UWorld 1 Flashcards
(120 cards)
1
Q
How do you manage pts with v fib or pulseless vtach
A
immediate defibrillation
{vs. pts with hemodynamic instability d/t a narrow or wide QRS complex tachyarrythmia (eg afib, a flutter, VT with a pulse) should be managed with synchronized cardioversion}
2
Q
OSA first tep tx
A
- weight reduction
- avoid sedatives and EtOH
- avoid supine posture d/r sleep
3
Q
chronic stable angina
A
chest discomfort occuring predictabl with exertion and relieve with rest
-results f/m mismatch of myocardial oxygen supply and demand
4
Q
three main medication classes for prevention of stable angina
A
beta blockers
-first line therapy, dec myocardial contractility and HR
CCB
- nondihydro: alternative to BB, dec myocardial contractility and HR
- dihydro: add to BB when needed; coronary artery vasoDILATION and dec afterload by systemic vasoDILATION
long-acting nitrates:
-long acting added for persistent angina; dec preload by dilation of capacitance veins
5
Q
etiology of constrictive pericarditis
A
- idiopathic or viral pericarditis
- cardiac sx or radiation therapy
- TB pericarditis (in endemic areas)
6
Q
CP of constrictive pericarditis
A
- fatigue and DOE
- peripheral edema and ascites
- inc JVP
- pericardial knock may be heard
- pulsus paradoxus
- Kussmaul’s sign
7
Q
Diagnostic findings of constrictive pericarditis
A
- ECG may be nonspecific or show afib or low voltage QRS complex
- imaging shows pericardial thickening and calcification
- jugular venous pulse tracing shows prominent x and y descents
8
Q
empyema
A
exudative effusions with a low glucose concentration d/t high metabolic activity of leukocytes and bacteria within the pleural fluid
9
Q
somatic symptom d/o
A
-excessive anxiety and preoccupation with >/=1 unexplained symptom
10
Q
illness anxiety d/o
A
fear of having a serious illness despite few or no symptoms and consistently negative evaluations
11
Q
conversion d/o (functional neurologic symptom d/o)
A
neurologic symptom incompatible with any known neurologic dz; often acute onset associated with stress
12
Q
factitious d/o
A
intentional falsification or inducement of symptoms with goal to assume sick role
13
Q
malingering
A
falsification or exaggeration of s/s to obtain external incentives (secondary gain)
14
Q
papillary thyroid carcinoma
A
primary treatment modaility: surgical resection
15
Q
cancer pain management
A
mild: nonopiods (acetaminophen, NSAIDS)
moderate: weak opioids +/- nonopiods (codeine, hydrocodone, tamadol)
severe: strong short-acting opioids (morphine, hydromorphone)…calculate total daily dose and convert to long acting formulation (fentanyl patch, oxycodone) PLUS short-acting opioids for breakthrough pain
16
Q
pulmonary HTN
A
common causes include LV systolic or diastolic dysfunction
-initla management includes loop diuretics and ACE inhibitors (or ARBs)
17
Q
osteoarthritis
A
RF: age>50, obesity, prior jt injury
hx: chronic, insidious s/s; minimal/no morning stiffness
PE: knees/hips, DIP jts, cervical/lumbar spine; hard, bony enlargement of joints; crepitus with movement
radiology: xrays=narrowed jt space, osteophytes, subchondral sclerosis
18
Q
approach to wide-complex tachycardia
A
AV dissociation? fusion/capture beats?
YES: diagnosis of ventricular tachycardia
a) stable-IV amiodraone
b)unstable: hypotension, altered mentation, respiratory distress…synchronized cardioversion
NO: consider SVT with aberrance
a) stable: maneuvers to determine rhythm (carotid massage, rate control and treat)
b) unstable: hypotension, altered mentation, respiratory distress…synchronized cardioversion
19
Q
pronator drift
A
- sn and sp sign for UMN or pyramidal tract dz affecting the UE
- on pt with pyramidal lesions the affected arm drifts downward and the palm turns (pronates) toward the floor
20
Q
ankylosing spondylitis
A
inflammatory back pain:
- insidious onset at age <40
- symptoms >3mo
- relieved with exercise but not rest
- nocturnal pain
exam findings:
- arthritis (sacroiliitis)
- reduced chest expansion and spinal mobility
- enthesitis (tenderness at tendon insertion sites)
- dacylitis (swelling of fingers and toes)
- uveitis
complications:
- osteoporosis/vertebral fractures
- aortic regurgitation
- cauda equina
lab: elevated ESR and CRP; HLA-B27 association
imaging: xray of sacroiliac jts, MRI of sacroiliac jts
21
Q
common causes of macrocytic anemia
A
- folate deficiency
- vit b12 deficiency
- myelodysplastic syndromes
- AML
- drug-induced (hydroxyurea, zidovudine, chemotherapy agents)
- liver dz
- alcohol abuse
- hypothyroidism
22
Q
common etiologies of cor pulmonale
A
- COPD (m/c)
- interstitial lung dz
- pulmonary vascular dz (eg, thromboembolic)
- OSA
23
Q
s/s on cor pulmonale
A
- DOE, fatigue, lethargy
- exertional syncope (due to dec CO)
- exertional angina (d/t inc myocardial demand)
24
Q
examination of cor pulmonale
A
- peripheral edema
- inc JVP with prominent a wave
- loud S2
- r-sided heave
- pulsatile liver from congestion
- tricuspid regurgitation murmur
25
imaging for cor pulmonale
- ECG: partial or complete RBBB, R. axis deviation, RVH, RAE
- echo: pulm HTN, dialted RV, tricuspid regurg
- R. heart catheterization: gold standard for diagnosis showing RV dysfunction, pulmonary HTN, and no left heart dz
26
central retinal vein occlusion
cp: acute or subacute painless monocular vision loss
- funduscopic exam: "blood and thunder" appearance consisting of optic disc swelling, retinal hemorrhages, dilated veins, and cotton wool spots
- venous dilation and tortuosity d/t venous occlusion
27
cyanide toxicity
- can occur in pts treated with nitroprusside who receive prolonged infusions, higher doses, or have underlying renal insufficiency
- CP: altered mental status, lactic acidosis, seizures, coma
28
etiology of avascular necrosis
- steroid use
- alcohol abuse
- SLE
- antiphospholipid syndrome
- hemoglobinopathies (eg sickle cell)
- infections (osteomyelitis, HIV)
- renal transplantation
- decompression sickness
29
avascular necrosis clinical manifestations
- groin pain on weight bearing
- pain on hip aBduction and internal rotation
- no erythema, swelling, or point tenderness
30
avascular necrosis lab findings and radiologic imaging
lab findings:
-nml WBC count and nml ESR and CRP
radiologic imaging: crescent sign seen in advanced stage; MRI is most sensitive modality
31
disseminated histoplasmosis epidemiology
- midwest and ctl US (ohio, Mississippi river valleys)
- soil contaminated by bird or bat droppings
- ince dose exposure or immunocompromised (AIDS)
32
disseminated histo s/s and tx
- systemic (f/c/malaise)
- weight loss and cachexia
- pulmonary (cough, dyspnea)
- mucuq lesions (papules, nodules)
- reticuloendothelial (HSM, LAD)
tx: ampho B (moderate-severe); itraconazole (mild/maintenance)
33
how do you reduce the risk of infection associated with urinary catheter use
clean intermittent catheterization
34
Goodpastures disease
- affects the lungs (causes cough, dyspnea, hemoptysis) and kidneys (causing nephritic range proteinuria, acute renal failure, and dysmorphic red cells/red cell casts on UA)
- diagnosis is made by renal biopsy showing linear IgG antibodies along the glomerular basement membrane
35
two types of contact dermatitis
1. allergic (type 4 HSR)
| 2. irritant (physical or chemical)
36
malaria chemoprophylaxis
- in areas with high rates of chloroquine resistance pts typically received atovaquone-proguanil, doxycycline, or mefloquine
- CP: cyclical fever with nonspecific constitutional and gi manifestations, anemia, and thrombocytopenia
37
causes of AMS
- drugs/toxins
- infections
- metabolic: electrolyte, hypo/hyperglycemia, endocrine, nutritional, hepatic/renal failure
- CNS
38
acute bronchitis
CP: cough for >5d to 3 weeks (+/- purulent sputum); absent systemic findings (f/c); wheezing or rhonchi; CW tenderness
diagnosis and tx: clinical diagnosis, CXR only when PNA is suspected; symptomatic tx (NSAIDs and/or bronchodilators); ABx not recommended
39
**antiplatelet/antithrombotic therapy for ischemic stroke**
- present within 3-4.5h of symptom onset: IV alteplase
- stroke sans prior antiplatelet therapy: ASA
- stroke on ASA therapy: ASA + dipyridamole OR clopidogrel
- stroke with evidence of afib: long-term anticoag (warfarin, dabigatran, rivaroxaban)
- stroke with large anteriro circulation occlusion within 24hrs of symptom onset: mechanical thrombectomy (regardless if pt received alteplase), then ASA
- pt with intracranial large-artery atherosclerosis: ASA + clopidogrel for 90d, then ASA
40
aortic regurg
- produces an early diastolic murmur
- can be associated with several physical signs caused by a hyperdynamic pulse including bounding or "water hammer" peripheral pulses
41
lumbar spinal stenosis
- common cause of back pain in pts >60
- characterized by back pain radiating to thighs that is worse with lumbar extension and persists while standing still
- vascular claudication is exertion-dependent and resolves with standing still
42
alveolar consolidation in PNA
- causes hypoxemia d/t R-to-L intrapulmonary shunting
- positional changes that makes teh consolidation more gravity dependent worsen V/Q mismatch, inc intrapulmonary shunting, and lead to worsened hypoxemia
43
exertional heat stroke
- occurs in otherwise healthy individuals undergoing conditioning in extreme heat and humidity d/t thermoregulation failure
- vs-
heat exhaustion: d/t inadequate fluid and salt replacement
-CNS dysfunction (AMS) is not present
44
cardiac tamponade etiology
- aortic aneurysm or postmyocardial infarction
- malignancy or radiation therapy
- infection (viral, TB)
- connective tissue dz (SLE)
- CV sx
45
cardiac tamponade clinical signs
- Beck triad: hypoTN, JVD, dec heart sounds
| - pulsus paradoxus (SBP dec >10 mm Hg with inspiration)
46
cardiac tamponade diagnosis
- ECG: low voltage QRS, electrical alternans
- CXR: enlarged cardiac silhouette, clear lungs
- echo: RA and ventricular collapse, plethora of the IVC
47
mycobacterium avium complex (MAC)
-ppx with azithromycin is given to pts with HIV when their CD4 cell count is <50/mm^3
48
MAC
-nonspecific systemic symptoms (fever, cough, abdo pain, diarrhea, night swears, weight loss) in presence of splenomegaly and an elevated alk phos
49
false negatives
will increase when the cut-off level of a diagnostic test is raised
50
what should raise suspicion for retroperitoneal hematoma
back pain and s/s of hemodynamic compromise
- anticoagulation with warfarin places pts at risk for hemorrhage
- retroperitoneal hematoma may occur even without a supratherapeutic INR
51
COPD
- pts often have chronic CO2 retention resulting in respiratory acidosis and compensatory metabolic alkalosis
- diuretics are often administered to treat cor pulmonale s/s but must be used cautiously as they can lead to a reduction in CO and subsequent development of perenal acute renal injury
52
syphilis manifestations
primary: painless genital ulcer (chancre)
secondary (systemic): diffuse rash (palms and soles), LAD (epitrochlear), condyloma lata, oral lesions, hepatitis
latent: asymptomatic
tertiary: CNS (tabes dorsalis, dementia), CV (aortic aneurysm/insufficiency), cutaneous (gummas)
53
syphilis diagnosis and tx
use both a treponemal and a nontreponemal test
| tx: pen G benzathine
54
amebiasis
- should be considered in pts with a liver abscess who have lived or traveled in an endemic area for Entamoeba histolytica
- initial eval: imaging, serologic testing empiric tx with metronidazole and a luminal agent (to eradicate intestinal colonization)
55
Nocardiosis
epi: endemic in soil, dz from inhalation or traumatic inoculation into skin, ic or elderly pts
clinical features: PNA-similar to TB, CNS involvement-brain abscess, cutaneous involvement
tx: Bactrim, surgical drainage of abscesses
56
treatment of choice for uric acid stones
-alkalinization of urine to pH 6-6.5 with oral potassium citrate
57
pellagra
- d/t niacin deficiency
- characterized by the "3 Ds": dermatitis, diarrhea, dementia
- prolonged isoniazid therapy can interfere with niacin metabolism and occasionally cause pellagra
58
symptoms of pulmonary HTN
- dyspnea, fatigue/weakness
- exertional angina, syncope
- abdominal distension/pain
59
signs of pulm HTN
- L. parasternal lift, RV heave
- loud P2, right-sided S3
- pancystolic murmur of tricuspid regurg
- JVD, ascites, peripheral edema, hepatomegaly
60
pulmonary arterial HTN
- common manifestation of systemic sclerosis that results form intimal hyperplasia of the pulmonary arteries
- absence of alveolar airspace dz and nml FEV1 and FEV1/FVC ratio help differentiate PAH from pulmonary HTN d/t lung dz or L-sided HF
61
common clinical features of untreated acromegaly
- pituitary enlargement, visual field defects, HA, CN defects
- gigantism, maloccluded jaw, arthralgias/arthritis, proximal myopathy, hyperhidrosis, skin tags, carpel tunnel syndrome
- cardiomyopathy, HTN, HF, valvular dz (mitral and aortic regurg)
- sleep apnea, narcolepsy, colon polyps/cancer, diverticulosis
- enlarged organs: tongue, thyroid, salivary glands, liver, spleen, kidney, prostate
- endo: galactorrhea, dec libido, DM, hyperparathyroidism, hyperTG
62
Hep C associated skin conditions
- porphyria cutanea tarda
| - cutaneous leukocytoclastic vasculitis (palpable purpura) 2/2 cryoglobulinemia
63
HIV infection associated skin conditions
sudden-onset severe psoriasis
- recurrent herpes zoster
- disseminated molluscum contagiosum
- severe seborrheic dermatitis
64
hemodynamics in HF
dec contractility-->dec CO-->compensatory neurohormonal activation-->inc SVR-->inc afterload
65
clinical manifestations of paroxysmal nocturnal hemoglobinuria
- hemolysis-->fatigue
- cytopenias (impaired hematopoiesis)
- venous thrombosis (intraabdominal, cerebral veins)
66
workup of paroxysmal nocturnal hemoglobinuria
- CBC (hypoplastic/aplastic anemia, thrombocytopenia, leukopenia)
- elevated LDH and low haptoglobin (hemolysis)
- indirect hyperbilirubinemia
- UA (hemoglobinuria)
- flow cytometry (absence of CD55 and CD59)
67
tx of paroxysmal nocturnal hemoglobinuria
- iron and folate supplementation
| - Eculizumab (monoclonal Ab that inhibits complement activation)
68
common causes of esophagitis in HIV
- candida albicans (white plaques, oral thrush)
- HSV (herpetic vesicles and round/ovoid ulcers; concurrent perioral/oral HSV)
- CMV: deep linear ulcers, distal esophagus
- idiopathic/aphthous: concurrent oral aphthous ulcers
69
infectious mono
suspected in a pt with: prolonged fever, malaise, exudative pharyngitis, hepatosplenomegaly, and generalized LAD
-pts may develop ai hemolytic anemia and thrombocytopenia up to 2-3 weeks after the onset of initial s/s
70
clinical manifestations of cushing syndrome
- ctl obesity (fat accumulation in the cheeks and dorsocervical and supraclavicular fat pads)
- skin atrophy and wide, purplish striae
- proximal mu weakness
- HTN
- glucose intolerance
- skin hyperpigmentation (if ACTH excess)
71
diagnosis of Cushing syndrome
- 24hr urinary cortisol excretion
- late-night salivary cortisol assay
- low-dose dexamethasone suppression test
72
viral myocarditis CP
- relatively young adults (age <60)
- viral prodrome (fever, malaise, myalgias)
- HF (dyspnea, orthopnea, edema)
- CP
- SCD
73
diagnosis of viral myocarditis
- ECG: nonspecific
- echo: 4 chamber dilation
- cardiac MRI: late enhancement of the epicardium
- biopsy: lymphocytic infiltration, viral DNA or RNA
74
treatment of viral myocarditis
- medication: diuretics, ACEI, BB
- temporary ventricular assist device (if needed)
- heart transplant if no recovery
75
nonalcoholic fatty liver dz definition
- hepatic steatosis on imaging or biopsy
- exclusion of significant alcohol use
- exclusion of other causes of fatty liver
76
clinical features of NAFLD
- mostly asymptomatic
- metabolic syndrome
- +/- steatohepatitis (AST/ALT ratio <1)
- hyperechoic texture on US
tx: diet and exercises, consider bariatric sx if BMI >/=35
77
raising the cutoff value
- will INC sp (fewer false positives) and DEC sn (more false negatives)
- screening tests need high sensitivity; confirmatory tests need high sp
78
causes of recurrent PNA involving same region of lung
local airway obstruction
- extrinsic bronchial compression (neoplasm, adenopathy)
- intrinsic bronchial obstruction (bronchiectasis, foreign body)
```
recurrent aspiration (region may vary depending on body position)
-sz; EtOH or drug use; GERD, dysphagia
```
79
causes of recurrent PNA involving different regions of lung
- immunodeficiency (HIV, leukemia, CVID)
- sinopulmonary dz (CF, immotile cilia)
- noninfectious (vasculitis, BOOP)
80
clinical manifestations of chikungunya fever
- incubation pd: 3-7 days
- high fevers, severe polyarthralgias (virtually always present)
- HA, myalgias, conjunctivitis, maculopapular rash
- lymphopenia, thrombocytopenia, elevated liver enzymes
81
indications for irradiated specialized RBC treatments
- BM transplant recipients
- acquired or congenital cellular immunodeficiency
- blood components donated by 1st or 2nd degree relatives
82
indications for leukoreduced specialized RBC treatments
- chronically transfused pts
- CMV seroneg at-risk pts (AIDS, transplant)
- potential transplant recipients
- previous febrile nonhemolytic transfusion reaction
83
indications for washed specialized RBC treatments
- IgA deficiency
- complement-dependent ai hemolytic anemia
- continued allergic reactions (eg hives) with red cell transfusion despite anti-histamine tx
84
pts with febrile neutropenia
- should be started on empiric broad spec Abc asas after blood cultures are obtained
- empiric monotherapy with an anti-pseudomonal agent (cefepime, meropenem, piperacillin-tazobactam) is recommended for initial management
85
infective endocarditis RF
- congenital heart dz or prosthetic valve
- previous endocarditis
- intravascular catheters
- IVDU
86
Infective endocarditis PE
- new regurgitant murmur
- skin: janeway lesions, osler nodes
- roth spots (eyes), splinter hemorrhages (nails)
- splenomegaly
- +/- signs of embolic phenomenon
87
diagnostic testing of infective endocarditis
- hematuria/proteinuria (glomerulonephritis_
- positive blood cultures
- TEE>TTE for detecting vegetation
88
Tx of infective endocarditis
acute: empirirc tx with vancomycin
subacute: tx based on culture results
89
Meds that cause hyperkalemia
-nonselective beta adrenergic blockers, ACEI, ARB, K-sparing diuretics; digitalis; cyclosporine; heparin; NSAIDS; Succinylcholine
90
HIV pts: HSV and VZV
both: can cause severe, acute retinal necrosis associated with pain, keratitis, uveitis, and funduscopic findings of peripheral pale lesions and central retinal necrosis
- CMV retinitis: painless, not usually associated with keratitis or conjunctivitis, characterized by funduscopic findings of hemorrhages and fluffly or granular lesions around the retinal vessels
91
myoglobinuria
- when theres large amt of blood on UA with a relative absence of RBCs on urine microscopy
- usually caused by rhabdo which frequently leads to acute renal failure
92
diuretic abuse
- leads to increased excretion of water and electrolytes by the kidneys, resulting in dehydration, weight loss, orthostatic hypoTN, hyponatremia, and hypokalemia
- urinary sodium and potassium will be elevated
93
primary percutaneous coronary intervention
- recommended within 90mins for acute, STEMI
- additional stabilization measures include: oxygen, full-dose ASA, platelet P2Y12 R-blockers, nitroglycerin for pain control, BB, and anticoagulation
-fibrinolysis may be administered within 12h of symptom onset for STEMI pts who cant undergo PCI but is associated with higher rates of recurrent myocardial infarction, ICH, andmortality compared to PCI
94
de Quervain tenosynovitis
- classically affects new moms who hold their infants with the thumb outstretched (abducted/extended)
- aBductor pollicis longus and extensor pollicis brevis tendons are affected
- passive stretch of these tendons elicits pain
95
COPD
decreased alveolar elasticity in COPD causes lung hyperinflation which results in inc total lung capacity, FRC, and RV, as well as diaphragmatic flattening
-flattened diaphragm has more difficulty contracting to expand the thoracic cavity, resulting in inc work of breathing
96
standard deviation of a nml distribution
68, 95, 99.7
97
gastrinoma (ZES)
- should be suspected in pts with multiple stomach ulcers and thickened gastric folds on endoscopy
- diagnosis is strongly suggested by a fasting serum gastrin level>1000pg/mL
- pts with non-diagnostic serum gastrin levels should be evaluated with a secretin stimulation test
98
digitalis toxicity
- causes inc ectopy and inc vagal tone
- atrial tachy with AV block occurs from the combination of these two digitalis effects and is relatively specific for digitalis toxicity
99
Zenker's diverticulum
- m/c in elderly men and cp: dysphagia, regurgitation, foul-smelling breath, aspiration, occasionally palpable mass
- contrast esophagram is test of choice for confirming the diagnosis
- tx: surgical
100
syphilis diagnostic serology
nontreponemal (RPR, VDRL)
- Ab to cardiolipin-cholesterol-lecithin Ag
- quantitative (titers)
- possible negative results in early infection
- dec in titers confirms tx
treponemal (FTA-ABS, TP-EIA)
- Ab to treponemal Ags
- qualitative (rxv/non-rxv)
- greater sn in early infection
- positive even after tx
101
squamous cell carcinoma
- the vast majority of head and neck ca
- suspicious for head and neck ca: hard, u/l non-tender LN in an older pt with a h/o smoking, such LN in the submandibular or cervical region
- undergo prompt bx to further evaluate this mass
102
Tinea versicolor (pityriasis versicolor)
path: malassezia globosa skin flora grows in exposure to hot and humid weather
clinical: hypo/hyper-pigmented or mildly erythematous lesions (face in kids, trunk and UE in adolescents/adults)
+/- fine scale and pruritus
diagnosis: KOH preperation shows hyphae and yeast cells in a "spaghetti and meatballs" pattern
tx: topical ketoconazole, terbinafine, selenium sulfide
103
central retinal artery occlusion
emergently treated with an ocular massage and high-flow oxygen administration
104
first generation H1-antihistamines
- have potent anticholinergic effects, may cause eye and oropharyngeal dryness as well as urinary retention
- d/t high prevalence of BPH, elderly men are at inc r/o urinary retention d/t anticholinergic activity
105
INC risk for gout
- meds: diuretics, low dose ASA
- sx, trauma, recent hospitalization
- volume depletion
- diet: high protein foods (meat, seafood), high-fat foods, fructose or sweetened beverages
- heavy alc consumption
- underlying medical conditions (HTN, obesity, CKD, organ transplant)
106
DEC risk for gout
- dairy product intake
- Vit C (>/= 1500 mg/day)
- coffee intake (>/=6 cups/day)
107
narrow-QRS-complex tachycardia
- IV adenosine is useful in initial diagnosis and management of pts with narrow QRS complex tachy
- it slows the sinurs rate, INC AV nodal conduction delay, or can cause a transient block in AV node conduction
- IV adenosine can be useful in identifying P waves to clarify diagnosis of a flutter or a tachy
- -it can also terminate paroxysmal supraventricular tachycardias by interrupting the AV nodal reentry circuit
108
reactive arthritis
- seroneg spondyloarthropathy resulting from enteric or GU infection
- findings in rxv arthritis may include: urethritis, conjunctivitis, mucoq lesions, enthesistis and asymmetric oligoarthritis
- NSAIDs=first line therapy
109
Jehovahs Witness
in the absence of an advance directive, a life-saving blood transfusion can be given to a JW who lacks decision-making capacity
110
Entamoeba histolytica
RF: developing nations, contaminated food/water, fecal oral sexual transmission (rare)
manifestation: 90% of pts asymptomatic; colitis: diarrhea, bloody stool with mucus, abdominal pain; liver abscess (RUQ pain, fever)--complications: rupture to pleura/peritoneum
diagnosis: S ova and p, stool ag testing (colitis), E histolytica serology (liver abscess)
tx: metro and intraluminal abx (paromomycin)
111
pulmonary emboli
- cp: sudden-onset pleuritic CP, cough, dyspnea
- hemoptysis can occue 2/2 pulm infarction
- chest CT scan showing a wedge-shaped infarction is pathonomonic
112
UTI
dipstick positive for leukocyte esterase and nitrite in the urine
- leukocyte esterase: significant pyuria
- nitrites: Enterobacteriaceae present
113
two important causes of hypoglycemia in non-diabetic pts with elevated insulin levels
1. insulinoma (beta cell tumor)
| 2. surreptitious use of insulin or sulfonylurea
114
UC
s/s: bloody diarrhea, weight loss/fever
endoscopic findings: erythema, friable mucosa; pseudopolyps; involvement of rectosigmoid; continuous colonic involvement (no skip lesions)
bx: mucosal and submucosal inflamm; crypt abscesses
complication: toxic megacolon, PSC, CRC, erythema nodosum, pyoderma gangrenosum, spondyloarthritis
115
hepatojugular reflux
- clinical tool to differentiate between cardiac and liver dz related causes of LE edema
- pts with periph edema d/t HF have elevated jugular venous pressure and positive hepatojugular reflux
- -those with peripheral edema from primary hepatic dz and cirrhosis have reduced or nml jugular venous pressure and negative hepatojugular reflux
116
tumor in the head of the pancreas
- cp: weight loss, jaundice, nontender, distended gallbladder on exam
- imaging: intra and extrahepatic biliary tract dilation
117
manifestations of cyanide accumulation and toxicity
- skin: flushing (cherry-red color), cyanosis (occurs later)
- CNS: HA, AMS, sz, coma
- CV: arrhythmias
- Resp: tachypneas followed by respiratory depression, pulm edema
- GI: abdo pain, n/v
- Renal: metabolic acidosis (from lactic acidosis), renal failure
118
Dressler's syndrome
- pts present weeks after an MI w/ CP that is improved by leaning forward
- NSAIDs=tx of choice
- anticoagulation should be avoided to prevent development of a hemorrhagic pericardial effusion
119
achalasia
CP: chronic dysphagia to liquids and solids, regurg; heartburn, weight loss
diagnosis: manometry (inc LES resting pressure, incomplete LES relaxation, dec peristalsis of distal esophagus); barium esophagram: smooth bird beak narrowing at gastroesophageal jxn
management: upper endoscopy to exclude malignancy; laparoscopic myotomy or pneumatic balloon dilation; botulinum toxin injection, nitrates and CCB
120
cryptococcal meningoencephalitis
CP: HA, fever, malaise; develops over 2 wks; can be more acute and severe in HIV
Diagnosis: CSF--high opening pressure, low glucose/high protein, WBC <50uL with mononuclear predominance, transparent capsule seen with India ink stain, cryptococcal Ag positive, culture on Sabouraud agar
tx: initially with Ampho B with flucytosine and maintenance with fluconazole
