to diagnose bipolar
|
really only need mania for the diagnosis
see less need for sleep, pressured speech, etc. |
|
bipolar and antidepressants, caution
|
because can trigger mania
|
|
what is bipolar II
|
hypomani + major depression (psychosis without occupational dysfunction)
|
|
what is cyclothymia
|
2 years of hypomani and depressed mood but no full bowen episodes of either
|
|
side effects of lithium
|
renal dysfunction (DI!!!)
thyroid dysunftion tremor CNS effects |
|
side effects of valproic acid
|
liver dysfunction
|
|
side effects of carbamazepine
|
bone marrow depression
|
|
key points that this is NOT normal grief, could be acute stress disorder, adjustment or depression
|
feeling worthless
slowing down suicidal ideation |
|
tx panic disorder
|
SSRI
|
|
Gen Anxiety D/o how treat
|
SSRIs, buspirone, benzos
|
|
simple phobia tx
|
behavioral tx
flooding systematic desensitization beta blockers |
|
PTSD vs acute stress disorder
|
< 4weeks is acute stress
PTSD is > 4 weeks |
|
what is somatization d/o
|
multiple complaints in multiple organ systems
|
|
difference amon the somatoform d/os
|
somatoform - not intentionall
factition: intential to be a patient malingering: fake for secondary gain |
|
schizoid vs schizotypal personality d/o
|
schizoid is loner
schizotypal, biazrro beliefs |
|
def of avoidant personality disorder
|
no friends BUT WANT THEM
fear crtique or rejection so won't try |
|
def of antisocial personality disorder
|
long criminal record, tortured animals... need CONDUCT DISORDER FOR THIS
FEEL NO REMORSE EtOH and somatization |
|
primitzie idealization
|
part of borderline disorder about splitting. Tx with behavioral therapy
|
|
Obsessive compulsive PERSONALITY DISORDER
|
this is not the classic OCD.
This is anal, stubborn, cheap, and they don't feel bad or tortured by it. |
|
reaction formation
|
gay guy that acts homophobic
|
|
tx OCD
|
SSRIs or clomipramine, behavioral therapy
|
|
tx narcolepsy
|
moadafinil (non amphetamine stimulant), amphetamines
|
|
what is dependence
|
abuse and tolerance
|
|
cocaine pupils, formications
|
dilated, feel like bugs on them
|
|
cocaine withdrawal
|
no dangerous
|
|
tx opioid overdose
|
naloxone, methadone later...
|
|
opioid withdrawal
|
won't die, even though they act like it
|
|
LSD bad trip tx
|
reassurance
benzo antipsychotic |
|
tx PCP intoxciation
|
urine acidification to eliminate it faster
|
|
inhalants withdrawal
|
nothing
|
|
benzo tx
|
flumazenil
|
|
benzo withdrawal
|
can be fatal
|
|
competency vs capacity
|
competency is legal judment
capactiy is by clinical judment |
|
reportable diseases
|
TB, HIV< spyhilis, gonorhea
|
|
pregnant woman and deciding medical tx for fetus
|
can refuse lifesaving care for themselves and their baby if they are compenent
|
|
if TB+, and not taking tx
|
resp isolation until sputum free of AFB, can detain them if necessary.
|
|
what can you accept from pharma?
|
books, meals, education
can attend conference but not travel, accept money for lodging |
|
brain death IF
|
no gag, no pupils, no corneal (no cerebral no brainstem reflexes)
no resp in 2 min low body temp EEG negative fo 30 min no cerebral circulation on MRI |
|
malabsorption disorder
|
CF
cirrhosis celiac sprue pancreatic insufficiency |
|
vit deficiencies in malabsorption disorders
|
ADEK (fat soluble)
|
|
when start Vit D and Ca2+
|
50TO or postmenopausal
|
|
sx of Vit A def
|
night blindness
scaly rash dry eyes bitot spots on conjunctiva |
|
toxicity of Vit A see
|
pseudotumor cerebri!
bone thicening! teratogen! |
|
Vit D deficiency see
|
rickets, hypocalcemia
|
|
Vit E definiciency see
|
anemia
peripheral neuropathy ataxia |
|
vit E overdose, see...
|
NEC in infants!!
|
|
B1 is what and deficieny
|
thiamine
wet beriri (CHF), dry beriberi (peripheral neuropathy wernicke/korsakoff |
|
What is B2 and its deficient
|
riboflavin
cheilosis, stomatitis, dermatitis |
|
what is B3 and its deficiency
|
naicin
pellagra (dementia, dermatitis, diarrhea) |
|
b6 what is it and deficiency
|
pyidoxine
peripheral neuropathy, |
|
can a b vitamin have toxicity?
|
B6 can! (pyridoine)... get peripheral neuropathy
|
|
what is b12
|
cobalamin
|
|
b12 vs folic acid deficiency
|
both macrocytic
B12 def HAS NEURO SX folic acid def NO NEURO SX |
|
too much iodine gets you
|
mxyedema (pretibial myxedema in graves!)
|
|
zinc def sx
|
hypogeusia (decreased taste), rash, slow wound healing
|
|
copper def and toxicity
|
def = menkes' (xlinked, kinky hair, MR)
excess = wilsons' |
|
manganese madness is
|
if too much manganeses like in some miners
|
|
rickets xray findings
|
craniotabes (thinning of skull, feels like pingpong ball)
rachitic rosary 9costochondarl beading on ribs) Delayed fontanelle closure |
|
most common cause of B12 def
|
pernicious anemia (auto Ab)
ileium out diphyllobothrium latum |
|
INH, what deficiency
|
B6 = pyridoxine
|
|
Vit K dependent clotting factors
|
II, VII, IX, X, protein C, S
|
|
Vit K and liver failure
|
won't work, so give FFP. Failed liver is inabaple of making the clotting factors that Vit K is supposed to help do.
|
|
the birth rate, death rate, ferility rate, remember
|
/1000 population
|
|
top 3 causes of infant mortality
|
congenital
prematurity, low birth weight SIDS |
|
top 3 causes of maternal mortality rate
|
PE
HTN Hemorrhage |
|
sensitivity, explained
|
D+/T+
SNOUT (rule out) - screening So if a high sens, you're going to catch the disease. So if it's negative, you don't have it. It's ruled out. it's the ability to detect the disease |
|
specificity, explained
|
ability to detect HEALTH (no dz)
SPIN (rule in) = confirmation. So if high ability to detect health and yours says you have the disease, you are SPIn ruled in. |
|
what is PPV vs NPR
|
PPV how likely pat has the dz, if have positive test.
NPV: how likely pt is actually healthy, if the test is negative. |
|
prevalence and PPV, NPV
|
PPV and prevalence go togther
NPV and prevalence go opposite |
|
sensitivity and PPV, NPV
|
sens and PPV in oppositve directions
sens and NPV in same direction (because fewer false negatives) |
|
formula for PPV and NPA
|
TP/T+
TN/T- |
|
2x2 chart and odds ratio
|
X is D, Y is test.
AB CD Odds is AD/BC |
|
attributable vs relative risk
|
attributable risk: # cases attribuatle to ONE risk factor.
Relative risk: compares dz risk in exposed population to the unexposed population. ONLY USE WITH PROSPECTIVE/EXPERIMENAL |
|
ODDS RATIO what mean, when use, how calculate
|
AB
CD Do AD/BC ONLY FOR RESTROSPECTIVE (case control) |
|
Standard deviation 1, 2, 3 SD in population
|
1SD 68%
2SD 95% 3 SD 99.7% |
|
normal distribution and mean, median, mode and SKEWS
|
normal: M=M=M
In positive skew: M>M>M In negative skew: M<M<M |
|
SD in skews
|
doesn't mean as much because aren't normal distributions
|
|
test reliability vs validity
|
reliability = precision. RANDOM EFFOR is the porblem
VALIDITY= ACCURANCE, Systematic error problem. |
|
incidence euql to
|
absolute risk
|
|
chi squares bs t test vs ANOVA
|
chi = compare percentages or proportions
T test = compare two means ANOVA = compare 3+ means |
|
type I error vs Type II error
|
Type I erro: saying there's a difference when there's not.
Tpye II: say there's no difference when there is |
|
what is POWER
|
the prability of rejecting the nullhypothesis when it is indeed false
|
|
what is an experimental study
|
CTs
compares two equal groups in which 1 variable is manipulated |
|
what is a prospective study
|
longitidinal, cohoro,
choose a sample population, divide in 2 groups and follow it over time. |
|
what is a retrospective study
|
samples chosen after the fact based on presence or absence of siease.
Can use ODDS RATIO |
|
what is a cross sectional study
|
looking for prevalence or dz and risk factors
|
|
no cows milk until
|
12mo
|
|
small infant head, think
|
micrcephatly from TORCH, rubella, CMS< virus, congeintal problem. NOT FROM DM or PREEX.
|
|
when start checking vision and hearing
|
vision at 3YO
hearing at 4YO |
|
red reflex to pick up waht
|
congenital catarachts (from rubella or TORCH)
or retinoblastoma |
|
until what age is lazy eye normal
|
if always bad, problem.
occasional misalignment normal until 3months. |
|
2 infectious diseases associated with acquired hearing loss in kids
|
meningitis and recurrent OM
|
|
what infants get iron supplements
|
preterm breastfed (formul has a supplement)
|
|
bad lead level and tx
|
?10, tx with DMSA
|
|
first see dentist
|
at 3 yo
|
|
when Vit D supplementation
|
if infant high risk no sun
OR if breastfeeding only x 6 months (formula has some) |
|
example of killed vaccines
|
influenza
cholera polio rabies hep A |
|
example of live attenuated vaccines
|
MMR
BcG typhoid |
|
examples of toxoid
|
tetanus
diptheria |
|
If baby with Hep B, check serology when
|
@ 9mo
And still chance to get chronic HepB o HCC. |
|
if at risk of tetanus, what give
|
tetanus ig and toxoid BOTH
|
|
rotavirus caution vaccine
|
intussuception
|
|
MMR allergy
|
eggs or neomycin
|
|
infleunza vaccine and allergies
|
not if allergic to eggs
|
|
if asplenic, need vaccines for
|
pneumococcal
haemophilus meningococcus (encapsulated bacteria) |
|
APGAR stands for
|
APPEARANCE: 0=pale, 1= acrocyanosis, 2= pinl
PULSE: 0, 1= <100, 2= >200 GRIMACE: 0, 1=grimace, 3= grimace and cry ACTIVITY: 0, 1 flexion, 2 active RESP RATE: 0, 1= weak, 2=good cry |
|
umbilical cord anatomy and if a problem
|
2 ateries, 1 vein. No urachus.
If only 1 artery, could have congenital renal problems. |
|
cavernous hemangioma what is it and management
|
brain, dilated blood vessels, resolves.
|
|
fontanelle closes by...?
|
18 mo
|
|
if large anterior fontanelle, it's from
|
hypothyroidism
hydrocephalus rickets IUGR |
|
newborn reflexes are and are gone by
|
Moro = startle
palmar grasp gone by 6months |
|
bith trauma causes caput succedaneum vs cephalhematoma
|
caput= succeeds at crossing midling.
cephalhematomas; don't cross midline |
|
PDA what is it and how close or leave open
|
open ductus ateriosus b/w pulm artery and aorta.
Close with NSAIds OPEN WITH PRSTAGLANDIN (PROP OPEN) |
|
where hear coarc of aorta murmur
|
systolic murmur over back.
|
|
noncyanotic heart defects
|
L-->R SHUNTS
ASD VSD PDA (start with D) |
|
cyanotic heart defects
|
R-->L shunts
ToF Tricspid atresia TGA (egg) Truncus arteriososis The Ts!!! |
|
heart defects and pophalxis
|
for all except ASD
|
|
PDA what is it, what hear, associated with what conditions
|
open ductus arteriosis b/w pulm artery and aorta
--macin like LUS border --associated with rubella dn high altitudes |
|
VSD, what is it and what hear
|
hosoytolic murmur
LV-->RV |
|
etiology of VSD
|
FS
TORCH Down's |
|
ASD is what
|
LA-->LV
(noncyanotic) |
|
T of F anomalies
|
VSD leads to
RV hypertrophy and pulm stenosis AND overriding aorta |
|
T of F sx
|
cyanotic defect
tet spells (squatting after exertion) Boot heart. |
|
Coarc of Aorta presentation
|
UE HTN
systolic murmur over bak |
|
coarc of A associated with
|
Turner syndrome
|
|
def of delayed puberty in boys and girls
|
boys if nothing by 14
nothing by 13 in girls |
|
what is mccune albright syndrome
|
cafe au lait spots, fibrous dysplasia, precocsiou pubert in girls
|
|
tx precocious pubert
|
GnRH agonists, to suppress progression and prevent premature epiphyseal closure
|
|
CAH in boys vs girls
|
boys, precosiou pubert. In girls is ambiguous genitalia.
|
|
xray findings in abuse
|
bucket handle and corner gractures
|
|
rolls front to back
|
4-5 months
|
|
stranger anxiety
|
6-9 months
|
|
pulls to stand
|
9mo
|
|
first words
|
9-12months
|
|
what is mccune albright syndrome
|
cafe au lait spots, fibrous dysplasia, precocsiou pubert in girls
|
|
bye bye
|
10 months
|
|
tx precocious pubert
|
GnRH agonists, to suppress progression and prevent premature epiphyseal closure
|
|
walks without help
|
13 month
|
|
CAH in boys vs girls
|
boys, precosiou pubert. In girls is ambiguous genitalia.
|
|
xray findings in abuse
|
bucket handle and corner gractures
|
|
rolls front to back
|
4-5 months
|
|
stranger anxiety
|
6-9 months
|
|
pulls to stand
|
9mo
|
|
first words
|
9-12months
|
|
bye bye
|
10 months
|
|
walks without help
|
13 month
|
|
what is mccune albright syndrome
|
cafe au lait spots, fibrous dysplasia, precocsiou pubert in girls
|
|
tx precocious pubert
|
GnRH agonists, to suppress progression and prevent premature epiphyseal closure
|
|
CAH in boys vs girls
|
boys, precosiou pubert. In girls is ambiguous genitalia.
|
|
xray findings in abuse
|
bucket handle and corner gractures
|
|
rolls front to back
|
4-5 months
|
|
stranger anxiety
|
6-9 months
|
|
pulls to stand
|
9mo
|
|
first words
|
9-12months
|
|
bye bye
|
10 months
|
|
walks without help
|
13 month
|
|
cup and spoon use
|
15-18months
|
|
runs
|
2yrs
|
|
never give hypertrophic obstructive cardiomyopathy
|
no positive inotropes like digoxin
no diuretics no vasdilators |
|
job of umbilical vein vs artery
|
umbilical vein carries oxygentaed blood from placenta to fetus
umbilical artery carries deoxygenated blood from fetus to placenta |
|
what closes right at birth
|
foramen ovale
|
|
most common TEF
|
blind esophagus
trachea with distal esophagus attached |
|
tx constipation in kids
|
magneisum hydoide
(bisacodyl only for emergencies) |
|
pyloric stenosis what is it and associated with...
|
erythromycin! crazy.
Also its the narrowing of opening from the stomach to intestines because of an enlarged muscle pylorus |
|
labs in pyloric stenosis
|
low chloride
low K metabolic alkalosis |
|
dx hirschsprungs
|
rectal biopsy, see aganlionic section of bowel
|
|
what is choanal atresia
|
back of nasal passage is blocked
|
|
intussecption associated with
|
HSP
CF Rotavaccine |
|
presentation of intussuception
|
currant jelly stools
sausage mass |
|
tx intussceptivon
|
barium or air enema
|
|
2 first signs of CF
|
mec ileius
rectal polapse |
|
bachdalek
|
diaphragmetic hernia on left (more common) can cause pulm hypoplasia
|
|
omphalocele vs gastroschisis
|
omphalocele in midline, no ring, sac.
Gastroschisis is RIGHT of midline, small bowel, no sac. |
|
HSP pesentation
|
GI bleeding and abdominal pain
palpable purpura on lower extrem arthritis swelling in feet, hematuria, protinuria |
|
HSP prodrome
|
upper resp infection...
|
|
what IS HSP
|
small vessel vasculitits and get igA-C3 complexes deposited in the small vessels
|
|
congenital hyperbili, unconjugated vs conjugatd
|
unconjugated - Criggle Najja and Gilbert
conjugated: rotor, dubin johnson |
|
physiologic jaundice looks like
|
1-2 days AFTER birth, unconjugated
|
|
causes of unconjugated hyperbilirubin in infants
|
HEMOLYTIC
- spherocytosis, G6PD def, SCD, ABO incompat, Breast milk NONHEMOLYTIC cephalohematoma sepsis hypothyroid breast feeding |
|
causes of conjugated infant jaundice
|
HEPATIC
--sepsis, CF, alpha 1 antitrypsin POSTHEPATIC biliary atresia bile duct obstruction |
|
biliary atresia, what kind of bili
|
CONJUGATED
|
|
sulfa and neonates
|
don't use because displace bili from albumin and can get kernicterus!!!
|
|
CAH labs
|
elevated 17hyroxyprogesterone
hypotension because low Na Hihg K |
|
treat CAH
|
steroids and fluids
|
|
imagine chart of CAH
|
progestero down 21 hycolase to aldosteron
to 17 hydroxyprogesterone with 21 hydrolxylas to cortisl THEN LEADING ON TO RIGHT WITH ANDROMES |
|
sarcoma boyroidis
|
malignancy of embryos but can see until 8YO
vesicles or grapes coming from the vagina |
|
why fetus with vaginal bleeding
|
phsiologic from maternal estrogen withdrawal
|
|
what can cause renal papillary necrosis
|
DM
SCD analgesic |
|
why spleen involved with SCD
|
because it's function in clearing the weird RBCs
|
|
classic signs of SCD
|
aplastic crises d/y parvo
bone pain from microinfarcts (avascular necrosis) renal papillary necrosis splenic sequenestration, acute chest syndrome pigment cholelithiasis pripasis stroke |
|
diagnose SCD
|
Hgb electrophoresis
|
|
SCD sx start when
|
6months bc need adult hemglobin production
|
|
t SCD
|
prophylactic pcn because of encapsulated organism infections until 5YO
vaccination folate supplementation |
|
how treat sickle cell crsis
|
O2
IVF analgesics narcotics |
|
dacylitis from SCD
|
hand foot syndrome with swelling and redness because sickled RBcs blocking the small vessels. NSAID tx.
|
|
IgA def what infections
|
respir and GI infections
|
|
what infections with X linked agammaglobulinemia
|
Bruton agammaglobulinemia
Resp infections, males only |
|
DiGeoge presentation
|
CTCH22
low Ca tetany (because no parathyroid) NO THYMUS |
|
SCID genetics and def
|
AR of Xlinked
B and T cell defects, cutanoues anergy No thymus no lymph nodes need Bm transplant to survive |
|
wiskott aldrich deficiency genetics and presentation
|
Xlinked
males only eczema, thrombocyopenia recurrent resp infections high IgE and IgA |
|
Chronic grnaulomatous disease genetics and presentation
|
Xlinked (males )
infections with cat positive, because immune system can't form the ROS to kill the pathogens so get granulomas in organs. |
|
tx of chronic granulomatous disease
|
daily bactrim
|
|
HUS prodorme, presentation
|
E. coli, shiga toxin
ATR (vs TTP which is FATRN) |
|
tx HUS
|
dialysis, transfusion
|
|
tx HSP
|
dialsis, transfusion
|
|
TTP presentation
|
FATRN
platelts screwed up, ADAMTS13 |
|
causes of TTP
|
OCPs
HIV pregnancy |
|
tx TTP
|
plasmapheresis
NSAIDS NO PLATELETS!!!!!!!!!!!!!! |
|
ITP cause and prodome
|
idiopathic low plateles
viral prodrome See antiplatelet antibodies. |
|
dx chronic granulomatous disease
|
nitroblue tetrazolium, tests ability to make ROS which is why negative in CHD.
|
|
young person with HTN, prob d/t
|
renal parenchymal disease
|
|
HTN, when start a second agent?
|
>160/100 ( Stage II HTN)
|
|
don't use thiazides in patient with
|
GOUT
Lithium Pregnancy |
|
beta blockers on electrolytes
|
High K, low sodium
|
|
antiHTN medications for pregnant patients
|
hydralazine
labetalol alpha methyldopa |
|
when does ACE-I cause renal failure
|
if person actually with RENOVASCULAR HTN, because this ends up stenosing the kidneys more
|
|
aldosterone receptor blockers on electrolytes
|
K+ increasing
(like spironolactone) |
|
Conn syndrome - what is it, and electrolytes
|
primary aldosteronism = aldosterone secreting adrenal adenoma
So high aldosterone, so high Na, Low K+, low renin |
|
what does adrenal medulla make
|
catecholamines
|
|
DM I an II - ketoacidosis vs hyperosmolar vs HLA association
|
DMI with DKA, II with HHNK
HLA association with Type I |
|
DM I and II and islet cell pathology
|
Type I with insulitis (because of AI destruction)
DMII with amyloid deposits |
|
DM and blurry vision can be from
|
retina hemorrhages
but maybe just osmotic lens swelling (near sightedness) which improves with tx |
|
Estimate glucose level
|
A1c x 20
|
|
goal of DM glucoses
|
fasting < 130, posprandial < 200
|
|
why get sweating and paliptations with hypoglycemia
|
because drops low and you get this huge release of adrenaline
|
|
C-peptide significance
|
FOUND WITH ENDOGENOUS INSULIN
|
|
DKA, acid base and tx
|
metabolic acidosis
give K+ (because insulin high and drove K+ into cell_ hosp replacement too |
|
consequence of DKA (eek!)
|
cerebral edema (give mannitol)
|
|
manifestations of low phos
|
muscle wekaness
rhabdo |
|
DKA is resolved IF (3)
|
1. Glucose < 200
2. AG < 12 (otherwise keep insulin) 3. Biarb > 18 but keep the IV insulin a few hours still running |
|
what does NNHK stand for, who gets it and main characteristics
|
Nonketototic, hyperglycemia, hyperosmolar
Type II DM ONLY notice hyperosmolarity > 310 NO KETONES |
|
mech of metformin
|
it's a biguandide
suppresses liver glucose production |
|
sulfonylurea ex and mech
|
glimepiride, glyburide
(inceased secretion of insulin) |
|
alpha glucosidase inhibitor, example and mech
|
acarbose
reduced carb absoprtion in gut (get side effects) |
|
what are the insulin secregagogues
|
don't use them anymore, but are glinide and nateglinide
|
|
calc insulin dose
|
0.5-1u/kg/day
|
|
Rapid acting insulin
|
aspart = novolog
lispro = humalog |
|
intermediate acting insulin
|
NPH = humulin, novolin
Lente insulin |
|
long acting insulin
|
glargine = lantus
|
|
somogyi vs dawn effect
|
somogy: rebounding high BG in response to low BG
Dawn phenom: waning insulin so higher BG PLUS higher because GH starts check 3AM glucose before doing something automatically with ahigh AM glucose |
|
don't use metformin in patients with
|
ETOH
CHF |
|
how much insulin to give day of surgery
|
1/2 the amount
|
|
beta blocker and DM caution
|
bb can reduce hypoglycemic signs
|
|
corneal arcus, what is it and who gets it
|
white ring around rius
cholesterol patients! |
|
how to calculate LDL
|
Tot Chol - HDL - TG/5
|
|
5 RF for CHD
|
Age
FH premature CHD Smoker current HTN diagnosis low HDL |
|
1st line drugs for hyperchol
|
STATINS
niacin cholestyramine (bile acid binding resin) |
|
3 ways to increase HDL
|
EtoH!
exercise estrogens |
|
what decreases HDL?
|
smoking
androgens progesterone hyperTG |
|
risk of statin + fibrate
|
increased risk of rhabdo and muscle failue
|
|
etoh on lipids
|
increases HDL!
but also increases TG and LDL |
|
thyroid d/o and lipis
|
hypothyroidism cause of hyperlipidemia
|
|
what meds can increase your lipids
|
OCPs
steroids thiazides beta blockers |
|
what is buerger disease
|
inflammation and clotting of small-medium vessels. IN A SMOKER!!!!!!!! see painful red fingers and toes
|
|
smoker and OCPs
|
smoker can't take OCps, but can take estrogen replacement therapty
|
|
alcohol increased risk of what canacers
|
oral, pharn, laryn, eso, liver DUH
ALSO maybe breast! gastric and pancreatic! |
|
the staging of alcohol withdrawal
|
12-48hrs = acute withdrawal syndrome (tremors, sweating, sz)
Then = Alcoholic Hallucinosis = hallucinations but no autonomic sx. 48-72hrs = DT, autonomic cx |
|
etoh and rhabdomyelitis!
|
yes, these is an association with alcohol!
|
|
wernicke vs korsakoff
|
wernicke is inadequate thimaine, ataxic, can't move eyes.
Korsakoff is can't form new memories, this is a CHRONIC thiamine deficiency |
|
homan sign
|
abrupt dorsiflexing of foot causes pain in DVT
|
|
sx and sig of superficial thrombophlebilitis
|
palpable clot in superficial vein
BENIGN< not sign of DVT nor PE Tx NSAIDs/ASA |
|
PE effect on heart
|
can result in pulm HTN, RV dysfunction
tricuspid regurgitation |
|
oral K antagonist
|
= warfarin
|
|
how to reverse heparin
|
protamine
|
|
how to reverse heparin
|
FFP (FASTER)
Vitamin K |
|
how to everse ASA
|
platelet transfusion
|
|
monitor heparin?
|
no, not required. IF EVER ABSOLUTLEY NNED TO could do antifactor Xa assay
|
|
hemophilia affects what blood test
|
PTT
|
|
DIC affects what blood test
|
all of them
|
|
liver dz affect what blood test
|
PT (or course)
|
|
uremia on platelets
|
causes a qualitative platelet defect
|
|
vit C deficiency on lab test
|
ALL NORMAL
|
|
calculate AG
|
Na+ - (Cl+HCO3)
12 normal >20 met acidosis also |
|
AG Metabolic Acidosis causes
|
MUDPILES
metahanol, uremia, DKA, paraldhyde, Iron, INH, lactic acidosis, ethylene glyceol, salicylates |
|
how tx ethleneg glycol (antifreeze)
|
fompeiazole then ethanol maybe
|
|
causes of NON AG Metabolic acidosis
|
DURHAM
Diarrhea, Ureteral diversion, RTA, HypeCl, Acetazolamide, mineralcorticoids |
|
causes of metabolic alkalosis
|
saline responsive: vomiting, NG draininage, diruetics, hypovolemia
saline resistant: Conn's, Cushing's, Alkali ingestion |
|
ASA intox on labs, and tx
|
metabolic acidosis and resp alkalosis
tx with alkalinization of urine |
|
COPD and on oxygen the Co2 and PH starts to fall
|
turn down O2 as high O2 levels may shut down resp drive of COPD patients if severe COPD
|
|
OSA on labs
|
chronic respi acidosis during sleep causes chronic metabolic compensation
|
|
Conn syndrome on electrolytes
|
High Na (aldoesteroneism), low K+
high bicarb (get metabolic alkalosis) |
|
furosemide on electrolytes
|
low Na, Los K, LOW CA
|
|
don't use bicarb to tx low pH unless
|
pH < 7
|
|
hyponatremia breakdown causes
|
1) make sure not from hyperglycemia.
THEN Hypovolemic: dehydration, diruetics, DM, addison's, low aldosteronism Euvolemic: SIADH Hypervolemic: CHF< renal failrure, cirrhosis. |
|
tx hypovolemic hypona
|
dehydration, diruetics, DM, addison's, hypoaldosteronism
NORMAL SALINE |
|
euvoluemic hyponatremia, cause and tx
|
SIADH
free water restriction |
|
hypervolemic hyponatremia, causes and tx
|
CHF, cirrhosis, nephoritic, renal failure
free water restriction and diruetics |
|
causes of SIADH
|
small cell ca lung
head truma/surgery meningitis opiodids!! chlopropamide |
|
how tx SIADH
|
euvolemic hyponatremia
Demeclocyline, tetracycline that causes DI! and free H2O restriction |
|
central pontine myelinolysis
|
when bring up low Na too fast.
|
|
uremia on platelets
|
causes a qualitative platelet defect
|
|
vit C deficiency on lab test
|
ALL NORMAL
|
|
calculate AG
|
Na+ - (Cl+HCO3)
12 normal >20 met acidosis also |
|
AG Metabolic Acidosis causes
|
MUDPILES
metahanol, uremia, DKA, paraldhyde, Iron, INH, lactic acidosis, ethylene glyceol, salicylates |
|
how tx ethleneg glycol (antifreeze)
|
fompeiazole then ethanol maybe
|
|
causes of NON AG Metabolic acidosis
|
DURHAM
Diarrhea, Ureteral diversion, RTA, HypeCl, Acetazolamide, mineralcorticoids |
|
causes of metabolic alkalosis
|
saline responsive: vomiting, NG draininage, diruetics, hypovolemia
saline resistant: Conn's, Cushing's, Alkali ingestion |
|
ASA intox on labs, and tx
|
metabolic acidosis and resp alkalosis
tx with alkalinization of urine |
|
COPD and on oxygen the Co2 and PH starts to fall
|
turn down O2 as high O2 levels may shut down resp drive of COPD patients if severe COPD
|
|
OSA on labs
|
chronic respi acidosis during sleep causes chronic metabolic compensation
|
|
reflexes and Na status
|
both cause hyperreflexia
|
|
Tx neprhogenic vs central DI
|
central: desmopressin
nephrogenic: paradoxical HCTZ |
|
hypernatermia classification
|
hypovolemic: mannitol, diarrhea, fever, loop diretics
Euvol: DI Hypervolemic: high aldosterone |
|
how does Sheehan syndrome result in DI
|
because no blood flow to pituitary so no PL, but post pit hit also, central DI
|
|
hypo vs hyperkalemia on EKG
|
hypo: U waves and lose T waves
HyperK: peaked K waves |
|
K and digitalis
|
digitalis can worsen a low K
|
|
another word for kayexalate
|
oral sodium polystyrene resin
|
|
manage severe hyperK
|
calcium gluconate for heart
sodium bicarb (make alkalosis to force K into cells) IV glucose Diruetics (furosemide) |
|
what does calcitonin do
|
from throid parafollicular cells (C-cells)
low Calcium this is the opposite of PTH |
|
hypo vs hypercalcemia on EKG
|
hypoCa2+ - QT prolongation
hyperCa2+ - QT shortening |
|
signs of hypocalcemia
|
tetany (Chvostek sign), convulsions
Trousseau sign, arm spasm with BP |
|
DiGorge genetics and Ca2+
|
AD
hypocalcemia |
|
Digeorge CATCH22
|
Cardiac anomalies (ToF)
Abnl facies Thymus absent (lot infections) cleft palate hypocalcemia 22q11 deletion |
|
Ca once parathyroid homrone out
|
HYPOCALCEMIA
|
|
kidney failure on Ca
|
renal filaure causes hypocalcemia
|
|
albumin and Ca
|
if Ca low, check albumin, can make it look lower
|
|
PTH on phos Ca Vit D
|
reduces Phos
increase Ca increases Vit D by getting kidney to metabolize and activate it |
|
Vit D on Ca and Phos
|
both up, free lover
|
|
sx hypercalcemia
|
bones (osteopenia?)
stones (kideny stones) groans (ileus) psychiatric overtones (depression, delitirum) |
|
most likely cause of high Ca2+
|
hhyperparathyroid
|
|
diuretics to decrease Ca2+
|
fursoemide, all low
(thiazides increase it) |
|
cuases of high Ca2+
|
hyper PTH
familial CA High Vit D Thiazides High VITAMIN A Sarcoid |
|
hypoMg who gets and sx
|
alcoholics
like hypo Ca |
|
who gets hyper Mg
|
renal failure b/c usually kidney very good at excreting Mg
|
|
who gets hypophos
|
DKA, EtOH, Refeeding syndrome
Keep running glucose all the time |
|
who gets hyper phos
|
renal failure (Cal carbonate is phos resmin)
low Vit D low PTH |
|
hypovolemic shock on CO, PCWP, SVR, SVO2
|
CO low
PCWP low (not lot in there ) = LAP SVR = diatsolic BP , HIGH!!!! SVO2 same as CO |
|
cardiogenic shock on CO, PCWP, SVR< SVO2
|
low CO
HIGH LAP (can't get out!) = LAP SVR HIGH!!! SVO2 same as CO |
|
septic shock on CO, PCWP, SVR< SVO2
|
CO HIGH ONLY ONE!!!!!!!!!! goes hyperdynamic
LOW PCWP LOW SVR SVo2 same |
|
neurogenic shock and CO, PCWP, SVR< SVO2
|
CO LOW
PCWP LOW SVR LOW SVO2 LOW ALL lOW |
|
skin findings in the different shocks
|
low SVR in Septic and neurogenic, so skin is warm and maybe flused
|
|
cardiogenic shock, don't give
|
fluids if pulm congestion
|
|
elderly and calories
|
need less
|
|
most common hearing loss in young people
|
otosclerosis
|
|
sleep changes in elderly
|
sleep less deeply
wake up more wake up earlier less stage 3, 4, REM sleep |
|
Pick disease
|
frontotemporal lobar degeneration
see tau proteins |
|
what meds in eldery mess with their balance
|
sedatives
anticholinergics |
|
if too much anticholingerics, what do
|
give physostigmine
|
|
what does swan ganz measure
|
PCWP, LAP
|
|
mech of dobuatmine
|
beta 1 agonist
INCREASE CO (inotrope) |
|
mech of dpamine
|
low dose: kidney perfeused.
High dose: Increase HR and SVR |
|
NE mech
|
alpha 1 agonist
INCREASE SVR |
|
Phenylephrine mech
|
alpha 1 agonist
INCREASE SVR |
|
EPINEPHRINE mech
|
increased HR and SVR!!!
|
|
# calories and protein goal for enteric feeding
|
30kcal/kg/day
1g/kg/day protein |
|
HRT side effects of heart, cloths, lipis
|
increased MI, increased clots
IMPROVES LIPIDS |
|
Lupus activity correlates with
|
dsDNA
|
|
side effect of saw palmetto
|
HTN
|
|
side effect imipenem
|
increased sz risk
|
|
MS treatment, acute and chronic
|
acute: steroids
chronic to reduce exacerbations: beta interferon or glatimir |
|
best prognostic sign for MS
|
if first sign is optic neuritis
|
|
how to distinguish lewy body from alzehemiers
|
lewy body has visual hallucinations, alzhemiers doesn't really
|
|
how tx keloids
|
intralesional steroids
|
|
ARDS tx on ventilaotr
|
PEEP
low TV |
|
tx papillary CA
|
thyroidectomy
|
|
medullary cancer in imaging
|
doesn't take up iodine
|
|
bcr-abl think
|
CML, 9,22, philadelphia tx gleeve or tyrosine kinase inhibitor
|
|
confirm clearance of H. pylori by
|
stool or breath test
|
|
C diff dx
|
immunoassay (not stool cx)
|
|
ApKD how monitor and extra effects
|
MRI onoy if family history for berry aneurtsms
monitor HTN #1 get hepatic cysts |
|
complications after gastric bypass
|
malabsoprtion, low vit D and low calcium
|
|
how to diagnose chronic granulamotous disease
|
deficient nitroblue tetrazolium (tests ability to make ROS, which is why it is negative here)
|
|
chediak higashi syndrome - genetics, pathophys
|
AR
defect in microtubule polymerization so low phagocytosis |
|
treatment of chronic granulomatous disease
|
daily bactrim
|
|
chediak higashi genetics and presentation
|
AR
giant granules eye and skin albinosis pyogenic infections |
|
complement deficiencies, management
|
N meningococaal vaccine because always get recurrent neisseria infections
|
|
chronic mucocutaneous candidiasis what is it
|
cellular immunodeficiency, just get tons of candida
anergy to candida skin testins T cell definiciency See with hypothyroidism |
|
HyperIgE syndrome what is it
|
recurrent staph infections
High IgE fair skin, red hair, eczema |
|
chronic otitis media may lead to
|
permanent perf of dum
cholesteatomas (excise them) |
|
abx to cover OM
|
amox
cefuorxime bactrim |
|
how treat RECURRENT otitis media
|
prophy antibiotics
|
|
when to do workup for kids UTI
|
Renal U/S and VCUF
If boy < 6yo x 1 if girl < 6yo x2 |
|
meningitis and fontanelle
|
can be bulging
|
|
herpes encephalitis in kids vs adults
|
in newborns it's HSV2
and children/adults it's HSV II |
|
herpes encephalitis on CT
|
temporal lob abnormalities
|
|
consequences of meningitisi
|
hearing loss
vision loss learning d/o |
|
neonatal, regular and elderly causes of meningitis
|
NEO: GBS, Ecoli, Listeria
OTHERS: S. prnumo, meningocoocal ELDERLY: strep penumor, listeria, G- |
|
tx of meningitis depending on age
|
NEO: amp (for listeria) and gent
OTHERS: vanc and cef ELDERLY: amp (listeria) + cef |
|
rubeola vs rubella vs roseola
|
rubeola = measles = Cs
rubella = german measles = LN roseola = exanthem = high fever and trunk out |
|
rubeola presentation
|
= MEASLES (C MEASLES)
Conjunctivitis Coryza Coplik spots |
|
complications of rubeola
|
= measles
giant cell PNA subacute sclerosing panencephalitis |
|
rubella presentation
|
= german measles
the LYMPH NODES complications as always are encephalitis and OM |
|
roseola presentation
|
HHV 6
high fever then abrupt normalcy but rash TRUNK OUT |
|
danger of person with shingles to others
|
CAN cause chickenpox in a person who has never been vaccinated before
|
|
how long is a varicella child contagious
|
until last lesion crusts over
|
|
rubella presentation
|
= german measles
the LYMPH NODES complications as always are encephalitis and OM |
|
what is scarlet fever
|
untreated strep (erythrogenic toxin)
circumoral pallor strawberry tongue desquamating rash |
|
roseola presentation
|
HHV 6
high fever then abrupt normalcy but rash TRUNK OUT |
|
tx scarlet fever
|
PCN in order to prevent rheumatic fever
|
|
danger of person with shingles to others
|
CAN cause chickenpox in a person who has never been vaccinated before
|
|
mono on blood tests
|
atypical lymphocytes with lymphocytosis
heterophile antibodies |
|
how long is a varicella child contagious
|
until last lesion crusts over
|
|
what is scarlet fever
|
untreated strep (erythrogenic toxin)
circumoral pallor strawberry tongue desquamating rash |
|
EBV assoc with what cancers
|
nasopharyngeal carcinoma
burkitt pymphoma |
|
splenomegaly and sports
|
NOs contact sports
|
|
tx scarlet fever
|
PCN in order to prevent rheumatic fever
|
|
what is toxic erythema
|
that's the rash you get with try tx EBV with penicillin (because thought it was strep)
|
|
mono on blood tests
|
atypical lymphocytes with lymphocytosis
heterophile antibodies |
|
EBV assoc with what cancers
|
nasopharyngeal carcinoma
burkitt pymphoma |
|
splenomegaly and sports
|
NOs contact sports
|
|
what is toxic erythema
|
that's the rash you get with try tx EBV with penicillin (because thought it was strep)
|
|
RMSF presentation
|
only rash at extremities and moves IN.
|
|
tx RMSF
|
doxy
chlorampheicol (in pregnancy yes use this) |
|
croup AKA and presentation
|
acute laryngotracheitis (parainfl virus)
barking cough stridor STEEPLE SIGN (subglottic edema) |
|
tx croup
|
humidified O2
racemic EPI oral steroids |
|
epiglottitis cause, presentation and careful
|
H. influ
sdeen fever fever, drooling, resp distress, NO COUGH Thumb sign in side view DOn"T EXAMINE THROAT OR IRRITATE CHILD! |
|
tx epiglotittis
|
prepared to establich airway
cephalosporin x 3 |
|
RMSF presentation
|
only rash at extremities and moves IN.
|
|
RSV later in life
|
could get more asthma
|
|
tx RMSF
|
doxy
chlorampheicol (in pregnancy yes use this) |
|
tx RSV
|
supportive although ribavarin and palivizumba as necessary
|
|
RMSF presentation
|
only rash at extremities and moves IN.
|
|
croup AKA and presentation
|
acute laryngotracheitis (parainfl virus)
barking cough stridor STEEPLE SIGN (subglottic edema) |
|
diphtheria presentation and tx
|
cornebacterium (G+)
gray pseudomembrane, myocarditis erythromycin and antitoxin |
|
tx RMSF
|
doxy
chlorampheicol (in pregnancy yes use this) |
|
tx croup
|
humidified O2
racemic EPI oral steroids |
|
pertussis presentation and tx
|
whooping tough (Bordella G-)
azithromycin or Bactrim |
|
croup AKA and presentation
|
acute laryngotracheitis (parainfl virus)
barking cough stridor STEEPLE SIGN (subglottic edema) |
|
epiglottitis cause, presentation and careful
|
H. influ
sdeen fever fever, drooling, resp distress, NO COUGH Thumb sign in side view DOn"T EXAMINE THROAT OR IRRITATE CHILD! |
|
RMSF presentation
|
only rash at extremities and moves IN.
|
|
tx croup
|
humidified O2
racemic EPI oral steroids |
|
tx epiglotittis
|
prepared to establich airway
cephalosporin x 3 |
|
epiglottitis cause, presentation and careful
|
H. influ
sdeen fever fever, drooling, resp distress, NO COUGH Thumb sign in side view DOn"T EXAMINE THROAT OR IRRITATE CHILD! |
|
tx RMSF
|
doxy
chlorampheicol (in pregnancy yes use this) |
|
RSV later in life
|
could get more asthma
|
|
tx epiglotittis
|
prepared to establich airway
cephalosporin x 3 |
|
croup AKA and presentation
|
acute laryngotracheitis (parainfl virus)
barking cough stridor STEEPLE SIGN (subglottic edema) |
|
RSV later in life
|
could get more asthma
|
|
tx RSV
|
supportive although ribavarin and palivizumba as necessary
|
|
RMSF presentation
|
only rash at extremities and moves IN.
|
|
RMSF presentation
|
only rash at extremities and moves IN.
|
|
RMSF presentation
|
only rash at extremities and moves IN.
|
|
RMSF presentation
|
only rash at extremities and moves IN.
|
|
tx croup
|
humidified O2
racemic EPI oral steroids |
|
tx RSV
|
supportive although ribavarin and palivizumba as necessary
|
|
tx RMSF
|
doxy
chlorampheicol (in pregnancy yes use this) |
|
diphtheria presentation and tx
|
cornebacterium (G+)
gray pseudomembrane, myocarditis erythromycin and antitoxin |
|
tx RMSF
|
doxy
chlorampheicol (in pregnancy yes use this) |
|
tx RMSF
|
doxy
chlorampheicol (in pregnancy yes use this) |
|
epiglottitis cause, presentation and careful
|
H. influ
sdeen fever fever, drooling, resp distress, NO COUGH Thumb sign in side view DOn"T EXAMINE THROAT OR IRRITATE CHILD! |
|
diphtheria presentation and tx
|
cornebacterium (G+)
gray pseudomembrane, myocarditis erythromycin and antitoxin |
|
croup AKA and presentation
|
acute laryngotracheitis (parainfl virus)
barking cough stridor STEEPLE SIGN (subglottic edema) |
|
pertussis presentation and tx
|
whooping tough (Bordella G-)
azithromycin or Bactrim |
|
croup AKA and presentation
|
acute laryngotracheitis (parainfl virus)
barking cough stridor STEEPLE SIGN (subglottic edema) |
|
croup AKA and presentation
|
acute laryngotracheitis (parainfl virus)
barking cough stridor STEEPLE SIGN (subglottic edema) |
|
tx RMSF
|
doxy
chlorampheicol (in pregnancy yes use this) |
|
tx epiglotittis
|
prepared to establich airway
cephalosporin x 3 |
|
pertussis presentation and tx
|
whooping tough (Bordella G-)
azithromycin or Bactrim |
|
RMSF presentation
|
only rash at extremities and moves IN.
|
|
RMSF presentation
|
only rash at extremities and moves IN.
|
|
RMSF presentation
|
only rash at extremities and moves IN.
|
|
RMSF presentation
|
only rash at extremities and moves IN.
|
|
RMSF presentation
|
only rash at extremities and moves IN.
|
|
tx croup
|
humidified O2
racemic EPI oral steroids |
|
tx croup
|
humidified O2
racemic EPI oral steroids |
|
croup AKA and presentation
|
acute laryngotracheitis (parainfl virus)
barking cough stridor STEEPLE SIGN (subglottic edema) |
|
RMSF presentation
|
only rash at extremities and moves IN.
|
|
RMSF presentation
|
only rash at extremities and moves IN.
|
|
tx croup
|
humidified O2
racemic EPI oral steroids |
|
tx croup
|
humidified O2
racemic EPI oral steroids |
|
tx RMSF
|
doxy
chlorampheicol (in pregnancy yes use this) |
|
rubella presentation
|
= german measles
the LYMPH NODES complications as always are encephalitis and OM |
|
RMSF presentation
|
only rash at extremities and moves IN.
|
|
tx RMSF
|
doxy
chlorampheicol (in pregnancy yes use this) |
|
RMSF presentation
|
only rash at extremities and moves IN.
|
|
tx RMSF
|
doxy
chlorampheicol (in pregnancy yes use this) |
|
tx RMSF
|
doxy
chlorampheicol (in pregnancy yes use this) |
|
tx RMSF
|
doxy
chlorampheicol (in pregnancy yes use this) |
|
tx RMSF
|
doxy
chlorampheicol (in pregnancy yes use this) |
|
RSV later in life
|
could get more asthma
|
|
croup AKA and presentation
|
acute laryngotracheitis (parainfl virus)
barking cough stridor STEEPLE SIGN (subglottic edema) |
|
croup AKA and presentation
|
acute laryngotracheitis (parainfl virus)
barking cough stridor STEEPLE SIGN (subglottic edema) |
|
croup AKA and presentation
|
acute laryngotracheitis (parainfl virus)
barking cough stridor STEEPLE SIGN (subglottic edema) |
|
epiglottitis cause, presentation and careful
|
H. influ
sdeen fever fever, drooling, resp distress, NO COUGH Thumb sign in side view DOn"T EXAMINE THROAT OR IRRITATE CHILD! |
|
epiglottitis cause, presentation and careful
|
H. influ
sdeen fever fever, drooling, resp distress, NO COUGH Thumb sign in side view DOn"T EXAMINE THROAT OR IRRITATE CHILD! |
|
tx RMSF
|
doxy
chlorampheicol (in pregnancy yes use this) |
|
epiglottitis cause, presentation and careful
|
H. influ
sdeen fever fever, drooling, resp distress, NO COUGH Thumb sign in side view DOn"T EXAMINE THROAT OR IRRITATE CHILD! |
|
croup AKA and presentation
|
acute laryngotracheitis (parainfl virus)
barking cough stridor STEEPLE SIGN (subglottic edema) |
|
croup AKA and presentation
|
acute laryngotracheitis (parainfl virus)
barking cough stridor STEEPLE SIGN (subglottic edema) |
|
epiglottitis cause, presentation and careful
|
H. influ
sdeen fever fever, drooling, resp distress, NO COUGH Thumb sign in side view DOn"T EXAMINE THROAT OR IRRITATE CHILD! |
|
croup AKA and presentation
|
acute laryngotracheitis (parainfl virus)
barking cough stridor STEEPLE SIGN (subglottic edema) |
|
roseola presentation
|
HHV 6
high fever then abrupt normalcy but rash TRUNK OUT |
|
tx RSV
|
supportive although ribavarin and palivizumba as necessary
|
|
tx RMSF
|
doxy
chlorampheicol (in pregnancy yes use this) |
|
tx RMSF
|
doxy
chlorampheicol (in pregnancy yes use this) |
|
croup AKA and presentation
|
acute laryngotracheitis (parainfl virus)
barking cough stridor STEEPLE SIGN (subglottic edema) |
|
tx epiglotittis
|
prepared to establich airway
cephalosporin x 3 |
|
tx epiglotittis
|
prepared to establich airway
cephalosporin x 3 |
|
tx epiglotittis
|
prepared to establich airway
cephalosporin x 3 |
|
tx croup
|
humidified O2
racemic EPI oral steroids |
|
tx croup
|
humidified O2
racemic EPI oral steroids |
|
diphtheria presentation and tx
|
cornebacterium (G+)
gray pseudomembrane, myocarditis erythromycin and antitoxin |
|
croup AKA and presentation
|
acute laryngotracheitis (parainfl virus)
barking cough stridor STEEPLE SIGN (subglottic edema) |
|
tx croup
|
humidified O2
racemic EPI oral steroids |
|
tx epiglotittis
|
prepared to establich airway
cephalosporin x 3 |
|
tx croup
|
humidified O2
racemic EPI oral steroids |
|
pertussis presentation and tx
|
whooping tough (Bordella G-)
azithromycin or Bactrim |
|
danger of person with shingles to others
|
CAN cause chickenpox in a person who has never been vaccinated before
|
|
epiglottitis cause, presentation and careful
|
H. influ
sdeen fever fever, drooling, resp distress, NO COUGH Thumb sign in side view DOn"T EXAMINE THROAT OR IRRITATE CHILD! |
|
tx croup
|
humidified O2
racemic EPI oral steroids |
|
tx croup
|
humidified O2
racemic EPI oral steroids |
|
tx croup
|
humidified O2
racemic EPI oral steroids |
|
RSV later in life
|
could get more asthma
|
|
epiglottitis cause, presentation and careful
|
H. influ
sdeen fever fever, drooling, resp distress, NO COUGH Thumb sign in side view DOn"T EXAMINE THROAT OR IRRITATE CHILD! |
|
epiglottitis cause, presentation and careful
|
H. influ
sdeen fever fever, drooling, resp distress, NO COUGH Thumb sign in side view DOn"T EXAMINE THROAT OR IRRITATE CHILD! |
|
tx croup
|
humidified O2
racemic EPI oral steroids |
|
epiglottitis cause, presentation and careful
|
H. influ
sdeen fever fever, drooling, resp distress, NO COUGH Thumb sign in side view DOn"T EXAMINE THROAT OR IRRITATE CHILD! |
|
tx epiglotittis
|
prepared to establich airway
cephalosporin x 3 |
|
epiglottitis cause, presentation and careful
|
H. influ
sdeen fever fever, drooling, resp distress, NO COUGH Thumb sign in side view DOn"T EXAMINE THROAT OR IRRITATE CHILD! |
|
epiglottitis cause, presentation and careful
|
H. influ
sdeen fever fever, drooling, resp distress, NO COUGH Thumb sign in side view DOn"T EXAMINE THROAT OR IRRITATE CHILD! |
|
croup AKA and presentation
|
acute laryngotracheitis (parainfl virus)
barking cough stridor STEEPLE SIGN (subglottic edema) |
|
RSV later in life
|
could get more asthma
|
|
how long is a varicella child contagious
|
until last lesion crusts over
|
|
RSV later in life
|
could get more asthma
|
|
RSV later in life
|
could get more asthma
|
|
epiglottitis cause, presentation and careful
|
H. influ
sdeen fever fever, drooling, resp distress, NO COUGH Thumb sign in side view DOn"T EXAMINE THROAT OR IRRITATE CHILD! |
|
tx RSV
|
supportive although ribavarin and palivizumba as necessary
|
|
tx RSV
|
supportive although ribavarin and palivizumba as necessary
|
|
RSV later in life
|
could get more asthma
|
|
tx RSV
|
supportive although ribavarin and palivizumba as necessary
|
|
diphtheria presentation and tx
|
cornebacterium (G+)
gray pseudomembrane, myocarditis erythromycin and antitoxin |
|
tx RSV
|
supportive although ribavarin and palivizumba as necessary
|
|
diphtheria presentation and tx
|
cornebacterium (G+)
gray pseudomembrane, myocarditis erythromycin and antitoxin |
|
tx epiglotittis
|
prepared to establich airway
cephalosporin x 3 |
|
epiglottitis cause, presentation and careful
|
H. influ
sdeen fever fever, drooling, resp distress, NO COUGH Thumb sign in side view DOn"T EXAMINE THROAT OR IRRITATE CHILD! |
|
tx epiglotittis
|
prepared to establich airway
cephalosporin x 3 |
|
diphtheria presentation and tx
|
cornebacterium (G+)
gray pseudomembrane, myocarditis erythromycin and antitoxin |
|
tx epiglotittis
|
prepared to establich airway
cephalosporin x 3 |
|
what is scarlet fever
|
untreated strep (erythrogenic toxin)
circumoral pallor strawberry tongue desquamating rash |
|
pertussis presentation and tx
|
whooping tough (Bordella G-)
azithromycin or Bactrim |
|
pertussis presentation and tx
|
whooping tough (Bordella G-)
azithromycin or Bactrim |
|
tx epiglotittis
|
prepared to establich airway
cephalosporin x 3 |
|
tx RSV
|
supportive although ribavarin and palivizumba as necessary
|
|
diphtheria presentation and tx
|
cornebacterium (G+)
gray pseudomembrane, myocarditis erythromycin and antitoxin |
|
tx croup
|
humidified O2
racemic EPI oral steroids |
|
pertussis presentation and tx
|
whooping tough (Bordella G-)
azithromycin or Bactrim |
|
RSV later in life
|
could get more asthma
|
|
tx epiglotittis
|
prepared to establich airway
cephalosporin x 3 |
|
tx epiglotittis
|
prepared to establich airway
cephalosporin x 3 |
|
tx scarlet fever
|
PCN in order to prevent rheumatic fever
|
|
tx epiglotittis
|
prepared to establich airway
cephalosporin x 3 |
|
RSV later in life
|
could get more asthma
|
|
RSV later in life
|
could get more asthma
|
|
diphtheria presentation and tx
|
cornebacterium (G+)
gray pseudomembrane, myocarditis erythromycin and antitoxin |
|
epiglottitis cause, presentation and careful
|
H. influ
sdeen fever fever, drooling, resp distress, NO COUGH Thumb sign in side view DOn"T EXAMINE THROAT OR IRRITATE CHILD! |
|
pertussis presentation and tx
|
whooping tough (Bordella G-)
azithromycin or Bactrim |
|
tx RSV
|
supportive although ribavarin and palivizumba as necessary
|
|
RSV later in life
|
could get more asthma
|
|
RSV later in life
|
could get more asthma
|
|
RSV later in life
|
could get more asthma
|
|
RSV later in life
|
could get more asthma
|
|
tx RSV
|
supportive although ribavarin and palivizumba as necessary
|
|
tx RSV
|
supportive although ribavarin and palivizumba as necessary
|
|
mono on blood tests
|
atypical lymphocytes with lymphocytosis
heterophile antibodies |
|
tx epiglotittis
|
prepared to establich airway
cephalosporin x 3 |
|
tx RSV
|
supportive although ribavarin and palivizumba as necessary
|
|
RSV later in life
|
could get more asthma
|
|
diphtheria presentation and tx
|
cornebacterium (G+)
gray pseudomembrane, myocarditis erythromycin and antitoxin |
|
tx RSV
|
supportive although ribavarin and palivizumba as necessary
|
|
EBV assoc with what cancers
|
nasopharyngeal carcinoma
burkitt pymphoma |
|
pertussis presentation and tx
|
whooping tough (Bordella G-)
azithromycin or Bactrim |
|
diphtheria presentation and tx
|
cornebacterium (G+)
gray pseudomembrane, myocarditis erythromycin and antitoxin |
|
diphtheria presentation and tx
|
cornebacterium (G+)
gray pseudomembrane, myocarditis erythromycin and antitoxin |
|
tx RSV
|
supportive although ribavarin and palivizumba as necessary
|
|
diphtheria presentation and tx
|
cornebacterium (G+)
gray pseudomembrane, myocarditis erythromycin and antitoxin |
|
tx RSV
|
supportive although ribavarin and palivizumba as necessary
|
|
tx RSV
|
supportive although ribavarin and palivizumba as necessary
|
|
diphtheria presentation and tx
|
cornebacterium (G+)
gray pseudomembrane, myocarditis erythromycin and antitoxin |
|
pertussis presentation and tx
|
whooping tough (Bordella G-)
azithromycin or Bactrim |
|
pertussis presentation and tx
|
whooping tough (Bordella G-)
azithromycin or Bactrim |
|
diphtheria presentation and tx
|
cornebacterium (G+)
gray pseudomembrane, myocarditis erythromycin and antitoxin |
|
pertussis presentation and tx
|
whooping tough (Bordella G-)
azithromycin or Bactrim |
|
pertussis presentation and tx
|
whooping tough (Bordella G-)
azithromycin or Bactrim |
|
pertussis presentation and tx
|
whooping tough (Bordella G-)
azithromycin or Bactrim |
|
diphtheria presentation and tx
|
cornebacterium (G+)
gray pseudomembrane, myocarditis erythromycin and antitoxin |
|
pertussis presentation and tx
|
whooping tough (Bordella G-)
azithromycin or Bactrim |
|
splenomegaly and sports
|
NOs contact sports
|
|
diphtheria presentation and tx
|
cornebacterium (G+)
gray pseudomembrane, myocarditis erythromycin and antitoxin |
|
what is toxic erythema
|
that's the rash you get with try tx EBV with penicillin (because thought it was strep)
|
|
pertussis presentation and tx
|
whooping tough (Bordella G-)
azithromycin or Bactrim |
|
pertussis presentation and tx
|
whooping tough (Bordella G-)
azithromycin or Bactrim |
|
how to diagnose strep retrospectively
|
natistrep O
anti DNAse |
|
PCN will only prevent what if strep+
|
only rheumatic fever + scarlet fever
NOT GN |
|
erythema martginatum
|
the rash you get with rheumatic fever
|
|
toxoplasma in babies
|
intracranial calcifications
chorioretinitnis Ring enhancing lesions |
|
how tx toxoplasmosis
|
pyrimethamine
sulfadiazine |
|
VZV presentation in babies
|
limb hypoplasia
scarring of skin |
|
syphilis in babies presentation
|
rhinitis
saber shins hutchinson teeth |
|
rubella in babies
|
blueberry muffin
cataracts heart defects |
|
CMV in babies
|
sensorineural deafness
ventricular calcifications |
|
causes of floppy baby
|
wednig hoffman (AR), progressive
botulism, sudden |
|
werdnig hoffman genetics and what is it
|
AR
degernation of anterior horn cells (motor) hypotonic at birth progressive |
|
dx and tx werdnig hoffman
|
dx with genetics or muscle biopsy
tx supportive |
|
dx botulism
|
finding toxin or organisms in the feces
|
|
tx botulism
|
human antitoxin
|
|
muscular dystorphy genetics and presentation
|
Xlinked
muscle weakness, large calves, low IQ, gower sign |
|
diagnose and tx muscular dystrophy
|
muscle biopsy
tx supportive (most die by 20yo) |
|
mitochondrial myopathies presentation
|
ragged red fibers on biopsy
ophto issues |
|
what is genetics and presentation of myotonic dystrophy
|
AD
20-30YO can't relax grip MR, blaness, testicular atrophy |
|
most common brain tumors in kids
|
astrocytoma
medulloblastoma |
|
wilms bs neurobalstoma presentation and location
|
flank masses
wilms fromkidney neuroblastoma from adrenal (get better on own) |
|
unicameral bone cyst how look, who gets, pronosis
|
well demarcated black on xray, in humerusin children
Is benign but can weakne bone to cause fractures |
|
osteosarcoma, who gets it, how look
|
10-20YO
sunburt appearance on xray maybe can feel a mass |
|
drops in neonataes eyes
|
silver nitrate, erythromycin OR tetracyline drops to prevent gonorrheal conjunctivitis
|
|
lineup of conjunctivits and times in newborn
|
chemical reaction
gonorrhea (2-5days_ topical chlamydia (5-14 days) systemic |
|
tx gonorrha conjunctivitis
|
if not prophy
TOPICAL erythrmocycin PLUS IV/IM ceftriaxone |
|
tx chlamydia conjunctivitis = inclusion conjunctivitis
|
oral erythmomycine, and treat so you can prevent chlamydia PNA
|
|
cataracts in newobrn, think
|
TOCH infection, or inherited disorder
|
|
when refer for strabismus
|
3 months.
|
|
congenital hip diysplasia treatment
|
pavliks harness
|
|
legg calves perthes what is it and how treat
|
reduction of blood flow to hip so get some osteonecrosis
tx with ORTHSOSIS |
|
SCFE what is it and how treat
|
fracture in growth plate so femoral head slips from est of feumor
SURGICALLY PIN IT (overweight kid) |
|
LCP, CHD, SCFE how manifest as adults?S
|
arthritis on hip!
|
|
what is nursemaids elbow and how fix it
|
radial head ssubluxation
see bhild won't move elbow after being lifted by the hand Do manual reduction by supinating elbow and 90 degrees flexion |
|
osgood schlatter disease what is it and tx
|
osteochondiritis and tibial tubercle, pain swelling
supportive treatment |
|
juvenile rheum artrtisis, labs, presntation, referral
|
referr to ophtho for uveitis
pain, limping eye disease growth retardation often RF negative |
|
conduct disorder turns into
|
antisocial
|
|
ADHD tx and side effects
|
treat with stimulants (methylphenidate)
dextraamphetamine amoxetin insmonia, abdominal pain, anorexia, weight loss Tx with drug holidays to combat side effects |
|
tourette and ADHD
|
tourette d/o can be caused and maybe unmasked by the use of stimulants for presumed ADHD
|
|
tx touette
|
if severe, haloperidol
otherwise flupheaazine (dop receptor blockers) |
|
encopresis/enuresis is problem starting when
|
encopresis @ 4
enuresis @ 5 |
|
complications of RDS (no surfactant)
|
IVH
BPD |
|
tx TTN
|
self resolves
|
|
hypospadia vs episapadias
|
hypospadia flaccid undersuface
epispadia ventral when rigid tx surgially epi also ass with exstrophy of bladder |
|
left vs right gonal veins drain into...
|
L into left renal veins
right gonadal/testicular/ovarian vein into IVC |