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Flashcards in UWSA1 Deck (89)
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1

what to think of if someone drinks antifreeze

ethylene glycol poisoning
-causing a metabolic acidosis with increased anion gap
-compensatory drop in paCO2

2

pt taking medication for BPH and nocturnal urinary symptoms, what should you be concerned about

they could be taking an alpha-blocker in which case lookout for orthostatic symptoms which occur du e to peripheral vasodilation

3

what heart problem can occur after a viral illness

acute pericarditis which can cause cardiac tamponade

4

why is there RBC elevation in CSF of someone with herpes encephalitis

result of hemorrhagic destruction of frontotemporal lobes

5

how does interstitial lung disease present
-progressive dyspnea and nonproductive cough
-fine bibasilar velcro-like crackles

pulmonary fibrosis that leads to stiffening of lungs and decreased lung compliance
-FEV1 and FVC decrease proportionally so the ratio is roughly the same or may even be increased

6

what is the most common cause of spinal stenosis and what is the classic symptom

dx definitively with MRI of spine even tho x-ray can suggest it

cause: degernative osteoarthritis (spondylosis)

symptom: neurogenic claudication, lower extremity pain with extension of spine and flexion relieves the pain

7

if pt has increased pigmentation in palmar creases what do you immediately think of

increased levels of ACTH (polypeptide) b/c when POMC gets cleaved into ACTH it also stimulates melanogenesis

8

when to use vaginal misoprostol

used for cervical ripening (softening and thinning of the cervix) in pts undergoing labor induction
-not used for pts in spontaneous active labor

9

most common etiology of active phase protraction of labor when cervical dilation is slower than expected (< 1cm ever 2 hours)

contraction inadequacy is most common
-give oxytocin

10

how to help prevent thrombotic events in pts with a.fib

give warfarin or NOAC (rivaroxaban, dabigatran, apixaban, edoxaban)

11

explain pleural fluid in pt with tb

very elevated protein (always >4), lymphocytic leukocytosis, low glucose < 60

12

what color is the fluid in a chylothorax

turbid or milky white
-due to leakage of chyle into thoracic space from obstruction of thoracic duct

13

when to give what vaccinations for HIV pts with CD4 count above 200

-all pts with HIV require pneumococcal and INACTIVATED influenza

-Zoster vaccination indicated for those with no hx of disease and no evidence of immunity

-once CD4count is below 200 then treat prophylactically for opportunistic infections

14

most common cause of superior vena cava syndrome

malignancy
-do radiation therapy

15

how does spontaneous bacterial peritonitis occur

peritoneal fluid becomes infected by enteric organism that translocates across intestinal wall
- >250 PMNs on paracentesis is diagnostic

16

how to treat bullous pemphigoid

high-potency topical glucocorticoids

17

which cancers most commonly go to the brain

melanoma, lung, breast, renal

18

why does tension pneumothorax lead to hypotension

essentially causes superior vena cava syndrome
-high intrathoracic pressure impedes venous return by compressing the vena cava
-needle decompression causes an increase in venous return

19

what is the most common manifestation of temporal lobe epilepsy

focal seizures with impaired awareness
-you know its from the temporal lobe because of the associated automatisms like hand or mouth movements

20

all forms of poorly controlled diabetes (pre and gestational) in pregnancy have increased risk of what

fetal lung immaturity
preterm delivery
macrosomia

21

when you see a pt with v.tach what is the next thing to do

determine if the pt is stable or unstable

-if stable then give IV amiodarone

22

how to treat supraventricular tachycardia/tachyarrhythmia

-adenosine
-digoxin
(verapamil or metoprolol if adenosine doesnt work)

23

what to think of if a pt has weakness and leg cramps after initiation of thiazide diuretic

significant hypokalemia

24

what to think of if pt has persistent hypertension OR hypertension and hypokalemia (muscle weakness)

hyperaldosteronism
-primary = tumor
-secondary = mimickers

25

what to lookout for after a pt has gastric bypass surgery

these pts have 30-40% chance of developing symptomatic gallstones due to rapid weight loss which promotes their formation (due to increased bile concentrations of mucin and calcium)

-usually pts get ursodeoxycholic acid 6 months postop to reduce risk of gallstone development

-if pt has gallstones before the surgery some surgeons might even just take out the gallbladder at that time too

26

pt with CKD has low calcium and high phosphate, what do you think of if they also have bone pain

secondary hyperparathyroidism
-kidney isnt helping increase the calcium so the bone works extra hard and becomes thinner cause its giving up so much calcium causing renal osteodystrophy and associated bone pain

27

how to treat overflow incontinence

cholinergic agonists

28

how does a pt with hepatic encephalopathy present and what do you look for after

altered mentation and asterixis with EtOH abuse hx

-look for cause in hx, look for infection, electrolyte abnormalities, and evaluate for high-nitrogen states like GI bleeding and dietary changes

-give lactulose

29

what presentation should make you think of septic shock

fever, tachycardia, hypotension, bronchial breath sounds (or something else that could be the site of initial infection)

30

what to be concerned about in septic shock

its a hypermetabolic state so pts might have insufficient o2 delivery to meet metabolic demands of peripheral tissues resulting in creased anaerobic metabolism from cells leading to buildup of lactic acid --> metabolic acidosis