Day 1 Review - Neuro1, Neuro2, Psych1 Flashcards
Tx MI 2/2 Cocaine
(1) Avoid Beta blockers (inhibit beta2 vasodilation) - Use Lorazepam or CCBs (2) NOT assume no CAD if age 35+ - Rule out with cardiac catheterization
Immunodeficiency disorder(s) w/ absent thymic shadow on newborn x-ray
(1) DeGeorge Syndrome - hypocalcemic (no parathyroid hormone) (2) SCID, specifically Adenosine Deaminase Deficiency (ADA)
BUN/Cr > 20: (1) Dx (2) Next step in management
(1) Dx: Dehydration or Prerenal Azotemia (elevation of BUN & Cr, may become uremia) (2) Tx: IV fluids
Vaccines not given to HIV+ patients
Live virus vaccines: Varicella/Zoster, Intranasal influenza, Oral polio; Less common - Yellow fever, BCG, Anthrax, Oral typhoid, Smallpox; One exception - MMR indicated if (1) No evidence of immunity (rubella titer) (2) CD4 > 200 (3) No AIDS defining illness
Vaccines for HIV+ patients
Annual muscular influenza, Hep B, S. pneumo; MSM - Hep A
HIT: (1) suspect (2) complciation
(1) Platelet drop greater than 50%, even if not thrombocytopenic range, in patient on Heparin (2) Thrombosis (counterintuitive, hypercoagulable)
Intervention for child with severe asthma exacerbation and persistently low O2 sat
Give oxygen to keep O2 sat above 92-94%; If unable to maintain, intubate & mechanically ventilate - indications: (1) Unable to maintain O2 sat above 92-94% (2) AMS (3) Unable to speak due to WOB
Androgen Insensitivity Syndrome: (1) Cause (2) Classic presentation (3) Labs
(1) 46XY but defect in androgen receptors; (2) P/w normal appearing female with rudimentary vagina, absent uterus/fallopian tubes, and gonads (i.e., 2 masses in labia majora), not menstruating; (3) Labs - high levels of testosterone, estrogen, & LH
Most common food-borne GI tract infection in developed countries
Salmonella
Hyperprolactinemia p/w
Premenopausal women - hypogonadism = amenorrhea & infertility; Postmenopausal -subclinical; Males - decreased libido, impotence, low sperm counts, gynecomastia; Galactorrhea possible in all
Hyperaldosteronemia: Labs/Dx
Hypokalemia, Increased sodium, Metabolic alkalosis (Think: Opposite of Spironolactone = K+ sparing diuretic, which causes hyperkalemia); Dx - Increased 24hr urine aldosterone
Antidote: (1) Opioids (2) Heparin (3) Benzodiazepines (4) Barbiturates (e.g., phenobarbital) (5) Carbon monoxide
(1) Naloxone/Naltrexone (2) Protamine sulfate (3) Flumazenil (4) Sodium bicarbonate to alkalinize urine, may need dialysis; Activated charcoal (5) 100% oxygen; if available, hyperbaric oxygen
OCPs for lactating women
Avoid combination of estrogen and progesterone (suppress milk production - good for non-lactating postpartum women); Progestin only pills (mini pill daily but same time every day; IM methoxyprogesterone shot every 3 mo.); Hypercoagulable after pregnancy - NO OCPs for postpartum women within first few weeks after pregnancy
Primary amenorrhea: (1) Definition (2) When/Why to start work-up
(1) Absence of menses at age 16 in presence of normal growth and secondary sexual characteristics (2) Above criteria (Note: many PCPs start work-up at age 15); Absence of secondary sexual characteristics by age 13
