Med shelf review Flashcards
Ppd positives?
- 15 normal ppl
- 10 exposed ppl –> ex. Pts with sillicosis
- 5 immunocompromised
Sillacosis
- from breathing in dust
- see hilar infiltrates on xray
- from deposits of sillicone on the hilar lymph nodes
- “egg shell” calcifications –> see a white border around them on xray and ct scan
What to do with pt before starting TNF-alpha blockers?
- PPD > 5 mm –> do chest X ray
- even if xray is negative, tx with isoniazide for 9 mnths
- then you can give drug after 3 mnths
Who is in the group considered exposed to TB?
- Healthcare workers
- Homless shelter
- Sillicosis pts
- Nursing home workers
Etc!
2 step PPD?
- give one test
- give a second test in two weeks
- given 2 times bc might be in a window of not being symptomatic, or bc it is a delayed hypersensitivity rxn and first test might “prime” them
diffuse pattern in lungs?
- seen in both lungs
- not in lobar pattern
- when you see this it means something was spread via blood, rather than air
- ex. Milliary TB, pneumoconiosis, histoplasmosis, varicella pneumonia, etc.
Shaggy heart
- asbestos exposure
- also see plural plaques –> not a precancerous! Only shows exposure!
Exposure to asbestosis & lung cancer
-exposure increases risk
Ferrugionous bodies?
- asbestos fibers covered by iron
- look like dumbbells
Ulnar deviation
-RA
RA and lungs?
- exudative pleural effusion –> do pleuralcentesis –> pleural fluid protein is > 0.5, glucose will be very low, & acidemic pH
- rheumatoid nodules
Bouchards nodes
-PIP
Psoriasis hand ssx?
- Pitting of nails
- Sausage fingers
- Scaly lesions
- Pencil in cup on Xray
Uric acid crystals in urine?
- RHOMBOID crystals!!!
- ONLY the joint fluid will have neg birefringement crystals
Clubbing: found in?
- Pulmonary fibrosis –> on exam hear inspiratory velcro-like crackles
Spiral CT?
- rotates and gets spiral slices of the lungs
- this will allow you too see more solitary nodules or PE, etc.
- “like curly fries!”
Why use contrast with CT in lungs?
- look at something in the vessels
- ex: look for PE, hilar lymph nodes, plura
How to help protect kidneys from contrast?
- HYDRATE
- Stop kidney toxic drugs before
- Sodium bicarb can be used to help draw out the contrast
Lung mass/abscess + pain in long bones (see elevation of the periosteum)?
- hypertrophic pulmonary osteoarthropaty (HPOA)
- can be seen with some cancers
Pt with CRESt w/ shortness of breath?
- pulmonary HTN
- normal spirometry
- normal lung volumes
- decreased diffusion capacity bc have thickening (onion skinning) of the vessels - Interstitial lung disease
- fibrosis secondary to CREST
- have Scl-70 in serum
Xantholasma and arcus?
-do Lipid pannel!
Arcus?
- ring around iris
- seen with hyperlipidemia
Dermatomyositis?
- Goltrans papules
- Heliotrophic rash
- Proximal muscle weakness
- Shaul sign
Varicellis zoster: where does the virus lie dormant?
-dorsal root ganglion
Syphillius pt given penicillin gets high fever, rash, etc?
- jaichurs-hymer rxn (sp?)
- occurs bc of lysis of the spirochetes
Lung dz that gets worse with tx at first?
- pnemocystis pneumoniae in a pt with a PO2 < 70
- give sterroids to help diminish this
Plummer-winson dz findings?
- Kolknicyea
- Smooth tongue
- Spoon nails (?)
- Esophageal webs –> higher risk for esophageal cancer
Hypersegmentation of neutrophils?
- more than 5
- B12 or folate deficiency –> tx for both
- can get neuropathy!
Tea and toast diet, what vitamin should be added?
- vitamin D!
- cant absorb calcium without D!
- also can be related to many other diseases if deficient
Petechi, easy bleeding with brushing teeth?
- auer rods can be seen! AML!
- easy bleeding bc of DIC
Howel jolly bodies?
- nuclear reminants on wright stain
- seen in pts without spleen!
- want to give these pts pneumo vaccine!
Heinz bodies?
- denatured hemoglobin
- wont stain on wright stains!
- need to do crystal violet stain!
- can have normal G6PD levels during a crisis, bc the deficient ones are destroyed and the normal ones are left behind
- can see bite cells too!
Fever, uktrred mental status, renal failure, low platelets, and schistocytes?
-thrombotic thrombocytopenic purpura
Anemia, renal failure, bone pain, hypercalcemia, rollot cells and plasma cells?
- multiple myeloma
- plamsa cells only seen in PERIPHERAL smears, not in martow
Schitsocytes?
- Artificial valve
2. TTP
DIC v. TTP?
- lab test: ptppt !!!!!!!!!
- DIC would be elelvated
- TTP would be normal
TTP tx?
- plasmaphoresis!!!!!!
- mortality of untreated = 95% !!!!!
CMV
- Reed sternber cells = eye looking back at you
Macroglossia + ridging on tounge + enlarged uvula + micrognathia
-obstructive sleep apnea!!!!
Apnea
-stop breathing for 10 sec
Normal # of apnea events per hour?
-5!
Indicators for dialysis?
- Uremic pericarditis
- Uremic encephalopathy
- Hyperkalemia that cant be medically tx –> give kalexelate (can be associated with colonic necrosis) can give beta-agonists, give insulin with glucose (push into cells)
- Overdose with small volume of distribution (not that lipid soluble) –> ex. Lithium toxic
- Refractory acidosis
- Fluid overload
Warfarin induced necrosis?
- warfarin reduces protein C &S first! –> they become more thrombogenic at first, so give heparin too!
- heparin acts through anithrombin 3
- can happen in breast, thigh, etc.
- dont stop heparin before 3 days! You need the overlap!!
Voccal cords moving in the wrong direction?
- paradoxical vocal cord mvmnt
- tx: speech therapy
- many are treated as asthmatics and dont actually have asthma!
- but, many do have asthma too!
- make sure to listen to trachea! You will head more of a stridor!
Fever, arthralgia, raised red tender lesions on shins (erythema nodosum), hilar adenenopathy?
- lofgren’s syndrome
- sarcoisdosis
- usually benign –> rarely reappears when it goes into remission!
Erythema nodosum: causes?
- Pregnancy
- Sarcoidosis
- Diabetes
- Etc!
White out of a lung on Xray?
- causes;
1. Pneumonia
2. Hemothorax
3. Collapse –> see crowding on ribs
4. Thorocotomy
5. Congential absence of lung
