COMBANK Flashcards
(16 cards)
Sx: Hypotension, JVD; EKG: ST elevation in lead II, II, aVF; treatment?
Aspirin, NS fluid, O2; Treatment for RCA infarction- want to inc pre-load and inc CO/BP if pt is hypotensive
Alcoholic with mid-epigastric abdominal pain, postprandial diarrhea, fat malabsorption and diabetes; Dx TOC?
Abdominal CT: Pt has chronic pancreatitis- abdominal CT is 90% effective in showing calcifications- enzymes may be normal
Acute pancreatitis causes and DxTOC
Causes: GET SMASHED- Gallstones, EtOH, tumor, Scorpion bite, Microbial (bacteria, viral- Mumps, parasites), Autoimmune (SLE, PAN, Crohn), Surgery or trauma, Hypertriglyceridemia, Emboli/ischemia, Drugs (sulfonamids, diuretics, HIV meds)
DxTest: abdominal CT
Stable vitals, asymptomatic, narrow QRS tachycardia; treatment?
Vagal maneuvers followed by adenosine. Adenosine MOA is slowing conduction through AV node and interrupting AV re-entry pathway
Pt returned from camping in Cape Cod. Sx: fever, diaphoresis, inc LDH and dec haptoglobin. Negative malaria test. Treatment?
Babesia microti txt- no treatment required in healthy pts. Elderly, ICR or asplenic = IV clinda and oral quinine or IV atovaquone and aizthromycin
Elderly male with bone pain and fatigue. Labs show hypokalemia and renal failure. Normal prostate. MOA of hypokalemia?
Multiple myeloma causing Type II RTA. Type II RTA means HCO3 is not resorbed -> non-anion gap acidosis, inc sodium in tubule -> inc aldosterone = hypokalemia
Alz pt with abd pain, non-bloody diarrhea, chronic constipation, no bowel movement in three days. Radiograph= coffee bean sign
sigmoid volvulus- usually in pts with dementia or neuropsychiatric impairment
Pt with AS, fever, subungual petechiase and small tender nodules on the 3rd and 4th fingers. Blood cultures show gram+, catalase+, and coagulase -. Organism?
Staph. Epidermidis. Common cause of subactue endocarditis. Strep viridins is also common cause
Pt with DM2, CHF and CAD. Long acting insulin?
Glargine- onset of 1-4hrs and lasts 24-48hrs.
NOT:
Insulin: onset 30-60min and lasts 5-8hrs
NPH: onset 6-10 and lasts 18-24hrs
Lispro: fastest onset of 5-10min
Aspart onset of 10-20min and lasts 3-5hrs
Pt with cirrhosis but denies alcohol, also shows ataxia, masklike facies, clumsiness and personality changes. PE shows centrally blanching angiomas on chest. greenish gold to brown rings around cornea. Disease?
Hepatolenticular degeneration (Wilson’s Disease)- AutoRecess in ATP7B transporter of copper.
Elderly male with difficulty initiating stream, weak stream, bladder fullness and increased nighttime urination. Increased PSA (>4ng). Dx TOC?
Transrectal ultrasound- indicated in pts with abnormal PSA or DRE. Definitive diagnosis is made with ultrasound guided transrectal biopsy
Sx: unilateral purulent discharge from eye, no photophobia or vision changes. Txt?
Disease: Bacterial conjunctivitis- S. pneumo most common
Txt: topical sulfacetamide or erythromycin
Baby born to young mother
Sx: unilateral, purulent discharge with edema of eyelids. Txt?
Disease: Gonococcal conjunctivitis
txt: one dose 1g IM ceftriaxone
Can be hyperacute onset in sexually young active adults
IVDA user
Sx: new onset seizures
CD4:CD8 ratio less than 1
txt?
Toxoplasmosis- MRI would show multiple ring enhancing lesions
Txt: pyrimehtamine and sulfadiazine
prophylaxis with TMP-SX at <100 CD4
18month male
SX; new onset “bump” in lower back with increased urinating frequency
Other associated features?
Beckwith-Wiedemann syndrome- omphalocele, macroglossia and a Wilm’s tumor. Typical symptoms are children under the age of two with mass, HTN and dec kidney function
Also WAGR- Wilms, aniridia, GU abnormalities and MR
Pt with Hx of pancreatitis
Sx: dull epigastric pain, not related to eating
Abdominal ultrasound shows 4cm cystic mass
txt?
Pancreatic pseudocyst- txt is supportive- does not need to be drained unless >6cm
