UW 10 Flashcards by Gaby Matamoros

Common complications of parenteral nutrition

Blood stream infection: Staph aureus and epidermidis, Klebsiella, Pseudomona, Candida

Cholelthiasis if >2 weeks: due to cholestasis

Hyperglycemia

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Methanol and Ethynele glycol intoxication presentation

Methanol:
Visual blurring, central scotomata
Afferent pupillary deffect
Altered mentation

Ethyline glycol:
Flank pain
Hematuria, oliguria (direct renal damage and crystal accumulation)
Cranial nerve palsy, tetany
Calcium oxalate crystals in urine

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Xray clue for constrictive pericarditis

Pericardial calcification

Chronic fibrosis and pericardial calcification

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Clinical presentation of pulsus paradoxus

Weak pulse that disappears with deep inspiration

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Chest pain with hx of viral symptoms 1-2 weeks before

Pericarditis

Can radiate to left shoulder

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Physiologic explanation of pulsus paradoxus in cardiac tamponade

Pericardial fluid pressure on heart does not allow for filling ===> decreasing cardiac output

Inspiration creates a pressure gradient that allows for increased in venous return to the right heart ==> drop in systemic pressure

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Normal fetal heart rate evaluation

2 acceleration >15 bmp, that last >15sec in a 20 min interval is considered normal

Normal rate: 110-160bmp

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Biphysical profile

2 points each: 8-10 reassuring, 6 equivocal, 0-2: Extremely worrisom (may consider delivery)

Test the Baby, MAN

Tone
Breathing
Movement
Amniotic (index)
Non stress test

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Example of a polypeptide hormone

ACTH

Comes from cleavage of propiomelanocortin and also produces MSH (melanocyte stimulating hormone) causing hyperpigmatation in Cushing sd that could be limited to sun exposed areas, scars, palmar creases and oral mucosa

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Hypercortisolism clinical manifestations

BAM CUNSHINGOID

Buffalo hump, Brusing
Amenorrhea
Moon facies
Crazy (mood, sleep alterations)
Ulcers
Sking changes. (Hyperpigmentation only in C. disease)
Hypertension
Infection
Necrosis
Glaucoma
Obesity/osteoporosis
Immunosupresion
Diabetes

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Dxx Cushing disease and syndrome

If ACTH is elevated = cushing disease
bilateral adrenal hyperplasia
Pitutary tumor vs. paraneoplastic sd (lung small cell carcinoma most common)

Cortisol only = cushing sd. (no skin pigmantation)
Adrenal tumor (unilateral), bening or malignant

Although obesity is a feature, the hypermetabolism state associated with malignacy can cause weight loss

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Example of amminoacid derived hormones

Neuroendocrine

Epineprhine, norepi (pheochromocytoma)
serotonin (carcinoid tumors)

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Arachidonic acid derivated

Leukotrienes, prostoglandins

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Ecthyma gangrenosum

Skin lesion that rapidly evolve from papule to pustule to ulcer.
Associated with Pseudomona infection in inmunocomprimised patients

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Labor stages

First
Latent: 0-6cm dilatation
Active: 6-10 cm (>1cm every 2hrs)

Second
10cm to delivery (30min - 3hrs 1st baby) (<30min multiparus)

Third:
Delivery to Placental expulsion

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Delivery protraction vs. arrest

Active phase prolongation:

Protraction:
Cervical change slower than expected
Oxytocin

Arrest:
No change in 4hrs with adequate contractions or no change i 6 hrs with inadequate contraction
Csectio

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Examples of alpha-bloquers

Non selective:
Phenoxybenzamine (for pheochromocytoma surgery)
Phentolamine

Selective:
tansulosin, prazosin, terasosin (for BPH)

A2 selective:
Mirtapzapine: antidepresive

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Anticoagulation in patients with Afib

CHA(2)DS(2)VAS >2points (for non valvular AF)

Warfarin

Novel oral anticoagulant (direct inhibition of Xa)
apixaban, rivaroxaban. (Do not use in renal failure)

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Imaging findings of Herpes encephalitis

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Frontoteporal abnormalities

CSF analysis

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pg 223

Characteristics of TB efussion

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High proteins (ussually >4mg/dl)
Very high LDH
Low glucose
Low pH
Mild leukocytosis with lymphocyte predominance (not neutrophil)
Systemic symptoms may not be present or not as severe as with empyema

Empyema have a very high leukocyte concentration >50000 and neutrophile predominance

Etiology of restrictive lung disease

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The lungs AIN’T compliant

Alveolar (edema, hemorrhage, pus)

Interstitial lung disease (idiopatic interstitial) pneumonias, idiopatic pulmonary fibrosis, inflamatory

Neuromuscular (myastenia, prhenic n palsy, myopathy)

Thoracic (kyphoscoliosis, obesity, ascitis, pregnancy, ankylosing spondilitis)

Spontaneous bacterial peritonitis

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Common complication of patients with cirrhosis due to bacterial translocation

Suspect if patient with cirrhosis +
Fever, chills, hypothermia, hypotension
Diffuse abdominal pain
Ascitis

Diagnosed if >250 PMN in ascitic fluid

Treatment: IV antibiotics (3rd gen. cephalosporin) + albumin, fluroquinolones for prophylaxis

Associated with poor 1 year prognosis

Physiological effect of tube decompresion in tension pneumothorax

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Allows for an increase in venous return

Live attenuated vaccine

Flu and polio nasal Varicella MMR Yellow fever

ALS

Anterior horn degeneration Asymetric limp weaknes UMN and LMN sings May present with mild CK elevation <1000

CK elevation dxx

ALS: very mild,

Korsacov syndrom

Confabulation and amnesia in the setting of heavy alcohol consumption

Temporal lobe epilepsy

Looks like an absent seizure (<20sec, no postictal state) but... Usually in adults + post ictal state (confusion, disorientation, amnesia) Classified as focal seizure with impaired awareness

Lupus mnemonic

DOPAMINE RASH ``` Discoid rash Oral ulcers Photosentivity Arthritis (not deformant) Malar rash Inmunologic criteria (anti dsDNA, anti Sm proteins) Neurologic symptoms ESR (elevated) Renal involment ANA Serositis (pleuritic pain, muffle heart sounds (pericarditis)) Hematologic abnormalities (cytopenias) ```

Skin findings on peripheral artery disease

Cold, thin, shiny with no hair

Complications of gastric bypass

Early: Leak Bowel ischemia ``` Late Anastomotic stricture Cholecystitis Dumping sd. Marginal ulcer ```

Urinary incontinance treatment

Urge type: antimuscarinic Oxybutin, tolterodine, darfenecin, trospium Overflow type: cholinergic agonist Bethanecol and beta agonist

Polymysitis/dermatomiositis

Proximal muscle weakness (dificulty climbing stairs, combing hair) CK elevation Positive: ANA, anti Jo malar rash similar to SLE

Complications of hyperglycemia in pregnancy

First trimester: Congenital heart disease, spontaneous abortion, small left colon sd, neural tube ``` >2nd trimester Macrosomia Organomegaly Neonatal hypoglycemia Polyctemia ``` All: RDS (insulin does not allow pneumocyte maturation), macrosomia, preterm delivery

Esophageal perforation management

NPO, saline, broad spectrum antibiotics, PPI Contained perforation: trial of medical management Not contained: surgical repair

Etiology of chronic pancreatitis

Alcoholism Cystic fibrosis Autoinmune Ductal obstruction

Sings and symptoms of chronic pancreatitis

Chronic epigastric abdominal pain (comes and goes) Malabsorption Diabetes Lipase may be normal

Weakness and leg cramps after intitation of thiazide diuretic

Severe hypokalemia. Think primary hyperaldosteronism

Best intial test for primary hyperaldosteronism. Treatment

Morning plasma aldosterone/ plasma renin Aldosterone level >15 and a PAC/PRA ratio >20 is diagnostic If tumor: resection If hyperplasia: aldosterone antagonist spironolactone, eplerenone

Metyrapone

Cortisol synthesis inhibitor used in patients with cushing sd awaiting for definite treatment

Glomerular vs no glomerular hematuria

Glomerular: Usually mycroscopic RBC cast, Dysmorphic RBC, positive blood + Proteins From no specific symptoms to neprhotic sd Post strep, IgA or Alport ``` Non glomerular Usually mycroscopic, No cast, positive blood. No proteins Sings of obstruction or dysuria Lithiasis, cancer, PKD, papillary necrosis ```

Renal ostedystrophy patophysiology

Renal failure===> low vitamin D production causes hypocalcemia and decreased PO4 secretion Elevated PO4 binds to Ca forming CaPO lowering Ca even more PTH stimulation Increases Ca resortion ===> bone pain

Serum albumin ascitis gradient

>1.1: portal hypertension <1: Cancer, nephrotic sd, tb, pancreatitis

Causes of hepatic encephalopathy

Increased NH3 production/absorption: Increased protein in diet, GI bleeding, constipation, infection Decreased NH3 excretion/metabolism Renal failure, diuretics, bypass hepatic blood flow post TIPS

Hepatic encephalopathy management

Lactulose: Increase NH4 formation (from NH3) | Rifaximin or neomycin (Decreased NH4 producing bacteria)

UW 10 Flashcards

(46 cards)