Flashcards in random3 Deck (121):
recent URI followed by sudden onset of cardiac failure in an otherwise healthy pt -- think?
Dilated cardiomyopathy (2dary to acute viral myocarditis)
most common virus to cause myocarditis?
Dilated ventricles w/ diffuse hypokinesia on echo - think?
asymmetric septal hypertrophy can be found in what?
when is concentric hypertrophy of the heart seen?
Chronic pressure overload
- Untreated HTN
Eccentric hypertrophy of heart dev when?
Chronic volume overload
- valve regurg
mid-diastolic murmur w/ an opening snap?
what is Mitral Stenosis effect on the R side of the heart?
- RV heave 2dary to pulm HTN
In primary pulm HTN what will not be present?
amiodarone side fx?
- Cardiac: sinus brady, heart blok, risk of QT prolong, & torsades
- Pulm: Chronic interstitial pneumonitis
- Elevated tansaminases, hepatitis
- Optic neuropathy, corneal microdeposits
- Blue-gray skin discoloration
- Peripheral neuropathy
prior to starting Amiordarone be sure to get what tests?
childhood vax complete + minor scrape on fence + last booster
childhood vax complete + minor scrape on fence + last booster >=10 yrs ago - what tetanus prophylaxis required?
Tetanus toxoid containing vaccine (Td or Tdap)
complete childhood vaxs, deep dirty wound, booster >=5yrs ago - what tetanus prophylaxis required?
Tetanus toxoid vax (Td or Tdap)
When do you give tetanus immuneglobulin?
when pt is unimmunized or immunecompromised
wound is severe/dirty
most severe mutation types/
missense mutation is?
single nucleotide changed
nonsense mutation is?
codon changed to a chain terminating codon --> severe mutation
Hyper conjugated bilirubinemia w/ normal AST, ALT, and alk phos - think (2)?
- Rotor syndrome
- Dubin-Johnson syndrome
Defects in hepatic secretion of bili
positive urine bilirubin - think?
1) It's conjugated bili
2) Due to: hepatic dysfunction, biliary obstruction, or defect in hepatic bili secretion (ie rotor or dubin johnson)
necrolytic migratory erythema -- think?
necrolytic migratory erythema looks like?
erythematous papules or plaques that coalesce to form a large, painful, and inflammatory blister/crusting w/ central clearing. Found commonly on perineum, extremities, and face.
serum glucagon >500 -- think?
erythematous plaque w/ central clearing + mild DM + Diarrhea + weight loss + normocytic, normochromic anemia - think?
episodic flushing = think?
episodic flushing, diarrhea, weight loss - think
low leukocyte alkaline phosphatase + leukocytosis w basophilia - think?
leukocytosis + high leukocyte alkaline phosphatase (LAP) + metamyelocytes > myelocytes -- think?
metamyelocytes and bands are?
late/mature neutrophil precursors
- found more in leukemoid rxn (compared to CML)
myelocytes and promyelocytes are?
early neutrophil precursors
- found more in CML (compared to leukemoid rxn)
painless gross GI bleeding w/ cause missed on colonoscopy -- think?
maroon stools + painless + nothing seen on colonoscopy -- think?
angiodysplasia (often missed on colonoscopy)
continuous abdominal bruit suggestive of?
resistent HTN + diffuse atherosclerosis, asymmetric kidney size, recurrent flash pulm edema, or serum creatinine >30% from baseline post ACE/ARB therapy -- think?
resistent HTN + abdominal bruit + recurrent flash pulm edema -- think?
Crigler Najjar syndrome type 2 can be treated w/ what to help reduce serum bili?
IV phenobarbital or clofibrate
In which crigler najjar does phenobarbital not help?
Crigler Najjar type 1 (severe)
-- phototherapy, plasmapheresis short term
-- long term needs liver transplant
type 2 is helped by phenobarbital
smudge cells - think?
lymphocytosis w/ small mature lymphocytes - think?
elderly pt + lymphadenopathy + hepatosplenomegaly + lymphocytosis w/ smudge cells - think
Hairy cell leukemia findings?
painless lymphadenopathy + night sweats + fevers + nL CBC and blood smear - -think?
dead space means?
ventilation fine, but perfusion dec (ie PE)
physiological shunting in lung means?
perfusion fine, but ventilation dec --> shunting of deoxygenated bld to L heart
Pneumonia --> what type of v/q mismatch?
physiological shunting (vent dec, perfusion fine)
serum progesterone measurement for infertility should be done when?
(b/t ovulation --> menses)
conductive hearing loss ?
obstruction of external sound to inner ear
sensorineural hearing loss involves?
involves inner ear, chochlea, auditory nerve
tuning fork on mastoid bone --> abnl suggests CONDUCTIVE hearing loss
air conducting should be heard longer than bone (so nL AC>BC, abnl BC>AC)
abnl rinne test indicates?
CONDUCTIVE hearing loss
tuning fork middle of forehead
* nL - same in both
* conductive - lateralize to obstructed/effected ear
* sensiorineural - lateralize to unaffected ear
abnl rinne test w/ weber laterilzes to same ear?
conductive hearing loss
shoulder pain radiating in an ulnar distribution where is leision?
pulm apex at thoracic inlet (superior sulcusl invade C8, T1 n.)-- > compress inf portion of brachial plexus --> Pancoast syndrome
normal rinne test b/l, weber lateralizes -- think?
sensorineural hearing loss
abl rinne in 1 ear, weber lateralizes to opposite ear - think?
mixed hearing loss
serous otitis media symp?
- middle ear effusion w/o evidence of acute infx
- conductive hearing loss
- hypomobile dull tympanic membrane
serous otitis media seen in what population?
Pt w/ HIV w/ hypomobile, dull typmanic membrane and conductive hearing loss -- think?
serous otitis media (non-infx effusion)
expansile, eccentric lytic lesion on epiphysis - think?
Giant cell tumor of bone
soap bubble appearance on XR of femur -- think?
giant cell tumor
popliteal synovial cyst is?
- enlarged gastrocnemius-semimembranous bursa in medial side of popliteal fossa
osgood schlatter disease is?
overuse injury caused by repetitive strain
- typically young kids and adolescents who have recently undergone a rapid growth spurt
xray apperance of osgood schlatter disease?
avulsion of the apophysis of tibial tubercle
osteitis fibrosa cystica aka?
von recklinghausen disease of bone
osteitis fibrosa cystica commonly due to ?
hypERparathyroidism from parathyroid CA
osteitis fibrosa cystica (von recklinghausen) is?
osteoclastic resorption of bone --> replacement w/ fibrous tissue (brown tumors) --> bone pain
salt and pepper appearance of skull think?
osteitis fibrosa cystica
distal clavicular tapering + bone cysts + brown tumors - think?
osteitis fibrosa cystica
brown tumors in bone think?
osteitis fibrosa cystica
findings of OA (4)?
- joint space narrowing
- osteophyte formation
- subchondral sclerosis
- subchondral cysts
osteoid osteoma on xray?
sclerotic, cortical lesion w/ central nidus of lucency
giant cell tumor of bone most commonly effects?
epiphyseal regions of distal femur and proximal tibia
memory issues w/ weight gain, fatigue, constipation, and hoarseness - think?
walking in normal pressure hydrocephalus?
broad-based, shuffling gait
wernicke korsakoff syndrome findings:?
Wernicke - ataxia, ophthalmoplegia, confusion
Korsakoff - confabulation and amnesia
vesicular rash on forehead on eye w/ dendriform ulcers on cornea and conjunctivitis + fever, malaise -- think?
Herpes zoster opthalmicus
treatment of herpes zoster opthalmicus?
w/in 72hrs --> high dose acyclovir
eye pain, photophobia, dec vision w/ clear vesicles on corneal epi and dendritic ulcers -- think?
Herpes simplex keratitis
(locally limited w/o rash -- distinguish from herpes zoster opthalmicus)
infx of lacrimal sac due to obstruction of nasolacrimal duct
bacterial keratitis seen w/?
contact lens wearers following corneal trauma
inflammatory cells in ant chamber of eye --> leukocytic exudate
eye appearance in bacterial keratitis?
cornea appears hazy w/ central ulcer and adjacent stromal abscess
- hypopyon may also be seen
complication of giant cell arteritis?
--> pts should have serial CXR
headache, jaw claudication, muscle fatigue, visual distrubances, ESR >50, tender cord at temporal area -- think?
giant cell arteritis
confusion, wheezing, and aseizure post smoke inhalation -- think?
carbon monoxide poisoning
treatment of CO poisioning?
100% oxygen via nonrebreather facemask
- hyperbaric O2 if unresponsive to facemask
cardioversion and defibrillation have no role w/ which pts?
- Pulseless electrical activity
reversible causes of pulseless electrical activity/asystole?
5H's and 5 T's
Hydrogen ions (acidosis)
pulselss VT or ventricular fibrillation - treat?
pulseless electrical activity or asystole should be managed w/
uninterrupted CPR w/ vasopressor therapy
most common nephrotic syndrome in adults in US?
focal segmental glomerular sclerosis
FSGS associated w/?
HIV, heroin use, morbid obesity
*african american and hispanic
Membranous nephropathy associated w?
- Hep B
- adeocarcinoma (breast, lung)
Membranoproliferative GN - associated w/?
Hep C>>Hep B
minimal change disease associated w/?
lymphoma (often Hodgkin)
Amyloidosis in kidney associated w.?
- Multiple myeloma
- chronic inflam disease (ie RA, bronchiectasis)
crystal induced nephropathy side effect of?
Indinavir (protease inhibitor; HIV treatment)
indinavir is ?
- HIV treatment
indinavir side effect?
--> hematuria w/ needle-shaped crystals in sediment
main organ of concern w/ indinavir (protease inhibitor)?
- due to crystal induced nephropathy
major rxns w/ HIV therapy? (6)
* Didanosine --> pancreatitis
* Abacavir --> hypersensitivity syndrome
* NRTIs --> lactic acidosis
* NNRTIs --> Steven-Johnson's syndrome
* Nevirapine --> Liver failure
*Indinavir - nephrotoxicity (crystals)
Main concern w/ didanosine?
Main concern w/ Abacavir?
Main concern w/ NRTIs?
Main concern w/ NNRTIs?
Main concern w/ Nevirapine?
Most common causes of osteomyelitis in sickle cell disease? (2)
Empiric treatment of osteomyelitis for children w/ sickle cell disease?
- 3rd gen Cephalosporin (ie ceftriaxone, cover salmonella)
- Anti-staph med (ie vanco, oxacillin, etc)
most common causes of osteomyelitis in children
most common cause of osteomyelitis in children 2mo-4yrs?
Kingella kingae (gram- bacillus)
most common cause of osteomyelitis >4yrs?
bilateral trigeminal neuralgia - what is one of the main causes?
bilateral trigeminal neuralgia + eye issues + arm weakness -- think?
Pill rolling tremor + bradykinesia + rigidity + mask-like face -- think?
caudate atrophy found w/?
depression + choreiform movements + subcortical dementia - think?
aseptic meningitis usually happens when?
aseptic meningitis often caused by?
young female bilateral trigeminal neuralgia -- concern for?
pleural plaques - think