Term
| What are the three types of atrial septal defects? List them in order of highest to lowest in location in the septum |
|
Definition
-sinus venosus defects
-ostium secundum (MC- in the region of the foramen ovale)
-ostium primum (down syndrome pt's commonly and may be associated with a complete atrioventricular canal defect) |
|
|
Term
| What is eisenmenger's disease? |
|
Definition
| In CHD irreversible pulmonary HTN leads to reversal of shunt, HF, and cyanosis |
|
|
Term
| About 75% of patients with holt oram syndrome have what type of heart defect? |
|
Definition
|
|
Term
| What other genetic disorder is associated with ASD besides holt oram? |
|
Definition
|
|
Term
| What are two things seen on a CXR that would lead you to think coarctation of the aorta? |
|
Definition
Figure 3 appearance
Notching of the ribs |
|
|
Term
| What should be given to an infant patient presenting with coarctation of the aorta and cardiac decompensation at first to try and restore blood flow? |
|
Definition
| Iv infusion of Prostaglandin E1 to chemically open the ductus arteriosus |
|
|
Term
| Most coarcted aortas are _________ in position |
|
Definition
|
|
Term
| Coarctation of the aorta is often accompanied by what two other heart defects |
|
Definition
-bicuspid aortic valve
-VSD |
|
|
Term
| What is postcoarcectomy syndrome and what is done to prevent it? |
|
Definition
| Restoring pulsatile blood flow to the mess enteric arteries can cause mess enteric arteritis so feedings are usually delayed for 48 hours to prevent this |
|
|
Term
| In coarctation of the aorta there is a difference in what part of the heart looks hypertrophied on ECG and CXR depending on the age of the child... Explain |
|
Definition
Infants: RVH
children: LVH |
|
|
Term
| Describe the murmur heard with a PDA |
|
Definition
|
|
Term
| What class of drugs will close a PDA? What class of drugs will maintain a PDA? |
|
Definition
NSAIDs will close a PDA so pregnant women must avoid them
Prostaglandins will maintain a PDA |
|
|
Term
| What are the four typical features in tetralogy of fallot? What is the less common fifth that makes up the Pentad? |
|
Definition
-RVOTO
-malaligned VSD
-aorta that overrides the VSD
-RVH
5th- ASD |
|
|
Term
| Why do older pt's with tetralogy of fallot sometimes squat to ease the symptoms? |
|
Definition
| To increase peripheral vascular resistance which decreases the magnitude of the left to right shunt across the VSD |
|
|
Term
| What is the characteristic CXR finding in a pt with tetralogy of fallot? |
|
Definition
|
|
Term
| In a pediatric pt with HTN what two classes of drugs are usually the first to be prescribed for treatment? |
|
Definition
-ACEI's: may be ESP beneficial in obese pt's since the likely mech is increased sodium retention and increased SNS activation- they also have beneficial effects in diabetes and dyslipidemia
-CCB's
*both classes are generally well tolerated and can be dosed once daily with a minimal side effect profile |
|
|
Term
| What two classes of hypertensive meds should be avoided in pediatric obese HTN patients? |
|
Definition
-diuretics: bc they can worsen insulin resistance and dyslipidemia, as well as increase SNS and renin activity
-BBs: bc they can lead to weight gain, increased TG's, and decreased HDL levels |
|
|
Term
|
Definition
| localized or diffuse dilation of an artery with diameter of at least 50% greater than the NL size of the artery |
|
|
Term
| what are the 3 layers of a blood vessel wall? |
|
Definition
|
|
Term
| What is the difference between a true aneurysm and a pseudo aneurysm? |
|
Definition
True= involves all three layers and is contained inside the endothelium
False= involves only the outer layer and is contained by adventitia |
|
|
Term
| What are the two types of shapes of aneurysms? Which shape is characteristic of a true and which is characteristic of a false aneurysm? |
|
Definition
-saccular= false
-fusiform= true |
|
|
Term
| what is the MC RF of a thoracic aortic aneurysm? What is the MC RF of a AAA? What is the MC RF of an aortic dissection |
|
Definition
atherosclerotic dz
atherosclerotic dz
HTN |
|
|
Term
| Name some commons RFs for TAA and AAAs |
|
Definition
| smoking, COPD, males, ATHEROSCLEROSIS, family hx, uni/bicuspid aortic valves, incr age, high BMI |
|
|
Term
| What is the indication for surgery with a thoracic aortic aneurysm? |
|
Definition
SIZE
-ascending aorta: >5.5cm or 2x the diam of NL contiguous aorta
-descending aorta: >6.5 cm |
|
|
Term
| what is the most commmon location of a AAA |
|
Definition
| infrarenal segment above the iliac bifurcation (95%) |
|
|
Term
| give the typical pt with a AAA |
|
Definition
| male >65 yo with peripheral vasc disease, who smokes (or did in the past) |
|
|
Term
| What is the most characteristic PE finding for a AAA |
|
Definition
| palpable pulsatile abd mass, but its found on <50% of patients |
|
|
Term
| What is the classic triad of a AAA rupture? |
|
Definition
1. abd pain
2. hypotension
3. palpable pulsatile abd mass
*present in 30-50% of cases |
|
|
Term
| what is the #1 radiological study to dx AAA |
|
Definition
|
|
Term
| What is the tx criteria for a unruptured AAA |
|
Definition
-quit smoking -aggressive HTN control (BBs)
-incidental (<3 cm) no further follow up
-3-4 cm= annual US to monitor change
-4-4.5 cm= US Q6 months
->4.5 cm= referral to vasc surg |
|
|
Term
| describe the blood vessel wall in an aortic dissection |
|
Definition
| an intimal tear allows blood to escape and is contained in the media creating a true and false lumen |
|
|
Term
| What are the 3 points of fixation of the aorta that are often injured in traumatic circumstances |
|
Definition
-aortic root
-at the attachment to the ligamentum arteriosum
-diaphragmatic hiatus |
|
|
Term
| what are the stanford classifications for aortic dissections and what is the tx for each |
|
Definition
-type A- ascending, surg
-type B- descending, med mngmnt |
|
|
Term
| what is the #1 RF for an aortic dissection |
|
Definition
|
|
Term
| name the three areas of the thorax where pain from different locations of an aortic dissection may occur? |
|
Definition
-ant chest/ mimicking acute MI= ascending
-neck/jaw: arch, root
-intrascap: descending |
|
|
Term
| what are good radiological exams for aortic dissection |
|
Definition
-CXR= widened mediastium >8 mm AP view
-TEE= noninvasive and at bedside
-CT for a hemodynamically stable pt |
|
|
Term
| What is the tx for an aortic dissection- immediate and surgical? |
|
Definition
immediate= IV bb to decr HR and diminish LV ejection force, Iv Na Nitroprusside to bring systolic below 120
type a= surg
type b= med mngmnt |
|
|
Term
| what is the definition of cardiogenic shock? |
|
Definition
| decreased cardiac output and tissue hypoxia in the presence of adequate intravascular volume |
|
|
Term
| what is the leading cause of death in acute MI? |
|
Definition
|
|
Term
| what is the hallmark s/sx of cardiogenic shock |
|
Definition
| hypoperfusion without hypovolemia |
|
|
Term
| what is the most important initial thing to order on a pt who presents with possible cardiogenic shock? |
|
Definition
|
|
Term
| give the three paremeters that define cardiogenic shock in regards to systolic BP, cardiac index, and pulmonary capillary wedge pressure |
|
Definition
systolic <90 (diastolic <60, no a parameter though)
cardiac index <2.2
PCW >15 mmHg |
|
|
Term
| what is the #1 pressor used in cardiogenic shock |
|
Definition
|
|
Term
| what are two blood thinning agents used in patients suffering from acute MI |
|
Definition
|
|
Term
| what is the cell life of a platelet? How does aspirin work? |
|
Definition
10 days-ish
inhibits platelet cyclo-oxygenase and lasts for the life of the cell |
|
|
Term
| what are some major causes of hypovolemic shock? |
|
Definition
| GI bleed, major surg, extrav of plasma, trauma, burns |
|
|
Term
| what are some common causes of obstructive shock |
|
Definition
| Tension PTX, pericardial tamponade, obstructive valvular disease, PE |
|
|
Term
| what is the clinical definition of orthostatic hypotension |
|
Definition
| sustained drop in systolic BP (>20 mmHg) or diastolic (>10 mmHg) within 3 minutes of standing |
|
|
Term
| how do you differentiate neurogenic from non-neurogenic causes of orthostatic hypotension when measuring orthostatic BPs |
|
Definition
| non-neurogenic causes will have the drop in BP but accompanied by an increase of HR of >15 bpm |
|
|
Term
| name some meds that can cause orthostatic hypotension |
|
Definition
| antihypertensives, antidepressants, ETOH, narcotics, insulin, CCBs |
|
|
Term
| what is the criteria for SIRS? |
|
Definition
2 of these must be met
-HR >90
-RR >20 or PaCO2 <32mmHg
-Temp >100.4 or <96.8
-Wbc >12000 or <4000 |
|
|
Term
|
Definition
| SIRS + a known source of infection |
|
|
Term
| what is designated as severe sepsis? |
|
Definition
| sepsis + end organ function |
|
|
Term
|
Definition
| state of acute ciruclatory failure characterized by persistent arterial hypotension despite adequate fluid resuscitation or by tissue hypoperfusion (lactate >4). unexplained by any other cause! |
|
|
Term
|
Definition
| viable bacteria within the liquid component of blood |
|
|
Term
| what is the number one drug used for a pt experiencing anaphylactic shock? What are the next two steps in medications? |
|
Definition
epinephrine
-H1 and H2 blocker (diphenhydramine + ranitidine)
-corticosteroids (prevent late phase anaphylaxis) |
|
|
Term
| what is neurogenic shock? |
|
Definition
| it occurs after a spinal cord injury. sympathetic outflow is disrupted resulting in unopposed vagal tone which leads to hypotension and bradycardia |
|
|
Term
| the anatomic level of injury impacts the severity of neurogenic shock, at what vertebral level is the entire sympathetic system likely to be disrupted |
|
Definition
above t1
from t1-L3 only partial sympathetic outflow may be disrupted |
|
|
Term
| what is used to maintain BP in neurogenic shock? reverse bradycardia? what can be given to prevent worsening of the neuro deficits |
|
Definition
crystalloid fluids, OR dopamine or dobutamine
atropine
methylprednisolone |
|
|
Term
| What is infective endocarditis? |
|
Definition
| an infection of the endocardium (innermost surface of the heart) usually involving the cusps of the valves |
|
|
Term
| What are some of the MC pts that would present with an infective endocarditis? |
|
Definition
| pts with structural cardiac defects (acfquired stenosis or regurgitation) or pts that have had a valve replacement. also IV drug users and hx of indwelling pulm catheter or central venous catheter |
|
|
Term
| if a patient presents with an unexplained fever and a new onset of a heart murmur, what should always be on the differential? |
|
Definition
|
|
Term
| what valve is MC associated with infective endocarditis? which valves are MC affected after? What valve is MC affected in IV drug users? |
|
Definition
-mitral, aortic, mitral +aortic, tricuspid, rarely pulmonic
-tricuspid in IV drug users (MC cause of R sided IE) |
|
|
Term
| Some common signs of infective endocarditis are splinter hemorrhages, osler nodes, roth spots, and janeway lesions. describe what each of these is |
|
Definition
-splinter hemorrhages: linear red marks on the nail bed
-osler nodes: painful raised lesions on the fingers and toes)
-roth spots: lesions on the retina with small, clear centers
-janeway lesions: painless red lesions on the palms or soles |
|
|
Term
| what is the MC causative agent in acute endocarditis (native valve) |
|
Definition
|
|
Term
| what is the MC causative agent in subacute native valve IE |
|
Definition
|
|
Term
| acute pericarditis is an inflammation of the pericardium characterized by what three things? |
|
Definition
| chest pain, pericardial friction rub, and EKG changes |
|
|
Term
| describe the chest pain associated with acute pericarditis |
|
Definition
| sharp, substernal or pericordial and pleuritic. radiating sometimes to the trapezius, relieved by sitting forward and upright but WORSENED when lying down, with inspiration/swallowing, and with certain body movements |
|
|
Term
| What is the mainstay of tx for acute pericarditis? how about acute pericarditis due to a recent MI? |
|
Definition
NSAIDs
use Aspirin with post MI bc NSAIDs delay ventricular healing |
|
|
Term
| Are corticosteroids indicated for tx of acute pericarditis? |
|
Definition
| not usually, they rarely tx it fully and it usually returns. use nsaids |
|
|
Term
| the pericardium usually contains how much fluid? it can expand to hold how much fluid? what happens when this is exceeded? |
|
Definition
20-50 mL
90-120 mL
capacity of atria and ventricle to fill is compromised which increases pericardial pressure, leading to decr stroke volume, decr CO, and hypotension |
|
|
Term
| what is cardiac tamponade? |
|
Definition
| a medical emergency caused by fluid in the pericardial space, resulting in decreased ventricular filling and subsequent hemodynamic compromise |
|
|
Term
| what is the MCC of pericardial effusion leading to cardiac tamponade? |
|
Definition
|
|
Term
| WHat is beck's triad? what is it the classic presentation of? |
|
Definition
cardiac tamponade!
1. hypotension
2. narrow pulse pressure
3. quiet heart sounds |
|
|
Term
| What are the three most common findings in a patient with cardiac tamponade |
|
Definition
dyspnea
jugular venous distention
tachycardia |
|
|
Term
| what is pulsus paradoxis? what is it pathognomic for? |
|
Definition
pericardial effusion!
-an abnormally large decrease in systolic pressure during inspiration. normal fall in pressure is <10 mmHg |
|
|
Term
|
Definition
| during inspiration venous return to the heart should increased and any neck vein distention should diminish. when there is an absence of collapse or a paradoxical rise in the jugular column--- this is kussmauls sign |
|
|
Term
| cardiac tamponade is completely reliant on the ________ of fluid accumulation |
|
Definition
|
|
Term
| during pericardial effusion, if fluid accumulates rapidly how much fluid does it take to cause in incr in pericardial pressure and a decr in CO? if it accumulates slowly, over time, how much fluid can theoretically accumulate before any hemodynamic compromise? |
|
Definition
|
|
Term
| what should all patients with cardaic tamponade receive initally for tx? what is the gold standard of tx? |
|
Definition
-O2, vol expansion with fluids, bed rest with leg elevation, inotropic drugs (dobutamine)
-pericardiocentesis! |
|
|
Term
| what are the 4 different kinds of pericardial effusions? |
|
Definition
1. exudates (leaky capillaries: infection, malignancy, trauma)
2. transudates (incr. hydrostatic or decr. oncotic pressures: CHF, atelectasis, renal or liver dz)
3. empyema: infection in pleural space
4. hemothorax: trauma or malignancy |
|
|
Term
| what is the gold standard for dx of a pericardial effusion |
|
Definition
| thoracocentesis and the fluid is sent for eval |
|
|
Term
| what is acute coronary syndrome |
|
Definition
| spectrum of clinical presentations seen in a range from unstable angina to NSTEMI to STEMI |
|
|
Term
| What is the primary cause of acute coronary syndrome? |
|
Definition
|
|
Term
| Low levels of what to cations can cause cardiac arrhytmias? these should always be checked in a patient with any cardiac complaint |
|
Definition
|
|
Term
| Initial tx for an acute coronary event is MONA, what does this stand for (include dosages) |
|
Definition
M- morphine 2-5 mg IV Q5-30min PRN (can sub Fentanyl)
O- oxygen 4 L/min via nasal cannula
N- nitroglycerin 0.4 mg SL Q5min MAX 3 tab
A- aspirin 165-325, sub clopidogrel 300-600mg loading dose if allergic to ASA |
|
|
Term
| what do ST elevations represent in a pt with ACS (acute coronary syndrome) |
|
Definition
| active and ongoing transmural myocardial injury |
|
|
Term
| NSTEMI can be differentiated from unstable angina, how? |
|
Definition
| presence of cardiac enzymes |
|
|
Term
| the posterior descending artery arises from the RCA or the LCA? |
|
Definition
| can arise from either, but most often arises from the RCA |
|
|
Term
| obstruction of the right coronary artery commonly affects what pacing node in the heart? how does the manifest physically? |
|
Definition
| SA node and the AV node and a bradycardia may be present with or without heart block |
|
|
Term
| What are the 5 cardiac risk factors? |
|
Definition
HTN
DM
Smoking
FAmily Hx
Hyperlipidemia |
|
|
Term
| What is Dresslers syndrome? |
|
Definition
| a post MI syndrome that includes pericarditis, fever, leukocytosis, and pericardial or pleural effusions |
|
|
Term
| Which cardiac enzymes are elevated 3-12 hrs after injury, are peaked at 24 hours, and return to normal at 5-14 days? |
|
Definition
|
|
Term
| which cardiac enzymes are elevated 3-12 hours after initial injury, peak at 24 hours, and return to normal at 48-72 hours |
|
Definition
|
|
Term
| what is the absolute first thing you should order on anyone with chest pain? |
|
Definition
|
|
Term
| differentiate stable vs unstable vs prinzmetal angina |
|
Definition
Stable- exacerbated with activity and relieves with rest
unstable- increasing intensity in a resting pt
prinzetal- vasospasm at rest with preservation of ability to do physical activity |
|
|
Term
| differentiate stable vs unstable vs prinzmetal angina |
|
Definition
Stable- exacerbated with activity and relieves with rest
unstable- increasing intensity in a resting pt
prinzetal- vasospasm at rest with preservation of ability to do physical activity |
|
|
Term
| What is the MC type of cardiomyopathy? also, the MCC of heart transplant, and the 3rd MCC of heart failure... |
|
Definition
|
|
Term
| What are the most common causes of dilated cardiomyopathy? |
|
Definition
-usually an insult to the cells
-Ischemia, d/t CAD and prior MI
-ETOH abuse
-infection |
|
|
Term
| Is dilated cardiomyopathy a diastolic or systolic problem? Describe the pathophysiology. |
|
Definition
| Its a diastolic issue. There is decreased LV function and decreased strength of contraction which leads to dilation of the LV, this dilation leads to further dysfunction of contractility and heart failure ensues. |
|
|
Term
| What two murmurs are associated with dilated cardiomyopathy, why? |
|
Definition
| tricuspid and mitral regurgitation can occur due to the progressive dilation |
|
|
Term
| What is the most common presenting symptom of dilated cardiomyopathy? What do the signs and symptoms generally mimic? |
|
Definition
-Dyspnea
-CHF (both L and R sided!)--> fatigue, DOE, SOB, orthopnea, paroxysmal nocturnal dyspnea, incr edema, incr weight, and incr abd girth |
|
|
Term
| What type of extra heart sound is associated with dilated cardiomyopathy? |
|
Definition
|
|
Term
| What will an echo of dilated cardiomyopathy pt show? |
|
Definition
| LV dilation and dysfunction with high diastolic pressure and decreased cardiac output. The LV wall is usually NL though |
|
|
Term
| What are the three points of tx for dilated cardiomyopathy |
|
Definition
-remove offending agent if possible (like ETOH)
-tx like CHF: diuretics, ACEI/ARBs, BBs, etc
-Anticoagulation should be considered since these pts are at high risk for embolization |
|
|
Term
| What are most cases of hypertrophic cardiomyopathy caused by? |
|
Definition
| most are inherited as an autosomal dominant trait, but some are due to spontaneous mutations |
|
|
Term
| Is the main issue in hypertrophic cardiomyopathy diastolic or systolic dysfunction? Explain pathophys |
|
Definition
| Diastolic. The ventricles become stiff and hypertrophied, causing increased diastolic filling pressures. There is no issue with systolic function. Also these pts often have an outflow obstruction that exacerbates the issues. The diastolic pressures increase further with things that incr HR and contractility (exercise) or decr L ventricular filling (valsalva) |
|
|
Term
| What are some sx of hypertrophic cardiomyopathy |
|
Definition
| -sx: DOE, angina, dizziness or syncope after exertion, palpitations, SUDDEN DEATH |
|
|
Term
| What are some signs of hypertrophic cardiomyopathy? What extra heart sound is associated? |
|
Definition
-S4 (due to blood from the atria hitting a noncomplaint ventricle)
-SEM
-bisiferous pulse
-elevated diastolic BP
-sustained PMI |
|
|
Term
| Where is the SEM of hypertrophic cardiomyopathy best heard? |
|
Definition
| Left lower sternal border |
|
|
Term
| What factors increase the SEM of hypertrophic cardiomyopathy and what decr it? |
|
Definition
-Increased: with valsalva and standing (decr L ventricular size and therefore decr filling)
-Decreased: sustained handgrip (incr systemic resistance decr the pressure gradient across the aortic valve), squatting or lying down (incr LV filling) |
|
|
Term
| What does and echo of a hypertrophic cardiomyopathy pt show? |
|
Definition
| LVH, asymmetric septal hypertrophy, small LV and diastolic dysfxn |
|
|
Term
| What is the tx FOR ALL PTS with hypertrophic cardiomyopathy |
|
Definition
| AVOID STRENUOUS ACTIVITY! |
|
|
Term
| What is the tx for a sx-atic pt with hypertrophic cardiomyopathy |
|
Definition
BBs, CCBs if no relief from BBs
diuretics if fluid retention |
|
|
Term
| What is the surgical option for hypertrophic cardiomyopathy patients |
|
Definition
| myomectomy by excising part of the myocardial septum, or mitral valve replacement |
|
|
Term
| What is the least common type of the 3 types of cardiomyopathy? |
|
Definition
|
|
Term
| Is restrictive cardiomyopathy a systolic or diastolic problem? explain pathophys |
|
Definition
| diastolic, restricted ventricular filling dt decreased ventricular compliance. The systolic function and ventricular wall thickness are normal |
|
|
Term
| What are some causes of restrictive cardiomyopathy |
|
Definition
| amyloidosis, sarcoidosis, hemochromatosis, scleroderma, idiopathic |
|
|
Term
| What are the s/sx of restrictive cardiomyopathy |
|
Definition
| -elevated filling pressures cause signs of L heart failure (dyspnea and exercise intolerance) and R heart failure (peripheral edema, ascites) |
|
|
Term
| What does an echo of a pt with restrictive cardiomyopathy show |
|
Definition
| Thickened myocardium and possible systolic ventricular dysfxn. Incr r and L atrium size with NL LV and RV size. |
|
|
Term
| In a pt with amyloidosis and restrictive cardiomyopathy what does the myocardium appear as on echo |
|
Definition
| brighter than usual or with a speckled appearance |
|
|
Term
| How is restrictive cardiomyopathy tx? |
|
Definition
-tx underlying cause: hemo (phlebotomy or deferoxamine), sarcoidosis (glucocorticoids), amyloidosis (possibly chemo)
-other CHF treatments as needed |
|
|
Term
| How is restrictive cardiomyopathy tx? |
|
Definition
-tx underlying cause: hemo (phlebotomy or deferoxamine), sarcoidosis (glucocorticoids), amyloidosis (possibly chemo)
-other CHF treatments as needed |
|
|
Term
| In AFib, what is the typical atrial rate? Ventricular rate? |
|
Definition
-atrial: >400
-ventricular: 75-175 |
|
|
Term
| What are the three main goals of tx of AFib? |
|
Definition
-Ventricular Rate control (of greater importance than rhythm control!)
- Restore NSR
-Assess need for anticoagulation |
|
|
Term
| What are some common drugs used for controlling ventricular rate in AFib? |
|
Definition
-CCBs: Diltiazem (Cardizem)
-Beta Blockers: Carvedilol, esmolol
-Digoxin (rarely ever used alone), Amiodarone (if refractory to other tx) |
|
|
Term
| What is the rule for cardioverting new onset Afib-- If its been present for less than 48 hours? Greater than 48 hours? |
|
Definition
-less than 48 hours, okay to cardiovert
-greater than 48 hours: either need to anticoagulate for 3 weeks then cardiovert, or get a TEE and r/o atrial thrombus and immediately cardiovert |
|
|
Term
| How long should a patient with new onset AFib be anticoagulated after cardioversion... assuming they will not need lifelong cardioversion ? |
|
Definition
|
|
Term
| In a hemodynamically UNSTABLE patient with AFib, what are the parameters for cardioversion? |
|
Definition
| Always immediately cardiovert, regardless of how long AFib has been going on |
|
|
Term
| What is the CHADS2 score? What are the parameters? What score requires anticoagulation chronically? |
|
Definition
-clinical prediction for the risk of stroke in patients with non-valvular AF
-CHF, HTN, age >75, DM, Previous stroke or TIA
-all are worth one point
-a score >2 should be started on OAC, unless contraindicated |
|
|
Term
| What is the pathognomonic description of AFib's rhythm? |
|
Definition
|
|
Term
| What is the pathognomonic description of a rhythm strip of a flutter? |
|
Definition
|
|
Term
| What is the most common cause of atrial flutter? |
|
Definition
|
|
Term
| What is an AV block? How many different types are there? |
|
Definition
It is a refractory conduction of impulses from the atria to the ventricles through the AV Node or the Bundle of His.
-There is first degree, Second degree type 1 (wenkebach) and second degree type 2 (Mobitz), and third degree (total) AV Block |
|
|
Term
| What is a first degree AV block-- what will be seen on EKG? What must be the same in every cycle for it to be considered first degree? |
|
Definition
-on EKG you will see a QRS that is greater than 0.2 seconds (or one large box on the EKG).
-The PR interval must be prolonged the same amount of time each cycle, and the P-QRS-T sequence is normal in every cycle also |
|
|
Term
| Where exactly is the delay in a first degree AV BLock? |
|
Definition
|
|
Term
| What is the tx for a first degree AV block? |
|
Definition
| it's a benign condition, no tx necessary |
|
|
Term
| What is the difference between the specific area that is blocked in the two types of second degree blocks? |
|
Definition
-In a Wenckebach (type 1), there is block of the AV node
-In a Mobitz (type 2), there is block of the purkinje fiber bundles (His Bundle or Bundle Branches) |
|
|
Term
| Describe what is seen on an EKG of a 2nd degree Mobitz block? |
|
Definition
| -there is progressive lengthening of the PR interval until finally the AV node is totally blocked and a QRS is dropped. There is usually a consistent pattern of P:QRS ratio too, such as 3:2 (always one more P than QRS) |
|
|
Term
| Does a 2nd degree Mobitz AV block require tx? |
|
Definition
| No, it's benign and no tx is necessary |
|
|
Term
| Describe what a 2nd degree Mobitz (type 2) AV block looks like on an EKG? The ratio of P to QRS? |
|
Definition
-you will see a number of totally blocked paced atrial depolarizations before conduction to the ventricles is successful.
-the ratio of P:QRS is often something like 3:1, or even higher |
|
|
Term
| What is the treatment of a 2nd Degree Mobitz (Type 2) AV block |
|
Definition
| this is a serious condition that can lead to a complete heart block, a pacemaker is often necessary |
|
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Term
| Just by looking at an EKG, how can one differentiate between a Wenckebach and Mobitz AV block, if they're both 2:1 ratio |
|
Definition
-since Wenckebach originates in the AV node, you will see a lengthened PR interval
-since Mobtiz originates below the AV node (His Bundle or Bundle Branches) you will see a widened QRS with a normal PR interval |
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Term
| How can one use vagal maneuvers on a pt to determine the difference between a Wenckebach and a Mobitz if they are both 2:1 and hard to differentiate on EKG? |
|
Definition
-The AV node is richly supplied with parasympathetic innervation, so vagal maneuvers inhibit the AV node, making it more refractory
-Since Wenkebach's originate in the AV node, the vagal maneuver will increase the parasympathetic innervation of the AV node, increasing the number of cycles/series to produce a 3:2 or 4:3 wenkebach
-in the Mobitz, the block is in the ventricular conduction, so a vagal maneuver will either eliminate the block or have no effect |
|
|
Term
| what is a complete 3rd degree AV block? |
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Definition
| it is total block of conduction to the ventricles, so atrial depolarizations are not conducted. The ventricles take over and start pacing at their inherent rate of 25-40 bpm |
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|
Term
| What is the tx of a complete 3rd degree AV block |
|
Definition
|
|
Term
| What is a bundle branch block? What will be seen on EKG (specifically, how wide will the QRS be?) |
|
Definition
-its a delay in conduction to either the Left or the Right bundle branch
-on EKG you will see a widened QRS with two peaks
-the QRS should be wider greater than .12 seconds (three small squares), bc simultaneous depolarization of the ventricles typically occurs in less than .12 seconds |
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|
Term
| What leads will you see a Right bundle branch block in? Left? |
|
Definition
|
|
Term
| What is considered an incomplete Bundle branch block? |
|
Definition
| when you see the two peaked R's of a BBB in a QRS of normal duration |
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|
Term
| which type of Bundle Branch block is thought of to be more severe (telling of a more serious underlying disease) |
|
Definition
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|
Term
| What is the tx for a symptomatic BBB? |
|
Definition
pacemaker
possibly cardiac resynchronization tx |
|
|
Term
| What two types of rhythms are bundled under the term 'supraventricular tachycardia'? |
|
Definition
-paroxysmal atria tachycardia and paroxysmal junctional tachycardia
-because they both originate above the ventricles |
|
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Term
| What is the difference between paroxysmal atrial tachycardia and paroxysmal junctional tachycardia in terms of where they occur |
|
Definition
-They both are paced at rates of 150-250 bpm
-PAT occurs from an irritable focus in the atria
-PJT occurs from an irritable focus in the AV junction |
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|
Term
| What will PAT look like on EKG? |
|
Definition
-the p waves will not look like normal sinus p waves.
-there will be a P for every QRS
-150-250 bpm |
|
|
Term
| What will PJT look like on EKG? |
|
Definition
| no discernable P waves, usually, and paced at a rate of 150-250 bpm |
|
|
Term
| When you see PAT with an AV Block at a 2:1 P:QRS ratio, what should be the first thing that comes to mind? What is the tx? |
|
Definition
-Digitalis toxicity
-Occurs more often in pt's with low K, so can carefully give IV K |
|
|
Term
| Why might one see inverted P waves randomly in PJT? |
|
Definition
| Because a rapidly pacing junctional focus may also depolarize the atria from below in a retrograde fashion |
|
|
Term
| What are some tx options for PSVT? |
|
Definition
-Valsalva, carotid massage, cough, holding breath, head immersion in cold water
-IV adenosine is first choice
-Back up choices are IV verapamil and IV esmolol |
|
|
Term
| What are the side effects of adenosine |
|
Definition
| -headache, flushing, SOB, chest pressure, nausea |
|
|
Term
| Why does digitalis cause the PAT with 2:1 AV BLock? |
|
Definition
| Because excess digoxin can provoke an atrial focus into such an irritable state that it suddenly paces rapidly. BUT it markedly inhibits the AV node so that only every second stimulus conducts to the ventricles |
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|
Term
| What is the definition of a premature atrial contraction (PAC)? What will it look like on EKG |
|
Definition
| early beat arising from an automaticity focus in the atria. On EKG will see an early p wave that looks different in morphology than the normal sinus P wave, but the QRS should be normal |
|
|
Term
| What is the tx for symptomatic PACs? |
|
Definition
|
|
Term
| What are some causes of PACs? |
|
Definition
| Adrenergic excess, alcohol, drugs, infection, electrolyte imbalances, dig toxicity |
|
|
Term
| What is a PVC? Look like on EKG? |
|
Definition
| A beat arising from an automaticity focus in one ventricle, that slowly spreads to the other. On EKG you will see a large, wide QRS complex with a compensatory pause afterword, and usually no p wave. The reason the QRS complex is so wide is it's paced by a ventricular focus that paces at an inherently slower rate than the SA node |
|
|
Term
| What is the most lethal cause of PVC? |
|
Definition
| hypoxic myocardial tissue |
|
|
Term
| What does a couplet, bigeminy, and trigeminy mean in terms of PVCs? |
|
Definition
| -couplet is two successive PVCs, bigeminy is a sinus beat followed by a PVC, trigeminy is a sinus beat followed by two PVCs |
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Term
|
Definition
| nothing unless symptomatic. BBs if symptomatic. Russ Dailey also mentioned lidocaine? |
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|
Term
| What is the definition of ventricular tachycardia? Where does it originate-- are p waves still present/atria still functioning? |
|
Definition
| the rapid firing of three or more PVCs in a row, at a rate between 100 and 250 bpm. AV dissociation is present, so the atria are steal beating at their inherent rate (not affected by the tachy), the problem is distal to the bundle of His (otherwise it would be a supraventricular tachycardia!) |
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|
Term
| What are two of the MCCs of PVC? Name some others... |
|
Definition
-CAD with hx of MI
-Electrolyte disturbances: hypoK, hypoCa, and hypoMg
-prolonged QT, drug toxicity, congenital defects |
|
|
Term
| What are Cannon A Waves? Why is it seen in V Tach? |
|
Definition
| venous pulsations that occur secondary to the right atrium contracting against a closed tricuspid valve. Since the atria are contracting at a normal rate and the ventricles are dissociated, the atria will inevitably at some points be contracting against closed valves. |
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|
Term
| What is the tx for VTach in a pt with sustained who is hemodynamically stable, and those who are unstable? |
|
Definition
-Stable: IV procainamide, amiodarone, or Solatol
-Unstable: immediate cardioversion then IV amiodarone to hold the NSR |
|
|
Term
| What is the tx for a stable pt in nonsustained v tach who has no underlying cardiac dz and is asymptomatic? how about those with underlying cardiac disease? |
|
Definition
-no tx, they are not at increased risk of sudden death
-electrophysiologic studies to determine need for ICD and amiodarone is the best antiarhythmic drug |
|
|
Term
| What is torsades de pointes and what causes it? |
|
Definition
-V Tach in which the QRS complexes are twisting around the baseline
-Caused spontaneously, 'lyte disturbances, or due to Long QT syndrome |
|
|
Term
| What is long QT syndrome? |
|
Definition
| a congenital or acquired DO that is characterized by recurrent syncope, a QT interval .5-.7 sec long, Ventricular arrhthmyias and occasionally sudden death |
|
|
Term
| What is Brugada syndrome? |
|
Definition
| a congenital DO more common in asian men that causes syncope, v fib, and sudden death |
|
|
Term
| What is the MCC of Vfib? other causes (2)? |
|
Definition
-ischemic heart disease
-antiarrythmics that cause Long QT syndrome
-AFib with RVR in a pt with WPW syndrome |
|
|
Term
| What will be seen on an EKG of VFib? |
|
Definition
| Bag of worms, no discernible waves, very irregular rhythm |
|
|
Term
| Give the steps for ACLS of a pt in VFib... |
|
Definition
-CPR and defibrillation x 2, start epi at 1 mg bolus then Q3-5 min, defib again
-After 3rd shock, start amiodarone 300 mg (may repeat once in 5 min a dose of 150 mg) |
|
|
Term
| What is the tx for torsades de pointes? |
|
Definition
| defibrillation and IV Magnesium |
|
|
Term
| 95% of HTN cases are due to essential HTN with no identifiable cause. What are some lifestyle choices that exacerbate essential HTN? |
|
Definition
| -ETOH, tobacco, high salt intake, lack of exercise, NSAIDs, and low K intake |
|
|
Term
| What is the MCC of secondary htn overall? in young women? other causes? |
|
Definition
-renal artery stenosis
-OCP use
-sleep apnea, coarctation of aorta, chronic steroid tx, cushing's, thyroid and parathyroid disease, primary hyperaldosteronism |
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|
Term
| What is a normal BP, pre HTN, HTN? HTN urgency vs. malignant htn (htn emergency)? |
|
Definition
-120/80 and below
-121-139/81-89
-140/90 and above
->180/>120 and the difference is emergency has signs of end organ damage |
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|
Term
| What are two of the most common initial pharm tx for HTN? in diabetics? mechanism of actions... |
|
Definition
-Thiazide diuretic (acts on distal renal tubule to increase excretion of sodium and chloride--these pt's should have a K supplement) and BB's (decr. HR and CO and decr renin release)
-ACE Inhibitor (inhibits renin-angiotensin system and inhibits bradykinin degradation--bradykinin dilates BVs, so inhibiting it's degradation helps to keep BP low) |
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|
Term
| What is the difference between the inital tx for a pt with stage 1 and stage 2 htn. |
|
Definition
-stage 1 (140-159/90-99) Lifestyle mods and 1 drug
-stage 2 (>160/>100) lifestyle mods and 2 drugs |
|
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Term
| What is an added bonus of thiazide diuretics, and part of the reason why they should always be first or second line in HTN tx? |
|
Definition
| bc they increase the effectiveness of all other HTN meds |
|
|
Term
| WHat time period of sx is necessary for a dx of GAD to be made? |
|
Definition
| excessive anxiety and worry (apprehensive expectation) occurring more days than not for at least 6 months |
|
|
Term
| Which sex is more commonly effected by GAD? |
|
Definition
| women 2x more often than men |
|
|
Term
| PET scan of a person with GAD may possibly reveal increased blood flow to what part of the brain? |
|
Definition
| the right parahippocampus in the frontal lobe |
|
|
Term
| What two classes of drugs are effective in the tx of GAD? |
|
Definition
-Benzodiazepines: alprazolam (xanax), diazepam (valium), clonazepam (klonopin), lorazepam (ativan)
-SSRIs: citalopram (celexa), paroxetine (paxil), venlafaxine (effexor), escitalopram (lexapro), and sertraline (zoloft) |
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|
Term
| What are the two classes of meds used for panic disorders in general> |
|
Definition
|
|
Term
|
Definition
| characterized by recurrent, unexpected panic attacks that occur abruptly and are accompanied by debilitating fear of having additional attacks-- also feeling of impending harm or death, fear of MI or stroke, and fear of going "crazy" |
|
|
Term
| panic disorder is more common in which sex? |
|
Definition
| 2-3x more common in females |
|
|
Term
| What can be infused into a patient with panic disorder to produce anxiety? This infusion causes an elevation in what neurotransmitter level? |
|
Definition
|
|
Term
| What comorbidity, of unknown significance, is seen in 50% of patients with panic DO? |
|
Definition
|
|
Term
| What SSRI and what benzo are specifically implicated for the tx of panic disorder? |
|
Definition
-alprazolam (xanax)
-paroxetine (paxil) |
|
|
Term
| How is the diagnosis of a phobia made? |
|
Definition
| the phobic stimuli must interfere with the patient's daily routine, social, or occupational functioning |
|
|
Term
| what are the five types of specific phobias? |
|
Definition
-animal
-natural environment (storms, heights, water)
-blood-injection injury (fear of invasive procedures)
-situational (bridges, tall buildings, heights, flying, etc)
-other (situations that may lead to choking/vomiting or getting an illness- kids could be loud noises or costumed characters) |
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|
Term
| What are the three main types of phobias? |
|
Definition
specific (5 subtypes)
social: fear of social situations in which embarrassment or humiliation in front of other people may occur (public speaking, using public restrooms, eating in public)
-agoraphobia (intense anxiety about placing oneself into a situation in which incapacitating problem could occur and no help would be available) |
|
|
Term
| what is the best class of medication to tx social and agoraphobia? specific phobias? |
|
Definition
-social and agoraphobia: SSRIs
-specific: short term benzo's and BB's |
|
|
Term
| in a patient less than 18 years old, how long must a phobia be present for it to be dx? |
|
Definition
|
|
Term
| FOr diagnosis of PTSD, the list of sx that the patient must have at least three of must be present for how long? |
|
Definition
|
|
Term
| When the sx of PTSD have been present for less than one month, what is the dx? |
|
Definition
|
|
Term
| what class of meds is considered first line for tx of PTSD? |
|
Definition
|
|
Term
| Describe the body image of a pt with anorexia nervosa? |
|
Definition
| these pt's have a distorted body image and an intense fear of becoming fat even though they are underweight |
|
|
Term
| what are the three criteria that make the diagnosis for anorexia nervosa? |
|
Definition
1. a self-induced starvation to a significant degree
2. a relentless drive for thinness or a morbid fear of fatness
3. the presence of medical signs and symptoms resulting from starvation |
|
|
Term
| what specific medication is contraindicated in patients with eating disorders because it lowers the seizure threshold? |
|
Definition
|
|
Term
| Name a medication commonly used in anorexic patients to stimulate appetite |
|
Definition
| cyproheptadine (periactin) an h2 receptor blocker that may promote weight gain |
|
|
Term
| what heart condition is a complication of anorexia? |
|
Definition
|
|
Term
| At what percentages below recommended weight for height is it indicated for an anorexic patient to be hospitalized? |
|
Definition
20% below hospitalize to restore nutritional state
30% below- psychiatric hospitalization for 2-6 months |
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|
Term
| Describe a bulimic patient |
|
Definition
| employ binge eating as well as vomiting, use of laxatives, and/or diuretics, excessive exercise, or other measures to avoid gaining weight. unlike anorexia- these pts maintain a normal body weight or they may be overweight |
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|
Term
| What are the 4 criteria necessary to make a dx of bulimia? |
|
Definition
1. episodes of binge eating occur twice a week or more for at least 3 months
2. compensatory behaviors are practiced after binge eating to prevent weight gain
3. weight is not severely lowered
4. pt has morbid fear of fatness, relentless drive for thinness, or both |
|
|
Term
| patients with bulimia who vomit a lot would have hypo/hyper-amylasemia? |
|
Definition
| hyperamylasemia due to hypersecretion from the salivary glands |
|
|
Term
| what is the body weight and BMI definition of obesity? |
|
Definition
| more than 20% over ideal body weight or a BMI greater than 30 |
|
|
Term
| what lipase inhibiting medication is sometimes used for obesity tx? |
|
Definition
|
|
Term
| What are the three basic forms of ADHD (ADD)? |
|
Definition
1. attentional
2. hyperactive/impulsive
3. combined |
|
|
Term
| Major neurologic fxns disturbed by the neurotransmitter imbalance of ADHD (ADD) fall into the category of ________ function |
|
Definition
|
|
Term
| what part of the brain are critical in executive function and have been identified in patients with ADHD (ADD) as being abnormal? |
|
Definition
| frontal cortex and the circuits linking them to the basal ganglia |
|
|
Term
| there are many criteria that need to be met to dx ADHD (ADD), at what age must symptoms be present before to make dx? how many situations must sx be present for dx? |
|
Definition
before age 7
greater than or equal to 2 situations (work, home, school etc) |
|
|
Term
| What two alpha2-adrenergic agonists are indicated for tx of ADHD (ADD)? |
|
Definition
-Guanfacine (Intuniv)
-Clonidine (Kapvay) |
|
|
Term
| What SNRI is inidcated for the tx of ADHD (ADD)? |
|
Definition
-Atomoxetine (Strattera)
*when stimulants can not be tolerated at a dose necessary for efficacy (e.g. bc of anxiety) and atomoxetine is not efficacious alone- the combo of this and a low dose stimulant is often very effective |
|
|
Term
| Name some adverse effects of psychostimulants in the tx of ADD (ADHD) |
|
Definition
| anorexia, sleep disturbances, mild anxiety, and rebound |
|
|
Term
| Name some of the major psychostimulants used in the tx of ADHD (ADD) |
|
Definition
-dextroamphetamine (dexedrine)
-methylphenidate (concerta, methylin, metadate, ritalin, quillivant XR)
-dextroamphetamine/amphetamine mix (adderall)
-dexmethylphenidate (focalin)
-lisdexamfetamine (vyvanse)
-methylphenidate transdermal patch (daytrana) |
|
|
Term
| WHat are the 3 key criteria from the DSM IV for diagnosis of autistic DO? |
|
Definition
1. impairments in social interaction
2. impairments in communication
3. a restricted repetitive range of interests, behaviors, and activities |
|
|
Term
|
Definition
| pervasive and sustained feeling tone that is experienced internally and that influences a person's behavior and perception of the world |
|
|
Term
|
Definition
| the external expression of mood |
|
|
Term
| what neurotransmitter is most commonly associated with depression? |
|
Definition
|
|
Term
| describe levels of dopamine possible in depression and mania |
|
Definition
depression: reduced
mania: increased |
|
|
Term
| describe the different ways depression can present in prepubertal, adolescents, and elderly patients |
|
Definition
-prepubescent: somatic complaints, agitation, single-voice auditory hallucinations, anxiety do's, phobia
-adolescence: substance abuse, antisocial behavior, restlessness, truancy, school difficulties, promiscuity, increased sensitivty to rejection and poor hygiene
-elderly: cognitive deficits, pseudodementia, apathy, and distractability |
|
|
Term
|
Definition
| maladaptive behavioral or emotional symptoms that develop within 3 months after a stressful life event and end within 6 months after the event AND are NOT caused by bereavement |
|
|
Term
| name some life situations that may lead to adjustment disorder in childhood and adulthood |
|
Definition
-adolescents: parental rejection/divorce, school problems, leaving home
-adults: marital discord, financial probs, loss of job |
|
|
Term
| describe bipolar 1 disorder |
|
Definition
| the occurrence of one or more manic or mixed episodes which often cycle with depressive episodes (depressive episode NOT necessary for dx). aka manic depression |
|
|
Term
|
Definition
| characterized by at least one or more major depressive episodes and at least one hypomanic episode. The patient has NEVER experienced a manic episode or a mixed episode. |
|
|
Term
| Name some of the top first line meds to treat bipolar disorder |
|
Definition
-Lithium (must monitor serum levels- very narrow therapeutic window- about 1 mmol/L)
-Valproic Acid (depakote)
-Carbamezapine (tegretol) |
|
|
Term
| 50% of hospitalized pts with MDD have what subtype? |
|
Definition
| melancholia- either a loss of pleasure in all activities or a lack of reactivity to usually pleasurable stimuli is present. |
|
|
Term
| Described catatonic depression |
|
Definition
| characterized by motor immobility or stupor, blurred affect, purposeless motor activty, extreme withdrawal, negativism, bizarre mannerisms, echolalia, echopraxia, or wavy flexibility |
|
|
Term
| what is the first line class of meds to treat depression |
|
Definition
|
|
Term
| name a good SSRI for elderly pts |
|
Definition
|
|
Term
Describe cyclothymic DO
-how long must sx be present?
-what is the longest amount of time that pt can be absent of sx? |
|
Definition
| recurring periods of relatively less severe depressive episodes and hypomania over a 2-year period, with symptoms free periods lasting for no more than 2 months at any time. Depressive episodes are not severe enough to be classified as MDD and manic or mixed episodes have not occurred. |
|
|
Term
Describe dysthymic disorder
-how long must sx be present?
-what is the longest amount of time a pt can go without sx? |
|
Definition
-chronic persistent mild depression that is manifested by pessimism, brooding, generalized loss of interest, decreased productivity, feelings of inadequacy, and social withdrawal
-There are no psychotic, manic/hypomanic features
-depressed mood for most of the day for more days than not for at least 2 years and pt has not gone without sx for more than 2 years at a time |
|
|
Term
| what personality disorder is described by: extreme sensitivty to rejection (inferiority complex) and they see themselves as unappealing |
|
Definition
|
|
Term
| what personality disorder is described by: enduring pattern of dependent, clinging, and submissive behavior; they cannot make their own decisions without help from others |
|
Definition
|
|
Term
| what personality disorder is described by: pervasive pattern of orderliness and perfectionism and inflexibility, unlike other personality do's these pts have an awareness of their DO and seek tx on their own |
|
Definition
|
|
Term
| what personality disorder is described by: pervasive distrust and suspicion of other, beginning by early adulthood. patients blame their own problems on others and seem hostile and agry |
|
Definition
|
|
Term
| what personality disorder is described by: characterized by a lifelone pattern of voluntary social withdrawal, often perceived as eccentric and reclusive. patients are quiet and unsociable and have constricted affect. they have no desire for close relationships and prefer to be alone |
|
Definition
|
|
Term
| what personality disorder is described by: pervasive pattern of eccentric behavior and peculiar thought patterns beginning in early adulthood, the pt is perceived by others as strange and eccentric |
|
Definition
|
|
Term
| what personality disorder is described by: inability to conform to social norms, pervasive pattern for disregard and violation of the rights and feelings of others. described as extremely manipulative, deceitful, impulsive, and totally lacking empathy or remorse. can seem exceedingly charming and normal on interview |
|
Definition
|
|
Term
| what personality disorder is described by: unstable and unpredicatble mood and affect and behavior as well as poorly established self image. mood swings and impulsivity are common, pts always seems to be in a state of crisis |
|
Definition
|
|
Term
| what personality disorder is described by: pts are overly dramatic, emotional, and seductive; they are excitable, with a high degree of attention seeking behavior and a tendency to exaggerate their thoughts and feelings |
|
Definition
|
|
Term
| what personality disorder is described by: pts have an inflated self image, pattern of grandiosity, and need for admiration, they also lack empathy |
|
Definition
|
|
Term
| What is delusional disorder? |
|
Definition
| characterized by the presence of non-bizarre, fixed, and unshakable delusions in the absence of other mood or psychotic symptoms (non-bizarre situations that could occur in real life) |
|
|
Term
| What are the four main types of delusions associated with delusional disorder? |
|
Definition
-erotomanic: someone is obsessed with the pt
-somatic: bodily delusions
-jealous: spouse/partner is cheating on the pt
-persecutory: paranoid delusions |
|
|
Term
| How long must delusions be present for a dx of delusional do? |
|
Definition
| 1 month with no other signs of psychotic DOs |
|
|
Term
| Name and describe the 5 subtypes of schizophrenia |
|
Definition
1. paranoid: presence of delusions of persecution or grandeur, pts are tense, suspicious, and guarded. intelligence remains intact
2. disorganized: marked regression to primitive, disinhibited, and chaotic behavior. incoherence, loosening of associations, flat affect, pronounced thought DO, unkempt, incongruous grimacing/grinning. early onset before 25 yoa
3. catatonic: classic is marked disturbance in motor function called waxy flexibility, purposeless excitement, speech disturbances
4. undifferentiated: prominent delusions, hallucinations, incoherence, or grossly disturbed behavior that does not meet the criteria for the above 3
5. residual: absence of the sx listed for #4, but continuing evidence of the disturbance through two or more residual symptoms (emotional blunting, social withdrawal) |
|
|
Term
specified symptoms of schizophrenia must be for how long of a period and continuous signs of disorder must be present for how long for a diagnosis
` |
|
Definition
|
|
Term
| what is the difference between schizophrenia and schizphreniform disorder? |
|
Definition
| schizophreniform is when symptoms have been present for less than 6 months |
|
|
Term
| when is the diagnosis of schizo affective disorder made? |
|
Definition
| when patients have features of a mood disorder (depression or mania) and schizophrenia (delusions, hallucination, disordered thinking) but does not meet the criteria for either dx alone |
|
|
Term
| what makes the dx of schizo affective |
|
Definition
| an uninterrupted period of illness occurs in which a major depressive episode, a manic episode, or a mixed episode occurs with the symptoms that meet the criterion for schizophrenia. during that same period of illness, delusions of hallucinations occur for at least 2 weeks in the absence of prominent mood symptoms |
|
|
Term
|
Definition
| a less severe form of mania characterized by elevated mood, hyperactivity, and grandiosity. in contrast to mania, these symptoms do not cause significant impairment in the individuals productivity at work, or social and family relationships (its a mild form of mania) |
|
|
Term
| What DOs are classified by pts presenting with vague physical complaints involving many organ systems that cannot be explained by general medical condition or substance use. visits to health care providers are numerous, although no do is ever found |
|
Definition
|
|
Term
| What are the 4 subtypes of somatiform DOs |
|
Definition
body dysmorphic
conversion
hypochondriasis
pain |
|
|
Term
| describe body dysmorphic disorder |
|
Definition
| preoccupation with an imagined defect in physical appearance or an exaggerated distortion of a minor flaw. the most common concerns are facial flaws. the pt goes to great lengths to hide or correct their perceived anomaly. |
|
|
Term
| describe conversion disorder |
|
Definition
| one or more neurologic complaints that cannot be clinically explained- sx are not intentionally produced and may be motor, sensory, seziure activity, or mixed. most common sx are shifting paralysis, blindness, and mutism |
|
|
Term
|
Definition
| preoccupation with the belief of having, or fear of contracting, a serious illness. not of delusional intensity, normal bodily sensations are misinterpreted as manifestations of diseas. fear persists even when medical eval shows no cause |
|
|
Term
|
Definition
| pain is reported in one or more areas without any identifiable cause and results in significant distress and impairment in functioning. pt views pain as a cause of all of their problems. usually an abrupt onset and pain may continue for weeks |
|
|
Term
| what is another name for factitious DO |
|
Definition
|
|
Term
| what is the primary motivation for a patient with factitious do (maunchausens) |
|
Definition
|
|
Term
| what is the DO when a patient intentionally fakes signs and symptoms of a medical or psychiatric DO in order to assume the sick role |
|
Definition
| factitious DO, aka munchausens |
|
|
Term
| what is the term for the DO in which a pt deliberately produces physical or psychological symptoms motivated by external gain. goals of the pt often include avoiding responsibilty, police or legal action, punishment or board, or obtaining drugs |
|
Definition
|
|
Term
| what does the term pseudocyesis mean |
|
Definition
| signs and symptoms of an intentional false pregnancy, or the pt has themselves convinced that they are pregnant |
|
|
Term
| what is somatization DO (Briquets) |
|
Definition
| it presents with hx of recurrent multiple physical complaints of several years duration |
|
|
Term
| according to exam master, what is the first line SSRI for panic DO? |
|
Definition
|
|
Term
| according to exam master, what is the first line SSRI for social phobia? |
|
Definition
|
|
Term
| according to EM, what is the first line SSRI for post partum depression |
|
Definition
|
|
Term
| what is the best non-pharm tx for OCD |
|
Definition
|
|
Term
| what is the term for : Consideration of objects or ideas as specific items rather than as an abstract representation of a more general concept, as contrasted with abstract thinking (e.g., perceiving a chair and a table as individual useful items and not as members of the general class, furniture). |
|
Definition
|
|
Term
|
Definition
| Agitated or restless movement, usually affecting the legs and accompanied by a sense of discomfort. It is a common side effect of neuroleptic medications. |
|
|
Term
| what is tardive dyskinesia? common sx? |
|
Definition
| a DO that involves involuntary movements, esp of the loewr face. caused by long term use of neuroleptics. common sx are facial grimacing, finger movement, jaw swinging, repetitive chewing, tongue thrusting |
|
|
Term
| list some common signs and symptoms of serotonin syndrome |
|
Definition
| agitation and restlessness, confusion, rapid HR, high BP, dilated pupils, loss of muscle coordination, musc twitching, heavy sweating, diarrhea, HA, shivering, goose bumps |
|
|
Term
| name some life threatening signs and symptoms of serotonin syndrome |
|
Definition
| high fever, seizures, irregular heart beat, unconsciousness |
|
|
Term
| what is the definition of substance abuse |
|
Definition
| substance use that has not met the criteria for dependence but has resulted in impairment |
|
|
Term
| what is substance dependence |
|
Definition
| physical dependence is the physiologic changes that occur with drug use and result in withdrawal symptoms on the termination of use. physiologic dependence refers to the craving or desire for the substance independent of the physiologic withdrawal sx. these two things occur together and is termed substance dependence. |
|
|
Term
| what is substance withdrawal |
|
Definition
| a need to use a substance to relieve or avoid physical symptoms associated with deprivation of it |
|
|
Term
| what is an alcohol deterrent medication that causes nausea when ETOH is consumed? |
|
Definition
|
|
Term
| what medication is used to reverse the effects of opioids? |
|
Definition
|
|
Term
| what is the timeline for the dx of acute reaction to stress |
|
Definition
| sx must persist for a minimum of two days up to 4 weeks within a month of the trauma. |
|
|
Term
| what disorder is diagnosed based on a pattern of behavior that involves violation of the basic right of others or of social norms with at least three acts of the following types: aggression toward people and animals, destruction of property, deceitfulness, and serious violations of rules |
|
Definition
|
|
Term
| what are the 5 stages of grieving? |
|
Definition
| denial, anger, bargaining, depression, acceptance |
|
|
Term
| What are some pathognomonic brain lesions of a patient with Alzheimer disease |
|
Definition
neurofibrillary tangles (NFTs)
beta amyloid plaques (senile plaques; SPs) |
|
|
Term
| Name some lab tests to run on a patient who is demented to rule out non-Alzheimer causes |
|
Definition
CBC
heavy metal screens
serum lytes
Glucose
TSH
B12 and folate
renal/liver fxn
drug and alcohol levels |
|
|
Term
| What is Dr. Olivera's treatment plan for a patient with Alzheimer disease? (the cholinergic drugs, not side meds). what is his timeline for tx (when do you stop?) |
|
Definition
-Aricept first (works on the Ach NT)
-Namenda added to Arciept after one year (sensitizes receptor to Ach)
-Exelon- works like Aricept, usually used alone, comes in patch form, has many GI side effects
*after 4 years stop tx, brain has less neurons and you will flood the brain with Ach |
|
|
Term
| Lumbar puncture is currently a research technique for Alzheimer disease, what is found in the CSF of an AD patient? |
|
Definition
| high levels of tau and phosphorylated tau and low levels of amyloid |
|
|
Term
| what is the MC type of dementia |
|
Definition
|
|
Term
| what are the three most common mechanisms of vascular dementia |
|
Definition
-multiple cortical infarcts
-strategic single lesion
-small vessel disease |
|
|
Term
| the absence of what on CT scan or MRI is evidence AGAINST vascular pathology? |
|
Definition
|
|
Term
| how does vascular dementia progress? pathognomonic... |
|
Definition
|
|
Term
| what is the mainstay of treatment for vascular dementia? name two classes of meds used |
|
Definition
-prevent new strokes
-Antiplatelets: aspirin, ticlopidine (ticlid), clopidogrel (plavix)
-Hemorheologic agents (improve cerebral blood flow): pentoxifylline (trental) |
|
|
Term
| what is the term for when demented patients start telling untrue stories? |
|
Definition
|
|
Term
| what are some meds used for agitation dementia? short term and long term? |
|
Definition
-short term: zyprexa
-long term: buspar or depakote |
|
|
Term
| what does the acronym P.DIMM WIT stand for in regards to causes of delerium |
|
Definition
Post operative state
Dehydration and malnutrition
Infection (sepsis, meningitis, encephalitis, UTI, etc)
Meds and drug tox (TCA, corticosteroids, anticholinergics, hallucinogens, cocaine)
metals
Withdrawal states (ETOH and benzos)
Inflammation, fever
Trauma, burns |
|
|
Term
| describe the difference between a demented patient and a delirious patient in terms of level of consciousness |
|
Definition
demented: preserved
delirious: altered and fluctuating |
|
|
Term
| describe the difference between a demented patient and a delirious patient in terms of hallucinations |
|
Definition
dement: rarely present
delir: frequent (visual) |
|
|
Term
| describe the difference between a demented patient and a delirious patient in terms of tremor |
|
Definition
dement: rarely present unless due to parkinson dz
delir: sometimes (asterixis) |
|
|
Term
| describe the difference between a demented patient and a delirious patient in terms of tremor |
|
Definition
dement: rarely present unless due to parkinson dz
delir: sometimes (asterixis) |
|
|
Term
| describe the difference between a demented patient and a delirious patient in terms of course. what is sundowning? |
|
Definition
dement: insidious and progressive
delir: rapid onset, then waxing and waning. SUNDOWNING: worsening at night |
|
|
Term
| describe the difference between a demented patient and a delirious patient in terms of reversibility |
|
Definition
dement: typically irreversible
delir: almost always reversible |
|
|
Term
| what is the treatment of deliriuM? |
|
Definition
treat cause
reduce meds if theyre the cause
symptomatic: neuroleptics (haloperidol, seroquel, risperdal), benzo's (lorazepam), olanzapine (zyprexa) |
|
|
Term
| what is the leading cause of childhood disability affecting function and development |
|
Definition
|
|
Term
| the brain lesions of cerebral palsy occur from the fetal or neonatal period up to age ___ years |
|
Definition
|
|
Term
| what is a common comorbidity (also of neuro origin) of patients with CP |
|
Definition
|
|
Term
| what is the most common type of Cerebral palsy that accounts for up to 80% of cases |
|
Definition
| spastic CP, due to cortex/pyramidal tract lesions |
|
|
Term
| what is a treatment for spasticity in CP |
|
Definition
|
|
Term
| What are two anticonvulsant meds used in CP? what are some symptomatic tx's? |
|
Definition
-dilantin and phenobarbitol
-stool softeners, glasses, hearing aids, walking aides |
|
|
Term
| what is the MCC of unilateral facial paralysis? |
|
Definition
|
|
Term
| what is another name for Bell Palsy |
|
Definition
| idiopathic facial paralysis (IFP) |
|
|
Term
| acute, unilateral, peripheral, lower motor neuron, facial nerve paralysis that gradually resolves over time in 80-90% of cases describes what DO |
|
Definition
|
|
Term
| How do you differentiate between Bell palsy and a lesion involving the central motor neurons above the level of the facial nucleus in the pons? |
|
Definition
| central motor neuron lesion described would cause weakness of the lower face alone |
|
|
Term
| What is the minimum diagnostic criteria for bell palsy |
|
Definition
| paralysis or paresis of all muscle groups on one side of the face, sudden onset, and absence of CNS disease |
|
|
Term
| what is the mainstay of tx for bell palsy |
|
Definition
|
|
Term
| glove and sock distribution of feeling is characteristic of what? |
|
Definition
|
|
Term
| Nerve injuries in peripheral neuropathies effect one of four components: neuronal or axonal, demyelinating, infiltrative, or ischemic. Give an example of a disease state for each type |
|
Definition
-Neuronal axonal: DM, charcot marie tooth
-Demyelinating: MS, Guillan Barre
-Infiltrative: sarcoidosis, amyloidosis
-Ischemic: DM, collagen vascular disease |
|
|
Term
| What is the MC complication of DM |
|
Definition
|
|
Term
| Name some major DDX for diabetic neuropathy |
|
Definition
-Vit B12 def
-Hypothyroidism
-Alcohol related neuropathy
-Other nutritional neuropathy |
|
|
Term
| what is the absolute best treatment for diabetic neuropathy |
|
Definition
|
|
Term
| Name some meds used for the tx of pain in diabetic peripheral neuropathy |
|
Definition
| FIRST NSAIDs, then...Amitriptyline (elavil), Gabapentin (neurontin), pregabalin (lyrica), and others |
|
|
Term
| what is the most common cause of acute flaccid paralysis in the US? |
|
Definition
|
|
Term
| what is another name for guillain barre syndrome |
|
Definition
| acute inflammatory demyelinating polyradiculoneuropathy |
|
|
Term
| describe how the symptoms of guillain barre present |
|
Definition
| symmetrical extremity weakness that begins distally and ascends |
|
|
Term
| describe the DTRs of a patient with Guillain barre |
|
Definition
|
|
Term
| what would be found on in the CSF of a patient with guillain barre in terms of WBC and protein |
|
Definition
protein is usually elevated >0.55 g/dL
WBC will be NL (<10 cells/mm3), if increased consider a different diagnosis |
|
|
Term
| What is the mainstay of tx for guillain barre? what are some other options? |
|
Definition
-hospitalization and symptomatic care- making sure to watch for signs of respiratory failure
-plasmapheresis and IV immunoglobulin tx have been shown to be effective |
|
|
Term
| guillain barre usually comes about after a preceding infection.... what two bugs are very commonly associated with it? |
|
Definition
campylobacter jejuni!!!!!
CMV |
|
|
Term
| What is the pathophys of myasthenia gravis |
|
Definition
| antibodies from against the nictotinic acetylcholine receptors, leading to an increase in the rate of receptor destruction |
|
|
Term
| describe the weakness exhibited in myasthenia gravis |
|
Definition
| exacerbated by continuous use of muscle and relieved with rest |
|
|
Term
| what are the two subtypes of myasthenia gravis |
|
Definition
|
|
Term
| what are the DTRs like in myasthenia gravis? compare to guillain barre? |
|
Definition
-preserved
-in GB they are diminished or absent |
|
|
Term
| What is the workup of a suspected Myasthenia gravis patient |
|
Definition
-anti-ach receptor antibody test
-EMG: shows decremental response to repetitive stimulation of motor nerves
-CT of thorax to rule out thymoma
-Edrophonium (tensilon) or neostigmine test to see if anti cholinesterase meds result in improved strength |
|
|
Term
| What are the 5 options of tx for a myasthenia gravis patient |
|
Definition
-Anticholinesterase inhibitors: pyridostigmine (mestinon) first choice
-Thymectomy is appropriate
-Corticosteroids: short term benefit
-IVIG (for elderly or mod-severe MG worsening to crisis)
-Plasmapheresis: reserved for crisis and refractory cases |
|
|
Term
| A pt with myasthenia gravis will usually not show worsening of sx after what time period? |
|
Definition
| 3 years- usually either plateaus or improves after three years |
|
|
Term
| What is the most common etiology of encephalitis? |
|
Definition
|
|
Term
| What are some s/sx that are more likely to be of encephalitis than of meningitis |
|
Definition
| confusion/disorientation, sleepiness, clumsiness/unsteady, behavior/personality changes, decreased level of consciousness |
|
|
Term
| What is the mainstay of treatment in an acutely ill patient presenting with encephalitis |
|
Definition
|
|
Term
| What is the most sensitive and specific test for dx of viral causes in encephalitis |
|
Definition
|
|
Term
| What imaging would be ordered in a pt with acute encephalitis |
|
Definition
MRI of the brain to rule out focal neurological causes (ie abscess)
-also, increased areas of T2 signal in frontotemporal localization is consistent with HSV encephalitis |
|
|
Term
| what would the glucose levels be in a pt's CSF who has viral meningitis/encephalitis? bacterial meningitis? |
|
Definition
|
|
Term
| What are three characteristic signs of meningeal irritation |
|
Definition
| headache, nuchal rigidity, and photophobia |
|
|
Term
| describe kernig's sign and brudzinskis sign |
|
Definition
Kernigs: with patient supine flex their hip and knee, if pt feels pain in the back this is positive sing
-brudzinskis: with patient supine, flex their neck toward their chest, if the pt flexes the hip and the knee in response then its a positive sign |
|
|
Term
| What is the prophylaxis for close contacts of a pt dx with meningitis |
|
Definition
| rifampin or ceftriaxone 1 dose IM |
|
|
Term
| What are the first and second most common causes of meningitis in patients greater than 18 yoa |
|
Definition
s pneumoniae
n meningitidis |
|
|
Term
| Describe the CSF of a patient with bacterial meningitis in terms of WBC, glucose, protein, and gram stain |
|
Definition
-increased WBC with PMN predominate and a left shift
-decreased glucose
-increased protein
-positive gram stain |
|
|
Term
| Describe the CSF of a patient with aseptic meningitis in terms of cells, protein, glucose... |
|
Definition
-increased in mononuclear cells- lymphocytic pleocytosis
-normal PRO or slightly elevated
-glucose WNL
-CSF can be completely NL |
|
|
Term
| Antibiotic tx should be started immediately in a pt with possible meningitis whose CSF is neither ______ or ______ |
|
Definition
|
|
Term
| What is the most common movement disorder? |
|
Definition
| essential tremor (aka benign essential familial tremor) |
|
|
Term
| What is a non-rx treatment that often provides dramatic, temporary relief for pts with essential tremor |
|
Definition
|
|
Term
| essential tremor usually effects the upper limbs, but what else can it effect that is often embarrassing for the pt |
|
Definition
| chin and speech if laryngeal muscles are involved |
|
|
Term
| Will an essential tremor go away when a pt goes to do a task> |
|
Definition
|
|
Term
| An essential tremor is postural or kinetic. what does this mean> |
|
Definition
postural (occurs with voluntary maintenance of a position against gravity)
kinetic (occurs with voluntary movement) |
|
|
Term
| What are the two cornerstone drugs of tx for essential tremor, which is started in the elderly and which is started in the young population |
|
Definition
-propanolol: young
- primidone: elderly |
|
|
Term
| Is an essential tremor usually bilateral? |
|
Definition
|
|
Term
| which tremor usually moves at a faster rate, essential or parkinsonian? |
|
Definition
|
|
Term
| Describe the inheritance pattern of Huntington disease. does it have any predilection for sex? |
|
Definition
|
|
Term
| What are the three parts to huntington disease? |
|
Definition
movement DO: chorea
cognitive DO: dementia
behavioral DO: irritable, moody, antisocial, depressed |
|
|
Term
| When are pts with Huntington dz usually dx? How long do they usually live after this? |
|
Definition
after the age of 30
10-25 years |
|
|
Term
| What is seen on a CT scan of a pt with Huntington dz |
|
Definition
| cerebral atrophy and atrophy of the caudate nucleus |
|
|
Term
| What is the first drug approved to specifically tx chorea associated with Huntington disease |
|
Definition
tetrabenazine (xenazine)
class: MOA inhibitor |
|
|
Term
| Name some drugs used in the tx of Huntington disease |
|
Definition
-risperdal or haldol for behavior and choreic movements
-paxil for depression
-depakote or klonopin for spasms and chorea |
|
|
Term
| what is the pathophysiology of parkinson disease |
|
Definition
| dopamine depletion in the brain leads to an imbalance of dopamine and acetylcholine |
|
|
Term
| Parkinson disease is a disorder of the ______/_______ |
|
Definition
|
|
Term
| what are the 2 characteristic neuropathologic findings in a pt with parkinson disease |
|
Definition
-loss of pigmented dopaminergic neurons in the substantia nigra pars compacta
-presence of Lewy Bodies |
|
|
Term
| What are the 4 cardinal signs of parkinson disease, 2 of the first 3 of which must be present for diagnosis |
|
Definition
-resting tremor
-rigidity
-bradykinesia
-postural instability (dystonia) |
|
|
Term
| describe the tremor in parkinson disease |
|
Definition
| resting tremor, sometimes pill rolling, that goes away with movement |
|
|
Term
| How is parkinson disease diagnosed? |
|
Definition
its clinical, no imaging scans are helpful
sometimes giving levodopa and seeing improvement can help with dx |
|
|
Term
| What is the cornerstone of tx of parkinson disease, explain how it works |
|
Definition
Carbidopa/levodopa (sinemet)
-Levodopa is the precursor of dopamine and carbidopa inhibits the decarboxylation of levodopa to dopamine in the peripheral circulation so that it goes to the brain
-levodopa alone can cause N/V due to buildup of dopamine in the peripheral circulation |
|
|
Term
| what is the basic pathophys of MS |
|
Definition
| inflammatory, demyelinating disease of the CNS |
|
|
Term
| What type of cycle does MS follow? |
|
Definition
|
|
Term
| Sx of an acute attack of MS last for how long? how often do attacks occur |
|
Definition
days to weeks
occur at about 1 per year |
|
|
Term
| Definitie diagnosis of MS requires what? what is a diagnosis criteria to follow (name)? |
|
Definition
-2 episodes of sx and 2 white matter lesions
-McDonald criteria |
|
|
Term
| what imaging study is good for dx MS? |
|
Definition
| MRI- identifies white matter lesions and plaques |
|
|
Term
| what is seen in the CSF after LP of a pt with MS |
|
Definition
| oligoclonal bands of immunoglobulin G and increased myelin protein |
|
|
Term
| what are the two tx aspects of MS |
|
Definition
-immunomodulatory tx for underlying immune DO
-therapies to relieve/modify sx |
|
|
Term
| what are two tx options for acute attack of MS |
|
Definition
-IV steroids
-plasmapheresis (for those who do not respond to steroids) |
|
|
Term
| What eye problem often goes along with MS |
|
Definition
|
|
Term
| What eye problem often goes along with MS |
|
Definition
|
|
Term
| what is the MC type of traumatic intracranial lesion? |
|
Definition
|
|
Term
| what is a subdural hematoma? |
|
Definition
| a collection of blood below the inner layer of the dura, but external to brain and arachnoid membrane |
|
|
Term
| What type of patients get subdural hematomas? |
|
Definition
| pts with severe high speed impact head injuries and pts on anticoags with minor head injuries |
|
|
Term
| what will a subdural hematoma look like on CT? |
|
Definition
| white and crescent shaped |
|
|
Term
| what is the consistency of an acute subdural hematoma? can they be evacuated with burr holes? |
|
Definition
-jelly like
-NO they cannot |
|
|
Term
| what is the consistency of chronic subdural hematoma? (>2 weeks). can it be evacuated with burr holes? what color is it on CT |
|
Definition
liquid and can be evacuated with burr holes
will be darker on CT, no longer white! |
|
|
Term
| what blood vessel is usually disturbed in a subdural hematoma? what makes the elderly at greater risk? |
|
Definition
-bridging veins
-atrophy of the brain puts stress on the bridging veins and they tear more easily |
|
|
Term
| What can be used to decrease ICP in a subdural hematoma? |
|
Definition
| mannitol (osmitrol) 1g/kg IV push |
|
|
Term
| what is a subarachnoid hemorrhage? |
|
Definition
| extravasation of blood into the subarachnoid space, between the pial and arachnoid membranes |
|
|
Term
| what is the most common cause of subarachnoid hemorrhages? what is the name most often associated with? |
|
Definition
-trauma
-nontraumatic hemorrhage that usually occurs in the setting of a ruptured cerebral aneurysm or arteriovenous malformation (AVM) |
|
|
Term
| what is the #1 sx in a pt with a totally classic presentation of subarachnoid hemorrhage |
|
Definition
| sudden onset of the worst headache of their life with N/V |
|
|
Term
| What is a complication with subarachnoid hemorrhages that is often seen around day 14? what is the tx for this |
|
Definition
| vasospasm! tx is triple H: hemodilution, hypervolemia, and hypertension |
|
|
Term
| What is a cardiac drug that should be avoided in patients with an already elevated ICP |
|
Definition
|
|
Term
| What is the most common type of aneurysm? Name the other two types. |
|
Definition
-Saccular (berry) 90%
-Fusiform: the entire vessel is diseased
-Mycotic: due to infectious etiology |
|
|
Term
| What is the size threshold for surgical repair of an aneurysm |
|
Definition
<7 mm are not typically operated on
>7 mm are usually considered for surgery |
|
|
Term
| What is an inherited disease that predisposes patients for aneurysms? |
|
Definition
| polycystic kidney disease |
|
|
Term
| Where does the spinal cord end? What is the name of the most distal bulbous part of the spinal cord? |
|
Definition
|
|
Term
| Where does the cauda equina end? |
|
Definition
|
|
Term
| What is cauda equina syndrome? |
|
Definition
| characteristic pattern of neuromuscular and urogenital sx resulting from simultaneous compression of multiple lumbosacral nerve roots below the level of the conus medullaris |
|
|
Term
| What are some common symptoms of cauda equina syndrome? |
|
Definition
| low back pain, sciatica (uni or BL), saddle sensory disturbances, bowel and bladder dysfunction, variable LE sensory and motor extremity loss |
|
|
Term
| Is cauda equina syndrome considered a lower motor neuron or upper motor neuron lesion? |
|
Definition
| LMN because the nerve roots are part of the peripheral nervous system |
|
|
Term
| What is the tx in the ED or primary care office for cauda equina syndrome? |
|
Definition
admit to the appropriate service (neurosurg, neuro, or ortho)
frequent neuro checks
*DO NOT let these patients go home without being evaluated by the consulting physician and without appropriate imaging |
|
|
Term
| What are the typical characteristic features of complex regional pain syndrome |
|
Definition
| dramatic changes in skin color and temperature over the affected body part, accompanied by intense burning pain, skin sensitivity, sweating and swelling |
|
|
Term
| what are some other names for complex regional pain syndrome? |
|
Definition
reflex sympathetic dystrophy
causalgia |
|
|
Term
| what may show on X-rays in patients with complex regional pain syndrome |
|
Definition
|
|
Term
| General characteristics and tx of cluster HAs |
|
Definition
unilateral stabbing pain, around eye, tearing and nasal congestion on same side. may happen many times in a month. peak in 10-15 min. not releived with rest, so these pt's want to pace around
tx with O2 via face mask, triptans, lidocaine in the nostrils, capsaicin intranasally |
|
|
Term
|
Definition
triptans (if no heart disease)
phenergan or compazine for nausea |
|
|
Term
| triptans should not be used in pts with underlying _____ disease |
|
Definition
|
|
Term
| What is an APAP combo med that is often used in the tx of tension and migraine headaches? |
|
Definition
|
|
Term
| what pain medication is contraindicated in a patient with a history of seizures |
|
Definition
|
|
Term
| What are the two viruses that most commonly cause croup? |
|
Definition
| Parainfluenza 1,2, and 3 and RSV |
|
|
Term
| Is the airway obstruction in croup classified as upper or lower? What are the two breath sounds that are pathognomonic? |
|
Definition
Upper
Inspiratory strider
Harsh barking SEAL-like or BRASSY cough |
|
|
Term
| What are the X-rays that should be ordered in a patient with croup? What will each show? |
|
Definition
-AP will show steeple sign
-lateral will rule out epiglottitis |
|
|
Term
| What are the two classes of drugs that may be administered to a patient that is hospitalized for croup? |
|
Definition
Steroids (dexamethasone, prednisone)
Epinephrine |
|
|
Term
| RSV is a member of which virus family? |
|
Definition
|
|
Term
| What is the name of the vaccine against RSV and what children are eligible to receive it? |
|
Definition
Palivizumab aka synagis
Kids less than 2 yoa with cyanosis heart dz, bronchopulmonary dysplasia, and those who were born prematurely |
|
|
Term
| RSV can be a significant cause of mortality in which pt population? |
|
Definition
|
|
Term
| What drug is often given to hospitalized infants with RSV? |
|
Definition
| Ribavirin, which is shown only to be beneficial in infants. It is a teratogenic drug that is contraindicated in pregnancy and can be risky to pregnant Health care workers |
|
|
Term
| What other illness is commonly seen in children infected with RSV |
|
Definition
|
|
Term
| What class of drugs is commonly used to treat RSV but has never been proven in trials to be efficacious |
|
Definition
|
|
Term
| What are the three clinical stages of pertussis? |
|
Definition
1. Catarrhal stage: often confused for a UR viral illness
2. Paroxysmal stage: spasms and coughing fits followed by the "whoop"
3. Convalescent stage: decrease in severity and number of symptoms from stage 2 but this stage my last for weeks |
|
|
Term
| What abx are usually used to tx pertussis? In particular, babies less than 1 month? What should be explained to a pt being tx with abx for pertussis? |
|
Definition
- macrolides--> erythromycin is best
- azithromycin is the only macrolide indicated for less than 1 month of age
- will not alleviate or shorten duration of sx, but will prevent spread to others and secondary infection in the pt |
|
|
Term
| What are the top two complications seen in pertussis pt's? |
|
Definition
|
|
Term
| What causes the paroxysms of coughing seen in pertussis pt's? |
|
Definition
| Due to the need to dislodge plugs of necrotic epithelial bronchial tissues and thick mucus |
|
|
Term
| Neonates are the most likely pt's to be infected with pertussis- how do they present differently? |
|
Definition
| Unlikely to have the classic whoop. More likely to have cns damage due to hypoxia and more likely to have a secondary bacterial pna |
|
|
Term
| Immunization is the best way to prevent pertussis, when is dtap given? Tdap? |
|
Definition
Dtap: 2,4,6,15-18 mo and 4-6 yrs
Tdap: 11-18 yrs and ALL pregnant women |
|
|
Term
| When do most cases of pertussis occur? |
|
Definition
|
|
Term
| What is the only proven effective therapy in the treatment of bronchiolitis? |
|
Definition
| Oxygen and supportive care! |
|
|
Term
| What virus is the #1 cause of bronchiolitis? |
|
Definition
|
|
Term
| What virus is the most common cause of bronchiolitis obliterans, a more severe type of RSV? |
|
Definition
|
|
Term
| what is the most common etiology of acute bronchitis |
|
Definition
|
|
Term
| does colored sputum in acute bronchitis always indicate a bacterial infection? |
|
Definition
| no, this is usually due to peroxidase production by the leukocytes in the sputum and is NOT indicative of acute bacterial infection |
|
|
Term
| what acute phase reactant marker can be used when determining if an acute bronchitis is caused by a virus or bacteria? |
|
Definition
|
|
Term
| when are abx indicated in acute bronchitis |
|
Definition
| not recommended UNLESS there is risk of serious complications due to comorbid conditions or if the pt is >65 yoa with a hospital stay in the past year, has DM, CHF, or is on steroids |
|
|
Term
| what is a range for how long the cough in acute bronchitis can last? |
|
Definition
| 10-20 days, sometimes longer than 1 month |
|
|
Term
| when ordering a CRP to differentiate bronchitis from PNA, what is the cutoff value? |
|
Definition
| <20 inidcates bronchitis and not PNA |
|
|
Term
| What is the most common causative organism for epiglottitis |
|
Definition
| HiB. Incidence of epiglottitis has decreased since vaccines of HiB BECAME COMMON |
|
|
Term
| What are two signs that one may see on the lateral neck radiograph of a pt with epiglottitis |
|
Definition
|
|
Term
| What are the two classes of abx used to treat epiglottitis? What are the top two specific drugs |
|
Definition
-3rd gen cephalosporins or amoxicillin/clavulanic acid
-rocephin or ampicillin and sulbactam (unasyn) |
|
|
Term
| What is a common abx used in epiglottitis patients who are allergic to penicillins and cephalosporins |
|
Definition
|
|
Term
| Influenza virus is from which family |
|
Definition
|
|
Term
| What serious complication has been documented with influenza A |
|
Definition
|
|
Term
| What is the gold standard for influenza diagnosis |
|
Definition
| Viral culture via nasopharyngeal swabs or throat samples |
|
|
Term
| What class of antiviral is still recommended for use against influenza? What are the two drugs? What is the dosing ? |
|
Definition
Neuraminidase inhibitors
-oseltamivir (tamiflu) 75 mg PO BID
-zanamivir (relenza) inhaled 10 mg BID x 5 d |
|
|
Term
| What drug is often rx with tamiflu to double systemic exposure to the drug |
|
Definition
|
|
Term
| Can pregnant women receive the flu vaccine? |
|
Definition
|
|
Term
| what is the clinical definition of community acquired PNA (CAP)? |
|
Definition
| develops in an outpatient setting or within 48 hours of hospital admission |
|
|
Term
| Besides being hospitalized for 48 hours, what are some other clinical indications of hospital acquired PNA? |
|
Definition
-hospitalization greater than 2 days in prior 3 mos
-home or extended care facility resident
-abx in prior three months
-chronic dialysis
-home infusion tx, home wound care
-contact with a patient with MDRO infection |
|
|
Term
| what are three things that could put a pt at high risk for aspiration PNA |
|
Definition
| decrease ability to clear oropharyngeal secretions, increase volume of secretions, or other comorbidities (GERD, achalasia, etc) |
|
|
Term
| PNA with productive sputum that is rust colored is likely due to what bacteria? |
|
Definition
|
|
Term
| PNA with productive sputum that is green colored is likely due to what bacteria? |
|
Definition
|
|
Term
| PNA with productive sputum that is red-currant jelly-like is likely due to what bacteria? |
|
Definition
|
|
Term
| PNA with productive sputum that is foul smelling and bad tasting is likely due to what bacteria? |
|
Definition
|
|
Term
| what causative organism of PNA is often seen in the winter/early spring time? |
|
Definition
|
|
Term
| what causative agent of PNA can present with mental status changes or diarrhea? |
|
Definition
|
|
Term
| PNA that has bradycardia on exam is likely due to what organism |
|
Definition
|
|
Term
| PNA in a pt that also has periodontal dz is likely due to what organism? |
|
Definition
|
|
Term
| PNA that also presents with bullous myringitis is likely due to what causative organism? |
|
Definition
|
|
Term
| PNA that presents with cutaneous nodules and CNS findings is likely due to what causative organism? |
|
Definition
|
|
Term
| What is the CURB-65 scoring system used for and what are the components? |
|
Definition
-to determine inpatient or outpatient tx in a patient with PNA
*one point for each of the following:
-confusion (altered mental status), -uremia (BUN >20 mg/dL), -resp rate >30 bpm, -BP <90/OR ,60, - age >65
*0-1 outpatient; 2: admit to medical ward; 3 or >: ICU admit |
|
|
Term
| what is the gold standard for diagnosing pna? |
|
Definition
|
|
Term
| what are two classes of abx recommended in pts with CAP who are previously healthy and have not had abx in the past 90 days? |
|
Definition
macrolide (azithromycin)
doxycycline |
|
|
Term
| how long after initiation of abx tx should PNA be evaluated? when can an abx be changed after initiation? |
|
Definition
48-72
dont change in less than 72 hours unless there is marked clinical deterioration |
|
|
Term
| what patients are eligible for the pneumococcal vaccine? |
|
Definition
| >65 yoa, and younger if at high risk (heart disease, SSD, pulm dz, DM, alcoholic cirrhosuis, or asplenic pts) |
|
|
Term
| alcoholic patients with PNA, think what as causative organism... |
|
Definition
|
|
Term
| immigrants with signs of PNA, think what as causative organism... (something that needs to be ruled out) |
|
Definition
|
|
Term
| pts with organ transplants, renal failure, chronic lung dz, or smokers with PNA think what as causative organism... |
|
Definition
|
|
Term
| HIV pts who present with PNA are likely to have a common pathogen as a causative organism, but what are two other possible causative agents |
|
Definition
pneumocystis carinii
mycobacterium TB |
|
|
Term
| COPD pts with PNA, think what as causative organism... |
|
Definition
|
|
Term
| pts with cystic fibrosis that present with PNA, think what as causative organism... |
|
Definition
|
|
Term
| young adults (esp in the college setting) that present with atypical PNA,think what as causative organism... |
|
Definition
|
|
Term
| what causative agent of PNA is associated with air conditioning units/aerosolized water? |
|
Definition
|
|
Term
| pts s/p splenectomy that present with PNA, what 3 causative agents should be investigated? |
|
Definition
| encapsulated organisms , step pneumo, and h flu |
|
|
Term
| leukemia or lymphoma patients that present with PNA, think what as causative organism... |
|
Definition
|
|
Term
| what are the 4 MC viral etiologies of PNA? |
|
Definition
| influenza, RSV, parainfluenza, and adenovirus |
|
|
Term
| what two age groups have an increased prevalence of viral PNA? |
|
Definition
|
|
Term
| viral etiologies are the second MCC of PNA behind _________ |
|
Definition
|
|
Term
| viral etiologies are the second MCC of PNA behind _________ |
|
Definition
|
|
Term
| what patient populations are at increased risk of influenza PNA? |
|
Definition
-kids with transplant or CF hx
-Adults with chronic disease or IC
-nursing home or chronic care facility resident
-healthy pt >65 yoa |
|
|
Term
| cytomegalovirus cells have a characteristic look on cytologic eval, what is it? |
|
Definition
|
|
Term
| what is common in viral PNA seen on CXR that can help begin to differentiate from bacterial PNA? |
|
Definition
| viral is usually bilateral and bacterial is often lobar |
|
|
Term
| What is the causative agent of histoplasmosis? What part of the world is it usually found? What is another name for it? |
|
Definition
-histoplasma capsulatum
-OH, MS, MO river valleys
-"OH River Valley Fever" |
|
|
Term
| what two animals' droppings can contribute to greater spread of histoplasma capsulatum in the soil? |
|
Definition
bird and bat
-birds dont carry dz and cannot spread it, but their droppings do enhance the soil's ability to grow the fungus
-bats can carry the dz and their droppings can actually be the source of spread |
|
|
Term
| What is the MC endemic fungal infection in humans |
|
Definition
|
|
Term
| What is the tx plan for histoplasmosis- mild, moderate and severe |
|
Definition
-mild or asymptomatic: supportive care
-s/sx >4 wks or overwhelming pulm involvement: itraconazole x6-12 weeks
-severe cases: start amphotericin B x 1-2 weeks then change to itraconazole x 1 year |
|
|
Term
| What is the causative agent of blastomycosis? What part of the world is it usually found? What is another name for it? |
|
Definition
-blastomyces dermatitidis
-mid west and northern US and Canada
-Gilchrist's disease |
|
|
Term
| Blastomycosis is common among what animal in endemic areas? |
|
Definition
|
|
Term
| What is the causative agent of coccidoidmycosis? What part of the world is it usually found? What is another name for it? |
|
Definition
-coccidoides immitus
-SW US and northern mexico
-San Jaoquin valley fever OR desert rheumatism |
|
|
Term
| What are some common extra-pulmonary skin manifestations of fungal PNA? |
|
Definition
erythema nodosum
erythema multiforme |
|
|
Term
| What is the MC extra-pulm manifestation of blastomycosis? |
|
Definition
|
|
Term
| What is the causative agent of paracoccidioidomycosis? What part of the world is it usually found? What is another name for it? |
|
Definition
-paracoccidoides brasilienessis
- Central and S america
-"S. American Blastomycosis" or "Lutz-Splendore-Almeida disease" |
|
|
Term
| what are the pathognomonic mucosal lesions associated with paracoccidioidomycosis? what is another extra-pulm manifestation? |
|
Definition
mulberry lesions
lymphadenopathy |
|
|
Term
| What is the causative agent of aspergillosis? What part of the world is it usually found? What is another name for it? |
|
Definition
-aspergillus
-growing on dead leaves, stored grain, compost piles, other decaying vegetation or marijuana leaves
-"FUNGUS BALL" may be seen on xray |
|
|
Term
| when an HIV patient presents with symptoms of PNA, what organism must you be worried about? |
|
Definition
|
|
Term
| what type of organism is pneumocystis jiroveci? |
|
Definition
|
|
Term
| What is the most common opportunistic infection in patients with HIV disease, particularly with CD4 counts less than 200? |
|
Definition
|
|
Term
| what does the CXR of a pt with pneumocystis jiroveci show? |
|
Definition
| diffuse perihilar infiltrates and no effusions . but may be NL |
|
|
Term
| what is the #1 tx for patients with pneumocystis jiroveci? |
|
Definition
|
|
Term
| who are candidates for prophylaxis of pneumocystis jiroveci and what is the prophylactic agent? |
|
Definition
| HIV patients with CD4 counts less than 200 and Bactrim is used |
|
|
Term
| Pts with pneumocystis jiroveci can have extra pulm manifestations in the thyroid and the eye... name them |
|
Definition
eye: retinal cotton wool spots
thyroid: rapidly enlarging mass |
|
|
Term
| What is the most common cause of disease related mortality in the world |
|
Definition
|
|
Term
| What organ of the body is the most common site of infection in patients with TB |
|
Definition
|
|
Term
| What is the most common extra plum manifestation of tb? What's the name for this? |
|
Definition
|
|
Term
|
Definition
| TB infection of the vertebral bodies |
|
|
Term
| Describe what a typical TB lesion looks like |
|
Definition
| Granuloma with central cassation and necrosis |
|
|
Term
|
Definition
| Evidence of healed primary lesion of TB in the lungs. Aka ranke's complex |
|
|
Term
| What can cause hyponatremia in TB patients? |
|
Definition
| Release of adh-like hormone from affected lung tissue |
|
|
Term
| What are the criteria for a positive PPD in the avg patient, a high risk patient, or a patient that is HIV pos or in close contact with a TB pos patient? |
|
Definition
Greater than or equal to 15
10
5 |
|
|
Term
| What is the gold standard for diagnosis of TB |
|
Definition
| Acid fast bacilli sputum smear and culture |
|
|
Term
| What TB drug should be suspect of overdose if the pt presents with seizures? What are two other adverse effects of this drug |
|
Definition
Isoniazid
Hepatotoxicity and peripheral neuropathy |
|
|
Term
| What TB drug turns body fluids red-orange? |
|
Definition
|
|
Term
| What TB drug can cause gout? |
|
Definition
|
|
Term
| What TB drug can cause retro bulbar optic neuritis resulting in decreased visual acuity and decrease in red green color perception? |
|
Definition
|
|
Term
| Which rarely used TB drug causes ototoxicity? |
|
Definition
|
|
Term
| What TB drugs should be used in pregnancy ? What only in MDRTB? What never used? |
|
Definition
-isoniazid, rifampin, and ethambutol
-pyrazinamide only if MDRTB
-do not use streptomycin |
|
|
Term
| What TB drug is avoided in kids? |
|
Definition
| Ethambutol bc it is hard to monitor visual side effects |
|
|
Term
| What class of abx is often employed in MDRTB |
|
Definition
|
|
Term
| What is a common tx for latent TB |
|
Definition
| Many different recommendations but isoniazid x9 months is popular as long as active TB has been ruled out |
|
|
Term
| Are patient with primary TB contagious ? |
|
Definition
|
|
Term
| In what part of the lungs does secondary (reactivation) TB usually occur? |
|
Definition
| The most oxygenated parts of the lungs -apical or posterior segments |
|
|
Term
| Carcinoid tumors most often arise in the small intestine, but what part of the lung are they also found? |
|
Definition
|
|
Term
| What is the most common primary lung tumor in kids |
|
Definition
| Bronchial carcinoid tumors |
|
|
Term
| What are some syndromes seen in pt's with bronchogenic carcinoid tumors |
|
Definition
-carcinoid syndrome (serotonin excess)
-cushings syndrome (excess ACTH)
-acromegaly (excess ghrh) |
|
|
Term
| Bronchogenic carcinoid tumors arise from what type of cells? Even more specific? |
|
Definition
Neuroendocrine
Klutchitsky cells |
|
|
Term
| What is the classic triad of carcinoid syndrome? What are other symptoms |
|
Definition
-cutaneous flushing, diarrhea, valvular heart dz
- also : wheezing, chest pain, cough, weight gain |
|
|
Term
| Describe what a bronchogenic carcinoid tumor looks like on bronchoscopy |
|
Definition
| Pink or purple and very well vascularized |
|
|
Term
| What is the mainstay of tx for a bronchogenic carcinoid tumor? What drug can be given to help with sx of hormone excess |
|
Definition
Surgical resection
Sandostatin (octreotide) |
|
|
Term
| War type of tumor of the lung is not associated with smoking, air pollution, or chemical exposure? |
|
Definition
|
|
Term
| What is the leading cause of chance deaths in men and women? |
|
Definition
|
|
Term
| What is another name for sclc (small cell lung cancer) |
|
Definition
|
|
Term
| Where does SCLC usually arise in the lung and where does It usually metastasize? |
|
Definition
| Central bronchi with metastasis to regional lymph nodes |
|
|
Term
| What type of NSCLC is usually bronchial in origin and what is it more likely to present with |
|
Definition
|
|
Term
| What is the most common NSCLC and lung tumor in general ? Where does it usually originate in the lung ? |
|
Definition
Adenocarcinoma
Lung periphery |
|
|
Term
|
Definition
| Invasion of the superior vena cava by a lung tumor, causing HA dyspnea, facial swelling and neck pain |
|
|
Term
| What syndrome is caused by apical tumors? Give the s/sx |
|
Definition
Horner's syndrome (due to invasion of the cervical sympathetic chain)
Sinking eyeball, lid drop, miosis, and anhidrosis (no sweating) |
|
|
Term
| What two nerve palsies are often seen with lung tumors |
|
Definition
Recurrent laryngeal (hoarse voice)
Phrenic (diaphragm hemiparesis) |
|
|
Term
| What endocrine syndromes are associated wit SCLC |
|
Definition
| Cushing's syndrome and SIADH |
|
|
Term
| What neuromuscular side effects are often seen with SCLC |
|
Definition
| Peripheral neuropathy, myasthenia (eaton lambert), cerebellum degeneration |
|
|
Term
| What endocrine issues are associated with squamous cell lung carcinoma |
|
Definition
|
|
Term
| What endocrine issue is associated with large cell lung cancer |
|
Definition
|
|
Term
| Thrombophlebitis is associated with which type of lung tumor |
|
Definition
|
|
Term
| Which type of NSCLC shows cavitation on CXR |
|
Definition
|
|
Term
| What 4 cancers most often metastasize to the lung |
|
Definition
Breast
Colon
Prostate
Bladder |
|
|
Term
| Where is a pancoast tumor located?? What are the s/sx? What syndrome are they associated with 60% of the time |
|
Definition
Superior sulcus, apical tumor involving the c8 and t1-2 nerve roots causing shoulder pain radiating down the arm
Horners syndrome |
|
|
Term
| What are the 4 most common sites of lung cancer metastasis |
|
Definition
Brain
Bone
Adrenal glands
Liver |
|
|
Term
| What two types of NSCLC can cause hypertrophic pulmonary osteoarthropathy? |
|
Definition
|
|
Term
| What is the tx for NSCLC? SCLC? |
|
Definition
NSCLC: surgery is best, radiation is usually an important adjunct to surgery but chemo doesn't really have any use
SCLC: usually chemo, sometimes radiation, but surgery is not usually useful bc these tumors are usually unresectable |
|
|
Term
| When evaluating a solitary pulmonary nodule, does this characteristic make you think benign or malignant? Age less than 50 |
|
Definition
| Benign, greater than 50 think malignant |
|
|
Term
| When evaluating a solitary pulmonary nodule, does this characteristic make you think benign or malignant? Smoking patient or a hx of smoking |
|
Definition
|
|
Term
| When evaluating a solitary pulmonary nodule, does this characteristic make you think benign or malignant? Size of nodule less than 2 cm |
|
Definition
| Benign, greater than 3 cm think malignant |
|
|
Term
| When evaluating a solitary pulmonary nodule, does this characteristic make you think benign or malignant? Nodule grossly irregular or spiculated |
|
Definition
| Malignant, if its circular with regular shape think benign |
|
|
Term
| When evaluating a solitary pulmonary nodule, does this characteristic make you think benign or malignant? Central laminated calcification |
|
Definition
| Benign, if there is a stipples or eccentric pattern of calcification think malignant |
|
|
Term
| When evaluating a solitary pulmonary nodule, does this characteristic make you think benign or malignant? Nodule changed in size over 2 years compared to past CXR... What's the next step? |
|
Definition
| Malignant, do a ct scan with thin sections through the nodule |
|
|
Term
| When evaluating a solitary pulmonary nodule, does this characteristic make you think benign or malignant? No change in nodule size over the past 2 years... Next step? |
|
Definition
| Benign, stop work up and follow up with pt yearly |
|
|
Term
| When evaluating a solitary pulmonary nodule, if the CXR shows either a new nodule or a nodule with change in size over a 2 yr period OR if there is no CXR available, so a ct scan is ordered with thin sections through the nodule- if the ct shows benign nodule how often should the patient be followed? |
|
Definition
|
|
Term
| What is another name for a solitary pulmonary nodule? At what size is it no longer called this? |
|
Definition
Coin lesion
At greater than 3 cm it is called a mass |
|
|
Term
|
Definition
| Aspirin sensitivity, asthma , and nasal polyps |
|
|
Term
| What is the atopic triad? |
|
Definition
| Wheeze, eczema, and seasona rhinitis |
|
|
Term
| Which two type of Cv medications can exacerbate asthma |
|
Definition
| Non selective beta blockers and ace inhibitors |
|
|
Term
| When spirometry is non diagnostic, what type of challenge test can be used to dx asthma ? |
|
Definition
| Histamine or methacholine challenge test |
|
|
Term
| For asthma diagnosis, a greater than ____% increase in FEV1 after bronchodilator therapy is diagnostic |
|
Definition
|
|
Term
| Normal people's FEV1 is > ???? |
|
Definition
|
|
Term
| Describe the characteristics of mild intermittent asthma |
|
Definition
| Sx less than 2 x per week, a symptomatic and normal PEF between exacerbations. Nighttime sx are less than or equal to 2 times per month . Fev1 greater than or equal to 80% predicted |
|
|
Term
| Describe the characteristics of mild persistent asthma |
|
Definition
| Sx greater than 2 x per week but less than 1x per day. Nighttime sx are greater than. 2x per month . Fev1 greater than or equal to 80% predicted |
|
|
Term
| Describe the characteristics of moderate persistent asthma |
|
Definition
| Sx are daily and daily use of SABA, exacerbations affect activity, exacerbations are greater than or equal to 2 times a week and may last days. Nighttime sx are greater than 1x per week . Fev1 greater than 60 but less than 80% predicted |
|
|
Term
| Describe the characteristics of severe persistent asthma |
|
Definition
| Continual symptoms with limited physical activity and frequent exacerbations. Nighttime sx are frequent, fev1 is less than 60% predicted |
|
|
Term
| Describe the stepwise tx for asthma (6) |
|
Definition
1 (intermittent): SABA (these are used in all steps)
2 low dose ICS
3 low dose ICS and LABA OR medium dose ICS
4 medium dose ICS and LABA
5 high dose ICS and LABA
6 high dose ICS and LABA and oral corticosteroid |
|
|
Term
| If an asthma pt is using their SABA greater than ____ days per week their tx is considered uncontrolled and treatment needs to be stepped up |
|
Definition
|
|
Term
|
Definition
| A abnormal, permanent dilatation of the bronchi and destruction of the bronchial walls |
|
|
Term
| Which genetic disorder causes over half the cases of bronchiectasis |
|
Definition
|
|
Term
| What is a main symptom of bronchiectasis |
|
Definition
Chronic purulent sputum that becomes foul smelling with a bacterial exacerbation
Hemoptysis may be seen!!! |
|
|
Term
| What is the diagnostic test of choice for diagnosis of bronchiectasis and what findings does it show |
|
Definition
| Chest ct which will reveal dilated tortuous airways |
|
|
Term
| A CXR on a patient with severe bronchiectasis cou,d possibly show what three pathological signs |
|
Definition
| Tram track lung markings, honey combing, and atelectasis |
|
|
Term
| What are the top three isolated bacterial pathogens in acute bronchiectasis exacerbations in adults |
|
Definition
H flu
Pseudomonas
Strep pneumoniae |
|
|
Term
| If a pt with bronchiectasis has severe hemoptysis what can be done? |
|
Definition
| Embolization is an option |
|
|
Term
| The induction of bronchiectasis requires what one thing PLUS one of three other things.... |
|
Definition
1. An infectious insult PLUS
Impairment of drainage a/o airway obstruction a/o defect in host defenses |
|
|
Term
| What class of abx is recommended for patients with bronchiectasis acute exacerbations according to the top three most common bacterial pathogens |
|
Definition
| Fluoroquinolones (we need pseudomonas coverage!) |
|
|
Term
| a forced expiratory time greater than _____ seconds indicates severe expiratory outflow |
|
Definition
|
|
Term
| Define pulmonary emphysema |
|
Definition
| abnormal permanent enlargement and destruction of the air spaces distal to the terminal bronchioles |
|
|
Term
| What is the pathogenesis of emphysema? |
|
Definition
destruction of alveolar walls is due to relative excess in protease (elastase) activity, or relative deficiency of anti protease (A1AT def.) activity in the lung. Elastase is released from PMNs and macrophages and digests human lung. This is inhibited by a-1 antitrypsin.
tobacco smoke increases the # of activated PMNs and macrophages, inhibits a-1 antitrypsin, and increases oxidative stress on the lung by free radical production |
|
|
Term
| Pulmonary emphysema patients are often nicknamed _______. Explain the physiology behind this (hint: begins with the destruction in the lung and its effect on the ability to oxygenate blood) |
|
Definition
PINK PUFFERS
due to the lowered ability to oxygenate blood, the body compensates with lowered cardiac output and hyperventilation. This V/Q mismatch results in relatively limited blood flow through the lung and a fairly well oxygenated lung with normal blood gases and pressures. Because of the low CO, the rest of the body suffers from hypoxia and pulmonary cachexia which eventually leads to muscle wasting and weight loss. |
|
|
Term
| What is the definition of chronic bronchitis |
|
Definition
| a productive cough occurring on most days for at least three months in a year for at least two consecutive years |
|
|
Term
| Chronic bronchitis patients are often nicknamed _______. Describe the phsyiology behind this (hint: the obstruction in the lungs leads to hypercapnia and respiratory acidosis....) |
|
Definition
| the respiratory acidosis leads to pulmonary artery vasoconstriction and cor pulmonale. the ensuring hypoxemia, polycythemia, and increased CO2 retention---- these patients have signs of right heart failure and are known as BLUE BLOATERS |
|
|
Term
| If a patient has smoked one pack of cigarettes per day for one year, how many pack years is this? |
|
Definition
|
|
Term
| the PaO2 in a patient with COPD generally stays normal until the FEV1 falls to < ______%, but hypercarbia and pulm HTN are not common until after it has fallen to < ______% |
|
Definition
|
|
Term
| What genetic disorder is the second leading cause of emphysema |
|
Definition
| alpha 1 antitrypsin deficiency |
|
|
Term
| What are the tx guidelines for a pt with mild-moderate COPD |
|
Definition
| begin with bronchodilator and MDI (anticholinergics- ipratropium A/O b agonists (albuterol) with low dose inhaled glucocorticoids (budesonide) |
|
|
Term
| What is the criteria for long term O2 therapy in a patient with COPD |
|
Definition
| PaO2 of <55mmHg OR O2 sat <88% OR PaO2 55-59 mmHg with evidence of polycythemia or cor pulmonale |
|
|
Term
| Pursed lip breathing and grunting expirations are common sx in which subset of cOPD |
|
Definition
|
|
Term
| What is a pathognomonic sign of emphysema that is present on the surface of the lung? |
|
Definition
| subpleural blebs or parenchymal bullae |
|
|
Term
| What will the BNP in a patient with chronic bronchitis look like? |
|
Definition
| It will be abnormal, but not as crazy high as in a person with CHF |
|
|
Term
| What is the most common lethal inherited disease in white people? |
|
Definition
|
|
Term
| what type of genetic disorder is cystic fibrosis? |
|
Definition
|
|
Term
| is a disease of _____crine gland dysfunction |
|
Definition
|
|
Term
| Which two organ systems are most often affected in CF? |
|
Definition
| these patients often have chronic lung disease and exocrine pancreatic dysfunction |
|
|
Term
| what may be seen on the nose exam of a CF patient |
|
Definition
|
|
Term
| What finding of vitamin A and what finding of B complex deficiency may be seen in CF patients? |
|
Definition
A- dry skin
B complex- cheilosis |
|
|
Term
| Why are some male CF patients sterile? |
|
Definition
| absence of the vas deferens |
|
|
Term
| Requirements for a CF diagnosis include either a positive genetic testing OR what one definite thing and an option of three others... |
|
Definition
-positive sweat chloride findings (>60 mEq/L) and 1 of the following:
-typical COPD
-documented exocrine pancreatic insufficiency
-positive family history (usually an affected sibling) |
|
|
Term
| recovery of which organism from bronchoalveolar lavage fluid supports the diagnosis of CF in a clinically atypical case and in children... |
|
Definition
|
|
Term
| What are the three primary goals in the tx of CF |
|
Definition
1. maintaining lung function as near to normal as possible by controlling respiratory infection and clearing airways of mucus
2. administering nutritional therapy to maintain adequate growth (CF patients have trouble absorbing fat soluble vitamins)
3. managing complications |
|
|
Term
| the CF transmembrane conductance regulator (CFTR) protein is the underlying cause of CF, what is the name of the first type of CFTR potentiator used to treat CF |
|
Definition
|
|
Term
| Which disease on the blueprint is a specific form of chronic progressing fibrosing interstitial PNA? |
|
Definition
| idiopathic pulmonary fibrosis (IPF) |
|
|
Term
| A pt presents with DOE ond nonproductive cough x 8 months that has been gradual in onset.... what is your initial thought about a dx... |
|
Definition
| idiopathic pulmonary fibrosis |
|
|
Term
| What might be heard when auscultating the chest of a person with idiopathic pulmonary fibrosis? |
|
Definition
| fine bibasilar inspiratory crackles (velcro) that start at the base and progress upwards with increasing disease |
|
|
Term
| A very common comorbidity of patients with idiopathic pulmonary fibrosis (20-40%) is.... |
|
Definition
|
|
Term
| What are two things that may be seen on the CXR of a pt with idiopathic pulmonary fibrosis? |
|
Definition
| honeycombing! and possibly ground glass opacities |
|
|
Term
| What is the best radiological study for the diagnosis of idiopathic pulm fibrosis |
|
Definition
|
|
Term
| What may a pulm function test show in a patient with idiopathic pulm fibrosis? |
|
Definition
| a restrictive defect with a decreased lung volume and a NL to increased FEV1/FVC ratio |
|
|
Term
| What is the only definitive treatment for idiopathic pulm fibrosis |
|
Definition
| lung transplantation because no effective pharmacologic treatment has yet been discovered |
|
|
Term
| Do anti inflammatory medications work for a patient with idiopathic pulm fibrosis? |
|
Definition
| NO. this is not a disease of inflammation, rather it is due to fibroblast proliferation and fibrogenesis |
|
|
Term
| What two classes of drugs used in combo have been tried in patients with idiopathic pulm fibrosis? |
|
Definition
| corticosteroids (10-15% of pts are responders) with Cytotoxic drugs (ex's: azathioprine and cyclophosphamide) |
|
|
Term
| What are the three most common presenting symptoms of a patient with pulm HTN (sx relating to their pulm HTN- disregard if the HTN is secondary) |
|
Definition
dyspnea
weakness
recurrent syncope |
|
|
Term
| What is the most common abnormal heart sound heard on auscultation in a pt with pulm HTN |
|
Definition
|
|
Term
| What two heart murmurs may be heard in a pt with pulm HTN |
|
Definition
| pulmonic regurg (graham steell murmur) a/o tricuspid regurg |
|
|
Term
| What are the findings on lung exam in a patient with pulm HTN |
|
Definition
| usually normal unless there is another pulmonary problem causing the pulm HTN |
|
|
Term
| WHAT is the criterion standard for diagnosing pulm hTN |
|
Definition
|
|
Term
| What type of thyroid disorder is often discovered in pts with idiopathic pulm HTN |
|
Definition
|
|
Term
| What is usually found on the EKG of a pt with pulm htn? |
|
Definition
| R axis deviation, R atrial enlargement, R ventricle hypertrophy, ST depression and T wave inversions in the anterior leads |
|
|
Term
| WHat class of drugs is often used to treat pulm HTN |
|
Definition
CCBs because they act on vascular smooth muscle to dilate the pulmonary resistance vessels and lower pressure
-they are used in high doses |
|
|
Term
| What are contraindications for CCB use in a pt with pulm HTN |
|
Definition
|
|
Term
| Name 4 ancillary tx's for pts with pulm HTN |
|
Definition
warfarin
digoxin (improve the RV fxn)
diuretics (for peripheral edema)
O2 |
|
|
Term
| Pulm HTN is defined as what pulmonary arterial pressures? |
|
Definition
| >25 mmHg at rest or >30 mm Hg during exercise |
|
|
Term
| what is the definition of cor pulmonale? |
|
Definition
| an alteration in the structure and function of the right ventricle caused by a primary disorder of the respiratory system |
|
|
Term
| what type of heart murmurs could be heard on a patient with cor pulmonale |
|
Definition
| split 2nd heart sound with an accentuated pulmonary component and systolic ejection click |
|
|
Term
| What would a CXR, ECG, and echo show on a patient with cor pulmonale? |
|
Definition
CXR: emlargement of the RA RV and pulm arteries
ECG: right axis deviation, peaked P waves, RV hypertrophy
Echo: positive for RV dilatation (NL LV size and fxn) |
|
|
Term
| what are the two things that can cause acute cor pulmonale? What would be characteristics of the RV in this case? |
|
Definition
-massive pulmonary embolism (sudden increase in pulm resistance)
-ARDS (RV overload caused by the pathologic features of the syndrome and mechanical ventilation requires a higher transpulmonary pressure)
-RV would be dilated as opposed to hypertrophied |
|
|
Term
| Name some meds used in cor pulmonale |
|
Definition
Diuretics- to decrease elevated RV filling volume and pressure
CCBs- pulm artery vasodilators to decrease RV afterload
O2 to decrease RV afterload
Warfarin- to prevent thromboembolism in high risk pt AND in patients where thromboembolus caused the problem |
|
|
Term
| what are some rescue drugs for unstable patients with cor pulmonale |
|
Definition
DRUGS that help RV contractility:
milrinone (inotropic agent, vasodilator)
norepinephrine
dobutamine (adrenergic CV agent) |
|
|
Term
| pneumoconioses are (obstructive/restrictive) lung diseases |
|
Definition
|
|
Term
| what is a restrictive pattern on PFTs |
|
Definition
| normal FEV1/FVC with decreased TLC |
|
|
Term
| what are some occupations that could expose someone to asbestos? |
|
Definition
| insulation, demolition, construction, mining, manufacturing, ship building |
|
|
Term
| what are two characteristic findings on CXR of asbestosis? |
|
Definition
| linear opacities and pleural plaques |
|
|
Term
| Coal worker's pneumoconiosis is usually (sx-atic/asx-atic) |
|
Definition
| asymptomatic until nodules are greater than 1 cm |
|
|
Term
| 62% of patients with coal workers pneumoconiosis will develop what? |
|
Definition
|
|
Term
| what are some occupations that could expose someone to silica? |
|
Definition
| mining, sand blasting, quarry work, stone work, glass and pottery work |
|
|
Term
| what are some diagnostic characteristics on CXR of silicosis? |
|
Definition
small nodular opacities in the upper lobes (silicotic nodules)
EGGSHELL appearance! (calcified hilar lymph nodes) |
|
|
Term
| what lung CA is not due to smoking, but due to asbestos exposure? |
|
Definition
|
|
Term
| what are some occupations that may expsoure a pt to beryllium? |
|
Definition
| high techonology fields (aerospace, nuclear power), ceramics, tool and dye manufacturing |
|
|
Term
| What is the tx for most pneumoconioses? |
|
Definition
Supportive: O2, vaccinations (pneumovax and flu) and rehab
corticosteroids may relieve chronic alveolitis in silicosis, but other pneumoconioses are unresponsive |
|
|
Term
| What is the pathognomic lesion of sarcoidosis |
|
Definition
|
|
Term
| what two organ systems are most often affected by sarcoidosis? |
|
Definition
| lungs and lymph nodes (hilar) |
|
|
Term
| A 45 yo black female presents with dry cough, dyspnea, and non-specific chest pain x 2 months.... you think.... |
|
Definition
|
|
Term
| What skin condition is commonly associated with arthralgic manifestations of sarcoidosis |
|
Definition
|
|
Term
| What is the name for the rash associated with sarcoidosis? |
|
Definition
lupus perino
violaceous papular lesions commonly on the face |
|
|
Term
| What radiographic modality is central to evaluation of sarcoidosis |
|
Definition
|
|
Term
| What are the serum ACE and calcium levels of a sarcoid patient |
|
Definition
| elevated because NCGs secrete ACE and 1,25 vitamin D |
|
|
Term
| What is the gold standard for diagnosing sarcoidosis? |
|
Definition
| biopsy showing non-caseating epitheloid granulomas |
|
|
Term
| What is the first line tx for a pt with sarcoidosis? |
|
Definition
Prednisone if the pt is stage 2 or 3
if no response after 1-3 months, taper off
if response, continue for 12 months |
|
|
Term
| What medication is an alternative to steroid tx in a pt with sarcoidosis |
|
Definition
|
|
Term
| A sarcoidosis patient should have monitoring follow up visits every 6-12 months (3-6 months if more severe disease) and what two things should be checked for progression or regression of disease |
|
Definition
|
|
Term
| what is another name for hyaline membrane disease? |
|
Definition
infant respiratory distress syndrome
surfactant deficiency |
|
|
Term
describe what is happening, surfactant wise, at the following weeks in gestation
24-28
28-32
35 |
|
Definition
24-28: surfactant begins to be produced
28-32: found in amniotic fluid
35: most neonates have adequate amounts of surfactant |
|
|
Term
| what may be seen on a CXR in a baby with hyaline membrane disease |
|
Definition
air bronchograms!
atelectasis
doming of diaphragm |
|
|
Term
| a baby with hyaline membrane disease may have what results on an ABG |
|
Definition
| increase CO2 and decrease O2 leading to a respiratory acidosis |
|
|
Term
| administration of exogenous surfactant for a baby with hyaline membrane disease is most efficacious within ______ hours of birth |
|
Definition
|
|
Term
| what type of ventilation is used in babies with hyaline membrane disease |
|
Definition
| CPAP low and slow and IV fluids |
|
|
Term
| what is the prophylaxis for a baby that is going to be premature and may not have enough surfactant |
|
Definition
| mom takes glucocorticoids (dexamethasone and beclamethasone) to help baby's lung maturity speed up |
|
|
Term
| which bronchus is more likely to have a foreign body lodged in it? |
|
Definition
|
|
Term
| What is a pleural effusion? |
|
Definition
| an abnormal collection of fluid in the pleural space resulting form excess fluid production or decreased absorption |
|
|
Term
| what is the pathophysiological balance that prevents pleural effusions? |
|
Definition
1. hydrostatic and oncotic forces
2. extensive lymphatic drainage
- when something disrupts this balance effusions can develop |
|
|
Term
| what is the #1 sx of pleural effusion? name some more... |
|
Definition
DYSPNEA!
cough
pleuritic chest pain
tachypnea |
|
|
Term
| physical exam findings for pleural effusions usually do not show up unitl >_____ mL of fluid are present in the pleural space? |
|
Definition
| >300 mL (NL amount of fluid in the pleura space is about 0.13 ml/kg of 1 mL in most healthy people) |
|
|
Term
| what are some PE findings present with a pleural effusion? |
|
Definition
-dimished/absent breath sounds
-dullness to percussion
-decreased tactile fremitus
-egophony |
|
|
Term
| What is the criteria used to determine if a pleural effusion is transudative or exudative? Name some criteria |
|
Definition
Lights criteria
-pleural fluid (PF) PRO/serum PRO >0.5 = exudative
-PF LDH/serum LDH >0.6= exudative
-PF LDH >2/3 the lab's upper limit of normal SERUM LDH |
|
|
Term
| Describe the difference between a transudative and exudative pleural effusion |
|
Definition
-transudative: usually ultrafiltrates of plasma in the pleura due to imbalance of hydrostatic and oncotic forces in the chest
-exudative: caused by inflammatory conditions and the pleural membrane is involved- permeability of pleural capillaries to PRO is incr. resulting in high PRO content in the fluid |
|
|
Term
|
Definition
| accumulation of air in the pleural space |
|
|
Term
| what is the MC RF for a primary spontaneous PTX |
|
Definition
|
|
Term
| What are the O2 sats often for a pt with a PTX? |
|
Definition
| They are often NL, so don't let this fool you |
|
|
Term
| What is the #1 diagnostic exam for PTX |
|
Definition
|
|
Term
|
Definition
-small will resolve on their own
-large or symptomatic: Chest tube inserted at the 4-5th intercostal space (nipple line in men) at the midaxillary line
-THEN O2 and serial CXR Q24hrs until resolved |
|
|
Term
| What are the differences between the presenting sx of a spontaneous PTX and a tension PTX |
|
Definition
spontaneous- acute onset of chest pain and SOB
tension- hypotension, hypoxia, chest pain, dyspnea |
|
|
Term
| Describe a primary spontaneous PTX (PSP) |
|
Definition
| occurs in pts without underlying lung dz (however many have underlying blebs!) and in absence of inciting event. pts are usually male, age 20-40 who are very tall and thin and are SMOKERS |
|
|
Term
| describe a secondary spontaneous PTX |
|
Definition
| occurs in pts with a wide variety of parenchymal lung disease- air enters the pleural space via distended, damaged, or compromised alveoli |
|
|
Term
| Describe a traumatic/tension PTX |
|
Definition
traumatic- due to blunt or penetrating trauma
tension- life threatening condition that develops when air is trapped in the pleural cavity under positive pressure- displacing mediastinal structures and compromising cardiopulmonary function |
|
|
Term
| name the chest tube sizes used for a pt with large PTX in stable condition, unstable condition, and a pt with an effusion |
|
Definition
16-22 French
22-28 French
8-16 French first, if ineffective try 22 or bigger |
|
|
Term
| What is a pulmonary embolism? |
|
Definition
| obstruction of the pulmonary arterial system with material that originated elsewhere in the body |
|
|
Term
| Name some common sources of pulmonary emboli |
|
Definition
-DVT (90%)
-tumors that invaded venous circ
-air
-fat from a long bone fx
-amniotic fluid from active labor |
|
|
Term
| Name the most common s/sx of PE |
|
Definition
Dyspnea/SOB
Tachypnea!
PLeuritic CHest pain
Hemoptysis
tachycardia |
|
|
Term
| Explain using a D-Dimer test to eval a possible PE |
|
Definition
| a normal D-Dimer always ruled out a PE, but if it is elevated it needs to be examined further. Many patients have elevated D-dimers for an assortment of reasons (esp hospitalized patients) |
|
|
Term
| What blood count is sometimes elevated in pts with PE |
|
Definition
| WBC- not always, but its not uncommon to see a WBC of >20,000 |
|
|
Term
| What are the gold standard radiological tests for eval of PE |
|
Definition
-#1 multi row detector CTA
-#2 pulm angio gram if #1 is not available
-CXR to rule out other diagnoses |
|
|
Term
| What are the first steps of tx for a pt with pe |
|
Definition
-O2!
-Heparin for at least 5 days
-Long term Warfarin (X3 months)- should be overlapped at least 5 days with heparin |
|
|
Term
| When is thrombolysis indicated in PE |
|
Definition
| when there is shock, refractory hypoxemia, or signs of RHF |
|
|
Term
|
Definition
hypercoagulability
endothelial injury
hemodynamic stasis |
|
|
Term
| What is Wells Criteria a scoring system for? |
|
Definition
|
|
Term
| What is acute respiratory distress syndrome (ARDS)? |
|
Definition
| the acute onset of BL pulmonary infiltrates and severe hypoxemia in the absence of evidence of cardiogenic pulmonary edema |
|
|
Term
| How is ARDS differentiated from an acute lung injury (ALI)? |
|
Definition
| PaO2/FIO2 is <200 in ARDS and <300 in ALI |
|
|
Term
| What is the basic pathophysiology of ARDS? |
|
Definition
| associated with diffuse alveolar damage (DAD) and lung capillary endothelial injury. early phase is considered exudative and later phase is considered fibroproliferative |
|
|
Term
| What are some causes of ARDS |
|
Definition
-direct lung injury (gastric acid aspiration, PNA, near drowning, pulm contusion, O2 toxicity, toxic inhalation)
-Sepsis (#1 RF for ARDS)
-drug OD
-acute pancreatitis |
|
|
Term
| When does ARDS usually present |
|
Definition
| within 24-48 hrs of the triggering event |
|
|
Term
| give the timeline of ARDS sx |
|
Definition
| dyspnea with exertion that progresses to dyspena at rest, tachypnea, anxiety, agitation, and increased O2 demands |
|
|
Term
| What diagnosis must be ruled out before a pt can be said to have ARDS |
|
Definition
| cardiogenic pulm edema- look for CHF, volume overload, JVD, murmurs, hepatomegaly, edema |
|
|
Term
| What Labs/Rads are useful for a pt with ARDS |
|
Definition
|
|
Term
| Are any drugs implicated for the tx of ARDS |
|
Definition
No
-corticosteroids are recommended but only show an increase in mortality to >14 days |
|
|
Term
|
Definition
| a colorless, odorless gas produced by combustion of carbonaceous material |
|
|
Term
| describe the pathophysiology of CO toxicity |
|
Definition
-causes impaired O2 delivery and utilization at the cellular level
-toxicity primarily results from cellular hypoxia from impedence of O2 delivery. CO reversibly binds hgb
-CO binds myoglobin even better than hgb-- causing myocardial depression and hypotension that exacerbates the problem |
|
|
Term
| what are the most common symptoms for non traumatic non fatal nonfire exposure to CO |
|
Definition
| HA (37%) dizziness (18%) nausea (17%) |
|
|
Term
| cherry red skin is known as a classic sign of CO toxicity, is it reliable? |
|
Definition
not really- "when youre cherry red, youre dead"
most patients present with pallor |
|
|
Term
| Whats an example work up for a pt with possible CO toxicity |
|
Definition
HbCO levels
ABG
Troponin, CKMB
CK (non traumatic rhabdo)
CXR and CT head to r/o other dx if no improvement |
|
|
Term
| what is the tx for CO toxicity? |
|
Definition
remove from expsoure
intubate if necessary
100% o2 until HbCO <10% |
|
|
Term
| What is marcus gunn pupil another name for? explain this phenomenon |
|
Definition
| relative afferent pupillary defect - when the good eye is stimulated with light both pupils will constrict fully, when the light is switched to the bad eye both pupils will dilate a bit because the stimulus carried through the optic nerve is weaker |
|
|
Term
| What eye pathology is associated with giant cell arteritis? |
|
Definition
| ischemic optic neuropathy |
|
|
Term
| what is the average tonometry reading for the eye? |
|
Definition
| 16 mm Hg (10-21 is the normal range) |
|
|
Term
| a patient complains of a painful eye with steamy vision with colored halos around light sources... you think....? |
|
Definition
| acute angle closure glaucoma |
|
|
Term
| A patient presents with acute onset of vision loss and explains it as a curtain being drawn from top to bottom... you think....? |
|
Definition
|
|
Term
| Name two drugs that can cause macular degeneration. |
|
Definition
| chloroquine or phenothiazine |
|
|
Term
| what is metamorphopsia? how can it be measured? |
|
Definition
| the phenomenon of wavy or distorted vision that is often seen in macular degeneration. it can be measured with an amsler grid |
|
|
Term
| What is one drug and one drug class that are known to cause cataracts? |
|
Definition
lovastatin
corticosteroids |
|
|
Term
| What is the immediate tx for a patient with acute angle closure glaucoma? |
|
Definition
start IV carbonic anhydrase inhibitor (acetazolamide, brinzolamide, dorzolamide, methazolamide..)
topical Beta blocker
and osmotic diuresis |
|
|
Term
| Describe what will be seen on a gram stain of an eye infected with gonorrhea and chlamydia |
|
Definition
chlamydia: no organisms seen
gonorrhea: intracellular gram-negative diplococci |
|
|
Term
| a blue or cyanotic sclera can be a normal finding or seen in children with ___________/___________ |
|
Definition
|
|
Term
| A lesion of the R optic nerve would cause |
|
Definition
| total blindness of the R eye |
|
|
Term
| a lesion at the optic chiasm would produce what visual defect? |
|
Definition
| bitemporal heteronymous hemianopsia |
|
|
Term
| A lesion of the R optic tract would produce what visual defects? |
|
Definition
| Left homonymous hemianopsia |
|
|
Term
| Describe the results of the Webber and Rinne test in conductive hearing loss |
|
Definition
Weber: lateralization to the affected ear
Rinne: bone conduction greater than air conduction |
|
|
Term
| Describe the results of the Weber and Rinne test in sensorineual hearing loss. |
|
Definition
Weber: sound will be louder in the ear that does not have SNHL
Rinne: impairment in both bone and air conduction but air conduction will remain greater than bone |
|
|
Term
| What are the clinical manifestations of menieres disease? What is the tx? |
|
Definition
hearing loss, tinnitus, and vertigo
diuretics and salt restriction (sx result from distention of the endolymphatic compartment) |
|
|
Term
| what class of abx can cause hearing loss? |
|
Definition
|
|
Term
| What is the difference between the nystagmus seen with central and peripheral vertigo? |
|
Definition
Peripheral: horizontal with a rotary component, fast-phase beats away from the diseased side and fixation inhibition
Central: nonfatigable nystagmus with vertical greater than horizontal plane, and no latency or suppression by fixation |
|
|
Term
| How do you differentiate thrush from leukoplakia? |
|
Definition
| Thrush can be scraped off, leukoplakia cannot |
|
|
Term
| What is the most common site of nosebleeds? Less common and more severe? |
|
Definition
Kiesselbach's plexus on the anterior aspect of the nose
Woodruff's plexus is a posterior bleed and requires emergency evaluation |
|
|
Term
| Describe vision loss in macular degeneration and what would be seen on the fundoscopic exam. |
|
Definition
gradual painless central vision loss
Drusen! |
|
|
Term
| Describe vision loss in macular degeneration and what would be seen on the fundoscopic exam. |
|
Definition
gradual painless central vision loss
Drusen! |
|
|
Term
| what is initial tx for epiglottitis? |
|
Definition
| IV abx (ceftizoxime or cefuroxime-- 3rd gen cephalosporins) and steroids (dexamethasone) |
|
|
Term
| what is initial tx for acute angle closure glaucoma? |
|
Definition
| IV acetazolamide (carbonic anhydrase inhibitor) |
|
|
Term
| When is MRI and when is CT indicated in diagnostic studies in a patient with sinusitis? |
|
Definition
MRI: if malignancy is suspected
CT: routine |
|
|
Term
| Name the organisms associated with chronic and acute otitis media |
|
Definition
chronic: pseudomonas, proteus, s aureus
acute: h flu, strep pneumonia, mycoplasma pneumoniae |
|
|
Term
| what is tx for herpes keratitis? |
|
Definition
|
|
Term
| cotton wool spots are seen in what eye problem |
|
Definition
|
|
Term
| What is presbycusis due to? is it sensorineural or conductive? |
|
Definition
loss of cochlear hair cells
sensorineural |
|
|
Term
| What is the examination of choice to examine a patient with suspected tracheoesopheageal fistula? What diagnosis in a pregnant mother would lead you to suspect this problem in her baby? |
|
Definition
-xray of the chest after inserting a nasogastric tube
-polyhydraminios |
|
|
Term
| stensons duct vs. whartons duct |
|
Definition
stensons- on the parotid gland
whartons- submandibular |
|
|
Term
| Acute sinusitis is usually due to viral etiology, only 0.2-2% are bacterial. What is the initial tx? When are abx implicated in adults and in children? |
|
Definition
nasal saline irrigation and APAP for pain
-abx in adults after a minimum of 7 days, in kids at 10-14 days |
|
|
Term
| what are 3 abx that are considered first line for acute sinusitis? |
|
Definition
amoxicillin
trimethoprim-sulfamethoxazole
doxycycline |
|
|
Term
| What is the pathophysiology behind vitamin A in visual health? |
|
Definition
| it is an important prosthetic group for visual pigments in the retina |
|
|
Term
| Define amblyopia and strabismus? |
|
Definition
Amblyopia- decreased acuity for non-anatomic reasons
Strabismus- type of amblyopia where one eye drifts off target |
|
|
Term
| What would be characteristic of vernal conjunctivitis on PE and on smear? |
|
Definition
| cobblestone papillae with milky exudates and eosinophils seen on smear |
|
|
Term
| A pt presents with acute angle closure glaucoma, what medication should be distributed immediately? |
|
Definition
| oral glycerin will reduce intraocular pressure rapidly |
|
|
Term
| a "boxcar" pattern seen on opthalmic exam signals what? |
|
Definition
| segmentation of the venous blood column- possibly a retinal artery occlusion |
|
|
Term
| Blepharitis can be anterior or posterior, differentiate the two. |
|
Definition
Anterior: affects the base of the eyelid
Posterior: usually due to meibomian gland dysfunction |
|
|
Term
| What rheumatic disease can initially present as blepharitis |
|
Definition
|
|
Term
| Name 6 of the top causes of blepharitis |
|
Definition
-staph infection
-dysfunction of the meibomian glands
-seborrheic dermatitis
-Demodex (parasite)
-rosacea
-Sjögren's |
|
|
Term
| Give the three steps to abx treatment of blepharitis, and how is a Demodex infection treated? |
|
Definition
-topical abx (erythromycin, e-mycin)
-topical abx/corticosteroid: sulfacetamide/prednisolone (blephamide)
-oral abx: tetracyclines
-domedex tx with ivermectin (PO) |
|
|
Term
|
Definition
| A firm nodular bulb that forms secondary to chronic inflammation of an internal hordeolum |
|
|
Term
| Will a chalazion be painful or tender to touch? |
|
Definition
| No, only if there is secondary infection and this would be the only instance in which topical abx would be appropriate in the tx of a chalazion |
|
|
Term
| What are the main tx options for a chalazion? |
|
Definition
-warm compress, baby shampoo, massage
-oral tetracyclines, no relief--> metronidazole
-oral corticosteroids |
|
|
Term
| Describe the differences beaten viral, bacterial, and allergic conjunctivitis |
|
Definition
Viral: watery dc
Bacterial: mucoid purulent dc
Allergic: mucoid dc that is stringy |
|
|
Term
| What is the most common cause of viral conjunctivitis ? What is also commonly seen? |
|
Definition
| Adenovirus and ipsilateral periauricular lymphadenopathy can be seen |
|
|
Term
| What are the treatments for non complicated bacterial conjunctivitis, gonococcal, chlamydial? |
|
Definition
Daytime: trimethoprim polymixin b (polytrim), at night erythromycin
Chlamydial: ees or azithromycin PO
Gonococcal: rocephin or penicillin IV |
|
|
Term
| Corneal involvement with conjunctivitis suggests which types of infection? |
|
Definition
Gonococcal or herpetic
HSV needs referral and tx with acyclovir |
|
|
Term
| What bacterial cause of conjunctivitis also commonly causes an ipsilateral OM |
|
Definition
|
|
Term
| A topical anesthetic is usually used in clinic to get a good exam on a pt with corneal abrasion, are these drops rx for the patient to use a home? |
|
Definition
| NO, pt can use APAP PO at home to help with pain |
|
|
Term
| Topical abx use is questionable as a staple in the tx of every corneal abrasion pt, but when are they a must? |
|
Definition
| When the abrasion is due to contact lenses |
|
|
Term
| Why is it so important to follow up with corneal abrasion patients? |
|
Definition
| Most corneal ulcers begin as abrasions |
|
|
Term
| Describe the difference in location between dacryocystitis and dacryoadenitis |
|
Definition
Cyst: medial base if the eye where the lacrimal duct is located
Adenitis: upper outer portion of the eye lid where the lacrimal gland is located |
|
|
Term
| What serious condition of the eye is sometimes seen with dacryocystitis |
|
Definition
| Orbital cellulitis- admit for IV abx |
|
|
Term
| What is the tx for acute and chronic dacryoadenitis and dacryocystitis |
|
Definition
Acute adenitis: keflex
Chronic adenitis: warm compress and symptomatic, biopsy if no improvement in 2 weeks
Acute cyst: augmentin
Chronic cyst: often requires surgery |
|
|
Term
| What are the 4 common types of ectropion? |
|
Definition
-senile: where aging relaxes the palpebral ligaments and causes the tarsus to sag outwards
-congenital: rare and associated with other developmental anomalies
-paralytic: 7th nerve palsy
-cicatricaial: formed after an infection or injury |
|
|
Term
|
Definition
| Eyelashes in contact with the cornea |
|
|
Term
| What autoimmune condition can cause entropion? |
|
Definition
| Ocular cicatricaial pemphigoid |
|
|
Term
| In the case of an intraocular impailment injury, the pupil may displace toward/away from the penetration site |
|
Definition
|
|
Term
| What can be done to exclude an intraocular or intraoribtal foreign body when a pt presents with what seems to be a superficial FB |
|
Definition
| CT scan, or X-ray if the FB is known to be metal |
|
|
Term
Which definition goes with the term horde old and which goes with chalazia:
-chronic non infectious granulomatous reaction
-acute focal infectious process |
|
Definition
Hordeola is acute
Chalazia is chronic |
|
|
Term
| What is the most common pathogen of causation in hordeola |
|
Definition
|
|
Term
| All non white pt's presenting with hyphema need to be screened for what |
|
Definition
|
|
Term
| IOP reduction is necessary for a sickle cell patient at what mmhg? A regular pt? |
|
Definition
|
|
Term
| If a hyphema patient has a normal or lower than normal IOP what is possible? |
|
Definition
|
|
Term
| What type of immunoglobulin is responsible for allergic rhinitis |
|
Definition
|
|
Term
| On a CBC of a patient with allergic rhinitis what will be seen? |
|
Definition
| Normal WBC with increased eosinophils |
|
|
Term
| What is the difference in the appearance of the nasal mucosa in a patient with seasonal allergic rhinitis and perennial allergic rhinitis ? |
|
Definition
Seasonal: mucosa looks bluish purplish in color
Perennial: bright red and shows inflammation |
|
|
Term
| What is the allergic triad? |
|
Definition
| Nasal polyps,, aspirin allergy, and asthma |
|
|
Term
| Antihistamines, in the tx of allergic rhinitis, are efficacious in treating most of she symptoms (sneezing, rhinorrhea, itching) but do not cause ignite ant improvement in wht? |
|
Definition
|
|
Term
|
Definition
| Ear discomfort due to pressure differences between the inside and outside of the ear drum. Most usually a negative pressure in the tympanic cavity |
|
|
Term
| What type of hearing loss ms be present with barotrauma? |
|
Definition
|
|
Term
| What are some tx options for barotrauma? |
|
Definition
| NSAIDs for pain, decongestant nose drops, steroids, then surgery if severe enough (paracentesis) |
|
|
Term
| The teed scale of severity is used to asses what? |
|
Definition
|
|
Term
| What is the first line antibiotic for Otitis media? Second line, if the first fails after three days? Second line, if pt is allergic to the class of the first line? |
|
Definition
Amoxicillin
Augmentin or rocephin (ESP if vomiting)
Macrolides (azithromycin, clarithromycin, clindamycin) |
|
|
Term
| What is the pathophysiology of otitis media? |
|
Definition
| Dysfunction of Eustachian tube drainage (could be due t a number of things) leaves air trapped in the middle ear which is eventually resorbed. It's creates a negative pressure and facilitates the reflux of nasopharyngeal bacteria into the Eustachian tube |
|
|
Term
| What is the most common pathogen for OM? Second? |
|
Definition
Strep pneumoniae
H flu ( different strain than meningitis so kids aren't protected by getting the vaccine) |
|
|
Term
| What is the most common pathogen in mastoiditis? |
|
Definition
|
|
Term
| A ct of the mastoid area in a pt with mastoiditis would show what? |
|
Definition
| Loss of mastoid air cells |
|
|
Term
| What cranial nerve is most often affected with mastoiditis |
|
Definition
|
|
Term
| When is it appropriate to treat mastoiditis with abx only, what abx? |
|
Definition
-in the early stages of disease when there is no sign of osteitis or peri osteitis
-rocephin
-ticarcillin (will cover pseudomonas in pt's with chronic mastoiditis ) |
|
|
Term
| What is the classical clinical triad for diagnosing mastoiditis? |
|
Definition
-prominent auricle with retroauricular swelling
-tenderness over the mastoid area
-otorrhea |
|
|
Term
| What are the 5 types of otitis externa? |
|
Definition
1. Acute diffuse: swimmers ear
2. Acute localized: usually an infected hair follicle
3. Chronic: pruritis more than pain and commonly due to drainage from a chronic OM
4. Invasive: in IC or diabetic patients, effects deep tissues of the ear canal and spread to the base of the skull
5. Eczematous |
|
|
Term
| Adults with otitis externa, especially if it is recurrent, should have what blood levels checked? |
|
Definition
| Glucose, because diabetes is a cause for recurrent and malignant otitis externa |
|
|
Term
| Describe the otorrhea seen in acute OE, chronic OE, fungal OE, acute perforated TM, chronic OM, fractured skull, allergy, and osteomyelitis... |
|
Definition
-acute OE: scant white
-chronic OE: more bloody, presence of granulomatous tissue
-fungus: small white or black florets with hyphae
-acute OM w. perf: mucus white yellow with pain
-chronic OM: same as above but no pain
-allergy: serous looking w. clear mucous
-osteomyelitis: foul odor
-fractured skull: CSF, high in glucose! |
|
|
Term
| What is the most common cause of otitis externa (OE)? |
|
Definition
| Pseudomonas aeruginosa (swimming pools and lakes) |
|
|
Term
| What bacteria is the cause of OE in IC adults and those with DM? |
|
Definition
|
|
Term
| What type of drug is the best to treat otitis externa? |
|
Definition
| An antibiotic steroid combo otic solution such as cortisporin (neomycin-polymyxinB-hydrocortisone) |
|
|
Term
| A perforated TM without associated infection or a legit MOA is a red flag for what in kids? |
|
Definition
|
|
Term
| When doing a weber test on a patient with TM perforation, which side will the sound lateralize? |
|
Definition
|
|
Term
| It's controversial to put otic abx drops into an ear with a perforated TM, but whwt class of abx should absolutely be avoided due to risk of sensorineural hearing loss? |
|
Definition
| Amino glycosides (gentamicin, neomycin, tobramycin) |
|
|
Term
| If a patient has a perforated TM and abuse is possible, what is a good way to verify ? |
|
Definition
| Look at the fluid coming from the ear, if its CSF from a ripped dura it will have a high glucose content and will leave a halo on a slide or cotton pad |
|
|
Term
| Which lymph nodes may be resent in a patient with GABHS pharyngitis |
|
Definition
|
|
Term
| Some pt's with GABHS pharyngitis present with symptoms of scarlet fever, give the three most prominent sx of this |
|
Definition
-circumpolar pallor
-white strawberry tongue turning to red strawberry tongue
-diffuse maculopapular rash that feels like goose flesh |
|
|
Term
| What is the gold standard for diagnosing GABHS pharyngitis |
|
Definition
| Throat culture, but RADT is often used in the clinical setting because its faster, but it's more expensive and has less sensitivity than a culture |
|
|
Term
| What abx is m own as the gold standard for GABHS pharyngitis? What does the peds book and dr. Jocher say is a better alternative and why? |
|
Definition
-penicillin
-cephalosporins (ESP keflex) because b-lactamase always present in the throat reduce the efficacy of penicillin and not cephalosporins |
|
|
Term
| What two abx should NOT be used in the tx of GABHS pharyngitis? |
|
Definition
| -tetracyclines and bactrim due to high levels of resistance |
|
|
Term
| How long should a pt stay out of work or school after startin abx to treat GABHS pharyngitis |
|
Definition
|
|
Term
| What complication of GABHS pharyngitis or an infection of the skin has not been shown to be preventable with abx? What are the three classic sx? |
|
Definition
Post strep glomerulonephritis
Hematuria, edema, HTN |
|
|
Term
| What is the common name for aphthous ulcers |
|
Definition
|
|
Term
| Describe what an aphthous ulcer looks like |
|
Definition
| Round or oval with yellow / white center and an erythema tours border and a gray floor |
|
|
Term
| What three nutritional deficiencies have been linked to aphthous ulcers |
|
Definition
|
|
Term
| When should a patient with laryngitis be referred to see a specialist? |
|
Definition
| If hoarseness is present >3 weeks |
|
|
Term
| Name five causes of oral candidiasis |
|
Definition
1. Breast fed infants
2. IC
3. Corticosteroid exposure (inhalers)
4. Abx use
5. DM |
|
|
Term
| How can one tell the difference between oral candidiasis and leukoplakia ? |
|
Definition
| Thrush can be scraped off to reveal an erythematous friable surface underneath |
|
|
Term
| What are 4 possible underlying etiologies in kids with chronic thrush |
|
Definition
-hypoparathyroidism
-Addison's disease
-hypothyroidism
-DM |
|
|
Term
| What are the three different types of dental abscesses? |
|
Definition
-peri apical: usually secondary to dental caries, originating in the pulp, MC in kids
-periodontal: involves the supporting structures of the teeth, MC in kids
-pericoronitis: infection of the gum flap that overlies the third molar |
|
|
Term
| Which tooth is MC effected in dental abscesses |
|
Definition
|
|
Term
|
Definition
| involuntary eye movements usually triggered by inner ear stimulation |
|
|
Term
| When it comes to central and peripheral causes of vertigo, which never has a vertical nystagmus and which may that finding be present? |
|
Definition
peripheral Never has a vertical nystagmus
a vertical nystagmus may be seen in central causes |
|
|
Term
| Tinnitus and deafness are often components of which type of vertigo- peripheral or central? |
|
Definition
|
|
Term
| Describe the difference in onset and severity between peripheral and central causes of nystagmus? |
|
Definition
peripheral is usually sudden and severe
central is usually slow onset and less severe |
|
|
Term
| What is pathognomonic for BPPV? |
|
Definition
|
|
Term
| what medication is often used to treat BPPV? what is a practice the patient can perform at home? |
|
Definition
meclizine (antivert)
epley manuever |
|
|
Term
| What associated finding in a pt with vertigo would lead you to believe it was central or cerebellar in origin? |
|
Definition
|
|
Term
| If a pt is suspected to have central causes of vertigo and MRI or CT of what structure is necessary? |
|
Definition
|
|
Term
| What is the most common form of labyrinthitis and name the mc causative organisms? |
|
Definition
Viral:
-Rubella and CMV prenatal
-Mumps and Measles: postnatal
-Herpes zoster oticus (Ramsay Hunt syndrome) |
|
|
Term
| What is a class of medications that are ototoxic and could be a potential cause of labyrinthitis? |
|
Definition
|
|
Term
| Does labyrinthitis occur with vertigo, nystagmus, or hearing loss? |
|
Definition
| It can occur with any of those, but not all need to be present for a dx |
|
|
Term
| What causes meneires disease? |
|
Definition
| the pathophys is not well understood- but the underlying cause is an overaccumulation of endolymph |
|
|
Term
| What are the guidelines for dx of Meneires dz? |
|
Definition
-recurrent spontaneous episodic vertigo (> or equal to 2 episodes of vertigo of at least 20 min duration must have occured)
-hearing loss
-aural fullness OR tinnitus |
|
|
Term
| What type of hearing loss is affected with Meneires disease? |
|
Definition
|
|
Term
| IF you preformed a Weber and Rinne test on a Meneires dz pt, what would be the results? |
|
Definition
-Rinne shows that air conduction remains > than bone
-Weber: the sound is more pronounced on the UNaffected side
*Normally the sound should be heard equally on both sides, in conductive hearling loss (NOT a meneiers pt) the sound is greater on the affected side, in sensorineural (MENEIRES pt) is is greater on the unaffected side |
|
|
Term
| What are some tx option for Meneires dz |
|
Definition
-meclizine
-salt restriction
-diuretics (AVOID LOOP because of ototoxicity potential)
-Aminoglycosides are a last resort bc they will destroy hearing in the process of releiving sx
-surg if all else fails |
|
|
Term
| What sinuses are the MC sites of sinusitis in children and in adults |
|
Definition
Maxillary is MC across the board
ehtmoid is most common in children |
|
|
Term
| What are the three factors that contribute to the development of a sinusitis? |
|
Definition
-obstruction of sinus drainage pathways (sinus ostia)
-ciliary impairment
-altered mucus quality and quantity |
|
|
Term
| How long should you wait before rx abx in a patient with sx of sinusitis |
|
Definition
-7-10 days
-sometimes a pt will think they are starting to feel better, and then the sx worsen around day 7 |
|
|
Term
| Name some abx that can be used to treat a sinusitis |
|
Definition
| -amoxicillin, augmentin, bactrim... |
|
|
Term
| What types of complications are common with sinusitis |
|
Definition
|
|
Term
| What sinusitis pt is a CT indicated in? |
|
Definition
| chronic sinusitis resistant to other tx, other complications, or an IC host |
|
|
Term
| What is the most common bleeding site in epistaxis |
|
Definition
|
|
Term
| What are some tx options for epistaxis |
|
Definition
-position the pt forward to keep blood from collecting posterior and obstructing the airway
-apply pressure to septum for 15-20 mins
-Decongest the mucosa with Afrin or lidocaine
-if necessary localize the clot and cauterize with silver nitrate |
|
|
Term
| Who are some pts you would suspect nasal polyps in |
|
Definition
-atopic: aspirin allergic, asthma pts
-pts with chronic sinus infections
-CF PATIENTS! |
|
|
Term
| What would a CT scan show for a nasal polyp? |
|
Definition
| cloudy opaque spots in the sinuses, and possible broken down bone from long standing polyps |
|
|
Term
| What are some tx options for nasal polyps? |
|
Definition
-nasal steroid sprays for blockages (nasonex, flonase, nasacort)
-oral corticosteroids if sx persist
-ABX if infection present
-SURG if necessary |
|
|
Term
| The initial manifestation of children and adults with HSV 1 often appears as what? |
|
Definition
-Kids: acute herpetic ginigivostomatitis
-Adults: acute herpetic pharyngotonsillitis |
|
|
Term
| What type of test is ordered to reveal a HSV infection? |
|
Definition
| tzank smear which will show multinucleated giant cells |
|
|
Term
| WHat is herpetic whitlow? |
|
Definition
| often seen in healthcare workers exposed to saliva of pts with HSV- infxn of the fingers at or near the cuticle or other site assoc with trauma |
|
|
Term
| What are some treatments for HSV1 |
|
Definition
magic mouthwash
antivirals- acyclovir etc |
|
|
Term
| what is the most common precancerous lesion of the lips and oral cavity? |
|
Definition
|
|
Term
| what is oral hairy leukoplakia associated with> |
|
Definition
| HIV- thought to be caused by EBV |
|
|
Term
| Which oral lesion can be scraped off- candidiasis or oral leukoplakia? |
|
Definition
| CANDIDIASIS- leukoplakia cannot be scraped off |
|
|
Term
| is oral hairy leukoplakia associated with malignancy? |
|
Definition
|
|
Term
| What social factors are directly related to the development of oral leukoplakia? |
|
Definition
|
|
Term
| what is the necessary eval for oral leukoplakia?? |
|
Definition
|
|
Term
| what is uveitis- what parts of the eye are involved |
|
Definition
| inflammation of the uveal tract of which the anatomy includes: iris, ciliary body, and choroid plexus |
|
|
Term
| what is the MC form of uveitis often seen in primary care or EDs? |
|
Definition
|
|
Term
| what is the causative agent of uveitis? |
|
Definition
often idiopathic
can be due to autoimmune diseases, too (IBD, RA, SLE, sarcoid, TB, syphilis, AIDS) |
|
|
Term
| What are two ways to differentiate uveitis from conjunctivitis |
|
Definition
-COnjunctival exam: perilimbal injection is present and increases in intensity as you approach the limbus. this is the opposite in conjunctitis
-Photophobia will be direct and consensual in uveitis, it will just be direct in conjunctivitis |
|
|
Term
| What is the #1 tx for a PA to remember for uveitis? |
|
Definition
|
|
Term
| What nerve and what muscle are most often associated with an orbital blowout fx- how do you test each |
|
Definition
infraorbital nerve (touch below the lower eyelid on both sides of face)
inferior rectus muscle (have the patient look up, they either wont be able to do it or they may have diplopia when they look up) |
|
|
Term
| what is the most common site of orbital blowout fracture? what site will put the pt at increased risk of orbital cellulitis? |
|
Definition
orbital floor (superior aspect of the maxillary bone)
medial wall fractures (ethmoid bone) |
|
|
Term
| What do you check for by palpating the bony rim of the orbit in a pt with a possible orbital wall fx? |
|
Definition
|
|
Term
| What is the imaging used to eval an orbital wall fx? |
|
Definition
|
|
Term
|
Definition
| defined as increased IOP with optic nerve damage |
|
|
Term
| What race is most often affected with glaucoma? |
|
Definition
|
|
Term
| What is the 2nd MCC of blindness in the US |
|
Definition
|
|
Term
| Describe the hx and PE of a pt with acute angle glaucoma (narrow angle) |
|
Definition
| -develops over hours, painful red eye with vision loss, pupils tend to be fixed mid-dilated, may see a "halo", may describe vision as "cloudy" or "steamy" |
|
|
Term
| Describe the vision loss of a pt with primary, open angle, glaucoma |
|
Definition
| peripheral first, then central |
|
|
Term
| Describe the open angle glaucoma- sex it affects most, and eye sx |
|
Definition
men > women
Incr. IOP
optic neuropathy |
|
|
Term
|
Definition
|
|
Term
| What is Ramsay Hunt Syndrome. what part of the body does it affect |
|
Definition
VZV infection of the head and neck that involves the facial nerve
-gives rise to vesiculation and ulceration of the external ear, ipsilateral ant 2/3 of tongue and soft palate, ipsilateral facial neuropathy |
|
|
Term
| how does a ramsay hunt pt typically present |
|
Definition
| deep pain within the inner ear that eventually radiates out to the pinna. pain can be present for hours to days before rash occurs |
|
|
Term
| what are the two drugs used to tx ramsay hunt |
|
Definition
| corticosteroids (prednisone) and acyclovir (zovirax) |
|
|
Term
| when does a ramsay hunt patient need to follow up with their PCP |
|
Definition
| 2 weeks, 6 weeks, and 3 months |
|
|
Term
| What is a peritonsillar abscess? |
|
Definition
| unilateral inflammatory process that is in tonsilar parenchyma and the peritonsilar tissue |
|
|
Term
| what are some signs and sx of a peritonsilar abscess |
|
Definition
| unilateral swelling and erythema of soft palate, hot potato voice, dysphagia, fever, drooling, uvular deviation |
|
|
Term
| the pathophysiology of peritonsillar abscess is unknown, what is a proposed theory |
|
Definition
| progression of an episode of exudative tonsillitis first into peritonsillitis and then into frank abscess formation |
|
|
Term
| what is the tx for a peritonsillar abscess |
|
Definition
| aspiration or incision and drainage followed by abx (augmentin or clindamycin) |
|
|
Term
| what are the sx of a retropharyngeal abscess |
|
Definition
| sore throat, fever, neck stiffness, and stridor |
|
|
Term
| what is the tx for retropharyngeal abscess |
|
Definition
-protect airway, O2, intubate if necessary
-call ENT
-admit with IV abx!!!! |
|
|
Term
| what is the tx for retropharyngeal abscess |
|
Definition
-protect airway, O2, intubate if necessary
-call ENT
-admit with IV abx!!!! |
|
|
Term
| What is another name for Ludwigs angina |
|
Definition
|
|
Term
|
Definition
| an oral floor abscess that can become potentially life threatening if the inflammatory process spreads to the deep cervical soft tissues and mediastinum |
|
|
Term
| Where does the inflammation of ludwig's angina usually begin? |
|
Definition
|
|
Term
| What will be seen clinically with ludwig's angina? what will the pt be complaining of? |
|
Definition
-edematous expansion with a firm, erythematous expansion in the submental and submandibular areas
-pt c/o difficulty swallowing and speaking
-high fever |
|
|
Term
| what needs to be done to make a dx of ludwigs angina |
|
Definition
|
|
Term
| What is the tx for Ludwig's angina |
|
Definition
ADMIT
consult ENT- they can I and D the abscess
IV abx |
|
|
Term
|
Definition
| opacity of the natural lens of the eye |
|
|
Term
| What are the two major types of cataracts? What are some risk factors for cataracts? |
|
Definition
-acquired and congenital
-DM, UV rays, smoking, excessive ETOH use, trauma, aging, hypothyroidism, down syndrome |
|
|
Term
| what will a cataract look like on fundoscopic exam? |
|
Definition
| black on a red background |
|
|
Term
| Mild cataracts that are not interfering with a patients ADLs can be treated with what? |
|
Definition
|
|
Term
| what is the most common tx of cataracts that are affecting a patients ADLs |
|
Definition
|
|
Term
| What are 4 diseases that can cause congenital cataracts |
|
Definition
Rubella
Mumps
Hepatitis
Toxoplasmosis |
|
|
Term
| Name some visual complaints that a pt with cataracts may have |
|
Definition
-yellow vision
-cloudy or foggy vision
-glare
-trouble driving at night
-reduced color perception
-double vision |
|
|
Term
| What is the leading cause of vision loss in patients older than 65? In patients younger than 65? |
|
Definition
age related macular degeneration
diabetic retinopathy |
|
|
Term
| Does ARMD effect central or peripheral vision? |
|
Definition
|
|
Term
| What are some RFs for ARMD? |
|
Definition
advancing age
white race
female gender
tobacco!!!!
UV rays |
|
|
Term
| What are the two types of ARMD? |
|
Definition
-wet, neovascular, exudative
-dry, non-neovascular, non-exudative |
|
|
Term
| What are some visual complaints in a patient with ARMD |
|
Definition
| blurred vision, distortion, peripheral vision is PRESERVED |
|
|
Term
| describe the pathophysiology of dry ARMD and what may be seen on fundoscopic exam |
|
Definition
-atrophy and degeneration of the retina
-drusen (debris within the retinal basement membrane) form and are seen as yellow spots on the retina on exam
-gradual visual acuity loss
-can at any moment change to the wet form.... |
|
|
Term
| describe the pathophysiology of wet ARMD and what may be seen on fundoscopic exam |
|
Definition
- less common that dry, but causes more severe visual loss
-causes sudden visual loss due to leakage of serous fluid into the retina, followed by abnormal vessel formation under the retinal pigment epithelium
-see serous fluid and intraretinal hemorrhages on exam |
|
|
Term
| What is the most important lifestyle modification that can be made in the tx of ARMD |
|
Definition
|
|
Term
|
Definition
-none has shown to be totally effective
-lutein and other vitamin supplements
-there are laser treatments and photodynamic therapy available |
|
|
Term
|
Definition
-none has shown to be totally effective
-lutein and other vitamin supplements
-there are laser treatments and photodynamic therapy available |
|
|
Term
| What is the most common cause of orbital cellulitis |
|
Definition
| bacterial ethmoid (occasionally frontal) sinusitis extension into the involved orbit |
|
|
Term
| What are the MC s/sx of orbital cellulitis |
|
Definition
-malaise and fever
-pain with eye movement
-limited ocular mobility, "CEMENTED GLOBE"! |
|
|
Term
| What imaging tests should be ordered of the orbit in a case of orbital cellulitis? |
|
Definition
|
|
Term
| What is the tx of orbital cellulitis? |
|
Definition
| ADMIT the pt and put on IV abx, MC oxacillin with a second agent depending on age |
|
|
Term
| What is the major DDX for orbital cellulitis? |
|
Definition
| paraseptal cellulitis which is more common but is anterior to the orbital septum so chemosis and limited mobility are absent |
|
|
Term
| What are two major complications of orbital cellulitis? |
|
Definition
-orbital inflammation leads to optic neuritis with atrophy and vision loss
-purulent thrombophlebitis of the orbital veins can lead to a cavernous sinus thrombosis |
|
|
Term
| What is the difference between a pterygium and a pinguecula? |
|
Definition
histologically they are the same: they are non-cancerous growth of tissue in the conjunctiva.
-a pinguecula does NOT grow onto the cornea
-a pterygium does grow onto the cornea! |
|
|
Term
| What is the treatment for a pterygium? |
|
Definition
none, let them be
they can be surgically excised if they start to interfere with vision, but they often recur unless the diseased bowman's layer is also removed |
|
|
Term
| What is the major risk factor for pterygium? |
|
Definition
|
|
Term
| The common presenting complaint in an emergency situation of "I can't see, and I feel like a curtain fell over my eye" is pathognomonic for what diagnosis? |
|
Definition
|
|
Term
| What are some other common visual symptoms of retinal detachment besides "curtain falling" |
|
Definition
| seeing flashing lights, floaters, blurred or blackening vision |
|
|
Term
| What is the treatment for a retinal detachment? |
|
Definition
emergency consult to ophthalmology--> surgery
patient should lay supine with head turned the direction of the affected eye |
|
|
Term
| What will be seen on fundoscopic exam of retinal detachment |
|
Definition
| often nothing, but possibly the rugous retina flapping in the vitreous humor |
|
|
Term
| what are some RFs for retinal detachment |
|
Definition
-can be spontaneous
-trauma
-extreme myopia
-older age |
|
|
Term
| Does every break in a retina lead to a retinal detachment? |
|
Definition
| No- detachment occurs when the liquefied vitreous body separates and vitreous humor penetrates beneath the retina through the tear and the forces of adhesions can no longer withstand the pressure |
|
|
Term
| What is more common, a retinal artery or retinal vein occlusion? |
|
Definition
| retinal vein occlusions are much more common |
|
|
Term
| What is the common presentation of a retinal vascular occlusion? |
|
Definition
| sudden painless marked unilateral vision loss |
|
|
Term
| What are common fundoscopic findings of a retinal artery occlusion |
|
Definition
| a pale or ground glass retina with a cherry red spot at the fovea. |
|
|
Term
| what is the name for the glistening yellow orange flakes of emboli that are seen on fundoscopic exam in a patient with retinal artery occlusion |
|
Definition
|
|
Term
| What are some risk factors for a retinal artery occlusion |
|
Definition
|
|
Term
| in retinal artery occlusion either the central retinal artery is occluded or a branch of it, what is the difference in pt presentation |
|
Definition
complete visual field defect in CRAO
sectional visual field defect in BRAO |
|
|
Term
| When is boxcar segmentation seen on fundoscopic exam |
|
Definition
| this is a sign of severe occlusion and slowing of the circulation.... often seen with branch retinal artery occlusion |
|
|
Term
| What is a beta blocker often used to lower IOP? |
|
Definition
|
|
Term
| what is the tx for retinal vascular occlusions? |
|
Definition
| immediate optho consult and lower IOP |
|
|
Term
| what is a risk factor for retinal vein occlusion that was not mentioned for RAO |
|
Definition
| glaucoma increases risk by 5x |
|
|
Term
| what is a risk factor for retinal vein occlusion that was not mentioned for RAO |
|
Definition
| glaucoma increases risk by 5x |
|
|
Term
| What are some findings on fundoscopic exam that are characteristic of a retinal vein occlusion |
|
Definition
| "BLOOD AND THUNDER RETINA": flame hemorrhages, edematous optic disk, edematous retinal vein, macular edema, possibly cotton wool spots |
|
|
Term
| What are the two types of diabetic retinopathy? What will you see on fundoscopic exam with each? |
|
Definition
-non-proliferative: venous dialtion, microaneurysms, retinal hemorrhages, retinal edema, hard exudates, and cotton wool spots
-proliferative: neovascularization, vitreous hemorrhage |
|
|
Term
| When should a newly diagnosed type 1 and type 2 diabetic get their first ophthalmic exam? then how often after that? |
|
Definition
-type 1: within 5 years of diagnosis, then annually
-type 2: at diagnosis, then annually |
|
|
Term
| Patients with diabetic retinopathy will be asymptomatic until what happens? |
|
Definition
| when the macula becomes involved or if their is vitreous hemorrhage |
|
|
Term
| What are cotton wool spots? What diagnosis are they most often associated with? Other dx's? |
|
Definition
-infarction of the nerve fiber layer of the retina
-DIABETIC RETINOPATHY!
-also retinal vein occlusion and htn retinopathy |
|
|
Term
| In hypertensive retinopathy and sclerotic changes in the eye, what is the basis behind each formation |
|
Definition
-htn: arterial changes primarily caused by vasospasm
-arteriosclerosis: changes due to thickening of the wall of the arteriole |
|
|
Term
| WHat may be seen on fundoscopic exam in a patient with htn retinopathy or sclerotic changes? |
|
Definition
arteriovenous nicking (discontinuity in the retinal vein secondary to thickened arterial walls) and cotton wool spots.
-in more serious disease you may see hemorrhages and exudates
-papilledema is an ominous finding seen in pts with severely elevated BP |
|
|
Term
| what is optic neuritis usually associated with? s /sx? |
|
Definition
-MS
-decreased vision, pain with movement, decr color perception |
|
|
Term
| dx and tx for optic neuritis? |
|
Definition
MRI can visualize the optic nerve very well
usually resolves on its own, color vision loss can be permanent, steroids can help sx and make healing faster |
|
|
Term
| what is the hallmark of intracranial HTN |
|
Definition
|
|
Term
| what is the main tx to remember when dealing with a pt with a hyphen? Why? |
|
Definition
-REFER punt to ophtho.
-bc the RBCs can block the trabecular meshwork and cause high IOPs. Give them an eye shield and do an emergent consult to ophtho |
|
|
Term
| an acoustic neuroma is a rare benign tumor affecting what nerve? |
|
Definition
| The 8th cranial nerve (auditoy/vestibulocochlear) this nerve functions in balance and in hearing |
|
|
Term
| when a patient has an acoustic neuroma, what other CN might be affected due to trauma during surgery or growth of the tumor? |
|
Definition
|
|
Term
| Explain the results of the webber and rinne test |
|
Definition
-Weber is normal if the sound does not lateralize. If it materializes to one side there is either conductive hearing loss on the side it lateralized to, or sensorineural hearing loss on the contralateral side.
-The Rinne test is positive if AC>BC. If there was lateralization towards the left in the Weber, then the Rinne was pos. on the left, this means there is sensorineural hearing loss on the contralateral side. If Rinne neg. in this instance, then there is conductive hearing loss on that Left side |
|
|
Term
| What are the s/sx of acoustic neuroma? |
|
Definition
| Gradual or sudden onset of hearing loss, ataxia, nystagmus, tinnitus, vertigo |
|
|
Term
| what is the number one concern for a DM patient with chronic OM? Tx? |
|
Definition
| Cholesteatoma, referral to ENT for surgery d/t bone destruction |
|
|
Term
| If a bug is the foreign body inside an ear canal, what must be done first before trying to remove? |
|
Definition
| kill it with rubbing alcohol, this goes for any live object in the ear |
|
|
Term
| what will dissolve styrofoam or super glue if in the ear canal? |
|
Definition
|
|
Term
| if a foreign body seems to far to grasp in the ear with a tool, what can be done first (if the tympanic membrane is intact)? |
|
Definition
|
|
Term
| what should be ruled out if the patient has sudden onset of hearing loss? |
|
Definition
|
|
Term
| What causes conductive hearing loss? |
|
Definition
| impaired transmission of sound along the external canal, across the ossicles and through the oval window. Can be due to cerumen, otosclerosis, OE or OM |
|
|
Term
| What is sensorineural hearing loss and what is the MCC |
|
Definition
| hearing loss secondary to disruption of the nerves or mechanics of hearing. MCC is presbycusis |
|
|
Term
| What class of drugs is asssoc with hearing loss? |
|
Definition
| aminoglycosides (-mycins-- gentamycin, streptomycin, neomycin, tobramycin) |
|
|
Term
What is the common name for hematoma of the external ear?
tx? |
|
Definition
cauliflower ear
drain the hematoma, then compress the skin against the cartilage, the hematoma will reform if the skin is not pressed between the cartilage |
|
|
Term
| Hemophilia A is a deficiency in what clotting factor? |
|
Definition
|
|
Term
| Hemophilia B is a deficiency in what clotting factor? |
|
Definition
|
|
Term
| What is another name for Hemophilia B? |
|
Definition
|
|
Term
| occupational exposure to ________ puts a patient at risk for development of leukemia |
|
Definition
|
|
Term
| occupational exposure to _______/______ increases the risk of lymphatic and hematopoietic cancers.. |
|
Definition
|
|
Term
| Hemophilia c is a deficiency in what clotting factor? |
|
Definition
|
|
Term
| What's two other names for hemophilia c |
|
Definition
| Rosenthal syndrome and plasma thromboplastin antecedent deficiency (PTA) |
|
|
Term
| What are some common manifestations of hemophilia a and b |
|
Definition
-joint bleeding
-Cns bleeds
-intramuscular hemorrhage
-GI bleeds
-mucous membrane bleeds |
|
|
Term
| What is the genetic inheritance of hemophilia a and b |
|
Definition
|
|
Term
| What two labs are diagnostic for hemophilia a and b, results? |
|
Definition
aPTT and PT
prolonged aPTT and a normal PT |
|
|
Term
| What is the tx for hemophilia a and b |
|
Definition
A: factor viii replacement and desmospressin can be used
B: factor ix concentrates but desmospressin does not play a role |
|
|
Term
| Which hemophilia is due to a vitamin k dependent factor |
|
Definition
|
|
Term
| What is the inheritance pattern of hemophilia c |
|
Definition
| Autosomal, affects males and females, often seen in Jewish people |
|
|
Term
| Are bleeding manifestations predictable in hemophilia c patients as they are with b and a ? |
|
Definition
| No and they do not correlate with factor xi levels either |
|
|
Term
| In a newly diagnosed hemophilia c patient with no bleeding hx and no family hx (which is NOT uncommon) which two things should be Double checked and ruled out ? |
|
Definition
| Nonspecific inhibitor and lupus anticoagulant |
|
|
Term
|
Definition
| FFP before dental extractions or surgery only |
|
|
Term
| What is the genetic inheritance pattern for sickle cell disease |
|
Definition
|
|
Term
| In sickle cell disease, HbS replaces which normal hb? |
|
Definition
|
|
Term
| Which bones are more commonly affected in kids and which in adults with sickle cell disease? What is the name of the vertebral infraction often seen |
|
Definition
Kids- diaphysis of small tubular bones (dactylitis, hand foot syndrome)
Adults- metaphyses and subchondrium of long bones
"H vertebrae" |
|
|
Term
| What are the 3 cardinal signs of sickle cell disease |
|
Definition
1. Hemolytic anemia
2. Painful vaso-occlusive crisis
3. Multiple organ damage from multiple infarcts |
|
|
Term
| What is an important vitamin supplement for sickle cell disease pt's to take |
|
Definition
| Folate! Bc megaloblastic changes secondary to folate deficiency can complicate their anemia |
|
|
Term
| What is the only drug approved by the FDA for the tx of sickle cell disease |
|
Definition
| Hydroxyurea: MOA increases total and feral hemoglobin and retards gelation and suckling of rbcs |
|
|
Term
| What clotting factor is Von willebrand factor a component of |
|
Definition
|
|
Term
| What are the two functions of vWF |
|
Definition
-helps platelets stick to the site if injury and form a clot
-binds to factor 8 to protect it from rapid clearance from circulation |
|
|
Term
| What are some clinical manifestations of Von willebrands disease |
|
Definition
Mucocutaneous blessing
Epistaxis
Gingival bleeding
Cutaneous brushing
Menorraghia
-in severe disease may see hemarthrosis as in hemophilia a |
|
|
Term
| What tests are used in the dx of Von willebrands disease |
|
Definition
-amount of protein: vWF antigen
-vWF activity-- ristocetin cofactors assay
-aPTT: mildly prolonged in 50% of patients due to low levels of factor 8
-PT should be normal |
|
|
Term
| What is the tx for Von willebrands disease |
|
Definition
-depends on the severity of bleeding
-desmopressin: the tx of choice for most bleeding episodes , if this is it enough can be given vWFA containing concentrate (humatate p) which is also used prophylactic ally for surgery
-FFP transfusion can be used in pt's who are refractory to other tx- but should be avoided due to possibility of viral transmission |
|
|
Term
| What medicine should pt's with Von willebrands disease avoid |
|
Definition
|
|
Term
|
Definition
| An abnormal decrease in the number of platelets in the blood |
|
|
Term
| What is idiopathic thrombocytopenic purpura |
|
Definition
| Thrombocytopenia without toxic exposure or a disease associated with decreased platelet count |
|
|
Term
| ITP in kids is often seen after what two instances |
|
Definition
| 1-4 weeks post viral infection or live virus immunization |
|
|
Term
| What is the pathophysiology behind ITP |
|
Definition
Caused by an antibody (IgG or IgM) that binds to platelet membranes and results in FC receptor mediated splenic destruction of antibody coated platelets
-rarely it is the presenting symptom of an autoimmune disease, like lupus |
|
|
Term
| What will labs show in ITP |
|
Definition
| Decreased platelets but coag studies will be normal |
|
|
Term
| What are the main tx options for ITP |
|
Definition
-IV glucocorticoids
-IV immunoglobulin
-splenectomy if refractory to other tx
-thrombopoietic agents if chronic ITP refractory to other tx |
|
|
Term
| What is the Pentad of TTP |
|
Definition
-microangiopathic hemolytic anemia
Thrombocytopenic purpura
Neurologic abnormalities
Fever
Renal dz |
|
|
Term
| HUS shares many common characteristics with TTP but what are two things that are more common in HUS? |
|
Definition
Renal abnormalities are more severe
More common in kids |
|
|
Term
| What is the basic pathophysiology of TTP |
|
Definition
Bland thrombi in the microvasculature of affected organs, consisting mostly of platelets with little fibrin and red cells
-pt's usually have unusually large multimedia of vWF in their plasma and they lack a plasma protease (ADAMST13) that usually breaks these multimers down |
|
|
Term
| What is more common in TTP than in HUS |
|
Definition
| CNS involvement with mental status changes and focal neurological deficits |
|
|
Term
| What are most cases of TTP associated with |
|
Definition
| Deficiency of ADAMST13 activity due to autoantibodies against its activity |
|
|
Term
| What will always eventually be seen on the peripheral smear of a patient with TTP |
|
Definition
|
|
Term
| What two lab tests utilized in TTP are indirect measures of the degree of hemolysis |
|
Definition
|
|
Term
| What is the therapy if choice for TTP |
|
Definition
| Plasma exchange with fresh frozen plasma |
|
|
Term
| What is an adequate response to FFP exchange in a TTP patient |
|
Definition
Disappearance of neurological signs and symptoms
Platelets greater than 50,000
Decrease in LDH |
|
|
Term
| describe the size and the color of RBCs in anemia of chronic disease? |
|
Definition
|
|
Term
| what are some common morbidities that pt's have who are affected with anemia of chronic disease |
|
Definition
| infection, heart disease, DM, RA, malignancy, CKD, endocrine diseases, liver disease |
|
|
Term
| describe the underlying basic pathophys of anemia of chronic disease? |
|
Definition
| low availability of iron (due to cytokines trapping it in the macrophages), suppressed erythropoiesis d/t CKD or inflammatory cytokines, and relative reduced life span of RBCs |
|
|
Term
| what is the serum transferrin and what will it be in anemia of chronic disease and in iron def anemia? |
|
Definition
-protein responsible for carrying iron around the body, it is increased when erythopoietin is enhanced
-decr in anemia of chronic disease bc there is less erythropoietin
-incr iron def anemia bc the erythropoietin is working hard |
|
|
Term
| what is the serum ferritin level and what would it be in anemia of chronic disease and iron def anemia? |
|
Definition
-indicator of available iron stores in the body
-incr in anemia of chronic disease, bc there is enough iron but the body is unable to use it efficiently
-decr in iron def anemia, bc the basis of the problem is lack of iron stores |
|
|
Term
| what is the tx for anemia of chronic disease? |
|
Definition
-treat underlying cause
-r/o other causes: blood loss, iron def, b12 folate def
-if serious and symptomatic, refer to heme for possible erythropoietin stimulating agents or transfusions |
|
|
Term
|
Definition
| a syndrome of bone marrow failure characterized by pancytopenia and marrow hypoplasia |
|
|
Term
| what are the three main manifestations of aplastic anemia and the s/sx that go along with them? |
|
Definition
-anemia: pallor, tachycardia, fatigue, HAs, dyspnea, palpitations
-neutropenia: frequent/prolonged infections, mouth/pharyngeal ulcerations
-thrombocytopenia: easy bruising, bleeding, petechial rashes |
|
|
Term
| describe aplastic anemia in terms of size and color of RBCs |
|
Definition
normocytic or mildly macrocytic
normochromic |
|
|
Term
| What is the tx of aplastic anemia? |
|
Definition
| hematologic emergency, needs to be referred to a physician who is expert in heme and IC care. |
|
|
Term
| what patient populations are at increased risk of folate def anemia? |
|
Definition
-ALCOHOLICS
-pregnant women
-elderly |
|
|
Term
| describe the size of RBCs in folate def anemia. Why? |
|
Definition
-MACROcytic
-there is inadequate thymidine d/t the def of folate which leads to slower DNA replication. enlarged hematopoietic precursors (megaloblasts) in the bone marrow give rise to enlarged RBCs (macrocytes) |
|
|
Term
| what is the most accurate test to measure a person's folate? |
|
Definition
| -measure the RBC folate. more telling of the persons actual levels as plasma folate can change dramatically from day to day based on diet |
|
|
Term
| Homocysteine levels and methylmalonic acid levels are usually measured to dx and differentiate between B12 def and folate dec anemia. Which anemia will have which results? |
|
Definition
-B12 will have both a increased homocysteine and methylmalonic acid
-Folate will ONLY have increased homocysteine! |
|
|
Term
| Why must you rule out B12 def before treating for folate def anemia? |
|
Definition
| Bc supplementing folate will mask the b12 def, but the neuro symptoms that are only a part of B12 def will continue to worsen if the B12 is not replaced. |
|
|
Term
| Hypersegmented polymorphonuclear cells are characteristic of what anemias? |
|
Definition
| B12 and folate def anemias |
|
|
Term
| give some s/sx of folate def anemia |
|
Definition
-glossitis
-vague GI sx
-weakness, fatigue, difficulty concentrating, irritability, HA
-palpitations, dyspnea |
|
|
Term
| what is the tx for folate def anemia? |
|
Definition
| Folate 1 mg PO per day until resolved |
|
|
Term
| what is a common drug that is a folate antagonist? |
|
Definition
|
|
Term
| what role does B12 play in the absorption of folate? |
|
Definition
| B12 is necessary for folate to be taken up in cells |
|
|
Term
| G6PD def is classified as what type of anemia? |
|
Definition
|
|
Term
| How is G6PD def genetically passed? |
|
Definition
|
|
Term
| describe how G6PD def causes a hemolytic anemia |
|
Definition
| -G6PD is a gene that processes glucose and produces NADPH. NADPH is needed to protect RBCs from the harmful effects of reactive oxygen species. Without the G6PD gene, oxidation of RBCs causes a hemolytic anemia |
|
|
Term
| What are three things a patient with G6PD def should avoid? |
|
Definition
-oxidative drugs (sulfa, ASA)
-infections
-FAVA BEANS |
|
|
Term
| what are signs/sx a patient is undergoing an acute hemolytic episode |
|
Definition
|
|
Term
| what will be seen on a peripheral smear of a pt with G6PD def? |
|
Definition
| Heinz Bodies and Bite cells. This is because heinz bodies are from the precipitates of denatured hgb in the cells. Macrophages prematurely lyse these RBCs and turn them into bite cells. |
|
|
Term
| what is the general tx for G6PD def |
|
Definition
-usually self limiting
-avoid oxidative drugs (SULFAs)
-maintain hydration
-replenish RBCs through transfusion when necessary |
|
|
Term
| what type of bean should be avoided in pt's with G6PD def? |
|
Definition
|
|
Term
| you hear heinz bodies and bite cells, you immediately think…. |
|
Definition
|
|
Term
| what is the most basic pathophys of any hemolytic anemia |
|
Definition
| bone marrow activity cannot compensate for erythrocyte loss |
|
|
Term
| Causes of hemolytic anemia are intrinsic and extrinsic. give ex's of each |
|
Definition
-intrinsic: sickle cell dz, G6PD, hereditary spherocytosis, paroxysmal nocturnal hemoglobinuria
-extrinsic: TTP, HUS, DIC, burns, autoimmune and lymphoproliferative disease, hypersplenism, drug box |
|
|
Term
| give some s/sx of hemolytic anemia |
|
Definition
-sx: fatigue, dyspnea, DARK RED URINE, back pain
-s: lymphadenopathy, splenomegaly, hepatomegaly, jaundice, pallor, tachycardia |
|
|
Term
| What lab values are the HALLMARK of hemolytic anemia |
|
Definition
| elevated reticulocyte count in the presence of a stable or falling Hematocrit |
|
|
Term
| what type of bilirubin will be elevated in a hemolytic anemia? |
|
Definition
| unconjugated (indirect) bilirubin |
|
|
Term
| an anemia that presents with low serum iron, low ferritin, and high TIBC is classically what? |
|
Definition
|
|
Term
| why does iron def cause anemia? |
|
Definition
| iron is needed for erythropoiesis, without it erythropoiesis is diminished and hgb production is inadequate |
|
|
Term
| what do the cells of iron def anemia look like? |
|
Definition
|
|
Term
| what is the most common cause of iron def anemia worldwide? in the US? |
|
Definition
-Malnutrition world wide
-in US blood loss |
|
|
Term
| What are some major causes of blood loss in the US that can cause iron def anemia? |
|
Definition
-heavy menstrual cycle
-GI bleed (check FOBT and refer for scope if necessary)
-ALWAYS ask about chronic NSAID use |
|
|
Term
| what is plummer vinson syndrome? |
|
Definition
| -esophageal webbing, postcricoid dysphagia, and iron def anemia |
|
|
Term
|
Definition
| spoon shaped nails seen in iron def anemia |
|
|
Term
| what is the tx of iron def anemia |
|
Definition
-correct underlying cause
-ferrou sulfate 300 mg BID-TID |
|
|
Term
| what are the side effects of supplementing iron? |
|
Definition
| CONSTIPATION, nausea, dyspepsia |
|
|
Term
| between alpha, beta, and gamma globins, which are present in the fetus and which in adults? |
|
Definition
-alpha present in fetus and adult
-beta present in adult
-gamma present in fetus
*gamma globins disappear and beta take over after birth, while alpha are present the whole time |
|
|
Term
| you hear target cells, you think…. |
|
Definition
|
|
Term
| define the following terms: anisocytosis an poikilocytosis |
|
Definition
-anisocytosis: abnormal variation in the size of RBC
-poikilocytosis: abnormally shaped RBCs |
|
|
Term
| what are some signs and sx that are unique to B12 def? |
|
Definition
| peripheral neuropathy, parasthesias, leg stiffness, ataxia, memory impairment, personality change, depressed mood |
|
|
Term
| what lab test will be elevated in b12 def but not folate |
|
Definition
| both will have elevated homocysteine levels, BUT b12 def will have an elevated methylmalonic acid and folate will NOT have an elevated MMA |
|
|
Term
| what is pernicious anemia? what is the test to dx? |
|
Definition
chronic illness caused by impaired B12 absorption d/t lack of intrinsic factor in gastric acid secretions
-must check for ab's to intrinsic factor, or just check the levels of IF in the gastric acid which will be decr or absent |
|
|
Term
|
Definition
| 100 mcg of cyanocobalamin IM qday x 7 days, then QOD x 7 days, then Q3-4 dys for 2-3 weeks, then Qmonth |
|
|
Term
| what are the GI sx of b12 def anemia? |
|
Definition
anorexia
jaundice
glossitis |
|
|
Term
| what is the basis behind factor V Leiden? |
|
Definition
| It is a hyper coagulability DO. Factor 5 is a clotting factor in the blood and ppl with this condition have a mutation which causes factor 5 to be deactivated more slowly--- leading to a hyper coagulable state |
|
|
Term
| What is the basis of Protein C and Protein S Deficiency? |
|
Definition
| -They exert their anticoagulation effects by inactivating factors 5 and 8. When there is a def these clotting factors are not inactivated and the pt becomes hyper coagulable |
|
|
Term
| Heparin potentiates what in the blood to cause anticoagulation? |
|
Definition
|
|
Term
| Describe the basis of antithrombin III def? |
|
Definition
| inhibits coag cascade by lysing thrombin and factor X a, when there is a def the coat cascade is not inhibited and the pt becomes hyperocagulable |
|
|
Term
| what anticoagulation medication can cause hyper coagulation? |
|
Definition
| HEPARIN! heparin induced thrombocytopenia (HIT) |
|
|
Term
| anticoagulation's of what autoimmune disease are associated with acquired hyper coagulability d/t poorly understood mechanisms? |
|
Definition
|
|
Term
| what is a test to determine the presence of lupus anticoagulants? |
|
Definition
|
|
Term
| what is the most common leukemia in children? peak age of onset? |
|
Definition
acute lymphocytic leukemia (ALL)
4 |
|
|
Term
| What are the presenting s/sx of ALL? |
|
Definition
| rapid onset of recurrent infections, easy bruising, fatigue, generalized weakness, and bleeding into the skin and major internal organs |
|
|
Term
| clinically what can be seen on exam of a pt with ALL? |
|
Definition
| enlarged lymph nodes and possibly splenomegaly |
|
|
Term
| what is the cure rate of ALL? |
|
Definition
| with chemo, almost all go into remission and 70% are cured |
|
|
Term
| in ALL, what is the hallmark finding in the bone marrow? |
|
Definition
| >25% of the bone marrow is lymphoblasts, there is massive infiltration of the bone marrow with immature lymphocytes (lymphoblast) |
|
|
Term
| what is the most prevalent of all the leukemias? |
|
Definition
| acute myelogenous leukemia, AML |
|
|
Term
| What is the hallmark laboratory finding of CLL? |
|
Definition
| isolated lymphocytosis, suspect CLL if lymphocytes in the blood is >5000 |
|
|
Term
| What two things will be seen on a peripheral smear of a pt with CLL? |
|
Definition
-mature, small lymphocytes
-smudge cells (the leukemic lymphocytes are fragile, so when they are smeared onto a glass they are broken and turn into smudge cells) |
|
|
Term
| What may be seen on a CXR of a patient with CLL or ALL? |
|
Definition
| enlarged mediastinal lymph nodes |
|
|
Term
| what is the prognosis of CLL? |
|
Definition
| most survive 7-9 years from the time of dx. This disease seems relatively harmless, but is resistant to cure |
|
|
Term
| what is the most common cell line involved in CLL? |
|
Definition
|
|
Term
| what will be seen on the peripheral smear of a patient with AML? |
|
Definition
|
|
Term
|
Definition
| -neutropenia causing incr infections, thrombocytopenia causing mucosal or cutaneous bleeding/easy bruising, lethargy, anorexia, bone and joint pain |
|
|
Term
| What will be seen on the bone marrow biopsy of a patient with AML? |
|
Definition
|
|
Term
| What is the chromosome associated with CML? how does this form? |
|
Definition
-philadelphia chromosome
-translocation between chromosomes 9 and 22 |
|
|
Term
| What are the three phases of CML? |
|
Definition
| chronic, acclerated, and blast crisis |
|
|
Term
| What is the designer drug created to tx CML? |
|
Definition
|
|
Term
| What is the only proven therapy for CML? |
|
Definition
| allogenic bone marrow transplantation |
|
|
Term
| Give a buzz word/defining characteristic for each of the 4 major leukemias. |
|
Definition
-ALL: MC in kids
-CLL: Smudge cells
-AML: MC leukemia, auer rods
-CML: philadelphia chromosome |
|
|
Term
| What is the difference between non-hodgkins and hodgkins lymphoma in terms of lymph nodes involved? |
|
Definition
-NHL: multiple peripheral LNs involved
-HL: localized to a single axial group |
|
|
Term
| What is the difference between non-hodgkins and hodgkins lymphoma in terms of spread? |
|
Definition
-NHL: noncontiguous spread
-HL: orderly contiguous spread |
|
|
Term
| What is the difference between non-hodgkins and hodgkins lymphoma in terms of mets? |
|
Definition
-NHL: extranodal mets common (brain)
-HL: extranodal mets uncommon |
|
|
Term
| When will you see Reed Sternberg cells on peripheral smear? |
|
Definition
|
|
Term
| what are some s/sx of lymphoma? |
|
Definition
swollen lymph nodes in the neck, axillary, and groin
fatigue, fever, night sweats
weight loss
chest pain, coughing, dyspnea |
|
|
Term
| Most lymphomas have a ___ cell phenotype |
|
Definition
|
|
Term
| What type of hematologic malignancy is characterized by: malignant transformation of a single plasma cell that proliferates in the bone marrow and destroys the surrounding bone? |
|
Definition
| multiple myeloma- a malignancy of plasma cells |
|
|
Term
| What will be seen on serum PRO electrophoresis, in the urine, and on X-ray of a pt with multiple myeloma? |
|
Definition
-Monoclonal spikes on electrophoresis
-bence jones proteins in the urine
-lytic lesions are present on x ray |
|
|
Term
| what is the bacteria associated with contact lens wearers who get corneal abrasions? What is the abx to rx> |
|
Definition
pseudomonas
cipro 0.3% solution otic 2 drops q1-4 hours |
|
|
Term
| what is the referral time for a corneal ulcer? |
|
Definition
| URGENT ophtho referral, they could go blind |
|
|
Term
| what is another name for niacin deficiency? What characterizes it? |
|
Definition
pellagra
the 3 d's: diarrhea, dermatitis, dementia |
|
|
Term
| What would the hydrogen breath test show in a lactose intolerant patient? |
|
Definition
| elevated hydrogen- colonic flora digests the unabsorbed lactose. |
|
|
Term
| Describe the probable AST/ALT ratio of a pt with alcoholic liver disease |
|
Definition
|
|
Term
| What diameter is considered positive for a PPD in a regular healthy patient with no risk factors for TB? a patient that is infected with HIV? |
|
Definition
|
|
Term
| What dz is described by an olive shaped mass felt in the RUQ at the lateral edge of the rectus abdominis muscle |
|
Definition
|
|
Term
| Describe the vomited material in a child with pyloric stenosis |
|
Definition
| Non-bilious because the obstruction takes place proximal to the duodenum |
|
|
Term
| What is felt on abdominal exam in a baby with pyloric stenosis? |
|
Definition
-olive shaped mass in the RUQ and lateral to the rectus abdominis
-peristalsis of ten abd may be even just after feeding before vomiting |
|
|
Term
| What may be seen on barium swallow in an infant with pyloric stenosis? |
|
Definition
The string sign
*US is the#1 study though |
|
|
Term
| In an infant with pyloric stenosis what are the common metabolic lab findings? |
|
Definition
Hypochloremic hypokalemic metabolic alkalosis with increased BUN
-repetitive vomiting of purely gastric materials results in loss of HCl and kidneys then start retaining hydrogen in favor of potassium
- BUN increases with dehydration |
|
|
Term
| In an infant with pyloric stenosis who is a poor surgical candidate, what is a non surgical option for tx that has been riven effective? |
|
Definition
| Atropine sulfate (the trial used it for 21 days) |
|
|
Term
| What is the clinical lab test of choice to diagnose lactose intolerance? |
|
Definition
| Lactose hydrogen breath test |
|
|
Term
| name some sources of vitamin A |
|
Definition
| liver, fish oils, fortified milk, orange pigmented veggies, and eggs |
|
|
Term
| name some functions of vitamin A |
|
Definition
| vision, epithelial cell maturity, resistance to infection, anti-oxidant |
|
|
Term
| who is at risk for a vitamin A deficiency? |
|
Definition
| elderly, alcoholics, liver disease |
|
|
Term
| what are the characteristics of a vitamin A deficiency |
|
Definition
| night blindness and dry skin |
|
|
Term
| what are some characteristics of vitamin A toxicity |
|
Definition
| skin disorders, hair loss, teratogenicity |
|
|
Term
| what is the best source of vitamin D |
|
Definition
|
|
Term
| what are the functions of vitamin D |
|
Definition
| calcium regulation and cell differentiation |
|
|
Term
| who is at risk of a vitamin D deficiency? |
|
Definition
| eldery, shut ins with low amounts of sunlight |
|
|
Term
| what are some characteristics of vitamin D deficiency? |
|
Definition
|
|
Term
| what are some characteristics of vitamin D toxicity |
|
Definition
| hypercalcemia, kidney stones, soft tissue deposits |
|
|
Term
| what are some sources of vitamin K |
|
Definition
| liver, green leafy vegetables, broccoli, peas, green beans |
|
|
Term
| what is the function of vitamin K |
|
Definition
|
|
Term
| what is the manifestation of a vitamin K deficiency |
|
Definition
|
|
Term
| what are the characteristics of vitamin K toxicity |
|
Definition
|
|
Term
| What are some sources of thiamin |
|
Definition
| pork, grains, dried beans, peas, brewer's yeast |
|
|
Term
| what are the functions of thiamin |
|
Definition
| carb metabolism and nerve function |
|
|
Term
| who is at risk of a thiamin deficiency |
|
Definition
|
|
Term
| what is the name of the disorder associated with thiamin deficiency? what are the manifestations? |
|
Definition
| Beriberi (nervous tingling, poor coordination, edema, weakness, cardiac dysfunction) |
|
|
Term
| what are some sources of riboflavin? |
|
Definition
| milk, spinach, liver, grains |
|
|
Term
| what is the function of riboflavin? |
|
Definition
|
|
Term
| what are some manifestations of a riboflavin deficiency? |
|
Definition
| oral inflammation (cheilosis and glossitis), eye disorders |
|
|
Term
| What are some sources of niacin? |
|
Definition
| bran, tuna, salmon, chicken, beef, liver, peanuts, grains |
|
|
Term
| what are the functions of niacin? |
|
Definition
| energy and fat metabolism |
|
|
Term
| who is at risk for a niacin deficiency? |
|
Definition
|
|
Term
| what is the name for the disease associated with a niacin deficiency? |
|
Definition
| pellagra (dermatitis, diarrhea, dementia, death) |
|
|
Term
| What is a side effect of taking a niacin supplement? |
|
Definition
|
|
Term
| what are some sources of vitamin C |
|
Definition
| citrus fruits, strawberries, broccoli, greens |
|
|
Term
| what are the functions of vitamin C |
|
Definition
| collagen synthesis, hormone function, neurotransmitter synthesis |
|
|
Term
| who is at risk for a vitamin C deficiency? |
|
Definition
| alcoholics and elderly men |
|
|
Term
| what is the name of the disease associated with a vitamin C deficiency |
|
Definition
| scurvy (poor wound healing, petechia, bleeding gums) |
|
|
Term
| what is a characteristic of vitamin C toxicity |
|
Definition
|
|
Term
| What is cholecystitis? what are the two types? |
|
Definition
inflammation of the gallbladder often due to obstruction of the cystic duct.
-acalculous (10%) and calculous (90%) |
|
|
Term
| Name some causes of acalculous chilecystitis |
|
Definition
| acute illness, fasting, vasculitis, CA, debilitation, major surg, severe trauma, long term TPN |
|
|
Term
| What are the main sx of cholecystitis-- where is the referred pain? is jaundice involved? is anything felt on palpation? |
|
Definition
colicky abd pain that may be epigastric at first and then moves to the RUQ. may be colicky at first and then becomes steady.
-may have referred pain to the R shoulder/scapular region
-jaundice (15%)
-palpable GB or RUQ fullness(30-40%)
-Murphys sign |
|
|
Term
| What is Murphys sign and what disease state is it associated with? |
|
Definition
it is positive when pt experiences pain with deep inspiration or cough during palpation of RUQ
CHOLECYSTITIS |
|
|
Term
| What is the initial imaging of choice to dx cholecystits? what is preferred after that? what are the secondary imaging studies? |
|
Definition
|
|
Term
| What are the results of LFTs and amylase and lipase in dx a cholecystitis patient |
|
Definition
-LFTs are ordered to rule out hepatitis but may be elevated in cholecystitis or CBD obstruction
-Amylase and lipase are ordered to r/o pancreatitis, but amylase may be slightly elevated with acute cholecystitis |
|
|
Term
| What are the most common Risk factors of acute cholecystitis |
|
Definition
-Female, fat, forty, fertile
-drugs (esp hormonal therapy in women)
-pregnancy
-rapid weight loss |
|
|
Term
| what is the most common surgery performed by general surgeons in the US |
|
Definition
|
|
Term
| What are the requirements for a pt to receive outpatient conservative tx for cholecystitis |
|
Definition
-afebrile with stable vital signs
-no evidence of obstruction by lab values
-no evidence of CBD obstruction on US
-no underlying med probs, advanced age, pregnancy, IC
-adequate analgesia
-reliable pt with transportation
-prompt follow up |
|
|
Term
| What is the conservative outpatient tx for uncomplicated cholecystitis |
|
Definition
-ABX: levaquin and flagyl
-antiemetics: phenergan
-Analgesics: oxy/APAP (percocet) OR hydro/APAP (vicodin) |
|
|
Term
| If a cholecystitis pts needs surgery but is not a surgical candidate, what is the next best option> |
|
Definition
| US guided percutaneous transhepatic cholecystostomy drainage tube coupled with abx for definitive tx |
|
|
Term
|
Definition
| an infection ascending in a bile duct that also has an obstruction |
|
|
Term
| what are the two main causes of cholangitis |
|
Definition
| biliary tract manipulation and common bile duct stones |
|
|
Term
| What is the usual presentation of a cholangitis patient |
|
Definition
-HX of choledocholithiasis or recent biliary tract manipulation with:
Charcot's triad or Reynolds pentad
-PE shows fever, icterus, jaundice, abd pain |
|
|
Term
| What is charcots triad and reynolds pentad and what disease state are they associated with |
|
Definition
CT: jaundice, fever, and RUQ tenderness
RP: CT + altered mental status and hypotension (indicates sepsis) |
|
|
Term
| What is the main work up for cholangitis |
|
Definition
CBC: leukocytosis
CMP: hyperbilirubinema and increased alkaline phosphatase
blood cultures: positive in 50% of patients |
|
|
Term
| What is the number one radiological study for dx of cholangitis |
|
Definition
|
|
Term
| What is the initial tx of cholangitis |
|
Definition
| broad spectrum IV abx and electrolyte and fluid replacement |
|
|
Term
| If surgical techniques are necessary for a cholangitis patient, what procedure is often performed over surgery |
|
Definition
| endoscopic biliary drainage and decompression |
|
|
Term
| What is a gall bladder disease state that is caused by IBD (generally ulcerative colitis) 80% of the time |
|
Definition
| PSC (primary sclerosing cholangitis) |
|
|
Term
| What are two complications of cholangitis |
|
Definition
| pyogenic liver abscess and acute renal failure |
|
|
Term
| what does choledocholithiasis mean |
|
Definition
| presence of gall stones in the common bile duct |
|
|
Term
| describe chronic cholecysitis |
|
Definition
| chronically having gallstones in the GB that cause progressive fibrosis and loss of function of the GB and can predispose to GB cancer |
|
|
Term
| what are the two main substances found in gallstones |
|
Definition
| cholesterol and calcium bilirubinate |
|
|
Term
| what is a gallstone dissoluting agent |
|
Definition
| ursodeoxycholic acid (ursodiol) |
|
|
Term
| do asymptomatic gallstones require tx? |
|
Definition
| not usually, see notes for exceptions |
|
|
Term
| What is the source of alkaline phosphatase site, when do you expect it to be elevated |
|
Definition
| Bile duct epithelium, will be elevated in bile duct obstruction |
|
|
Term
| What is entero hepatic circulation |
|
Definition
| Circulation of bile acids from the liver to gut back to the liver |
|
|
Term
| What is the source of cck |
|
Definition
|
|
Term
| At what level of serum total bilirubin does one begin to get jaundiced |
|
Definition
|
|
Term
| Give 6 signs and symptoms of obstructive jaundice |
|
Definition
Jaundice
Dark urine
Clay colored stools (acholic stools)
Pruritius
Loss of appetite
Nausea |
|
|
Term
| What causes itching in obstructive jaundice |
|
Definition
| Bile salts in the dermis (not bilirubin!) |
|
|
Term
| What is the initial diagnostic study of choice for evaluation of the biliary tract/gallbladder/cholelithiasis |
|
Definition
|
|
Term
| What is the initial study of choice for obstructive jaundice |
|
Definition
|
|
Term
| What lab results are associated with obstructive jaundice |
|
Definition
| Elevated alkaline phosphatase, elevated bilirubin with or without LFTs |
|
|
Term
| Is hypercholesterolemia a risk for gallstone formation? |
|
Definition
|
|
Term
|
Definition
| Referred right sub scapular pain of biliary colic |
|
|
Term
| What is the major feared complication of ERCP |
|
Definition
|
|
Term
| What is the major risk factor for sclerosing cholangitis, in particular what type of this disease |
|
Definition
| Inflammatory Bowel disease, ulcerative colitis |
|
|
Term
| What is sclerosing cholangitis |
|
Definition
| Multiple inflammatory fibrous thickening s of bile duct walls resulting in biliary strictures |
|
|
Term
|
Definition
| Small bowel obstruction from a large gallstone (>2.5 cm) that has eroded through the gallbladder and into the duodenum/small bowel |
|
|
Term
|
Definition
| Tumor that involves the junction of the right and left heretic ducts |
|
|
Term
| What is the most common abdominal surgical emergency |
|
Definition
|
|
Term
| Name some signs and sx of appendicitis |
|
Definition
Abd pain that migrates to the RLQ
Anorexia, n/v
Pain in testes
Diarrhea (18%)
Rebound tenderness, guarding, diminished bowel sounds |
|
|
Term
| Where is McBurney's point |
|
Definition
| RLQ, point one third from the anterior superior iliac spine to the umbilicus in a patient with appendicitis |
|
|
Term
|
Definition
| Deep palpating of the LLQ causes referred pain in RLQ in a pt with appendicitis |
|
|
Term
|
Definition
| RLQ pain when right thigh is extended or flexed against resistance as patient lies on left Side in a pt with appendicitis |
|
|
Term
|
Definition
| Pain in the RLQ when flexed right thigh is internally and externally rotated with patient supine in a pt with appendicitis |
|
|
Term
|
Definition
| Pain with cough in a pt with appendicitis |
|
|
Term
| What is the MCC of appendicitis |
|
Definition
|
|
Term
| What is a major DDx for a pt with appendicitis who is a female of child bearing age |
|
Definition
|
|
Term
| What's the radiographic study of choice in a patient with suspected appendicitis |
|
Definition
|
|
Term
| What's a good opioid for the tx pain due to appendicitis? |
|
Definition
| Demerol (meperidine) bc it reduces pressure in the gut so it is good for abdominal pain |
|
|
Term
| What is the average length of a healthy appendix |
|
Definition
|
|
Term
| In the later stages of pregnancy what might appendicitis present as |
|
Definition
|
|
Term
| What is the MANTRELS mnemonic used for and what are the components of it |
|
Definition
Appendicitis
migration to the RLQ
Anorexia
N or v
Tenderness in the RLQ (2 pt's)
Rebound pain
Elevated temp
Leukocytosis (2 pt's)
Left shift |
|
|
Term
| Can you have an abnormal urlinalysis with appendicitis |
|
Definition
| Yes; mild hematuria and pyuria are common in appendicitis with pelvic inflammation resulting in inflammation of the ureter |
|
|
Term
| Does a positive urinalysis rule out appendicitis |
|
Definition
| No; ureteral inflammation resulting from the periappendiceal inflammation can cause abnormal urinalysis |
|
|
Term
| How long after removal of a NONruptured appendix should antibiotics continue post-op |
|
Definition
|
|
Term
| How long do you give antibiotics for perforated appendicitis |
|
Definition
| Until the patient has a normal WBC count and is afebrile, ambulating, and eating a regular diet (usually 3-7 days) |
|
|
Term
| What is the most common general surgical emergency in pregnancy |
|
Definition
|
|
Term
|
Definition
| Pelvic pain caused by ovulation |
|
|
Term
| do asymptomatic gallstones require tx? |
|
Definition
| not usually, see notes for exceptions |
|
|
Term
|
Definition
| A process in which a segment of intestine invaginates into the adjoining intestinal lumen, causing bowel obstruction |
|
|
Term
| What is the triad of sx characteristic to intussusception |
|
Definition
| -vomiting, abd pain, and passage of blood per rectum |
|
|
Term
|
Definition
| Sausage shaped mass in the right hypochondrium and emptiness in the RLQ |
|
|
Term
| When is the mass in intussusception best palpated |
|
Definition
| Between spasms of colic when the infants quiet |
|
|
Term
| What is the traditional and most reliable way to make the dx of intussusception in kids |
|
Definition
|
|
Term
| What are the two characteristic signs of intussusception found in ultra Sound. Is ultra sound the study of choice for intussusception |
|
Definition
-target sign and pseudo kidney signs
-no, contrast enema is |
|
|
Term
| What is the most common type of non op reduction used in intussusception |
|
Definition
| Pneumatic with air insufflation |
|
|
Term
| What are the two terms used to describe the intestine in intussusception |
|
Definition
-intussusceptum: invaginating portion of the intestine
-intusssuscipiens: the receiving portion of the intestine |
|
|
Term
| How is intussusception dx and tx in adults |
|
Definition
|
|
Term
| What is another name for toxic megacolon |
|
Definition
|
|
Term
|
Definition
| An acute toxic colitis with dilatation (either total or segmental) of the Colon |
|
|
Term
| What is a RF for toxic megacolon in an infant |
|
Definition
|
|
Term
| What are some risk factors for toxic megacolon in adults |
|
Definition
| UC, crohns colitis, pseudomembranous colitis, infectious colitides |
|
|
Term
| Name some s/ sx of toxic megacolon |
|
Definition
Fever, rectal bleeding, tenesmus, vomiting, abd distention, severe bloody diarrhea, vomiting, dehydration
Rigid abdomen, localized, diffuse or rebound abd tenderness |
|
|
Term
| What are the two hallmarks of toxic megacolon |
|
Definition
| Non obstructive colonic dilatation >6 cm and signs of systemic toxicity |
|
|
Term
| What are the diagnostic criteria for toxic megacolon |
|
Definition
1. Radiographic evidence of colonic dilatation
2. Any 3 of the following: fever, tachycardia, leukocytosis, or anemia
3. Any 1 of the following: dehydration, altered mental status, electrolyte abnormality, hypotension |
|
|
Term
| Keeping in mind predisposing factors for toxic megacolon, what may make the symptoms and physical findings be minimal |
|
Definition
| Inflammatory colitides which often cause this problem are often treated by high dose steroids which can mask the s/sx |
|
|
Term
| Describe the form of toxic megacolon most commonly associated with ulcerative colitis |
|
Definition
| Transverse colon dilated greater than 6 cm with loss of haustration |
|
|
Term
| What are the three main treatment goals of toxic megacolon |
|
Definition
-reduce colonic distention to prevent perforation
-correct fluid and electrolyte disturbances
-tx toxemia and precipitating factors |
|
|
Term
| Describe the different between the abd pain of appendicitis and the abd pain of gastroenteritis |
|
Definition
| In appendicitis the pain precedes vomiting, then migrates to the RLQ where it intensifies from local peritoneal irritation |
|
|
Term
| What patient behavior should make you seriously question the diagnosis of appendicitis |
|
Definition
| If the patient is hungry and wants to eat. |
|
|
Term
| What is the most common bacterial cause of mew enteric lymphadenitis that can lead to appendicitis |
|
Definition
|
|
Term
| What is the most common cause of small bowel obstruction in toddlers (<2yrs old) |
|
Definition
|
|
Term
| What is the most common site of intussusception |
|
Definition
| Terminal ileum involving the ileocecal valve and extending into the ascending colon |
|
|
Term
| What are the top four causes of SBO |
|
Definition
1. Post op adhesions
2. Malignancy
3. Crohn's disease
4. Hernias |
|
|
Term
| Describe the bowel Segments proximal to a SBO |
|
Definition
| Proximal to the SBO is dilated |
|
|
Term
| Describe the main difference in orientation between a proximal and distal SBO |
|
Definition
Proximal will have abd pain that has occurred for a shorter period of time that is colicky and accompanied by bilious vomiting
Distal pain is lasting as long as several days, progressive in nature, and accompanied by abd distention |
|
|
Term
|
Definition
| Nausea, vomiting (more proximal SBO), diarrhea (early finding), constipation (late finding), fever/tachycardia (late finding and may be seen with strangulation) |
|
|
Term
| Describe the bowel sounds heard in a SBO |
|
Definition
| Hyperactive early and hypo active later |
|
|
Term
| What the radiological study of choice for SBO , what will you see |
|
Definition
| X-ray of abd/pelvis two views supine and upright. Dilated small bowel loops with air fluid levels, absent or minimal colonic gas |
|
|
Term
| What are the top five steps in the ED for the care of an SBO |
|
Definition
Aggressive fluid resuscitation
Bowel decompression by NG tube
PRN analgesia and antiemetics
Surgical consult
Abx |
|
|
Term
| In a SBO that is simple or partial (NOT strangulated) what should be done for up to three days as tx |
|
Definition
| Non op trial of NG tube decompression and most will resolve themselves |
|
|
Term
| What type of SBO is a surgical emergency |
|
Definition
|
|
Term
| What are the two MCC of LBO |
|
Definition
Colon cancer (60%)
Diverticulitis (20%) |
|
|
Term
| What drug is associated with acute mesenteric ischemia |
|
Definition
|
|
Term
| T which intestinal artery do emboli preferentially go to in acute mesenteric ischemia |
|
Definition
|
|
Term
| What is the classic triad of acute mesenteric ischemia |
|
Definition
1. Acute onset of pain
2. Vomiting, diarrhea, or both
3. Hx of a fib, heart disease, or both |
|
|
Term
| What is the gold standard diagnostic test for acute mesenteric ischemia |
|
Definition
|
|
Term
| What are the symptoms of acute mesenteric ischemia |
|
Definition
| Severe pain, out of proportion to the exam, vomiting/diarrhea/hyper defecation, maybe heme stools |
|
|
Term
| What are the symptoms of chronic mesenteric ischemia |
|
Definition
| Weight loss, post paranoiac abdominal pain, anxiety/fear of food due to the pain, could have NVD, could have heme positive stools |
|
|
Term
| What vasodilatory drug is used in non occlusive mesenteric ischemia papaverine |
|
Definition
|
|
Term
| What action taken by a patient with chronic mesenteric ischemia can help with the severe pain |
|
Definition
|
|
Term
| What three vessels supply blood to the gut |
|
Definition
|
|
Term
| What gene is involved in hereditary familial polyposis syndrome |
|
Definition
|
|
Term
| High intake of what two things can be protective against polyp formation |
|
Definition
|
|
Term
| What are the screening guidelines for colonoscopy as far as when to begin, when to being if first degree family hx, and when to rescreen after polyp removal |
|
Definition
50
5 years before diagnosis of relative
Every 3 or 5 years depending on the polyp, whether its low risk or high risk respectively |
|
|
Term
| What are the two anatomic classifications of polyps |
|
Definition
Sessile (flat)
Pedunculated (on a stalk) |
|
|
Term
| What are the 4 histologic classifications of polyps |
|
Definition
-inflammatory pseudopolyp (as seen in UC or crohns)
-hamartamotus (NL tissue in abnormal configuration)
-hyperplastic (benign, NL cells, no malignant potential)
-neoplastic (proliferation of undifferentiated cells, pre or pre malignant |
|
|
Term
| What are the three subtypes of neoplastic polyps |
|
Definition
Tubular adenoma, tubulovillious adenomas, villous adenomas
Villous>tubulovillious > tubular |
|
|
Term
| What region of the colon are most polyps found in |
|
Definition
|
|
Term
|
Definition
| A painful linear tear or crack in the distal anal canal which , in the short term, usually involves only the epithelium and in the long term involves full thickness of the anal mucosa |
|
|
Term
| On what part of the anus does an anal fissure usually occur? What does different placement suggest? |
|
Definition
Anterior or posterior canal midline
Off midline: crohns, aids, std (syphilis) or cancer |
|
|
Term
| What are some mainstays of treatment for anal fissures |
|
Definition
| Bulking agents (Metamucil), increased fluids, site baths, and nitroglycerin if the first three provide no relief |
|
|
Term
| What is the usual cause and pathophysiology of an anorectal abscess |
|
Definition
| Obstruction of anal glands with obstructing debris leading to infection and eventual abscess formation |
|
|
Term
| What are the mainstays of treatment for an anorectal abscess |
|
Definition
| Surgical drainage (I and D) followed by WASH : warm water cleansing, analgesics, stool softeners, and high fiber diet |
|
|
Term
| Give some causes of hemorrhoids |
|
Definition
| Prolonged erect posture, constipation, pregnancy, diarrhea, obesity, fam hx, portal HTN, ascites, anatomic abnormalities |
|
|
Term
| What are the two types of hemorrhoids |
|
Definition
|
|
Term
| What are the four stages of external hemorrhoids |
|
Definition
Stage 1: bleed with defacation
2: protrude from anal opening but reduce spontaneously
3: requires manual reduction after bowel movements. Pain and discomfort
4: chronically protruding and risk of strangulation |
|
|
Term
| What is the treatment for hemorrhoids.. Stage 1 and 2, stage 3, and stage 4 |
|
Definition
1&2: high fiber diet, increased fluids, and bulk laxatives
3: suppositories with anesthetic and astringent
4 or unresponsive: surgery injection , rubber band ligation, or sclerotherapy |
|
|
Term
| What are some signs and symptoms of hemorrhoids |
|
Definition
| Pruritus ani, rectal bleeding/pain, fullness or mass sensation |
|
|
Term
| What types of HPV are known causes of rectal warts and neoplasms |
|
Definition
Warts 6 and 11
Neoplasms 16 and 18 |
|
|
Term
| What are some treatment options for anal warts |
|
Definition
| Imiquimod (Aldara), cryotherapy, laser treatment, electrodessication, surgical destruction/excision |
|
|
Term
| What are the too three sites of metastasis from a colorectal cancer |
|
Definition
|
|
Term
| Name some medications, other ingested items, that can cause esophagitis by relaxing smooth muscle |
|
Definition
-nitrates, CCBs, caffeine, albuterol, aminophylline
-SMOKING |
|
|
Term
| What are 3 classic symptoms of esophagitis? |
|
Definition
-heartburn
-acid regurgitation (water brash or pyrosis)
-dysphagia or odynophagia |
|
|
Term
| Obstruction of liquids during swallowing is a red flag for a DO other than esophagitis, name a few |
|
Definition
-neuromuscular DO
-neoplasm
-esophageal diverticulum |
|
|
Term
| What is the most common fungal cause and the most common viral cause of esophagitis in an IC pt |
|
Definition
|
|
Term
| on upper endoscopy, what will be seen for a patient with esophagitis due to CMV or HIV, HSV, or Candida |
|
Definition
CMV or HIV: deep, large ulcers
HSV: shallow multiple ulcers
Candida: white plaques |
|
|
Term
| What is a type of esophagitis seen in pts with food allergies? Tx? |
|
Definition
eosinophilic
fluticasone via metered dose inhaler |
|
|
Term
| You see a birds beak appearance on a CXR, you think |
|
Definition
|
|
Term
| you see a corkscrew appearance of the esophagus on the CXR, you think... |
|
Definition
|
|
Term
| What is neurogenic dysphagia? |
|
Definition
| causes difficulty swallowing with both liquids and solids. Caused by injury or dz of the brain stem of cranial nerves involved in swallowing |
|
|
Term
| what is zenker's diverticulum? |
|
Definition
| out pouching of posterior hypo pharynx that can cause regurgitation of undigested food/liquids into the pharynx several hrs after eating |
|
|
Term
| What is achalasia? how does it look on a CXR? |
|
Definition
| -global esophageal motor disorder in which peristalsis is decreased an LES tone increased. Causing slowly progressive dysphagia with episodic regurgitation and chest pain |
|
|
Term
| How does scleroderma sometimes manifest in the esophagus? |
|
Definition
| causes decreased esophageal sphincter tone and peristalsis- predisposing the pt to the symptoms and complications of reflux esophagitis |
|
|
Term
| a pt presents after a night of heaving drinking with hematemesis... you immediately think? |
|
Definition
|
|
Term
| What exactly is a mallory weis tear? |
|
Definition
| a linear mucosal tear in the esophagus, usually at the GE junction |
|
|
Term
| SCC of the esophagus is (more/less) common in the US than adenocarcinoma of the esophagus? In which part of the esophagus does each occur? What are the predisposing factors for each? |
|
Definition
-more
-SCC: prox 2/3; AdenoCA: distal 1/3
-SCC: smoking, alcohol; AdenoCA: barrett's, GERD, scleroderma, zollinger ellison, hiatal hernia |
|
|
Term
| What are some s/sx of an esophageal neoplasm? |
|
Definition
progressive dysphagia/odynophagia
unintentional weight loss
vomiting |
|
|
Term
| What is the most common cause of esophageal stricture? the second and third? |
|
Definition
GERD (70-80%)
post op strictures (10%)
corrosive strictures (<5%) |
|
|
Term
| Name some common s/sx of esophageal stricture? |
|
Definition
| dysphagia, odynophagia, unintentional weight loss, regurgitation of food, food impaction, chest pain, heart burn |
|
|
Term
| What are the two best treatments for esophageal stricture> |
|
Definition
esophageal dilatation
PPIs |
|
|
Term
| There are three disease processes that cause strictures. name each and give a short description |
|
Definition
-intrinsic: inflammation, fibrosis, neoplasia
-extrinsic: lymph node enlargement or direct invasion
-dz's that disrupt esophageal peristalsis a/o LES function by effects on smooth muscle and its innervation |
|
|
Term
| What causes esophageal varices? Which is usually caused by .... |
|
Definition
| Portal HTN, usually caused by cirrhosis (alcoholism) or long standing hepatitis |
|
|
Term
| What part of the esophagus do esophageal varices usually occur? |
|
Definition
|
|
Term
| Esophageal varices are usually asymptomatic until a life threatening bleed occurs. What are some s/sx that can occur before a life threatening bleed? |
|
Definition
| weakness, malaise, anorexia, abd pain, pallor, jaundice, ascites, splenomegaly |
|
|
Term
| what syndrome can cause thrombosis of portal vein and is on the DDX for esophageal varices? |
|
Definition
| budd chiari syndrome: triad of abd pain, ascites, and hepatomegaly |
|
|
Term
| what is the tx for a bleeding esophageal varice? |
|
Definition
EVL
high vol fluid replacement
pharmacologic vasoconstriction (octreotide) and BB |
|
|
Term
| how does octreotide work in the tx of esophageal varices? What is another option |
|
Definition
causes splanchnic vasoconstriction and reduces portal pressures.
vasopressin is second line due to cardiac side effects |
|
|
Term
| What is the tx for nonbleeding esophageal varices? |
|
Definition
|
|
Term
| What are the three major pathophysiologic causes of GERD |
|
Definition
1. dysfunction of the LES allowing reflux of gastric contents
2. Poor esophageal motility decreases clearance of acidic material
3. Delayed gastric emptying causes increased intragastric pressure resulting in increased pressure against the LES--- overcoming LES pressure and leasing to reflux |
|
|
Term
| Name some major risk factors for GERD |
|
Definition
-drug induced (nitrates, bronchodilators, CCBs)
-caffeine, smoking,
-Pregnancy
-Obesity
-Scleroderma |
|
|
Term
| What are pharmacologic treatments for GERD |
|
Definition
| H2 antagonists and PPIs, Both decrease gastric acid secretion in different ways |
|
|
Term
|
Definition
Ranitidine- Zantac
Cimetidine- tagamet
famotidine- pepcid
nizatidine- axid |
|
|
Term
|
Definition
omeprazole- prilosec
pantropazole- protonix
esomeprazole- nexium
lansoprazole- prevacid |
|
|
Term
| What is the MCC of chronic gastritis? |
|
Definition
|
|
Term
| WHat are some s/sx of gastritis? |
|
Definition
| epigastric burning, early satiety, N/V, belching, halitosis, black tarry stool, vomiting coffee ground material |
|
|
Term
| what are some causes of gastritis other than H. pylori |
|
Definition
| regular use of NSAIDs, excess etoh, excess smoking, severe stress, |
|
|
Term
| what is the best test for evaluation of Upper GI pain? |
|
Definition
|
|
Term
| What is first line tx for mild-mod gastritis with no concerning sx? |
|
Definition
| H2 blocker or PPI and stop NSAIDs |
|
|
Term
| What is the triple therapy for h pylori? quadruple? |
|
Definition
-Triple (use when low clarithromycin resistance)
1. PPI 2. Amoxicillin (sub Flagyl if pcn allergic) 3. Clarithromycin
-Quad therapy (when clarithromycin resistance high)
1. PP1 2. Bismuth 3. Flagyl 4. Tetracycline |
|
|
Term
| why do NSAIDs cause gastritis? |
|
Definition
| NSAIDs are cox inhibitors. COX is the rate limiting enzyme in prostaglandin formation. PGs protect the mucosal lining of the stomach from acid. NSAIDs inhibit cox, decrease PGs and lead to mucosal injury |
|
|
Term
| why do NSAIDs cause gastritis? |
|
Definition
| NSAIDs are cox inhibitors. COX is the rate limiting enzyme in prostaglandin formation. PGs protect the mucosal lining of the stomach from acid. NSAIDs inhibit cox, decrease PGs and lead to mucosal injury |
|
|
Term
| What is the MCC type of gastric neoplasm seen? where is it most prevalent |
|
Definition
| adenocarcinoma. not common at all in the US, huge problem in Japan |
|
|
Term
| Name some RF's for adenocarcinoma of the stomach |
|
Definition
-h pylori
-chronic atrophic gastritis
-tobacco abuse
-FAP
-NPHCC
-pernicious anemia
-eating lots of high preservative foods |
|
|
Term
| What are three areas of lymph nodes that gastric adenocarcinoma commmonly metastasizes to? |
|
Definition
-sister mary joseph's node: umbilicus
-Virchows: left supraclavicular
-Irish's: left axillary |
|
|
Term
| What is Zollinger Ellison syndrome? What hereditary issue is it related to? Where are they often found? What is the dx lab? |
|
Definition
gastrin secreting tumor (gastrinoma) that results in PUD
MEN 1
pancreas and duodenum
Fasting gastrin level >150 |
|
|
Term
| What is the most common extra nodal site for a non-hodgkin lymphoma |
|
Definition
|
|
Term
| What is the most common cause of peptic ulcer disease (PUD)? what is another very common cause? |
|
Definition
|
|
Term
| Give the sx of a duodenal ulcer, the sx of a gastric ulcer, and the shared symtpoms |
|
Definition
-Duodenal: relieved with food and antacids, worse at night
-Gastric: aggravated by food, more constitutional sx (anorexia, weight loss, NV)
-Both: burning, gnawing mid epigastric pain; may radiate to the back; dyspepsia (belching, bloating, distention, heart burn) |
|
|
Term
| If a patient with PUD does not have a hx of NSAID use and is negative for H Pylori, what must be ruled out? How? |
|
Definition
| ZES, gastrin levels with or without secretin test |
|
|
Term
| What is the tx for PUD? If it is caused by H Pylori? |
|
Definition
-avoid triggers
-PPIs and H2 receptor antagnists
-Triple tx for HP: PPI, clarithromycin, amoxicillin |
|
|
Term
| What are some non-infectious types of hepatitis? |
|
Definition
| alcoholic, drug induced, autoimmune, and many hereditary types |
|
|
Term
| name three viruses that can cause hepatitis in mostly IC patients |
|
Definition
|
|
Term
| What types of hepatitis are spread via the fecal oral route? |
|
Definition
|
|
Term
| Hepatitis D can only be transmitted with Hepatitis ___ |
|
Definition
|
|
Term
|
Definition
| parenterally or sexually. also perinatal |
|
|
Term
|
Definition
parenteral
sexual and perinatal are not common |
|
|
Term
| What types of Hepatitis can progress to chronic disease? |
|
Definition
|
|
Term
| Some chronic Hep patients are asymptomatic (carriers) and only present with the late complications. name the two end stage complications of Hep |
|
Definition
cirrhosis
hepatocellular carcinoma (HCC) |
|
|
Term
| Which type of Hep has a greater chance of progressing from acute to chronic, B or D? Which has a greater risk of developing cirrhosis or HCC? |
|
Definition
-C (>80%), B is only 10-15%
-B (25-40%), C is only 10-25% |
|
|
Term
| What are some s/sx of viral hepatitis? |
|
Definition
-s: jaundice, tea colored urine, tender hepatomegaly
-sx: malaise, anorexia, low grade fever, vague abd discomfort, NVD |
|
|
Term
| What lab shows active HAV? |
|
Definition
| immunoglobulin M AB to HAV |
|
|
Term
|
Definition
| supportive, be careful not to spread, avoid ETOH and other toxins |
|
|
Term
For Hep B, what do the following markers tell:
-HBsAg
-anti HBc
-anti HBs
-HBeAg |
|
Definition
-HbsAg: ongoing infection
-anti HBc: acute hepatitis
-anti HBs: immunity by past infection or vaccine
-HBeAg: highly contagious active infection |
|
|
Term
| What does the presence of the Hep C antibody mean? |
|
Definition
|
|
Term
| What two types of Hep are commonly co-infections with HIV? |
|
Definition
|
|
Term
| where is Hep E prevalent? |
|
Definition
| india, pakistan, SE Asia, parts of Africa |
|
|
Term
| What is the MCC of cirrhosis? 2nd MCCs? |
|
Definition
-Alcoholic liver dz
-Hep B and Hep C |
|
|
Term
| What is the pathophysiology of cirrhosis... specifically what two major events are caused by this distortion of liver anatomy? |
|
Definition
-decreased blood flow through the liver with subsequent HTN in portal circulation causes widespread manifestations: ascites, peripheral edema, splenomegaly, and varices (esophageal, gastric, hemorrhoids, caput medusae)
-hepatocellular failure leads to impairment of biochemical functions such as: decr. albumin synthesis and decr. clotting factor synthesis |
|
|
Term
| What is Child's Classification? Give the classes |
|
Definition
-estimates hepatic reserve in liver failur
-class A is mild dz
-Class C is most severe dz |
|
|
Term
| What is the gold standard for dx of cirrhosis? |
|
Definition
|
|
Term
| What are the classic signs of chronic liver disease? |
|
Definition
| -ascites, varices, gynecomastia, testicular atrophy, palmar erythema, spider angiomas, hemorrhoids, caput medusae |
|
|
Term
| What is the tx of cirrhosis? |
|
Definition
-abstinence from ETOH (regardless of underlying cause)
-interferons for Hep B and C if they're they cause
-liver transplant (must be ETOH free for 6 months) |
|
|
Term
| What is the mnemonic to remember the complications of cirrhosis? What does it stand for? |
|
Definition
-AC 9H
-ascites
-coagulopathy
-portal HTN, hypoalbuminemia, hyperammonemia, hyperestrinism, hepatic encephalopathy, hepatorenal syndrome, hyperbilirubinema/jaundice, HCC |
|
|
Term
| What is the most life threatening complication of portal HTN? |
|
Definition
|
|
Term
| What are the three locations of varices common with Portal HTN? |
|
Definition
-gastric (10%), esophageal (90%)
-rectal hemorrhoids
-caput medusae (distention of abd wall veins) |
|
|
Term
| How does ascites of the abdomen occur in portal HTN, specifically what are the pressure changes that are occurring? |
|
Definition
| -the accumulation of fluid in the peritoneal cavity occurs from an increase in hydrostatic pressure 2ary to portal HTN and then a decrease in oncotic pressure 2ary to hypoalbuminemia |
|
|
Term
| What is the method of diagnosis for ascites? |
|
Definition
| abd US can detect as little as 30 mL of fluid |
|
|
Term
| The fluid from a paracentesis of a pt with portal HTN would show what in regards to total PRO concentration and serum ascites albumin gradient? |
|
Definition
-total pro concentration <3 g/dL (transudate)
-serum ascites albumin gradient >1.1 g/dL (<1.1 g/dL is unlikely to be from portal HTN) |
|
|
Term
| What causes hepatic encephalopathy? What are some s/sx of hepatic encephalopathy |
|
Definition
-toxic metabolites (AMMONIA) usually filtered out by the liver accumulate and reach the brain
-decr. mental function, confusion, poor concentration |
|
|
Term
| What musk findings may be seen with hepatic encephalopathy |
|
Definition
-rigidity and hyperreflexia
-ASTERIXIS (flapping tremor) that can be seen with extension of the arms and dorsiflexion of the hands |
|
|
Term
| what does SBP stand for in terms of a cirrhosis pt? |
|
Definition
| -spontaneous bacterial peritonitis |
|
|
Term
| what is the MC agent of SBP |
|
Definition
|
|
Term
| what is the dx parameters for SBP? |
|
Definition
|
|
Term
| What are the signs of hyperestrinism in cirrhosis? why does hyperestrinism happen? |
|
Definition
-testicular atrophy, gynecomastia, spider angiomas, palmar erythema
-occurs d/t lack of estrogen binding PRO, so the serum estrogen levels increase |
|
|
Term
| Why is Vit K ineffective in tx coagulopathy caused by cirrhosis? What is the tx? |
|
Definition
-bc Vit K cannot be used by the failing liver
-FFP is the tx |
|
|
Term
| what percentage of pt's with cirrhosis get HCC (hepatocelllular carcinoma)? |
|
Definition
|
|
Term
| Name some s/sx of a hepatic neoplasm |
|
Definition
| -weight loss, RUQ abd pain, tender hard palpable liver mass, peritoneal friction rub, hepatic bruit |
|
|
Term
| Where are hepatic cancer most common? (areas of the world) |
|
Definition
| where hep B is endemic (SE asia and subsaharan africa) |
|
|
Term
| What serum lab value is highly specific (91%) but only 64% sensitive for liver neoplasms? |
|
Definition
| alpha fetoprotein >20 ng/mL |
|
|
Term
| What is the pathophysiology of acute pancreatitis? |
|
Definition
| -it is an inflammation of the pancreas resulting from prematurely activated pancreatic enzymes that invoke pancreatic tissue autodigestion |
|
|
Term
| What are the two main causes of pancreatitis? Name some other less common causes? MC pimping question? |
|
Definition
-ETOH abuse (40%)
-Gallstones/biliary tract dz (40%)- gallstones passing into CBD and blocking the ampulla of vater
-s/p ERCP, drug induced, post-op
-Scorpion Bites |
|
|
Term
| What is the MCC of acute pancreatitis in pediatrics |
|
Definition
|
|
Term
| Describe the s/sx of acute pancreatitis |
|
Definition
-acute epigastric abd pain, severe steady and dull, made worse with oral intake, laying supine, made better with leaning forward
-N, V, anorexia
-low grade temp, hypotensive, tachycardic
-epigastric tenderness and abd distention |
|
|
Term
| Between amylase and lipase, which is more specific for acute pancreatitis dx? Which is most commonly used? What are some criteria for out of the range of NL for the more commonly used test? |
|
Definition
-lipase more specific than amylase
-amylase MC ordered
-amylase 5x the upper limits of NL should strike suspicion |
|
|
Term
| What criteria is often used to evaluate mortality in patients with acute pancreatitis? What lab marker is not a part of this criteria that one would think would be? |
|
Definition
Ranson's Criteria
amylase is not a part of it! |
|
|
Term
| What is the best rad for dx of acute pancreatitis? |
|
Definition
|
|
Term
| What are the signs of a hemorrhagic pancreatitis? |
|
Definition
| -Cullen's (ecchymosis around the umbilicus), Grey Turner's (ecchymosis of the flanks) , and Fox's (ecchymosis along the inguinal ligament) Signs |
|
|
Term
| What is the tx of acute pancreatitis? |
|
Definition
-NPO, BOWEL REST!
-IV fluids
-Pain control, usually necessitates narcotics
-NG tube if severe NV or ileus |
|
|
Term
| At what # of positive Ranson Criteria should a patient go to the ICU for monitoring? |
|
Definition
|
|
Term
| What is the pathophysiology of chronic pancreatitis? |
|
Definition
| -persistent or continuing inflammation of the pancreas, with fibrotic tissue replacing pancreatic parenchyma, and alteration of pancreatic ducts (areas of stricture/dilation)-- eventually resulting in irreversible destruction of the pancreas |
|
|
Term
| What is the MCC of chronic pancreatitis? |
|
Definition
|
|
Term
| What are the signs and sx or chronic pancreatitis? |
|
Definition
-recurrent or persistent severe epigastric abd pain, often made worse with ETOH or eating, 50% radiate to back, worse when lying and better when leaning forward
-NV
-weight loss due to malabsorption, alcohol abuse, and DM
-steatorrhea due to malabsorption |
|
|
Term
| What is the classic triad of chronic pancreatitis? |
|
Definition
| steatorrhea, pancreatic calcifications, and DM |
|
|
Term
| What is the gold standard for diagnosis of chronic pancreatitis? |
|
Definition
|
|
Term
| Are labs helpful in determination of chronic pancreatitis? |
|
Definition
| No, amylase and lipase are usually NL or only slightly elevated |
|
|
Term
| What is the biggest social concern/complication associated with chronic pancreatitis? |
|
Definition
|
|
Term
| What are some non-op tx for chronic pancreatitis? |
|
Definition
-NPO/ BOWEL REST for acute exacerbation
-narcotics
-Pancreatic enzymes and H2 blockers
-Insulin
-Abstinence from ETOH
-frequent, small-vol, low-fat meals |
|
|
Term
| What is the goal of surg in chronic pancreatitis? |
|
Definition
| relieve incapacitating pain |
|
|
Term
| What is the most common type of pancreatic neoplasm (histologically speaking) |
|
Definition
|
|
Term
| What is the most common location of a pancreatic neoplasm? second and third MC? |
|
Definition
-head (75%)
-body (20%)
-tail (5-10%) |
|
|
Term
| What is the most clearly est. risk for pancreatic ca? what are some others? |
|
Definition
-Tobacco abuse!
-diabetes, heavy ETOH, chronic pancreatitis, increasing age |
|
|
Term
| Is painless jaundice a common sign of pancreatic cancer? |
|
Definition
|
|
Term
| What is Courvoisier's Sign? |
|
Definition
| palpable gallbladder most often due to CA of the pancreatic head |
|
|
Term
| What is the most sensitive test for dx of pancreatic neoplasm? |
|
Definition
|
|
Term
| what are two cancer markers that are measured in pancreatic tumors dx? |
|
Definition
|
|
Term
| What medications can contribute to constipation? |
|
Definition
| NARCOTICS, anticholinergics (antidepressants), iron, CCBs, aluminum or Ca antacids, Laxative abuse/dependence |
|
|
Term
| What are some endocrine/metabolic causes of constipation? |
|
Definition
| hypothyroid, hypercalcemia, hypokalemia, dehydration, uremia |
|
|
Term
| How much fiber should be recommended per day to a pt suffering from constipation? H20 intake? |
|
Definition
10-20 grams of fiber per day
64 oz or 1.5-2 L of water |
|
|
Term
| What is the cause of diverticulosis? |
|
Definition
| increased intraluminal pressure. the inner layer of the colon bulges through a focal area of weakness in colon wall (usually an area of blood vessel penetration) |
|
|
Term
| What is the cause of diverticulitis? |
|
Definition
| inflammation of one or more diverticula suspectedly due to fecal material or undigested food getting stuck in the out pouching causing obstruction, which may lead to erosion and micro perforation |
|
|
Term
| What is the most common area of the colon for diverticula? |
|
Definition
| sigmoid colon, probs d/t higher pressure in this area |
|
|
Term
| What are some known risk factors for diverticular dz? |
|
Definition
| low fiber diet (which leads to) and constipation. Causes increased intraluminal pressures |
|
|
Term
| What quadrant of the abdomen is the pain and discomfort of diverticular dz usually manifested? |
|
Definition
|
|
Term
| How is diverticulosis dx? Diverticulitis? |
|
Definition
-barium enema
-CT scan with oral and IV contrast (a barium enema or colonoscopy is CONTRAINDICATED in these pts due to the risk of perforation) |
|
|
Term
| What is a sign on a CBC of diverticulitis? |
|
Definition
|
|
Term
| What is the tx of diverticulosis? diverticulitis? |
|
Definition
-high fiber, low reside diet
-PO or IV abx depending on the severity, low residue or bowel rest diet, and analgesics |
|
|
Term
| Where can crohn's disease be located in the GI tract? What are the most common areas? |
|
Definition
-anywhere from the mouth to the anus
-the terminal ileum is one of the most common areas and it is predominantly R sided |
|
|
Term
| On colonoscopy/biopsy what does Crohn's disease look like? |
|
Definition
-skip lesions
-apthous ulcers
-cobblestone appearance
-transmural extensions to the entire bowel wall
-pseudopolyps |
|
|
Term
| Is smoking a RF for Crohns or UC? Is smoking protective in Crohns or UC? |
|
Definition
-rf for Crohns
-protective in UC |
|
|
Term
| Give some general s/sx of crohns disease |
|
Definition
| low grade fever, malaise, fatigue, abdominal pain (often RLQ), non-bloody diarrhea, cramping, |
|
|
Term
| What is the best test to dx crohn's? |
|
Definition
|
|
Term
| What is the general medical (not surgical) tx for Crohns disease/ |
|
Definition
-sulfasalazine (5-asa mesalamine is the main component) more helpful in UC and colonic issues but can be used here
-metronidazole if no help from 5-asa
-prednisone if refractory to the two above, add immunosuppressants if necessary |
|
|
Term
| What two things are absorbed in the terminal ileum and are therefore often malabsorbed in Crohn's disease patients? |
|
Definition
| B12 and Bile Acids (give a bile acid sequestrant for these pts) |
|
|
Term
| Is surgery ever used in pts with Crohns? Recurrence rate? |
|
Definition
| Yes, it is often necessary in all Crohns pts due to complications. BUT disease recurs in 50% of pts at 10 years post op |
|
|
Term
| Where is UC located in the GI tract? How does it spread? |
|
Definition
-always in the rectum
-travels from rectum proximally but the small bowel is usually not involved |
|
|
Term
| Describe how UC looks on colonscopy/biopsy? |
|
Definition
-its localized to the mucosa only (NOT transmural)
-uninterrupted involvement (NO skip lesions)
-PMNs accumulate in the crypts of the colon called crypst abscesses |
|
|
Term
|
Definition
| intermittent bloody, pus filled diarrhea, rectal urgency, tenesmus, fever, malaise, weight loss, abd pain |
|
|
Term
| What is the gold standard of dx of UC |
|
Definition
|
|
Term
| What is used to treat the acute exacerbations of UC |
|
Definition
|
|
Term
| What is the mainstay of tx for Crohns disease? |
|
Definition
| Sulfasalazine (5-ASA mesalamine is the active component) which helps to maintain remission |
|
|
Term
| Is surgery often implicated in UC? |
|
Definition
| Yes, a total colectomy is often curative unlike Crohn's |
|
|
Term
| Sclerosing cholangitis is a complication of UC, is it prevented by a colectomy? |
|
Definition
|
|
Term
| 1/2 of all _______ cancers are associated with UC |
|
Definition
| bile duct cancers (cholangicarcinoma) |
|
|
Term
| What is the MCC death in UC? |
|
Definition
| Toxic megacolon, affects <5% of UC patients |
|
|
Term
| What is the MC indication for surg in a crohns pt? |
|
Definition
|
|
Term
| What is a complication of Crohns that is not common in UC, most likely due to its transmural pattern? |
|
Definition
|
|
Term
| Erythema nodosum is an associated complication with what type of IBD |
|
Definition
|
|
Term
| sclerosing cholangitis is a complication of what type of IBD |
|
Definition
|
|
Term
| Pyoderma gangreosum is a complication of what type of IBD |
|
Definition
|
|
Term
| What are the main serum labs to order to dx Celiac Disease (2)? |
|
Definition
-IGA anti-endomysial antibodies
-IGA tissue transglutaminase |
|
|
Term
| What will a small bowel biopsy of a pt with celiac disease show? |
|
Definition
| flattened villi (the reason for malabsorption) |
|
|
Term
| What is the tx of celiac disease? |
|
Definition
strict gluten free diet
-prednisone in refractory cases |
|
|
Term
| What drug's only indication is irritable bowel syndrome, and is a common pain reliever for IBS patients? What is the MOA? |
|
Definition
-Dicyclomine Hcl (Bentyl)
-its an antispasmodic and anticholinergic agent which alleviates smooth muscle spasm of the GI tract |
|
|
Term
| What is the tx for intussusception, peds vs adult? |
|
Definition
In peds the dx and tx is barium enema
in adults the dx is CT and tx is surg |
|
|
Term
|
Definition
| In intussusception, a sausage shaped mass in the R hypochondrium and emptiness in the RLQ |
|
|
Term
| Of the three types of colonic polyps, rank them from least to greatest, with risk of carcinoma |
|
Definition
| tubulous< tubulovillous< villous |
|
|
Term
| What are the three most common sites of colon cancer mets? |
|
Definition
| Liver, lung, and peritoneum |
|
|
Term
| When should a pt who does not have any close family hx of colon cancer have their first colonoscopy? How often after that? |
|
Definition
|
|
Term
| in a pt with a first degree relative who had colon ca, when should they get their first colonoscopy? |
|
Definition
| ten years before the age of diagnosis of that first degree relative |
|
|
Term
| anal warts are caused by which strains of HPV? anal cancer is caused by which strains? |
|
Definition
|
|
Term
|
Definition
| when the uterine body and cervix can easily be flexed against one another |
|
|
Term
|
Definition
| softening of the cervix which develops by the beginning of the second month of pregnancy |
|
|
Term
|
Definition
| congestion of the pelvic vasculature causing bluish or purplish discoloration of the vagina and cervix |
|
|
Term
|
Definition
| widening of the softened area of the isthmus, resulting in bluish cervix and compressibility of the isthmus on bimanual exam-- occurs at 6-8 weeks of pregnancy |
|
|
Term
| thumb print sign seen on lateral x ray |
|
Definition
|
|
Term
|
Definition
| white patches on the conjunctivae that are a sign of Vitamin A deficiency |
|
|
Term
|
Definition
| asthma, nasal polyps, and aspirin hypersensitivity |
|
|
Term
| Serum electrophoresis shows a "monoclonal spike", you think....... |
|
Definition
|
|
Term
|
Definition
| varicosities found under the tongue- they are clinically insignificant and require treatment |
|
|
Term
|
Definition
|
|
Term
|
Definition
| dark blue inclusions seen in the RBC membrane on peripheral smear. these are usually removed under normal splenic conditioning, therefore they are seen in a splenectomized patient |
|
|
Term
|
Definition
| refers to skin lesions appearing on lines of trauma due to certain causative agents or by existing skin diseases, like psoriasis. The irritation of trauma itself can act as a co-factor in producing linear patterns. |
|
|
Term
|
Definition
| the appearance of minute blood droplets after the removal of the psoriasis scales. |
|
|
Term
|
Definition
| purple papules on the fingers seen in dermatomyositis |
|
|
Term
|
Definition
| seen in Ehlers-Danlos syndrome when the patient can touch the tip of the nose with their tongue. |
|
|
Term
|
Definition
| appears in allergic patients who develop urticaria when the skin is rubbed. |
|
|
Term
|
Definition
|
|
Term
|
Definition
| pain in the left shoulder secondary to splenic rupture. |
|
|
Term
|
Definition
| ecchymosis around the umbilicus that can sometimes be seen with acute pancreatitis |
|
|
Term
|
Definition
| ecchymosis of the flanks that can sometimes be seen with acute pancreatitis |
|
|
Term
|
Definition
| tibial bone tenderness that can sometimes be elicited with deep vein thrombosis |
|
|
Term
|
Definition
| abdominal rebound tenderness. This is an indication of peritoneal irritation |
|
|
Term
|
Definition
| white scale that when scratched off causes punctate bleeding, seen in psoriasis |
|
|
Term
| What is the McMurrays test used to evaluate? |
|
Definition
|
|
Term
| What is a very common MOI in meniscal tears? |
|
Definition
| twisting action exerted on the knee joint while the foot is still in a weight-bearing position. |
|
|
Term
| Differentiate between the swelling observed with a meniscal tear and ligament tear |
|
Definition
| effusions associated with meniscal injuries accumulate over hours in contrast to ligamentous injuries, in which hemorrhage causes immediate swelling. Thus, the knee swelling and pain associated with meniscal tears are typically worse the day after the injury. |
|
|
Term
| What joints are often affected in OA of the hands? |
|
Definition
|
|
Term
| What are three hand deformities commonly seen in pt's with RA? |
|
Definition
Boutonniere deformity (PIP) of the fingers
swan neck deformity (DIP) of the fingers
z deformity of the thumb |
|
|
Term
| What is gamekeepers thumb and what physical exam findings would make you think this is the dx |
|
Definition
| ulnar collateral ligament is ruptured causing laxity when moving the thumb into abduction |
|
|
Term
| what are the first and second line treatments for acute gout attack? |
|
Definition
first: NSAIDs
second: Colchicine (reserved for pts who cant take NSAIDs or corticosteroids, and due to its side effects it is not first line) |
|
|
Term
| a child has the most severe genu valgum at about what age |
|
Definition
| age 3-4, and this requires no tx |
|
|
Term
| what type of splint should be used for a possible scaphoid fracture |
|
Definition
|
|
Term
| what type of fx causes the dinner fork deformity of the wrist |
|
Definition
|
|
Term
| what gait is associated with bilateral spastic paresis of the legs? |
|
Definition
|
|
Term
| what gait is associated with a foot drop, often secondary to lower neuron disease? The patient drags his foot, or lifts the knee high and slaps the foot against the ground. This gait may be unilateral or bilateral. |
|
Definition
|
|
Term
| What gait is unsteady and wide-based. The feet are thrown forward, out, and then down. There is a distinct 2-slap sound, secondary to the heel striking first, then the forefoot. This is associated with polyneuropathy or posterior column damage. |
|
Definition
|
|
Term
| what gait is staggering, unsteady, and wide-based. The patient has difficulty with turns, and cannot stand steady when feet are together and eyes closed (Romberg's sign). |
|
Definition
|
|
Term
| a benign cartilaginous tumor nearly always found in the spine and in the epiphysis of long bones. They represent approximately 1% of all bone tumors. These tumors are usually well-defined, radiolucent lesions that have a thin area of sclerotic material that ranges in size from 1 to 4 cm. They may also contain small calcifications. These tumors are seen most often in people between the ages of 10 and 30 years. The majority of cases are seen in children and young adults between the ages of 5 and 25 years. The mean age is about 20 years |
|
Definition
|
|
Term
| describe the salter harris fx grading systems (I-V) |
|
Definition
Type I is a transverse fracture through the growth plate
Type II the fracture lies above the growth plate, sparing the epiphysis.
Type III is a fracture through the growth plate and epiphysis, sparing the metaphysis.
Type IV is a fracture through all 3 elements of the bone, the growth plate, metaphysis, and epiphysis.
Type V is a compression fracture of the growth plate (resulting in a decrease in the perceived space between the epiphysis and diaphysis on X-ray). |
|
|
Term
|
Definition
| the inability to completely abduct the thigh to the surface of the examining table when hip and knee are flexed, the major sign of hip dislocation or subluxation |
|
|
Term
| what is trendelenburgs sign |
|
Definition
| is positive in persons with congenital hip dislocation and pelvis abnormality. When the person stands on the affected leg, the opposite (normal) gluteal fold falls. This test is almost impossible to do on an infant. |
|
|
Term
| In a baby with a dislocated hip would there be increased or decreased skin folds on the affected side? |
|
Definition
|
|
Term
| In a baby with a dislocated hip, will the affected leg look longer or shorter when he/she is held supine with legs flexed? |
|
Definition
|
|
Term
| name two drugs appropriate for the tx of smooth muscle spasm pain (as in IBS) |
|
Definition
|
|
Term
| you have a pt with constant pelvic pain, which is because of soft tissue involvement with inflammation and compression pain... name two appropriate tx regimens |
|
Definition
| morphine and steroids OR ibuprofen |
|
|
Term
| you have a pt with striated muscle spasm pain (as in a tension HA), name two meds you could use to tx this type of pain |
|
Definition
| cyclobenzaprine or diazepam |
|
|
Term
| ixodes scapularis is another name for..... |
|
Definition
|
|
Term
|
Definition
| prepatellar bursitis- this bursa is located on the anterior patella between the patella and the skin |
|
|
Term
| what class of drugs is used to treat myasthenia gravis, name two. what can be a side effect of using these drugs, and what is the antedote? |
|
Definition
cholinesterase inhibitors- neostigmine and pyridostigmine
-cholinergic crisis which is tx by propmt withdrawal of cholinesterase inhibitors |
|
|
Term
|
Definition
deformity that is due to the rupture of the extensor tendon at the base of the dorsal distal phalanx of any digit of the hand. Patients will report pain dorsally at the DIP joint with the inability to actively extend the DIP joint.
-swan neck deformity can be due to chronic mallet finger |
|
|
Term
| what is the etiological agent in lyme disease and what is the transmitting organism |
|
Definition
| Borrelia burgdorferi , the etiological agent, is transmitted by Ixodes spp. ticks |
|
|
Term
| what is the most common arthropathy among adults, particularly in the elderly? |
|
Definition
|
|
Term
| What is the basic pathophysiology of OA |
|
Definition
| articular cartilage loss accompanied by increasing thickness and sclerosis of the subchondral bone plate---> outgrowth of osteophytes at joint margin---->stretching of articular capsule----> weakness of the muscles bridging the joint |
|
|
Term
| give some common signs and symptoms of OA |
|
Definition
-morning stiffness in AM lessing last than 30 m
-increasing pain with increasing joint usage
-asymmetric involvement
-NO SYSTEMIC S/SX |
|
|
Term
| what are the MC joints of the hands affected by OA? other joints? |
|
Definition
-DIP (heberdens nodes) and PIP (bouchards nodes)
-hips, knees, spine |
|
|
Term
| what is the max dose of APAP per day? |
|
Definition
|
|
Term
| what is the usual progression of tx for an OA pt |
|
Definition
| APAP--NSAIDs/voltaran gel---steroid injections (>Q3-6 months)--simvisc (only covered after failing steroid injections)---total joint replacement |
|
|
Term
| describe the anatomy of a joint affected with RA |
|
Definition
high synovium to cartilage ratio
pannus (hyperplastic synovial tissue) formation erodes cartilage, subchondral bone, articular capsule, tendons, and ligaments |
|
|
Term
| what are the most common joints affected with RA? If what joint is affected is the Dx of RA unlikely? |
|
Definition
wrists, MCP, and PIP
-DIP are RARELY almost NEVER involved |
|
|
Term
| What are some common signs and sx of RA |
|
Definition
-morning stiffness lasting greater than 1 hr that gets better as the day goes on
-arthritis and soft tissue swelling
-symmetric distribution |
|
|
Term
| what sex is more commonly affected by RA |
|
Definition
|
|
Term
| what are two extraarticular manifestations that are pretty pathognomonic for RA (skin and lung...) |
|
Definition
-rheumatoid nodules are pathognomonic
-pleural effusions with pleural fluid very low in glucose |
|
|
Term
| Give the three most common hand joint deformities seen in RA |
|
Definition
-ulnar deviation of the MCPs
-boutonniere deformities of the PIP where PIP is flexed and DIP is hyperextended
-swan neck deformtity: MCP flexed, PIP hyperextended, DIP flexed |
|
|
Term
| what does aspiration of an RA joint tell you |
|
Definition
| it quantifies inflammation and excludes gout and septic arthritis |
|
|
Term
| what lab tests are useful in dx of RA |
|
Definition
-CRP and ESR are elevated
-RF is elevated 80% of the time, but often not in early disease |
|
|
Term
| what is the general treatment for RA |
|
Definition
NSAIDs and DMARD (usually methotrexate) started immediately
-PO corticosteroids can be used if NSAIDs not helping |
|
|
Term
|
Definition
| triad of RA, neutropenia, and splenomegaly |
|
|
Term
| what is still's disease associated with? |
|
Definition
|
|
Term
| what is the anatomical distribution of a septic arthritis usually? what are the MC affected joints |
|
Definition
often only affects one joint
MC knee THEN hip, shoulder, ankle, wrist |
|
|
Term
| what is the MC pathogen of septric joint? what other pathogen needs to be considered in certain population? |
|
Definition
s. aureus
-n. gonorrhea in a young sexually active pt |
|
|
Term
| what will the synovial fluid of a septic joint look like (color, wbc, PMN %, cx results) |
|
Definition
green yellow
>50,000 WBC
75% or greater PMN
positive cx |
|
|
Term
| which joint affected by septic arthritis definitely needs arthrotomy and arthrocentesis |
|
Definition
|
|
Term
| what is the tx of septic joint |
|
Definition
| IV abx followed by PO for 7-10 days |
|
|
Term
| the pencil in cup deformity seen on xrays of the hand is common with what type of arthritis? what part of the phalanx is generally deformed? |
|
Definition
psoriatic arthritis
proximal phalanx |
|
|
Term
| in a pt with psoriatic arthritis give the lab results for ESR, CBC, uric acid, and RF |
|
Definition
esr= elevated
CBC= normocytic normochromic anemia
uric acid= hyperuricemia
RF= normal |
|
|
Term
| what is the tx for psoriatic arthritis? |
|
Definition
NSAIDs if mild
methotrexate |
|
|
Term
| What is the classic triad of Rieter Syndrome? Zarbocks describes a tetrad, what is the 4th component? |
|
Definition
-urethritis (non-gonococcal)
-conjunctivitis
-arthritis
*mucosal ulcers (painless and shallow) |
|
|
Term
| what genotype is associated with reactive arthritis in 50-80% of patients |
|
Definition
|
|
Term
| Reactive arthritis is usually preceded by what how many days before onset of arthritis? what are the most common organisms? |
|
Definition
enteric or urethral infection, 1-4 weeks before
-GU: chlamydia and ureaplasma
-GI: shigella, salmonella, yersinia, campylobacter |
|
|
Term
| describe the arthritis of reactive arthritis |
|
Definition
usually affects large joints below the waist
asymmetric
oligoarticular
new joints may become involved sequentially
joints are painful, less mobile, and have effusions |
|
|
Term
| what would a CBC, ESR, and CRP show in a pt with reactive arthritis. what are two other tests that should be ordered? |
|
Definition
cbc- anemia
-ESR and CRP would be elevated
-order joint fluid analysis and HIV test |
|
|
Term
| what is the first line medication for reactive arthritis, 2nd line |
|
Definition
|
|
Term
| what is another name for reactive arthritis |
|
Definition
| rieter syndrome- more likely used if the classic triad is present |
|
|
Term
| At what age should women be screened by DEXA scan for osteoporosis? |
|
Definition
65 and post menopausal
*studies do not show evidence of a positive benefit for screening men |
|
|
Term
| what is the most common site of an osteoporotic fracture? |
|
Definition
|
|
Term
| what is the recommended calcium supplementation for osteoporosis prevention and or treatment |
|
Definition
|
|
Term
| what are the first line treatment options for osteoporosis? 2nd line? 3rd line? last line? other tx fails? |
|
Definition
1st line: bisphosponates
2nd line: boniva (ibandronate)
3rd line: raloxifene (SERM)
last line: calcitonin
failure: terparatide (PTH analog) |
|
|
Term
| what causes PTH to be secreted? |
|
Definition
| hypocalcemia.. so high PTH means that calcium is being drawn out of bones |
|
|
Term
| why does hyperthyroidism sometimes cause osteoporosis? |
|
Definition
| its associated with accelerated bone remodeling, reduced bone density, and as much as a 25% increase in serum calcium levels |
|
|
Term
| where is ALP found besides the biliary tract? |
|
Definition
| bone, so high levels are seen in growing children, metastatic osteoblastic activity, and bone breakdown |
|
|
Term
| What are the ways osteomyelitis can come about? |
|
Definition
-hematogenous
-contiguous spread from adjacent soft tissues and joints
-direct inoculation of infection into bone as a result of trauma a/o surgery |
|
|
Term
| When an osteomyelitis is spread via hematogenous seeding it is usually (mono microbial/polymicrobial) in nature. What about if its spread via contiguous/direct routes? |
|
Definition
monomicrobial
polymicrobial |
|
|
Term
| Name the three top organisms that cause osteomyelitis |
|
Definition
s. aureus
coag negative staph
aerobic gram negative bacilli |
|
|
Term
| what is pathognomic sign on PE of a chronic osteomyelitis |
|
Definition
|
|
Term
| In a patient with a diabetic foot ulcer, if either of what two symptoms are seen is osteomyelitis so likely that no further non-invasive evaluations need to be conducted |
|
Definition
>2x2 cm in size
palpable bone |
|
|
Term
| What is the reference standard for diagnosis of osteomyelitis |
|
Definition
| isolation from a bone biopsy sample obtained via sterile technique, together with histologic findings of inflammation and osteonecrosis |
|
|
Term
| what is the best radiological study for osteomyelitis? |
|
Definition
|
|
Term
| What is the form of osteomyelitis that manifests as TB of the vertebral bodies? |
|
Definition
|
|
Term
| Name some RFs for osteomyelitis |
|
Definition
Open Fracture!
diabetes
IV drug use
vascular insufficiency |
|
|
Term
| How long should IV abx be implemented in osteomyelitis? Name the top two abx used |
|
Definition
4-6 weeks
-Penicillin ase resistant penicillin (Oxacillin)
-Ist gen cephalosporin (Cefazolin) |
|
|
Term
| What joints of the hand are commonly affected by OA? |
|
Definition
-distal PIP: heberdens nodes
-proximal PIP: bouchards nodes |
|
|
Term
| housemaid's knee is bursitis of what? |
|
Definition
|
|
Term
| what is the MC organism assoc with osteomyelitis? How about osteomyelitis in a patient with sickle cell disease? |
|
Definition
|
|
Term
| What are the primary carcinomas that MC spread to the bone? |
|
Definition
| prostate, breast, thyroid, lung, kidney |
|
|
Term
| What is the ideal tx of an open fracture? |
|
Definition
| Refer to ortho and within 4-8 hours of injury pt is in OR getting derided and irrigated followed by IV abx |
|
|
Term
| What are the 5 types of Salter Harris Fractures? |
|
Definition
1: straight through the epiphyseal plate
2: through the epiphysis into the metaphysis
3: Through the epiphysis and the articular surface
4: Through the epiphysis and metaphysics
5: Crushed epiphyseal plate |
|
|
Term
| What is a torus fracture and what is the tx |
|
Definition
| -when the bone bucks due to a compression injury. Can be one side of the cortex or both sides buckling. Also called a buckle fx. Tx is 4-6 weeks in a cast |
|
|
Term
| What is a green stick fracture. Tx> |
|
Definition
When bowing causes a break in one side of the cortex
Tx is cast if the angulation is less than 15 degrees, if greater than 15 degrees they need referral to ortho |
|
|
Term
| What is the MC dislocations of the shoulder and the hip? |
|
Definition
anterior dislocation of the shoulder
posterior dislocation of the hip |
|
|
Term
|
Definition
| stretch of a terminal extensor tendon which is treated with extensor splinting x 6 weeks |
|
|
Term
| What ligament is MC associated with an ankle sprain? |
|
Definition
| ATL (anterior talofibular ligament) |
|
|
Term
| What is the tx of a shoulder dislocation |
|
Definition
| immobilization by a sling and swatch (valpaeu's sling) |
|
|
Term
| what injuries need to be checked in a pt with a clavicle fracture? what is the tx? |
|
Definition
brachial plexus injuries (pain, weakness, reflex, sensory abnormalities)
figure of eight sling x 4-6 weeks |
|
|
Term
| Which nerve needs to be checked for injury in a humeral shaft fracture |
|
Definition
|
|
Term
| what is the initial splint used in a humeral shaft fx? |
|
Definition
|
|
Term
| What artery needs to be checked for damage in a supracondylar humerus fx? Why is this so important? |
|
Definition
| Brachial artery bc it is the most spastic artery in the body and can lead to Volkmann's ischemic contractures |
|
|
Term
| what is kienbocks disease? |
|
Definition
| osteonecrosis of the lunate |
|
|
Term
| What are tinels and phalens signs? Assoc with what condition |
|
Definition
Carpal Tunnel
Tinels is tingling with percussion over the volar aspect of the wrist
Phalens is tingling after flexing both wrists for >1 min |
|
|
Term
| What type of splint is used in the initial treatment of carpal tunnel? |
|
Definition
|
|
Term
| what organism is specific to the human mouth and is often associated with human bites? |
|
Definition
|
|
Term
|
Definition
fracture of the distal radius with dorsal angulation
silver fork deformity |
|
|
Term
|
Definition
| distal radius fracture with volar angulation |
|
|
Term
| what is gamekeepers thumb, signs, tx |
|
Definition
| sprain or tear of the ulnar collateral ligament of the thumb, inability to pinch strongly, thumb spica cast or surg depending on degree of rupture |
|
|
Term
|
Definition
| lateral epicondylitis, pain with lifting object esp when arm is pronated |
|
|
Term
| what is golfers elbow, baseball elbow? sx? |
|
Definition
| medial epicondylitis, pain with resisted pronation or flexion of the wrist |
|
|
Term
| what is nursemaids elbow? |
|
Definition
| subluxation of the radial head |
|
|
Term
| what is the MC fx carpal bone? |
|
Definition
|
|
Term
| WHat are the sx of a scaphoid fracture? |
|
Definition
| pain over the anatomical snuff box |
|
|
Term
| What is dequervains disease? Test to dx? tx? |
|
Definition
-stenosing tenosynovitis involving the abductor pollicis longus and extensor pollicis longus
-Finkelsteins test when pt puts thumb into palm and then ulnar flexes wrist will cause pain
-THumb spica splint |
|
|
Term
| Describe the pain felt in sciatica? |
|
Definition
| pain felt in the buttock, posterior thigh, and posterolateral aspect of the leg around the lateral malleolus to the lateral dorsum of the foot and the entire sole |
|
|
Term
| Radiographs of the spine are not necessary when Hx and PE show no sign of a serious condition. What are the red flags? |
|
Definition
| fever, weight loss, morning stiffness, hx of IV drug or steroid use, trauma, hx of cancer, saddle anesthesia, loss of anal sphincter tone, or major motor weakness |
|
|
Term
| What is the MC curve of scoliosis? What is the least common and spinal cord pathology needs to be ruled out if present? |
|
Definition
Right thoracic curve is MC
Left thoracic curve is RARE |
|
|
Term
| What is Schuermans disease? |
|
Definition
|
|
Term
| What is the mc extra pulmonary location of TB after the lymph nodes? |
|
Definition
|
|
Term
| WHat is the brace used to tx scoliosis with a curve greater than 60 degrees |
|
Definition
|
|
Term
| what PE move will relieve the pain in spinal stenosis |
|
Definition
|
|
Term
| What is ankylosing spondylitis? what extraarticular manifestations are seen? on xray> |
|
Definition
-seronegative spondyloarthropathy that progresses to fusion of the vertebrae
-uveitis, cardiac abnormalities, and interstitial lung disease
-bamboo spine |
|
|
Term
| WHat is caudal equina? s/sx? Tx? |
|
Definition
-major disk herniation that compresses several nerve roots, usually L4-L5 level
-loss of bowel bladder function, saddle anesthesia, leg pain, numbness, paralysis
-SURGICAL EMERGENCY IMMEDIATE REFERRAL |
|
|
Term
| what is the name of the disease that manifests as aseptic necrosis of the hip in children |
|
Definition
| legg calves perches disease |
|
|
Term
| What may be seen on lateral films of a patient with aseptic necrosis? |
|
Definition
|
|
Term
| what is slipped capital femoral epiphysis (SCFE) |
|
Definition
| weakening of the epiphyseal plate of the femur resulting in displacement of the femoral head |
|
|
Term
| s/sx of a meniscal tear? tests? tx? |
|
Definition
-joint pain along the joint line (usually medial), locking (inability to fully extend the knee), giving way, trouble with squatting or walking up/down steps
-McMurray and Apleys test
-NSAIDS and PT, then surg for sx unresponsive to conservative tx |
|
|
Term
| what is osgood schlotters disease? |
|
Definition
| apophysitis of the tibial tubercle caused by trauma or overuse |
|
|
Term
| what causes cruciate injuries? s/sx? tx? |
|
Definition
-excessive pivotal force during running jumping cutting
-hearing a pop and complaining of knee instability, hemarthrosis develops quickly
-Lachmans test is most sensitive
-conservative then surg if under 40 who are unresponsive |
|
|
Term
| When will a patient with achilles tendonitis complain of pain on exam, test to rule out rupture? |
|
Definition
passive dorsiflexion and resisted plantar flexion
thompsons test |
|
|
Term
| in a person with hallux valgus, a valgus deformity of greater than how many degrees is considered abnormal? |
|
Definition
|
|
Term
| What is a mortons neuroma? What is the consequence of surgical repair? |
|
Definition
traction of the interdigital nerve against the transverse metatarsal ligament
third and fourth toes will be chronically numb |
|
|
Term
| plantar fasciitis? s/sx? tx? |
|
Definition
-microtears in the plantar fascia (usually in runners or obese)
-pain with the first few steps of the morning and heel pain at night
-conservative tx, surgery if severe |
|
|
Term
| What is a monteggia fx? Galeazzi fx? |
|
Definition
-prox ulnar fx with dislocated radial head
-prox ulnar fx with displaced distal radial ulnar joint at the wrist |
|
|
Term
| Name three drugs that are often used in the tx of fibromyalgia |
|
Definition
| Pregabalin (lyrica), amitriptyline (elavil), fluoxetine (prozac) |
|
|
Term
| Joint fluid analysis of a patient with gout reveals? |
|
Definition
| uric acid crystals that are needle/rod shaped and negatively birefringent, incr WBC |
|
|
Term
|
Definition
-NSAIDs (indomethacin) number 1 for acute
-colchicine is back up for an acute attack if pt can't take NSAIDs, has lots of side effects (diarrhea)
-Allopurinal for prophylaxis |
|
|
Term
| What is pseudo gout? What will be found on synovial fluid analysis? Tx? |
|
Definition
-calcium pyrophosphate dehydrate disease
- rhomboid shaped positively birefringent crystals
-Same as Gout, NSAIDs, colchicine, steroids if necessary |
|
|
Term
| Juvenile RA is similar to adult RA, but what are some characteristics that define it? |
|
Definition
| -Higher fever, pink maculopapular rash in the evenings, pericarditis and valvulitis more common, hepatomegaly and splenomegaly more common, Uveitis is more common and these pt's must est. care with an ophthalmologist |
|
|
Term
| What is polyarteritis nodosa? What other diseases is it assoc with? |
|
Definition
-small and med. artery inflammation (skin, kidney, peripheral nerves, muscle, gut)
-HEP b and HEP C, sogrens, RA, HIV, varicella |
|
|
Term
| S/sx of polyarteritis nodosa? |
|
Definition
-fever, anorexia, weight loss, fatigue, abd pain, arthralgias, HTN, 3rd CN damge
-SKIN: palpable purport and lived reticularis |
|
|
Term
| How is polyarteritis nodosa Dx? |
|
Definition
| Gold standard is biopsy and the characteristic finding is LEUKOCYTIC INFILTRATE |
|
|
Term
| What is the tx of polyarteritis nodosa? |
|
Definition
steroids (prednisone)
cyclophosphamide/methotrexate etc if necessary |
|
|
Term
|
Definition
| a disease of striated muscle affected the PROXIMAL muscles of the limbs, neck and pharynx |
|
|
Term
| What are some labs that are characteristic of polymyositis |
|
Definition
-incr aldolase and CPK
-ANTI jo1 AB! |
|
|
Term
| What skin finding are assoc with polymyositis? |
|
Definition
-Dermatomyositis: Malar and helitrope type rashes
*Guttrons papules: flat topped purple lesions usually seen over MCP and interphalangeal joints (assoc. with anti jo 1 ab) |
|
|
Term
|
Definition
-Prednisone, methotrexate
-PT! |
|
|
Term
| What should be excluded in all pts with polymyositis? |
|
Definition
| common neoplasms (skin, lung, breast, prostate) |
|
|
Term
| What is the pathophys of polyarteritis nodosa? |
|
Definition
| PMN invasion of all layers and fibrinoid necrosis plus resulting intimal proliferation lead to reduced intimal area, which results in ischemia, infarction, and aneurysms |
|
|
Term
| what are the s/sx of polymyalgia rheumatica |
|
Definition
| -proximal, bulateral, symmertrical muscle pain/stiffness/weakness that is present more in the morning or after periods of inactivity. Can have assoc. fatigue, anorexia, weight loss, depression |
|
|
Term
| If a patient is dx with polymyalgia rheumatic, what definitely needs to be R/O |
|
Definition
| giant cell arteritis!!!! often presents with PR and will cause blindness if not treated |
|
|
Term
| What labs should you order in a pt who may have polymyalgia rheumatic? |
|
Definition
| -ESR (incr), CPK (NL- will differentiate from polymyositis), then R/O with TSH, ANA, CBC, LFTs, Renal Fxn, Muscle Bx, and EMG will ALL BE NORMAL! |
|
|
Term
| WHat is the tx for polymyalgia rheumatic? |
|
Definition
-Alone: prednisone 15-20 mg QD
-with temporal arteritis: 40-60 mg prednisone QD |
|
|
Term
|
Definition
| splenmegaly, neutropenia, RA |
|
|
Term
| What are some common extraarticular manifestations of RA? |
|
Definition
-malaise, anorexia, weight loss, fever
-RHEUMATOID SKIN NODULES!!!
-plueral effusion (low complement and low glucose)
-pericarditis, effusion, cardiac nodules
-scleritis, dry eyes
-Felty syndrome
-anemia of chronic disease |
|
|
Term
|
Definition
-Slceroderma findings
_Calcinosis, Raynauds, Esophageal disease, Sclerodactyly, Telangiectasis |
|
|
Term
|
Definition
| evaluates tear secretion by holding filter paper in the lower eyelid. less than 5mm in 5 min is positive. testing for sogrens |
|
|
Term
| What is the pathognomnic testing and findings for sogrens |
|
Definition
| minor salivary gland bx will show lymphocytic infiltration with secondary degeneration, necrosis, fibrosis, and atrophy |
|
|
Term
| what antibodies are ALWAYS present in drug induced lupus |
|
Definition
|
|
Term
| What is the most sensitive test for lupus? Most specific? |
|
Definition
Anti ANA
specific: Anti- sm and anti-ds DNA |
|
|
Term
| Diastolic rumbling murmur located at the apex and best heard in the left lateral position. |
|
Definition
|
|
Term
| Diastolic rumbling murmur typically accompanied by a thrill heard along the left sternal border and is louder with inspiration |
|
Definition
|
|
Term
| Which murmur presents as a soft, early diastolic, high pitched murmur heard best when sitting and leaning forwards |
|
Definition
|
|
Term
| What vitamin deficiency causes poor night vision and frequent sore throats? |
|
Definition
|
|
Term
| What vitamin deficiency causes pellagra which includes symmetrical dermatitis on sun exposed areas, scarlet glossitis, diarrhea, and memory aberrations? |
|
Definition
|
|
Term
| Which vitamin deficiency can cause hemolytic anemia in infants? |
|
Definition
|
|
Term
| Which vitamin deficiency presents with bleeding tendencies, impaired wound healing, swollen friable gums, splinter hemorrhages on the nails? |
|
Definition
|
|
Term
| Which vitamin deficiency can present with peripheral neuropathy, seborrheic dermatosis, glossitis, and cheilosis? |
|
Definition
| Pyridoxine or Vitamin B12 deficiencies |
|
|
Term
| Which organism is responsible for enterocolitis caused by shellfish? |
|
Definition
|
|
Term
| What is the first-line therapy for C Difficile? |
|
Definition
|
|
Term
| What heart condition is seen in Turner's pts? |
|
Definition
|
|
Term
| Which heart condition causes stronger pulses in the arms than in the legs, pulses paradoxes? |
|
Definition
|
|
Term
| What is cervical motion tenderness a "red flag" for? |
|
Definition
|
|
Term
| What does a fat-pad sign in pediatric x-ray of an elbow mean? |
|
Definition
|
|
Term
| Which condition has characteristic signs including Kayser-Fleischer rings and low serum ceruloplasmin? |
|
Definition
|
|
Term
| What is the tx for a cholesteatoma? |
|
Definition
|
|
Term
| Adult pt with Pink, red papulosquamous rash with scattered discrete coppery papules on the palms of the hands. What does this rash indicate? |
|
Definition
|
|
Term
| First step in treating an acute presentation of severe hypercalcemia associated with malignancy? |
|
Definition
| Aggressive hydration with normal saline |
|
|
Term
| What SE can sumatriptan used to treat a migraine have? |
|
Definition
| coronary vasospasms causing chest pain or discomfort |
|
|
Term
| What is the most appropriate treatment for actinic keratosis? |
|
Definition
|
|
Term
| What test is confirmatory for a thoracic aorta dissection? |
|
Definition
|
|
Term
| How do amphetamine salts, used in dieting work? Should you recommend them to your patients? |
|
Definition
| Release of dopamine and norepinephrine; NO |
|
|
Term
| What is the treatment for pulmonary sarcoidosis? |
|
Definition
|
|
Term
| What is the treatment for extra-pulmonary sarcoidosis? |
|
Definition
| Anti-tumor necrosis factor (Anti-TNF) |
|
|
Term
| Is sarcoidosis in the lungs caseating or non-caseating? |
|
Definition
|
|
Term
| Which syndrome has a clinical picture of iron deficiency anemia causing fatigue and dyspnea, as well as esophageal webs causing dysphagia? |
|
Definition
|
|
Term
| What condition is caused by the normal lining of the esophagus being replaced by metaplastic cells and is commonly seen in individuals with longstanding reflux disease? |
|
Definition
|
|
Term
| What condition is described as a post-MI condition that is an auto-immune phenomenon and presents as pericarditis with associated fever, leukocytosis, and pericardial or pleural effusions? |
|
Definition
|
|
Term
| What condition is described as an esophageal motility d/o that causes progressive, gradual dysphagia for solids and liquids, with regurgitation of undigested foods? What is confirmatory for this condition? |
|
Definition
| Achalasia; Barium esophagram shows "bird's beak" appearance |
|
|
Term
| What condition is characterized by tears in the mucosa at the gastroesophageal junction that is many times linked to alcohol abuse and excessive vomiting? |
|
Definition
|
|
Term
| With a presumptive diagnosis of a thoracic aortic dissection what would a finding on CXR consistent of that diagnosis? |
|
Definition
| Widening of the mediastinum |
|
|
Term
| What is the MC space-occupying CNS lesion in pts with HIV/AIDS with CD4 counts under 100 while not on prophylaxis? |
|
Definition
|
|
Term
| Head CT reveals multiple peripheral ring-enhancing lesions. Pt is immunosuppressed and has sx including stumbling, memory problems, confusion and had 1 tonic/clonic seizure. What condition has these characteristics? |
|
Definition
|
|
Term
| What is the most reliable method of moving an esophageal foreign body? |
|
Definition
| Rigid esophagoscopy with a fiberoptic telescopic system and forceps extraction |
|
|
Term
| What condition typically presents with crampy abdominal pain, N/V and localized hyperactive bowel sounds? |
|
Definition
|
|
Term
| Best empiric medication for CAP, especially Mycoplasma pneumoniae? |
|
Definition
|
|
Term
| On EKG T-wave inversions and Q-waves in lead II, III and aVF, what do these findings indicate? |
|
Definition
| Acute inferior myocardial Infarction |
|
|
Term
| What is the treatment for gestational diabetes? |
|
Definition
| Diet, exercise, and insulin therapy if blood glucose remains high despite diet control |
|
|
Term
| Where is the most likely site for pathology in Addison's disease? |
|
Definition
|
|
Term
| Pt presents with lethargy, weight loss, N/V, and salt craving. Labs show hyponatremia and hyperkalemia as well as elevated ACTH. What condition do you suspect? |
|
Definition
|
|
Term
| What is the most likely pathogen causing pneumonia in the hospital setting? |
|
Definition
|
|
Term
| What is the major COD in hypothermia cases? |
|
Definition
|
|
Term
| At what body temp is hypothermia diagnosed? |
|
Definition
|
|
Term
| A 59-year-old woman presents by ambulance for second- and third-degree burns to her head and neck, anterior surface of her upper extremities, anterior surface of her right leg, and her anterior trunk including her genital area. What percentage of her body is burned? |
|
Definition
| 46% - In this case, 9% for her head and neck, 9% for the anterior surface of both arms, 9% for the anterior surface of her right leg, 9% for her anterior upper torso, 9% for her anterior lower torso, and 1% for the genital area for a total of 46% |
|
|
Term
| What is the MC arrhythmia associated with hyperthyroidism? |
|
Definition
|
|
Term
| A 28y/o gravid female @ 24 weeks gestation presents with c/o insomnia, fatigue, DOE, and palpitations. On PE mild periorbital edema is found with hyperreflexia. What condition do you suspect, and how would you confirm the dx? |
|
Definition
| gestational thyrotoxicosis - confirm with thyroid panel |
|
|
Term
| What is chronic cough in a non-smoker MC due to? How do you confirm this? |
|
Definition
| Post-nasal drip; trial of anti-histamines |
|
|
Term
| What are the initial steps in managing moderate to severe hypothermia? |
|
Definition
| Acid-base balance correction and cardiac support |
|
|
Term
| How do you confirm Multiple Myeloma in a pt? |
|
Definition
| Serum protein electrophoresis |
|
|
Term
| What condition has typical presentation of symptoms including fatigue, pallor, back pain and occasional infection (especially in an older pt)? |
|
Definition
|
|
Term
| Which condition presents in an infant with choking, cyanosis, respiratory distress, and copious secretions with symptoms generally worsening during feeding and commonly there is a hx of polyhydramnios? |
|
Definition
| Tracheoesophageal fistula |
|
|
Term
| White reflex in the eye = ? |
|
Definition
|
|
Term
| What is the most appropriate f/u if on DRE you find a non-tender, non-enlarged prostate, with an isolated left posterior lobe nodule? |
|
Definition
| Refer the patient for a transrectal ultrasound of the prostate and order a PSA level |
|
|
Term
| What muscle lies directly lateral and adjacent to the spinous process of the spine? |
|
Definition
|
|
Term
| Which trace mineral has the following functions: transports vitamin A, taste perception, wound healing, making of sperm, and essential in fetal development? |
|
Definition
|
|
Term
| What is a major risk factor found in almost every epidemiological study of SIDs |
|
Definition
| Maternal smoking during pregnancy |
|
|
Term
| What is the confirmatory test for scabies? |
|
Definition
| skin scraping with immersion oil |
|
|
Term
| What 'condition' has presenting symptoms can include hypertension, tachycardia, diaphoresis, anxiety, dilated pupils, agitation, nasal congestion, and psychosis? |
|
Definition
|
|
Term
| A RadioActive I131 Uptake (RAIU) and scan on a symmetrically enlarged thyroid reveals high uptake in a diffuse, uniform pattern throughout the gland. What do you suspect? |
|
Definition
|
|
Term
| What does hyperresonance to percussion on lung exam accompanied by dyspnea and one-sided chest pain indicate? |
|
Definition
|
|
Term
| Can lisinopril be used in a pregnant pt for control of BP? |
|
Definition
|
|
Term
| What is the confirmatory test for CO poisoning? |
|
Definition
|
|
Term
| What does increased TIBC, decreased serum ferritin and decreased serum iron indicate? |
|
Definition
|
|
Term
| What examination technique can help to show that a mass is a ganglion cyst? |
|
Definition
| Transilluminating the mass |
|
|
Term
| What is the best initial tx for Meniere's disease? |
|
Definition
|
|
Term
| What is recommended to prevent contrast nephropathy in higher-risk patients? |
|
Definition
|
|
Term
| In the management of a patient with alcoholic cirrhosis, what is the most important factor for their survival? |
|
Definition
|
|
Term
| What are the most reliable predictors of drowning outcome? |
|
Definition
| presence or absence of coma, pupillary response and blood glucose levels |
|
|
Term
| What is the best diagnostic test to confirm a diagnosis of acute thyroiditis? |
|
Definition
| Needle aspiration for culture |
|
|
Term
| What are the MC organisms responsible for causing acute thyroiditis? (3) |
|
Definition
| Staphylococcus aureus, Streptococcus, and S. pneumoniae |
|
|
Term
| An 8-year-old child is brought to you with acute fever. Parents notice redness of the skin in the neck area. The thyroid gland is extremely tender to palpation. What condition do you suspect? |
|
Definition
|
|
Term
| Whenever, a young patient presents with fever, progressive exertional dyspnea, hypoxia, and loss of weight, what condition should always be in your ddx? |
|
Definition
| pneumocystis carinii pneumonia (PCP) and acquired immunodeficiency syndrome (AIDS) |
|
|
Term
| What is the mainstay of treatment for PCP in AIDS pts? |
|
Definition
| trimethoprim-sulfamethoxazole and corticosteroids |
|
|
Term
| Where/how is mitral valve stenosis best auscultated? |
|
Definition
| With the patient lying on the left side, at the apex of the heart |
|
|
Term
| On close inspection of a 6 y/o child, you note a tiny, white, wingless insect and tiny eggs attached to the hair shafts. What condition do you suspect? |
|
Definition
|
|
Term
| What is the most appropriate treatment for gestational thyrotoxicosis? |
|
Definition
| Propylthiouracil (PTU) therapy |
|
|
Term
| What is the most common nerve traumatized in head injuries? What does this cause? |
|
Definition
| sixth nerve palsy; Injury of this nerve results in internal deviation of the eye and failure to move the eye outwards |
|
|
Term
| How is traumatic sixth nerve palsy managed? |
|
Definition
| Observation for 6 months plus prism |
|
|
Term
| What is the treatment for paroxysmal supraventricular tachycardia (PSVT)? |
|
Definition
|
|
Term
| What is the most appropriate treatment for severe acne? |
|
Definition
| oral isotretinoin added to other acne regimen |
|
|
Term
| What type of seizure is described as a pt suddenly blacking out, her body became very rigid and unmovable, accompanied by jerking motions with her arms, legs and head for a few minutes, then stopped? |
|
Definition
|
|
Term
| A 20-year-old woman presents with intermittent nosebleed for the past 2 weeks. She also reports that her menstrual periods have increased in amount in the past 2 months. She recently underwent surgery for small bowel resection and only eats 1 meal a day. Laboratory investigations reveal prolonged prothrombin time and prolonged activated partial thromboplastin time and a normal platelet count. What is the most likely diagnosis? |
|
Definition
|
|
Term
| Seal-like cough in child = ? |
|
Definition
|
|
Term
| Steeple sign on lateral head/neck x-ray = ? |
|
Definition
|
|
Term
| Where is the uterine fundus typically palpable at 20 weeks from the last menstrual period (LMP)? |
|
Definition
| Lower border of umbilicus |
|
|
Term
| What is the treatment for ultraviolet keratitis, or "snow blindness"? |
|
Definition
|
|
Term
| Differential for a coin lesion in the lungs? (3) |
|
Definition
a) lung carcinoma (most commonly an adenocarcinoma)
b) granuloma
c) hamartoma |
|
|
Term
| What is the most appropriate treatment Dressler's syndrome? |
|
Definition
|
|
Term
| A 63-year-old man presents with bleeding gums and a general feeling of illness. He indicated that he has been running a low-grade fever for the last few days, feels fatigue, and has bone and joint pain. He thought that he just had the flu, but he became concerned when his gums began to bleed. On examination, you note a pale individual, mild petechia on the extremities, gingival hyperplasia, and a palpable spleen. You order a CBC, which reveals pancytopenia and blasts with auer rods on the differential. What is your diagnosis? |
|
Definition
| Acute myelogenous leukemia (AML) |
|
|
Term
| A 39-year-old woman presents with a history of repeated, short episodes of intensely anxious moments with physiologic manifestations such as tachypnea, tachycardia, dizziness, headache, and a smothering sensation. After an extensive workup, she was diagnosed with panic disorder. What is the best initial drug of choice for sustained treatment of her condition? |
|
Definition
|
|
Term
| What tests can be done to help in the diagnosis of MS? |
|
Definition
| Visual Evoked Potentials, CSF oligoclonal bands, CSF gamma globulin |
|
|
Term
| What is the treatment for renal cell carcinoma? |
|
Definition
| Referral to a urologic surgeon for radical nephrectomy |
|
|
Term
| On a PF test, what value is a combo of Inspiratory Reserve Volume, Expiratory Reserve Volume and Tidal Volume? |
|
Definition
|
|
Term
| On a PF test which value is described as the amount of air inhaled and exhaled during quiet, resting breathing? |
|
Definition
|
|
Term
| On a PF test, which value is described as the amount of air forcefully inhaled after normal inhalation? |
|
Definition
| Inspiratory Reserve Volume |
|
|
Term
| On a PF test, what value is described as the amount of air forcefully exhaled after a normal exhalation? |
|
Definition
| Expiratory Reserve Volume (ERV) |
|
|
Term
| What classification system helps to classify the severity of COPD? What is the basis of this system? |
|
Definition
| GOLD Classification; Spirometric Findings (FEV1, FEV1/FVC ratio) |
|
|
Term
| What condition is characterized by thickening of the renal artery causing decreased vessel diameter which eventually leads to renal artery stenosis? What is a common symptom of this dz? |
|
Definition
| fibromuscular disease (FMD) of her renal arteries; HTN |
|
|
Term
| A 4 y/o presents with a red area on his cheek that has gradually enlarged, and is slightly pruritic although it is non-tender. On PE the lesion is described as a 3-cm annular erythematous lesion on his right cheek that is slightly scaly with central clearing and a papulovesicular border. What condition do you suspect? |
|
Definition
| Tinea corporis ("ringworm") |
|
|
Term
| What is the common causative agent of tinea corporis in children? |
|
Definition
|
|
Term
| What is the treatment for ringworm, or tinea corporis in a child? |
|
Definition
| Clotrimazole 1% cream topically tid for 3 weeks |
|
|
Term
| A 21-year-old woman presents at 10 weeks gestation with vaginal bleeding and lower abdominal cramping. This is her second pregnancy, and she is concerned about losing her baby. Examination demonstrates bright red blood coming through a closed cervical os. What is the most likely diagnosis? |
|
Definition
|
|
Term
| What does the Neer test evaluate for? |
|
Definition
|
|
Term
| You order an ultrasound of the lower abdomen and find the intestinal sac has traversed through a weakened area of the abdominal wall and through Hesselbach's Triangle. What type of hernia is this? |
|
Definition
|
|
Term
| What is the classic triad of a pheochromocytoma crisis? |
|
Definition
| Headache, palpitations, and diaphoresis |
|
|
Term
| What is the MC cardiac manifestation of thyrotoxicosis? |
|
Definition
|
|
Term
| In the medication regimen for HIV, zidovudine, lamivudine, and efavirenz, which one is contraindicated for use in pregnant pts? |
|
Definition
|
|
Term
| What part of the EKG tracing shows that the ventricles are completely depolarized? |
|
Definition
|
|
Term
| A soft, early diastolic, high pitched murmur, best heard with sitting and leaning forward. |
|
Definition
|
|
Term
| Is MVP a systolic or diastolic murmur? |
|
Definition
|
|
Term
| Is pulmonic stenosis a systolic or diastolic murmur? |
|
Definition
|
|
Term
| What is the most important diagnostic criteria for pneumonia? |
|
Definition
| CXR will show consolidation |
|
|
Term
| A CXR shows hyper-translucent lung fields with loss of peripheral vascular markings and the pt c/o a dry cough, diagnosis? |
|
Definition
|
|
Term
| What pathogen is associated with bloody diarrhea, fever and a recent anti-biotic use? |
|
Definition
|
|
Term
| Which murmur type is a machinery like murmur? |
|
Definition
| PDA - Patent ductus arteriosis |
|
|
Term
| Harsh pan-systolic murmur? |
|
Definition
| Ventricular septal defect |
|
|
Term
| What is the treatment of Wilson's disease? |
|
Definition
| lifelong chelation or oral zinc and a low copper diet |
|
|
Term
| 28y/o presents with a pink-red papulosquamous eruption with scattered discrete coppery papules on the palms of his hands, he is afebrile and has had no recent hx of illness. Skin exam reveals soft, flat, moist papules scattered on his perineum. What condition do you suspect? |
|
Definition
|
|
Term
| Impingement which nerve root may cause numbness and tingling primarily on the medial surface of the arm and into the lateral hand into the fourth and fifth digits. It may also cause dysfunction of the hand as it innervates the small hand muscles |
|
Definition
|
|
Term
| Impingement of which nerve root may cause neck and upper shoulder numbness and pain |
|
Definition
|
|
Term
| Impingement of which nerve root may cause deltoid and shoulder numbness and pain, and biceps tendon reflex may be diminished |
|
Definition
|
|
Term
| Impingement of which nerve root can cause numbness and tingling down the arm into the thumb, with weakness in the bicep muscle and diminished brachioradialis tendon reflex in the affected extremity |
|
Definition
|
|
Term
| Impingement of which nerve causes numbness and pain down the affected arm and into the middle finger, and the triceps reflex may be diminished on exam |
|
Definition
|
|
Term
| What part of the body is affected by Addison's disease? |
|
Definition
|
|
Term
| What is death in the cases of hypothermia usually caused by? |
|
Definition
|
|
Term
| What is the diagnostic test of value for detecting multiple myeloma? |
|
Definition
| serum protein electrophoresis |
|
|
Term
| Most common direction of shoulder dislocation |
|
Definition
|
|
Term
| Most common primary malignant intraocular tumor of childhood |
|
Definition
|
|
Term
| What diagnostic test should be used in the management of children with minor closed head injury with loss of consciousness, amnesia at the time of evaluation, or headache or vomiting? |
|
Definition
|
|
Term
| Which trace mineral has the following functions: transports vitamin A, taste perception, wound healing, making of sperm, and essential in fetal development? |
|
Definition
|
|
Term
| What factor has emerged as a major risk factor in almost every epidemiologic study of SIDS? |
|
Definition
| Maternal smoking during pregnancy |
|
|
Term
| Confirmatory test for scabies? |
|
Definition
| Skin scraping with immersion oil |
|
|
Term
| Pt with one month of hoarseness, not recent illnesses. Hx of 20 pk/yr smoking. Has non-tender anterior lymphadenopathy, what is the dx? |
|
Definition
|
|
Term
| Patient c/o fever, flank pain, urinary changes (dysuria, gross hematuria), and nausea/vomiting. On physical exam, findings include an elevated temperature, no hypertension, no edema, and a moderately ill-appearing patient with tenderness at the costoverterbral angle (CVA). Dx? |
|
Definition
|
|
Term
| Pt presents with purpuric rash, arthralgias, abdominal pain and mild hematuria on the urinalysis. Proteinuria is noted at <3.5. What is the Dx? |
|
Definition
| Henoch-Schönlein Purpura, a systemic small vessel vasculitis, classified as a nephritic disease |
|
|
Term
| Presenting symptoms of which intoxication can include hypertension, tachycardia, diaphoresis, anxiety, dilated pupils, agitation, nasal congestion, and psychosis. |
|
Definition
|
|
Term
| Pt presents with sharp pain on one side of the mouth that radiates to the ipsilateral ear, eye, or nostril. What is the Dx? |
|
Definition
|
|
Term
| Pt c/o a multitude of symptoms that have included diplopia or blurred vision early on, then an insidious onset of progressive weakness, numbness, and/or tingling in the extremities. What are you considering as a dx? |
|
Definition
|
|
Term
| Pt presents with ptosis and diplopia, as well as difficulty swallowing, fatigue, and muscle weakness. What condition are you considering as the dx? |
|
Definition
|
|
Term
| What is an upper motor neuron disease that causes limb weakness, stiffness, and fasciculations? |
|
Definition
| Primary lateral sclerosis |
|
|
Term
| After an acute respiratory illness, the pt presents with an acute onset of pain in the thyroid gland, and a fever, elevated WBCs, and high sedimentation rate. Thyroid hormone is elevated and TSH is low. What is the dx? |
|
Definition
|
|
Term
| What is the most consistent finding on PE for a pneumothorax? |
|
Definition
| hyperresonance to percussion over the affected area |
|
|
Term
| Treatment of choice for peptic ulcer disease? |
|
Definition
|
|
Term
| What condition has hallmark symptoms of epigastric pain (dyspepsia) described as aching, dull, or gnawing? |
|
Definition
| PUD (Peptic Ulcer Disease) |
|
|
Term
| What is the confirmatory test for carbon monoxide poisoning? |
|
Definition
|
|
Term
| What examination technique would help to show that a mass is a ganglion cyst? |
|
Definition
| Transilluminating the cyst |
|
|
Term
| How can an acute thyroiditis diagnosis be confirmed? |
|
Definition
| Needle aspiration of the thyroid |
|
|
Term
| What test is performed first in the diagnosis of atherosclerotic vascular disease? |
|
Definition
| Doppler ultrasound can detect narrowing of arteries and is not invasive |
|
|
Term
| A 60-year-old man presents with severe, cramping pain in his lower extremities. He states that for the last 6 months, he noted that he has had pain in his lower legs when he walks and when walking with his wife for several blocks, the pain would extend to his hips and buttocks. The pain would go away with a period of rest. On physical examination, you note that his legs are pale, cool to the touch, and atrophy of the muscles is noted bilaterally. The femoral pulses are diminished upon palpation and a bruit can be heard over the iliac and femoral arteries. What is the dx? |
|
Definition
| occlusive disease of the lower extremities |
|
|
Term
| What test can be used to diagnose occlusive disease of the lower extremities? |
|
Definition
|
|
Term
| Retinal examination of the right eye reveals a cherry-red spot, what do you suspect? |
|
Definition
| Central retinal artery occlusion |
|
|
Term
| What is a key indicator of acute massive hemorrhage due to perforation? |
|
Definition
| key to this assessment is the large drop in hemoglobin and hematocrit indicating significant blood loss |
|
|
Term
| What is the MC presentation of upper GI bleeding? |
|
Definition
| hematemesis (bright red blood of coffee grounds) or melena |
|
|
Term
| Pt presents with R shoulder pain that has become progressively worse overtime, he has not tried to alleviate the pain and it is worse at night while he is trying to sleep or when he is in the shower washing his hair. There was no hx of trauma or injury. PE shows no swelling, atrophy, redness or bruising. Point tenderness is located over the right lateral deltoid muscle. ROM at 80 degrees ABduction elicits pain. Pos Neer's impingement. Neg drop arm test. Neg apprehension test. What is the dx? |
|
Definition
| Rotator cuff tendonitis (tendinopathy) |
|
|
Term
| What PE test is positive if there is an Acromioclavicular sprain? |
|
Definition
| Cross body ADduction test would be positive |
|
|
Term
| Which pts are at a higher risk of adhesive capsulitis? |
|
Definition
| diabetics, pts with thyroid disorders, and pts who were immobilzed after a recent illness |
|
|
Term
| Pt has a wide-complex, rapid, regular tachyarrhythmia at 160 beats per minute, crushing chest pain and the monitor shows evidence of "P" waves at 75 beats per minute. What is his rhythm? |
|
Definition
|
|
Term
| Which arrhythmia is described as a very chaotic tachyarrhythmia with no readily discernible P waves and no readily discernible QRS complexes? |
|
Definition
|
|
Term
| What medication can you use in a patient with acute renal failure as a diuretic? |
|
Definition
|
|
Term
| What diuretic should be used to reduce intracranial pressure in cerebral edema? |
|
Definition
|
|
Term
| What disorder includes symptoms of both schizophrenia and a mood disorder? |
|
Definition
|
|
Term
| What disorder requires the presence of symptoms, namely delusions, hallucinations, speech disturbances, and negative symptoms for a period of more than 1 month but less than 6 months? |
|
Definition
|
|
Term
| What disorder requires the presence of symptoms, namely delusions, hallucinations, speech disturbances, and negative symptoms for a period of more than 6 months? |
|
Definition
|
|
Term
| Which drug is recommended as a prophylaxis for influenza when the flu vaccine cannot be taken? |
|
Definition
|
|
Term
| Which drug is used to help treat influenza? |
|
Definition
|
|
Term
| In which pts should the use of Zanamivir be avoided? |
|
Definition
|
|
Term
| A 48-year-old female patient complains of a sore tongue. Upon examine, her tongue is pinkish-red, completely smooth, and appears to be without any papillae. It protrudes symmetrically. No lesions, white patches/areas, or ulcerations are appreciated. What is the most likely diagnosis? |
|
Definition
|
|
Term
| What does atrophic glossitis indicate? |
|
Definition
| Deficiency in riboflavin, niacin, folic acid, vitamin B12, pyridoxine or iron |
|
|
Term
| Pt presents with a sore tongue that is white on examination. The white curdlike d/c can be scraped off and leaves a red denuded area underneath. What is your diagnosis? |
|
Definition
|
|
Term
| A 40 y/o pt with a hx of HIV presents with a lesion on her tongue. It is whitish-tan in color and has a feathery appearance. On PE the lesion cannot be scraped off. What is your diagnosis? |
|
Definition
|
|
Term
| A pt with a suspected inguinal hernia has a U/S study done with findings including the intestinal sac has traversed the deep inguinal ring. What type of inguinal hernia is this? |
|
Definition
|
|
Term
| What are the borders of Hesselbach's triangle? |
|
Definition
| the rectus abdominus, the inferior epigastric artery, and the inguinal ligament |
|
|
Term
| A pt with a suspected inguinal hernia has a U/S study done with findings including the intestinal sac entering through the weakened abdominal fascia and into the anatomic region known as Hesselbach's Triangle. What type of inguinal hernia is this? |
|
Definition
|
|
Term
| A 40 y/o female pt presents with anorexia, nausea, vomiting, constipation, fatigue, HA, and confusion. CBC and CMP reveal hypercalcenia of 14mg/dl. What is the first-step in the initial management of this pt? |
|
Definition
| aggressive rehydration with IV normal saline then give the bisphosphonate pamidronate |
|
|
Term
| A pt came in to the ER for a severe migraine and received treatment 20 minutes ago. Upon re-examination she is c/o significant chest pain that wasn't there previously. Which med used in the treatment of migraines can cause this adverse effect? |
|
Definition
| Sumatriptan can cause coronary vasospasms |
|
|
Term
| What is the treatment for actinic keratosis? |
|
Definition
|
|
Term
| A 57-year-old man comes in for a routine checkup, but he also is concerned about a lesion on his head. On PE the lesion is rather crusted, rough, yellow-brown solitary lesion on the middle forehead at the hairline. You question him about his use of sunblock. He replies that he does not use any type of SPF protection. Additionally, he informs you that he has had major sunburns throughout life and spends the weekends on his sailboat when possible. What is your dx? |
|
Definition
|
|
Term
| What confirmatory imaging technique is most useful in detecting thoracic aortic dissection? |
|
Definition
|
|
Term
| A 42-year-old woman presents for an evaluation of back pain. She states that she has a history of recurrent UTIs and that on occasion, she has noted that her urine appears red. Upon physical examination, she demonstrates CVA tenderness and a palpable abdominal mass. Her vital signs include blood pressure of 145/90 mmHg, respiratory rate of 16 breaths/min, and heart rate of 72 bpm. You order a urinalysis which has the following abnormal results: leukocyte esterase 1+, protein trace, and blood 3+. The microscopic examination reveals 5-10 WBCs/hpf and 20-30 RBCs/hpf. You perform an abdominal ultrasound that demonstrates multiple, bilateral fluid collection within the kidneys. What is the most likely diagnosis? |
|
Definition
|
|
Term
| Which HTN medication should be used in pregnant pts to control their HTN? |
|
Definition
|
|
Term
| What is the MOA of amphetamines? |
|
Definition
| Release of dopamine and norepinephrine |
|
|
Term
| A 36-year-old African-American woman presents to your facility for an evaluation of a nonproductive cough, malaise, mild fever, and mild dyspnea. A chest X-ray demonstrates a right hilar mass. A pulmonologist is consulted and performs a biopsy during bronchoscopy. The report reveals that the mass is a noncaseating granuloma. What is the dx? Which therapeutics should you prescribe? |
|
Definition
| Sarcoidosis; Corticosteroids |
|
|
Term
| A 68-year-old woman presents with symptoms of dyspnea on exertion, easy fatigability, and lassitude for past 2 to 3 months. She also stated that recently she is having difficulty swallowing. She denied hemoptysis, GI, or vaginal bleeding. Occult blood was negative. A Hemoglobin & Hematocrit was ordered, and the results were 7.2 g/dl and 22%, respectively. She was diagnosed with iron deficiency anemia. The results of a barium esophagram reveal esophageal webbing. What is this condition known as? |
|
Definition
|
|
Term
| What is an esophageal motility disorder with gradual, progressive dysphagia for solids and liquids with regurgitation of undigested food and appears on barium swallow as a "bird's beak" appearance? |
|
Definition
|
|
Term
| What condition occurs post-MI, and presents as pericarditis with associated fever, leukocytosis, and pericardial or pleural effusions? |
|
Definition
|
|
Term
| What condition is described as a mucosal tear at the gastroesophageal junction and has a history of vomiting? |
|
Definition
|
|
Term
| What condition is described as a condition where the normal lining of the esophagus is replaced with metaplastic cells and occurs in individuals with long standing reflux disease? |
|
Definition
|
|
Term
| You decide that a patient most likely has a thoracic aortic dissection. You obtain a STAT chest x-ray. Which finding would be most consistent with your presumptive diagnosis on CXR? |
|
Definition
| Widening of the mediastinum |
|
|
Term
| What is the MC space-occupying CNS lesion seen in pts with HIV and CD4 cell counts under 100? |
|
Definition
|
|
Term
| A 42-year-old man presents to the local emergency department with a history of HIV infection/AIDS. He has been non-compliant with his HIV medication and has taken no medication at all for at least 4 months. His last CD4 count was 123 cells/mcL 6 months ago, and his HIV viral load was 9,26,000 copies/mcL. His girlfriend states that he has been stumbling and having memory problems and confusion for the past month. He also had what his girlfriend described as a tonic-clonic seizure 1 week prior but refused to come for treatment at that time. A CT of his head revealed multiple peripheral ring-enhancing lesions. What is the most likely diagnosis? |
|
Definition
|
|
Term
| A Head CT reveals RING-ENHANCING lesion in a pt with HIV, who is non-compliant on meds. Neurological sx including balance difficulties, confusion, memory issues and seizures are present. What is your dx? |
|
Definition
|
|
Term
| What is the most reliable method of removing an esophageal foreign body? |
|
Definition
|
|
Term
| A pt presents with localized high pitched bowel sounds with crampy abdominal pain, nausea, and vomiting. What condition do you suspect? |
|
Definition
|
|
Term
| What is an infectious disorder characterized by fever, lymphadenopathy, arthralgias, weight loss, and chronic diarrhea? |
|
Definition
|
|
Term
| What is the appropriate treatment for a patient with a suspected scaphoid fracture has radiographs that are read as "normal," but clinically there is a fracture? |
|
Definition
| Thumb spica splint, limit use, follow up in 2 to 3 weeks for repeat radiographs |
|
|
Term
| First-Line therapy for community acquired pneumonia? |
|
Definition
|
|
Term
|
Definition
Septal - V1, V2
Anterior - V3, V4
Lateral - V5, V6
Inferior - II, III AVF |
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Term
| A 61-year-old male presents to the local ED with chest pain for the last hour. An ECG is obtained and found to have T wave inversion and wide Q waves in leads II, III, and AVF. The EKG findings are most consistent with what type of MI? |
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Definition
| Acute Anterior Myocardial Infarction |
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Term
| What is the treatment for diabetes insipidus? |
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Definition
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Term
| A 28-year-old man presents with increasing polyuria and nocturia without significant changes in his weight. He has noted increased thirst subsequent to increased urination. Urine osmolality is low, and the urine is poorly concentrated on the water restriction test. Glucose & Na is WNL. What is the probable diagnosis? |
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Definition
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Term
| Impingement of this nerve can cause numbness and tingling down the arm into the thumb, with weakness in the bicep muscle and diminished brachioradialis tendon reflex in the affected extremity. |
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Definition
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Term
| Impingement of which nerve root may cause neck and upper shoulder numbness and pain. |
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Definition
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Term
| Impingement of which nerve root may cause deltoid and shoulder numbness and pain, and biceps tendon reflex may be diminished. |
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Definition
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Term
| Impingement of which nerve root causes numbness and pain down the affected arm but into the middle finger and the triceps, reflex may be diminished on exam. |
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Definition
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Term
| A mother brings her 5-year-old son to your facility presenting with several blisters on his cheek and around his nose. On examination, you note several large flaccid, thin-roofed bullae on both cheeks, minimal involvement around the nose and several outcrops of bullae on his wrists. What is the diagnosis? |
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Definition
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Term
| How should Impetigo be treated? |
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Definition
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Term
| What electrolyte abnormality would cause a shortened QT interval, and sx including loss of appetite, lethargy and constipation? |
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Definition
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Term
| What electrolyte imbalance is associated with sarcoidosis? |
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Definition
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Term
| What is the MCC of a lung abscess? |
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Definition
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Term
| What is the MCC of cholangitis? |
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Definition
| CBD stones with obstruction of the CBD |
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Term
| A 26-year-old man is brought to the emergency department by ambulance for second-degree burns to his right arm, anterior surface of his right legs, and his anterior trunk, sparing his genital area. Which of the following represents a reasonable estimation of the extent of his burns? |
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Definition
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Term
| What is the most common cause of bacterial pneumonia among non-institutionalized individuals with no significant co-morbid conditions? |
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Definition
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Term
| What pathogen is responsible for Roseola? |
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Definition
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Term
| What childhood illness is described as a maculopapular beginning on the face, spreading to the entire body, and disappearing by the 4th day after prodrome of low-grade fever, ocular pain, sore throat, and myalgias? |
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Definition
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Term
| Which childhood illness consists of the prodrome of fever, cough, conjunctivitis, and coryza & the rash appears as maculopapular, spreading down from the face and hairline to the trunk over 3 days and becoming confluent? |
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Definition
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Term
| What childhood illness is described as a rash appears as raised, fiery-red maculopapular lesions on the cheeks that give a "slapped-cheek" appearance? |
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Definition
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Term
| What is the underlying cause of amaurosis fugax? |
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Definition
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Term
| Pt presents with an obvious bulge in the right lower quadrant extending into the right scrotal sac. The abdomen itself is soft, flat, and non-tender. Bowel sounds are slightly hyperactive; there are no rushes or tingling sounds. The bulge cannot be reduced and is tender. Bowel sounds are present within the mass. An x-ray, flat and upright, of the abdomen shows some dilated small bowel extending into the right scrotal sac, but signs of obstruction are absent. What do you suspect? |
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Definition
| Incarcerated Indirect Hernia |
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Term
| What is the best treatment for a ruptured proximal biceps tendon? |
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Definition
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Term
| What drug is the most effective drug for rapid termination of a reentrant PSVT? |
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Definition
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Term
| What medication is recommended in pts with severe acne, cystic acne, or acne refractory to treatment? In which pts should their use be avoided? |
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Definition
| Retinoids (isotretinoin); Should be avoided in prego women or those trying to conceive as they are teratogenic |
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Term
| Which seizure is described as beginning with jerking motions in the pts arms and legs, then the pts body becomes rigid and unmovable with the pt being unresponsive and afterwards confused with no recollection of the event? |
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Definition
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Term
| In which type of seizure does a pt not lose consciousness? |
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Definition
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Term
| A 20-year-old woman presents with intermittent nosebleed for the past 2 weeks. She also reports that her menstrual periods have increased in amount in the past 2 months. She recently underwent surgery for small bowel resection and only eats 1 meal a day. Laboratory investigations reveal prolonged prothrombin time and prolonged activated partial thromboplastin time and a normal platelet count. What is the most likely diagnosis? |
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Definition
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Term
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Definition
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Term
| 4 y/o pt presents with a progressive fever, sore throat, and cough for a couple of days to a sudden midnight onset. The cough is accompanied by stridor at rest and a hoarse cough. What is your diagnosis? |
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Definition
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Term
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Definition
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Term
| What pathogen causes epiglottitis? |
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Definition
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Term
| 3 y/o pt presents with Drooling, hoarseness, high fever, sore throat, and is sitting with hands on knees leaning forward and looks lift a sniffing dog. What is your dx? |
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Definition
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Term
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Definition
| humidified air, inhaled or oral corticosteroids, and nebulized racemic epinephrine. |
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Term
| What is the tx for epiglottitis? |
|
Definition
| Intubation, IV ceftriaxone or cefuroxime |
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Term
| Treatment for Kawasaki's disease? |
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Definition
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Term
| A 3-year-old girl presents with fever and rash for 5 days. She has no significant past medical history and no recent travel history. She is current up to date with her vaccinations. On exam, her temperature is 102.6 F, heart rate is 96, and blood pressure is 84/54. She is in no acute distress. She has a generalized maculopapular rash with erythematous palms. She has bilateral conjunctival injection without exudate, a strawberry tongue, cracked red lips, and grey tympanic membranes. There is an enlarged anterior cervical lymph node on the left side measuring 1.9 cm. Her lungs are clear. She has a soft systolic murmur best heard over the left sternal border. Her abdomen is soft without organomegaly. What is your Dx? |
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Definition
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Term
| Where is the fundus typically palpable at 20 weeks gestation? |
|
Definition
| lower border of the umbilicus |
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Term
| At the end of the first trimester, where can the fundus be palpated? |
|
Definition
| Just above the pubic symphysis |
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Term
| When the fundus is located just below the xiphoid, what week of gestation is the prego female at? |
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Definition
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Term
| What nerve is affected by carpal tunnel? |
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Definition
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Term
| What nerve is affected if there is thenar atrophy? |
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Definition
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Term
| What nerve is affected if there is hypothenar atrophy? |
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Definition
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Term
| If a pt presents with snow blindness or ultraviolet keratitis, what is the treatment? |
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Definition
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Term
| Differential for "coin lesions"? (3) |
|
Definition
lung carcinoma (MC adenocarcinoma)
granuloma
hamartoma |
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Term
| What lung condition tends to spread very quickly and commonly occur with a hx of smoking? |
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Definition
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Term
| What lung condition results from inflammation, destruction and dilatation of the bronchi and gives a typical honeycomb appearance on CXR? |
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Definition
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Term
| What lung condition results from an inhalation of dust containing silica for many years and scattered nodules in the lungs? |
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Definition
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Term
| What is the treatment for Dressler syndrome? |
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Definition
| ASA, NSAIDs, or corticosteroid taper |
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Term
| A post-MI pt returns for f/u visit c/o sharp inspiratory chest pain. If Dressler syndrome is the dx, what would show on the EKG? |
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Definition
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Term
| A post-MI pt returns for f/u visit c/o sharp inspiratory chest pain. If Dressler syndrome is the dx, what would show on the EKG? |
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Definition
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Term
| A post-MI pt returns for f/u visit c/o sharp inspiratory chest pain. If Dressler syndrome is the dx, what would show on the EKG? |
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Definition
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Term
| A post-MI pt returns for f/u visit c/o sharp inspiratory chest pain. If Dressler syndrome is the dx, what would show on the EKG? |
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Definition
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Term
| CBC findings of pancytopenia, blasts with auer rods as well as gingival hyperplasia and mild petechiae on the extremities is indicative of what condition? |
|
Definition
| AML - acute myelogenous leukemia |
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Term
| Best drug for the sustained treatment of panic disorder? |
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Definition
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Term
| Which of the evoked potential tests is the most useful in the diagnosis of MS? |
|
Definition
| visual evoked potential is pos in 85% of MS pts |
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Term
| Tx for RCC (renal cell carcinoma)? |
|
Definition
| referral to urology for radical nephrectomy |
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Term
| Tx for tinea corporis 'ringworm'? |
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Definition
|
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Term
| What is the appropriate treatment for nummular eczema? |
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Definition
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Term
|
Definition
|
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Term
| Tx for uncomplicated cellulitis |
|
Definition
| amoxicillin and cephalexin |
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Term
| Bright red blood coming through a closed cervical os describes which type of clinical abortion? |
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Definition
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Term
| Bright red blood coming through a dilated cervix indicates what type of abortion? |
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Definition
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Term
| When do the majority of spontaneous abortions occur? |
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Definition
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Term
|
Definition
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Term
| Hernia through hesselbach's triangle = ? |
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Definition
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Term
| On inguinal hernia examination the mass pushes against the side of the examiners finger, what is the dx? |
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Definition
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Term
| On inguinal hernia examination the mass pushes against the tip of the examiners finger, what is the dx? |
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Definition
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Term
| What is a complication of giant cell arteritis of the temporal arteries if the pt does not receive tx? |
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Definition
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Term
| What is the classic triad of pheochromocytomas? |
|
Definition
| HA, palpitations and diaphoresis |
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Term
| In which pt population are pheochromocytomas MC found? |
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Definition
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Term
| 32 y/o female pt presents with paroxysmal episodes of HA, palpitations and diaphoresis which last for 20 minutes. During one episode her BP was recorded at 194/110. She denies any precipitating events and notes they have occured both with activity and at rest. PE is unremarkable. What do you suspect? |
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Definition
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Term
| Which of the following HIV meds is prego cat D and should be d/c during pregnancy... Lamivudine, Zidovudine, Efavirenz |
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Definition
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Term
| What are the TOC for an active infection of meningococcemia? |
|
Definition
| PCN G (If PCN allergic give chloramphenicol and cephalosporins) |
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Term
| What point on the EKG tracing shows where the ventricles are completely depolarized? |
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Definition
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Term
| During pregnancy what is the best treatment for chlamydia? |
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Definition
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Term
Which type of fat helps decrease low-density lipoproteins?
A Butter
B Beef tallow
C Coconut oil
D Olive oil
E Palm kernel oil |
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Definition
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Term
| The diagnostic corneal pigmentation seen in Wilson's disease is known as what? |
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Definition
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Term
| What lab value is most suspicious for recurrence of thyroid malignancy? |
|
Definition
| Increasing serum thyroglobulin levels |
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Term
| What is Horner's syndrome due to? |
|
Definition
| bronchogenic carcinoma tumor mass extending to the sympathetic chain |
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Term
| A 50-year-old African-American man presents to the emergency room complaining of inability to see well for the past 2 weeks. He is a married newspaper editor and is not on any medications. He has been smoking 2 packs of cigarettes a day for the past 30 years. On examination of his right eye, there is ptosis and miosis. A chest radiograph reveals a rounded opacity in the right lung field. What is the most likely diagnosis? |
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Definition
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Term
| Ptosis, Miosis, hemianhydrosis and enophthalmos are indicators of which condition? |
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Definition
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Term
| What is the resting membrane potential of a sinus nodal fiber under normal conditions? |
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Definition
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Term
| Tx for tumor lysis syndrome? |
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Definition
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Term
| Pt presents after recent chemo tx for lymphoma with restlessness, tachycardia, muscle weakness, increased WBC count, azotemia, hypocalcemia, and hyperkalemia. What condition do you suspect? |
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Definition
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Term
| What spinal abnormalities are seen in Marfan's syndrome? |
|
Definition
| Scoliosis and Kyphoscoliosis |
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Term
| The primary site for blood pressure regulation in the vascular system is ____________________? |
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Definition
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Term
| What are the progestin components of an OC responsible for? |
|
Definition
| primarily suppresses luteinizing hormone (LH) secretion (and thus prevents ovulation) |
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Term
| What are the estrogen components of OC responsible for? |
|
Definition
| suppress follicle-stimulating hormone (FSH), as well as provide stability to the endometrium and potentiation of the progestin's actions |
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Term
| Which joints and how many does gout typically affect at initial onset? |
|
Definition
| Usually affects smaller, LE joints and usually is monoarticular |
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Term
| Which is the leading cause of fatal accidental poisoning among children 6-years-old and under in the United States? |
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Definition
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Term
| Acute attack of pain, vision blurred, halos, steamy cornea, conjunctival injection and nausea are symptoms characteristic of what condition? |
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Definition
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Term
| A 34-year-old woman has been newly diagnosed diabetes. When evaluating this patient to determine if she is a type 1 versus type 2 diabetic, which laboratory results would specifically indicate type 2 Diabetes? |
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Definition
| Elevated Serum C-peptide - markers of endogenous insulin production (which is absent in Type 1 diabetics) |
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Term
| Which pts typically present with the following clinical findings: are impulsive, have unstable interpersonal relationships, are suffused with anger and fear, lack self-control, are suicidal, and demonstrate aggressive behavior? |
|
Definition
| Borderline personality d/o |
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Term
| Which pts present with personalities are exhibitionists, grandiose, preoccupied with power, and have poor social interactions? |
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Definition
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Term
| Which type of pts have personalities fear rejection, have low self-esteem, and hyperreact to rejection and failure? |
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Definition
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Term
| Which pts have personalities that are dependent, immature, seductive, vain, and egocentric? |
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Definition
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Term
| Which pts have personalities that are selfish, callous, impulsive, have legal problems, and are promiscuous? |
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Definition
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Term
| A 62-year-old man is in the hospital. He is able to hear things and repeat what is said to him. However, he does not understand what he has just heard. What is this phenomenon called? |
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Definition
| Echolalia (Echophrasia means they don't understand what they heard) |
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Term
| The substitution of a similar sounding word for another word is called what? |
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Definition
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Term
| An aphasia where there is a problem with reading is called what? |
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Definition
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Term
| A condition where a patient has difficulty performing motor acts, despite having the muscular capacity and coordination to do so is known as? |
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Definition
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Term
| A writing disturbance is called what? |
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Definition
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Term
| A 55-year-old male comes in with complaints of nonproductive cough which has worsened over the last two months. He recently noted the appearance of blood-streaked sputum. Sputum cytology revealed the small cluster of hyperchromatic pleomorphic cells with very scanty cytoplasm. What condition do you suspect? |
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Definition
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Term
| What is the prophylactic DOC for malaria with no drug-resistance? |
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Definition
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Term
|
Definition
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Term
| What med can be used in the prevention of gout? |
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Definition
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Term
| Treatment for strep pharyngitis if pt is PCN allergic? |
|
Definition
| Macrolides - Azith, Eryth, |
|
|
Term
| What part of the virus is used in the preparation of the Hep B vaccine in the U.S? |
|
Definition
| Hepatitis B surface antigen (HBsAg) |
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Term
| DOC for giardia infection? |
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Definition
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Term
| Pt presents after a camping trip with hx acute watery diarrhea and now c/o flatulence, foul-smelling stools, abdominal pain and distention, and anorexia. What condition do you suspect? |
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Definition
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Term
| Pt present post-seizure and caregiver describes hx of fever, abdominal pain, tenesmus, and bloody mucoid stools. What condition do you suspect? |
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Definition
|
|
Term
| MCC of diarrhea in children <2y/o? |
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Definition
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Term
| What physical finding may indicate an advanced Carpal Tunnel Syndrome? |
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Definition
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Term
| Which asthma medication prevents the release of mast cell autocoids to treat exercise-induced asthmatic attacks? |
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Definition
|
|
Term
| lightheadedness on getting up is a typically sign of what? |
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Definition
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Term
| What is the most important facet of obesity treatment? |
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Definition
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Term
|
Definition
|
|
Term
| friction rub + recent flu infection = ? |
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Definition
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Term
| Which test is most sensitive to monitor the affects of heparin? |
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Definition
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Term
| What lesions is described as strictly macular, 1 to 3 cm in diameter, but can be as large as 5 cm, appear as light yellow, light brown, or dark brown, and are uniformly mixed in color? |
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Definition
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Term
| What skin lesion is described as flat-topped, yellow, firm nodules that are primarily located on the elbows and knees? |
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Definition
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Term
| Positive Finklesteins test indicates? |
|
Definition
| DeQuervain's tenosynovitis |
|
|
Term
| What is a common hx finding of people with deQuervain's? |
|
Definition
| Repetitive use of their thumb |
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Term
Eye trauma:
1. When should you never palpate the eye?
2. Workup
3. Treatment for penetrating trauama, foreign body, metallic foreign body, chemical burn |
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Definition
1. never palpate if suspected globe trauma
2. workup: visual acuity (snellen chart), pupillary reactions, IOP (schiotz tonometer)
3. Tx:
- penetrating: DO NOT REMOVE OBJECT, transport to ER for ophtho consult asap
- foreign body: fluorescien stain, evert lids, patch (<24 hr)
- metal: remove w/ rotating burr
- chemical: flush with water or NS for at least 30 min - transfer to ER |
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Term
| Orbital floor is composed of what 3 bones? |
|
Definition
maxillary, palatine, zygomatic
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|
Term
| Orbital (Blow-out) Fx: sx and tx |
|
Definition
Sx: swelling, misaligment, restricted movement (specifically inability to look up), double vision, subcu emphysema, exophthalmos
tx: refer to ophtho, avoid sneezing, nasal decongestants, ice packs, abx during transport |
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|
Term
| Corneal abrasion: sx, workup, treatment |
|
Definition
sx: pain, sensation of foreign body, photophobia, tearing, injection, blepharospasm (twitching eyelid)
workup: visual acuity; slit lamp or fluorescein stain
tx:
- topical anesthetic (cannot take home)
- abx ointment - polymyxin/bacitracin
- patching - no longer than 24 hrs
- follow up in 1-2 days |
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|
Term
Retinal detatchment:
1. separation of retina from ___ layer, usually beginning in the ___ area
2. causes?
3. sx
4. tx |
|
Definition
1. separation of retina from pigmented epithelial layer usually begins at superior temporal area
2. causes: spontaneous, trauma, extreme myopia
3. sx: "curtain of darkness" being drawn from top to bottom, flashes, floaters - monocular
- may be afferent pupillary defect
- fundoscopy may show rugous retina in vitreous
4. tx: emergency ophtho consult for surgery, stay supine |
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|
Term
What disease?
Cause: age-related or due to toxic effects of drugs (chloroquine/malaria, phenothiazine)
Pathogenesis: Drusen deposits in Bruch's membrane (innermost part of choroid) lead to degeneration, loss of nutrition, atrophy, neovascularization, mottling, serous leaks, hemorrhages to retina
Sx: insidious onset central vision loss, metamorphopsia (wavy or distorted vision) measured by amsler grid
Tx? |
|
Definition
macular degeneration
laser therapy, intravitreal anti-VEGF, vitamins, antioxidants --> none are definitive |
|
|
Term
Ophthalmologic emergency with poor prognosis
causes: emboli, thrombi, vasculitides
sx: sudden, painless, unilateral vision loss
Fundoscopy: arteriolar narrowing, separation of arterial flow (box-carring), retinal edema, perifoveal atrophy (cherry-red spot), optic atrophy, pale retina
tx? |
|
Definition
Central retinal artery occlusion
tx: emergent referral to ophtho for vessel dilation and paracentesis
workup for atherosclerosis to avoid recurrence |
|
|
Term
Leading cause of blindness in adults in US
Non-proliferative: venous dilation, microaneurysms, retinal hemorrhages, retinal edema, hard exudates
Proliferative: neovascularization, vitreous hemorrhage
tx? |
|
Definition
diabetic retinopathy
tx: glucose control, BP control, laser photocoagulation, vitrectomy |
|
|
Term
Cataracts:
1. Causes
2. sx
3. tx |
|
Definition
Causes: age, trauma, congenital cause, medications (steroids, lovastatin), sun exposure
sx: insidious onset of decreased visual acuity, double vision, fixed spots, reduced color perception, yellow discoloration of lens
tx: surgical excision with lens replacement |
|
|
Term
painful eye, loss of vision, circumlimbal injection, steamy cornea, fixed/dilated pupil, n/v, diaphoresis
tx? |
|
Definition
acute angle-closure glaucoma
tx: IV carbonic anhydrase inhibitor (acetazolamide), topical BB, osmotic diuresis
NEVER USE MYDRIATICS
- laser or surgical iridotomy is definitive |
|
|
Term
chronic, asymptomatic, potentially blinding disease defined as increased IOP, defects in periperal visual field, and increased cupt-to-disc ratios
tx? |
|
Definition
chronic open-angle glaucoma
tx: referal to ophtho
- topical and systemic meds to decrease IOP and aqueous humor production (timolol, acetazolamide) and increase outflow (prostaglandin analogs) |
|
|
Term
Orbital cellulitis:
1. more common in what age?
2. causes?
3. organisms
4. sx
5. workup
6. tx |
|
Definition
1. more common in kids
2. causes: sinusitis, dental infx, facial infx, globe/eyelid infx, lacrimal infx, trauma
3. bugs: strep pneumo, staph aureus, h. flu, MRSA, gram neg
4. sx: ptosis, eyelid edema, exophthalmos, purulent discharge, conjunctivitis, fever, decreased EOM, sluggish pupillary response
5. Workup: CBC, blood culture, culture of drainage, sinus xray and CT
6. Tx: hospitalization with IV ABX (broad spectrum until cause is found) |
|
|
Term
common in newborn after first month of life due to lacrimal duct not opening
usually resolves by 9 mo
tx? |
|
Definition
dacryostenosis
tx: warm compress, massage, surgical probe in unresolved
|
|
|
Term
inflammation of lacrimal gland caused by obstruction
common pathogens: staph, GABHS, staph epi, candida
sx: pain, swelling, tenderness, redness, purulent discharge
tx? |
|
Definition
dacryocysitits
tx: warm compress, abx |
|
|
Term
Red eyelid rims with adherent eyelashes, dandruff-like deposits (scurf) and fibrous scales (collarettes) on eyelids
- conjunctiva clear or slightly erythematous
causes: seborrhea, staph/strep, meibomian gland dysfunction
tx? |
|
Definition
blepharitis
tx: eyelid scrubs w/ diluted baby shampoo and cotton swabs
- topical abx if infx suspected |
|
|
Term
acute small, painful nodule or psutule within a gland on the eyelid
internal: caused by inflammation of meibomian gland
external: inflammation of glads of Moll (apocrine) or Zeis (sebaceous) at the palpebral margin
cause: usually staph aureus
sx: acute onset pain and edema of eyelid
tx? |
|
Definition
Hordeolum
(external is Stye)
tx: warm compresses, topical abx, I&D if refractory |
|
|
Term
painless, induraed lesion deep from palpebral margin
secondary to chrornic inflammation of internal hordeolum or meibomian gland
sx: insidious onset, minimal irritaion, pruritic, erythema
tx? |
|
Definition
chalazion
warm compresses, may need excision |
|
|
Term
1. when lids/lashes are turned in due to scar tissue or orbicularis oculi spasm
2. when lids/lashes are turned out due to advanced age, trauma, infx, palsy of CN VII |
|
Definition
|
|
Term
Viral conjunctivitis:
1. most common cause?
2. tx? |
|
Definition
cause: adenovirus
- transmission via direct contact via fingers or in swimming pools
tx: eye lavage w/ NS BID x 7-14 days
- vasoconstrictor-antihistamine drops
- warm to cool compresses |
|
|
Term
Bacterial conjunctivitis:
1. common pathogens
2. sx
3. tx |
|
Definition
1. common pathogens: strep pneumo, staph aureus, h. aegyptius, moraxella
- rare pathogens: chlamydia and gonorrhea
2. sx: purulent discharge, matting, mild discomfort
- Viral conjunctivitis is watery discharge
2. tx: topical abx (systemic for GC/chlamydia) |
|
|
Term
1. elevated yellow, fleshy conjunctival mass on sclera adjacent to cornea due to actinic (UV) exposure, repeated trauama, dry/windy conditions. can be resected if cosmetically undesirable
2. slowly growing thickening of bulbar conunctiva - highly vascular, growing from nasal side of cornea. can interfere with vision and then needs to be excised.
3. cholesterol deposits on skin around eyes |
|
Definition
1. pinguecula
2. pterygium
3. xanthalasma |
|
|
Term
optic disc swelling due to increased ICP - appears as blurred disc margins, obliterated vessels
usually no sx, may have transient visual disturbance
causes? |
|
Definition
papilledema
HTN, hemorrhagic stroke, subdural hematoma, pseduotumor cerebri |
|
|
Term
where is lesion of optic nerve?
1. blurred vision in one eye
2. blurred vision in both eyes
3. corresponding defects in both visual fields
Right Homonymous hemianopia means?
Binasal heteronymous hemianopia?
Bitemporal heteronymous hemianopia? |
|
Definition
1. blurred vision in one eye - anterior to optic chiasm
2. blurred vision in both eyes - at optic chiasm
3. corresponding defects in both visual fields - posterior to optic chiasm
Right Hemonymous hemianopia means right visual field of each eye is affected --> due to lesion on left side of brain
Binasal heteronymous hemianopia: loss of vision in the nasal field of both eye. Due to impingmenet of lateral retina fibers - usually due to calcification of internal carotid
Bitemporal heteronymous hemianopia: loss of vision in the temporal field of both eyes. Due to pressure on optic chiasm - usually due to pituitary tumor, craniopharyngioma, or meningioma |
|
|
Term
condition in which binocular fixation is not present
inward misalgment: estropia
outward misalignment: extropia
positive cover-uncover test
tx? |
|
Definition
strabismus
tx: patch or surgery |
|
|
Term
1. reduced visual acuity not correctable by refractive means, usually due to strabismus but can be due to toxemia or uremia
2. yellowing of sclera due to retention of bilirubin
3. blue sclera are commonly found in ___ |
|
Definition
1. amblyopia
2. icterus
3. osteogenesis imperfecta |
|
|
Term
Hearing tests:
1. Tuning fork is placed on forehead. lateralization to affected ear indicates conductive hearing loss. lateralization to unaffected ear indicates sensorineural hearing loss.
2. Tnuning fork is placed on mastoid process. BC > AC indicates conductive hearing loss (something is blocking sound waves from exiting ear canal). Diminished bone and air conduction indicates SN hearing loss. |
|
Definition
|
|
Term
In ___ hearing loss, air conduction is greater than bone conduction, but both AC and BC are diminished compared to normal
most common cause is presbyacusis
Men more affected than women
genetic predisposition
caused by noise exposure
higher frequencies more affected
may be associated with tinnitus
tx? |
|
Definition
Sensorineural hearing loss
tx: hearing aids |
|
|
Term
In ___ hearing loss, bone conduction is greater than air conduction
increased threshold for perceived sound intensity
causes: cerumen impaction, AOE, otosclerosis, AOM |
|
Definition
|
|
Term
recurrent, progressive chronic hearing loss, tinnitus, dizziness/vertigo resulting from distention of endolymphatic compartment in inner ear
cause: unknown
attacks last for minutes to hours
tx? |
|
Definition
Meniere's disease
tx: diuretics, salt restriction
may need surgery |
|
|
Term
insidious hearing loss caused by neoplasm with progressive tinnitus, vertigo, ataxia, brain stem dysfunction
dx via ct/mri
tx? |
|
Definition
acoustic neuroma (vestibular schwannoma)
tx: surgery |
|
|
Term
| Drugs that can cause hearing loss |
|
Definition
Aminoglycosides (streptomycin, kanamycin, neomycin)
ethacrynic acid (loop diuretic)
chloramphenicol
|
|
|
Term
| Causes of hearing loss in infants and children |
|
Definition
congenital: rubella, asphyxia, erythroblastosis
acquired: measles, mumps, pertussis, meningitis, flu, labyrinthitis |
|
|
Term
Otitis Media:
1. most common organisms
2. recurrent cases, think?
3. bullae suggest infection with ___
4. spiking fever, postauricular pain, and erythema - think?
5. tx - first line, pcn allergy, persistent infx, mastoiditis |
|
Definition
organisms: s. pneumo, h. flu, m. catarrhalis, strep pyogenes, staph aureus
recurrence: allergies, secondhand smoke
bullae suggest mycoplasma
spiking fever, postauricular pain - think mastoiditis - due to inadequate treatment
Treatment:
1. First Line: amoxicillin, erythromycin/sulfonamide, augmentin, bactrin, cefaclor
2. Erythromycin or clarithromycin for penicillin allergy
3. Myringotomy, tympanostomy, adenoidectomy if failure to resolve
4. IV abx for mastoiditis |
|
|
Term
Otitis externa:
1. most common organisms
2. treatment
3. complication |
|
Definition
1. most common organisms: pseudomonas, enterobacter, porteus
2. tx: abx drops
3. complications; malignant otitis externa - necrotizing infection requiring hospitalizaiton and parenteral abx - happens in diabetics or immunocompromised |
|
|
Term
1. sensation of movmenet or of objects moving around you
2. caused by labyrinthitis, meniere's, positioning, vestibular neuronitis, migraines, anatomic abnormalities. Sudden onset, associated with n/v, tinnitus, decreased hearing, horizontal nystagmus away from diseased side with fixation inhibition. Typically have positive Dix-Hallpike (or Nylen-Barany) maneuver.
3. caused by brain stem disease, AV malformations, brain tumors, MS, vertebrobasial migraines. characterized by slow onset, nonfatigable vertical nystagmus not inhibited by fixation, accompanying motor/sensory/cerebellar defects
treatment for vertigo? |
|
Definition
1. true vertigo
2. peripheral vertigo
3. central vertigo
tx:
1. acute: diazepam - IM or PR
2. mild: meclizine, cyclizine, dimenhydrinate
3. severe: scopolamine
4. Chronic: encourage movement; surgery |
|
|
Term
swelling/irritation of inner ear resulting in severe acute verigo, hearing loss, tinnitus - may occur after otitis or a virus
can last 1-6 weeks. residual sx for years.
tx? |
|
Definition
labyrinthitis
tx: meclizine, promethazine, dimehydrinate |
|
|
Term
rupture of TM due to auditory tube dysfunction during pressure changes. often results in OM.
tx? |
|
Definition
barotrauma
prevention: swallowing or yawning during pressure change to autoinflate tubes, topical decongestnats, myringotomy |
|
|
Term
| precaution for pts with current ruptured TM |
|
Definition
|
|
Term
Sinusitis
1. organisms
2. risk factors
3. sx
4. complications
5. dx
6. tx |
|
Definition
organisms: viral most common, bacterial - s. pneumo, m. catarrhalis, h. flu (same as AOM)
risk factors: recent URI, chronic rhinitis, smoking, hx trauma/foreign body
sx: headache, face pain - worsens when leaning forward, puruelent drainage, fever, malaise
complications: osteomyelitis, cavernous sinus thrombosis, orbital cellulitis
dx: clinical, CT in chronic sinusitis resistant to treatment (waters view XR may be helpful but less than CT), MRI is more sensitivie than CT if malignancy is suspected
Tx: saline nasal spray, decongestants, hot packs /steam
abx if bacterial for 10-14 days |
|
|
Term
Rhinitis: any inflammation of the nasal mucosa
3 types:
1. immunoglobulin E-mediated reactivity to airborne antigens. commonly occurs in people with other atopic disease and a family hx.
2. rhinorrhea caused by increased mucus from the nasal mucosa precipitated by changes in temp, humidity, odors, alochol, or neurotransmitter imbalance
3. caused by overzealous use of decongestant containing oxymetazoline or phenylephrine - causes rebound congestion which prompts increased use of the agent, causing a vicious cycle
treatments? |
|
Definition
1. allergic rhinitis
2. vasomotor rhinitis
3. rhinitis medicamentosa
treatment:
1. allergic: avoid allergens, antihistamines, cromolyn sodium, nasal or systemic corticosteroids, nasal saline, immunotherapy
2. vasomotor: avoid irritant
3. medicamentosa: discontinue irritant, topical corticosteroids |
|
|
Term
pharyngitis/tonsillitis:
1. complication and sx & tx
2. acute onset of fever, exudates, cervical adenopathy, abdominal pain (in kids). Tx?
3. insidious onset with coryza, lack of exudate, low grade fever, +/- adenopathy. tx?
4. complications of improper treatment of GABHS |
|
Definition
Complication: peritonsillar abscess/cellulitis (AKA quinsy) -
severe throat pain, pain with swallowing and opening mouth, deviation of soft palate/uvula, muffled voice
- tx: aspiration or I&D followed by abx. tonsillectomy in 10% (airway obstruction, persistent marked asymmetry, recurrent infx)
2. GABHS. tx: penicillin or erythromycin. treat if neg strep test but high clinical suspicion
3. viral pharyngitis. Tx: get strep screen. supportive if neg
4. GABHS complications: rheumatic fever, ludwig's angina (infx of floor of mouth), tonsillar abscess
|
|
|
Term
| Centor Criteria to guide dx and tx of pharyngitis |
|
Definition
fever >38C (100.4F), tender anterior cervical adenopathy, lack of cough, pharyngotonsillar exudates
3 or more criteria highly suggestive of GABHS
2 criteria indicates need for culture
1 criteria - GABHS unlikely |
|
|
Term
Hallmark: hoarseness with little to no pain
cause: typically viral following URI
tx? |
|
Definition
Laryngitis
tx: supportive, avoid using voice to avoid formation of nodules |
|
|
Term
Oral lesions:
1. single or multiple ulcers on buccal mucosa with red halos. painful. idiopathic or due to herpes.
2. burning pain in tongue, cheek, or throat. white film that CAN BE SCRAPED OFF, leaving underlying raw, erythematous, friable tissue
3. painless white film that CANNOT BE SCRAPED OFF. commonly seen in chewers, smokers, AIDS, ethanol use. 5% malignant - always biopsy. |
|
Definition
1. apthous ulcers
2. candidiasis
3. leukoplakia |
|
|
Term
Epiglottitis:
1. most common organisms
2. group at higher risk?
3. sx?
4. workup
5. tx |
|
Definition
organisms: GABHS, staph, pneuomococci, H. flu (incidence has greatly decreased with H. flu vaccine)
diabetics at highest risk
- most common age group: 2-7 y/o, in adults 45-65 y/o
sx: abrupt high fever, difficulty swallowing, sore throat, drooling, sitting in tripod or sniffing position, muffled voice
workup:
1. lateral soft tissue neck xray - THUMB SIGN (thumb-like projection)
tx: Do not cause the pt distress
- intubation
- IV fluids and abx x 24-72 hrs followed by oral abx
- all unimmunized close contacts should get prophylactic rifampin |
|
|
Term
Epistaxis:
1. ___ on anterior aspect of nose is most common site
2. tx?
3. ___ is uncommon site but is emergency bc it is arterial bleeding and could comprimise airway. usually due to trauma. requires ENT consult for posterior packing. |
|
Definition
1. Kiesselbach's plexus
2. tx: apply firm pressure to nares with pt standing or sitting upright for 10-15 min.
- ID bleeding site
- anesthetize w/ cocaine or lidocaine, cauterize w/ silver nitrate if bleeding site is idenitified
- pack for 24 hrs
3. Woodruff's plexus (posterior bleed) |
|
|
Term
pedunculated tumors of the nasal mucosa often seen in pts with allergic rhinitis
sx: nasal phonations, constant feeling of congestion
tx?
samter's triad? |
|
Definition
nasal polyps
tx: corticosteroids, removal if that fails although they're usually benign
Samter's triad: asthma, nasal polyps, aspirin sensitivity |
|
|
Term
| inflammation of alveoli or interstitium of lung caused by microorganisms. primary cause of mortality from infectious disease. |
|
Definition
|
|
Term
Community-Acquired Pneumonia:
1. common causative agents
2. typical presentation (time period)
3. breath sounds
4. most common causative organization in all pt groups?
5. workup
6. tx (outpt and inpt)
7. indications for inpt |
|
Definition
Organisms: most commonly bacteria - Strep pneumo, h. flu, m. catarrhalis, staph aureus, kelbsiella pneumoniae, gram neg bacilli.
- viral causes: flu, RSV, adenovirus, paraflu
typical presentation: 1-10 days of increasing cough, purulent sputum, SOB, tachycardia, pleuritic CP, fever, hypothermia, sweats, rigors
breath sounds: crackles, bronchial over area of consildation
MOST COMMON ORGANISM: strep pneumo
Workup:
** PE alone is not enough to dx pneumonia **
- CXR: lobar or segmental infiltrates, air bronchograms, pleural effusion. No pathognomonic xray presentation.
- sputum culture to ID species
Tx:
1. oral abx if not immunocompromised or resp distress - doxy, erythromycin, macrolides (clarithro, azithro), fluoroquinolones
2. Inpt: ceftriaxone or cefotaxime PLUS azithro or fluoroquinolone (must cover strep pneumo and legionella)
Indications for inpt:
- neutropenia
- more than one lobe
- poor host resistance
- >50 y/o with comorbidities (relative)
- AMS
- hemodynamic instability |
|
|
Term
Polyvalent Pneumococcal Vaccine (Pneumovax):
1. Contains antigens of 23 common strains
2. Efficacy
3. ___ recommended as a 4 dose series for kids 6w-15mo old
4. ___ reccommended for kids 2-5 y/o and >65 y/o or any person with chronic illness that increases risk for CAP (cardiopulmonary disease, sickle cell, splenectomy, liver disease). Boosters required q 6 years. |
|
Definition
Efficacy: 51-86%
Pneumococcal conjugate vaccine (PCV) for 6w-15mo
Pneumococcal polysaccharide vaccine (PPV) 2-5 y/o and >65 y/o |
|
|
Term
What organism typically causes each set of penumonia sx?
1. low grade fever, cough, bullous myringitis, cold agglutinins (autoimmune hemolytic anemia)
2. slow onset, immunosuppressed pts. increased LDH, more hypoxemic than expected. interstitial infiltrates
3. chronic cardiac or resp disease, hyponatremia, diarrhea
4. longer prodrome, sore throat and hoarseness
5. single rigor, rust-colored sputum
6. currant jelly sputum, chronic illness, alcohol abuse |
|
Definition
1. low grade fever, cough, bullous myringitis, cold agglutinins (autoimmune hemolytic anemia) - mycoplasma pneumoniae (walking pneumonia)
2. slow onset, immunosuppressed pts. increased LDH, more hypoxemic than expected. interstitial infiltrates - PNEUMOCYSTIS JIROVECII (carinii)
3. chronic cardiac or resp disease, hyponatremia, diarrhea - Legionella pneumoniae
4. longer prodrome, sore throat and hoarseness - Chlamydia pneumoniae
5. single rigor, rust-colored sputum - strep pneumo
6. currant jelly sputum, chronic illness, alcohol abuse - Klebsiella penumoniae |
|
|
Term
Common pneumonia pathogens for each patient group:
1. alcoholics
2. COPD
3. CF
4. Young adults, college students
5. Air coditioning
6. Post-splenectomy
7. leukemia/lymphoma
8. <1 y/o
9. <2 y/o |
|
Definition
1. alcoholics - Klebsiella
2. COPD - h. flu
3. CF - pseudomonas
4. Young adults, college students - mycoplasma, chlamydia
5. Air coditioning - legionella
6. Post-splenectomy - h. pneumo, strep pneumo (encapsulated organisms)
7. leukemia/lymphoma - fungal
8. <1 y/o - RSV
9. <2 y/o - paraflu |
|
|
Term
| atypical species causing CAP |
|
Definition
mycoplasma (erythromycin)
chlamydia (tetracycline)
legionella (erythromycin)
m. catarrhalis
sx: low grade fever, aches, fatigue, mild pulm sx
- common in otherwise healthy young adults |
|
|
Term
Hospital-Acquired Pneumonia:
1. occur >__ after admission to hospital
2. highest risk pts
3. common organisms
4. dx
5. tx? |
|
Definition
1. >48 hr
2. ICU and ventilator pts at highest risk
3. organisms: staph aureus, gram neg bacilli, pseudomonas (most common in ICU, worst prognosis), klebsiella, e. coli, enterobacter
4. dx: clinical, supported by sputum/blood culture and CXR
5. tx: empiric abx - cefepime, ticarcillin/clavulanic acid (timentim), piperacillin/tazobactam (zosyn), meropenem |
|
|
Term
HIV-related pneumonia:
1. most common opportunistic infx in people with HIV - fever, tachpnea, dyspnea, nonproductive cough - tx?
2. other organisms and sx?
3. prophylaxis? |
|
Definition
1. pneumocystic jirovecii - tx: bactrim
2. others: strep, h. flu, pseudomonas, mycobaccterium - sx are more fulminant (sudden onset)
3. prophylactic Bactrim for all pts with CD4 <200 bc pneumocystis has nearly 100% mortality rate without treatment |
|
|
Term
TB:
1. organism
2. 10% infected with TB will develop dz - called (a)
3. 5% of exposed people fail to contain (a) and develop active TB within 2 years, which is called (b)
4. 95% of infected people have no sx, called (c). These patients are NOT infectious/contagious. Reactivation of TB in these pts is due to immunocompromise.
5. sx
6. xray for each stage
7. screening
8. dx - confirmatory, supportive, histological hallmark |
|
Definition
1. organism: Mycobacterium tuberculosis - transmission via droplets
2. 10% infected with TB will develop dz - called primary TB
3. 5% of exposed people fail to contain primary TB and develop active TB within 2 years, which is called progressive primary TB
4. 95% of infected people have no sx, called latent TB. These patients are NOT infectious/contagious. Reactivation of TB in these pts is due to immunocompromise.
5. sx: fever, drenching night sweats, anorexia, weight loss, cough, pleuritic CP, dyspnea, hemoptysis, posttussive rales - typically last >3 weeks
6. Xrays:
- Primary: homogenous infiltrates, hilar/paratracheal adenopathy, segmental atelectasis
- progressive: cavitations
- reactivated: fibrocavitary apical dz, nodules, infiltrates, - healed primary infx: Ghon complexes (calcified primary focus), Ranke complexes (calcifed primary focus and calcified hilary lymph nodes)
7. screening: tuberculin skin test (purified protein derivative - PPD) - does not differentiate between active and latent infx
8. dx: ID mycobacterium TB from cultures or by DNA or RNA amplification
- acid-fast bacilli on sputum supports dx but does not confirm
- histological hallmark: bx with caseating/necrotizing granulomas |
|
|
Term
| TB Treatment Regimens per disease state (latent, active, drug-resistant, HIV, converters, exposure) |
|
Definition
multi-drug regimens necessary for active TB:
1. Latent TB: INH x 9 mos or Rifampin for 4 mos or Rifampin and pyrazinamide for 2 mos (if in contact with resistant TB pts)
2. active TB: INH + rifampin + pyrazinamide + ethambutol x 2 mos THEN INH + rifampin x 4 mos (if INH sensitive TB)
3. Drug-resistant TB: seek expert advice for regimen
4. Converters (people who tested neg previously but now test pos): INH for 6-12 mos
5. kids and immunocompromised who have been exposed should be treated until skin test is neg 12 weeks after exposure
Pts with HIV require tx for at least 1 year |
|
|
Term
| PPD screening results via reaction size |
|
Definition
>/= 5 mm induration: confirm in HIV pos, recent contact of active TB, evidence of TB on CXR, immunosuppressed on steroids
>/= 10 mm induration: recent immigrants from countries with high rates of TB, HIV neg IV drug users, mycobacteriology lab personnel, residents/employees of high risk congregate settings (healthcare workers), DM, silicosis, chronic renal failure, <4 y/o, kids exposed to adults at high risk
>/=15 mm induration: persons with no risk factors |
|
|
Term
|
Definition
INH: hepatitis, peripheral neuropathy (co-administer B12 [pyridoxine])
Rifampin: hepatitis, flu, orange body fluids
Ethambutol: optic neuritis (red-green vision loss) |
|
|
Term
| The ___ vaccine can be administered to TB-neg pts with high risk - prolonged exposure to untreated or ineffectively treated pts (mission trips) |
|
Definition
| Bacille Calmette-Guerin (BCG) vaccine |
|
|
Term
Acute bronchitis:
1. 90% caused by?
2. organisms in pt with chronic lung disease
3. workup?
4. tx? |
|
Definition
1. 90% caused by: viruses (RSV, rhinovirus, coronavirus)
2. organisms in pt with chronic lung disease: h. flu, strep pneumo, m. catarrhalis
3. workup: usually none unless to differentiate from pneumonia. CXR neg in bronchitis
4. tx: supportive
- abx for: elderly, underlying cardiopulmonary dz, cough >7-10 days, immunocompromised |
|
|
Term
Acute bronchiolitis:
1. definition
2. organisms
3. sx
4. CXR
5. tx |
|
Definition
1. definition: inflammation of broncioles (airways <2mm). primarily in infants and young kids
2. organisms: RSV (most common), paraflu, adenovirus, rhinovirus
3. sx: rhinorrhea, sneezing, wheezing, low-grade fever
4. CXR: usually normal, may have air trapping, peribronchial thickening
5. tx: usually supportive - nebulized albuterol, IV fluids, antipyretics, chest physiotherapy, humidified O2
|
|
|
Term
AKA laryngotracheobronchitis
commonly affects kids 6 mos - 5 years
most common cause: parainfluenza 1 and 2 (also, RSV, adenovirus, flu, rhinovirus)
sx: barking/seal-like cough, inspiratory stridor, hoarseness, aphonia, low-grade fever, rhinorrhea
dx: usually clinical
PA neck xray: STEEPLE SIGN (subglottic narrowing)
tx? |
|
Definition
croup
tx: none
may need corticosteroids, humidified O2, nebulized epinephrine |
|
|
Term
leading cause of cancer death in men and women
1. AKA oat cell - more likely to spread early, rarely amenable to surgery. mets to regional lymph nodes. assume micromets at presentation. mean survival 6-18 weeks.
2. type of NSCLC - centrally located mass more likely to present with hemoptysis. dx via sputum cytology.
3. type of NSCLC - most common type. typically mets to distant organs. arises from mucus glands. usually appears in periphery of lung.
4. type of NSCLC - heterongeneous group of undifferentiated types that do not fit elsewhere. mets is early. central or peripheral. |
|
Definition
bronchogenic carcinoma
1. small cell
2. squamous cell carcinoma
3. adenocarcinoma
4. large cell carcinoma |
|
|
Term
Lung Cancer (bronchogenic carcinoma):
1. sx
2. workup
3. Tx (SC and NSC)
4. prognosis |
|
Definition
sx: cough, hemoptysis, pain, anorexia, wt loss, asthenia (weakness), adenopathy, hepatomegaly, clubbing, paraneoplastic syndromes
workup: CXR/CT
- sputum cytology for cell type
- bronchoscopy w/ bx
- PET scan
tx:
- SC: chemo
- NSC: surgery
Prognosis:
- SC: mean 6-18 weeks. Rarely live >5 years
- NSC: 35-40% survival at 5 years if surgery |
|
|
Term
| Paraneoplastic syndromes associated with small cell carcinoma |
|
Definition
Endocrine: cushing's, SIADH, acanthosis nigricans
Neuromuscular: neuropathy, myesthenia, cerebellar degeneration
Heme: anemia, DIC, eosinophilia, thrombocytosis |
|
|
Term
| Paraneoplastic syndromes associated with non-small cell carcinoma |
|
Definition
Heme: anemia, DIC, eosinophilia, thrombocytosis
Metabolic: hypercalcemia, gynecomastia, acanthosis nigricans
Thrombophlebitis
|
|
|
Term
| Lung cancer complications: SPHERE |
|
Definition
S: SVC syndrome - plethora (Excess blood causing reddish complexion), HA, AMS
P: pancoast tumor (in lung apex) - Horner's syndrome, shoulder pain, brachial plexus injury
H: Horner's syndrome - anhidrosis, ptosis, myosis
E: endocrine - carcinoid syndrome (flushing, diarrhea, telangiectasias)
R: recurrent laryngeal nerve impingement (hoarseness)
E: Effusion (exudative) |
|
|
Term
Solitary pulmonary nodules (AKA coin lesions):
1. nodule if <__, mass if greater
2. cause?
3. dx
4. workup?
5. tx |
|
Definition
Solitary pulmonary nodules (AKA coin lesions):
1. nodule if <3 cm, mass if greater
2. cause: usually infectious granuloma - TB, fungal infx, foreign body reaction. 40% malignant (rare before 30 y/o)
3. dx: usually found unexpectedly on CXR
4. findings suggestive of benign: well-circumscribed, >5 cm, calcification, central cavitation, doesn't enlarge in 2 years, no sx
5. tx: watch if low probability of malignancy - CT q 3 mos x 1 year then q6 mos x 2 years
- high chance of malignancy: resection asap
- intermediate chance: bx |
|
|
Term
AKA bronchial gland tumors
- well-differentiated neuroendocrine tumors
- usually pts <60 y/o
- low-grade malignant neoplasms - grow slowly, rarely mets
- sx: hemoptysis, cough, focal wheezing, recurrent pneumonia, bleeding, obstruction
Bronchoscopy: pink/purple central lesion, well vascularized. pedunculated or sessile.
tx? |
|
Definition
carcinoid tumor/adenoma
tx: surgical excision
NEVER chemo or radiation - tumors are resistant |
|
|
Term
Asthma:
1. Characterized by 3 components:
2. strongest predisposing factor?
3. sx
4. Workup: PFT, ABG, CXR, special tests |
|
Definition
Asthma:
1. Characterized by 3 components: airflow obstruction, bronchial hyperreactivity, inflammation of airway
2. strongest predisposing factor: atopy
3. sx: intermittent cough, chest tightness, breathlessness, wheeze (wheeze less common in kids) with asymptomatic periods between attacks
4. Workup:
- PFT: FEV1/FVC <75% - indicates obstruction, increase in FEV1 >10% after bronchodilator therapy
- ABG: usually normal and not necessary but may reveal hypoxemia and hypercapnia in severe cases - PaO2 <60mmhg, PaCO2 >40 mmHg
- CXR: +/- hyperinflation
- special tests: Histamine or methacholine challege test (bronchial provocation test) when spirometry is nondiagnostic - decrease in FEV1 >20% |
|
|
Term
| Classification of chronic stable asthma severity based on sx, nighttime sx, use of rescue meds, and PFT |
|
Definition
Intermittent asthma:
1. sx <2 days/week, no interference with daily activities
2. Nighttime sx: <2x/mon
3. Use of rescue: <2 days/week
4. PFT: FEV1 >80%, FEV1/FVC normal
Mild persistent:
1. sx >2 days/week, minor interference with daily activities
2. Nighttime sx: 3-4x/mon
3. Use of rescue: >2 days/week, not daily, not more than once a day
4. PFT: FEV1 >80%, FEV1/FVC normal
Moderate persistent:
1. sx daily, some interference with daily activities
2. Nighttime sx: >1x/week
3. Use of rescue: daily
4. PFT: FEV1 60-80%, FEV1/FVC reduced by 5%
Severe persistent:
1. sx continual, severe interference with daily activities
2. Nighttime sx: often daily
3. Use of rescue: several times a day
4. PFT: FEV1 <60%, FEV1/FVC reduced >5% |
|
|
Term
| 6 Step asthma treatment algorithm |
|
Definition
Step 1 (intermittent asthma): SABA
Step 2: low dose ICS + SABA
Step 3: (Low dose ICS + LABA + SABA) OR (med dose ICS + SABA)
Step 4: Med dose ICS + LABA + SABA
Step 5: High dose ICS + LABA + SABA + consider omalizumab for pts with allergies
Step 6: High dose ICS + LABA + SABA + Oral corticosteroid and consider omalizumab
Consider allergen immunotherapy for pts step 2-4 with allergies
Ideally, all pts should do daily peak flow monitoring |
|
|
Term
abnormal, permanent dilation of the bronchi and destruction of bronchial walls
causes:
- congenital (CF - most common cause)
- acquired (TB, fungal infection, abscess)
- obstruction (tumor)
sx: chronic purulent sputum, often foul-smelling, hemoptysis, chronic cough, recurrent pneumonia
PE: crackles, clubbing
CT (imaging of choice): dilated, turtuous airways
CXR (only abn in symptomatic pts): crowded bronchial markings, basal cystic spaces, tram-track markings, honeycombing, atelectasis
tx? |
|
Definition
bronchiectasis
tx: bronchodilators, chest phsyio, abx if productive cough (amoxicilin, augmentin, bactrin, TCN), surgery if disabling sx (little long term benefit) |
|
|
Term
COPD:
1. ___: condition in which air spaces are enlarged as a consequence of destruction of alveolar septae
2. ___: disease characterized by chronic productive cough (phlegm) occuring most days for 3 mos of the year for 2 consecutive years without an acute cause
3. most common cause
4. other causes
5. sx
6. PE
7. CXR
8. PFT |
|
Definition
1. emphysema: condition in which air spaces are enlarged as a consequence of destruction of alveolar septae
2. chronic bronchitis: disease characterized by chronic productive cough (phlegm) occuring most days for 3 mos of the year for 2 consecutive years without an acute cause
3. most common cause: smoking
4. other causes: pollutants, recurrent URI, eosinophilia, bronchial hyperresponsiveness, a1-antitrypsin deficiency
5. sx: progressive SOB, excessive cough, sputum production
- emphysema-predominant: weight loss, chronic dry cough
- advanced dz: asthenia, dyspnea, pursed lips, grunting expirations
6. PE: increased AP diameter of chest, increased resonance, decreased breath sounds, crackles, wheezing, prolonged expiration, rhonchi, raspy breathing
7. CXR: hyperinflation, flat diaphragms,
- Emphysema: parenchymal bullae or subpleural blebs (pathognomonic)
- CB: peribronchial or perivascular markings
8. PFT: decresed FEV1/FVC, airflow obstruction on forced expiratory spirometry |
|
|
Term
| Sx and CXR for emphysema-predominant vs. bronchitis-predominant COPD |
|
Definition
Emphysema-predominant (Pink Puffers):
Sx: exertional dyspnea, quiet lungs, no peripheral edema, thin, barrel chest, hyperventilation
CXR: decreased lung markings at apices, flattened diaphragms, hyperinflation, small/thin heart, parenchymal bullae and blebs
Bronchitis-predominant (Blue Bloaters):
Sx: mild dyspnea, chronic productive cough, noisy lungs, peripheral edema, overweight, cyanotic, pursed-lip breathing
CXR: Increased interstitial markings at bases, diaphragms not flattened |
|
|
Term
COPD treatment:
1. single most important intervention
2. Inhalors
3. only intervention to improve course of COPD
4. Encourage ___
5. Yearly __ and __ vaccines |
|
Definition
1. single most important intervention: smoking cessation
2. Inhalors: anticholinergic (ipratroprium or tiotropium) better than B-adrenergic for long term
- SABA should be available for acute exac.
3. only intervention to improve course of COPD: supplemental O2
4. Encourage graded aerobic exercise
5. Yearly flu and pneumococcal vaccines |
|
|
Term
CF:
1. genetic inheritance
2. characterized by ?
3. increased risk for ___, ___, ___
4. median survival
5. Suspect in any young pt with hx of ___, ___, ___
6. sx
7. workup: ABG, PFT, CXR, special test
8. tx |
|
Definition
1. genetic inheritance: autosomal recessive
2. characterized by abnormal mucus production
3. increased risk for GI malignancy, osteopenia, arthropathies
4. median survival: 31 y/o
5. Suspect in any young pt with hx of chronic lung dz, pancreatitis, infertility
6. sx: cough, excess sputum, decreased exercise tolerance, sinus pain, purulent nasal discharge, steatorrhea, diarrhea, abd pain
7. workup:
- ABG: hypoxemia, compensated resp acidosis
- PFT: mixed obstructive/restrictive
- CXR: hyperinflation, peribronchial cuffing, mucus plugging, bronchiectasis, increased interstitial markings, small, round, peripheral opacities, focal atelectasis, pneumothorax
- special test: quantitative chloride sweat test >60 mEq/L on two different days
8. tx: comprehensive to clear airway secretions, reverse bronchoconstriction, tx resp infx, replace pancreatic enzymes, nutrition |
|
|
Term
Pleural effusions:
1. result from ___
2. 25% due to ___
3. type of effusion due to "leaky capillaries" - usually due to malignancy, trauma, infx
4. type with intact capillaries due to increased hydrostatic or decreased oncotic pressure - CHF, atelectasis, cirrhosis, renal dz
5. effusion of pus due to infection in pleural space
6. bleeding into pleural space due to trauma or malignancy
7. sx
8. PE
9. workup
10. tx |
|
Definition
1. result from inflammation of structures adjacent to pleural space or within chest cavity
2. 25% due to malignancy
3. type of effusion due to "leaky capillaries" - usually due to malignancy, trauma, infx: exudate
4. type with intact capillaries due to increased hydrostatic or decreased oncotic pressure - CHF, atelectasis, cirrhosis, renal dz: transudate
5. effusion of pus due to infection in pleural space: empyema
6. bleeding into pleural space due to trauma or malignancy; Hemothorax
7. sx: none if small. dyspnea, orthopnea,
8. PE: dullness, reduced breath sounds, possible mediastinal shift
9. workup:
- lateral decubitus CXR best for seeing small effusion
- thoracentesis is gold standard - send this fluid for workup
10. tx: thoracensis for removal of fluid
- transudates resolve with resolution of underlying dz
- malignant effusions may require pleurodesis
- empyema needs drainage then abx |
|
|
Term
| Light's criteria for determining transudate vs. exudate. Fluid is considered to be EXUDATE if it meets any one criteria: |
|
Definition
1. pleural fluid protein to serum protein ratio >0.5
2. pleural fluid LDH to serum LDH ratio >0.6
3. pleural fluid LDH >2/3 upper limit of normal for serum LDH |
|
|
Term
PTX:
1. tall thin males btwn 10-30 y/o are at most risk for ___
2. ___ is secondary to sucking chest wound or pulmonary lac that allows air to enter pleural space but not leave
3. Chest percussion?
4. Tx |
|
Definition
1. tall thin males btwn 10-30 y/o are at most risk for primary (spontaneous) PTX
2. tension is secondary to sucking chest wound or pulmonary lac that allows air to enter pleural space but not leave
3. Chest percussion: hyperresonance, decreased fremitus, decrased breath sounds
4. Tx:
- small: none
- large, symptomatic: chest tube
- tension: needle decompression followed by chest tube
- serial CXR q24 hr until resolved |
|
|
Term
Pulmonary embolism:
1. Causes
2. Risk factors
3. Sx
4. initial test of choice and definitive test
5. Wokrup: ABG, EKG, CXR, ventilation-perfusion scan, pulmonary angiography, Spiral CT
6. tx |
|
Definition
1. Causes: thrombi in venous circulation or right side of heart - tumors, DVT, air from central lines, amniotic fluid from labor, fat from long bone fx
2. Risk factors
- VIRCHOW'S TRIAD: hypercoagulable state, venous stasis, vascular inflammation or injury
- 50-60% of pts with DVT will have PE
3. Sx: pleuritic CP, dyspnea, apprehension, cough, hemoptysis, diaphoresis, tachycardia, tachypnea, crackles, accentuated S2, low grade fever
- Homan's sign lacks sensitivity and specificity
4. initial test of choice: spiral CT
- definitive test: pulmonary angiography - but reserved for cases in which dx is uncertain after CT
5. Wokrup:
- ABG: resp alkalosis
-EKG: tachy, NSTT changes, S1Q3T3 pattern is classic but seen in <20% (prominent S in I, Q and inverted T in III)
- CXR: non-specific
- ventilation-perfusion scan: perfusion defects with normal ventilation - NL SCAN RULES OUT SIGNIFICANT PE
-pulmonary angiography
- Spiral CT
6. tx:
- Heparin acutely
- LMWH or coumadin after acute phase for min of 3 mos
- high risk pts: vena cava filter, early ambulation, intermittent penumatic compression stockings, low dose heparin, LMWH
|
|
|
Term
when pulmonary arterial pressure rises to a level inappropriate for a given cardiac output
- self-perpetuating
- primary dxz is idiopathic, rare, and fatal
- sedondary has many causes as a result of obliteration and obstruction of pulmonary tree
- hypoxia is most important and potent stimulus of pulmonary arterial vascoconstriction. other causes are acidosis and vaso-occlusive diseases
sx: dyspnea, angina-type pain, weakness, fatigue, edema, ascites, cyanosis, syncope
PE: narrow splitting and accentuation of S2, systolic ejection click
CXR: enlarged pulmonary arteries
EKG: RVH, RAH, RV strain
Echo and catheterization provide accurate measurement of pressure
Tx? |
|
Definition
Pulmonary HTN
tx: chronic oral anticoagulation, CCBs, prostacyclin (pulmonary vasodilator)
- heart-lung transplant often needed
- treat underlying disorder if secondary pulm htn |
|
|
Term
Restrictive lung disease characterized by dry cough, exertional dyspnea, fatigue, malaise, clubbing, inspiratory crackles
CXR: progressive fibrosis over several years
CT: diffuse, patchy fibrosis w/ honeycombing
PFT: decreased lung Volume with normal to incresaed FEv1/FVC ratio (restrictive dz)
tx? |
|
Definition
idiopathic fibrosing interstitial pneumonia (AKA idiopathic pulmonary fibrosis)
Tx: none |
|
|
Term
Pneumoconioses:
1. definition?
2. sx
3. pft
4. tx |
|
Definition
definition: chronic fibrotic lung diseases caused by the inhalation of coal dust or various inert, inorganic, or silicate dusts
sx: often none, dyspnea, inspiratory crackles, clubbing, cyanosis
pft: restrictive lung disease (decreased TLC, normal or increased FEV1/FVC)
tx: supportive - O2, vaccinations, rehab, smoking cessation, +/- steroids |
|
|
Term
Which pneumoconiosis?
1. occupation: insulation, demolition, construction
CXR: linear opacities at bases, pleural plaques
Complications: increased risk of lung cacner and mesothelioma, ESPECIALLY IF SMOKER
2. occupation: coal mining
CXR: nodular opacities in upper fields
complications: progressive massive fibrosis
3. occupation: mining, sand blasting, quarry, stone work
CXR: nodular opacities at upper fields
complications: incrased risk of TB, progressive massive fibrosis
4. Occupation: high tech fields - aerospace, nuclear power, ceramics, foundries, tool and die manufacturing
CXR: diffuse infiltrates, hilar adenopathy
Complications: requires chronic steroids |
|
Definition
1. ASBESTOSIS
occupation: insulation, demolition, construction
CXR: linear opacities at bases, pleural plaques
Complications: increased risk of lung cacner and mesothelioma, ESPECIALLY IF SMOKER - asbestosis and cigarette smoke are synergistic to cause lung cancer
2. COAL WORKER'S PNEUMOCONIOSIS
occupation: coal mining
CXR: nodular opacities in upper fields
complications: progressive massive fibrosis
3. SILICOSIS
occupation: mining, sand blasting, quarry, stone work
CXR: nodular opacities at upper fields
complications: incrased risk of TB, progressive massive fibrosis
4. BERRYLIOSIS
Occupation: high tech fields - aerospace, nuclear power, ceramics, foundries, tool and die manufacturing
CXR: diffuse infiltrates, hilar adenopathy
Complications: requires chronic steroids |
|
|
Term
multiorgan disease of idiopathc cause characterized by non-caseating granulomatous inflammation in affected organs (lungs, lymph, eyes, skin, liver, spleen, salivary glands, heart, CNS)
highest incidence: north american blacks, northern european whites
sx: cough, dyspnea, chest discomfort, malaise, fever, erythema nodosum, enlargement of parotids, liver, spleen, lymph nodes
CBC: leukopenia, eosinophilia, high esr, hypercalcemia, hypercalciuria
- Elevated ACE level
- CXR: symmetric bilateral hilar and paratracheal adenopathy with diffuse reticular infiltrates
- Transbronchial bx: non-caseating granulomas
tx? |
|
Definition
Sarcoidosis
tx: corticosteroids at modest maintenance dose |
|
|
Term
Acute (adult) respiratory distress syndrome:
1. 3 clinical settings account for 75% of cases
2. underlying abnormality
3. sx
4. CXr
5. tx |
|
Definition
1. 3 clinical settings account for 75% of cases: sepsis, multiple trauma, aspiration of gastric contents
2. underlying abnormality: increased permeability of alveolar capillary membrnes leads to protein-rich pulmonary edema
3. sx: rapid onset profound dyspnea, tachypnea, frothy pink/red sputum, diffuse crackles, cynosis, refractory hypoxemia
4. CXR: normal at first hen infiltrates at periphery (spares costophrenic angles), air bronchograms
5. tx: treat underlying condition
- supportive: O2 via intubation with low levels of positive end-expiratory pressure (PEEP)
- high mortality rate |
|
|
Term
| treatments of choice for foreign body aspiration |
|
Definition
1. Heimlich for acute
2. bronchoscopy otherwise |
|
|
Term
most common cause of respiratory disease in pre-term infant
- caused by surfactant deficiency
- sx: resp distress
CXR: air bronchograms, diffuse atelectasis, ground-glass appearaance, domed diaphragms
tx? |
|
Definition
hyaline membrane disease
tx: ventilation
- administer exogenous surfactant |
|
|
Term
Anemias (general):
1. Definition: conditions involving ___ or ___ levels below normal
2. 4 general causes
3. sx
4. Labs |
|
Definition
1. Definition: conditions involving hemoglobin or PRBC levels below normal
2. 4 general causes: increased rbc destruction, decrased rbc production, bleeding, systemic disease
3. sx: fatigue, HA, exertional dyspnea
- acute anemia: tachycardia, orthostatic hypotension, faintness, pale/cold extremities, pallor, cheilosis, jaundice, beefy red tongue, koilonychia (spooned nails)
- chronic: hyperkinetic ciruculation (large pulse volume, tachycardia)
4. retic count tells you increased destruction or decreased production:
- high retic count = increased destruction
- low retic count = decreased production |
|
|
Term
Hgb, Hct, and RBC values for normal adult males and females
Normal MCH, MCV, MCHC, RDW, Retic count (corrected) for all normal adults |
|
Definition
Males:
Hgb: 13.6-17.5 g/dL
Hct: 39-49%
RBC: 4.6-6.3 million/mL
Females:
Hgb: 12.0-15.5 g/dL
Hct: 35-45%
RBC: 4.2-5.4 million/mL
MCH: 26-34 pg
MCHC: 31-36 g/dL
MCV: 80-100 fL
RDW: 11.5-14.5%
Retic count (corrected): 0.5-2.5% |
|
|
Term
|
Definition
Low iron:
1. iron deficiency
2. Post-hemorrhagic
Normal iron:
1. anemia of chronic disease
2. thalassemia
3. sideroblastic
4. hemoglobinopathies |
|
|
Term
|
Definition
increased retic count:
1. hemorrhagic
2. hemolysis
normal retic count, megaloblastic:
1. B12 deficiency
2. Folate deficiency
normal retic count, non-megaloblastic:
1. hypoplastic marrow |
|
|
Term
|
Definition
increased retic count:
1. prior hemolysis
2. prior hemorrhage
normal retic count, normal bone marrow:
1. hypothyroid
2. liver disease
3. anemia of chronic disease
normal retic count, abnormal bone marrow:
1. myeloma
2. mets
3. myelofibrosis
4. Leukemia
5. Renal failure |
|
|
Term
Iron Deficiency Anemia:
1. Result from inadequate supply of iron for synthesis of ___.
2. In adults, ____ is almost universally the cause
3. other causes
4. Never assume iron def anemia is due to ___
5. sx
6. labs
7. tx |
|
Definition
1. Result from inadequate supply of iron for synthesis of hemoglobin.
2. In adults, GI bleed is almost universally the cause
3. other causes: NSAIDs, Asiprin, low dietary iron (kids and pregnancy), decreased iron absorption, increased iron requirements, hemoglobinuria, blood donation, iron sequestration, trauama, intravascular hemolysis
4. Never assume iron def anemia is due to menstruation in women
5. sx: pallor, easy fatigue, irritability, anorexia, tachy, tachypnea on exertion, poor weight gain in infants, brittle nails, cheilosis, smooth tongue, esophageal webs (plummer-vinson syndrome)
- PICA is hallmark
6. labs: low Hct and hgb
- smear: hypochromic microcytes, anisocytosis (cells of unequal size), poikilocytosis (abnormal shapes)
- plasma ferritin <30 ug/L
- Serum iron <30 ug/L
- transferritin saturation <15%
- TIBC increased
- elevated platelets in severe anemia
7. tx:
- Ferrous sulfate 325 mg TID - best on empty stomach, better with OJ x 6 mos and again during pregnancy/lactation
- parenteral iron for intolerant pts
- ID source of blood loss |
|
|
Term
alpha thalassemia:
1. definition: ___cytic hereditary anemia in which synthesis of alpha-globin chains is reduced resulting in defecting hemoglobinization of RBCs
2. cause
3. population
4. most prominent feature of all thalassemias |
|
Definition
1. definition: microcytic hereditary anemia in which synthesis of alpha-globin chains is reduced resulting in defecting hemoglobinization of RBCs
2. cause: gene deletion
3. population: SE asian/chinese
4. most prominent feature of all thalassemias: microcytosis out of proportion to degree of anemia |
|
|
Term
Types of alpha thalassemia and sx, tx, and labs of each
1. 4 copies of a-globin chain
2. 3 copies of a-globin chain
3. 2 copies
4. 1 copy
5. 0 copies |
|
Definition
1. 4 copies of a-globin chain: normal
2. 3 copies of a-globin chain: silent carrier, no sx
3. 2 copies: trait/minor - mild microcytic anemia, no tx
- Hct 28-40% (slightly low)
- normal hgb on electrophoresis
- smear: acanthocytes, target cells
- retic count: normal
4. 1 copy: major (hemoglobin H disease) - chronic hemolytic anemia with periods of hemolytic exacerbations caused by illness and stress
- Tx:routine transfusion, folate, may need splenectomy or allogeneic bone marrow transplant, avoid iron supplements (risk of iron overload) and oxidative drugs
- Hct: 22-32% (very low)
- Hgb H on electrophoresis
- Hgb 3-6 g/dL
- smear: target cells, poikilocytes
- Increased retic count
5. 0 copies: still born (hydrops fetalis) |
|
|
Term
| Oxidative drugs that should be avoided in people with Hemoglobin H disease (a-Thalassemia major) |
|
Definition
| dapsone, primaquine, quinidine, sulfonamides, nitrofurantoin |
|
|
Term
Beta Thalassemia:
1. cause
2. population
3. Pathophys |
|
Definition
1. cause: point mutation
2. population: mediterranean
3. Pathophys: begins at 4-6 mos when the body switches from Hgb F to Hgb A |
|
|
Term
| B-thalassemia minor, intermedia, and major - pathophys, sx, labs, tx, alleles |
|
Definition
Minor:
- Only one B globin allele has mutation.
- Sx: microcytic anemia
- MCV: <80 fL
- Hct: 28-40% (slightly low)
- Electrophoresis: Hgb A2 and Hgb F
- Smear: target cells, basophilic stippling
- retic count: normal or increased
- alleles: B+/B or B0/B
Intermedia:
- may need transfusions in times of stress, illness, pregnancy
- alleles: B+/B+ or B0/B
Major (Cooley anemia):
- Pathophys: both alleles have mutations
- sx: severe microcytic anemia, splenomegaly, bony deformities, death by cardiac failure
- tx: blood transfusions, splenectomy, bone marrow transplant
- alleles: B+/B+ or B0/B+
or B0/B0
- Hct: 10%
- Electrophoresis: Hgb A2 and F
- Smear: target cells, poikilocytes, basophilic stippling, nucleated RBCs
- Retic count: increased |
|
|
Term
acquired disorders with reduced hemoglobin synthesis causing iron accumulation, especially in mitochondria
Prussian blue staining shows ?
causes: myelodysplasia, chronic alcoholism, lead poisoning
Hct 20-30%
Hypochromic, microcytic
Basophilic stippling if lead poisoning
tx? |
|
Definition
sideroblastic anemia
tx: treat underlying condition
- treatiron accumulation
- may need transfusion
- NOT erythropoietin |
|
|
Term
Normocytic normochromic anemias:
1. cause
2. Upregulation of __ in response to inflammatory mediators is important cause
3. ___ is most common cause
4. sx
5.labs
6. tx |
|
Definition
1. cause: organ failure or impaired marrow function resulting from systemic disaese
2. Upregulation of hepcidin in response to inflammatory mediators is important cause
3. T cell-mediated autoimmune suppression of hematopoiesis is most common cause
4. sx: those of chronic disease
5. labs:
- normal or increased iron stores and serum ferritin
- normal or low TIBC
- low serum iron and transferritin saturation
6. Tx:
- treat underlying disease
- erythropoieitin for renal failure, cancer, inflammatory d/o |
|
|
Term
Aplastic anemia:
1. __cytic, __chromic
2. cause
3. sx
4. labs
5. tx |
|
Definition
1. normocytic, normochromic
2. cause: injury or abn expression of pluripotent hematopoietic stem cells
3. sx: weakness, fatigue, vulnerability to infx, pallor, purpura, petechiae
4. labs:
- PANCYTOPENIA
- Hypocellular bone marrow
5. tx:
- Mild: RBC and platelet transfusions
- Severe: bone marrow transplant, immunosuppression |
|
|
Term
Folic acid deficiency anemia:
1. cause
2. daily requirement
3. sx
4. labs
5. tx |
|
Definition
1. cause: poor dietary intake (alcoholism, anorexia, low fruits and veggies), defective absoprtion through GI tract, pregnancy, hemolytic anemia, consumption of folic acid antagonists (phenytoin, bactrim, sulfasalazine)
2. daily requirement: 50-100 mg/dL - usually met by diet
- increased requirements in pregnancy, hemolytic anemia, exfoliative skin dz
3. sx: glossitis, vague GI sx, NO NEURO SX
4. labs:
- pathognomonic: macro-ovaloctyes and hypersegmented PMNs
- Howell-Jolly bodies
- RBC folate <150 ng/mL
- serum B12 usually normal
5. tx:
- oral folate 1mg/day
- avoid alcohol and folic acid antagonists |
|
|
Term
Vit B12 (cobalamin) deficiency:
1. most common cause
2. other causes
3. where do you get B12?
4. absorption and storage occurs where?
5. sx
6. labs
7. tx |
|
Definition
1. most common cause: pernicious anemia
2. other causes: strict vegan diet, gastric surgery, blind loop syndrome, pancreatic insufficiency, Crohn's
3. where do you get B12: animal products
4. absorption occurs in the terminal ileum and storage in the liver
5. sx: golssitis, pale icterus, vague GI sx
- Neuro sx: stocking-glove paresthesias, loss of position/fine touch/vibratory sense, clumsiness, dementia, ataxia
6. labs:
- high MCV
- smear: anisocytosis, poikilocytosis, macro-ovalocytosis, hypersegmented PMNs
- low retic count
- high LDH and indirect bilirubin
- low B12
7. tx:
- pernicious anemia: lifelong B12 IM
- oral high dose cobalamin daily
- treat reversible causes
- Neuro sx reversible if treated within 6 mos |
|
|
Term
Anemias characterized by episodic or continuous RBC destruction.
2 classifications:
1. causes including hereditary spherocytosis and elliptocytosis, paroxysmal nocturnal hemoglobinuria, G6PD deficiency, methemoglobinemia, sickle cell
2. causes including autoimmune and lymphoproliferative diseases, drug toxicity, TTP, ITP, HUS, DIC, valvular hemolysis, metastatic adenocarcinoma, vasculitidies, infx, hypersplenism, burns
general sx?
labs? |
|
Definition
hemolytic anemias
1. intrinsic red cell defects
2. external/extracellular causes
general sx: jaundice, gallstones, pallor, sx related to decreased O2 to tissues
Labs:
Hallmark: elevated retic count in presence of falling or stable hematocrit
- smear: immature RBCs, nucleated RBCs, morphologic changes
- elevated indirect/unconjugated bilirubin
- elevated total bilirubin (4 mg/dL)
- elevated LDH |
|
|
Term
| Infection with this virus can lead to a transient aplastic (hemolytic) crisis and increased risk for infection with salmonella and pneumococcus. |
|
Definition
|
|
Term
Sickle Cell Anemia:
1. transmission
2. pathophys
3. Population
4. Sx - crises, trait
5. Labs
6. Tx
7. Life expectancy
Pts with sickle cell should avoid what environmental conditions? |
|
Definition
1. transmission: autosomal recessive
2. pathophys: hemolytic anemia caused by RBCs containing mainly Hgb S , which sickle under deoxygenated conditions
3. Population: blacks 1/400 have disease, 8% carry trait
4. Sx:
- begin in infancy when Hgb S takes over for Hgb F
- Crises: begin by adolescence - vascular occlusions produce pain, organ swelling/dysfunction/infarction lasting hours to days
- Crises induced by red cell dehydration, acidosis, hypoxemia
- Trait: difficulty concentrating urine
5. Labs
- Electrophoresis: Hgb S
- Smear: 5-50% sickled cells, target cells, nucleated RBCs, Howell-Jolly bodies
- Elevated retic count, WBC, platelets, indirect bilirubin
6. Tx:
- Crises: fluids, analgesia, O2, exchange transfusion
- Pneumococcal vaccine q10 years
- Folate supplements
7. Life expectancy: 40-50 years
Pts with sickle cell should avoid high altitudes - induce crises
|
|
|
Term
| Pts with sickle cell are at increased risk for what conditions? |
|
Definition
| Pts with sickle cell at increased risk for anything that can be caused by RBCs getting stuck in vasculature: cholelithiasis, splenomegaly, poor healing, stroke, priapism, retinopathies and therefore blindness, osteomyelitis, AVN of femoral head, infection with encapsulated organisms (S. pneumo, H. flu, N. meningitidis, GBS, Klebsiella, Salmonella) |
|
|
Term
G6PD deficiency:
1. transmission
2. Population
3. pathophys
4. sx
5. labs
6. tx |
|
Definition
1. transmission: X-linked recessive
2. Population: american black males (10-15%), Mediterranean
3. pathophys:
- This deficiency is protective against malaria
- Crises induced by oxidative stress: infection, drugs (aspirin, dapsone, primaquine, quinidine, sulfonamides, nitrofurantoin)
4. sx:
- episodic hemolysis, but otherwise healthy, no splenomegaly
- severe deficiency: chronic hemolysis
- Women carriers typically have no sx
- Favism: in some pts, episodes induced by eating beans (everyone with favism is G6PD deficient, not everyone with G6PD deficiency shows favism)
5. labs:
- During episodes: elevatted retic and indirect bilirubin
- Smear: bite cells, Heinz bodies (denatured hgb)
- Low G6PD levels
6. tx:
- supportive
- avoid oxidative drugs |
|
|
Term
Polycythemia Vera:
1. Definition: a slowly progressive bone marrow disorder characterized by ____ and ____. Unregulated expansion of RBC mass leads to ___, which leads to decreased cerebral blood flow.
2. Dx: Presence of ___ mutation
3. secondary causes
4. morbidity and mortality
5. median age at presentation, median life expectancy
6. complications
7. dx criteria
8. sx
9. labs
10. tx |
|
Definition
1. Definition: a slowly progressive bone marrow disorder characterized by increased number of RBC and increased total blood volume. Unregulated expansion of RBC mass leads to hyperviscosity, which leads to decreased cerebral blood flow.
2. Dx: Presence of JAK2 mutation
3. secondary causes: smoking, renal tumors
4. morbidity and mortality: most commonly thrombosis, also bleeding, PUD, GI bleed
5. median age at presentation: 60 y/o (60% male) median life expectancy: 11-15 years after dx
6. complications: myelofibrosis, CML, AML
7. dx criteria: splenomegaly, normal arterial O2 sat, elevated RBC mass (RBCM)
8. sx: increased bloody viscosity and volume (HA, dizziness, fullness of head and face, weakness, fatigue, tinnitus, blurred vision), burning, pain, redness of extremities, stroke, pruritis after bathing, episatxis, PUD, plethora, systolic HTN, engorged retinal veins, splenomegaly
8. labs:
- Hct >54% (males) or 51% (females)
- Elevated platelets, WBC, Alk phos, B12, B12 binding capacity
- Smear: neutrophilic leukocytosis, increased basophils, increased eosinophils, large/bizarre platelets
- low erythropoeitin
- normal RBC morphology
- hypercellular bone marrow
- absent iron stores
- Hyperuricemia
9. tx:
- Phlebotomy
- myelosuppression wiht hydroxyurea or anagrelide
- low dose aspirin for thrombosis risk |
|
|
Term
diseases characterized by unrestrained growth of leukocytes and leukocyte precursors
risk factors: fam hx; exposure to ioningzing radiation, benzene, alkylating agents |
|
Definition
|
|
Term
What leukemia?
Most common in kids 3-7 y/o (80%)
Sx related to replaement of bone marrow with neoplasia
- gingival bleeding, episatxis, menorrhagia, DIC, infection (often uncommon organisms, fungal), CN palsy, gingival hyperplasia, adenopathy, hepatosplenomegaly
Presentation: fatigue, abrupt onset fever, lethargy, HA, bone/joint pain (sternum, tibia, femur)
Labs:
- HALLMARK: pancytopenia with circulating blasts (20% of bone marrow)
- hyperuricemia, mediastinal mass on CXR
- Presence of terminal deoxynucleotidyl transferase (in 95%)
tx? Complication of tx?
prognosis? |
|
Definition
ALL
Tx:
- induction chemo
- consolidation therapy
- allogeneic bone marrow transplant
Complication of tx:
- increased uric acid levels - need diuretics and allopurinol
Prognosis:
- >50% cured with chemo
- prognosis related to WBC count at dx |
|
|
Term
which leukemia?
Primarily a disease of adulthood. Median age at dx is 60 y/o
Sx: related to replacement of bone marrow with cancer cells
- gingival bleeding, epistaxis, menorrhagia, infection
- slow onset of fatigue, anorexia, dyspnea, rashes, CN palsies, gingival hyperplasia
Labs:
- HALLMARK (all acute leukemia): pancytopenia with >20% circulating blasts
Hallmark lab finding?
tx?
Prognosis? |
|
Definition
AML
Hallmark: AUER RODS
tx: induction chemo, consolidating therapy
prognosis: >70% who are <60 y/o acheive complete remission; further chemo leads to cure in 30-40% |
|
|
Term
Which leukemia?
clonal malignancy of B lymphs
- most prevalent of all leukemias
- 2x more common in men
- Med age: 65 y/o
- Staging using RAI system
- mean survival 6 years
Sx:
- indolent course
- recurrent infx, splenomegaly, lymphadenopathy
- Richter's syndrome (5%): fever w/o infx, high LDH, rapidly enlarging nodes - turns into DLBCL (very aggressive)
Labs:
- Hallmark: isolated lymphocytosis with leukocytosis >20K
- Smudge cells are pathognomonic
- Bone marrow: hypercellular with left shift
tx? |
|
Definition
|
|
Term
What leukemia?
Presents in young to middle-aged adults (med age 55 y/o)
3 phases:
1. chronic, accelerated, acute (blast crisis - >30% blasts)
Sx: fatigue, anorexia, wt loss, low-grade fever, excessive sweating, splenomegaly
Labs:
- Hallmark: Leukocytosis with WBC >150K
- HALLMARK FINDING?
dx?
tx? |
|
Definition
CML
Hallmark: PHILADELPHIA CHROMOSOME and BCR-ABL GENE
dx: Identification of BCR-ABL gene by PCR
tx: imatinib mesylate (STI571), dasatinib, nilotinib
- allogeneic bone marrow transplant - only therapy proven to be curative |
|
|
Term
Hodgkin's disease:
1. Refers to a group of cancers characterized by enlargement of ___, ___ and ___ and presence of ____.
2. ___ appears to be an important factor, found in 40-50% of cases
3. Population
4. sx?
5. labs
6. staging
7. tx |
|
Definition
1. Refers to a group of cancers characterized by enlargement of lymphoid tissue, spleen and liver and presence of REED-STERNBERG CELLS.
2. Epstein-Barr virus appears to be an important factor, found in 40-50% of cases
3. Population: bimodal peak: 20's and >50
4. sx:
- Presentation: painless cervical, supraclavicular, or mediastinal adenopathy, possibly pain in node after ingestion of alcohol
- Stage A: no constitutional sx
- Stage B: constitutional sx - fever, night sweats, wt loss, pruritis, fatigue
5. labs: CT of neck, chest, abd, pelvis
- bx of marrow
- recovery of reed-sternberg cells confirms dx
6. staging:
ANN ARBOR System
7. tx:
- ABVD (adriamycin, bleomycin, vinblastin, dacarbazine) chemo is curative in 50%
- Radiation for IA and IIA |
|
|
Term
| Ann Arbor staging system for Hodgkin's and Non-Hodgkin's Lymphoma |
|
Definition
I: single lymph node region OR simgle extralymphatic site
II: 2 or more lymph node regions on the same side of diaphragm OR one solitary extralymphatic site and one or more lymphnode regions on same side of diaphragm
III: lymph node regions on both sides of diaphragm with spleen involvement or solitary involvement of an extra lymphatic site OR both
IV: Diffuse involvement of extralymphatic sites with or without nodal involvement
A: no constitutional sx
B: constiutitional sx |
|
|
Term
| Incidence of what types of lymphomas are higher in HIV/immunocompromised? |
|
Definition
|
|
Term
Non-Hodgkin's Lymphoma:
1. peak incidence
2. sx
3. labs
4. tx |
|
Definition
1. peak incidence: 20-40 y/o
2. sx:
- painless adenopathy
- extralymphatic sites: GI tract, skin, bone, bone marrow
- constitutional sx
3. labs:
- bx enlarged nodes
- CT of chest, abd, pelvis
- marrow bx
- LDH
4. tx:
- Single node: radiation
- low grade: rituximab +/- chemo
- aggressive low grade: allogeneic transplant
- intermediate/high grade: chemo and autologous stem cell transplant |
|
|
Term
Multiple Myeloma:
1. malignancy of ___ cells. Possibly caused by ___
2. med age at dx
3. sx
4. labs
5. tx |
|
Definition
Multiple Myeloma:
1. malignancy of plasma cells. Possibly caused by herpes virus
2. med age at dx is 65
3. sx: anemia, bone pain (low back, ribs), infx, spinal cord compression, hyperviscosity, renal failure
4. labs:
- INCREASED PARAPROTEIN LEVELS
- hypercalcemia, proteinuria, elevated ESR
- anemia with rouleaux formation (RBCs stack like coins)
- XR: PUNCHED OUT LYTIC LESIONS on axial skeleton, esp skull
- positive BENCE JONES PROTEINS
5. tx:
- lenalidomide, dexamethasone, doxorubicine, bisphosphonates |
|
|
Term
Bleeding disorders (general):
1. Petechiae are seen almost exclusively in ____
2. If bleeding is caused by platelets, the __ and __ are usually involved
3. If bleeding is caused by coagulation, the __ and ___ are usually invoolved
4. Spontaneous hemarthroses are found only in ____
5. Causes of acquired bleeding disorders
6. Initial assessment in all bleeding disorders |
|
Definition
1. Petechiae are seen almost exclusively in thrombocytopenia
2. If bleeding is caused by platelet problems, the skin and mucosa are usually involved
3. If bleeding is caused by coagulation problems, the skin and muscles are usually invoolved
4. Spontaneous hemarthroses are found only in hemophilia
5. Causes of acquired bleeding disorders: neoplasia, infection, malabsorption, shock, OB complications, drugs (NSAIDs, aspirin, abx, anticoagulants, thiazides, gold, heparin), SLE, CLL
6. initial assessment: plt count, smear, bleeding time (Pt, PTT), thrombin clotting time |
|
|
Term
Thrombocytopenia:
1. Decrease in number of ___. Most common cause of abn bleeding
2. Causes:
a. ____ is a self limited autoimmune IgG disorder found in kids and is associated ith preceeding viral URI
b. ___ may occur at any age (peak 20-50 y/o) and is more common in women, coexists with other autoimmune diseases
3. Sx - acute/chronic
4. Labs
5. Tx |
|
Definition
1. Platelets
2. causes: acute ITP, chronic ITP
3. Sx:
- acute ITP: abrupt appearance of petechiae, purpura, hemorrhagic bullae on skin and mucus membranes
- chronic ITP: petechiae on skin and mucus membranes, epstaxis, oral bleeding, menorrhagia
- usually no splenomegaly
- HIT: same sx as ITP - also induced by sulfonamides, quinine, thiazides, cimetidine, gold
4. Labs:
- acute: decreased platelets 10-20K, eosiniophilia, mild lymphocytosis
- chronic: platelets 25-75K
- smear: megathrombocytes
- normal coag studies
5. Tx:
- Acute: resolves spontaneously. may need steroids or splenectomy
- Chronic: high dose prednisone. may need IVIG, immunosuppression, splenectomy, platlet transfusion, stem cell transplant
- avoid platelet antagonists |
|
|
Term
Platelet consumption syndromes:
rare but often fatal. found in previously halthy people between 20-50. women >men. HIV pts. May be precipitated by estrogen, pregnancy, quinine, ticlopidine.
- sx: thrombocytopenia with purpura, petechiae, pallor, abd pain, microangiopathic hemolytic anemia, fever, neuro defects that wax and wane over minutes, renal failure, pancreatitis
- Labs: anemia, shistocytes (fragments of RBCs), polychromatophilia, reticulocytosis, thrombocytopenia, Coomb's negative, high LDh and indirect bilirubin, normal coag tests
Tx? |
|
Definition
TTP - thrombocytopenic purpura
Tx: emergency large volume plasmapheresis
- prednisone
- anti-platelet agents |
|
|
Term
platelet consumption syndrome:
found primarily in kids. may be precipitated by pregnancy and estrogens in adults.
- happens most commonly after infx with e. coli 0157:H7, shigella and salmonella
Sx: renal failure, purpura, petechiae, abd pain, fever, NO neuro signs
labs: anemia, shistocytes, polychromatophilia, reticulocytosis, thrombocytopenia, coom's neg, high LDH and indirect bilirubin, normal coag tests
tx? |
|
Definition
HUS
tx: conservative - fluids and electrolytes
- may need plasmapheresis in adults |
|
|
Term
platelet consumption syndrome:
causes generalized hemorrahge in pts wtih severe underlying systemic illnes like sepsis, tissue injury, OB complications, cancer, transfusion reactions
sx: skin and mucus membrane bleeding, shock, thrombosis
labs:
low fibrin
- high fibrin degredation products (high D dimer)
- thormbocytopenia
- prolonged PT
- schisocytes
tx? |
|
Definition
DIC
tx: prompt and aggressive at underlying cause
- blood component transfusions |
|
|
Term
Platelet function disorders:
1. causes
2. sx
3. labs
4. tx |
|
Definition
causes:
- congenital
- acquired: ASPIRIN AND NSAIDS MOST COMMON, drugs, uremia, alcohol, myeloproligerative disease, hypothermia, vit deficiency
sx: prolonged bleeding time, skin/mucus bleeding
labs: normal number of platelets, abn plt function study
tx: discontinue cause
- dialysis if uremia
- tranfusion may be necessary |
|
|
Term
Von Willebrand Disease:
1. transmission
2. characterized by reduced levels of ___
3. sx
4. labs
5. tx |
|
Definition
1. transmission: autosomal dominant
2. characterized by reduced levels of Fact VIII antigen or ristocetin cofactor and deficient or defective Von Willebrand factor (vWF)
3. sx: bleeding in nasal, sinus, vaginal and Gi memebranes; exacerbated by aspirin; better with estrogens and pregnancy
4. labs:
- normal PT and PTT
- prolonged bleeding time
- low vWF
5. tx
- desmopressin acetate for Type I
- Factor VIII concentrates if factor replacement is necessary |
|
|
Term
Hemophilia A:
1. other names
2. Hereditary disease characterized by ____
3. transmission
4. sx
5. labs
6. tx |
|
Definition
1. other names: factor VIII deficiency or classic hemophilia
2. Hereditary disease characterized by prolonged coagulation time
3. transmission: X-linked recessive
- many older pts are HIV pos because of infected factor VIII tansfusions
4. sx: spontaneous hemorrhages with heparthroses, epistaxis, intracranial bleeding, hematemesis, melena, microscopic hematuria, gigival bleeding, bleeding after surgery or trauma
5. labs:
- prolonged PTT
- normal PT, bleeding time, fibrinogen, plt count
- low factor VIII, normal vWF
6. tx:
- infusion of factor VIII concentrates
- Desmopressin in mild disease
- avoid aspirin, celecoxib, opioids |
|
|
Term
1. AKA fator IX deficiency or Christmas disease - a hterogeneous group of disorders similar to hemophilia A but less frequent. X-linked recessive
2. mild, autosomal recessive d/o seen in ashkenazi jews. treated with FFP |
|
Definition
1. AKA fator IX deficiency or Christmas disease - a hterogeneous group of disorders similar to hemophilia A but less frequent. X-linked recessive --> Hemophilia B
2. mild, autosomal recessive d/o seen in ashkenazi jews. treated with FFP --> Fractor XI deficiency |
|
|
Term
Most common acquired coagulopathies secondary to poor diet, liver failure, malabsorption, malnutrition, drugs (esp broad-spectrum abx)
typical presentation: postop pt not eating well and receiving broad spectrum abx that suppresses colonic bacteria and then experience soft tissue bleeding
labs:
- Prolonged PT, maybe prolonged PTT
- normal fibrinogen, thrombin, platelet count
- Elevated LFTs
- Decreased factor II, VII, IX, X
tx? |
|
Definition
Vit K-dependent factor deficiencies
tx: directed at underlying cuase
- oral/parenteral vit K to restore factor production
- FFP for hemorrhage
- increase leafy veggies |
|
|
Term
Thrombotic disorders:
1. Predisposing factors
3. acquired causes
4. congenital causes |
|
Definition
1. Predisposing factors: >40 y/o, DVT, recurrent thrombosis, fm hx, repeated thrombosis despite anticoagulation (suggests neoplasm)
3. acquired causes: SLE, malignancy (Trousseau's syndrome), prengancy, nephrotic syndrome, estrogens, immobilization, myeloproliferative disease, UC/Crohn's, Behcet's syndrome, intravascular devices, DIC, hyperlipidemia, paroxysmal nocturnal hemoglobinuria, TTP, HUS, hyperviscosity, anticardiolipin abx, HIT, antiphospholipid syndrome, heparin use
4. congenital causes: antithrombin III def, factor V Leiden, protein C def, protein S def, dysfibrogenemia, abn plaminogen, activated protein C resistence |
|
|
Term
Lupus anticoagulant
- __% of lupus pts
- risks
- tx |
|
Definition
Lupus anticoagulant
- 5-10% of lupus pts
- risks: bleeding, thrombosis, spontaneous abortion
- tx: Russell's viper venom, prednisone |
|
|
Term
| 3 factors needed to maintain adequate pressure in cardiac system |
|
Definition
functioning pump
sufficient fluid volume
resistance
all cardiac pathology comes from abnormalities of one of these 3 factors |
|
|
Term
Shock:
1. Definition: severe cardiac failure due to ___ or ____
2. Physical responses to shock are due to what 6 hormones?
4. sx
5. labs
6. tx |
|
Definition
1. Definition: severe cardiac failure due to poor blood flow or inadequate distribution of flow --> both result in inadequate O2 delivery to tissues
2. Physical responses to shock are due to what 6 hormones? catecholamines (epi, NE, dopamine), renin, ADH, glucagon, cortisol, GH
4. sx:
- hypotension, orthostasis, tachycardia, peripheral hypoperfusion (cold extremities, "thready" pulse), AMS, oliguira, anuria, insulin resistance, metabolic acidosis
5. labs: CBC, T&C, coagulation studies, electrolytes, glucose, UA, serum Cr, pulse O2, ABG
6. tx:
- ABCs
- Trendelenburg to maximize blood to brain
- O2
- IV fluids
- sustain urine at 0.5 ml/kg/hr or more
- continuous EKG
- Pressors (dopamine) |
|
|
Term
4 types of shock:
1. caused by hemorrhage, loss of plasma, loss of fluids/electrolytes resuling in decreased intravascular volume - may be obvious loss of third spacing.
2. from MI, dysrhythmias, HF, valvular defects, septal defects, HTn, myocarditis, cardiac contusion, myocardiopathies
3. tension pneumo, pericardial tamponade, obstructive valvular disease, pulmonary problems including massive PE
4. sepsis, systemic inflammatory response, anaphylaxis, neurogenic (spinal cord injury, adverse effect of epidural anesthetic) |
|
Definition
1. caused by hemorrhage, loss of plasma, loss of fluids/electrolytes resuling in decreased intravascular volume - may be obvious loss of third spacing --> HYPOVOLEMIC SHOCK
2. from MI, dysrhythmias, HF, valvular defects, septal defects, HTn, myocarditis, cardiac contusion, myocardiopathies --> CARDIOGENIC SHOCK
3. tension pneumo, pericardial tamponade, obstructive valvular disease, pulmonary problems including massive PE --> OBSTRUCTIVE SHOCK
4. sepsis, systemic inflammatory response, anaphylaxis, neurogenic (spinal cord injury, adverse effect of epidural anesthetic) --> DISTRIBUTIVE SHOCK |
|
|
Term
Postural Hypotension:
1. causes
2. criteria
3. likely cause based on PE findings |
|
Definition
1. causes: reduced CO, paroxysmal cardiac dysrhythmias, low blood volume, medications, endocrine/metabolic disorders
2. criteria: drop in systolice > 20 mmHg between supine and sitting and/or standing
3. likely cause based on PE findings:
- if accompanied by a rise in pulse >15 bpm, depleted blood volume is likely
- if no change in pulse - think meds, CNS disease (Parkinson's, Shy-Drager), or peripheral neuropathy |
|
|
Term
Primary (essential) HTN:
1. causes __% of all HTN
2. cause?
3. exacerbating factors
4. sx
5. workup |
|
Definition
Primary (essential) HTN:
1. causes 95% of all HTN
2. cause: unknown, but has genetic influence (more common in blacks), increases with age, environmental influence (obesity, excessive salt intake)
3. exacerbating factors: alcohol excess, smoking, lack of exercise, polycythemia, NSAIDs, low potassium intake
4. sx: usually none, maybe non-descript headache
5. Workup:
- EKG: LVH with strain pattern in advanced disease
- CXR: LVH
- Labs: may have evidence of other diseases such as renal failure or DM |
|
|
Term
|
Definition
OSA
estorgens
pheochromocytoma
coarctation
pseudotumor cerebri
parenchymal disease
renal artery stenosis
chronic steroid therapy
Cushing's
thyroid and parathyroid disease
primary hyperaldosteronism
pregnancy |
|
|
Term
| HTN urgency vs. HTN emergency vs. Malignant HTN |
|
Definition
Urgency:>220/>125
- BP must be reduced within hours bc there are risk factos for end-organ damage
Emergency: diastolic >130
- must be reduced within one hour to prevent progression of end organ damage or death
Malignant HTN:
- elevated BP associated with papilledema and either encephalopathy or nephropathy - if untreated, progressive renal failure occurs
|
|
|
Term
BP classification for adults 18 and older, dx criteria
Normal
PreHTN
Stage 1
Stage 2 |
|
Definition
Normal: <120/<80
PreHTN: 120-139/80-99
Stage 1: 140-159/90-99
Stage 2: >160/>100
Dx criteria for stage 1 is >140/>90 on three separate occasions
|
|
|
Term
Management of HTN:
1. Non-pharmacologic
2. Typical therapy
3. Therapy for refractory cases
4. therapy for emergencies |
|
Definition
1. Non-pharmacologic:
DASH diet: Dietary Approaches to Stop HTN - low sat fat, low cholesterol, low total fat, increased fruits and veggies, increased low fat and fat free milk products, increased fiber
- weight loss, increased exercise, smoking cessation, limited alcohol, limited sodium
2. Typical therapy:
- First line: Thiazide diuretics - consider need for K+ supplement
- Bblockers - more effective in younger pts
- ACE inhibitors - first drug of choice in pts with HTN and DM
- Others: ARBs, CCB, aliskiren (renin inhibitor)
3. Therapy for refractory cases: alpha-adrenergic antagonists, central sympatholytics, aldosterone receptor antagonists
4. therapy for emergencies:
- parenteral drugs - sodium nitroprusside, nitro, BB, nicardipine, enalaprilat, hydralazine, thrimethaphan, fenoldopam, loop diretics
- oral agents (for mild emergencies): clonidine, captopril, nifedipine
- do not lower BP too quickly |
|
|
Term
| When to use Loop diuretic |
|
Definition
In HTN pt with renal dysfunction and only when close electrolyte monitoring is available
- Need K+ supplement |
|
|
Term
Beta blockers:
- indications
- actions
- what pt population most effective for HTN |
|
Definition
Indications: HTN, angina, arrhythmias, chronic headache, CHF, tremor, glaucoma, migraine, MVP, MI, pheochromocytoma, orthostatic tachycardia syndrome, tachycardia in anxiety and hyperthyroidism, theophylline overdose, aortic dissection, HOCM, Marfan syndrome, portal HTN, hyperhidrosis, anxiety
Actions: decrease HR and CO
HTN: better in young white pts |
|
|
Term
ACE-I:
1. indications
2. MOA
3. SE
4. CI |
|
Definition
Indications: HTN, DM, CHF, renal failure, scleroderma, MI
vasodilation via prostaglandin production and inhibit bradykinin degredation
SE: cough due to bradykinin increase, hyperkalemia
CI: |
|
|
Term
What HTN drug to use in each situation:
1. first line, generally
2. young whites
3. renal failure
4. DM
5. blacks and elderly
6. prostatic hyperplasia
7. refractory HTN |
|
Definition
1. first line, generally - thiazides (HCTZ)
2. young whites - BB, ACE-I
3. renal failure - Loops
4. DM - ACE-I
5. blacks and elderly - CCB
6. prostatic hyperplasia - alpha blockers
7. refractory HTN - central sympatholytics (clonidine), aldosterone receptor antagonists (spironolactone) , arterial dilators (hydralazine) |
|
|
Term
| New York Heart Association Functional Classification for Heart Disease |
|
Definition
Class I: no limitation of activity; normal activity does not cause undue fatigue, dyspnea, angia
Class II: slight limitation; ordinary activity results in sx
Class III: Marked limitation; comfortable at rest but less than normal activity causes sx
Class IV: unable to engage in any physical activity wihtout sx; uncomfortable at rest |
|
|
Term
Congestive Heart Failure:
1. Definition: clinical sydnrome characterized by ___ and ___
2. results from changes in at least one of 4 things
3. Adversely affects ___ and ___
4. sx - left vs. right HF
5. Labs
6. Xray findings
7. EKG findings
8. Echo findings
9. Tests to assess severity
11. causes |
|
Definition
1. Definition: clinical sydnrome characterized by dyspnea and abn retention of water and sodium
2. results from changes in at least one of 4 things: heart contractility, proload, afterload, HR
3. Adversely affects CO and Left atrial pressure
4. sx - left vs. right HF
- left: exertional dyspnea, nonproductive cough, fatigue, orthopnea, pnd, basilar rales, gallops, exercise intolerance
- right: JVD, hepatic congestion (sometimes tender), nausea, dependent pitting edema
- Both: parasternal lift, enlarged apical impulse, diminished first heart sound, S3 gallop, S4 gallop, pallor, cold skin, nocturia, hypotension, narrow pulse pressure
5. Labs: anemia, renal insufficiency, hyperkalemia, hyponatremia, elevated LFTs, hypokalemia from diuretics, elevated BNP or N-terminal pro-BNP
6. Xray findings: cardiomegaly, pulmonary effusion, perivascular/interstitial edema (Kerley B lines), venous dilation, alveolar fluid
7. EKG findings: non-specific, underlying arrhythmia, conduction defects, LVH, old MI
8. Echo findings: size of chambers, valve abn, pericardial effusion, shunting, wall abn
9. Tests to assess severity: stress test, radionuclide angiography, cardiac cath
11. causes: myocardial and pericardial disorders, valvular disorders, congenital anomalies
- high output filaure: non-cardiac causes (thyrotoxicosis, anemia) |
|
|
Term
CHF treatment
1. non-pharm
2. initial
3. to treat associated angina or HTN
4. other measures |
|
Definition
First, treat reversible causes
1. non-pharm: progressive aerobic exercise, low-sodium diet, stress reduction
2. initial: thiazide or loop + ACE
- others: K-sparing diuretics, ARBs, BB, direct inotropes (Dig), arterial and venous vasodilators
3. to treat associated angina or HTN: CCB - amlodipine
4. other measures: anticoagulation, antiarrhythmics, implantable cardiac defibrillators, biventricular pacers, coronary revascularization, cardiac transplant |
|
|
Term
Atherosclerotic Disease:
1. Atherosclerosis is characterized by what 4 processes in the intima of large and medium vessels?
2. Risk factors
3. Important biomarker
4. Complications/outcomes
5. Tx |
|
Definition
1. Atherosclerosis is characterized by what 4 processes in the intima of large and medium vessels: lipid deposition, fibrosis, calcification, plaque formation
2. Risk factors: smoking, cholesterol >200 mg/dL, diet, obesity, sedentary lifestyle, homocystinuria, familial dyslipidemias
3. Important biomarker: CRP
4. Complications/outcomes: depend on vessels involved - cognitive disorders, kidney failure, MI, stroke
5. Tx: smoking cessation, exercise, dietary modifications, treat dyslipidemias |
|
|
Term
Ischemic heart disease (angina):
1. Definition?
2. general causes
3. risk factors
4. sx
5. ___: a clenched fist over the sternum and clenched teeth when describing CP
7. Wokrup: EKG changes, most useful and cost-effective test?, other tests, definitive dx procedure?
8. treatment |
|
Definition
1. Definition: insufficient O2 supply to cardiac muscle
2. general causes: atherosclerotic narrowing, constriction of coronary arteries, congenital anomalies, emboli, arteritis, dissection
3. risk factors: male, age, low-estrogen, smoking, fm hx, HTN, DM, abdominal obesity, inactivity, dyslipidemias, alcohol, low intake of fruits and veggies, metabolic syndrome
4. sx: paroxysmal squeezing/burning CP, sensation of smothering, fear of death, midsternal - radiates to jaw, shoulders, arms, wrists, back of neck
- lasts <3 min, relieved by nitro and rest, exacerbated by physical activity
5. Levine's Sign: a clenched fist over the sternum and clenched teeth when describing CP
7. Wokrup:
- EKG changes: horizontal or down-sloping ST depression during attack, flattened or inverted T waves (EKG normal in 25%)
- most useful and cost-effective test: exercise stress test (pos if 1mm or 0.1 mV ST depression)
- other tests: echo, myocardial perfusion scintigraphy, radionuclide angiography, stresh echo, PET, SPECT, CT, MRI, EBCT, ambulatory EKG
- definitive dx procedure: coronary angiography
8. treatment:
- preventative/rehabilitative: exercise, weight loss, low fat and cholesterol diet, smoking cessation, DM/HTN/hyperlipidemia control
- Acute: nitro
- Long term: long acting nitrates, BB, Ranolazine, CCB (3rd line), platlet-inhibitors (aspirin, clopidegrel), revascularization |
|
|
Term
| Metabolic Syndrome criteria |
|
Definition
Includes 3 or more:
** abdominal obesity (40 in or more for men, 35 in for women)
trigs >150 mg/dL
HDL <40 (men) or <50 (women)
** fasting glucose >110 mg/dL (insulin resistance)
HTN
** - most important |
|
|
Term
| Stable angina vs. Unstable angina vs. Prinzmetal's angina |
|
Definition
Stable: lasts <3 min, relieved by nitro/rest
Unstable angina/MI: lasts >30 min, unrelieved by nitro/rest, occurs at rest or with little exertion, increasing pattern of pain from usual angina
Prinzmetal's/variant angina: caused by vasospasm at rest with preservation of exercise capacity |
|
|
Term
| Cautions and side effects for long-acting nitrates |
|
Definition
include 8-10 hr treatment-free interval to prevent tolerance
SE: HA, nausea, light-headedness, hypotension |
|
|
Term
Acute Coronary Syndrome:
1. a spectrum of problems ranging from unstable angina to MI, but classified as ___ or ___ events.
2. determination of MI is based on ___
3. Causes of MI
4. most common cause of death due to MI
5. pt groups likely to present with atypical MI sx
6. sx
7. PE findings
8. most sensitive imaging modality to quantify extent of infarct |
|
Definition
1. a spectrum of problems ranging from unstable angina to MI, but classified as ST elevated or non-ST elevated events.
2. determination of MI is based on cardiac markers
3. Causes of MI: prolonged myocardial ischemia - usually thrombus formation from atherosclerotic plaque. Could be vasospasm, reduced blood flow, increased metabolic demand, embolic occlusion, vasculitis, aortitis, coronary artery dissection, cocaine
4. most common cause of death due to MI: Vfib
5. pt groups likely to present with atypical MI sx: elderly, women, DM
6. sx: increasingly severe CP >30 min, diaphroesis, weakness, anxiety, restlessness, light-headedness, syncope, cough, dyspnea, orthopnea, nausea, vomiting, abd bloating --> most commonly happen in early morning
7. PE findings: brady or tachycardic, hyper or hypotensive, low grade fever
- Lungs: clear, rales, or wheezing
- Cardio: normal, JVD, soft heart sounds, MR murmur, S4 gallop, pericardial rub after 24 hrs
8. MRI with gadolinium
|
|
|
Term
| post-MI syndrome including pericarditis, fever, leukocytosis, pericardial or pleural effusion lasting 1-2 weeks |
|
Definition
|
|
Term
| EKG progression during MI |
|
Definition
| : Peaked T waves --> ST elevation --> Q waves --> T wave inversions |
|
|
Term
| Location of MI by EKG lead: inferior, anterior, posterior/anteroseptal, anterolateral |
|
Definition
Inferior: II, III, aVF
Anterior: V1, V2, V3 (Class: V1-V6, aVL)
Posterior/anteroseptal: V1, V2
Anterolateral: V4-V6 |
|
|
Term
Cardiac markers in acute MI:
1. elevates in 1-4 hrs, peaks at 6-7 hrs, returns to NL in 24 hrs
2. elevates in 3-5 hours, peaks at 24 hrs, NL at 28-72 hrs (usually not drawn due to false positives)
3. elevates in 3-12 hours, peaks at 24 hours, NL at 48-72 hours
4. elevates in 3-12 hours, peaks at 24 hrs, NL at 5-10 days
5. elevates in 3-12 hours, peaks at 12-48 hrs, NL at 5-14 days
6. elevates in 10 hrs, peaks at 24-48 hrs, NL at 10-14 days |
|
Definition
1. elevates in 1-4 hrs, peaks at 6-7 hrs, returns to NL in 24 hrs --> Myoglobin
2. elevates in 3-5 hours, peaks at 24 hrs, NL at 28-72 hrs (usually not drawn due to false positives) --> Total CK
3. elevates in 3-12 hours, peaks at 24 hours, NL at 48-72 hours --> CK-MB
4. elevates in 3-12 hours, peaks at 24 hrs, NL at 5-10 days --> Troponin I
5. elevates in 3-12 hours, peaks at 12-48 hrs, NL at 5-14 days --> Troponin T
6. elevates in 10 hrs, peaks at 24-48 hrs, NL at 10-14 days --> LDH |
|
|
Term
| Acute coronary syndrome Treatment |
|
Definition
All pts: IV fluids, O2, nitro, pain mgmt, may need benzos for sedation, BB, risk stratification, CCB if can't tolerate nitro or BB
No ST elevation: antiplatelet (aspirin, clopidogrel) and anticoagulation (Lovenox, enoxaparin, fondoparinux, bivalirudin)
ST elevation: Aspirin and Clopidogrel, coronary angiography with PCI within 90 min
- thrombolytics w/in 3 hrs if cant do PCI (alteplase, reteplase, tenecteplase)
- statin in days following MI |
|
|
Term
| CI to thrombolytics in MI |
|
Definition
Absolute: previous hemorrhagic stroke, any stroke w/in last year, knkown intracranial neoplasm, active internal bleeding, suspected aortic dissection
Relative: known bleeding diasthesis, trauma w/in past 2-4 weeks, major surgery in last 3 weeks, prolonged or traumatic resuscitation, recent internal bleed, noncompressible vascular punction, active diabetic retinopathy, pregnancy, active PUD, current use of anticoagulants, BP >180/110 |
|
|
Term
| risk stratification systems for acute coronary syndromes: TIMI and GRACE |
|
Definition
TIMI: thrombolysis in MI - one point for each:
>65 y/o, 3 or more risk factors for coronary disease, use of aspirin in last 7 days, known CAD with stenosis 50% or more, more than one episode of rest angina in last 24 hrs, ST deviation, elevated cardiac markers
- score of 3 or more is high risk
GRACE: global registry of acute coronary events: more complex, usually not done |
|
|
Term
| Cyanotic Congenital Heart Anomalies all have __ to __ shunts |
|
Definition
| right to left - blood does not get pumped through lungs to become oxygenated |
|
|
Term
Congenital heart defect:
Cyanotic
Murmur: crescendo-decrescendo holosystolic at LSB radiating to back
PE findings: cyanosis, clubbing, increased RV impulse at LLSB, loud S2
important facts: polycythemia usually present, others? |
|
Definition
Tetralogy of fallot
Tet spells: extreme cyanosis, hyperpnea, agitation - medical emergency
4 defects: overriding aorta, large VSD, RVH, right ventricular outflow obstruction |
|
|
Term
Cyanotic
Murmur depends if tricuspid regurg
PE findings: cyanosis w/ tachypnea at birth, no dyspnea, hyperdynamic apical impulse, single S1 and S2
important facts: sudden onset severe cyanosis and acidosis, ASD and PDA are present |
|
Definition
| pulmonary atresia - pulmonary valve is closed |
|
|
Term
Cyanotic congenital heart defect
Murmur: variable
PE findings: shock, early HF, resp distress, single S2
important facts: occurs more frequently in males. accounts for 25% of deaths before 7 days |
|
Definition
| hypoplastic L heart syndrome |
|
|
Term
Cyanotic congenital heart defect
Murmur: systolic
PE findings: cyanosis in newborn, tachypnea w/o resp distress, CHF, poor feeding, loud S2, absent LE pulses |
|
Definition
| transposition of great vessels |
|
|
Term
Non-Cyanotic congenital heart defect
Murmur: rumbling SEM at 2nd left ICS
PE findings: failure to thrive, fatigue, RV heave, wide split S2
Most common type: ostium secondum |
|
Definition
|
|
Term
Non-Cyanotic congenital heart defect
Murmur: SEM at LLSB
PE findings: asymptomatic to CHF
important facts: more common in Japanese and Chinese |
|
Definition
|
|
Term
Non-Cyanotic congenital heart defect
Murmur: continuous "machinery"
PE findings: wide pulse pressure, hyperdynamic apical pulse
tx? |
|
Definition
PDA
tx: prostaglandin inhibitors - Indomethacin (NSAID) |
|
|
Term
Non-Cyanotic congenital heart defect
Murmur: systolic, LUSB and left interscapular area or continuous
PE findings: CHF in infants, older kids have systolic HTN
important facts: difference btwn arterial pulses or btwn upper and lower extremity BPs |
|
Definition
|
|
Term
Cyanotic or non-cyanotic congenital heart defect
Murmur: depends
PE findings: cyanosis, CHF, or asymptomatic
important facts: represents a constellation of defects. present in 15-20% of Down's pts |
|
Definition
|
|
Term
Valvular disorder:
impedes ejection to left side of heart
Midsystolic harsh loud murmur often with thrill at R 2nd ICS and radiates to neck and L sternal border best heard with patient sitting and leaning fwd |
|
Definition
|
|
Term
Valvular disorder:
results in volume overload of L ventricle
High pitched, blowing Soft systolic and diastolic decrescenedo grade 1-3 at L 2-4th ICS that radiates to apex and RSB. Heard best with pt sitting and leaning forward at full exhalation.
May be associated with "Austin Flint" murmur |
|
Definition
|
|
Term
Valvular disorder:
impedes bloow flow btwn L atrium and ventricle
Low pitch grad 1-4 middiastolic murmur heard best at apex in left lateral decubitus position at full exhalation. May hear opening snap following S2 |
|
Definition
|
|
Term
Valvular disorder:
May be caused by MVP.
variable intensity medium to high pitched blowing pansystolic murmur heard best at apex and radiates to left axilla |
|
Definition
|
|
Term
Valvular disorder:
Variable intensity medium pitch blowing pansystolic murmur heard best at LLSB with radiation to right sternum and xiphoid. May increase with inspiration. Often associated with JVD |
|
Definition
|
|
Term
Valvular disorder:
Variable intensity, possibly with thrill Medium pitched harsh midsystolic crescendo-decrescendo murmur at 2-3rd L ICS with radiation to left shoulder and neck |
|
Definition
|
|
Term
| Systolic and Diastolic murmurs |
|
Definition
Systolic: Aortic stenosis, Mitral regurg, Tricuspid regurg, pulmonic stenosis
Diastolic: aortic regurg, mitral stenosis
ARMS |
|
|
Term
Aortic and Mitral vavlular disorders:
1. most common presenting sx
2. typical pt with MVP
3. CXR findings for each
4. definitive method for dx
5. tx |
|
Definition
1. most common presenting sx: dyspnea, fatigue, decreased exercise tolerance, cough, rales, PND, hemoptysis, hoarsenss, thready carotid pulses
2. typical pt with MVP: thin females with minor chest wall deformities
3. CXR findings for each
- aortic: LAE, LVH
- mitral: LAE
4. definitive method for dx: TEE, cardiac cath
- Doppler is good for pressure gradient assessment
5. tx:
- Long term: need surgery for repair, replacement or ballooning
- Short term, mild cases: diuretics, vasodilotors, dig, BB, abx for endocarditis prophylaxis |
|
|
Term
Tricuspid and Pulmonic valvular disorders:
1. Usual presentation
2. Complications
3. CXR
4. EKG
5. definitive testing
6. tx |
|
Definition
1. Usual presentation: in infancy or childhood - exercise intolerance, JVD, peripheral edema, hepatomegaly
2. Complications: due to right-sided pressure overload. RVH, systemic venous congestion, RHF
3. CXR: prominent right heart border, dilation of superior vena cava
4. EKG: RAD, P wave abnormalities associated with RAE, prominent R and deep S waves associated wtih RVH
5. definitive testing: echo and cardiac cath
6. tx: sodium restriction, diuretics, vasodilators, positive inotropes
- Definitive: surgery |
|
|
Term
Supraventricular Rhythms:
1. may be normal in athletes. Usually represents SA node pathology. increased risk for ectopic rhythms
2. occurs with fever, exercise, pain, emotion, shock, thyrotoxicosis, anemia, HF, drugs
3. normal finding. do not alone constitute disease.
4. very common. occurs in people without structural problems. tx?
5. most common chronic arrhythmia. risk increases with age, called "holiday heart" when caused by alcohol use or withdrawal. tx?
6. occurs in pts with COPD, CHF, ASD, or CAD. tx?
7. occur in pts with normal hearts, myocarditis, CAD, or dig toxicity
general sx?
Pharm tx
Non-pharm tx |
|
Definition
Supraventricular Rhythms:
1. may be normal in athletes. Usually represents SA node pathology. increased risk for ectopic rhythms - Sinus Bradycardia <60 bpm
2. occurs with fever, exercise, pain, emotion, shock, thyrotoxicosis, anemia, HF, drugs - Sinus tachycardia >100 bpm
3. normal finding. do not alone constitute disease. - PACs
4. very common. occurs in people without structural problems. tx? - PSVT - tx: valsalva, coughing, breath holding, stretching, putting head btwn knees, applying cold water to face, unilateral carotid massage
5. most common chronic arrhythmia. risk increases with age, called "holiday heart" when caused by alcohol use or withdrawal. tx? - Afib - electric cardioversion, rate control (BB), anticoagulation
6. occurs in pts with COPD, CHF, ASD, or CAD. tx? - Aflutter - ibutilide or electric cardioversion, Amiodarone or dofetilide for chronic disase. Radiofrequency ablation for recurrent
7. occur in pts with normal hearts, myocarditis, CAD, or dig toxicity - Junctional rhythms
general sx? - palpitations, angina, fatigue, none
general Pharm tx - adenosine, verapamil, BB, CCB, dig
Non-pharm: surgery, ablation, cardioversion, pacing |
|
|
Term
Definition: 3 or more consecutive ventricular premature beats
- may be sustained or unsustained
- frequent complication of MI and dilated cardiomyopathy
tx? |
|
Definition
V tach
- severe hypotension or LOC may require SYNCHRONIZED cardioversion
- pharm interventions: lidocaine, procainamide, amiodarone, Mg2+
- if recurrent, may need implantable defibrillator |
|
|
Term
Vtach in which QRS complex twists around the baseline. EKG exhibits a continuously changing axis. May indicate what two electrolyte abn?
tx? |
|
Definition
Torsades de Pointes
may indicate hypokalemia or hypomagnesemia
tx: BB, Mg, temporary pacing |
|
|
Term
ventricular arrhythmia that may be congenital or acquired and causes recurrent syncope. can lead to severe ventricular arrhythmias and sudden death
Congenital causes: Romano-Ward syndrome, Jervell Lange-Nielsen syndrome
Acquired: usually drug induced
tx? |
|
Definition
Long QT syndrome; QT interval 0.5-0.7 sec long (normal is 0.42s)
tx: implantable defibrillator |
|
|
Term
genetic disorder more common in asians and men that causes syncope, ventricular fib, and sudden death. common cause of sudden cardiac death
tx? |
|
Definition
Brugada's syndrome
tx: implantable defibrillator |
|
|
Term
conduction disturbance mainly found in elderly, may occur in infants
exacerbated by dig, CCB, BB, sympatholytics, antiarrhythmics
May result from underlying collagen vascular or metastatic disease, surgical injury, or coronary disease
sx: usually none. may have syncope, dizziness, confusion, HF, palpitations, angina |
|
Definition
|
|
Term
refractory conduction of impulses from atria to ventricles through AV node and/or bundle of his
sx: weakness, fatigue, light-headedness, syncope
tx? |
|
Definition
AV conduction block (first, second, third degree heart block)
tx: pacing |
|
|
Term
| EKG characteristics of 1st, Mobitz I, Mobitz II, and 3rd degree Heart Blocks |
|
Definition
1st: Prolonged PR interval >0.2s
Mobitz I (Wenckebach): progressive prolongation of PR followed by a dropped beat- AV node disturbance
Mobitz II: atrial impulse is unexpectedly not conducted, resulting in a dropped QRS without previous prolongation of PR - Purkinje fiber/bundle of His disturbance
3rd: No communication between atria and ventricles - beat at completely different rates |
|
|
Term
Dilated Cardiomyopathy:
1. represent 95% of cardiomyopathies - associated with ___, which causes dilation of the left ventricle
2. Causes
3. ___ is a special kind seen aftre major catecholamine discharge and is an apical left ventricular ballooning with sx indistinguishable from MI
4. sx?
5. EKG findings
6. CXR findings
7. echo/nuclear/cath findings (abn cardiac physiology associated with dilated cardiomyopathy)
8. tx |
|
Definition
1. represent 95% of cardiomyopathies - associated with reduced strength of ventricular contraction, which causes dilation of the left ventricle
2. Causes: genetic (25-30%), excess alcohol, postpartum, chemo, endocrinopathies, myocarditis, idiopathic
3. Takotsubo cardiomyopathy is a special kind seen aftre major catecholamine discharge and is an apical left ventricular ballooning with sx indistinguishable from MI
4. sx: HF sx, dyspnea, S3 gallop, rales, JVD
5. EKG findings: ST-T wave changes, conduction abn, ventricular ectopy
6. CXR findings: in longstanding disease - cardiomegaly, pulmonary congestion
7. echo/nuclear/cath findings: high diastolic pressure and low CO
8. tx: abstinence from alcohol, treat underlying disease, treat CHF if present |
|
|
Term
Hypertrophic Cardiomyopathy:
1. Characteristic anatomical changes
2. Cause
3. Outcome
4. Sx
5. PE
6. EKG
7. tx |
|
Definition
1. Characteristic anatomical changes: massive hypertrophy of septum, small left ventricle, systolic anterior mitral motin, diastolic dysfunction
2. Cause: genetic
3. Outcome: sudden death in pts <30 y/o at rate of 2-3% yearly
4. Sx: dyspnea, angina, syncope, arrhythmia. Sudden death is often presenting sx
5. PE: sustained PMI, triple PMI, loud S4 gallop, SEM, bisferiens carotid pulse (double pulse per beat), jugular pulsations with prominent "a" wave
6. EKG: NSTT changes, exaggerated septal Q waves, LVH
7. Tx: BB, CCB, disopyramide (antiarrhythmic)
- ablation of hypertrophic septum
- pacing, implantable defibrillator, or mitral replacement may be necessary |
|
|
Term
Restrictive cardiomyopathy:
1. results from ___ or ___
2. caues
3. sx
4. CXR
5. Best imaging modality?
6. tx |
|
Definition
1. results from fibrosis or infiltration of ventricular wall due to collagen defects
2. causes: amyloidosis, radiation, post-op changes, DM, endomyocardial fibrosis
3. sx: decreased exercise tolerance, righ sided heart failure
4. CXR: enlarged cardiac silhouette
5. Best imaging modality: echo
6. tx: diuretics, may eventually need transplant |
|
|
Term
Pericardial disorders:
most often occurs as a result of infection, autoimmune disease, CTD, neoplasia, radiation, chemo, drug toxicity, cardiac surgery, myxedema, TB. More common in men and pts under 50 y/o.
- Sx: sharp, pleuritic substernal CP relieved by sitting upright and leaning forward.
- PE: Friction rub.
- EKG: diffuse ST elevation
- tx? complications? |
|
Definition
Pericarditis. Key is relieved by sitting up leaning fwd. Tx: abx if bacterial cause, steroids, pericardiocentesis if effusion, colchicine, surgery
Complications: restrictive pericarditis, effusion |
|
|
Term
Pericardial effusion:
1. cauess
2. sx?
3. tx?
4. pathognomonic EKG change |
|
Definition
causes: pericarditis, uremia, truama
sx: due to restrictive pressure on heart - +/- pain, dyspnea, cough
tx: pericardiocentesis
EKG change: electrical alternans (changing QRS amplitudes that alternate beat to beat) |
|
|
Term
occurs when fluid compromises cardiac filling and thus impairs cardiac output
sx: tachycardia, tachypnea, narrow pulse pressure, pulsus paradoxus, electrical alternans
tx? |
|
Definition
cardiac tamponade
tx: pericardiocentesis, pericardial window |
|
|
Term
| Pulsus Paradoxus & Kussmaul's sign |
|
Definition
abnormally large decrease in systolic bp >10 mmHg and pulse amplitude during inspiration - can hear a beat on auscultation but cannot feel that beat in the radial pulse
Kussmaul's sign: JVD on inspiration |
|
|
Term
Infective endocarditis:
1. most common pathogens
2. common causes
3. sx
4. workup
5. tx
6. If abscess develops, ___ is the cause |
|
Definition
1. most common pathogens: staph aureus, group D strep, enterococci, HACEK
2. common causes: IV drugs (staph - tricuspid valve), prostetic valves (staph, gram neg, fungi), chronic regurg, bacteremia (common after dental, upper respiratory, urologic, and lower GI procedures)
3. sx: fever, cough, dyspnea, arthralgia, back/flank pain, GI upset, stable murmur, pallor, splenomegaly
- CLASSIC: palatal, conjunctival, or subungual petechiae; splinter hemorrhages; Osler nodes; Janeway lesions; Roth spots
4. workup:
- 3 sets of blood cultures at least 1 hr apart, preferably before starting abx
- echo
- CXR to reveal pulmonary infiltrate
5. tx:
- empiric broad spectrum abx --> VANC + CEFTRIAXONE
- abx prophylaxis before dental work or surgery for pts with prosthetic valves, previous endocarditis, congenital heart disease, valve disease, HOCM, cardiac transplant, valvuloplasty --> amoxicillin
- valve replacement may be necessary
If abscess develops, fungus is the cause |
|
|
Term
|
Definition
Gram neg organisms that are part of normal flora but can result in endocarditis, esp in kids
- Haemophilus
- Actinobacillus
- Cardiobacterium hominis
- Eikenella corrodens
- Kingella
|
|
|
Term
Classic Signs of endocarditis:
1. painful, violaceous, raised lesions of fingers, toes, feet
2. painless red lesions to palms and soles
3. exudative lesions to retina
4. tiny blood clots under nails |
|
Definition
1. painful, violaceous, raised lesions of fingers, toes, feet --> Osler ndoes
2. painless red lesions to palms and soles --> Janeway lesions
3. exudative lesions to retina --> Roth spots
4. tiny blood clots under nails --> Splinter hemorrhages |
|
|
Term
| Duke criteria for infective endocarditis - must have two major, one major and one minor, or three minor criteria for clinical dx |
|
Definition
Major:
- 2 pos blood cultures of typically causative organisms
- evidence of endocardial involvement on echo
- development of new regurg murmur
Minor:
- predisposing factor
- Fever >100.48F
- Vascular phenomena (embolism, pulmonary infarct)
- Immunologic phenomena (glomerulonephritis, osler nodes, roth spots)
- pos blood culture not meeting major criteria |
|
|
Term
Rheumatic Fever:
1. Def: systemic immune response occurring __-__ weeks following infection with ___.
2. Typical lesion
3. Common valvular involvement
4. sx
5. Tx |
|
Definition
1. Def: systemic immune response occurring 2-3 weeks following infection with GABHS throat
2. Typical lesion: perivascular granuloma with vasculitis on a heart valve
3. Common valvular involvement: mitral > aortic > triscupid
4. sx: Jones criteria - see next flashcard
5. Tx:
- strict bed rest until stable
- salicylates and corticosteroids
- IM penicillin (erythromycin for penicillin allergy)
- Benzathene penicillin q4 weeks to prevent recurrence |
|
|
Term
| Jones criteria for dx of rheumatic fever - need two major or one major and two minor |
|
Definition
Major: carditis, erythema marginatum (pink rings on trunk and inner surfaces of limbs, subcu nodules, Sydenham's chorea, polyarthritis
Minor: fever, polyarthralgia (pain w/o swelling), reversible PR prolongation, rapid ESR, CRP |
|
|
Term
Peripheral artery disease:
1. typically a result of ___
2. sx
3. 3 types
4. workup, pos ABI
5. Tx |
|
Definition
Peripheral artery disease:
1. typically a result of atherosclerosis
2. sx: LE ischemia, pain relieved by rest (intermittent claudication), limitation of activity, weak peripheral pulses, numbness, tingling, ulcerations (lat surface of foot/ankle and distal toes), pallor, poikilothermia, paralysis, embolism, ED
3. 3 types:
a. Type 1 - limited to aorta and common iliac - in smokers and hyperlipidemia
b. Type 2 - involves aorta, common iliac, and external iliac
c. Type 3 - most common, arota, iliac, femoral, popliteal, tibial
4. workup:
- if <0.9 ABI - represents significant disease
- Doppler flow studies
- CTA/MRA
5. Tx:
- stop smoking
- progressive exercise
- statins
- cilostazol - main tx
- antiplatelets
- phosphodiesterase inhiitor for ED |
|
|
Term
Varicose veins:
1. risk factors
2. sx
4. ___ test differentiates saphenofemoral valve incompetence from perforator vein incompetence
5. tx |
|
Definition
1. risk factors: pregnancy, fm hx, prolonged sitting or standing, hx of phlebitis
2. sx: dilated, tortuous veins in LE; smaller blue-green flat veins, telangiectasias, spider veins; aching; fatigue; abd pigmentation, fibrosis, atrophy, ulceration - prolonged disease
4. Brodie-trendelenburg test differentiates saphenofemoral valve incompetence from perforator vein incompetence
5. tx: graduated eleastic stockings, leg elevation, regular exercise, endovenous radiofrequency or laser ablation, compression sclerotherapy, surgical stripping of saphenous tree |
|
|
Term
Partial or complete occlusion of a vein and inflammatory changes
- Causes: PICC lines or IV
sx: dull pain, erythema, tenderness, induration, palpable cord
most common in long saphenous vein
tx? |
|
Definition
superficial thrombophlebitis
tx: bed rest, local heat, elevation, NSAIDs |
|
|
Term
DVT:
1. risk factors
2. Virchow's triad
3. sx
4. dx
5. tx |
|
Definition
1. risk factors: major surgical procedures, prolonged bed rest, OCP, hormone replacement, clotting disorders, age, type A blood, obesity, multiparity, IBD, SLE
2. Virchow's triad: stasis, vascular injury, hypercoagulable state
3. sx: none, swelling, heat, redness
4. dx: Duplex ultrasonogrpahy is preferred
- Venography is most accurate but is associated with increased risk
- elevated d-Dimer - can rule out but not rule in
5. tx: Lovenox or Heparin followed by warfarin |
|
|
Term
Chronic venous insufficiency:
1. characterized by ____, which results in stasis of venous blood - often associated with hx of DVT, leg injury, varicose veins
2. sx
3. tx |
|
Definition
1. characterized by loss of venous wall tension, which results in stasis of venous blood - often associated with hx of DVT, leg injury, varicose veins
2. sx: progressive edema, itching, dull pain w/ standing, ulceration just above ankle
- Skin: shiny, thin, atrophic, dark pigment, subcu induration
3. tx:
- elevate legs, avoid extended standing or sitting, compression hose
- ulcers: wet compression, compression stockings, hydrocotisone, zinc oxide - may need skin grafting |
|
|
Term
Giant Cell Arteritis:
1. Systemic inflammatory condition of ___ vessels primary affecting >50 y/o, frequently associated wtih PMR
2. most frequently involves which artery?
3. complications
4. sx
5. workup
6. tx |
|
Definition
1. Systemic inflammatory condition of med-large vessels primary affecting >50 y/o, frequently associated wtih PMR
2. most frequently involves which artery - temporal artery and branches of carotid
3. complications: blindness, large vessels (aortic aneurysm)
4. sx: HA, scalp tenderness, jaw claudication, throat pain, vision problems, sx of PMR (shoulder/hip girlde), resp tract issues, mononeuritis multiplex, FUO, unexplained neck/head pain
5. workup:
- markedly elevated CRP and ESR
- CBC: anemia, thrombocytosis
- elevated alk phos
- TEMPORAL ARTERY BX for dx
6. tx: High dose prednisone for 1-2 mos with low-dose aspirin |
|
|
Term
Aortic aneurysm:
1. causes
2. Classic patient with AAA
3. sx
4. imaging
5. tx |
|
Definition
1. causes: atherosclerosis, congenital defects (Ehlers-Danlos, Marfan's, giant cell arteritis, vasculitis, trauma, syphilis)
2. Classic patient with AAA: elderly MAN smoker with CAD, emphysema, and renal impairment
3. sx: asymptomatic, pulsating abd mass, abd/back pain, renal/LE occlusion
- Thoracic aneurysms: substernal/back/neck pain, dyspnea, stridor, cough, dysphagia, hoarseness, SVC syndrome
- Dissection: tearing severe back, abd, flank pain with hypotension and shock
4. imaging:
- abd US is choice for abd
- aortography, CT, MRI for thoracic
5. tx:
- surgical repair |
|
|
Term
GERD:
1. sx
2. dx
3. when to do EGD
4. r/o?
5. other tests
6. tx |
|
Definition
1. sx: heartburn, regurg, dysphagia, hoarseness, halitosis, cough, hiccups, CP
2. dx: usually clinical
3. when to do EGD: severe disease, >45 with new onset sx, long-standing or frequent sx, failure to respond to therapy
4. r/o: myocardial ischemia with EKG
5. other tests: barium swallow, esophageal manometry, ambulatory 24 hr pH monitoring
6. tx:
- Lifestyle: smoking cessation, avoid eating at bedtime, avoid large meals, avoid foods that cause irritation and alcohol, raise head of bed
- Drugs: antacids, alginic acid for mild sx
- H2 blockers 1st line for mild GERD (famotidine, cimetidine, ranitidine, nizatidine)
- PPI is most powerful - first line for mod-severe disease, unresponsive to H2s, or have erosive gastritis (omeprazole, lansoprazole, etc)
- Nighttime sx: H2 at bedtime + PPI during day
- Avoid B-agonists, a-antagonists, nitrates, CCB, anticholinergics, theophylline, morphine, meperidine, diazepam, barbiturates --> decrease LES tone |
|
|
Term
Infectious Esophagitis:
1. rare except in immunocompromised
2. Causes
3. sx
4. workup
5. tx |
|
Definition
1. rare except in immunocompromised
2. most common causes:
- Candida, CMV, HSV
3. sx: odynophagia, dysphagia in immunocompromised pt
4. workup: EGD reveals large deep ulcers if CMV, multiple shallow ulcers if HSV, white plaques if candida
- culture from EGD is definitive
5. tx:
- Candida: fluconazole or Ketoconazole
- HSV: acyclovir
- CMV: ganciclovir |
|
|
Term
Esophageal motility disorders:
1. most common presenting sx
2. workup
3. general tx
Types:
1. causes difficulty with solids and liquids due to injury to CN involved in swallowing
2. outpouching of posterior hypopharynx causing regurg of undigested food and liquid into pharynx several hours after eating
3. progressive of dysphagia for solids. slow progression indicates ___, rapid progression indicates ___.
4. global esophageal motor disorder in which peristalsis is decreased and LES tone is increased causing slowly progressive dysphagia with episodic regurg and CP. Barium swallow: "parrot-beak" appearance due to dilated esophagus tapering to a distal obstruction
5. dysphagia or intermittent CP that may or may not be assocaite with eating
6. this disease eventually progresses into an esophageal motor issue but will first have many other systemic sx |
|
Definition
Esophageal motility disorders:
1. most common presenting sx: dysphagia
2. workup: barium swallow, pharyngoscopy, esophagoscopy, esophageal manometry
3. general tx: dilation of strictures, resection of neoplasia
- medical managment: CCB, nitrates, botulinum
Types:
1. causes difficulty with solids and liquids due to injury to CN involved in swallowing --> Neurogenic dysphagia
2. outpouching of posterior hypopharynx causing regurg of undigested food and liquid into pharynx several hours after eating --> Zenker's Diverticulum
3. progressive dysphagia for solids. slow progression indicates webs or rings, rapid progression indicates Neoplasm --> Esophageal stricture
4. global esophageal motor disorder in which peristalsis is decreased and LES tone is increased causing slowly progressive dysphagia with episodic regurg and CP. Barium swallow: "parrot-beak" appearance due to dilated esophagus tapering to a distal obstruction --> Achalasia
5. dysphagia or intermittent CP that may or may not be assocaite with eating --> Diffuse esophageal spasm
6. this disease eventually progresses into an esophageal motor issue but will first have many other systemic sx --> scleroderma |
|
|
Term
Esophageal neoplasm:
1. most common types
2. common mets
3. risk factors
4. sx
5. workup
6. tx |
|
Definition
1. most common types: squamous cell and adenocarcinoma (Barrett's is precursor for adeno)
2. common mets: mediastinum
3. risk factors: smoking, chronic alcohol, exposure to caustic agents, hot roods, mucosal abn, poor oral hygiene, HPV
4. sx: progressive dysphagia for solid food + marked weight loss
- also heartburn, vomiting, hoarseness
5. workup:
- Biphasic barium esophagram best for visualizing
- endoscopy with brushings
- endoscopic US and CT for staging
6. tx
- surgery, +/- chemo and radiation
- 4-60% 5 year survival |
|
|
Term
Mallory-Weiss tear:
1. definition
2. causes
3. dx via?
4. tx |
|
Definition
1. definition: linear mucosal tear in esophagus, generally at GE junction causing hematemesis
2. causes: wretching, vomiting - usually due to alcohol
3. dx via EGD
4. tx - usually none, may need epi injection or thermal coagulation |
|
|
Term
Esophageal Varices:
1. definition
2. causes
3. dx
4. tx |
|
Definition
1. definition: dilations of esophageal veins
2. causes: portal HTN from cirrhosis or chronic viral hepatitis OR Budd-Chiari syndrome causing thrombosis of portal vein
- NSAIDs exacerbate
3. dx: clinical in pt with cirrhosis and hematemesis
4. tx:
- hemodynamic support - high volume fluid replacement, vasopressors
- EGD and pharmacologic vasoconstriction (octreotide) |
|
|
Term
Gastritis/Duodenitis:
1. Protective factors
2. Causes
3. sx
4. workup
5. tx |
|
Definition
1. Protective factors: mucus, bicarb, mucosal blood flow, prostaglandins, alkaline state, hydrophobic layer, epithelial renewal --> any imbalance in these can cause inflammation
2. Causes:
- autoimmune (pernicious anemia) cause Type A gastritis
- H. pylori - gram-neg spiral-shaped bacillus causes TYPE B gastritis
- NSAIDs (diminish prostaglandin production)
- stress
- alcohol
3. sx: dyspepsia and abd pain
4. workup: endoscopy w/ bx for extent and presence of HP
- urea breath test or fecal antigen test for HP
5. tx:
- treat cause, remove causes (NSAIDs, alcohol) |
|
|
Term
Alteration in gastric motility caused by myopathic diseases of smooth muscle and neuro dysfxn
sx: neasuea, feeling of fullness after meals
tx? |
|
Definition
delayed gastric emptying
tx: prokinetic meds (cisapride, metoclopramide [reglan]) |
|
|
Term
PUD:
1. causes
2. complications
3. sx
4. workup
5. tx |
|
Definition
1. causes: HP is most common, NSAIDs, alcohol, stress
2. complications: malignancy, bleeding (most common cause of non-hemorrhagic GI bleed)
3. sx: burning/gnawing abd pain
- duodenal ulcer pain improves with food
- gastric ulcer pain worsns with food and often results in wt loss
- other: dyspepsia, bloating, distention, heartburn, nausea, belching
4. workup:
- endoscopy is best
- stool, blood, breath HP tests
5. tx:
- avoid irritating factors
- HP regimen
- PPI, misoprostol (synthetic prostaglandin) |
|
|
Term
| H. pylori treatment regimens |
|
Definition
1. PPI + clarithromycin + amoxicillin (sometimes add metronidazole)
2. bismuth subsalicylate + TCN + metronidazole + PPI |
|
|
Term
Zollinger-Ellison Syndrome:
1. definition
2. r/o what syndrome?
3. sx
4. workup
5. tx |
|
Definition
1. definition: gastrin-secreting tumor called gastrinoma causes hypergastrinemia with results in refractory PUD
2. r/o what syndrome? MEN-1 (multiple endocrine neoplasia)
3. sx: sx of PUD with secretory diarrhea, may be refractory to tx or may not
4. workup:
- fasting gastrin level >150 pg/mL indicates hypergastrinemia
- secretin test to confirm ZES - give 2 U/kg IV secretin, if + ZES gastrin will icnrease by 200 pg/mL
- Endoscopy, CT, MRI to locate tumor
5. tx: PPI, surgical resection of gastrinoma |
|
|
Term
Gastric adenocarcinoma:
1. epidemiology
2. sx
3. workup
4. tx |
|
Definition
1. epidemiology: one of the most common cancers worldwide but less in US, 2x more common in men, rare before 40, strong association with HP
2. sx: Dyspepsia + anemia + wt loss
- postprandial vomitng if lesion in pylorus
3. workup: endoscopy with cytology in any pt >40 with dyspepsia that is unresponsive to thearpy
- abd CT to determine extent
4. tx:
- curative or palliative resection
- chemo or radiation for palliation
- 80% cure rate if caught early, 50% cure rate if through muscularis propria, 10% if lymphatic spread |
|
|
Term
Signs of metastatic gastric adenocarcinoma:
1. left supraventricular lymphadenopathy
2. umbilical nodule |
|
Definition
1. Virchow's node
2. Sister Mary Joseph Nodule |
|
|
Term
Types of diarrhea:
1. large volume wihtout inflammation - indicates pancreatic insufficiency, ingestion of bacterial toxins, laxative use
2. bloody diarrhea with fever - indicates invasive organisms or IBD. usually with elevated WBC
3. almost always caused by C. Diff which can lead to pseudomembranous colitis |
|
Definition
1. secretory diarrhea
2. inflammatory diarrhea
3. antibiotic-associated diarrhae |
|
|
Term
| Causes of bloody diarrhea |
|
Definition
enterohemorrhagic e. coli
shigella
campylobacter
salmonella causes purulent diarrhea |
|
|
Term
| Diarrhea causes that have tx other than supportive |
|
Definition
giardia: metronidazole 250 mg BID x 10 days
cyclospora: Bactrim BID x 1 days
crypto is usually only seen with HIV
|
|
|
Term
Constipation:
1. normal BM frequency
2. pts over 50 with new-onset constipation should be evaluated for ?
3. tx |
|
Definition
1. normal BM frequency:3/day - 3/week
2. pts over 50 with new-onset constipation should be evaluated for colon cancer
3. tx:
- lifestyle managment: fiber 10-20 g/day, fluids 1.5-2 L/day
- lasting >2 weeks or refractory to lifestyle mods - further investigation |
|
|
Term
small bowel obstruction:
1. most common causes
2. sx
3. PE
4. lab and xr findings
5. tx |
|
Definition
1. most common causes: adhesions and hernias; then neoplasm, IBD, volvulus
2. sx: abd pain, distention, vomiting of partially digested food, obstipation
3. PE: high pitched bowel sounds and rushes --> becomes silent
4. lab and xr findings: dehydration, electrolyte imbalance
- XR: air-fluid levels
5. tx: NPO, NG suction, IV fluids, monitoring, may need surgery |
|
|
Term
Large bowel obstruction:
1. causes
2. sx/pe
3. labs/xr
4. tx
complications of all bowel obstructions |
|
Definition
1. causes: most common cause is neoplasm; strictures, hernia, volvulus, intussusception, fecal impaction
2. sx/pe: distention, pain; high pitched bowel sounds and rushes
3. labs/xr: dehydration, electrolyte imbalance; air-fluid levels
4. tx: NG tube, NPO, IV fluids, monitoring - surgery very likely
Complications of both: infarction, necrosis, peritonitis, death, shock (fever and tachy) |
|
|
Term
Volvulus:
1. Definition:
2. most common areas affected?
3. sx
4. PE
5. dx via
6. tx
7. complications |
|
Definition
1. definition; twisting of any portion of bowel on itself,
2. most commonly in the sigmoid or cecal areas
3. sx: cramping abd pain, distention, nausea, vomiting, obstipation
4. PE: tympany, tachy, fever
5. dx via: abd xray - colonic distension
6. tx: urgent endoscopic decompression - surgery if this fails
7. complications: ischemia --> gangrene, peritonitis, sepsis |
|
|
Term
Malabsorption:
1. caused by problems in what 4 processes?
2. sx
3. workup
treatment is directed at cause |
|
Definition
1. caused by problems in what 4 processes: digestion, absorption, imapired blood flow, impaired lymph flow
2. sx: diarrhea is usually primary complaint; bloating, abd discomfort, wt. loss, edema, steatorrha, specific sx to deficieincy
3. workup
a. 72 hr fecal fat test - if this is normal, do more specific tests
b. D-xylose test - to differentiate maldigestion from malabsorption - if D-xylose is detected in blood and urine after administration, then the body CAN properly absorb nutrients
c. specific test for specific deficiency
|
|
|
Term
Celiac Disease:
1. definition
2. sx
3. dx
4. tx |
|
Definition
1. definition: inflammation of small bowel with the ingestion of gluten-containing foods - wheat, rye, barley - resulting in malabsorption
2. sx: highly variable - diarrhea, steatorrhea, flatulence, wt loss, weakness, abd distention, failure to thrive, iron def, coaguloapthy, hypocalcemia
3. dx: IgA antiendomysial and antitissue transglutaminase antibodies - comfirm with small bowel bx
4. tx: gluten-free diet, may also need lactose-free until inflammation resolves, supplements to correct nutritional deficiencies
- prednisone for refractory cases |
|
|
Term
Crohn's Disease
1. AKA
2. cause
3. characteristics
4. complications
5. sx
6. dx
7. tx |
|
Definition
1. AKA: regional enteritis
2. cause: unknown but genetic predisposition
3. characteristics: can involve all parts of GI tract from mouth to anus. Most common is terminal ileum and right colon. Often spares rectum. Skip lesions. Lesions are transmural.
4. complications: fistula, abscess, apthous ulcers, renal stones, colon cancer, toxic megacolon, perforation
5. sx: abd cramps, diarrhea, lowgrade fever, polyarthallgia, anemia, fatigue, blood in stool
6. dx: colonoscopy w/ bx - entire colon wall involved, granulomas often present
7. tx:
- acute: prednisone +/- aminosalicylates, may need flagyl or cipro
- elemental diet helpful
- Maintenance: Mesalamine
- Smoking cessation
- may need surgery (segmental resection) |
|
|
Term
Ulcerative Colitis:
1. characteristics
2. sx
3. complications
4. ___ seems to be protective
5. dx via
6. tx
In all IBD, avoid what tests during acute flares? |
|
Definition
1. characteristics: generally starts distally at rectum and moves proximally - no skip lesions
2. sx: tenesmus, bloody/pus-filled diarrhea; LLQ pain, wt loss, malaise, fever
3. complications: toxic megacolon, malignancy (these more common than in crohn's); episcleritis, scleritis, arthritides, sclerosing cholangitis, erythema nodosum (tender red bumps caused by inflammation of fat cells under skin), pyoderma gangrenosum (ulcers caused by necrosis, usually on legs)
4. smoking seems to be protective
5. dx via: colonoscopy or sigmoidoscopy
6. tx:
- Topical or oral aminosalicylates (sulfasalazine, mesalamine) and corticosteroids are mainstay
- immunomodulators for refractory disaese
- surgery can be curative (proctocolectomy)
In all IBD, avoid what tests during acute flares: colonoscopy, barium enema --> can cause perforation or toxic megacolon |
|
|
Term
IBS:
1. cause
2. epidemiology
3. sx
4. dx
5. tx |
|
Definition
1. cause: combo of altered motility, hypersensitivity to intestinal distension, psychological distress
2. epidemiology: more common in women, begins early-mid adulthood, usually lifelong
3. sx: abd pain worsened by food and relieved with defecation, gas, postpradial urgency, changes in stool freequency and character, alternating diarrhea and constipation, dyspepsia
4. dx: dx of exclusion - stool studies, colonoscopy, barium enema, US, CT to r/o other problems
5. tx: reassurance, avoidance of triggers,
- mainstays: high-fiber diet, bulking agents (psyllium hydrophilic mucilloid),
- antispasmodics, antidiarrheals, prokinetcs, antidepressants as needed |
|
|
Term
invagination of proximal segment of bowel into the portion just distal to it.
- occurs most commonly in kids following viral infection
- in adults, it's almost always due to neoplasm
- sx: severe colicky pain, currant jelly stools (mucus and blood), sausage-like mass on abd exam
tx - kids and adults? |
|
Definition
intussusception
tx: hospitalize all pts
- Kids: air or barium enema - may be dx and curative
- adults: CT, then surgery - do NOT do barium enema |
|
|
Term
Diverticular disease:
1. incidence
2. prevention of diverticulitis in pts with diverticulosis
3. sx
4. workup
5. tx |
|
Definition
1. incidence: 60% of pts >60 y/o will have diverticulosis, 20% of these pts will be symptomatic; 20% of diverticulitis is <40 y/o
2. prevention of diverticulitis in pts with diverticulosis: high fiber diet, avoidance of obstructing/constipating foods (nuts, seeds, popcorn)
3. sx: sudden onset abd pain usually LLQ or suprapubic; +/- fever, +/- peritonitis, n/v
- bleed: sudden onset large volume hematochezia that resolves spontaneously
4. workup:
- fecal occult blood
- CBC: mild-mod leukocytosis
- XR: to r/o free air
- CT: if no response to therapy
- Barium enema should be avoided during acute episode
5. tx:
- mild diverticulitis: low-residue diet and braod spectrum abx; may need hospitalization for IV abx, bowel rest, analgesia
- Surgery for peritonitis, abscess, fistula, obstruction |
|
|
Term
1. medical emergency - pt typically >50 y/o with cardiovascular or collagen vascular disease presents with sudden onset severe abd pain out of proportion to exam; involuntary guarding, rebound tenderness, heme+ stool
- colonoscopy to confirm dx
- causes: vascular emboli/thrombus
tx?
2. pt typically >50 y/o with cardiovascular or collagen vascular disease presents with abdominal angina 10-30 min after eating that is relieved by squatting or lying down
- cause: insufficient (though present) blood supply to bowel
- tx? |
|
Definition
1. acute mesenteric ischemia
2. chronic mesenteric ischemia
tx: surgical revascularization and hydration
AMI has high mortality rate |
|
|
Term
Toxic megacolon:
1. definition
2. cause in kids
3. cause in adults
4. sx
5. xray findings
6. tx |
|
Definition
1. definition: extreme dilation and immobility of colon - a medical emergency
2. cause in kids: Hirschsprung's disease
3. cause in adults: UC, crohn's, pseudomembranous colitis, infections
4. sx: fever, prostration, severe creamps, abd distension, rigid abdomen, rebound tenderness
5. xray findings: colonic dilation
6. tx: decompression, colostomy, resection
- fluids and electolyte balance |
|
|
Term
| congenital aganglionosis of colon leading to functional bowel obstruction in the newborn - improper formation of Auerbach's plexus |
|
Definition
|
|
Term
genetic predisposition to multiple colonic polyps with near 100% risk of colon cancer
associated sx: pigmented retinal lesions, jaw cysts, sebaceous cysts, osteomata (Gardner's syndrome)
screening recommendations? |
|
Definition
familial polyposis syndrome
screening: q1-2 years beginning at 10-12 y/o |
|
|
Term
Colorectal cancer:
1. # leading cause of cancer death in US
2. prognosis
3. sx
4. lab findings |
|
Definition
1. 3rd leading cause of cancer death in US
2. 5 year survival: 90% at stage A (mucosa only), 70-80% at stage B (through wall, regional lymph nodes), 5 % at C or D (+ lymph nodes, mets)
3. sx: slow-growing, disease is late by the time sx appear - abd pain, change in bowel habits, occult bleeding, obstruction, fatigue, weakness
4. lab findings:
- occult blood
- carcinoembryonic antigen for monitoring but not detection
- colonoscopy or barium enema for visualization
- CXR and CT for mets
5. Tx:
- surgery
- add chemo for Stage III (Duke C) or higher
- radiation for rectal tumors |
|
|
Term
painful swelling at anus with painful defectation
exam: localized tenderness, erythema, swelling, fluctuance - may have fever if deep
tx? |
|
Definition
anorectal abscess
tx: surgical drainage + WASH regimen (warm-water cleansing, analgesia, stool softeners, high-fiber diet) |
|
|
Term
open tract btwn two epithelium lined areas most commonly associated with deep anorectal abscess
sx: discharge and pain
tx? |
|
Definition
anorectal fistula
tx: surgery
- Do NOT explore on exam bc it may open new tracts |
|
|
Term
Anal fissure:
1. most common place
2. sx
3. tx |
|
Definition
Most commonly posterior midline
sx: tearing pain on defecation + hematochezia in stool or on TP
tx: bulking agents, increased fluids, sitz baths, topical nitro or styptic (silver nitrate, gentian violet) |
|
|
Term
| Stages of hemorrhoids and tx for each |
|
Definition
I: confied to anal canal - may bleed with defecation
II: protrude from anal opening but reduce spontaneously. may have bleeding and mucoid discharge
III: require manual reduction after BM
IV: chronically protruding, risk strangulation
I-II: high fiber diet + increased fluids + bulk laxatives
III-IV: anesthetics/astringent suppositories
IV: surgery - banding, injection, sclerotherapy |
|
|
Term
abscess in sacrococcygeal cleft associated with subsequent sinus tract development
- 4x more likely in males
- more common in hirsute and obese people, rare in >40 y/o
sx: painful, fluctuant area in sacrococcygeal cleft
tx? |
|
Definition
pilonidal disease
tx: surgical drainage w/ abx |
|
|
Term
sx: abd pain, rectal discomfort, anorexia, n/v, HA, acute confusion, incontinence of small amounts of water and semi-formed stool
PE: rock-hard still in rectal vault on exam
complications and tx? |
|
Definition
fecal impaction
complications: urinary obstruction, infection, colon perf, stercoral ulcer, appendicitis from fecalith
tx: digitally brekaing up impaction followed by saline or tepid-water enema
|
|
|
Term
Appendicitis:
1. most common cause
2. epidemiology
3. complications
4. sx
5. PE findings
6. workup
7. tx |
|
Definition
1. most common cause: fecalith
- less common cause is infection (CMV, adenovirus, histoplasma), collagen vascular disease, IBD
2. epidemiology: 10-30 y/o, most common abd surg emergency
3. complications: perforation and peritonitis (20%) - high fever, generalized abd pain, inceased leukocytosis
4. sx: intermittent periumbilical/epigastric pain that localizes to RLQ (McBurney's point) 12 hrs later and becomes constant - worse wtih movement
- nausea, anorexia, vomiting, low-grade fever
5. PE findings:
- Psoas sign: pain with raising leg against resistance while supine
- obturator sign: pain with flexing and internally rotating right him with knee bent while supine
6. workup: leukocytosis, microscopic hematuria/pyuria
- CT to confirm
7. Tx: appy + broad spectrum abx |
|
|
Term
Pancreatitis:
1. common causes
2. sx
3. labs
4. tx
complications |
|
Definition
1. common causes: cholelithiasis, alcohol abuse
- others: hyperlipidemia, trauma, drugs, hypercalcemia, PUD, meds
2. sx: epigrastric pain radiating to back that lessens when leaning fwd or in fetal position, n/v, fever, leukocytosis, peritonitis, hypovelemia, ARDS, tachy, shock
3. labs:
- amylase: elevated, sometimes for only 48-72 hrs
- Lipase: more specific if elevated 3x or more
- leukocytosis
- hemoconcentration
- LFTs elevated
- BG, bilirubin may be elevated
- Ca may be low
4. tx:
- BPO
- maintain fluids
- meperidine (demerol) for pain
- abx
- parenteral hyperalimentation
Complications: pancreatic pseudocyst, renal fialure, pleural effusion, hypocalcemia, pancreatic abscess |
|
|
Term
| Ranson's Criteria for pancreatitis |
|
Definition
Leukocytes >16K
BG >200
LDH >350
AST >250
PO2 <60 mmHg
Base deficit >4
Falling Ca
Rising BUN |
|
|
Term
Chronic pancreatitis:
1. most common cause
2. classic triad
3. labs
4. tx |
|
Definition
1. most common cause: alcohol (90%)
2. classic triad: pancreatic calcification, steatorrhea, DM (only actually in 20% of pts)
- others steatorrhea
3. labs:
- amylase elevated early but decreases with each episode
- Abd xr: calcification of pancreas in 20-30%
4. tx
- alcohol cessation
- low fat diet
- surgical removal of part of pancreas
|
|
|
Term
Pancreatic cancer:
1. # leading cause of cancer death in US
2. risk factors
3. sx
4. imaging
5. tx |
|
Definition
1. 5th leading cause of cancer death in US
2. risk factors: age, obesity, tobacco, chronic pancreatitis, previous abd radiaiton, fm hx
3. sx: abd pain, jaundice, palpable GB (Courvoisier's sign - for pancreatic head cancer)
4. imaging: CT
5. tx: surgical resection (Whipple's procedure) if no mets +/- chemo and radiation |
|
|
Term
Choledocholelithiasis:
1. definition
2. sx
3. best imaging
4. labs
5. tx |
|
Definition
1. definition: gallstone in common bile duct
2. sx: colic, jaundice, pancreatitis, cholangitis
3. best imaging: ERCP
4. labs:
- elevated DIRECT bilirubin, amylase, lipase
5. tx: ERCP, lap chole, common bile duct exploration |
|
|
Term
Acute Cholecystitis:
1. obstruction of ___, usually caused by a stone
2. sx
3. workup
4. tx |
|
Definition
1. obstruction of bile duct, usually caused by a stone
2. sx: colicky epigastric or RUQ pain after high fat meal, may radiate to R shoulder/scapula, n/v, low-grade fever, costipation, mild paralytic ileus
3. workup:
- elevated bili, WBC
- HIDA (hepatoiminodiacetic acid) scan for confirmation
- may see stone on XR
- may need ERCP
4. tx - surgery |
|
|
Term
Acute cholangitis:
1. definition
2. causes
3. sx
4. workups
5. tx |
|
Definition
1. definition: potentially deadly combo of common bile duct obstruction + ascending infection (E. coli, enterococcus, klebsiella, enterobacter) that can lead to sepsis and death
2. causes: choledocholelithiasis (most common), neoplasm, stricture
3. sx: RUQ tenderness, jaundice, Fever (CHARCOT'S TRIAD)
- + AMS, hypotension (Reynold's Pentad)
4. workups:
- RUQ US - biliary dilation or stones
- CBC: leukocytosis w/ left shift, increased bili, increased trasnaminase
- ERCP is optimal for dx and tx - don't do until pt is stable or unless it's urgent
5. tx:
- abx (fluoroquinolone, ampicillin, gentamycin +/- flagyl), fluids, electrolyte replacement, analgeisa
- ERCP - drainage, sphincterotomy, stone removal, stent placement once stable
- cholecystectomy later |
|
|
Term
chronic thickening of bile duct walls of unknown etiology, although 80% are associated with IBD
- strongly associated with cholangiocarcinoma, pancreatic carcinoma, colorectal carcinoma
sx: jaundice, pruritis with fatigue, malaise, wt. loss, +/- organomegaly
labs: same as acute cholangitis (Charcot's triad - fever, jaundice, RUQ tenderness)
tx? |
|
Definition
Primary sclerosing cholangitis
tx: Ursodiol + ERCP managment of stricture
- liver transplant is only tx with known survival benefit |
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Term
| most common cause of acute hepatitis |
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Definition
viral
(alcohol is second) |
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Term
Viral hepatitis:
1. __ and __ are transmitted by fecal-oral contamination
2. __, __, and __ are transmitted parenterally or by mucus membrane contact
3. sx of __, and __: mild, no long term sequelae
4. sx of __ and __: variable from asymptomatic to fulminant. may become chronic. often coinfection iwth HIV
5. __ is only seen in conjunction with B and is associated with a more severe course
6. tx? |
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Definition
1. A and E are transmitted by fecal-oral contamination
2. B, C, D are transmitted parenterally or by mucus membrane contact
3. sx of A and E: mild, no long term sequelae
4. sx of B and C: variable from asymptomatic to fulminant. may become chronic. often coinfection iwth HIV
5. D is only seen in conjunction with B and is associated with a more severe course
6. tx:
- acute: supportive
- chronic: avoid alcohol and hepatotoxins, treat HIV if present, vaccinate against other heps |
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Term
Hep B testing:
1. indicates ongoing infx of any duration
2. indicates immunity by past infection or vaccination
3. indicates acute hepatitis - present between disappearance of (1) and appearance of (2)
4. indicates highly contagious active infection |
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Definition
1. indicates ongoing infx of any duration: HBsAg (hep B surface antigen)
2. indicates immunity by past infection or vaccination (anti-HBs)
3. indicates acute hepatitis - present between disappearance of (1) and appearance of (2) - Anti-HBc (Hep B core antibody)
4. indicates highly contagious active infection - HBeAg (Hep B envelope antigen) |
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Term
hepatitis caused by numerous agents including alcohol, acetaminophen, carbon tetrachloride, isoniazid, halothane, phenytoin
tx: d/c causative agent
___ for acetaminophen toxicity |
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Definition
toxic hepatitis
acetylcystein for acetaminophen tox |
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Term
irreversible fibrosis and nodule regenration throughout the liver
- in US almost all due to alcohol, Hep B, and Hep C
sx: weakness, fatigue, weight loss, n/v/anorexia, menstrual changes, impotence, loss of libido, gynecomastia, abd pain, hepatomegaly
late stages: ascites, pleural effusion, peripheral edema, ecchymosis, esophageal varices, hepatic encephalothay
Labs: Nl until late disease then anemia, elevated AST, alk phos, gamma-globulin
decreased albumin
tx? |
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Definition
Cirrhosis
tx: abstenince from alochol
ascites: salt restriction, spironolactone, bed rest
- liver transplant in some pts |
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Term
| Liver abscess is usually caused by ___ or ___. tx? |
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Definition
entamoeba histolytica or coliform bacteria
tx: abx + percutaneous drainage or abx |
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Term
Liver neoplasms:
1. benign causes
2. mets to liver
3. primary liver cacner type and causes
4. sx
5. labs
6. tx |
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Definition
1. benign causes: cavernous hemangioma, hepatocellular adenoma, infantile hemangioendothelioma
2. mets to liver: from lung and breast msot common
3. primary liver cacner type and causes: hepatocellular carcinoma - Hep B, C, aflatoxin B1 (from aspirgillus), cirrhosis
4. sx: malaise, wt loss, abd swelling, weakness, jaundice, RUQ pain, hepatosplenomegaly, hepatic bruit, ascites, jaundice, wasting, fever
5. labs:
- alpha fetoprotein elevated in cancer
- US, CT, MRI, hepatic angiography to see lesion
- Needle bx only if tumor is not resectable
6. tx:
- benign: treat if very large or danger of rupturing heaptic capsule
- mets: tx primary lesion
- carcinoma: resection if confind to one lobe and no concurrent cirrhosis -- poor prognosis |
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Term
Def: protrusion of an organ through the wall that normall contains it - can entrap intestines and cause blockage
Types:
1. generally congntial at birth, may resolve on its own or may need surgery
2. protrusion of stomach through diaphragm via ESOPHAGEAL HIATUS. can cause GERD. tx?
3. associated commonly with veritcal incisions and in pts with obesity and infection
4. due to weakening in anterior abd wall - can be incisional or umbilical |
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Definition
HERNIA: Def: protrusion of an organ through the wall that normall contains it - can entrap intestines and cause blockage
Types:
1. generally congntial at birth, may resolve on its own or may need surgery - umbilical
2. protrusion of stomach through diaphragm via ESOPHAGEAL HIATUS. can cause GERD. tx? - hiatal/diaphragmatic - acid reduction, surgery
3. associated commonly with veritcal incisions and in pts with obesity and infection - incisional
4. due to weakening in anterior abd wall - can be incisional or umbilical - ventral |
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Term
Inguinal hernias:
1. most common type - passage of intestine throuhg internal inguinal ring down canal and may pass into scrotum
2. passage of intestine throuhg external inguinal ring and Hesselbach's traingle - raarely passes into scrotum
3. least common - passage through femoral ring |
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Definition
1. indirect
2. direct
3. femoral |
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Term
| Hesselbach's triangle components |
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Definition
AKA Inguinal triangle
- Medial border: Lateral margin of the rectus sheath, also called linea semilunaris
- Superolateral border: Inferior epigastric vessels
- Inferior border: Inguinal ligament, sometimes referred to as Poupart's ligament
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Term
congenital anomaly commonly associated with tracheoesophageal fistulae
sx: newborn with excessive saliva and choking/coughing when feeding
- inability to pass NG tube establishes dx
tx? |
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Definition
esophageal atresia
tx: surgery
- pulmonary aspiration in interim and withhold oral feedings |
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Term
congenital anomaly that can cause immediate resp distress in newborn bc affected lung is compressed from pressure of abd contents
dx: bowel sounds in chest
CXR: loops of bowel in hemithroax with displacmenet of heart and mediastinum
tx? |
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Definition
diaphragmatic hernia
tx: immediate intubation and ventilation, NG suction, surgery |
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Term
congenital anomaly characterized by gastric outlet obstruction more commonly in males
sx: progressive, nonbilious, projectile vomintng in a child who remains hungry btwn 4-6 wks old
- wt loss, dehydration
- alive-shaped mass to right of umbilicus
US: "STRING SIGN" - delayed gastric empyting |
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Definition
pyloric stenosis
tx: srugrery |
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Term
| bowel obstruction in first days of life is usually? |
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Definition
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Term
congenital absence of Meissner's and Auerbach's plexuses (autonomic nerves enervating bowel wall)
sx: constipation, obstipation, vomiting, FTT
tx/ |
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Definition
HIrschsprung's disease (congenital megacolon)
tx: surgical resection |
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Term
Which nutritional deficiency?
1. sources: liver, fish oil, fortified milk, eggs
2. functions: vision, epithelial cell maturity, infx resistance, antioxidant
3. at-risk groups: elderly, alcoholic, liver disease
4. sx: night blindness, dry skin
5. toxicity: skin disorder, hair loss, teratogenicity |
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Definition
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Term
Which nutritional deficiency?
1. sources: fortified milk
2. functions: calcium regulation, cell differentiation
3. at-risk groups: elderly, low sun exposure
4. sx: rickets, osteomalacia
5. toxicity: hypercalcemia, kdiney stones, soft tissue deposits |
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Definition
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Term
Which nutritional deficiency?
1. sources: plant oils, wheat, asparagus, peanuts, margarine
2. functions: retard cell aging, vascular and RBC wall integrity, antioxidant
3. at-risk groups: rare
4. sx: hemolytic anemia, degenerative nerve changes,
5. toxicity: vit K inhibition, HA, myalgia, weakness |
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Definition
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Term
Which nutritional deficiency?
1. sources: liver, green leafy veggies, broccoli, peans, green beans
2. functions: clotting
3. at-risk groups: rare
4. sx: bleeding
5. toxicity: anemia, jaundice |
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Definition
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Term
Which nutritional deficiency?
1. sources: pork, grains, dired beans, peas, brewer's year
2. functions: carb metabolism, nerve fxn
3. at-risk groups: alcoholism, poverty
4. sx: BeriBeri (tingling, poor coordination, edema, weakness, cardiac dysfunction)
5. toxicity: none |
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Definition
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Term
Which nutritional deficiency?
1. sources: milk, spinach, liver, grains
2. functions: energy
3. at-risk groups: n/a
4. sx: eye problems, oral inflammtion
5. toxicity: none |
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Definition
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Term
Which nutritional deficiency?
1. sources: bran, tuna, salmon, chicken, beef, liver, peanuts, grains
2. functions: energy, fat metabolism
3. at-risk groups: poverty and alocholism
4. sx: flushing
5. toxicity: non |
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Definition
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Term
Which nutritional deficiency?
1. sources: liver, broccoli, eggs
2. functions: energy, fat metabolism
3. at-risk groups: alcoholism
4. sx: tingling, fatigue, HA
5. toxicity: none |
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Definition
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Term
Which nutritional deficiency?
1. sources: cheese, eggs, cauliflower, PB, liver
2. functions: glucose production, fat synthesis
3. at-risk groups: alcoholism
4. sx: dermatitis, tongue pain, anemia, depression
5. toxicity:none |
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Definition
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Term
Which nutritional deficiency?
1. sources: animal protein, spinach, broccoli, banana, salmon
2. functions: protein metabolism, neurotransmitter synthesis, hgb
3. at-risk groups: alcoholism, adolescnece
4. sx: HA, seizure, anemia, flaky skin, sore tongue
5. toxicity: nerve destruction |
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Definition
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Term
Which nutritional deficiency?
1. sources: green/leafy veggies, orange juice, grains, organ meats
2. functions: DNA synthesis
3. at-risk groups: alcoholism, pregnancy
4. sx: megaloblastic anemia, sore tongue, diarrhea, AMS
5. toxicity: non |
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Definition
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Term
Which nutritional deficiency?
1. sources: animal foods
2. functions: folate metabolism, nerve fxn
3. at-risk groups: elderly, vegans
4. sx: megaloblastic anemia, poor nerve fxn
5. toxicity: none |
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Definition
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Term
Which nutritional deficiency?
1. sources: citrus, strawberries, broccoli, greens
2. functions: collagen synthesis, hormone fxn, neurtoransmitter syndthesis
3. at-risk groups: alcoholism, elderly men
4. sx: scurvy (poor wound healing, petechiae, bleeding gums)
5. toxicity: diarrhea |
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Definition
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Term
Lactose intolerane:
1. cause?
2. sx
3. management |
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Definition
1. cause: lactase deficiency - common in almost everyone after age 12
2. sx: n/v, bloating, flatulence, diarrhea, cramping,
3. management: avoid milk and dary products or use lactase drops |
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Term
rare autosomal recessive inability to metaoblize pheylalanine,w hich accumulates in CNS causing mental retardation and movement disorders
dx after age 3 leads to irreversible brain damage
tx? |
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Definition
phenylketonuria
tx: low-pheylalanine diet and tyrosine supplementation, strict protein control for life |
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Term
Acute Renal Failure (acute kidney injury):
1. refers to a syndrome of rapidly deteriorating ___ with the accumulation of nitrogenous wastes (urea and creatinine) referred to as ____.
2. Serum Cr usually incrases by >___ mg/dL or >__% over baseline
3. 2 disesase account for the majority of ARF: ___ and ___
4. Overall mortality rate is 10-50%
5. important hx
6. sx |
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Definition
1. refers to a syndrome of rapidly deteriorating GFR with the accumulation of nitrogenous wastes (urea and creatinine) referred to as azotemia.
2. Serum Cr usually incrases by >0.5 mg/dL or >50% over baseline
3. 2 disesase account for the majority of ARF: ATN and reduced renal perfusion
4. Overall mortality rate is 10-50%
5. important hx: procedures and medications, exposure to nephrotoxins, fm hx renal dz, urologic disaes, HTN, hypotension, volume loss, CHF, DM
6. sx: n/v/d, pruritis, drowsiness, dizziness, hiccups, SOB, anorexia, hematochezia, anuria, oliguria, change in volume status (acute wt gain or loss), AMS, edema, weakness, dehydration, rahse, JVD, uriniferous odor, ecchymosis |
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Term
Acute Renal failure (cont):
1. ___ is the key parameter to measure renal function.
2. ___ provides an estimate of renal function but is more sensitive to dehydration, catabolism, diet, renal perfusion, liver disease.
3. General tx |
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Definition
1. GFR
2. BUN
3. short-term dialysis if Cr >5-10 mg/dL, unresponsive acidosis, electrolyte disorders, fluid overload, uremia |
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Term
What type of ARF is most likely? What are examples of this type?
tachycardia and hypotension
Urine Na <20 mEq/L (NL is 40-220)
Fractional excretion of Na < 1%
Urine Osmolality 500mOsm (low-normal)
BUN:Cr ratio 20:1 |
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Definition
Pre-renal
Hypovolemia, hypotension, ineffective circulating volume (CHF, cirrhosis, nephrotic syndrome, early sepsis), aortic aneurysm, renal artery stenosis or embolism |
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Term
What is the cause of ARF? And what are some examples?
- UA: granular casts, WBC/RBC casts, proteinuria, or tubular epithelial
- urine Na >40 mEq/L
- FENA >1-2%
- Urine osmolality 250-300 mOsm
- BUN:CR <15:1 |
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Definition
Intrinsic renal failure
ATN
Nephrotoxins (NSAIDs, aminoglycosides, radiologic contrast)
interstitial disease (AIN, SLE, infx)
Glomerulonephritis
Vascuar disease (polyarteritis nodosum, vasculitis) |
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Term
What is the cause of ARF? What are some examples?
distended bladder, CVA tenderness, or enlarged prostate |
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Definition
Postrenal failure
tubular obstruction
obstructive uropathy (urolithiasis, BPH, bladder obstruction) |
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Term
| Stages of Chronic Kidney Disease - sx and labs of each |
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Definition
I: kidney damage with persistent albuminuria but normal GFR >90 mL/min
II: kidney damage with mild decrease in GFR 60-89 mL/min
III: moderate decrease in GFR: 30-59 mL/min
IV: severe decease in GFR: 15-29 mL/min
V: kidney failure with GFR <15 mL/min
I-II: asymtpomatic, no increase in BUN or Cr
III: may have sx; Cr and BUN increase; PTH, erthropoietin, calcitriol become abn
IV: symptomatic with anemia, hyperkalemia, acidosis, hypocalcemia, hyperphosphatemia
V: candidate for kidney replacement
Uremic syndrome begins usually Stage III: insidious fatigue, malaise, anorexia, nausea, vomiting, metallic taste, hiccups, dyspnea, orthopnea, impaired mentaiton, insomnia, irritability, muscle cramps, restless legs, weakness, pruritis, easy burising, altered consciousness, cachexia, wt loss, muscle wasting, pallor, HTN, ecchymosis, sensory deficits, asterixis, Kussmaul respirations |
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Term
CKD:
1. most common causes
2. prognosis
3. 2 methods for calculating GFR
4. general lab markers for kidney damage, besides GFR
5. treatment options |
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Definition
1. causes: DM, HTN, glomerulonephritis, polycystic kidney disease
2. prognosis: generally progresses to renal failure, which has a 35% 5 year survival rate
3. Cockcroft-Gault formula and Modification of Diet in Renal Disease (MDRD) equation
4. microalbuminuria progressing to proteinuria, BUN and Cr, Hgb, Hct, electrolytes, UA
5. Tx:
- ACE and ARBs slow progression, esp if proteinuria
- manage comorbidities: BP <130/80, HbA1C <1.7%, LDL <100, tobacco cessation, wt control
- maintain hgb and bleeding time with iron, erythropoeitin, and antiplatelets
- adjust other medications with renal dosing
- Diet: low protein, water, sodium, potassium, phosphorus; adequate calories; Ca and Vit D supplements
- may need dialysis or transplant |
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Term
Glomerulonephritis:
1. Refers to damage of glomeruli by ___ in the membranes as a result of an immunologic response.
2. epidemiology
3. sx
4. labs and dx
5. tx |
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Definition
1. Refers to damage of glomeruli by deposition of inflammatory proteins in the membranes as a result of an immunologic response.
2. epidemiology: 60% in kids 2-12 y/o
3. sx: hematuria (tea or cola-colored urine), oliguira or anuria, edema of face and eyes in morning, edema of feet and ankles in evening, HTN
4. labs and dx: ASO titer if recent strep infx
- UA: hematuria with acanthocytes (misshapen RBCs), RBC casts, proteinuria
- Serum complement (C3) levels decreased
- Dx via renal bx
5. tx:
- steroids and immunosuppression
- tx sx of HTN, hyperkalemia, edema, acidosis |
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Term
Causes of glomerulonephritis:
1. Focal cuases in kids
2. focal causes in adults
3. diffuse causes in kids
4. diffuse causes in adults |
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Definition
1. Focal cuases in kids: benign hematuria, Honch-Schonlein purpura, mild postinfectious GN, IgA nephropathy, Hereditary nephritis
2. focal causes in adults: IgA nephropathy, hereditary nephritis, SLE
3. diffuse causes in kids: postinfectious GN, membranoproliferative GN
4. diffuse causes in adults: SLE, membranoproliferative GN, rapidly progressive GN, postinfectious GN, vascultitis |
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Term
Nephrotic Syndrome:
1. Definition
2. Characteristic sx
3. S/S
4. Labs: UA, CMP
5. Tx |
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Definition
1. Definition: excretion of >3.5g protein/24 hrs
2. Characteristic sx: hypoalbuminemia, lipiduria, hypercholesterolemia, edema
3. S/S: malaise, abd distnention, anorexia, facial edema, puffy eyelids, oliguria, scrotal swelling, sob, wt. gain, ascites, edema, HTn, orthostatic hypotension, retinal sheen, skin striae
4. Labs:
- UA: proteinuria, lipiduira, glycosuria, hematuria, "foamy" urine, RBC/granular/hyaline/fatty casts. Key finding: "oval fat body"
- CMP: hypoalbuminemia, azotemia, hyperlipidemia
- C3 low or NL
5. Tx:
- Meds: ACE, diuretics (sparingly)
- Diet: restrict sodium and fluid intake, watch protein and K+ intake
- anticoagulation if thrombosis
- avoid nephrotoic drugs
- +/- steroids, cyclophosphamide, cyclosporine |
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Term
| Causes of nephrotic syndrome - primary renal disease and secondary renal disease |
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Definition
Primary renal: focal GN, IgA nephropathy, Membranoproliferative GN, membranous glomerulopathy, mesangial proliferative GN, minimal change disease, rapidly progressive GN, congenital nephrotic sydnrome
Secondary renal: poststrep GN, SLE, malignancy, toxemia of prengnacy, drugs, nephrotoxins, lymphoma/leukemia, DM, amyloidosis |
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Term
Polycystic Kidney Disease:
1. Cysts are made of?
2. most common kind
3. less common kind
4. acquired kind
5. sx
6. labs: cbc, AU, imaging
7. tx |
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Definition
1. Cysts are made of: epithelial cells from renal tubulues and collecting system - they replace the mass of the kidneys and thus reduce function
2. most common kind: autosomal dominent - almost always bilateral. sx develop during 4th decade
3. less common kind: autosomal recessive - begins in utero. can lead to fetal and neonatal death. survivors have reduced life expectancy
4. acquired kind: from long term or ESRD. more common in african americans
5. sx: back and flank pain, HA, hematuria, HTn, recurrent UTI, wt loss, renal colic, n/v, palpable kidneys
6. labs:
- cbc: anemia
- UA: proteinuria, hematuria, pyuria, bacteriuria
- imaging: US is imaging of choice - fluid-filled cysts
7. tx: no cure
- management of pain
- BP <130/80 with ACE or ARB
- Diet: high fluid, low protein
- tx infx with abx that can penetrate cysts (Bactrim, fluoroquinolones, chloramphenicol, vanc)
- may need dialysis or transplant |
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Term
Nephrolithiasis:
1. causes
2. epidemiology
3. types of stones
4. sx
5. UA
6. imaging |
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Definition
1. causes: increased saturation of urine with salts; lack of inhibition (citrate) in the urine to prevent formation
2. epidemiology: men>women, 3-4th decades
3. types of stones:
- calcium most common 75-87% (radiopaque)
- uric acid 5-8% (radiolucent but acidic urine)
- cysteine: <1% (radiolucent but cysteinuria)
- Struvite 10-15% (combo of calcium, ammonium, and magnesium - radiopaque); increased with infx with urease-producing bacteria
4. sx: unilateral back pain and renal colic that waxes and wanes w/ hematuria, dysuria, urinary frequency, fever, chills, n/v, diaphoresis, tachy, restless, CVA tenderness, abd distention
5. UA: microscopic or gross hematuria, leukocytes, crystals - always culture urine
6. imaging: CT w/o contrast is best - can see stones 1mm small |
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Term
Where is kidney stone based on pain?
1. pain radiates to anterior abd
2. pain radiates to groin, testicle, labia
3. urinary frequency and urgency with lower pelvic pain |
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Definition
1. upper ureter
2. lower ureter
3. UVJ |
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Term
Tx of nephrolithiasis:
1. <5mm stones
2. 5-10 mm stones
3. >10 mm stones |
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Definition
1. <5mm stones: pass spontaneously - drink lots of fluids, strain urine to catch stone for analysis, analgesia, alpha blocker or CCB may facilitate passage
2. 5-10 mm stones: consider elective intervention if no complicating factors - lithotripsy or ureteroscopy; increase fluids, analgesia
3. >10 mm stones: inpt treatment with adequate fluids; percutaneous nephrostomy is gold standard if renal fxn is jeopardized; uregent lithotripsy if <2cm; percutaneous nephrolithotomy for >2cm |
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Term
Hypernatremia:
1. definition
2. causes
3. sx
4. labs
5. tx
6. problem with correcting too rapidly |
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Definition
1. definition: Na >145 mEq/L - either too much salt or not enoguh water
2. causes: inadquate fluid intake, excess water loss (diarrhea) - thirst deficit, hypotonic fluid loss, urinary loss, GI loss, insensible loss, burns, diuretics, osmotic diuresis, sodium excess, DI
3. sx: neuro manifestations - thirst, restlessness, irritability, disorientation, lethargy, delirium, convulsions, coma
- dry mouth and mucus membranes, lack of tears, decreased salivation, flushed skin, tachy, hypotension, fever, oliguria, anuria, hyperventilation, letahrgy, hyperreflexia
4. labs:
- Na>145
- low urine sodium may be high or low dependent on cause
5. tx: INPT
- free water (orally preferred, IV as 5% dextrose)
- treat hypovolemia with isotonic saline first, treat hypernatremia second
- dialysis for sodium >200 mEq/L
correcting too rapidly can cause cerebral/pulmonary edema, esp in DM |
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Term
hypernatremia with low urine sodium + polyuria
how to determine nephrogenic vs. central? |
|
Definition
diabetes insipidus
central: ADH will increase urine osmolality
nephrogenic: ADH has no effect bc receptors are not present |
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Term
Hyponatremia:
1. Sodium <__
2. hyponatremia with hypervolemia occurs in what conditions
3. hyponatremia with euvolemia happens with what conditions
4. ___ is hypotonic hyponatremia with urine osmolality >100 mOsm/kg; NL cardiac, hepatic, thyroid, adrenal, and renal fxn and no extracellular fluid deficit. urine sodium is usually >40 meq/L
5. sx
6. labs
7. tx |
|
Definition
1. Sodium <135 mEq/L
2. hyponatremia with hypervolemia occurs in CHF, nephrotic syndrome, renal failure, cirrhosis
3. hyponatremia with euvolemia happens in hypothyroidism, glucocorticoid excess, SIADH
4. SIADH is hypotonic hyponatremia with urine osmolality >100 mOsm/kg; NL cardiac, hepatic, thyroid, adrenal, and renal fxn and no extracellular fluid deficit. urine sodium is usually >40 meq/L
5. sx: occur at 125 meQ/L or less - lethargy, disorientation, muscle cramps, anorexia, hiccups, n/v, seizures, weakness, agitation, hyporeflexia, orthostatic hyotension, Cheyne-Stokes respirations, delirium, coma, stupor
6. labs:
- sodium <135
- low plasma osmolality except in cases of hyperglycemia or prteinemia
7. tx:
- treat hypovolemia inpt with isotonic saline
- neprho/endo consult |
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Term
| an abnormal pattern of breathing characterized by progressively deeper and sometimes faster breathing, followed by a gradual decrease that results in a temporary stop in breathing called an apnea - cycles over 30 sec to 2 min |
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Definition
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Term
Causes of Hyponatremia:
1. plasma osmolality 280-295 mOsm/kg
2. plasma osmolality >295
3. plasma osmolality <280
4. urine osmolality <100
5. urine osmolality >100
6. Normal extracellular fluid volume?
7. deceased ECFV + increased urine sodium
8. decreased ECFV + decreaed urine soidum
9. increased ECFV + increased urine sodium
10. incresaed ECFV + decreased urine sodium |
|
Definition
Step One: plasma osmolality
1. plasma osmolality 280-295 mOsm/kg: isotonic hyponatremia (paraproteinemia, hypertriglyceridemia)
2. plasma osmolality >295: hypertonic hyponatremia (hyperglycemia)
3. plasma osmolality <280: hypotonic hyponatremia --> measure urine osmolality
Step Two: Urine osmolality
4. urine osmolality <100: excessive water intake (primary polydipsia)
5. urine osmolality >100: impaired renal diluting --> assess ECFV
Step Three: Assess extracellular fluid volume
6. Normal extracellular fluid volume: endocrinopathies (hypothyroid, glucocorticoid inusfficiency), SAIDH, reset osmostat, K+ depletion, thiazide diuretics
7. deceased ECFV + increased urine sodium: renal solute loss (diuretics, osmotic diuresis, Addison's)
8. decreased ECFV + decreaed urine soidum: extrarenal sodium loss
9. increased ECFV + increased urine sodium: renal failure
10. incresaed ECFV + decreased urine sodium: edematous disorders (CHF, cirrhosis, nephrotic) |
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Term
| Overly rapid correction of hyponatremia can cause? |
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Definition
| central pontine myelinolysis resulting in neuro damage |
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Term
Diabetes Insipidus:
1. a disorder of ___
2. Neurogenic/central DI is caused by ____
3. Nephrogenic DI is caused by ___
4. sx
5. tests to determine cause
6. Tx |
|
Definition
1. a disorder of water
2. Neurogenic/central DI is caused by deficient secretion of ADH (vasopressin) from the posterior pituitary
3. Nephrogenic DI is caused by kidnyes unresponsive to ADH - congenital (x-linked) or acquired (lithium, hypokalemia, hypercalcemia, renal dz)
4. sx: polyuria 12 L/day, nocuria, polydipsia
5. tests:
- desmopressin testing and water deprivation testing - if test results in reduced urine output, it is central DI
- Urine osmolality of <250 despite hypernatremia indicates DI
6. Tx:
- central: parenteral or intranasal desmopressin (DDAVP)
- diuretics, chlorpropamide, carbamazepine for mild disease
- nephrogenic: HCTZ or amiloride diuretics or indomethacin
- limit salt and protein |
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|
Term
Volume depleiton:
1. occurs when body fluids are lost from __ compartment at a rate that exceeds intake
2. sources of fluid loss
3. sx
4. labs
5. tx |
|
Definition
1. occurs when body fluids are lost from extracellular compartment at a rate that exceeds intake
2. sources of fluid loss: GI tract, kidneys, skin, third spacing (ascites), burns
3. sx: thirst, decreased urine output, decreased skin turgor, dry mucus membranes, tachy, fatigue, cramps, dizziness, orthostatic hypotension, ischemia, shock, lethargy, confusion
4. labs: increased Hct and albumin, decreased urine sodium, increased urea
5. tx:
- tx by increasing salt and water intake
- severe: oral fluids with electrolytes, glucose, amino acids
- IV fluids (isotonic) if pts cannot tolerate oral solutions |
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Term
hyperkalemia:
1. causes
2. associated disorders
3. sx
4. labs, EKG findings
5. tx |
|
Definition
1. causes: redistribution from intracellular to extracellular, K retention, impaired K excretion, increased tissue breakdown, hemolysis, thrombocytosis
2. associated disorders: renal failure, ACEs, hyporeninemic hypoaldosteronism, cell death, metabolic acidosis
3. sx: dysrhythmias, cardiac arrest, neuro sx (numbness/tingling, weakness, flaccid paralysis)
4. labs, EKG findings
- K+ >5 meq/l
- BUN and Cr should be assessed to assess renal fxn
- urine K, Cr, and osmolality to reveal decreased excretion
- EKG changes starting at 6 meq/l: peaked T waves --> flattened P wave --> prolonged PR interval --> widened QRS (>7 meq/L) --> sine wave with cardiac arrest (8-10 meq/L)
5. tx:
- correct hyperkalemia, then find cause
- d/c K-sparing diuretics and K supplements
- low K diet
- severe: calcium gluconate IV to counteract hyperkalemia effects on heart
- Sodium bicarb, glucose, and insulin to drive K back into intracellular
- Sodium plystyrene sulfonate (Kayexalate) when K is extrememly high
- may need dialysis |
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|
Term
Hypokalemia:
1. serum K <__
2. causes
3. sx
4. EKG findings
5. helpful labs to determine cause
6. tx
7. hypokalemia potentiates the effects of what drug? |
|
Definition
1. serum K <3.5 mEq/L
2. causes: diuretics, renal tubular acidosis, GI loss
3. sx: ventricular arrhythmias, hypotension, cardiac arrest
- neuro sx: malaise, skeletal muscle weakness, cramps, ileus, constipation (smooth muscle involvement)
- Other: polyuri, nocturia, hyperglycemia, rhabdomyolysis
4. EKG findings: flattened/inverted T waves, increased U waves, ST depression, ventricular ectopy
5. helpful labs to determine cause acid-base parameters, urinary K and Cl
6. tx:
- only emergency if cardiac sx
- nonemergent: oral K as KCl is preferred
- emergent (<2.5 mEq/L or arrhythmias): IV K replacement
7. hypokalemia potentiates effects of cardiac glycosides and my lead to dig toxicity -- need more aggressive replacement of K in this situation |
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Term
Ca and P imbalances:
1. mechanisms for Ca and P homeostasis are complex and maintained by several mechanisms that involve ___, ___, ___, ___, and ___.
2. Effect of PTH on Ca and P
3. 3 most common causes of Ca and P imbalance
4. |
|
Definition
1. mechanisms for Ca and P homeostasis are complex and maintained by several mechanisms that involve Vit D, small intestine, renal tubules, PTH, bone
2. Effect of PTH on Ca and P:
- Increase PTH = increased Ca and decreased P
- Decreased PTH = decrease Ca and increased P
3. Parathyroid disorders, chronic renal failure, malignancy are most common causes of Ca/P disorders |
|
|
Term
Hypercalcemia:
1. common causes
2. sx and when they start
3. serum calcium determination
4. workup to find cause
5. tx |
|
Definition
Hypercalcemia: neuro sx, malignancy
1. common causes: Malignancy most common (lung, squamous cell, female genital tract, multiple myeloma, lymphoma, renal cell carcinoma
- other: vit D intox, hyperparathyroidism, sarcoidosis
2. sx and when they start: begin at >12 mg/dl, depending on hydration status, underlying malignancy, and rapidity of onset - BONES, GROANS (constipation, nausea, anorexia), STONES (polyuria, polydipsia, lithiasis, dehydration), MOANS, Psych UNDERTONES (AMS)
3. serum calcium determination: total calcium + [0.8x(4-albumin)] --> just remember have to correct for albumin
4. workup:
- CXR for underlying pulmonary mass
- UA for hematuria (renal cell carcinoma)
- ESR/protein electrophoresis for monoclonal gammopathy (AKA Paraproteinemia) = multiple myeloma
- 24 hr urine ca collection: high = malignancy, low = hyperparathyroidism (?) or familial hypocalciuric hypercalcemia
- serum Vit D for toxicity
5. tx:
- isotonic saline if hypovolemic (loops if hypervolemic after volume replacement)
- tx underlying cause
- notice correcting Ca is not a treatment |
|
|
Term
Hypocalcemia:
1. causes
2. sx
3. workup
4. tx |
|
Definition
Hypocalcemia: neuro --> cardiovascular
1. causes: more common than hypercalcemia - chronic disease, esp kidney; hypoparathyroidism
2. sx: usually none
- dry skin, brittle nails, muscle cramps, pruritis, SOB, numbness/tingling, psoriasis, perioral numbness
- Cardiovascular: syncope, angina, wheezing, bradycardia, crackles, S3
- Neuro: Trousseau's sign (carpal tunnel spasm after BP cuff applied for 3 min), Chvostek's sign (spasm of facial muscle after tapping facial nerve in front of ear); irritability, confusion, dementia, seizure
3. workup:
- corrected serum Ca <8.5 mEq/L
- Measure ionized Ca (unaffected by albumin but is affected by acid-base status), Mg, P, albumin, LFT, Cr, BUN
4. tx:
- treat cardiac emergencies first
- severe hypocalcemia: replace with IV calcium gluconate or calcium chloride
- mild: outpt tx with oral calcium and vit D |
|
|
Term
Hyperphosphatemia:
1. most commonly secondary to ___
2. tx
Hypophosphatemia:
1. most commonly secondary to ___ or ___
2. Level for moderate and severe
3. sx of severe
4. tx |
|
Definition
Phosphate: rhabdo
Hyperphosphatemia:
1. most commonly secondary to CKD
2. tx: dietary P restriction, oral P binders (calcium carbonate) BID with meals
Hypophosphatemia:
1. most commonly secondary to diminished supply or absortion OR increased urinary loss or redistribution
2. Level for moderate and severe:
- Mod: 1.0-2.5 mg/dl - usually asymptomatic
- severe: <1 mg/dl
3. sx of severe: rhabdomyolysis, paresthesia, encephalopathy
4. tx: oral P repletion |
|
|
Term
Hypermagnesemia:
1. Mg >__ mEq/L
2. most mg is stored where?
3. causes
3. sx
4. EKG changes, other lab changes
5. tx |
|
Definition
Hypermagnesemia: impaired neuromuscular transmission, EKG changes
1. Mg >2.5 mEq/L
2. most mg is stored in muscle and bone
3. causes: CKD, overdose from Mg-containing meds (laxatives, antacids), iatrogenic (tx for eclampsia or preterm labor)
3. sx: usually none, but when they do exist, they reflect impaired neuromuscular transmission:
- reduced DTR
- muscle weakness, hypotension, resp depression, cardiac arrest
- n/v/flushing
4. EKG changes: widened QRS, prolonged PR and QT
- other lab changes: bleeding and clotting time
5. tx: 10-20 mL 10% calcium gluconate IV over 10 min
- saline diuresis and IV furosemide to increase Mg excretion
- dialysis if severe |
|
|
Term
Hypomagnesemia:
1. Mg <__ meQ/L
2. causes
3. associated disorders
4. sx
5. labs, EKG
6. tx |
|
Definition
Hypomagnesemia: EKG changes, weakness, seizures/tetany, hypoparathyroid
1. Mg <1.5 meQ/L
2. causes: diminished intake or impaired absorption
3. associated disorders: alcoholism, chronic diarrhea, hypoparathyroid, hyperaldosterone, diuretics, osmotic diuresis, nutritional deficiencies (prolonged parenteral feedings, malnutrition)
4. sx: lethargy, anorexia, n/v, weakness, tetany, seizures
5. labs: associated hypokalemia, calcemia, calciuria
- EKG: prolonged PR and QT, widened QRS
6. tx: oral mag oxide
- severe: mag sulfate IV or IM |
|
|
Term
Acid base disorders:
1. low pH, high PCO2; high HCO3
2. Low pH, Low PCO2, Low HCO3
3. high pH, low PCO2, Low HCO3
4. High pH, High PCO2, High HCO3 |
|
Definition
Analysis:
1. pH: acidosis or alkalosis?
2. PCO2: to determine resp or metabolic
3. HCO3 (for compensaiton): if high PCO2, HCO3 will be high to compensate
- if low PCO2, HCO3 will be low to compensate
- If PCO2 and HCO3 do not match, it is not compensated
1. low pH, high PCO2; high HCO3: Respiratory acidosis
2. Low pH, Low PCO2, Low HCO3: metabolic acidosis
3. high pH, low PCO2, Low HCO3: resp alkalosis
4. High pH, High PCO2, High HCO3: metabolic alkylosis |
|
|
Term
1. pH <___ represents acidosis
2. pH <___ represents acidemia
3. pH >___ represents alkalosis
4. pH >___ represents alkalemia |
|
Definition
1. pH <7.4 represents acidosis
2. pH <7.35 represents acidemia
3. pH >7.4 represents alkalosis
4. pH >7.45 represents alkalemia |
|
|
Term
Definition: increase in pCO2 in blood (hypercapnia) and decreased blood pH
causes: failure of lungs to excrete CO2 that is generated through normal metabolism due to alveolar hypoventilation or overproduction of CO2
causes: REDUCED pulmonary function - primary pulmonary disease, myasthenia gravis, CNS dysfunction, drug-induced hypoventilation
Acute: increased pCO2 with minimal change in bicarb
After 2-5 days: renal compensation occurs leading to bicarb production and H+ secretion in distal neprhon
sx?
tx? |
|
Definition
respiratory acidosis
sx: metabolic encephalopathy (hypercapnic encephalopathy) - HA, drowsiness progressing to stupor and coma
Tx: treat underlying disorder
- pCO2 >60mmHg indicates need or assisted ventilation |
|
|
Term
Definition: decrease in pCO2 (hypocapnia) and increased pH due to INCREASED VENTILATORY DRIVE causing excessive elimination of CO2
causes: Anything that causes increased ventilation - anxiety (hysterical hyperventilation) is most common, salicylate intox, hypoxia, intrathroacic disoders, CNS dysfunction, septicemia, liver insufficiency, pregnancy, inappropriate mechanical ventilation
Acute: decreased CO2 and low pH
within hours: decrease in HCO3 due to H+ secretion in distal neprhon; serum Cl- levels rise to maintain electroneutrality
sx?
tx? |
|
Definition
Respiratory alkalosis
sx: same as hypocalcemia - paresthesias (extremities and perioral), light-headed, confusion, tetany, acroparesthesias (burning of hands and feet), giddiness
tx: treat underlying condition
- rebreathing
- Co2-enriched breathing or controlled ventilation if pH>7.6 |
|
|
Term
elevated serum H+ intitiated by either loss of bicarb or addition of H+
causes:
1. Increased anion gap (H+ retention): lactic acidosis, diabetic ketoacidosis, starvation ketosis; ethylene glycoal, methanol, or salicylate intoxication, renal tubular acidosis, renal insufficiency, adreanl insufficiency
2. normal anion gap (HCO3 loss): diarrhea, pancreatic/biliary drainage, ureteral diversion
pneumonic for high anion gap acidosis?
sx?
tx? |
|
Definition
Metabolic acidosis
High anion gap metabolic acidosis: MUDPILES
Methanol
Uremia (CKD)
DKA
Propylene glycol
Infection, Iron, Isoniazid, Inborn Error
Lactic acidosis
Ethylene glycol/Ethanol
Salicylates
Sx: Hyperventilation is first sign (stimulation of resp drive to blow off CO2), ventricular arrhythmias, neuro sx (lethargy to coma)
Tx:
-DKA: insulin and volume replacement
- give bicarb if pH <7.2 |
|
|
Term
increase in serum bicarb with no change in PCO2 causing an increase in extracellular pH >7.42 - due to kidney failing to excrete excess HCO3
causes: loss of H+ (vomiting), addition of bicarb (Hyperalimentaiton), disproportionate loss of Cl (diarrhea)
- vomiting, NG suction, villous adenoma, cl diarrhea, diuretics, hypercalcemia, milk-alkali syndreom, mineralcorticoid excess (hyperaldosteronism/Conn's syndrome), Bartter's and Gitelman's sydnromes, Clo and K depletion due to excessive steroids
pH >7.42, increased bicarb, increased PCO2
Urine chloride to delineate cause
sx? tx? |
|
Definition
metabolic alkalosis
sx: neuro: hypocalcemia sx, hypokalemia sx
tx:
- goal: increaed renal bicarb excretion
- if Cl-responsive (gastric fluid loss, diuretic cause): NaCl solution
- Cl-resistant (mineralcorticoid excess cause): spironolactone, aldosterone antagonist, remove adrenal adenoma |
|
|
Term
|
Definition
Na - (HCO3 + Cl)
normal anion gap is 8 +/- 4 mEq/L |
|
|
Term
Cystitis:
1. common orgnaisms
2. sx
3. UA
4. when to image
5. tx |
|
Definition
1. common orgnaisms: e. coli 80-85%, then enterococci (gram +)
2. sx: irritative voiding (urgency, frequency, dysuria), suprapubic discomfort, hematuria - sx may appear after sex
3. UA: pyruia, bacteriuria, hematuria, pos culture
4. when to image: pyelo, recurrent infx, anatomic abn
5. tx:
- uncomplicated: fluoroquinolone (cipro) 3-5 days
- resistant e. coli: bactrim
- encourage fluids
- phenazopyridine (urinary analgesia - turns pee orange), sizt baths for sx
|
|
|
Term
Pyelo:
1. acute infx process involving what 2 parts of kidney?
2. complications
3. organism
4. chronic pyelo is usually due to ?
5. sx
6. labs - CBC, UA, when to image
7. tx and follow up |
|
Definition
1. acute infx process involving renal parenchyma and renal pelvis - usually begins as UTI
2. complications: bacteremia - more common in DM and elderly
3. organism: gram neg (e. coli 85%, proteus, klebsiella, enterobacter, pseudomonas)
4. chronic pyelo is usually due to urinary tract abn such as vesicoureteral reflux
5. sx: fever, flank pain, shaking cills, irritative voiding sx; n/v/d; tachy, fever, CVA tenderness
6. labs:
- CBC: leukocytosis w/ left shift
- UA: pyuria, bacteriuria, hematuria, WBC casts, culture
- complicated infx: renal US may show hydronephrosis secdonary to obstruction
7. tx:
- outpt: quinolones or bactrim x 1-2 weeks
- Inpt for severe infx or complicating factors (old, comorbids, obstruction, inability to tolerate oral) - IV fluoroquinolones or ampicillin + gentamycin until sensitivities are back. Cont 24-48 hrs after afebrile then oral abx to complete at least 2 weeks of therapy
- Failure to respond to abx warrants imaging
- FU urine cultures 1-2 weeks after treatmetn |
|
|
Term
Prostatits:
1. acute bacterial due to?
2. chronic bacterial due to?
3. chronic nonbacterial due to?
4. complicaitons
5. sx
6. labs: UA, culture, Four-glass localization test
7. tx |
|
Definition
1. acute bacterial due to gram neg rods (e. coli, enterobacter, pseudomonas)
2. chronic bacterial due to evolution or recurrent acute infx - still gram neg rods
3. chronic nonbacterial is most common - unknown cause - often called chronic pelvic pain syndrome
4. complicaitons: prostatic abscess (complication of acute bacterial)
5. sx:
- acute: sudden onset fever, chills, low back and perineal pain
- Chronic: variable, no fever, usually intermittent and recurrent sx
- all forms have irritative voiding sx and some obstruction + swollen,tender prostate
6. labs:
- UA: pyuria
- culture of prostatic fluid: e. coli usually (neg if nonbacterial) + lecithin count (low is bad)
- Four-glass localization test: to determine chronic prostatitis from another UTi - UA at initial void, midstream, and after prostatic massage, and then also a prostatic secretion sample. DO NOT DO IN ACUTE PROSTATIIS
7. tx:
- Inpt: parenteral gentamycin + ampicillin until culture and afebrile x 24-48 hrs
- <35 y/o: ofloxacin x 10 days or ceftriaxone IM followed by 10 days of doxy
- >35 y/o: cipro or bactrim for 10-14 days
- Chronic: cipro x 4 weeks, ofloxacin x 6 weeks, or bactrim x 1-3 mos
- NSAIDs
- may need transurethral resection if recurrent/resistant
- NEVER MASSAGE PROSTATE IN ACUTE BACTERIAL - CAN LEAD TO SEPSIS |
|
|
Term
Orchitis:
1. most common causes
2. sx
3. UA
4. when to image
5. tx |
|
Definition
1. most common causes: UTI or mumps
2. sx: swelling, tenderness, fever, tachy - usually unilateral
3. UA: pyuria, bacteriuria, + culture
4. when to image: abscess or tumor suspected
5. tx:
- mumps: viral, so sx relief - ice, analgesia
- bacteria <35: ceftriaxone 250 IM + doxy 100 BID x 10 days --> covers STDs
- bacteria >35: cipro 500 BID x 10-14 days |
|
|
Term
Epididymitis:
1. Infx of epididymis acquired by retrograde spread of organisms through the ___
2. most common causes by age
3. sx
4. UA
5. tx |
|
Definition
1. Infx of epididymis acquired by retrograde spread of organisms through the vas deferens
2. most common causes by age
- <35: gonorrhea, chlamydia
- >35: e. coli
3. sx: heaviness, dull ache in affected hemiscrotum that can radiate up ipsilateral flank; markedly swollen and exquisitely tender epididymis - becomes warm, erythematous, large; fever, chills
- Prehn's sign: relief with scrotal elevation
4. UA: pyuria, bacteriuria
5. tx:
<35: ceftriaxone 250 IM + doxy 100 BID x 10 days
>35: cipro 500 BID x 10-14 days
- bed rest, scrotal elevation, analgesia |
|
|
Term
BPH:
1. epidemiology
2. sx
3. labs
4. tx |
|
Definition
1. epidemiology: avg age 60-65 y/o
2. sx: prostatism (obstruction and irritation)
- obstructive sx: decrease force and caliber of stream, histancy, straining, postvoid dribbling, sensation of incomplete emptying
Irritative: frequency, nocturia, urgency
- recurrent UTI, urinary retention
3. labs:
- DRE: enlarged prostate
- PSA: slightly elevaed
- evaluate for renal damage, infx, prostate/bladder cancer as needed
4. tx:
- mild-mod: watchful wiating and monitoring
- Meds: alpha aderenergic antagonists (doxazosin, terazosin, tamsulosin), 5alpha-reductase inhibitors (finesteride/Proscar)
-Procedures: balloon dilation, microwave irradiation, stent placement
- surgical transurethreal resection |
|
|
Term
Types of incontinence:
1. results from bladder contractions that cannot be controlled
2. dysfuncion of urethral sphincter that allows urine to laek with incrased intra-abd pressure - laughing coughing sneezing
3. urinary retention leads to bladder distention and overflow of urine
4. untimely urination caused by physical or cognitive disability preventing person from reaching the toilet
5. mixed incontinence: elements of __ and __ |
|
Definition
1. urge
2. stress
3. overflow
4. functional
5. stress and urge |
|
|
Term
urinary incontinence:
1. reversible causes
2. ___ is a related sx complex characterized by frequency, urgency, nocturia w/ or w/o urge incontinence
3. untreated overflow incontinence can lead to __ and ___
4. common associated disorders
5. workup
6. tx |
|
Definition
1. reversible causes: meds, prostatectomy, excess fluid intake, atrophic vaginitis, fecal impaction, UTI, impaired mobility, glycosuria
2. overactive bladder is a related sx complex characterized by frequency, urgency, nocturia w/ or w/o urge incontinence
3. untreated overflow incontinence can lead to hydroneprhosis and obstructive nephropathy
4. common associated disorders: neuro disease (stroke, alzheimers, parkinsons), metabolic disorder (DM, hypoxemia), pelvic disorders (uterine prolapse)
5. workup:
- UA: glycosuria, UTI
- postvoid residual volume
- urodynamic studies (cystometry) to measure bladder contractions
- stress test, US, cystoscopy, cystography to ID anatomic abn
6. tx:
- Kegels, electrical muscle stimulation, biofeedback, bladder training
- Stress: pessaries, implants, estrogen, surgery
- Urge & overactive bladder: anticholinergics (oxybutynin, tolterodine)
- Overflow: catheterization |
|
|
Term
Prostate cancer;
1. common slow-growing neoplasm of __ cells
2. Majority originate in ___ zone then __ zone, then ___ zone
3. risk factors
4. sx
5. workup
6. tx |
|
Definition
1. common slow-growing neoplasm of adenomatous cells
2. Majority originate in peripheral zone (most palpable on DRE) then transitional zone (part around urethra), then central (part with ejaculatory ducts) zone
3. risk factors: genetics, hormones, diet and environment, infeciton
4. sx: usually none; obstructive/irritative occur if invasion into urethra, bladder neck, or trigone; mets: bone pain, nerve impingment
5. workup
- DRE: enlarged nodular prostate
- PSA: elevated
- tissue pathology
- transrectal US: hypoechoic lesions
- Bx
- Staging wtih CT/MRI, lymph node bx, bone scan
6. tx:
- low grade: none
- stage A and B (confined to prostate): readical retropubic prostatectomy, brachythearpy (internal radiation), external beam radiation
- Stage C (local invasion): same as A and B but less effective
- Stage D (distant mets): hormonal (orchiectomy, antiandrogens, LHRH agonists, estrogen) |
|
|
Term
Bladder cancer:
1. risk factors
2. cell type
3. sx
4. dx procedure
5. staging procedure
6. tx |
|
Definition
1. risk factors: smoking, occupational toxinogens (rubber, dye, printing, chemical); schistosomiasis; cyclophosphamide exposure; chronic infx
2. cell type: uroepithelial (transitional cells)
3. sx: painless hematuria most common; bladder irritability and infx
4. dx procedure: cystoscopy w/ bx
5. staging procedure: IV urogram, pelvic/abd CT, CXR, bone scan, pyelography
6. tx:
- superficial: endoscopic resection and fulguration (electricity to destory tissue) with cystoscopy q3 mos; intravesicular instillation of thiotepa, mitomycin-C or bacillus calmette-guerin
- Reccurent, diffuse TCC in situ, and invasion into muscle: cystectomy
- Chem and radiation for non-surgical candidates |
|
|
Term
Renal Cell carcinoma:
1. risk factors
2. hereditary forms
3. sx
4. labs
5. dx via?
6. tx |
|
Definition
1. risk factors: smoking is #1, dialysis
2. hereditary forms: hippel-lindau disease; hereditary papillary renal carcinoma
3. sx: wide range - "internists' tumor" - hematuria, abd pain/mass, flank pain
4. labs: (possibilities)
- CBC: normochromic anemia, erythrocytosis, hypercalcemia
- elevated LFTs
- CMP: elevated ESR, hypercalcemia
- HTN
5. dx via Ct scan
6. tx - depends on Furman grade and stage:
- Localized disease (T1-T3a): radical nephrectomy
- Disseminated disease: radiation (palliative)
- alpha-interferon and interleukin have shown some succes in all stages |
|
|
Term
AKA nephroblastoma - the most common solid renal tumor of childhood
sx: abd mass; anorexia, n/v, fever, abd pain, hematuria, HTN due to elevated renin
UA: hematuria
US: initial study of choice to evaluate mass
CT: for staging
CXR for lung mets
tx? |
|
Definition
Wilms' tumor
tx:
- Surgery + chemo +/- radiation
- radical nephrectomy w/ lymph node sampling is choice in surgically resectable tumors
- chemo: vincristine, doxorbicin, dactinomycin |
|
|
Term
Testicular cancer:
1. risk factors
2. sx
3. workup
4. types |
|
Definition
1. risk factors: cryptorchidism; hx of test cancer
2. sx: painless solid testicular mass; heaviness, ureteral obstruction; abd complains
3. workup:
- US is initial study for mass
- CT for mets
- elevated a-fetoprotein or a-human chorionic gonadotropin: dx for nonseminomas
4. types:
- seminomas (embryonal carcinoma, teratoma, mixed type, choriocarcinoma) or nonseminomas
|
|
|
Term
|
Definition
Orchiectomy for all cancers PLUS:
Seminomas:
Stage I- radiation to para-aortic and ipsilateral iliac nodes
Stage IIa&b- increased radiation
Stage IIc & III - chemo
Nonseminomas (not radiosensitive):
Stage I: nerve-sparing retroperitoneal lympho node dissection or just surveillance
Stage II: surgery or chemo
Stage III: surgery and chemo
|
|
|
Term
inability to retract foreskin over glans
congenital is usually physiologic
acquired: poor hygiene, chronic balanitis - consider DM if this happens
sx: erythema, tenderness, purulent drainage, inability to retract foreskin, obstructed urinary stream, hemauria, pain
tx? |
|
Definition
phimosis
tx:
- congenital: nothing, will fix itself as kid ages
- acquired: abx, steroid creams, circumcision |
|
|
Term
entrapment of foreskin behind glans
usually caused by catheterizaiton without retracting foreskin or by forcibly retracting a phimosis or by vigorous sex
sx: pain, edema, erythema
ID any encircling foreign bodies: hair, rubber bands, etc
tx? |
|
Definition
paraphimosis
tx: emergent reduction
- try manually first - squeeze glans for 5 min to reduce edema then try to reduce
- surgical reduction
- after reduction, needs circumcision |
|
|
Term
ED:
1. things needed for adequate erection
2. most causes of __ cause
3. risk factors
4. PE
5. important hx
6. workup
7. tx |
|
Definition
1. things needed for adequate erection: parasympatetic and somatic nerve supply, arterial flow, venous constriciton, hormonal stimulation, desire
2. most cases of organic cause (with secondary psych cause)
3. risk factors: HTN, DM, hyperlipidemia, cardiovascular dz
4. PE: penile deformity, atrophy, HTn, neuropathy
5. important hx:
- meds - antiHTN are often cause
- sexual hx: frequency and timing, partners, presence of morning erections, ejaculation, ability to masturbate --> international index of erectile function establishes a baseline
- PMH: HTN, DM, endocrine disease, meds, pelvic surgery, truama
6. workup: CBC, UA, lipids, thyroid function, testosterone, glucose, prolactin
- FSH, LH if prolactin is abn
- nocturnal penile tumescence - normal nocturnal erections = psychogenic cause
- direct injection of vasoactive substances induces eretion in vascular insufficiency --> indicates need for more vscular studies
7. tx:
- psych: behaviorally oriented sex therapy
- phosphodiesterase-5 inhibitors is mainstay (sildenafil, vardenafil, tadalafil) --> SE are flushing, HA, dyspepsia, rhinitis, visual disturbance, priapism - cannot take wtih nitrates due to risk of hypotension
- vaccum constriction devices, injected/inserted vasoactive substances, penile prosthesis, arterial reconstruction |
|
|
Term
fluid-filled congenital remnants of tunica vaginalis resulting from patent processus vaginalis
sx: soft, nontender fullness of hemiscrotum that transilluminates - may wax and wane in size. may have concurrent indirect hernia
labs: neg UA, US rarely indicated
tx? |
|
Definition
hydrocele
tx: elective reapir |
|
|
Term
painless cystic mass containing sperm, usually <1cm in size
- lies superior or posterior, distinct from testes
sx: round, firm cystic mass with distinct boards, free floating above testicle. transilluminates. +/- tenderness
dx via US
tx? |
|
Definition
spermatocele
tx: none usually
- can do surgical removal or sclerosing
- DO NOT DO NEEDLE ASPIRATION |
|
|
Term
testis abnormally twisted on spermatic cord compromising arterial supply and venous drainage leading to ischemia
most common in 12-18 y/o, esp with hx of cryptorchidism
sudden onset severe unilateral pain and swleling, neg Prehn's sign
clinical dx |
|
Definition
testicular torsion
tx: analgesia
- manual detorsion (twist outward and laterally) can be attempted but will need surgery anyway
- surgical detorsion and orchipexy are definitive - can save testicle if within 6 hr
- may need elective orchipexy on contralateral testicle |
|
|
Term
venous varicostiy wihtin spermatic vein (pampiniform plexus)
more common on LEFT
chronic nontender mass that does not transiluminate - bag of worms, increases with valsalva, decreases when supine and with scrotal elevation
Dx via US
tx? |
|
Definition
varicocele
tx: surgical repair (vein ligation) if painful or possible cause of inferitility |
|
|
Term
Primary amenorrhea:
1. Absence of spontaneous menses by age ___.
2. Women who fail to menstruate in the preseence of estrogen stimulation of endometrium are at increased risk for?
3. Amenorrhea in a woman with no secondary sex characteristics suggsests what differentials (8)?
4. Amenorrhea in a woman with breast development but no pubic or axillary hair suggests ___.
5. amenorrhea in a woman with normla secondary sex characteristics suggests what differentials (3)?
6. Amenorrhea in a woman with incompltely developed sex characteristics sggests what differentials (4)? |
|
Definition
1. Absence of spontaneous menses by age 16.
2. Women who fail to menstruate in the preseence of estrogen stimulation of endometrium are at increased risk for endometrial cancer
3. Amenorrhea in a woman with no secondary sex characteristics suggsests what differentials (8)?
- gonadal agenesis/dysgenesis, ovarian resistance syndrome, galactosemia, GnRH deficiency, constitutional delay, CNS lesions, stress, hyperprolactinemia
4. Amenorrhea in a woman with breast development but no pubic or axillary hair suggests androgen insensitivity.
5. amenorrhea in a woman with normla secondary sex characteristics suggests what differentials (3)?
- imperforate hymen, transverse vaginal septum, cervical/mullerian agenesis
6. Amenorrhea in a woman with incompltely developed sex characteristics sggests what differentials (4)?
- tumor of hypothalamus or pituitary, hypothyroid, premature ovarian failure, hyperprolactinemia |
|
|
Term
___ duct in embryology becomes the female reproductive system
___ duct becomes the male reproductive system |
|
Definition
| mullerian (paramesonephric); wolffian (mesonephric) |
|
|
Term
| Hypothalamic hormones (8) and action of each |
|
Definition
1. thyrotropin releasing hormone - stimulates TSH and prolactin release
2. dopamine: inhibits prolactin release
3. growth hormone releasing hormone: stimulates GH release
4. somatostatin: Inhibits GH and TSH release
5. Gonadotropin releasing hormone: Simulates FSH and LH release
6. corticotropin releasing hormone: stimulates ACTH release
7. Oxytocin: stimulates uterine contraction and lactation (letdown reflex)
8. Vasopressin (ADH): increases permeability of distal tubule and collecting ducts to water, increasing water reabsorption and urine concentration |
|
|
Term
| Anterior pituitary hormones (7) and their actions |
|
Definition
1. Adrenocorticotropic hormone (ACTH): stimulates adrenal secretion of glucocorticoids, mineralcorticoids, and sex steroids
2. Beta endorphin: inhibits perception of pain
3. TSH (thyrotropin): stimulates secretion of T3 and T4
4. FSH (follicle stimulating hormone): Growth of reportuctive system
5. LH: sex hormone production
6. Growth Hormone: Promotes growth and lipid and carb metabolism
7. Prolactin: stimulates milk production and secretion of estrogen/progesterone
|
|
|
Term
| Posterior pituitary hormones (2) and their actions |
|
Definition
Both are synthesized by the hypothalamuc but secreted by the PP
1. Oxytocin - uterine contractions, lactation
2. Vasopressin (ADH) - water retention, raises BP, concetrates urine, contracts arterioles, induces aggression |
|
|
Term
| Adrenal hormones and their actions |
|
Definition
CORTEX:
1. Aldosterone (cortex; mineralcorticoid): regulation of blood pressure by increasing absorption of sodium and excretion of potassium and H+ on the distal convoluted tubues and collecting duct - stimuli are ACTH (transient) and angiotensin II (major)
2. Cortisol (cortex; glucocorticoid): metabolizes fats, proteins, carbs; incrases blood sugar through gluconeogenesis; enhances activity of glucagon and catecholamines; activates anti-stress and anti-inflammatory pathways - basal level secreted by zona fasciculata, can produce bursts in response to ACTH
3. androgens (DHEA, androstendione [testosterone precursor])
MEDULLA: Catecholamine secretion (Norepi and epi) via chromaffin cells
|
|
|
Term
Secondary amenorrhea:
1. in a woman who has previously menstruated, it is defined as the absence of menses for ___ or longer.
2. In a woman with oligomenorrhea, it is defined as absence of menses for ___ or longer
3. most common cause
4. Look for s/s of what common causes?
5. IN women with normal estrogen, the cause is likely to be __ or __.
6. IN hypoestrogenic women, causes include (6) |
|
Definition
1. in a woman who has previously menstruated, it is defined as the absence of menses for 6 mos or longer.
2. In a woman with oligomenorrhea, it is defined as absence of menses for 12 mos or longer
3. most common cause: pregnancy
4. Look for s/s of what common causes - drug use, stress, significant wieght change, excessive exercise, prolactinemia (galactorrhea)
5. IN women with normal estrogen, the cause is likely to be PCOS or Asherman's syndrome
6. IN hypoestrogenic women, causes include CNS tumor, stress, hyperprolactiemia, hypophysitis, Sheehan's syndrome, premature ovarian syndrome
|
|
|
Term
1. hypopituitarism caused by necrosis due blood loss or hypovolemic shock during and after childbirth. Sx: agalactorrhea, amemorrhea/oligomenorrhea, other sx of pituitary dysfunction
2. adhesions or fibrosis w/in uterus (intraunterine synechiae) due to polyps |
|
Definition
1. Sheehan's syndrome
2. asherman's syndrome |
|
|
Term
| Workup for all causes of amenorrhea |
|
Definition
1. pregnancy test
2. FSH, estrogen, prolactin, testosterone, progesterone challenge test (for sufficient estrogen)
3. other: thyroid studies, pelvic US, hypthalamic/pituitary/pelvic CT |
|
|
Term
Primary dysmenorrhea:
1. Definition: painful mesntruation caused by excess ___ in the menstrual fluid, which causes smooth muscle contraction leading to painful uterine contractions and n/v/d. onset typically w/in __-__ months of menarche
2. Sx
3. dx via?
4. tx |
|
Definition
1. Definition: painful mesntruation caused by excess prostaglandin E2 in the menstrual fluid, which causes smooth muscle contraction leading to painful uterine contractions and n/v/d. onset typically w/in 3-6 months of menarche
2. Sx: cramping in central lower abd/pelvix radiating to back and thighs beginning at or before onset of menses and lasting for 1-3 days; normal PE
3. dx via hx and PE
4. tx: start NSAIDs just before expected menses and continue 2-3 days; OCP; head and regular exercise
- bad causes: tocolytics, CCB, progestogens |
|
|
Term
Secondary dysmenorrhea:
1. painful menstruation caused by ___. Ex?
2. sx
3. tx |
|
Definition
1. painful menstruation caused by identifiable cause. Ex: disease of uterus or pelvis (endometriosis, adenomyosis, fibroids, PID) or IUD
2. sx: painful menstruation, bloating, menorrhagia, dysparunia
- adenomyosis: implantation of endometrium in myometrium - tender, symmetrically enlarged, "boggy" uterus
3. tx: tx underlying conditions, remove IUD, treat sx
- may need more procedures to r/o or treat worse causes |
|
|
Term
PMS:
1. ___ is PMS severe enough to cause dysfunction in daily living
2. cause
3. sx and dx criteria (involving sx during certain stage of cycle)
4. tx |
|
Definition
1. premenstrual dysphoric disorder (PMDD) is PMS severe enough to cause dysfunction in daily living
2. cause: unknown, likely hormonal imbalance
3. sx: begin 1-2 weeks before menses, end 1-2 days after onset of menses
- sx free during follicular phase (day 1 to ovulation)
- mood: irritability, anxiety, depression, sleep changes, appetite changes, poor concentration, fatgiue, insomnia
- fluid retention: edema, weight gain, breast pain, bloating, constipation, backache
- Sx consistent month to month within same pt but vary from woman to woman
4. tx:
- education
- lifestyle: caffeine reduction, salt restriction, low-fat and high-complex carb diet, fresh foods, increased exercise, relaxation, stress reduction
- Drugs: pyridoxine (Vit B6), primrose oil, OCP, diretics, NSAIDs, SSRIs
|
|
|
Term
Phases of menstrual cycle and hormone levels:
Follicular phase/Proliferative phase
Luteal phase/secretory phase
Menses
LH peak
Ovulation |
|
Definition
Follicular phase/Proliferative phase:
- Follicular phase is stage of egg
- Proliferative phase is stage of endometrium
- Day 1-14
Luteal phase/secretory phase
- Luteal phase is stage of egg
- secretory phase is stage of endometrium
- Day 14-28
Menses:
- Day 1-4/5
LH peak
- Day 14, induces ovulation
|
|
|
Term
Menopause:
1. Menopuase is ____. Perimenopause is ___.
2. Mean age
3. time range
4. ___ is assoicated with early menopause
5. Premature menopause is that before ____
6. sx
7. lab confirmation
8. tx |
|
Definition
1. Menopuase is the last menses. Perimenopause is time frame surrounding last menses (3-5 years).
2. Mean age: 51.5
3. time range: 44-55
4. smoking is assoicated with early menopause
5. Premature menopause is that before 40 y/o
6. sx: vasomotor sx, urogenital atrophy, accelerated bone loss, loss of estrogen-related cardiovascular protection, changes in sleep cycle, thin skin, increased ffacial hair, lost scalp hair, brittle nails, decreased cognition, decreased libido
7. lab confirmation: FSH >30
8. tx: for sx - hormone replacment, SERMs and bisphosphonates for osteoporosis, lifestyle modifications, topical estrogen or urogenital cancer |
|
|
Term
| Hormone replacement risks and contraindications |
|
Definition
Risks: increased cardiovascular risk, breast caner, cognitive changes, gall bladder disase, migraine
CI: undiagnosed vaginal bleeding, acute thrombosis, hx of estrogen-dependent tumors |
|
|
Term
| unopposed estrogen increases risk for |
|
Definition
|
|
Term
Abnormal uterine bleeding in the absence of an anatomic lesion; usually caused by problem with the hypothalamic-pituitary-ovarian axis
- most commonly occurs during menopause or shortly after menarche due to abnormal cycles
- other causes: PCOS, exogenous obesity, adrenal hyperplasia
tx? |
|
Definition
Dysfunctional uterine bleeding
tx: observation, iron, volume replacement, estrogens, OCP, D&C |
|
|
Term
| OCP relative contraindications |
|
Definition
| smoking, HTN, DM, hx vascular disease, breast cancer, liver disease, HA |
|
|
Term
Lyomyomata (uterine fibroids):
1. dependo n ___ and appear more in women with endometrial hyperplasia, anovulatory, or hormone-producing tumors
2. 4 fold increase in ___
3. sx
4. tx |
|
Definition
1. depend on estrogen and appear more in women with endometrial hyperplasia, anovulatory, or hormone-producing tumors
2. 4 fold increase in endometrial cancer
3. sx: none, firm, irregular uterine enlargement; menorrhagia, metorrhagia (intermenstrual bleeding), dysmenorrhea; increased risk of SAB
4. tx: observation
- sx: myomectomy, hysterectomy, D&C
- GnRH agonists and mifepristone to reduce tumor size and aid fertility
- arterial ambolization |
|
|
Term
Endometrial cancer:
1. epidemiology
2. 2 types: __ is found in younger perimenopausal womne; ___ is found in older postmenopausal women
3. most common cell type
4. risk factors
5. ___ have a protective effect
6. sx
7. workup
8. tx |
|
Definition
1. epidemiology: med age 58 y/o, white > black
2. 2 types: estrogen-dependent is found in younger perimenopausal womne; estrogen-independent is found in older postmenopausal women
3. most common cell type: adenocarcinoma
4. risk factors: obesity, nulliparity, infertility, late menopause, DM, unopposed estrogen, HTN, gallbaldder dz, chronic tamoxifen use; NOT related to sexual hx
5. OCP have a protective effect
6. sx: inappropriate uterine bleeding
7. workup:
- any woman with postmenopausal bleeding: pap, endocervical curettage, endometrial bx
- other: fractional D&C, transvaginal US
8. tx:
- total hysterectomy with BSO
- may need radiation, high dose progestins |
|
|
Term
Endometriosis:
1. epidemiology
2. complication
3. sx
4. dx
5. tx |
|
Definition
1. epidemiology: nulliparous women in 20's and 30's
2. complication: infertility
3. sx: dysmenorrhea, deep-thrust dyspareunia, dyschezia, intermittent spotting, pelvic pain, cul-de-sac tenderness, fixed uterus
4. dx: laparoscopy, US
5. tx:
- few sx: expectant
- Sx: NSAIDs, prostaglandin synthetase inhibitors (cyclooxygenase/COX inhibitors)
- surgery
- Danazol or GnRH to improve fertility
- OCP or progestins |
|
|
Term
Extension of endometrium through myometrium; not thought to be related to endometriosis
sx: secondary dysmenorrhea
classic pt: middle aged parous woman with severe secondary dysmenorrhea and meenorrhagia and symmetrically enlarged uterus
dx via pelvis US |
|
Definition
adenomyosis
tx:
o Tx: D&C, GnRH agonist, mifepristone, hysterectomy
|
|
|
Term
uterine prolapse:
1. most typically occurs after ___
2. risk factors
3. sx
4. tx |
|
Definition
1. most typically occurs after pregnancy
2. risk factors: anything increases intra-abd pressure - chronic coughing, repetitive heavy lifting; obesity, asthma, COPD, pelvic tumors, ascites
3. sx: worse after prolonged stnding or late in the date, relieved by laying down; vaginal fullness, low abd ache, low back pain
- "feels like sitting on a ball"
- often associated cystocele, rectocele, or enterocele
4. tx:
- wt reduction, smoking cessation, kegel's, pessary
- surgery |
|
|
Term
Ovarian cysts:
1. most types are ___
2. sx
3. dx via?
4. tx |
|
Definition
1. most types are functional: follicular, corpus luteum
2. sx: asymptomatic, mass, pain, menstrual delay, hemorrhage (rupture)
3. dx via pevlic US
4. tx:
- <8 cm: follow for a few cycles
- large/persistent: laparoscopy
- PMP: assume malignant until proven otherwise |
|
|
Term
PCOS:
1. most common cause of __ and __
2. clinical features
3. typical pt
4. underlying abnormality
5. increased risk for?
6. sx
7. workup
8. tx |
|
Definition
1. most common cause of androgen excess and hirsutism
2. clinical features: polycystic ovaries, amenorrhea/oligomenorrhea, infertility
3. typical pt: nroaml puberty and then progressively longer anemorrhea
4. underlying abnormality: hypothalamic/pituitary dysfunction and insulin resistance
5. increased risk for endometrial hyperplasia/carcinoma
6. sx: hirutism, obesity (truncal), infertility, intractable acne, menstrual irregularities, acanthosis nigricans, impaired glucose tolerance/DM
7. workup:
- US: "string of pearls"
- serum androgen (high), increased LH/FSH ratio, lipid abnormlaities, insulin resistance
8. tx:
- weight loss
- Hirsutism: androgen lowering agents, OCP
- Inferitility: clomiphene, wedge resection of ovary
- Meds for lipids and insulin resistance |
|
|
Term
Ovarian cancer:
1. risk factors
2. ___ may be protective
3. Sx
4. workup
5. tx
6. prognosis |
|
Definition
1. risk factors: old, nulliparous, white, fm hx ovarian or endometrial cancer
2. OCP may be protective
3. Sx: none til late; ascites, abd distention, vague GI complaints, mass
4. workup:
- BRCA 1 gene (pos in 5%)
- P53 gene
- Transvaginal/abd US to distinguish benign/malignant mass
5. tx: surgery + chemo + radiation
6. prognosis:
- 40% 5 year survival |
|
|
Term
Cervical dysplasia/neoplasia:
1. Risk factors
2. ___ is atypical changes in transformation zone of the cervix - it is the preinvasive form of cervical cancer
3. Epidemiology
4. sx
5. workup
6. tx |
|
Definition
1. Risk factors: HPV, early first intercourse, early childbearing, multiple partners, high risk partners, hx STD, low SES, african american, smoking
2. cervical intraepithelial neoplasia (CIN) is atypical changes in transformation zone of the cervix - it is the preinvasive form of cervical cancer
3. Epidemiology: CIN in 20's, CIS 25-35 y/o, cacner >40 y/o
4. sx: abn pap
- vaginal bleeding/discharge
5. workup:
- Pap smear
- abn pap: colposcopy with bx; conization if unsatisfactory colposcopy or severe disease
- test for HPV
6. tx:
- mild: may resolve spontaneosuly
- CIN: LEEP, electrocautery, cryocautery, laser, conizaiton, or excision
- Cancer: hysterectomy with pelvic lymphadenectomy or radiation |
|
|
Term
HPV:
1. types that cause cancer
2. types that cause condyloma
3. __% of CIN and __% of invansive cerivcal cancer are HPV+ |
|
Definition
cancer: 16, 18, 31, 33, 45
condyloma: 6 and 11
80% of CIN and 90% of cancer |
|
|
Term
|
Definition
3 years after first intercourse or age 21, whichever comes first
Annual pap reduces cervical cancer by 95%
|
|
|
Term
|
Definition
| All girls age 11-12 (approved for 9-26) |
|
|
Term
Vulvo-vaginal neoplasm:
1. epidemiology
2. risk factors
3. sx
4. workup
5. tx |
|
Definition
1. epidemiology: rarest of gyn cancers - most are squamous cell and occur in PMP women
2. risk factors: exposure to DES in-utero (increased risk for adenocarcinoma of vagina), obesity, HTN, DM, arteriorsclerosis, hx of vulvar itching, HPV infx, smoking, coexisting cervical cancer
3. sx: PMP bleeding or bloody discharge
4. workup:
- acetic acid application or staining with toluidine blue with bx via culposcopy or Lugol staining
5. tx:
- early: local excision, topical 5-FU, laser
- surgical excision + radiotherapy
- clear cell lesions: radical hysterectomy with vaginectomy or radiation |
|
|
Term
Benign breast disorders:
1. breast tenderness; usually associated with cycle, OCP, hormone replacement
2. infection or abscess; most commonly caused by staph aureus in primigravid lactating women; can be from secondary infx of galactocele. Sx: tenderness, heat, pain, fever and chills
3. most common; include cysts, papillomatosis, fibrosis, adenosis, ductal epithelial hyperplasia; asymptomatic or painful masses; multiple, size fluctuation
4. 2nd most common; occur more in young black women; round, smooth discrete, mobile, non-tender
workup
tx? |
|
Definition
Benign breast disorders:
1. breast tenderness; usually associated with cycle, OCP, hormone replacement - mastodynia/mastalgia
-TX: Vit B6, bromocriptine, tamoxifen, danazol
2. infection or abscess; most commonly caused by staph aureus in primigravid lactating women; can be from secondary infx of galactocele. Sx: tenderness, heat, pain, fever and chills - mastitis
- TX: penicillinase-resistant abx (cloxacillin, dicloxacill, nafcillin) or cephalosporin, hot compresses; surgery for abscess
3. most common; include cysts, papillomatosis, fibrosis, adenosis, ductal epithelial hyperplasia; asymptomatic or painful masses; multiple, size fluctuation -- Fibrocystic changes
TX: no tx
4. 2nd most common; occur more in young black women; round, smooth discrete, mobile, non-tender - fibroadenoma
TX: excision or expectant managment
workup: mammography, US, bx
- try to induce discharge
- bx any fibroadenomatous mass in woman <25
avoid caffeine, salt
- Vit D and HCTZ premenstrually may help |
|
|
Term
Breast cancer:
1. epidemiology
2. risk factors
3. increases risk for?
4. cell types
5. sx
6. dx
7. tx
quadrant distribution |
|
Definition
1. epidemiology: most common female malignancy; 2nd leading cause of cancer death in women
2. risk factors: usually none; BRCA pos, increasing age, nulliparity, early menarche, late menopause, long term estrogen or radiation exposure, delayed childbearing, first degree relative
3. increases risk for endometrial cancer
4. cell types: ductal carcinomas and lobular carcinomas
- paget's is a ductal carcinoma
- All lobular carcinomas and 2/3 of ductals are estrogen-receptor positive
5. sx:
- single, nontender, firm, immobile mass
- persistent noncyclic breast pain
- nipple d/c, retraction, dimpling, breast enlargment or shrinkage, skin thickening, peau d'orange skin, eczematous changes, axillary node enlargement, ulcerations, edema, palpable supraclavicular nodes
6. dx:
- PE + mammography and fine needle or steriotactice core needle bx; may need US + excisional bx
- estrogen and progesterone receptor analysis
7. tx:
- staging first
- lympectomy, radical mastectomy, partial mastectomy all have equivalent survival rates if followed with radiation
- chemo and hormonal manipulation may be beneficial
- Tamoxifen for estrogen-receptor pos and PMP women
quadrants:
- 45% upper outer
- 25% under nipple |
|
|
Term
Periodic abstinence contraceptive methods:
1. rely on absence just before ovulation until 2-3 days later
2. Just using calendar prediction has __% failure rate
3. baseal body temp (drops just before ovulation) + calendar results in __ pregnancies per 100 couples per year
4. Cervical mucus resembles ___ and is the most effective if used with basal body temp |
|
Definition
1. rely on absence just before ovulation until 2-3 days later
2. Just using calendar prediction has 35% failure rate
3. baseal body temp (drops just before ovulation) + calendar results in 5 pregnancies per 100 couples per year
4. Cervical mucus resembles egg white and is the most effective if used with basal body temp |
|
|
Term
Oral hormonal contraceptives:
1. most reliable and reversible means of pregnancy prevention
2. Theoretical failure rate is ___%; acutal failure rate is __-__%
3. ___ are half as effective as combo pills and may cause amenorrhea. should only be used in lactating women and >40 y/o
4. Other advantages of OCP
5. disadvantages
6. adverse effects |
|
Definition
1. most reliable and reversible means of pregnancy prevention
2. Theoretical failure rate is 1%; acutal failure rate is 4-6%
3. Minipills (progestin only) are half as effective as combo pills and may cause amenorrhea. should only be used in lactating women and >40 y/o
4. Other advantages of OCP: less benign breast disease, iron def anemia, and PID, fewer ovarian cysts
- protection against: ectopic pregnancy, ovarian and endometrial cacner, dysmenorrhea, menorrhagia, RA
- improves: hirsutism, acnes, endometroiosis
5. disadvantages:
- increased risk of thrombus esp in smokers and lipid disorders
- possible increased risk of breast cacner, HTN, cholelithiasis, benign liver tumors
6. adverse effects: missed periods, intermenstrual bleeding, bloating, acne, nausea, HA, weight gain |
|
|
Term
Other forms of birth control:
1. Medroxyprogesterone acetate 150 mg q90 days is most common form of ____ birth control. failure rate is ___ in first year
2. implantation of 6 rods of levonorgestrel. Good efficacy, lots of SE.
3. applied once a month. Not effective if >200 lbs
4. inserted for 3 weeks, removed for 1 week
5. creates a hostile environment for fertilized ovum; failure rates __%/year. contraindications?
6. emergency contraception consists of ___ or __ wihtin the first __ hrs after coitus. |
|
Definition
1. IM injection: Medroxyprogesterone acetate 150 mg q90 days is most common. failure rate is 0.3% in first year
2. Norplant: implantation of 6 rods of levonorgestrel. Good efficacy, lots of SE.
3. Patch: applied once a month. Not effective if >200 lbs
4. Ring: inserted for 3 weeks, removed for 1 week
5. IUD: creates a hostile environment for fertilized ovum; failure rates 1-1.5%/year.
- absolute contraindications: pregnancy, undiagnosed vag bleeding, acute infx, past salpingitis, suspected gyn cancer
- relative contraindications: nulliparity, previous ectopic or STD, mulitple partners, severe dysmenorrhea, uterine abn, anemia, valvular heart disease, young age
6. emergency contraception consists of high dose estrogen+ progestin or progestin only wihtin the first 72 hrs after coitus. |
|
|
Term
Infertility:
1. definition
2. female factors
3. male factors
4. wokrup
5. tx |
|
Definition
Infertility:
1. definition: failure to conveive after 1 year of unprotected sex
2. female factors: ovulatory (central, peripheral, metabolic), pelvic (infx, anatomy, endometriosis), cervical
3. male factors: endocrine and anatomic disorders, abn spermatogeneis or motility, sexual dysfunction
4. wokrup:
- semen analysis first - NL excludes most male factors
- Basal body temp, ovulation prediction tests, and progesterone levels to confirm ovulation
- Luteal phase endometrial bx, FSH, prolactin, TSH levels
- Post-coital testing to measure sperm survival
- Hysterosalpingography to determine tubal patency and uterine abn
- Other: laparascopy, sperm penetration assay, sperm ab testing, US, hysteroscopy
5. tx:
- Clomiphene citrate 50-100 mg beginning day 3-5 to promote ovulation
- artificial insemination
- assisted reproduction |
|
|
Term
PID:
1. organisms
2. complications
3. sx
4. workup
5. tx |
|
Definition
1. organisms: multiple - usually bacterial
2. complications: infertility, ectopic
3. sx: lower abd and pelvic pain, usually BL; n/v, HA, lassitude, fever, cervical motion tenderness (chandelier sign), purulent d/c, bartholin/skene gland tenderness, adnexal mass
4. workup:
- gonorrhea and chlamydia test
- transvag US if adnexal mass
- culdocentesis or laparoscopy may be required
5. tx:
- mild: outpt abx, antipyretic, analgesia, bed rest, remove IUD
- severe: IV abx, poss surgery
- evaluate and treat sex partners
|
|
|
Term
| How to estimate due date/estimated date of confinement (EDC) |
|
Definition
Nagele's or McDonald's rule:
Start at first day of last menstrual cycle, go back 3 mos, add 7 days
LMP Jan 15 --> Oct 15 --> EDC is Oct 22 |
|
|
Term
| 5 digit gravida parita notation |
|
Definition
G_P_ _ _ _
P's: number of term infants
premature deliveries
abortions
living kids |
|
|
Term
first OB visit should take place __ weeks after LMP
- should see OB q__ weeks until __ weeks
- then q __ weeks until ___ weeks
- then weekly thereafter |
|
Definition
first OB visit should take place 6-8 weeks after LMP
- should see OB q 4 weeks until 28 weeks
- then q 2-3 weeks until 36 weeks
- then weekly thereafter |
|
|
Term
Clinical features of pregnancy:
1. Fundal high at umbilicus at __ weeks, then should corolate to weeks gestation from there on
2. fetal heart tones at __-__ weeks using doppler. normal FHT rate
3. Quickening (first movement) should be felt at __-__ weeks in primi and __-__ weeks in multigravida |
|
Definition
1. Fundal high at umbilicus at 20 weeks, then should corolate to weeks gestation from there on
2. fetal heart tones at 10-12 weeks using doppler. normal FHT rate 120-160
3. Quickening (first movement) should be felt at 18-20 weeks in primi and 14-18 weeks in multigravida |
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Term
Pregnancy tests:
1. Low pregnancy-associated plasma protein A (PAPP-A) and high free B-hCG indicate increased risk for ?
2. US can detect fetal heart beat at __-__ weeks after LMP
3. Nuchal fold scan can be done at __-__ weeks. Screens for what disorders?
4. catheter or needle bx of placemntal cells at 10-13 weeks |
|
Definition
1. Low pregnancy-associated plasma protein A (PAPP-A) and high free B-hCG indicate increased risk for trisomy 21
2. US can detect fetal heart beat at 5-6 weeks after LMP
3. Nuchal fold scan can be done at 10-13 weeks. Screens for what disorders: trisomy 13, 18, 21 and Turner's
4. chorionic villus sampling (CVS) |
|
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Term
Subjective signs and sx of pregnancy
Signs:
1. bluish color of vagina/cervix
2. softening between fudus and cervix
others? |
|
Definition
amenorrhea, n/v, breast tenderness, quickening, easy fatigue, urinary frequency/urgency/nocturia/infection
1. Chadwick's sign
2. Hagar's sign
increased basal body temp
melasma/chloasma (dark pathces on face), linea nigra, pos preg test, palpation of fetus, fetal heart tones, US of fetus
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Term
Where is fetus at each week gestation?
12 weeks
14-16 weeks
20 weeks
20-38 weeks
18-40 weeks |
|
Definition
12 weeks: pubic symphysis
14-16 weeks: halfway btwn symphysis and umbilicus
20 weeks: umbilicus
20-38 weeks: corresponds to cm measurement
38-40 weeks: xiphoid |
|
|
Term
| Indications for nuchal screening, CVS, or amniocentesis |
|
Definition
materal age >35
previous child with chrom abn
mom or dad has chrom abn
fm hx chrom abn
neural tube defect risk (amnio only)
abn first or second trimester screening results |
|
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Term
| Tests done at first prenatal visit |
|
Definition
CBC, type, Rh, rubella titer, hep B, chlamydia/gonorrhea cultures, HIV test, UA, Coombs' test, syphilis, pap
offer to screen parents for: CF, sick cell, other conditions |
|
|
Term
| Tests done in first trimester |
|
Definition
PAPP-A
Free B-hCG
US
Nuchal translucency
CVS |
|
|
Term
|
Definition
Unconjugated estriol
Maternal AFP
Inhibin A
US
Amnio (15-18 weeks) |
|
|
Term
|
Definition
Gestational DM (24-28 weeks)
Rh test again if unsensitized - give Rhogam (28 weeks)
GBS culture (35 weeks)
Hgb and Hct (35 weeks)
NST
US
Biophysical profile |
|
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Term
Non-stress test
1. NL (reactive) test requires ___ accelerations of FHR in 20 min of up to 15 bpm from baseline for 15 sec and in the absence of decelerations
2. ___ are not reassuring and warrant intervention
Biophysical profile:
1. examines 5 parameters |
|
Definition
Non-stress test
1. NL (reactive) test requires 2 accelerations of FHR in 20 min of up to 15 bpm from baseline for 15 sec and in the absence of decelerations
2. Late decelerations (occur after peak of contraction) are not reassuring and warrant intervention
Biophysical profile:
1. examines 5 parameters: NST, amniotic fluid level, gross fetal movemnets, fetal tone, fetal breathing |
|
|
Term
Ectopic pregnancy:
1. 99% occur __-
2. causes
3. risk factors
4. sx
5. workup
6. tx |
|
Definition
1. 99% occur fallopian tube
2. causes: occlusion of tube due to adhesions,
3. risk factors: hx of previous, previous salpingitis/PID, previous abd or tubal surgery, use of IUD, assisted reproduction
4. sx: unilateral adnexal pain, abn menstruation, spottening, tenderness/mass, syncope, GI distress
- signs of rupture: severe abd or shoulder pain, periotnitis, tachy, syncpe, orthostatic hypotnesion
5. workup
- hCG increase less than expected (should double every 48 hrs)
- hCG >1500 with no intrauterine gestation on transvag US
6. tx:
- medical: MTX if hCG <5000, ectopic <3.5 cm on US, hemodynamic stability, compliant pt for FU
- Surgery:
- Laparoscopy is preferred
- Laparotomy for significant abd adehesions or clinically unstable
- F/U hCG and pelvic is critical |
|
|
Term
Abortion:
1. definition: termination of pregnancy by any means before __ weeks
2. ___ is spontaneous, premature expulsion of productions of conception. Occurs in 15-20% of recognized pregnancies. 80% occur in the first trimester, of these __% are associated with chromosomal abn.
3. risk factors:
4. dx of abortion via?
5. other tests to run
6. tx |
|
Definition
1. definition: termination of pregnancy by any means before 20 weeks
2. spontaneous abortion is spontaneous, premature expulsion of productions of conception. Occurs in 15-20% of recognized pregnancies. 80% occur in the first trimester, of these 50% are associated with chromosomal abn.
3. risk factors: smoking, infx, maternal systemic disease, immunologic disease, drugs
4. dx of abortion via US - inappropriate development or interval growth, poorloy formed or unformed fetal pole, feltal demise
5. other tests to run: blood type and Rh status
6. tx
- Early pregnancy: allow products of conception to pass and follow up pelvic exams, hCGs and transvag US
- Later; D&C |
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|
Term
Classification of spontaneous abortion:
1. vaginal bleeding without open cervix or passage of products of conception
2. vaginal bleeding with open cervix; no way to maintain pregnancy
3. vaginal bleeding with open cervix; products of conception have partially passed
4. no vaginal bleeding and no open cervix but fetal demise has occurred |
|
Definition
1. threatened
2. inevitable
3. incomplete
4. missed |
|
|
Term
| spectrum of diseases arising from placenta - includes moles, placental site invasive moles, trophoblastic tumors, choriocarcinoma |
|
Definition
| gestational trophoblastic disease (GTD) |
|
|
Term
benign form of gestational trophoblastic disease wtih 2 forms:
1. empty egg and appearance of "grapelike vesicles" or "snowstorm pattern" on US. 20% progress to malignancy
2. nonviable fetus present. 5% prgoress to malignancy
sx of either: abn vag bleeding, uterine size greater than dates, hyperemesis gravidarum, preeclampsia sx before 20 weeks
labs:
hCG often >100K
tx? |
|
Definition
Hydatidiform mole
1. complete
2. incomplete
tx:
- benign/low risk - chemo
- high risk/mets - chemo with or without surgery and radiaiton
- Followup: serial hCG measurements, contraception for next 6-12 mos |
|
|
Term
Multiple gestation:
1. incidence
2. sx
3. ___ twins are fraternal twins. Risk increases with fam hx, fertility drugs, tall/heavy mothers, african americans
4. __ twins are identical twins. they occur radomly and are associated with fetal transfusion syndrome and discordant fetal growth
5. complications |
|
Definition
1. incidence - 3%; twins 1/80 births
2. sx: worse than normal pregnancy
3. dizygotic twins are fraternal twins. Risk increases with fam hx, fertility drugs, tall/heavy mothers, african americans
4. monozygotic twins are identical twins. they occur radomly and are associated with fetal transfusion syndrome and discordant fetal growth
5. complications: preterm labor, sab, preeclampsia, anemia, intrauterine growth restriction, cord accidents, death of one twin, congenital anomalies, abn presentation, placental abruptio or previa |
|
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Term
Gestational DM:
1. ___ intolerance of varying severity only present in pregnancy
2. lifetime risk of developing DM after pregnancy is >__%
3. Recurrence in subsequent pregnancies is __-__%
4. maternal complictions
5. fetal complications
6. risk factors
7. dx
8. tx |
|
Definition
1. carb intolerance of varying severity only present in pregnancy
2. lifetime risk of developing DM after pregnancy is >50%
3. Recurrence in subsequent pregnancies is 60-90%
4. maternal complictions: preeclampsia, hyperacceleration of DM complications, traumatic birth
5. fetal complications: macrosomia, prematuria, fetal demise, delayed lung maturity
6. risk factors: previously large for gestational age infant, obesity, >25 y/o, glucosuria, fm hx of DM, african american, asian, hispanic, american indian
7. dx:
- screen high risk at first prenatal visit
- screening at 24-28 weeks - nonfasting 50g glucose challenge test - if glucose at 1 hr is >130 then do 3 hr glucose tolerance test
- 3 hr glucose tolerance test: 100g glucose in morning after overnight fast then take glucose levels at 1, 2, and 3 hrs. Dx of GDM if 2 of 3 results are abdn
8. tx
- anetpartum BPP and NST beginning at 34 weeks
- screen PP 6 weeks for regular DM
- diet and exercise
- check BG upon waking and after each meal
- 2 hr PP BG >120 may need insulin |
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Term
Preterm:
1. Preterm delivery is the delivery of a viable infant before __ weeks of gestation
2. complications
3. risk factors
4. Defintion: regular uterine contractions (>4-6 per hour) and presence of one or more: cervical dilation of __ or more at presentation, Cervical dilation of __ or more on serial exam, cervical effacement >__%
5. sx
6. workup
7. Tx |
|
Definition
1. Preterm delivery is the delivery of a viable infant before 37 weeks of gestation
2. complications: most common cause of neonatal death
- can cause developmental delays, CP, lung disease if associated with LBW
2b. risk factors: HTN, DM, infx, premature rupture of membranes, abruptio placenta, smoking, cocaine, uterine malformation, cervical incompetence, infx, low prepregnancy weight
3. Sx: contractions, pressure, menstrual-like cramps, watery/bloody discharge, low back pain
4. Defintion: regular uterine contractions (>4-6 per hour) and presence of one or more: cervical dilation of 2cm or more at presentation, Cervical dilation of 1cm or more on serial exam, cervical effacement >80%
6. workup: US to examine cervix length; vaginal secretion exam - fetal fibronectin (if neg, means labor within the next 7-14 days is very unlikely)
7. Tx:
- bed rest, oral or IV hydration, abx if infx, steroids to enhance lung maturity
- tocolytics (See next slide)
- prevention: hx of preterm delivery - weekly injections of 17a-hydroxyprogesterone caproate from 16-36 weeks |
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Term
Tocolytic agents:
1. inhibits mymoterial contractility mediated by calcium. SE include nausea, fatgiue, weakness, decreasd reflexes, resp depression, cardiac collapse. ___ is reversal drug.
2. Stimulate B-receptors to relax smooth muscle to decrease uterine contractions. SE include maternal and fetal tachy, emesis, HA, pulmonary edema
3. inhibit smooth muscle contractility by decreasing intracellular Ca ions. SE: maternal hypotension and tachy. |
|
Definition
1. MgSo4 (mag sulfate). calcium gluconate is reversal
2. B-mimetic adrenergic agents (ridodrine, terbutaline)
3. CCBs |
|
|
Term
Premature rupture of membranes (PROM) and preterm premature rupture of membranes (PPROM)
1. PROM: rupture of amniotic membranes before onset of labor at or beyond __ weeks. Most women go into labor w/in __ hrs
2. PPROM: occurs before ___ weeks and preceds 30-40% of all preterm deliveries
3. Major complication
4. sx
5. dx
6. tx of each |
|
Definition
1. PROM: rupture of amniotic membranes before onset of labor at or beyond 37 weeks. Most women go into labor w/in 24 hrs
2. PPROM: occurs before 37 weeks and preceds 30-40% of all preterm deliveries
3. Major complication: infection (chorioamnionitis or endometritis)
- also cord prolapse
4. sx: gush or persistent leakage of fluid from vagin, vaginal discharge, pelvic pressure
5. dx: fern test with nitrazine paper
- US to check amniotic fluid level
- DO NOT do digital exam unless delivery is imminent
6. tx for each:
- PROM: expectant - hospitalization with careful monitoring; active: induction with prostaglandin cervical gel or oxytocin to expedite delivery and decrease risk of infx
- PPROM: expectant if no signs of maternal or fetal infection/distress - hospitalize with strict bed rest, <34 weeks: betamethasone for fetal lung maturation, abx to prevent infx and prolong pregnancy, daily NST and BPP, amniocentesis for fetal lung maturity; delivery if any indication of materal or fetal infx or distress |
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Term
HTN in pregnancy:
1. Chronic HTN is that which presents <__ weeks
2. HTN that presents after __ weeks but has no other sx
3. tx |
|
Definition
1. Chronic HTN is that which presents <20 weeks
2. HTN that presents after 20 weeks but has no other sx
3. tx (same for both):
- monthly US to check for IUGR, serial BP and urine protein, weekly NST in third trimester
- Meds: only in severe cases; methyldopa is choice, labetalol is alternative |
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Term
Preeclampsia/Eclampsia:
1. sx must occur after __ wks. Most often occurs close to term but can occur up to __ wks post partum
2. Classic triad
3. HELLP syndrome
4. Def of eclampsia
5. Risk factors
6. maternal complicaitons
7. fetal complications
8. general sx
9. workup
10. tx |
|
Definition
1. sx must occur after 20 wks. Most often occurs close to term but can occur up to 6 wks post partum
2. Classic triad: HTN, edema, proteinuria (edema not necessary for dx)
3. HELLP syndrome: Hemolysis, Elevated Liver Enzymes, Low Platelets
4. Def of eclampsia: preeclampsia + seizures
5. Risk factors: nulliparity, <20 y/o or >35 y/o, multiple gestation, DM, chronic HTN
6. maternal complicaitons: progression to eclampsia or HELLP, abruptio placenta, reanl failure, cerebral hemorrhage, pulmonary edema, DIC
7. fetal complications: hypoxia, LBW, preterm delivery, perinatal death
8. general sx: edeam, sudden weight gain, HA, visual disturbance, n/v, RUQ pain, decreased urine output, HTN, hyperreflexia, proteinuria
9. workup:
- urine protein, 24 hr urine protein, CBC, fibrinogen, PT/PTT, CMP, LFT, Cr, Uric acid
10. tx:
- delivery of baby is ultimate tx, always delivery if >37 weeks
- Mild: outpt if reliable pt
- Inpt: MgSO4 IV to decrease chance of seizures - cont for 24 hrs after delivery; hydralazine or labetalol for acute HTN; betamethasone if <34 weeks for lung maturation
- Severe preeclampsia or eclmapsia warrants induction and delivery regardless of gestational age |
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|
Term
| Classification of Severe vs. Mild Preeclampsia |
|
Definition
Severe:
- BP >160-180 or diastolic >110 on two occasions 6 hrs apart while pt is on bed rest
- 5 g/24 hr proteinuria or 4+ on dipstick
- Uric acid >>>4.5 mg/dl
- Elevated AST, ALT, LDH, Cr
- Sx: HA, blurred vision, scotoma, clonus, RUQ pain
Mild: BP >140/90 but <160/110 or increase of 30 systolic or 15 diastolic from prepregnancy
- proteinuria >300 mg/24 hr but <5g/24 hr
- Uric acid >4.5
- Normal Cr and Liver enzymes
- Hyperreflexia is only sx |
|
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Term
Rh incompatibility occurs when mom is Rh_ and baby is Rh_, then give RhoGam to mom when?
- complication of Rh sensitization?
- In a sensitized pregnancy, __, __, and __ should be used to look for evidence of fetal distress
- ___ or __ test can measure occurance and degree of fetomaternal hemorrhage |
|
Definition
Rh incompatibility occurs when mom is Rh- and baby is Rh+, then give RhoGam to mom at 28 weeks and within 72 hrs of delivery
- complication of Rh sensitization: hemolysis (hydrops fetalis)
- In a sensitized pregnancy, US, Coombs' test, and amniocentesis should be used to look for evidence of fetal distress
- Apt or Kleihauer-Betke test can measure occurance and degree of fetomaternal hemorrhage |
|
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Term
Abruptio placenta:
1. Definition?
2. most common cause of ?
3. rik factors
4. complications
5. sx
6. dx
7. tx |
|
Definition
1. Definition: separation of normally implanted placenta after 20th week but before birth
2. most common cause of third trimester bleeding
3. rik factors: trauma, smoking, HTN, decreased folic acid, cocaine, alcohol (>14 drinks/wk), uterine anomalies, high parity, previous abruption, advanced maternal age
4. complication: liberation of tissue thromboplastin or consumption of fibrinogen activates external clotting pathway leading to DIC
- compromise placental blood flow, renal failure, coagulation failure, hemorrhage, death
5. sx: PAINFUL THIRD TRIMESTER BLEEDING, uterine/back pain, hypertonic/irritable uterus, evidence of fetal distress
6. dx: clinical
7. tx:
- definitive: delivery of fetus and placenta via C/S
- T&C, coagulation studies, IV access in unstable pt
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Term
Placenta Previa:
1. definition
2. __ is contraindicated in these pts bc it could cause severe bleeding
3. risk factors
4. sx
5. dx via?
6. tx |
|
Definition
1. definition: placenta partially or completely covers cervical os
2. digital exam is contraindicated in these pts bc it could cause severe bleeding
3. risk factors: smoking, advanced age, high parity, any process that can cause scarring of lower uterus
4. sx: PAINLESS THIRD TRIMESTER BLEEDING
5. dx via US
6. tx:
- before term: watchful waiting if pt is stable - may need blood transfusion, abstain from vaginal penetration
- If dx before 20 weeks, high chance that placenta will migrate back up uterine wall
- C/S if delivery is necessary |
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Term
Routine labor and delivery:
1. Vertex position
2. Other possible positions
3. station |
|
Definition
1. Vertex position: head down
2. Other possible positions: breech, face, transverse compound (arm or leg is presenting part)
3. station: location of presenting part in relation to maternal ischial spine - 0 station is at ischial spines
- stations above spine are denoted as neg numbers, stations above spine are denoted in pos numbers |
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Term
Stages of labor:
1. First stage begins ___, ends ___. Length is typically ___ for nulliparous and __ for multiparous
2. Second stage begins at __ and ends at ___. Length is __ for primiparous and __ for multiparous
3. Third stage begins at ___ and entails ___. Lasts ___.
Bloody show usually happens when?
ROM usually happens when? |
|
Definition
1. First stage begins at start of true labor (regular contractions) , ends at full dilation. Length is typically 6-20 hrs for nulliparous and 2-14 hrs for multiparous
2. Second stage begins at full dilation and ends at 5-60 min for multiparous
3. Third stage begins at delivery and entails separation and expulsion of placenta. Lasts 0-30 min, usually only 5 min.
Bloody show usually precedes true labor
ROM usually happens before or during first stage |
|
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Term
Fetal Heart monitoring during labor:
1. Normal
2. early decelerations
3. variable decelerations
4. late decelerations
what to do if bad HR? |
|
Definition
1. Normal: 120-160 bpm, accelerations of 15 bpm for 15 sec are good
2. early decels: mirror contractions, due to fetal head compression -benign
3. variable decels: rapid drops in FHR with a return to baseline with no identifiable pattern --> usually indicate cord compression
4. late decels: FHR drops during second half of contraction --> denote uteroplacental insufficient - bad
any worrisome signs: change mom's position, stop oxytocin, administer O2 to mom, measure fetal scalp pH |
|
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Term
| 3 vessels in umbilical cord |
|
Definition
|
|
Term
Apgar scoring:
1. done at __ and __ min
2. NL score
3. Signs |
|
Definition
1 & 5 min
NL: 7-10
Signs:
1. Activity/muscle tone
2. Pulse
3. Grimace (reflex irritability)
4. Appearance (skin color)
5. Respiration |
|
|
Term
Abnormal labor and delivery:
1. ___ occurs when the cervix fails to dilate progressively and the fetus fails to descend
2. common causes
3. tx |
|
Definition
1. dystocia occurs when the cervix fails to dilate progressively and the fetus fails to descend
2. common causes: pelvis (pelvis too small), powers, passenger (head too big)
- cephalopelvic disproportion
- inadequate contractions
3. tx:
- Oxytocin for inadequate contractions
- c/s |
|
|
Term
C-section and VBAC:
1. indications for C/S
2. risks with VBAC
3. Risks with C/S
4. type of incision |
|
Definition
1. indications for C/S: previous CS, dystocia, failure to progress, breech position, fetal distress
2. risks with VBAC: uterine rupture
3. Risks with C/S: thromboembolic events, increased bleeding, infection (abx prophylaxis)- higher risk with each subsequent C/S
4. type of incision: low transverse |
|
|
Term
Induction of labor:
3 methods |
|
Definition
1. prostaglandin gel on cervix to "ripen" cervix - can be done twice
2. oxytocin drip until contractions are 3 min apart
3. amniotomy - artificially rupturing membranes |
|
|
Term
Postpartum hemorrhage:
1. definition
2. causes of early and late PP hemorrhage
3. ___ - enlarged/soft uterus with increased bleeding, pain, fever, foul-smelling lochia
4. tx |
|
Definition
1. definition: bleeding sufficient to require transfusion or a 10% drop in Hct
2. causes of early and late PP hemorrhage
- Early: <24 hrs after delivery - abn involution of placental site, cervical or vag lac, retained placenta
- Late: >24 hrs to 6 weeks PP - subinvolution of uterus, retained products of conception, endometritis
3. subinvoluted uterus - enlarged/soft uterus with increased bleeding, pain, fever, foul-smelling lochia
4. tx
- uterine massage and compression
- IV acces, prepare blood - oxytocin, ergonovine, methylergonovine, prostaglandins
- may need surgery |
|
|
Term
Endometritis:
1. common precipitating factors
2. Sx
3. tx
4. prevention |
|
Definition
1. common precipitating factors: C/S, ROM >24 hrs before delivery
2. Sx: 2-3 days PP - fever >101 (38.3) and uterine tenderness, adnexal tenderness, peritonitis, decrease bowel sounds, leukocytosis
3. tx:
- Clinda + gentamycin are first line
- Add ampicillin if no response in 24-48 hrs
- Add metronidazole if sepsis is present
4. prevention: single dose of abx at time of cord clamping |
|
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Term
Puerperium (post-partum):
1. uterus should be back to antenatal size by __ weeks
2. __ is discharge that occurs after delivery and can last for __-__ weeks
3. Menses should return in __-__ weeks if not breast feeding
4. Postpartum follow up __ weeks after delivery
5. __ may accompany lactation
6. lactating mothers should continue __ |
|
Definition
1. uterus should be back to antenatal size by 6 weeks
2. Lochia is discharge that occurs after delivery and can last for 4-5 weeks
3. Menses should return in 6-8 weeks if not breast feeding
4. Postpartum follow up 6 weeks after delivery
5. atrophic vaginitis may accompany lactation
6. lactating mothers should continue PNV |
|
|
Term
1. Characterized by progressive loss of articular cartilage with reactive changes in the bone, resulting in pain and destruction of the joint.
2. chronic disease with synovitis affecting multiple joints and other extra-articular manifestations |
|
Definition
|
|
Term
OA:
1. sx
2. ___ are bony deformities of the DIP
3. ___ are bony deformities of the PIP
4. other common sites
5. 3 sites that are typically spared
6. Xray findings
7. tx |
|
Definition
1. sx: decreased ROM, joint crepitus, pain gradually worsening throuhgout the day
2. Heberden's nodes are bony deformities of the DIP
3. Bouchard's nodes are bony deformities of the PIP
4. other common sites: wrist, hip, knee, spine
5. 3 sites that are typically spared: MCPs, ankle, elbow
6. Xray findings: asymmetric joint space narrowing, subchondral sclerosis, cysts, marginal osteophytes
7. tx:
- Lifestyle: wt loss, moderate physical activity
- Medical: NSAIDs, intra-articular steroids and viscosupplements, bracing, canes, quads strengthening
- May need joint replacement |
|
|
Term
RA:
1. typical onset
2. __ are usually spared
3. extra-articular manifestations
4. lab findings
5. xray findings
6. tx |
|
Definition
1. typical onset: 40-60 y/o women; juvenile is onset <16 y/o
2. DIP are usually spared
3. extra-articular manifestations: skin, lungs, kidneys, eyes, liver, blood, heart, osteoporosis
4. lab findings:
- Elevated CRP and ESR
- + RF and anti-CCP antibodies
- joint aspiration
- xray: soft tissue swelling and juxta-articular demineralization
5. xray findings:
- refer to rheum --> PT and OT
- Meds: NSAIDs + DMARDs (MTX is first, then corticosteroids, sulfasalazine, antimalarials, leflunomide)
- Newer drugs: etanercept, abatacept, rituximab, infliximab, adalimumab
- may need surgery
6. tx |
|
|
Term
RA Dx Criteria (need at least 4):
1. Morning stiffness >__ for at least 6 weeks
2. Arthritis and soft tissue swelling of >__ joints for at least 6 weeks
3. Arthritis of __ for at least 6 weeks
4. ___ arthritis present for at least 6 weeks
5. ___ in specific places - bony prominences, extensor surfaces, juxta-articular regions
6. Rheumatoid factor >__ percentile
7. Radiological changes suggestive of ___ or ___ |
|
Definition
RA Dx Criteria (need at least 4):
1. Morning stiffness >1 hr for at least 6 weeks
2. Arthritis and soft tissue swelling of >3 joints for at least 6 weeks
3. Arthritis of hands for at least 6 weeks
4. Symmetric arthritis present for at least 6 weeks
5. Subcu nodules in specific places - bony prominences, extensor surfaces, juxta-articular regions
6. Rheumatoid factor >95th percentile
7. Radiological changes suggestive of joint erosion or bony decalcification |
|
|
Term
Dx based on joint fluid analysis:
1. yellow with 200-300 WBC/uL, 25% PMNs, negative culture
2. yellow to opalescent (milky, irridescent) with 3-50K WBC/uL, 25-50% PMNs, and neg culture
3. Yellow to green with >50K WBC/uL 75% PMNs and pos culture |
|
Definition
1. osteoarthritis
2. RA
3. Septic |
|
|
Term
Childhood onset Idiopathic Arthritis - chronic synovitis and a number of extra articular features (fever, rash, wt loss, other organ involvment)
Types:
1. spiking fevers 102-104F (39-40C), myalgia, polyarthralgia, salmon-pink maculopapular rash appearing in the evening with fever. Rash may be elicited by scratching the skin (____ phenomenon). Minimal articular findings. May have hepatosplenomegaly, lymphadenoapthy, leukocytosis, pericarditis, myocarditis.
2. invovlement of 4-5 med to large joints. at risk for yveitis that may lead to blindness if pos ANA test.
3. resembles adult RA with symmetric invovlement of 5 or more small and large joints + fatige, low grade fever, rheumatoid nodules, and anemia
tx? |
|
Definition
1. Systemic (still's diseae and juvenile RA)
2. Pauciarticular
3. Polyarticular
tx: NSAIDs and PT are most beneficial |
|
|
Term
Cause: hematogenous spread of bacteremia, periarticular osteomyelitis, infection caused by dx or therapeutic procedures or infection elsewhere
- 90% involve only one joint
- sx: acute joint swelling, fever, warmth and effusion, TTP, increased pain with minimal ROM
___ is most common organism
sexually active adults may be at risk for infection with ___
Workup?
Tx? |
|
Definition
Septic/infectious arthritis
S. aureus most common
N. gonorrhea in sexually active
workup:
- joint fluid analysis - >50K WBCs, positive for bacteria
- Blood culture (pos in 40%)
- xray only shows soft tissue swelling
tx:
- Aggressive IV abx followed by oral for 7-10 days
- arthrotomy and arthrocentesis often required for s. aureus
|
|
|
Term
inflammatory arthritis with skin involvement preceding joint disease by months to years
sx: mild and intermittend symmetric arthritis, pitting of nails, onycholysis, sausage-fingers
Labs:
- ESR elevated
- normocytic normochromic anemia
- +/- high uric acid
- Normal RF
- Xray: "pencil in cup" deformity of fingers
tx? |
|
Definition
Psoriatic arthritis
tx: NSAIDs for mild
- MTX
- Not steroids or antimalarials
|
|
|
Term
seronegative arthritis that presents with the tetrad of urethritis, conjunctivitis, oligoarthritis, and mucosal ulcers
- often a sequelae to STDs (chlamydia - 9x more common in males) or gastroenteritis (shigella, salmonella, yersinia, campylobacter)
Sx: arthritis of large joints below waist, mucosal lesions (balanitis, stomatitis), urethritis, conjunctivitis
50-80% are HLA-B27 pos
- neg synovial fluid
- xray: evidence of permanent and progressive joint disease
tx? |
|
Definition
Reactive arthritis (Reiter syndrome)
tx: NSAIDs
- abx at time of infx will reduce chance of development |
|
|
Term
GOUT:
1. systemic disease of altereed ____ metabolism and subsequent sodium urate crystal precipitation into synovial fluid
2. most common intial attack
3. Workup: joint aspirate, serum uric acid
4. tx? |
|
Definition
1. systemic disease of altereed purine metabolism and subsequent sodium urate crystal precipitation into synovial fluid
2. most common intial attack: MTP of great toe (podagra) - sudden onset swelling, redness, pain
3. Workup:
- joint aspirate: rod-shaped negatively birefringent crystals
- serum uric acid >8 mg/dl (not diagnostic)
4. tx:
- elevation and rest
- diet: decrease ingestion of purines (organ meats, fish, yeast, mussels) and alcohol
- Meds: NSAIDs are initial (acute - Indomethacin TID)
- btwn attacks: colchicine, probenicid, sulfapyrazone, allopurinol, febuxostat |
|
|
Term
inflammation of peripheral joints due to calcium pyrophosphate deposition
- characterized by abrupt and recurrent onset of attacks
- most commonly affected joints: knee, wrist, elbow
Joint aspirate: rhomboid-shaped negatively birefringent calcium pyrophosphate crystals
Xray: fine, linear calcificationsi n cartilage (chondrocalcinosis)
tx? |
|
Definition
calcium pyrophosphate dehydrate disease (CPPD) - AKA PSEUDOGOUT
sx: NSAIDs, colchicine, intra-articular steroid injections |
|
|
Term
autoimmune disorder characterized by inflammation and pos ANA abs and invovlement of multiple organs
- most commonly affects women of childbearing age
- may be caused by drugs (procainamide, hydralazine, isoniazid, methyldopa, quinidine, chlorpromazine) - resolves when drug is stopped. + antihistone abs
Abs for Smith anitgen, double-stranded DNA, or depressed serum complement may be used to track progression of disease
tx? |
|
Definition
LUPUS
tx: exercise and sun protection for all pts
- NSAIDs
- Antimalarials (hydroxycholorquine or quinacrine)
- Corticosteroids for skin
- Oral corticosteroids for flares
- MTX |
|
|
Term
| Dx Criteria for SLE (need at least 4, including ANA) |
|
Definition
Malar rash
Discoid rash (scarring and atrophy due to sun exposure)
Photosensitivity
Oral ulcers
Arhtitis
Serositits (heart, lungs, peritoneal)
Renal disease (proteinuria, casts)
+ ANA
Heme disorder (hemolytic anemia, leukopenia, leukocytosis, thrombocytopenia)
Immunologic disorder (LE cell, anti-DNA, anti-Sm, flase pos test for syphilis)
Neuro disroder (sezirues or psychosis w/o other cause) |
|
|
Term
Inflammatory disease of striated muscle affecting proximal limbs, neck, and pharynx and possibly skin (dermatomyositis). can also affect joints, lungs, heart, and GI tract
Unknown cause, strong association wiht occult malignancy
Women: men 3:1
Labs:
1. elevated CPK (creatine phosphokinase) and aldolase
2. myopathic inflammation on muscle bx
tx? |
|
Definition
polymyositis
tx: high dose steroids, MTX, or azathioprine until sx resolve |
|
|
Term
pain and stiffness of shoulder and pelvic girdles, accompanied by constitutional sx (fever, fatigue, wt loss, depression)
women 2x more than men
unknown cause, associated with temporal arteritis
sx: stiffness, worse in morning
labs: ___ is markedly elevated
tx? |
|
Definition
PMR
markedly elevated ESR
tx: low dose corticoteroids (higher doses if GCA) |
|
|
Term
Small and medium artery inflammation of skin, kideny, peripheral nerves, muscle, and guy
male:female 3:1
- unknown cause, assoicated with Hep B
sx: wt loss, fever, anorexia, abd pain, peripheral neuropathy, arthralgia, arhtirits, skin lesions (palpable purpura), livedo reticularis, HTN, edema, oliguria
Labs: high ESR and CRP, proteinuria, ANCA +
dx via?
Tx? |
|
Definition
Polyarteritis nodosa
dx via vessel bx or angiography
tx:
- high dose corticosteroids
- may need cytotoxic drugs and immuno therapy
- may need Hep B tx
- treat HTN |
|
|
Term
collagen deposition in skin and sometimes kidneys, heart, lungs, stomach due to unknown cause
women:men 4:1
Sx:
1. diffuse: skin and systemic changes
2. limited: skin of face, neck, elbows, knees + isolated pulm HTN
Other sx: Raynaud's, esophageal dysfunction, polyarthraligas
+ ANA in 90%
- anticentromete ab
tx? |
|
Definition
Scleroderma (systemic sclerosis)
Tx:
- treat each organ process - ACE for renal disease, PPI for GI disease, etc) |
|
|
Term
|
Definition
|
|
Term
| Components of CREST syndrome |
|
Definition
Calcinosis
Raynaud's
Esophageal dysfunction
Sclerodactyly
Telangiectasias
type of limited scleroderma |
|
|
Term
Autoimmune disorder that destroys salivary and lacrimal (exocrine) glands
- may be secondary to preexisting connective tissue disorder (RA, SLE, scleroderma, myositis)
sx: dry mouth, dry eyes, parotid enlargment
labs?
tx? |
|
Definition
Sjogren's
Labs:
+ RF, ANA, anti-Ro abx, Anti-La antbodies
- Schirmer test <5 mm wetting
- bx of lower lip mucosa: lymphocytic infiltrate and gland fiborsis
tx is symptomatic:
- artificial tears and saliva, incerased oral fluid, ocular/vaginal lubricants, pilocarpine |
|
|
Term
|
Definition
| SSRI, SNRI, TCA, Lyrica (pregabalin), aerobic exercise, pt education, stress reduction, sleep assistance |
|
|
Term
| Tx for tendinitis/tenosynovitis |
|
Definition
| RICE, NSAIDs, excision of scar tissue |
|
|
Term
|
Definition
| rest, NSAIDs, steroid injections |
|
|
Term
Osteomyelitis:
1. inflammation of bone caused by a ___ organism
2. most common organism
3. acute hematogenous osteo most commonly affects ____
4. salmonella osteo most commonly affects ___
5. exogenous osteo results from ___ or ___
6. complications: ___ is dead bone surrounding granulation tissue; ___ is periosteal new bone
7. dx via? xray fidnings
8. tx |
|
Definition
1. inflammation of bone caused by a pyogenic organism
2. most common organism: s. aureus
3. acute hematogenous osteo most commonly affects long bones in kids
4. salmonella osteo most commonly affects sickle cell pts
5. exogenous osteo results from open fx or surgery
6. complications: late sequestra is dead bone surrounding granulation tissue; involucrum is periosteal new bone
7. dx via blood culture or bone bx
- xray fidnings lag 7-10 days so US is better for acute
8. tx:
- Acute: 1 wk IV abx, then 2 wks oral
- Chronic: 4 wks to 24 mos IV and PO abx
- remove hardware |
|
|
Term
Bone Neoplasia:
1. 5 cancers that most commonly mets to bone
2. Bone that most commonly gets mets
3. Benign/malignant bone tumors are more common
4. most common primary benign bone neoplasm of hand - asymptomatic unless causes pathologic fx
5. most common primary malignanct bone tumor
6. Found in pts btwn 5 and 25 in diaphysis of long bones, ribs, flat bones
7. most common in 10-20 y/o arising in metaphyseal area of long bones.
8. 60 y/o or older, ___ is the most common bone lesion
9. primary bone cancer presenting in pt >60 in the central metaphyseal area |
|
Definition
1. 5 cancers that most commonly mets to bone: prostate, breast, lung, kidney, thyroid
2. Bone that most commonly gets mets: spine
3. Benign bone tumors are more common
4. most common primary benign bone neoplasm of hand - asymptomatic unless causes pathologic fx: Endochondroma
5. most common primary malignanct bone tumor: multiple myeloma
6. Found in pts btwn 5 and 25 in diaphysis of long bones, ribs, flat bones: Ewing's sarcoma
7. most common in 10-20 y/o arising in metaphyseal area of long bones- Key word "spindle cell neoplasm": osteosarcoma
8. 60 y/o or older, mets is the most common bone lesion
9. primary bone cancer presenting in pt >60 in the central metaphyseal area - chondrosarcoma |
|
|
Term
Bone neoplasia:
1. sx suggestive of malignancy
2. dx
3. key labs
4. tx |
|
Definition
1. sx: night pain, any painful bony mass, systemic sx (fever, wt loss, anorexia, fatigue),
- dull ache followed by severe pain - pathologic fx
2. dx via open incisional bx
3. labs: alk phos and LDh elevated due to bone break down
- multiple myeloma: paraprotein (Bence Jones protein) detected in serum or urine via electrophoresis
4. tx:
- Benign tumors: excision
- Malignant: wide resection, chemo, limb salvage, radiaiton |
|
|
Term
a disease of abnormal bone remodeling characterized by a decrease in total bone volume although the bone that is present is normal just less dense
1. 2 categories: PRimary (type 1 and type 2) and Secondary
2. risk factors
3. workup
4. imaging
5. xray shows evidence of decreased bone density when __% loss is present
6. tx and prevention |
|
Definition
osteoporosis
1. 2 categories:
- Primary (most prevalent, mainly women):
a. type 1 (postmenopausal): most common
b. type 2 (senile): men and women
- Secondary: condition in which bone is lost bc of other diseases (malignancy, steroid use, GI disorders, hormonal imbalance, Cushings, hyperthyroid, hyperparathyroid)
2. risk factors:
- modifiable: alcoholism, smoking, low body weight, sedentary lifestyle, low calcium and vit D, steroid use, recurrent falls
- nonmodifiable: advanced age, caucasain or asian, female
3. workup:
- Ca, phosphate, alk phos, serum protein electrophoresis
- R/O secondary causes
4. imaging:
- DEXA (dual energy xray absorptiometry) is best to measure bone density w/ least radiation
5. xray shows evidence of decreased bone density when 30% loss is present
6. tx:
- Prevention: wt bearing exercise; increased Ca, Vit D, and phosphorous intake; smoking cessation, limited alcohol
- First line: bisphosphonates
- HRT
-SERMs
- calcitonin
- teriparatide |
|
|
Term
| Osteoporosis screening recommendations |
|
Definition
1. PMP women <65 with risk factors
2. all PMP women >65
3. PMP women who present with fx
4. Anyone considering therapy that affects bone density
5. Women who have been on HRT for prolonged periods
6. Men w/ fx after minimal trauma
7. pts wtih radiological evidence of osteopenia
8. anyone with a disease known to increase risk for osteoporosis
9. Patients with RA |
|
|
Term
|
Definition
HRT: increased risk of MI, stroke, breast cancer, thromboembolic events
SERMs: increased risk of DVT |
|
|
Term
Fractures:
1. imaging for occult or stress fx
2. CT for __, __, or __ fx
3. ___ is the study of choice for occult hip fx |
|
Definition
1. radionucleotide bone scan
2. pelvic, facial, intra-articular
3. MRI |
|
|
Term
Any bleeding fx should be considered __ until proven otherwise
- tx for these fx? |
|
Definition
open fx
debride and irrigate in OR within 4-8 hrs
- IV abx (cephalosporins and aminoglycosides) for first 48 hrs
- tetanus status
- immobilization and fixation |
|
|
Term
Tx for each kind of fx:
1. Femoral neck
2. Femoral shaft
3. intertrochanteric
4. Significant chance of ___ with femur fx
5. tibia and fibula in adults |
|
Definition
1. Femoral neck: percutaneous screens or hemiarthrplasty
2. Femoral shaft: intramedullary rods or plates
3. intertrochanteric : sliding hip screw fixation or long gamma nail
4. Significant chance of hemorrhage with femur fx
5. tibia and fibula in adults:
- simple: closed reduction with cast
- complicated: ORIF |
|
|
Term
| Salter-Harris classification |
|
Definition
I: Separate: fx through growth plate
II: Above: fx above growth plate
III: Lower: fx below growth plate
IV: Through: fx through growth plate (metaphysis to epiphysis)
V: Ram: plate is smashed together |
|
|
Term
Incomplete fx in children:
1. fall on outstretched hand - tx?
2. occur when long bones bow causing a break in one side of the cortex. Tx if <15 deg angulation? Ts if >15 deg angulation? |
|
Definition
1. fall on outstretched hand - tx: Torus/Buckle, 4-6 weeks in cast
2. occur when long bones bow causing a break in one side of the cortex. Greenstick Fx - Tx if <15 deg angulation is long arm or leg cast; Ts if >15 deg angulation is referal to ortho srugery |
|
|
Term
Total loss of congruity between articular surfaces of a joint
tx? |
|
Definition
dislocation
tx:
1. ensure vascular status
2. closed reduction
3. immboliization for 2-4 weeks, then ROM activity, then full activity |
|
|
Term
| any loss of congruity less than a complete dislocaiton |
|
Definition
|
|
Term
| dislocation of tarsometatarsal joint complex and the second metatarsal joint associated with a fraction |
|
Definition
|
|
Term
1. injury to bone-tendon unit at the myotendinous junction or the muscle itself
2. injury to the collagenous tissue such as ligaments or tendons
3. complications?
4. tx |
|
Definition
1. injury to bone-tendon unit at the myotendinous junction or the muscle itself -- strain
2. injury to the collagenous tissue such as ligaments or tendons -- sprain
3. complication - avulsion fx
4. tx:
- supportive: RICES (s is support/bracing) |
|
|
Term
most common cause of facial pina
sx: pain aggrevated by jaw movment, restricted ROM, click or pop
causes?
tx? |
|
Definition
TMJ syndrome
causes: psych/stress, joint capsulititis from bruxism or clenching, hypermobility syndrome and malocclusion
tx: lifestyle/behavior modificiation
- referral to odontologicst or oral/maxillofacial surgeon if refractory |
|
|
Term
Neck pain:
1. most common condition affecting C spine
2. sx of cervical compression
3. tx? |
|
Definition
1. most common condition affecting C spine: spondylosis
2. sx of cervical compression: paresthesias in fingers, increased pain with extension, decreased pain with flexion, long-tract signs (clonus, babinski, gait disturbance)
3. tx:
- c collar, traction, PT, analgesia, surgery |
|
|
Term
| neck injury often resulting from rear impact |
|
Definition
whiplash
Tx: C collar 2-3 days, ice and heat, analgesia, gental active ROM asap
|
|
|
Term
| Rheumatoid spondylosis of neck can result in ___, often requiring surgical stabilization |
|
Definition
| atlantoaxial and midcervicla subluxation |
|
|
Term
| Shoulder pain: diffuse, not well localized is usually due to ? |
|
Definition
| referred pain - usually cervical |
|
|
Term
Rotator cuff syndrome:
1. causes
2. underlying pathology is usually ___
3. sx
4. dx of tear?
5. tx |
|
Definition
1. causes: eccentric overload (throwing a lot), underlying glenohumeral instability, poor muscel strength, training errors
2. underlying pathology is usually impingement of supraspinatus tendon under subacromial arch
3. sx: dull ache that interferes with sleep and is exacerbated with abduction
4. dx of tear: MRi or arthrography
5. tx:
- rest, NSAIDs, local steroids, PT
- Surgery: arthroscopic subacromial decompression or repair of tear |
|
|
Term
Shoulder dislocation
1. most common cause
2. which is more common
3. sx
4. imaging
5. tx |
|
Definition
1. most common cause: fall on oustretched arm in abduction and extension
2. which is more common: anterior
3. sx: pt supporting that arm with the other arm, loss of contour, elbow pointing outward
4. imaging: AP and Y view
- MRI for for labral tear (Bankart's lesion)
5. tx:
-assess neurovascular status
- reduction and stabilizaiton (Velpaeu's sling) |
|
|
Term
inflammatory process that may follow injury to shoulder or arise on its own (esp in DM)
pain and restricted glenohumeral movment
Arthrography: decreased joint capsule volume, capsular constriction
tx? |
|
Definition
adhesive capsulitis
tx: NSAIDs, passive ROM, manipulation under anesthesia |
|
|
Term
| OA of humeral head is usually due to 5 causes |
|
Definition
osteonecrosis
trauma
septic arthritis
endocrine d/o
neuropathic d/o |
|
|
Term
most common fx in kids and adolescents
due to fall on outstretched arm
sx: visible deformity, arm supported by other arm
imaging
tx? |
|
Definition
clavicle fx
AP xray
tx:
kids: figure of eight sling for 4-6 weeks
adults: sling for 6 weeks |
|
|
Term
AKA "separated shoulder" due to tearing of acromioclavicular or coracoclavicular ligaments
- due to fall on or impact to tip of shoulder
- sx: 'step off' of AC joint
imaging?
tx? |
|
Definition
AC separation
imaging: AP view of bth shoulders, may need stress imagin (holding weight)
tx:
-mild-mod: sling and analgesia
- severe; surgery |
|
|
Term
Pain, swelling, tenderness in greater tuberosity of shoulder
- usually seen in older pts wtih osteoporosis (women>men)
- ecchymosis after 24-48 hrs
- holding affected extremity against chest
- imaging?
- tx? |
|
Definition
humeral head fx
imaging: AP, lateral, and Y
tx: closed reduction and Velpaeu's sling (sling with swath), early mobilization with pendulum exercises to prevent frozen shoulder
- ORIF for displaced fx |
|
|
Term
MOI: MVA, fall on outstretch hand, penetrating injury
sx: pain, arm swelling, deformity, shortening
imaging: AP and lateral
tx?
complications? |
|
Definition
humeral shaft fx
tx: coaptation splint followed by hanging cast, sarmiento's brace, surgery
complication: radial nerve injury |
|
|
Term
MOI: fall on outstretched hand with hyperextension of elbow
sx: minimal pain and swelling initially, later swelling gets worse around elbow
Imaging: Ap and lateral
tx?
Complications? |
|
Definition
supracondylar humerus fx
tx:
Kids: closed reduction in OR with posterior splint
Adults: ORIF
Complications:
- brachial artery injury leading to Volkmann's ischemic contracture
- varus or valgus deformity
|
|
|
Term
Volkmann's ischemic contracture:
1. sx
2. most common cause
3. tx |
|
Definition
sx: claw deformity of hand with blue/white fingers and absent radial pulse
always due to radial artery obstruction
most commonly: supracondylar humeral fx that injures brachial artery
tx: fasciotomy |
|
|
Term
Wrist/Hand pain:
1. ___ is most common cause of carpometacarpal joint thumb pain and DIP pain
2. Kienbock's disease
3. __ is another common cause of wrist/hand pain causing swellin gthat is symmetrical and primarily affects MCP and PIP joints
4. ___ affects the palmar aponeurosis of the ring, little, and middle fingers causing painful nodules, pitting, and contractures. tx? |
|
Definition
1. OA is most common cause of carpometacarpal joint thumb pain and DIP pain
2. Kienbock's disease: osteonecrosis of lunate
3. RA is another common cause of wrist/hand pain causing swellin gthat is symmetrical and primarily affects MCP and PIP joints
4. Dupuytren's contracture affects the palmar aponeurosis of the ring, little, and middle fingers causing painful nodules, pitting, and contractures.
- Tx: heat, stretching, US, steroids
- surgical release if >30 deg |
|
|
Term
Carpal tunnel:
1. sx
2. confirmatory studies
3. tx |
|
Definition
1. sx: night pain, numbness, paresthesia sparing little finger, clumsiness, weakness, thenar atrophy
2. confirmatory studies: EMB or nerve conduction velocity (NCV)
3. tx:
- activity modification, NSAIDs, volar wrist splint
- steroid injections
- srugery |
|
|
Term
fx of neck of 4th or 5th metacarpal
- loss of knuckle with tenderness and pain
- puncture wound over MCP suggests?
- tx? |
|
Definition
Boxer's fx
puncture wound over MCP suggests punch to another person's mouth --> tx for Eikenella corrodens
tx:
reduction if >25 deg angulation then splinting and f/u in 1-2 weeks |
|
|
Term
distal radius fx w/ dorsal angulation due to fall on dorsiflexed hand
- AKA silver fork deformity
tx? |
|
Definition
Colle's fx
tx: reduction then casting |
|
|
Term
sprain or tear of the ulnar collateral ligmanet of thumb
= hx of sprained thumb or fall on hand
PE: ligamentous laxity of ulnar collateral ligament with instability and weak pinch
tx? |
|
Definition
Gamekeeper's thumb
tx:
- partial tear: immobilization with thumb spica
- total tair: surgery |
|
|
Term
most common overuse elbow injury - 40-50 y/o
- involves tendinous insertion of EXTENSOR CARPI RADIALIS BREVIS
sx: pain on lifting objects, worse when arm is pronated
PE: pain duplicated by extending fingers and wrist against resistance
imaging?
tx? |
|
Definition
latearl epicondylitis "tennis elbow"
imaging: MRI for tendinous damage
tx: cessation of activity for 6 weeks
- counterbalance brace
- PT and OT
- steroid injections for short term relief
- NSAIDs
- Surgery if fail 6 mos conservative managment |
|
|
Term
affects flexor-pronator muscles at their origin
sx: hx of repeititve stress, pain reproduced by resisted pronation and flexion of wrist
- may complain of ulnar nerve paresthesias
tx? |
|
Definition
Medial epicondylitis ("golfers elbow" or "baseball elbow")
tx: NSAIDs, PT/OT
Medial ccounterforce brace
surgery usually not necessary |
|
|
Term
swelling overlying olecranon process, usually painless, preserved ROM
due to repeititve trauma or acute injury
- occassionally due to s. aureus
tx? |
|
Definition
olecranon bursitis
t: ace wrap, NSAIDs, compresses
- NOT drainage unless infected |
|
|
Term
pain over lateral elbow that worsens with forearm rotation
imaging |
|
Definition
radial head fx
imaging: AP and lateral xray
- fat pad signs suggest hemarthrosis
|
|
|
Term
radial head subluxaiton in kids due to extensive longitudinal traction - radial head slips out of annular ligament
- present wtih extremity fully pronated and partially flexed held tight to side |
|
Definition
|
|
Term
| Scaphoid fx: if suspected, what testing? tx? |
|
Definition
AP, lateral, and scaphoid xrays
- if neg, repeat in 2-3 weeks
- can do bone scan or MRI
tx:
thumb spica (long arm if displaced, short arm if not) and referral to ortho surgery
- 1 cm displacement or greater = ORIF |
|
|
Term
de Quervain's:
1. affected tendons
2. populations
3. tx |
|
Definition
abduction pollicis longus and extensor pollicis brevis
more common in women >30 and DM
tx:
- thumb spica, NSAIDs, PT/OT for one month
- steroid injection if conservative methods fail
- surgical decompression |
|
|
Term
Low Back pain:
1. most common causes
2. pain originating in back and radiation down the leg suggests ____
3. ___ is felt in the buttock, posterior thig, and posterolateral leg around lateral malleolus and down to lateral dorsum of foot and entire sole
4. unliateral back pain that is worse with standing in one position suggests ____
5. pain in elderly increased by wakling and relieved by leaning forward suggests ___ |
|
Definition
1. most common causes: prolapsed disc, low back strain
2. pain originating in back and radiation down the leg suggests nerve root irritation
3. sciatica is felt in the buttock, posterior thig, and posterolateral leg around lateral malleolus and down to lateral dorsum of foot and entire sole
4. unliateral back pain that is worse with standing in one position suggests Si joint
5. pain in elderly increased by wakling and relieved by leaning forward suggests spinal stenosis |
|
|
Term
Which actions does each do?
L2/3
L 3/4
L4/5
L5/S1 |
|
Definition
L 2/3: flexes hip
L3/4: extends Knee, patellar reflex
L4/5: dorsiflexes ankle, inverts ankle
L5/S1: extends him, flexes knee, plantar flexes ankle, everts ankle, achille's reflex
|
|
|
Term
Scoliosis
1. most common population
2. most common curve
3. workup
4. tx |
|
Definition
1. most common population: girls onset of puberty growth spurt to end of spinal growht
2. most common curve thoracic tothe right
3. workup:
- AP standing xray for any curv e>5 deg
- Cobb angle
4. tx
- 10-15 deg: 6-12 month follow up
- 15-20 deg: serial AP xray q 3-4 mos
- >20 deg: referal to ortho |
|
|
Term
Kyphosis:
1. ___ : idiopathic osteochondrosis of T spine
2. ___: progressive kyphosis caused by TB in spine
3. imaging
4. tx |
|
Definition
1. juvenile kyphosis (Scheuermann's disease): idiopathic osteochondrosis of T spine
2. Pott's disease: progressive kyphosis caused by TB in spine
3. imaging: standing xray
4. tx:
- 45-60 deg: exercises, xrays q3-4 mos
- >60 deg or pain: milwaukee brace
may need surgery |
|
|
Term
Spinal stenosis:
1. narrowing of ___ or ___
2. central stenosis is compression of ___
3. lateral stenosis is compression of ___
4. sx
5. imaging
6. tx |
|
Definition
1. narrowing of spinal canal or neural foramina
2. central stenosis is compression of thecal sac
3. lateral stenosis is compression of nerve root lateral to thecal sac
4. sx: neural claudication, exacerbation with walking, relieved by leaning fwd
5. imaging: CT, postmyelographic CT, MRI
6. tx: rest, abd exercise, pelbic tilt, flexion, NSAIDs, weight loss
- epidural steroids
- decompression/fusion |
|
|
Term
seronegative spondyloarthropathy that progresses to fusion of vertebrae
sx: back pain, stiffness, restricted ROM, synovitis of knees, plantar fasciitis, achilles tendonitis, uveitis, cardiac probs, intersitital lung disease
starts at SI joint and progresses up
3-4th decades
workup
tx |
|
Definition
ankylosing spondylitis
Schober's test, occiput-wall distance, test ROM, chest expansion
- Elevated: ESR, CRP, HLA-B27 pos
Xray: bamboo spine, osteopenia
tx:
PT w/ posture, extension exercises, breathing exercises, SWIMMING
- NSAIDs |
|
|
Term
large midline disc herniation that compresse several nerve roots, usually L4-5
sx: bowel/bladder dysfunction, leg pain, numbness, saddle anesthesia, paralysis
tx? |
|
Definition
cauda equina syndrome
tx: surgical emergency |
|
|
Term
Aseptic necrosis/osteonecrosis/avascular necrosis of the hip:
1. most commonly seen at what age?
2. kids, called ____, seen at age 2-11, most commonly 4-8.
3. sx?
4. complications
5. study of choice
6. tx |
|
Definition
1. most commonly seen at what age 30-50
2. kids, called Legg-Calve-Perthes Disase, seen at age 2-11, most commonly 4-8.
3. sx: dullache or throbbing localized to groin, lateral hip, buttocks, pain with wt bearing, relieved with rest, loss of rotation or abduction, antalgic limp
4. complications: OA, femoral head collapse, disability
5. study of choice: MRI (crescent sign)
- xray in kids
6. tx:
- Early: protective weight bearing, alendronate
- Surgery |
|
|
Term
weakening of epiphyseal plate of femur resulting in displacement of femoral head
typically fat boy age 10-16 with insidious onset of thigh/hip/knee pain and limp
imaging
tx? |
|
Definition
SCFE
imaging: frog leg lateral
tx:
- crutches and no weight bearing until and after surgery
- surgical pinning
|
|
|
Term
Meniscal injury:
1. MOI
2. which is most often injured?
3. sx
4. clinical tests
5. imaging
6. tx |
|
Definition
1. MOI: rotational force of femur on tibia
2. which is most often injured: medial
3. sx: joint line pain, inability to fully extend knee, feeling of "locking", feeling of giving way, swelling, pain with stairs or squatting
4. clinical tests: Mcmurray, Apley
5. imaging: MRI (may need arthroscopy)
6. tx:
- activity modification, NSAIDs, quad strengthing
- Arthroscopy: persistent sx unresponsive to conservative tx or irreducible locking |
|
|
Term
apophysitis of tibial tubercle by trauma or overuse
- onset 8-15 years, males 3x more than females
- sx: anterior knee pain, swelling over tibial tubercle - related to activity
imaging?
tx? |
|
Definition
osgood-schlatter disease
xray usually nothing, may show fragmentation of tibial tubercle
tx: abstain from activity; stretching, ice, NSAIDs |
|
|
Term
ACL tear:
1. MOI
2. sx
3. dx
4. tx |
|
Definition
MOI: pivoting motion during running, mjumping, or cutting
Sx: hearing a pop, knee pain/instability, hemarthrosis w/in3-4 hours,
Dx: Pos Lachman's test
- can do MRI as adjunct
- xray to R/o fx
tx:
- if not in competitive sports: PT and bracing
- Surgery with autograft or allograft fo 40, competitive sports, or inability to do desire activity
|
|
|
Term
Ankle sprain:
1. 85% MOI is?
2. Most common ligament?
3. sx
4. workup
5. tx |
|
Definition
MOI: usually inversion
ATFL most common
Sx: pop, ecchymosis, tenderness, intability (anterior drawer)
Xray to R/o fx
tx: RICE
- crutches 48-72 hrs
- brace
- PT |
|
|
Term
common injury in runniners and pts with sudden increase in activity - considered an overuse injury due to improper stretching/training
gradual onset of pain during or after activity in posterior calf
- pain on passive dorsiflexion an dresisted plantar flexion
- NL ankle ROM and strength
testing
tx? |
|
Definition
achilles tendonitis
testing: Thompson to r/o rupture
- MRI to r/o rupture
tx: NSAIDs and PT |
|
|
Term
most common deformity of MTP
10x more common in women
sx: medial eminence pain, metatarsal head pain, deformity, inability to find shoes that fit
imaging?
tx? |
|
Definition
hallux valgus (bunion)
wt bearing xray: angle of MTP >15 deg is abnormal
tx: shoes with wide toe box, use pads
-surgery |
|
|
Term
result of traction of interdigital nerve against transverse metatarsal ligament usually affecting third web space
- more common in women 10x
- sx: pain and localized numbness when walking/standing, relieved with rest; palpable mass at web space
test
tx? |
|
Definition
Morton's neuroma
Squeezing forefoot reproduces sx - clinical dx
tx: metatarsal pads and wide toe box
- steroid injections
- surgical removal of neruoma (results in both toes being permenantly numb) |
|
|
Term
common in runners and overweight pts caused by microscopic tears
sx: pain with first few steps in morning, heel pain at night
PE: pain with palpation of calcaneal origin and inflexible achille's
xray may reveal?
tx? |
|
Definition
Plantar fasciitis
xray may reveal calcaneal fx or bone spur or calcification of plantar fascia
tx: 6-12 mos conservative tx - PT, stretching, heel pads, arch supports, massage w/ tennis ball
- steroid injectinos (can cause rupture of fascia)
- surgery for extreme cases |
|
|
Term
Graves' disease:
1. how does it stimulate thyroid hyperfunction?
2. increased risk for?
3. sx of graves' but not other hyperthyroid
4. labs
5. tx |
|
Definition
1. how does it stimulate thyroid hyperfunction - abs attach to TSH receptors
2. increased risk for - Addison's, alopecia areata, celiac disease, cardiomyopathy, hypokalemic periodic paralysis, other autoimmune diseases
3. sx of graves' but not other hyperthyroid: opthalmopathy, pretibial myxedema
4. labs: F-ed up thyroid labs + TSH receptor antibody, antithyroglobulin, or antithyroperoxidase antibody
- may have elevated ANA or anti-DSDNA
- radioactive thyroid scan shows increased uptake
5. tx
- BBs
- thioureas (PTU, methimazole)
- radioactive iodine ablation |
|
|
Term
Hyperthyroidism:
1. complications
2. most common cause
3. tx |
|
Definition
1. complications: afib, hypercalcemia, osteoporosis, impotence, nephrocalcinosis, decreased libido, gynecomastia, decreased sperm count
- men of asian or native american descent: hypokalemic periodic paralysis after IV dextrose, oral carbs, or vigrorous exercise
- thyroid storm
2. most common cause is graves
3. tx:
- Sx: BBs
- PTU, methimazole (thioureas)
- iodinated contrast agents
- radioactive iodine ablation
- treat a fib if present
Pregnancy: PTU, surgery (NOT iodine) |
|
|
Term
life threatening thyroid emergency after stressful illness, thyroid surgery, or radioactive iodine administration
- high fever, tachycardia, vomiting, diarrhea, dehydration, marked weakness, muscle wasting, extreme restlessness, confusion, delirium, emotional lability
- high mortality rate
tx? |
|
Definition
thyroid storm
tx: BBs and hydrocortisone; thiourea drug followed by iodide |
|
|
Term
| presence of antithyroid peroxidase and antithyroglobulin abs in pts with fatigue, lethargy, constipation, weight gain, hair loss, bradycardia |
|
Definition
| Hashimoto's thyroiditis (chronic lymphocytic thyroiditis) |
|
|
Term
acute painful goiter with dysphagia, low grade fever, fatigue, and malaise in young and middle aged women
may have thyrotoxicosis followed by hypothyroidism
- usually resolves w/in 12 mos
tx? |
|
Definition
subacute thyroiditis
tx: aspirin, symptomatic |
|
|
Term
thyroiditis with fever, pain, redness, flutuant neck mass caused by bacterial, fungal, or parasitic infx
tx? |
|
Definition
suppurative thyroiditis
tx: abx, surgical drainage |
|
|
Term
Thyroid cancer:
1. most common type
2. presentaion
3. risk factors
4. least/most aggressive types
5. labs
6. dx
7. tx |
|
Definition
1. most common type : papillary carcinoma, then follicular
2. presentaion: single nodule (although only 5% of palpable nodules are malignant), hoarseness, neck discomfort, dysphagia, stony/hard gland
3. risk factors: head and neck radiation as a kid
4. least/most aggressive types: most is anaplastic, least is papillary
5. labs:
- normal thyroid function tests
- +- eevated thyroglobulin
6. dx: neck US followed by fine needle bx
7. tx:
- surgical resection with near-total thyroidectomy then radiation - must monitor for hypocalcemia and then treat with T4 |
|
|
Term
one-third are sporadic, one third are familial, and one-third are associated with multiple endocrine neoplasia (MEN) type 2
sx: flushing, diarrhea, fatigue, Cushing's
sx: thyroid nodule with high srum calcitoning and carcinoembryonic antigen |
|
Definition
|
|
Term
causes: post-thyroidectomy, heavy metal toxicity, granuloma, Riedel's thyroiditis, tumors, infx, autoimmune problems, neck irradiation, Mg Deficiency
sx: tetany, carpopedal spasm, cramping, confusions, circumoral and distal extremity tingling, irritability, pos Chvostek's and trousseau's signs
chronic dz: anxiety, parkinsonism, mental retardiation, cataracts
low serum Ca, urinary Ca, PTH, Mg,
High serum phosphate
Skull CT may show dense bones and basal ganglia calcification
EKG: prolonged QT and T wave abn
Slit lamp: posterior lenticular changse
Xray; Increased bone density
tx? |
|
Definition
Hypoparathyroidism
tx:
- emergency: airway, IV calcium gluconate
- Maintenance: oral calcium 1-2g /day, Vit D, calcitriol
- Mg supplement
- Transplant of cryopreserve parathyroid tissue
- avoid phenothiaziens and furosemide |
|
|
Term
| ___ includes hypoparathyroidism + congenital facial and cardiac anomalies |
|
Definition
|
|
Term
| ___ results from a group of disease that are characterized by hypocalcemia due to renal resistance to PTH |
|
Definition
|
|
Term
more common in women and in those >50 y/o
- most commonly identified on routine chemistry panel
- sx: may have polyuria/polydipsia (due to hypercalcemia-induced DI), reanl stones, renal failure, bone painbone demineralizaiton, pathologic fx, cystic bone lesions (jaw)
- mild: bones, stones, moans, groans, psych undertones
labs:
1. calcium >10.5 mg/dl is hallmost
- Phosphate <2.5 mg/dl
- elevated PTH
- EKG: prolonged PR, shortened QT, bradycardia, heart block, asystole
- urine Ca lower than expected
tx? |
|
Definition
hyperparathyroidism
tx: surgery for sx (may cause hypocalcemia and transient hyperthyroidism)
- intensive hydration, bisphosphonates to inhibit bone resorption, calcium receptor agonists, PMP estrogen, propranolol, Vit D, avoid immobility
- Avoid thiazides, large doses of Vit A and D, calcium-contining antacids and supplements
Screen all pts for familial hypocalciuric hypercalcemia with Cr and 24 hr urince calcium |
|
|
Term
| Causes of hyperparathyroidism |
|
Definition
parathyroid adenoma (80%)
hyperplasia, carcinoma |
|
|
Term
|
Definition
Diabetic retinopathy - leading cause of blindness in US >60
Diabetic nephropathy: 1/3 of ESRD in US
- 30-40% of T1DM, 15-20% of T2DM
accelearted atherosclerosis - increased risk of stroke and CAD and lower extremity amputaiton
Neuropathy (most common complication) - periperhal symmetric polyneuropathy, erectile dysfunction, atonic bladder, delayed gastric emptying
Skin: candida, slow wound healing, necrobiosis lipoidica diabeticorum, acanthosis nigricans |
|
|
Term
T1DM:
1. antibodies/genes
2. dx
3. ___ reflects glycemic control over preceding 8-12 weeks
4. ___ reflect glycemic control over preceding 1-2 weeks
5. Typical insulin to carb ratio
6. Layout of diet (carbs, fat, protein, cholesterol, fiber) |
|
Definition
1. antibodies/genes: HLA-DR3, HLA-DR4, HLA-DQ, islet cell abx
2. dx: random glucose >200 with sx or fasting level >126 on one or more occassion
3.A1c reflects glycemic control over preceding 8-12 weeks
4. serum fructosamine reflect glycemic control over preceding 1-2 weeks
5. Typical insulin to carb ratio:1 U/10-15 g carbs
6. Layout of diet (carbs, fat, protein, cholesterol, fiber): 45-65% carbs, 10-35% protein, 25-35% fat, limit cholesterol, increase soluble fiber |
|
|
Term
Rapid acting insulins
Long acting insulins
Short acting insulin
Mid-acting insulin |
|
Definition
Rapid acting insulins: lispro, aspart, glulisine - peak in 1 hour, last 4 hours - take 20 min before meals
Long acting insulins: glargine, detemir - 17 hr duraiton of action
Short acting insulin: regular - peaks in 1 hr, lasts 5-7 hrs - take 1 hr before meals
Mid-acting insulin - NPH - 2-4 hrs, peak in 8-10 hrs, last 18-24 hrs
daily aspirin should be taken |
|
|
Term
T2DM:
1. strongest contributing factors
2. 2 pathogenic processes
3. DM2 cannot lead to ketosis but can lead to ____
4. dx
5. diabetic dyslipidemia |
|
Definition
1. strongest contributing factor: overweight/obese - esp iwth fat distribution to upper body
2. 2 pathogenic processes: tissues resistant to insulin, beta cells resistant to glucose
3. hyperosmolar nonketotic state
4. dx (same as T1DM): random glucose >200 or fasting >126 on more than one occasion
5. diabetic dyslipidemia: high trigs, low HDL, LDL becomes smaller and denser |
|
|
Term
| Impaired fasting glucose, imapired glucose tolerance |
|
Definition
IFG: glucose 100-125
IGT: glucose 140-199 2 hrs after 75 g oral glucose
strong risk factors for development of T2DM -- need primary prevention (diet, wt loss, exercise) |
|
|
Term
T2DM drugs:
1. act by increasing insulin release from pancreas. most commonly used oral hypoglycemics. associated with weight gain and increased risk of hypoglycemia.
2. reduced hepatic glucose production. first or second line agent. first line in obese pt with mild disease. Assists in wt loss, decreases trigs, no risk of hypoglycemia. CI in pts at increased risk for lactic acidosis (Cr>1.5). GI side effects.
3. delay absorption of carbs from intestine, thereby decreasing glucose in the blood stream.
4. lowers BG by slowing gastric emptying, thereby stimulating more insulin release and preventing glucoagon release. must be injected. associated with wt loss. |
|
Definition
1. Sulfonylureas (glyburde, glipizide, glimepiride - all 2nd generation, more commonly used) act by increasing insulin release from pancreas. most commonly used oral hypoglycemics. associated with weight gain and increased risk of hypoglycemia.
2. Metformin: reduced hepatic glucose production. first or second line agent. first line in obese pt with mild disease. Assists in wt loss, decreases trigs, no risk of hypoglycemia. CI in pts at increased risk for lactic acidosis (Cr>1.5). GI side effects.
3. Thiazolidinediones (pioglitizone, rosiglitazone): delay absorption of carbs from intestine, thereby decreasing glucose in the blood stream.
4. Exenatide (Byetta): lowers BG by slowing gastric emptying, thereby stimulating more insulin release and preventing glucoagon release. must be injected. associated with wt loss.
|
|
|
Term
| T2DM - other meds (not hypoglycemics) and monitoring, acceptable glucose, BP, and LDL/HDL levels |
|
Definition
Aspirin 81-325 mg daily
monitoring: foot care, annual ophtho exams, anual urine albumin and serum Cr
Glucose: 70-130 mg/dl before meals, 180 or less 1 hr PP, 150 or less 2 hr PP
BP: <130/80
LDL: <100
HDL: >50 |
|
|
Term
Hypoglycemia:
1. causes
2. sx and what BG they begin and Whipple's triad |
|
Definition
1. causes: endocrine d/o, liver malfunction, renal failure, hyperinsulinism and extrapancreatic tumors (primary hypoglycemia), GI surgery, dumping syndrome, functional, B-cell dysfunction, alcohol, factitious, immunopathic, drugs
2. sx and what BG they begin: begin at 60 mg/dl, cognitive impairment at 50 mg/dl
- sweating, palpitations, anxiety, tremulousness, neuroglycopenia (altered behaviour/fxn)
- Whipple's triad: hx of hypoglycemia, fasting BG of 40 mg/dl or less, immediate recovery on administration of glucose |
|
|
Term
Addison's disease (chronic adrenocortical insufficiency):
1. most common cause
2. secondary adrenocortical insufficnecy?
3. factors that precipitate adrenal crisis
4. sx
5. sx of crisis
6. CMP
7. dx testing
8. tx |
|
Definition
1. most common cause: autoimmune destruction of adrenal cortex
2. secondary adrenocortical insufficnecy: pituitary failure
3. factors that precipitate adrenal crisis: infx, trauma, surgery, stress, lymphoma, mets, amyloid, scleroderma, hemochromotosis, cessation of medication
4. sx: non-sepcific fatigue, weakness, wt loss, arthralgia, GI, amenorrhea, salt craving, orthostatic hypotension, delayed DTR, hyperpigmentation, smaller heart, scant axillary/pubic hair, lymphoid hyperplasia
5. sx of crisis: hypotension, acute abd/back pain, v/d, dehydraiton, hypotension, AMS
6. CMP: hypercalcemia, low BUN, hyponatremia, hypoglycemia, hyperkalemia
7. dx testing:
- <3 ug/dl 8am plasma cortisol + >200 pg/ml plasma ACTH
- low cortisol + low ACTH = secondary disease
- Cosyntropin stimulation test: cortisol rise >20 ug/dl is normal; anything else is suspicous
- Srum DHEA <1000 ng/ml
8. tx:
- oral hydrocortisone or prednisone + fludrocortisone acetate
- DHEA for women
- Crisis: IV saline, glucose, and glucocorticoids |
|
|
Term
Cushing's (hypercortisolism)
1. def of cushing's SYNDROME
2. Def of cushing's DISEASE
3. causes of syndrome
4. sx
5. dx for each
6. tx for each |
|
Definition
1. def of cushing's SYNDROME: hypercortisolism either by exogenous or endogenous cause
2. Def of cushing's DISEASE: excess ACTH secretion - usually from pituitary adenoma (most common in pre-menopausal women)
3. causes of syndrome: Cushing's disease is most common; adrenocortical tumors, nonpituitary ACTH-secreting tumors (small cell lung cancer)
4. sx: hypercortisolism - central obesity, HTN, thirst, polyuria, glycosuria, extremities appear wasted, backache, HA, oligomenorrhea/amenorrhia, ED, impaired wound healing, easy bruising, skin infx, psych sx
- d/o of Ca metaoblism: AVN, osteoporosis, fx, hypercalciuria, kidney stones
- Buffalo hump, moon facies, supraclavicular fat pads, violaceous striae
- proximal muscle weakness
5. dx for each:
- Disease: overnight dexamethasone suppression test results in plasma cortisol >10 ug/dl. Random ACTH >20 pg/dl suggests disaese. Need pitutiary MRI
- Syndrome: free cortisol in urine >125 mg/dl in 24 hrs; >95 mcg cortisol per gram creiatinine
6. tx for each:
- Disease: transsphenoidal resection of adenoma then hydrocortisol replacement, radiation and chemo for nonresectable tumors
- Syndrome: adrenal inhibitors (mtyrapone, ketoconazole) to suppress cortisol; parenteral octreotide to suppress ACTH |
|
|
Term
Acromegaly and gigantism:
1. ___ is excess GH in a child - whole body grows. causes?
2. ___ is excess GH in an adult. Result in excessive growth of hands, feet, jaw, internal organs. usually caused by?
3. other sx?
4. dx - labs and imaging
5. tx |
|
Definition
1. gigantism is excess GH in a child - whole body grows. causes - pituitary tumor, mcCune-Albright, MEN-1
2. acromegaly is excess GH in an adult. Result in excessive growth of hands, feet, jaw, internal organs. usually caused by pituitary adenoma
3. other sx: doughy, moist handshake, macroglossia, carpal tunnel, deep voice, OSA, goiter, HTN, cardiomegaly, wt gain, insulin resistance, arthralgia, colon polyps, hyperhydrosis, cystic acne, acanthosis nigricans, HA, spinal stenosis, temporal hemianopsia, decreased libido/ED, menstrual abn
4. dx:
- Labs: prolactin, IGF-1, glucose, liver enzymes, BUN, TSH, free T4, phosphorous, calcium --> all measured fasting
- Growth hormone measured 1 hr after ingestion of glucose syrup
- MRI for pituitary adenoma
5. tx:
- transsphenoidal resection of adenoma
- Dopamine agonists for surgery failure
- somatostatin analogs, Pegvisomant (GH receptor antagonist) |
|
|
Term
Most common kind of Dwarfism with short limbs, long/narrow trunks, large heads, midface hypoplasia, prominents brow
- delayed motor milestones but normal intelligence
- bowed legs, obesity, dental problems, frequent otitis media |
|
Definition
Achondroplasia
can treat orthopedic problems
- use of GH is contraversial |
|
|
Term
| Male with hypoglycemia and micropenis... think? |
|
Definition
|
|
Term
DI:
1. pathogenesis: deficieny of or resistance to ___
2. primary
3. secondary
4. sx
5. workup
6. tx |
|
Definition
1. pathogenesis: deficieny of or resistance to vasopressin (ADH)
2. primary: genetic or sporadic
3. secondary: hypothalamic/pituitary pathology - tumor, anoxic encephalopathy, surgery trauma, infection, sarcoid, Langerhans cell granulomatosis, mets
4. sx: intense thirst - fluid intake 2-20 L/day, craving for ice water, large volume polyuria, hypernatremia, dehydration, unremitting enuresis
5. workup: no single diagnostic test
- BUN, glucose, calcium, uric acid, K, Na
- 24 hr urine iwth low specific gravity
- Vasopressin challenge test for central DI
6. tx:
- Desmopressin (DDAVP)
- mild cases: no tx except hydration
- some response to HCTZ with K
- Nephrogenic: indomethacin alone or with HCTZ, DDAVP, or ameloride |
|
|
Term
Vit D deficiency:
1. ___ - found in adults. may be induced by phenytoin, carbamazepine, valproate, barbituates
2. ___ - found in kids.
3. sx of each
4. dx of each
5. tx |
|
Definition
1. osteomalacia - found in adults. may be induced by phenytoin, carbamazepine, valproate, barbituates
2. rickets - found in kids.
3. sx of each
- osteomalacia: diffuse muscle weakness (esp pelvic girdle), pathologic fx, bone pain
- Rickets: skeletal deformity
4. dx of each:
- Osteomalacia: XRAY - decreased bone denisty with Milkman lines or Looser lines (pseudofx) are dx
- Rickets: Bone bx, low Vit D
5. tx :
ergocalciferol 50K twice a week x 6-12 mos then 1-2K daily
- may need phosphate, calcium supplement
- discontinue anything with aluminum or causative drugs |
|
|
Term
localized dysplastic bone formation
1-3% can turn into osteosarcoma
sx: 3/4 have none; bone and joint pain (spine, pelvis, femur, tibia, humerus, skull); pathologic fx; ;increased hat size; bowed tibias, kyphosis; mixed SN and conductive hearing loss; increased CO
Labs:
- High Alk phos, urinary hydroxyproline
- hypercalciuria
- XRAY: dense, expanded bones, fissures in long bones
tx? |
|
Definition
Paget's disease (osteitis deformans)
tx: bone scan and xray for extent
- cyclic administration of bisphosphonates |
|
|
Term
Dyslipidemias:
1. elevated trigs increases risk for what two things?
2. eruptive and tendinous xanthomas or lipemia retinalis typically indicate?
3. premature arcus senilis indicates?
4. screening recommendations?
5. tx |
|
Definition
1. elevated trigs increases risk for what two things: pancreatitis and CAD
2. eruptive and tendinous xanthomas or lipemia retinalis typically indicate: hypertriglyceridemia
3. premature arcus senilis indicates: hypercholesterolemia
4. screening recommendations:
- anyone with CHD or cardiac risk factors
- no risk factors: 35 y/o for men, 45 y/o for women |
|
|
Term
Tx for hyperlipidemia/CAD
- fat __%
-sat fat <__%
- cholesterol <__ mg daily
- increase?
- increase ___ exercise (increases HDL)
- ___ diet (increases HDL)
Drugs:
1. ___ daily for high LDL or CAD risk
2. ___: reduced long-term mortality and optimal effect on lipids - poorly tolerated due to flushing
3. ____ - reduce incidence of coronary events in middle-aged men
4. ____ - inhibit cholesterol formation, reduce CAD risk. Myositis is side effect.
5. ____: reduce LDL. SE: cholelithiasis, hepatitis, myositis
6. ___ blocks intestinal absorption of dietary and biliary cholesterol. |
|
Definition
LIfestyle:
- fat 25-30%
-sat fat <7%
- cholesterol <200 mg daily
- increase soluble fiber, garlic, soy, pecans, sterols, vit C, modest alcohol, anti-oxidant-containing veggies and fruits
- increase aerobic exercise (increases HDL)
- Mediterranean diet (increases HDL)
Drugs:
1. aspirin 81-325 mg daily for high LD or CAD risk
2. NIacin: reduced long-term mortality and optimal effect on lipids - poorly tolerated due to flushing
3. Bile acid binders (cholestyramine) - reduce incidence of coronary events in middle-aged men
4. HMG-CoA Reductase inhibitors (statins) - inhibit cholesterol formation, reduce CAD risk. Myositis is side effect.
5. Fibric acid derivatives (Fenofibrate, gemfibrozil): reduce LDL. SE: cholelithiasis, hepatitis, myositis
6. Ezetimibe blocks intestinal absorption of dietary and biliary cholesterol. |
|
|
Term
Stroke:
1. major risk factors
2. 2/3 of ischemic strokes are cauesd by ___, 1/3 caused by ___
3. hemorrhagic strokes are usually due to ____
4. strokes involving ____ circulation are commonly associated with hemispheric signs and sx (aphasia, apraxia, hemiparesis, hemisensory loss, visual field defect)
5. strokes involving ____ circulation are commonly associated with brain stem dysfunction (coma, drop attacks, vertigo, n/v, ataxia)
6. ___ (cause) strokes typically occur in a stepwise fashion, being preceeded by TIAs. ___ and ___ strokes are less predictable
7. Best imaging modality for acute stroke?
8. When to do LP or angiograpy? |
|
Definition
1. major risk factors: HTN, hypercholesterolemia, DM, OCP, smoking, heavy alcohol use, AIDS, elevated homocysteine
2. 2/3 of ischemic strokes are cauesd by thrombi, 1/3 caused by emboli
3. hemorrhagic strokes are usually due to HTN
4. strokes involving anterior (anterior cerebral/choroidal, middle cerebral) circulation are commonly associated with hemispheric signs and sx (aphasia, apraxia, hemiparesis, hemisensory loss, visual field defect)
5. strokes involving posterior (vertebral/basilar arteries) circulation are commonly associated with brain stem dysfunction (coma, drop attacks, vertigo, n/v, ataxia)
6. thrombotic (cause) strokes typically occur in a stepwise fashion, being preceeded by TIAs. Embolic and hemorrhagic strokes are less predictable
7. Best imaging modality for acute stroke - CT
8. When to do LP or angiograpy - hemorrhage or vascular abn is suspected |
|
|
Term
| Stroke Tx - ischemic and hemorrhagic |
|
Definition
Ischemic:
1. thrombolysis rTPA within 3 hours (most effective) - can be given up to 12 hrs
2. Antiplatelet for ischemic/TIA
3. Anticoagulant for cardiac embolus
4. Endarterectomy if 70-99% blockage of carotid
Hemorrhagic:
- conservative and supportive measures - control HTN and edema (mannitol, corticosteroids)
- clipping or coil embolization may be an option |
|
|
Term
| Contraindications for rTPA |
|
Definition
suspicion for or evidence of intracranial bleed
recent intracranial surgery
serious head trauma or previous stroke
hx intracranial bleed
current bleeding diathesis
unctonrolled HTN >185/>110
Seizure at stroke onset
active internal bleed
intracranial neoplasm
AVM or aneurysm
Heparin w/in past 48 hrs
Platelet count <100K |
|
|
Term
TIA:
1. definition: sudden onset neuro sx that resolve within ___
2. proportion of TIA pts that have a stroke w/in 5 years?
3. TIA in ___ circulation causes contralateral hand-arm weakness/sensory loss, ipsilatral visual sx, aphasia, amaurosis fugax
4. TIA in ___ ciruclation causes diplopia, ataxia, vertigo, dysarthria, CN palsy, LE weakness, dimness/blurred vision, perioral numbness, drop attack
5. Definitive study
6. other workup
7. tx |
|
Definition
1. definition: sudden onset neuro sx that resolve within 24 hrs
2. proportion of TIA pts that have a stroke w/in 5 years - 1/3
3. TIA in carotid circulation causes contralateral hand-arm weakness/sensory loss, ipsilatral visual sx, aphasia, amaurosis fugax
4. TIA in vertebrovascular ciruclation causes diplopia, ataxia, vertigo, dysarthria, CN palsy, LE weakness, dimness/blurred vision, perioral numbness, drop attack
5. Definitive study: Arteriography (MRI works and is less invasive)
6. other workup:
- cardiac - arrhtyhmias, murmurs
- hematologic workup to ID coagulopathies: normal ESR r/o temporal arteritis, PT/PTT, APA, cholesterol, CBC
7. tx:
- Antiplatelets if not cardiogenic (aspirin, clopidogrel, ticlopidine, dipyridamole, sulfinpyrazone)
- carotid endarterectomy
- Control BP, cholesterol, BG, a fib, stop smoking and alochol, lose weight |
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Term
SAH:
1. usually due to ___ or ___
2. Ruptured ___ aneurysm accounts for 75% of nontraumatic SAH. 50% mortality rate. 50-60 y/o
3. Risk factors
4. sx, - ____ happens in 40% producing less severe by atypical HA with focal neuro deficit
5. dx study
6. other workup
7. tx |
|
Definition
1. usually due to arterial aneurysm or AVM
2. Ruptured saccular (berry) aneurysm accounts for 75% of nontraumatic SAH. 50% mortality rate. 50-60 y/o
3. Risk factors: smoking, HTn, hypercholesterolemia, PCKD, coarctation
4. sx: worst headache of my life, n/v, ams, HTN, fever, nuchal rigidity and other meningeal signs
- Herald bleed (aneurysm leak) in 40% - may precede a catastrophic hemorrhage by hours to weeks
5. dx study: CT
6. other workup:
- CSF - markedly elevated opening pressure and bloody fluid
- angiography when convenient for other aneurysms
7. tx:
- supportive to prevent elevated arterial or IC pressure to prevent further rupture - bed rest, sedation, stool softeners
- HTN management
- Surgery: clipping, wrapping, removal of emboli |
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Term
Seizure disorders:
1. definition: transient disturbances of cerebral fxn caused by _____
2. status epilepticus is when ____ or ___
3. ___ seizures are characterized by loss of consciousness + seizure (convulsive or non-convulsive)
4. these seizures are associated with _____ lasting for min to hours
5. ___ are not accompanied by impaired consciousness and are usually characterized by tonic or clonic movmenet of a limb or transiently altered sensory which may spread to include the entire side of the body, called a Jacksonian march
6. ____ seizures are often characterized by an aura followed by impaired consciousness lasting seconds to minutes, n/v, focal snesory perceptions, focal tonic/clonic activity |
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Definition
1. by abnormal paroxysmal neuronal discharges
2. status epilepticus is when seizures fail to cease spontaneously or recur so frequently that full consciousness is not restored between episodes
3. Generalized seizures are characterized by loss of consciousness + seizure (convulsive or non-convulsive)
4. these seizures are associated with postictal confusion/obtundation lasting for min to hours
5. simple partial seizures are not accompanied by impaired consciousness and are usually characterized by tonic or clonic movmenet of a limb or transiently altered sensory which may spread to include the entire side of the body, called a Jacksonian march
6. complex partial seizures are often characterized by an aura followed by impaired consciousness lasting seconds to minutes, n/v, focal snesory perceptions, focal tonic/clonic activityabn paroxysmal neuronal discharges in the brain |
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Term
Seizures:
1. IN ___ seizures, EEG shows generalized spikes and associated slow waves.
2. In ___ seizures, EEG shows focal rhythmic discharge at onset but occasionally no ictal activity will be seen
3. In ___ seizures, EEG shows interictal spikes or spikes associated with slow waves in temporal and frontotemporal areas
4. Labs to do to r/o other causes? |
|
Definition
1. IN generalized absence seizures, EEG shows generalized spikes and associated slow waves.
2. In simple partial seizures, EEG shows focal rhythmic discharge at onset but occasionally no ictal activity will be seen
3. In complex partial seizures, EEG shows interictal spikes or spikes associated with slow waves in temporal and frontotemporal areas
4. Labs to do to r/o other causes: CBC, BG, liver, renal function, RPR |
|
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Term
Seizure Tx:
1. First, treat any correctable causes (hyponatremia, hypoglycemia, drug intox)
2. First seizure in a pt with normal neuro exam, imaging, and EEG?
3. Goal of medical therapy?
4. First line for generalized convulsive, simple partial, and complex partial
5. first line for generalized nonconvulsive (absence) seizures
6. ___ is reserved for pts who are unresponsive to other meds or combinations - serious SE such as aplastic anemia and hepatic failure.
7. Tx for status epilepticus? |
|
Definition
1. First, treat any correctable causes (hyponatremia, hypoglycemia, drug intox)
2. First seizure in a pt with normal neuro exam, imaging, and EEG --> no treatment
3. Goal of medical therapy use a single agent in progressive doses until seizures are controlled or toxicity occurs
4. First line for generalized convulsive, simple partial, and complex partial - carbamazepine, phenytoin, valproic acid, gabapentin, topiramate, lamotrigine, oxcarbazepine, levetiracetam, zonisamide
5. first line for generalized nonconvulsive (absence) seizures - ethosuximide
6. Felbamate is reserved for pts who are unresponsive to other meds or combinations - serious SE such as aplastic anemia and hepatic failure.
7. Tx for status epilepticus:
- ABCs
- position pt to prevent aspiration
- manage hyperthermia (cooling blanket, induction of paralysis with neuromusclar blocking agent)
- Diazepam or lorazempam IV +/- loading dose of phenytoin or fosphenytoin |
|
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Term
Multiple Sclerosis:
1. Characterized by inflammation associated with multiple foci of ___ in the CNS __ matter
2. Thought to be a ___ disorder with CNS immunoglobulin production and alteration of T lymphs. Association with HLA-DR2
3. Onset?
4. Sx |
|
Definition
1. Characterized by inflammation associated with multiple foci of demyelination in the CNS white matter
2. Thought to be a autoimmune disorder with CNS immunoglobulin production and alteration of T lymphs. Association with HLA-DR2
3. Onset: 18-45; women>men
4. Sx:
- Initial: any of an array of sx - focal weakness, numbness/tingling, optic neuritis, diplopia, focal neuralgia, balance issues, urinary sx - lasting for days to weeks
- Attacks come and go with different sx each time
- often results in cognitive and psych deficits
5. dx:
- MRI with gadolinium to visualize white matter lesions
- LP: sterile inflammation with mild lymphocytosis or slight protein elevation, elevated IgG, oligoclonal bands, increased myelin basic protein
- evoked potential testing for nerve transmission
6. tx:
- exacerbations: corticosteroids
- Optic neuritis: high dose IV corticosteroids
- Prevent relapse: Interferon-beta, Glatiramer acetate
- prevent progression in secondary progressive: cyclophosphamide, azathioprine
- sx tx: amantadine/pemoline for fatigue, baclophen/diazapam for spasticity
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Term
Dementia: progressive impairment of intelectual functioning with compromise in at least two of the following (6)
causes? |
|
Definition
dx needs compromise in at least 2: language, memory, visuospatial skills, emotional behavior, personality, cognition
causes: Alzheimer's most common
- vascular, Parkinson's, HUntington's, frontotemproal, due to infx |
|
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Term
Alzheimer's:
1. Risk factors
2. characterized by steadily progressive ___ and other cognitive deficits, beginning during 6th or 7th decade
3. Classic Pathology
4. sx
5. dx
6. tx |
|
Definition
1. Risk factors: increseing age, fm hx, lower education, female
2. characterized by steadily progressive memory loss and other cognitive deficits, beginning during 6th or 7th decade
3. Classic Pathology: neurofibirllatory tnagles and amyloid plaques (book says extracellular neuritic plaques)
4. sx: progressive memory loss, disorientation, language trouble, inability to perform complex motor activity, inattention, visual misperception, poor problem solving, inappropriate social behavior, hallucinations
5. dx:
- Evidence of mental decline in 2 areas documented by mental status exam and then formal neuropsychological testing
- MRI/Ct and labs only to r/o other causes
6. tx:
- tx sx
- acetylcholinesterase inhibitors - tacrine, donepazil/aricept, galantamine, rivastigmine/exelon
- NMDA receptor antagonist - amantadine |
|
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Term
Vascular dementia:
1. AKA multi-infarct dementia - including ___ and ___ infarcts
2. Associatd with ____
3. sx progression
4. workup
5. tx |
|
Definition
1. AKA multi-infarct dementia - including lacunar and multiple-cortical infarcts
2. Associatd with HTN
3. sx progression: forgetfulness with social graces maintained and no depression/inattentiveness --> loss of computational ability --> problems with word finding and concentration --> difficulty with ADLs --> complete disorientation and social withdrawal
4. workup: only to r/o other causes
5. tx: control HTN to slow progression
- tx sx |
|
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Term
Dementia that causes behavioral sx (euphoria, apathy, disinhibition) and compulsive disorders as well as primitive reflexes
Causes: Pick's dementia, ALS
MRI: may be normal, may reveal atrophy
PET: hypometabolism in affected areas
tx? |
|
Definition
Frontotemporal dementia
tx: supportive, maybe SSRIs |
|
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Term
Pseudodementia:
1. a term to describe pts with psych illness that appear to be demented
2. most common cause?
3. sx |
|
Definition
1. a term to describe pts with psych illness that appear to be demented
2. most common cause: major depression
3. sx: memory problems and upset/distressed but no concentration or attention span issues (true dementia people will have concentration/attention/memory issues and not seem concerned about it)
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Term
band-like headache; steady or aching, not pulsatile; NO neuro deficits, photophobia, phonophobia, n/v
precipitated by stress, lack of sleep, hunger, and eyestrain
PE: +/- tenderness to posterior cervical and suboccipital muscles
no workup necessary
tx? |
|
Definition
tension headache
tx: NSAIDs
- antimigraine meds
- head and muscle relaxants
- may need antidepressants or psychotherapy |
|
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Term
unilateral throbbing or pulsatile HA. Pts report desire to lie down in quiet dark rooms
types:
1. presents with an aura involving visual changes, field cuts, or flashing lights in one hemifield contralateral to pain - may have transient neuro deficit
2. headache accompanied by n/v, photo/phonophobia, anorexia
no workup necessary
triggers?
tx? |
|
Definition
Migraine
1. migraine with aura (classic migraine)
2. migraine without aura (common migraine)
Triggers: chocolate, red wine, cheese, monosodium glutamate, hormonal changes (menstruation), fatigue, stress, exertion
Mild-mod:
- abortive: aspirin, NSAIDs, isometheptene - often combined with caffeine
- serotonin receptor agonists (triptans - sumatriptan, zolmitriptan) and ergotamines
Severe/frequent:
- Prophylaxis: BBs, TCAs, CCBs, NSAIDs, valproic acid, topiramate
- biofeedback
- Botox
|
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Term
severe unilateral periorbital HA that lasts for 30-90 min and occur severeal times a day for a period of weeks to months - typically in middle aged men
other sx: ipsilateral lacrimation, conjunctival injection, nasal congestion, myosis, ptosis
pts usually pace around the room
no workup = only to r/o other issues
tx? |
|
Definition
Cluster HA
tx: 100% O2, injectable ergotamines, sumatriptan, anagesics (intranasal butorphanol)
- prophylaxis: valproate, cyproheptadine, lithium, CCB, oral steroids |
|
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Term
rhythmic, 6-8 Hz to and fro movement of upper extremities and someitmes head (titubation), may affect speech
unknown cause but often inherited autosomal dominant - begins at any age
- enhanced by emotional stress
- better with alcohol
no workup needed
tx? |
|
Definition
Benign essential (familial) tremor
tx: low dose BB (usually indefinitely)
- primidone is second line |
|
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Term
Parkinson's:
1. pathophys: degeneration of cells in the ____, causing a deficiency of ___ (neurotransmitter) and am imbalance of this with ____.
2. sx?
3. dx
4. tx |
|
Definition
1. pathophys: degeneration of cells in the substantia nigra, causing a deficiency of dopamine (neurotransmitter) and am imbalance of this with ACh.
2. sx: resting pill rolling tremor, bradykinesia, rigidity, postural instability, shuffling gait with no arm swing, infrequent blinking, masklike facies, depression and cognitive impairment in 50%
3. Dx via PE:
- Cogwheel rigidity on passive ROM
- slowed rapid alternating movements
- en-bloc turns
4. tx:
- Increase dopamine - Levodopa/carbidopa, bromocriptine for those who fail levodopa, MOAB inhibitors (inhibit breakdown of dopamine) like Selegline, COMT inhibitors (reduce breakdown of levodopa) like tolcapone and entacapone
- Decrease ACh - Amantadine, benzotropine, trihexyphenidyl |
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Term
Inherited autosomal dominant disorder that occurs in all ethnic groups - due to gene on short arm of chrom 4
- sx develop >30 y/o, which means those who are affected often already have kids
sx: progressive chorea and dementia, fatal w/in 15-20 years
- Earliest change: irritability, moodiness, antisocial behavior - progresses to dementia
- Earliest physical signs: restlessness/fidgetiness - progress to chorea and dystonic posturing
CT: cerebral atrophy, atrophy of caudate nucleus
MRI/PET: decreaed glucose metabolism
tx? |
|
Definition
Huntington's disease
tx: no cure, no halt to progression
- sx: phenothiazines for dyskinesia, haldol for behavior |
|
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Term
chronic impairment of muscle tone, strength, movements, or coordination from cerebral injury before birth, during deliverty, or perinatal.
sx vary widely - spasticity, ataxia, seizure, mental retardation, speech, hearing, vision disorder
PE: hyperreflexia, microcephaly, limb length discrepancy, cataracts, retinopathy, CHD
tx? |
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Definition
CP
tx: suppotive - attain max function and potential
- may need meds for seizures and spasticity |
|
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Term
usually a primary case, but could be secondary to peirpheral neuropathy, uremia, pregnancy, iron deficiency
subjective need to move, abnormal tingling, creeping/crawling sensations, itchiness, heaviness, burning, cold, tension - during periods of prolonged inactivity
- myoclonus at rest
tx? |
|
Definition
Restless Leg syndrome
Tx:
- first line: dopamine agonists or ropinirole (requip)
- Opiate agonists and bnezos
- iron replacement if low |
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Term
Unilateral facial muscle weakness without other neurological defects and without apparent cause. More common on RIGHT side.
- More frequently seen in pregnancy, DM, trauma, infx, neoplasia, or toxins
- Can be entire CN VII distribution (complete palsy) or partial
- Begins abruptly, may progress over hours to 2 days
- May have pain in ipsilateral ear, impaired taste or lacrimation, or hyperacusis
dx is clinical but can be confirmed with EMG or nerve conduction test
tx? |
|
Definition
Bell's Palsy
tx:
- 60% resolve spontaneously w/in a few days to a few months
- poorer prognosis associated with severe pain, complete palsy, hyperacusis, advanced age
- Oral acyclovir and prednisone at onset of sxx increases chance of complete recovery |
|
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Term
DM Peripheral Neuropathy:
1. 70% are mixed motor, sensory, autonomic
2. Risk of developing neuropathy is related to ___
3. sx
4. dx
5. tx |
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Definition
1. 70% are mixed motor, sensory, autonomic
2. Risk of developing neuropathy is related to severity and duration of hyperglycemia
3. sx: stocking-glove neuropathy - numbness, pain, dysesthesia (burning), paresthesia, reduced DTR or vibratory sense
- Autonomic Sx: postural hypotension, cardiac arrhythmia, imparied thermoregulation (sweating), bowel/bladder/gastric disturbances, sexual dysfunction
4. dx: clinical - can do serial nerve conduction studies
- r/o other causes
5. tx: no real tx
- tight glucose control
- shooting/stabbing pain: phenytoin, mexiletine, carbamazepine
- deep, constant, aching pain: amitriptylline, nortriptyline, desipramine, gabapentin, fluphenazine
- SNRis |
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Term
idiopathic polyneuropathy often following minor infections, immunizations, or surgeries - often cause is unknown
- Campylobacter is most suspicious
sx: symmetric weakness that BEGINS DISTALLY, ASCENDS PROXIMALLY
- DTR decreased or absent, CN affected in 45-75%
- sensory abn are common
- pain is present in 85%
- autonomic dysfunction: tachy, cardiac irregularities, labile blood pressure, sweating, impaired pulmonary fxn, sphincter dysfxn, paralytic ileus
- can be life threatening
dx: slowed nerve conduction of motor and sensory nerves
- CSF shows only elevated protein
tx? |
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Definition
Guillain-Barre
tx: hospitalization, close resp monitoring, close BP and HR monitoring - can quickly become hypotensive and arrhtyhmic
- IVIG and plasmapheresis |
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Term
Muscle weakness and fatiguability that improves with rest; insidious onset made evident by coincidental infx that makes it worse
- can occur at any age, more common in older men and younger women
- Abs against ACh receptor
Sx: ptosis, diplopia, difficulty chewing/swallowing, resp trouble, limb weakness - may vary in intensity during day - may have relapses and remissions
PE: weakness and fatiguability of muscles that improves after a rest
- normal sensation, normal reflexes
dx via?
CXR to R/O?
tx? |
|
Definition
Myasthenia Gravis
dx:
- rapid improvement by administering anti-cholinesterase (edrophonium)
- OR serum assay for ACh receptor antibodies
CXR to r/o thymoma
tx:
1. AChE inhibitor (puridostigmine)
2. Thymectomy
3. corticosteroids, immunosuppressants, IVIG, plasmapheresis for refractory disease |
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Term
syndrome in which muscle power increases with sustained contraction due to defective release of ACh in response to nerve impulse
often seen in association with small cell carcinoma
dx?
tx? |
|
Definition
Lambert-Eaton Syndrome (myasthenic syndrome)
dx via EMG - muscle response to repeated stimulation is increased significantly
tx: plasmapheresis and immunosuppression
- treat the tumor if present |
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Term
Bacterial meningitis:
1. sx are based on three processes
2. 3 main causative organisms
3. sx
4. workup
5. tx for Neonates to 3 mos; 3 mo-55 y/o; >55 or alcoholism or dibilitating illness; Hosptial acquired, posttraumatic, postneurosurgery, immnocompromised |
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Definition
1. sx are based on three processes: inflammation, increased ICP, tissue necrosis
2. 3 main causative organisms: s. pneumo, N. meningitidis, GBS
3. sx: acute onset Fever, HA, vomiting, stiff neck
- Petechial rash if N. meningitidis
4. workup:
- CT first to r/o space occupying lesion
- LP with CSF analysis: turbid to grossly purulent, elevated pressure, WBC 1000-10k with increased neutrophils, protein 100-500, glucose decreased to <40 (bacteria is eating glucose and producing protein)
- dx via gram stain of CSF
5. tx:
- Begin ABX immediately if CSF is not clear and colorless
- Neonates to 3 mos: amp and cefotaxime
- 3 mo-55 y/o: cefotaxime or ceftriaxone + vanc
- >55 or alcoholism or dibilitating illness: amp + cef + vanc
- Hosptial acquired, posttraumatic, postneurosurgery, immnocompromised: amp + cefazidime + vanc
Repeat LP after 24 hrs - should be sterile
Repeat in 3 days - should be decrease in pleocytosis and neutrophils |
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Term
Viral/asceptic meningitis/encephalitis:
1. most common orgnaimss
2. sx
3. workup
4. tx |
|
Definition
organisms: enteroviruses (coxsackie, echovirus), HSV2, arthropod-borne illnesses or simply just inflammation
sx: acute confusion (not as acute as bacterial), rash, pharyngitis, adenopathy, pleuritis, carditis, jaundice, organomegaly, diarrhea
- encephalitis: marked AMS, seizures, personality changes, focal neuro deficits
LP:
- normal pressure
- lymphocytosis or monocytosis; WBC <1000
- normal protein & glucose
tx:
1. symptomatic unless due to HSV, then acyclovir
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Term
Meningitis caused by mycobacterium TB, fungi (cryptococcus, coccidoides, histoplasma) and spirochetes (treponema pallidum, borrelia burgdorferi)
- common in immunocompromised
- could be non-infectious (sarcoid)
sx: less acute than other meningitis, evolving over weeks to months with subtle mental status changes
CSF: high protein, low glucose, lymphocytosis --> GET CULTURE
Ct/MRI: enhancement of meninges and occassionally hydrocephalus |
|
Definition
Granulomatous meningitis
tx based on cause |
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Term
typically results from direct sprad of infx from sinus, ear, soft tissue
- may be localized to extradural, subdural, or parenchyma
sx: space-occupying lesion - vomiting, fever, AMS, focal neuro signs preceded by sinus infx, otitis, pharyngitis
workup: CT then LP
- usually identified on CT or MRI
organism: usually polymicrobial
tx? |
|
Definition
brain abscess
tx: ABCs
- abx tht penetrate BBB --> IV penicillin + chloramphenicol, metronidazole, or both (add Nafcillin if s. aureus is suspected)
- may need surgery |
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Term
Brain trauma:
1. prognosis is related to what 2 factors?
2. brief loss of consciousness with bradycardia, hypotension, resp arreast for a few seconds suggests?
3. HA< confusion, somnolence, seizure, focal neuro deficit several hours after injury suggests?
4. Bruising on side of injury is called ___, on contralateral side is called ____.
5. components of Glasgow coma scale
6. workup
7. tx - hemorrhage and increased ICP |
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Definition
1. prognosis is related to what 2 factors - LOC time (>2 min is worse) and amnesia
2. brief loss of consciousness with bradycardia, hypotension, resp arreast for a few seconds suggests --> concussion
3. HA< confusion, somnolence, seizure, focal neuro deficit several hours after injury suggests --> epidural hemorrhage
4. Bruising on side of injury is called coup injury, on contralateral side is called contracoup injury.
5. components of Glasgow coma scale: eye movement, verbal response, motor response
6. workup:
- xray or CT of spine and skull for fx or bleeding and swelling
7. tx:
- hemorrhage: surgical evacuation
- increased ICP: induced hyperventilation, IV mannitol, IV furosemide |
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Term
Spinal cord injury:
1. extreme hypotension after acute injury may result in ___
2. ___ results in immediate flaccid paralysis and loss of sensation below the level of the lesion, temporarily lost reflexes, urinary and fecal retension. Spastic paraplegia or quadriplesia with hyperreflexia and extensor plator reflex is result.
3. ___ ipsiliateral motor disturbance and loss of proprioception + contralateral loss of pain and temperature below the level of the lesion
4. ____ results in lower motor neuron deficit and loss of pain/temp with sparing of vibration and fine motor
5. workup
6. tx |
|
Definition
1. extreme hypotension after acute injury may result in cord infarction
2. total cord transection results in immediate flaccid paralysis and loss of sensation below the level of the lesion, temporarily lost reflexes, urinary and fecal retension. Spastic paraplegia or quadriplesia with hyperreflexia and extensor plator reflex is result.
3. Brown Sequard syndrome - ipsiliateral motor disturbance and loss of proprioception + contralateral loss of pain and temperature below the level of the lesion
4. central cord syndrome results in lower motor neuron deficit and loss of pain/temp with sparing of vibration and fine motor
5. workup: imaging only - CT or MRI
6. tx:
- immobilization and decompression laminectomy with fusion and anatomic realignment
- early high-dose steroids helpful if started w/in 8 hrs |
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Term
CNS tumors:
1. Half are ___
2. ___ is most common intramedullary tumor
3. Most common sources of intracranial mets
4. Spinal tumors lead to spinal cord dysfunction by what 3 processes
5. lesions in the ___ lobe produce personality changes, slowed mental activity, progresive intellectual decline, contralateral grasp reflex, expressive aphasia
6. lesions in ___ lobe lead to seizures, olfactor/gustatory hallucinations, licking/smacking of lips, depersonalization, emotion/behavior changes, visual field defects, audiotry illusions
7. __ lobe lesions cause contralateral sensory disturbances, seizures, cortical sensory loss (impaired sterognosis), inattention
8. ___ lobe lesions produce homonymous hemianopsia or other field defects, visual agnosia for colors and objects, unformed visual hallucinations
9. ____ lesions result in CN palsies, ataxia, incoordination, nystagmus, pyramidal and sensory deficits in limbs |
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Definition
1. Half are gliomas
2. ependymoma is most common intramedullary tumor
3. Most common sources of intracranial mets: GI tumors, lung, breast, kidney
4. Spinal tumors lead to spinal cord dysfunction by what 3 processes - direct compression, ischemia, invasive infiltration
5. lesions in the frontal lobe produce personality changes, slowed mental activity, progresive intellectual decline, contralateral grasp reflex, expressive aphasia
6. lesions in temporal lobe lead to seizures, olfactor/gustatory hallucinations, licking/smacking of lips, depersonalization, emotion/behavior changes, visual field defects, audiotry illusions
7. parietal lobe lesions cause contralateral sensory disturbances, seizures, cortical sensory loss (impaired sterognosis), inattention
8. occipital lobe lesions produce homonymous hemianopsia or other field defects, visual agnosia for colors and objects, unformed visual hallucinations
9. brain stem lesions result in CN palsies, ataxia, incoordination, nystagmus, pyramidal and sensory deficits in limbs |
|
|
Term
|
Definition
Wokrup:
- Ct/MRI with contrast
- Arteriagraphy
- EEG
- Ct myelography for spinal cord
- CSF: xanthochromic, grealty increased protein, normal cell content, normal glucose
tx:
- surgery if possible
- shunting of hydrocephalus
- radiation/chemo
- corticosteroids to reduce edema
- anticonvulsants
- decompression
- irradtion of epidural spinal mets regardless of cell type |
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Term
Sleep disorders:
1. ___ is when dreaming happens
2. ___ is divided into 4 stages
3. ___ is difficulty getting to sleep or staying asleep, intermittent wakefulness, early morning awakening - usually associated with psych disorders
4. ___ is associated with fragmented sleep, decreased total sleep time, quicker onset of REM sleep, shift to REM earlier in the night
5. ___ is associated with decreased total sleep time, shortened REM latency, and increased REM activity
6. ___ occurs in pts with OSA, narcolepsy, or nocturnal myoclonus
7. ___ include nightmares, sleep terrors, sleepwalking, and enuresis |
|
Definition
Sleep disorders:
1. REM sleep is when dreaming happens
2. non-REM is divided into 4 stages (stages 3&4 are delta sleep)
3. insomnia/dyssomnia is difficulty getting to sleep or staying asleep, intermittent wakefulness, early morning awakening - usually associated with psych disorders
4. depression is associated with fragmented sleep, decreased total sleep time, quicker onset of REM sleep, shift to REM earlier in the night
5. mania is associated with decreased total sleep time, shortened REM latency, and increased REM activity
6. hypersomnia occurs in pts with OSA, narcolepsy, or nocturnal myoclonus
7. parasomnias include nightmares, sleep terrors, sleepwalking, and enuresis |
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Term
Sleep:
1. conditions/behaviors associated with insomnia
2. Pts with ___ experience sudde, brief sleep attacks, cataplexy, sleep paralysis, hypnagogic hallucinations preceding sleep
Tx for each:
1. insomnia
2. OSA
3. Narcolepsy
4. nocturnal myoclonus
5. sleep terror and sleepwalking |
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Definition
1. conditions/behaviors associated with insomnia: depression, alcoholism, heavy smoking, inappropriate use of sedatives/hypnotics, uremia, asthma, hypothyroid
2. Pts with narcolepsy experience sudde, brief sleep attacks, cataplexy, sleep paralysis, hypnagogic hallucinations preceding sleep
Tx for each:
1. insomnia: sleep hygiene, avoid meds if possible
2. OSA: wt loss, CPAP
3. Narcolepsy: stimulants - dextroamphetamine, modafinil
4. nocturnal myoclonus: clonazepam
5. sleep terror and sleepwalking: benzos |
|
|
Term
Psych Diagnoses:
1. DSM endorses a criteria-based diagnostic approach that requires the following three conditions to be met ?
2. DSM axes |
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Definition
1. DSM endorses a criteria-based diagnostic approach that requires the following three conditions to be met: not caused by the effects of a drug, not caused by the effects of a medical condition, significant impairment of social and/or occupational functioning.
2. DSM axes:
Axis I: All mental disorders includng substance abuse and developmental
Axis II: personality disorders and mental retardation
Axis III: Any general medical condition/physical disorder
Axis IV: psychosocial and environmental situation that contribute to a disorder - homelessness, economic troubles
Axis V: global assessment of function (GAF), rating system to assess level of daily function based on social, occupational, and psych assessment |
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Term
| Psychotic disorder symptoms |
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Definition
Positive sx: hallucinations, bizarre behavior, deluisions
Negative sx: flat affect, apathy, poor grooming, social withdrawal, anhedonia, poor eye contact, poverty of speech
memory and consciousness are not impaired |
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Term
Types of schizophrenia:
1. most common. characterized by persecutory and grandiose delusions or auditory hallucinaitons
2. characterized by disorganized speech or behavior and flat or inappropriate affect.
3. rare. manifested by at least two of the following: motor immobility, excess motor activity without purpose, extreme negativism or mutism, peculiarly voluntary movement (bizarre postures, stereotyped movments, grimacing), echolalia, echopraxia (mimicking behavior)
4. delusions and hallucinations are prominent; paranoid, disorganized, catatonic sx are absent
5. negative sx predominate with only minimal pos sx. |
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Definition
1. paranoid schizophrenia: most common. characterized by persecutory and grandiose delusions or auditory hallucinaitons
2. disorganized schizophrenia: characterized by disorganized speech or behavior and flat or inappropriate affect.
3. catatonic schizophrenia: rare. manifested by at least two of the following: motor immobility, excess motor activity without purpose, extreme negativism or mutism, peculiarly voluntary movement (bizarre postures, stereotyped movments, grimacing), echolalia, echopraxia (mimicking behavior)
4. Undifferentiated schizophrenia: delusions and hallucinations are prominent; paranoid, disorganized, catatonic sx are absent
5. Residual schizophrenia: negative sx predominate with only minimal pos sx. |
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Term
Schizophrenia:
1. sx
2. dx criteria
3. treatment and SE |
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Definition
Sx:
- prodromal phase: preceds first psychotic break - functional decline, social withdrawal, irritability
- Psychotic phase: delusions, disorganized through, perceptual disturbance
- Residual phase : between psychotic episodes - blunted affect, odd thinking/behavior, other negative sx
Dx criteria - at least 2 must be present during a 1 month period with continuous signs for at least 6 mos:
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized behavior
5. Negative sx
Tx:
1. hospitalizaiton if suicidal ideology , inability to care for themselves, or threat to others
2. Combo of antipsychotics and psychosocial therapy
- Typical Neuroleptics/antipsychotics: haldol, chlorpromazine, thioridazine, loxapine, fluphenazine for positive sx (likely to have extrapyramidal sx, neuroleptic malignant syndrome, tardive dyskinesia, agranulocytosis)
- Second generation neuroleptics - risperidone, olanzapine, aripiprazole, ziprasidone, quetiapine - for neg sx --> FIRST LINE |
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Term
Schizophrenia Sx:
1. erroneous beliefs based on misinterpretation of reality - paranoia, ideas of reference, thought broadcasting
2. False perceptions in any of the sensory modalities - must not be an isolated incident, in a clouded sensorium, or part of a religious/cultural experience
3. Includes inability to stay on topic (loose associations) or unable to provide an answer related to a question (tangential response).
4. exhibited as unpredictable agitation, inappropriate sexual behavior, childlike silliness, catatonic motor, reduced self-care and hygiene |
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Definition
1. delusions
2. hallucinations
3. disorganized speech
4. disorganized behavior |
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Term
disorder that meets the criteria for major depressive episode, mani episode, or mixed episode during which criteria for schizophrenia are also met
- better prognosis than schizophrenia |
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Definition
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Term
disorder characterized by presence of nonbizarre delusions (siutaitons that may occur in real life) for at least 1 month
- behavior is not obviously odd and functioning is not significantly impaired
- Subtypes: erotomanic (belief that another person is in love with you), jealous (belief that a partner is being unfaithful), somatic (delusions of a physical disorder), persecutory (delusions of mitreatment or persecution) |
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Definition
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Term
| sx occur for at least 1 day but less than 1 month - pt returns to premorbid functioning after sx abate - usually occurs after catastrophic event |
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Definition
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Term
| Same sx as normal schizophrenia but last between 1-6 mos |
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Definition
| schizophreniform disorder |
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Term
Psych disorder in which pt presents with vague physical complaints involving many organ systems that cannot be explained
- most common complaints are GI, reproductive, or neuro, or pain - worse with stress
- population: more common in women, <30 y/o, esp adolescents, 50% have mental disorder
tx? |
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Definition
somatization disorder
tx: monthly scheduled visits with a healthcare provider |
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Term
disorder characterized by preoccupation with an imagined defect in physical appearance or exaggerated distortion of a minor flaw (usually facial)
- self conscious, fear of humiliation,
- females>males; onset 15-30 y/o
tx? |
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Definition
body dysmorphic disorder
tx: SSRIs, treat coexisting psych disorders |
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Term
one or more neuro complaints that can't be explained clinically
- sx not intentionally produced. May be motor, sensory, seizure, or mixed.
- Most common: shifting paralysis, blindness, mutism
- Pts display lack of concern and indifferent to their sx (La Belle indifference)
- sx last for days to a month and recur during stress
- 20-25% incidence
tx? |
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Definition
conversion disorder
tx: psychotherapy is first line
- hypnosis, anxiolytics, relaxation
- Lorazepam |
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Term
pts who intentionally fake sx of a medical or psych illness with primary motivating to assume the sick role
- begins in early adulthood
- Pts generally seek hospitalization and get angry and sign out AMA if confronted
- Munchausen, Munchausen by proxy
tx? |
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Definition
Factitious disorder
tx: psychotherapy
- SSRI |
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Term
deliverate production of physical or psych sx moivated by external gain - avoiding responsibility, police or legal action, punishment, or difficult situation, getting money or drugs or free hospital room and board
- pts express vague, poorly defined complaints and claim they cause great distress
- self-inflicted injury
- pts uncooperative |
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Definition
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Term
preoccupation with the belief of having or the fear of contracting a serious illness
- not delusional
- normal body sensations are interpreted as manifestations of disease
- commonly associated with anxiety and depression
- fear persists after medical exam reveals no problems
- generally chronic
tx? |
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Definition
Hypochondriasis
tx: group psychotherapy
- regularly scheduled appointments for reassurance
- SSRIs |
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Term
pain in one or more areas without identifiable cause - results in significant distress and impairment in fuunctioning
- LBP, HA, atypical facial pain, pelvic pain
- view that the pain causes all their problems
- ususally abrupt onset, increase in intensity over weeks or months
- Acute is <6 mos, chronic is >6 mos
- Peak 30-50 y/o, more common in women
tx? |
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Definition
Pain disorder
tx: psycho/behavioral thearpy
- SSRIs, TCAs
- Do not give analgesia or sedatives |
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Term
3 of these sx are present for at least one week in a ___ episode:
inflated self esteem or grandiostiy
irritability
decreased need for sleep
pressured speech
flight of ideas
distractibility
impaired judgment
psychomotor agitation |
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Definition
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Term
| ___ episode is characterized by at least 4 continuous days of abnormally and persistently elevated, expansive, or irritable mood with at least 3 manic sx - but no social and occupational functional impairment or psychotic features and no need for hospitalization |
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Definition
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Term
| ___ episode is characterized by rapidly alternating moods with sx of both mania and depression |
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Definition
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Term
Subtypes of MDD:
1. SAD - tx?
2. characterized by anhedonia, psychomotor retardation, agitation, anorexia, weight loss, depressed mood (worse in morning), feelings of guilt, sleep disturbance (early morning wakening), suicidal idealation. tx?
3. characterized by overeating and weight gain, oversleeping, reactive mood, leaden paralysis, oversensitivity to rejection. tx?
4. characterized by motor immobility or stupor, blurred affect, purposeless motor activity, extreme withdrawal, negativism, bizarre mannerisms, posturing, echolalia, echopraxia, waxy flexibility
5. presence of delusions/hallucinations
6. onset of sx within 4 weeks postpartum |
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Definition
1. SAD - tx is light therapy and SSRI
2. characterized by anhedonia, psychomotor retardation, agitation, anorexia, weight loss, depressed mood (worse in morning), feelings of guilt, sleep disturbance (early morning wakening), suicidal idealation --> Melancholia; Tx: SSRI and ECT
3. characterized by overeating and weight gain, oversleeping, reactive mood, leaden paralysis, oversensitivity to rejection. --> atypical depression; Tx: MAOIs or SSRI
4. characterized by motor immobility or stupor, blurred affect, purposeless motor activity, extreme withdrawal, negativism, bizarre mannerisms, posturing, echolalia, echopraxia, waxy flexibility --> Catatonic depression
5. presence of delusions/hallucinations --> Psychotic depression
6. onset of sx within 4 weeks postpartum --> postpartum |
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Term
Precautions with antidepressant meds:
1. MAOIs required a ___-free diet to avoid hypertensive crisis
2. MAOIs and SSRIs combined can result in ____ which causes acute mental status change, restlessness, diaphoresis, termor, hyperthermia, seizure, coma, death
3. TCAs and MAOIs together can cause ___ and ___ |
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Definition
Precautions with antidepressant meds:
1. MAOIs required a tyramine-free diet (wine, beer, cheese, aged foods, smoked meats) to avoid hypertensive crisis
2. MAOIs and SSRIs combined can result in serotonin syndrome which causes acute mental status change, restlessness, diaphoresis, termor, hyperthermia, seizure, coma, death
3. TCAs and MAOIs together can cause delirium and HTN |
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Term
Characterized by one or more manic or mixed episodes with cycle with depressive episodes
manic episodes: sudden escalation of mood, go without sleep for days, become excessively talkative or loud, socially outgoinging, overly confident, hypersexual, disinhibited, flamboyant clothing, thought processes race, flight of ideas, easy distraction, +/- psychotic sx
tx? |
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Definition
Bipolar I Disorder
tx: lithium, valproic acid, olanzapine, or carbamazepine
- 2nd gen antipsychotics: risperidone, aripriprazole, quetiapine, ziprasidone are good for acute sx
- SSRIs or buproprion for acute depression - can precipitate mania |
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Term
| at least one episode of MDD + at least one episode of hypomania but no mania |
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Definition
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Term
chronic, persistent mild depression manifest by pessimism, brooding, generalized loss of interest, decreased productivity, feelings of inadequacy, social withdrawal but no psychotic or manic features
- MDD develops in 10-20%
- Pt depresed most of the day for more days than not for 2 years and has not been without sx for more than 2 mos at a time but has had no major depressive episode
at least two are noted: poor concentraiton, indecisiveness, hopelessness, poor appetite, overeating, insomnia, hypersomnia, low energy, fatigue, lack of self esteem
tx? |
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Definition
Dysthymic disorder
tx: SSRI, bupropion, TCAs, MAOIs |
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Term
pts described as moody, erratic, impulsive, volatile - characterized by recurring periods of relatively less severe depressive episodes and hypomania over a 2 year period with symptom free periods lasting for no more than 2 months at a time.
- Depression not severe enoguh to be classified as major depressive episode and manic and mixed episodes do not occur
- May progress to bipolar
tx same as bipolar |
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Definition
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Term
disorder characterized by maladaptive behavior or emotions that develop wihtin 3 mos of a stressful life event and end within 6 mos
- sx cause significant impairment in functioning
- sx NOT caused by bereavement
tx? |
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Definition
Adjustment disorder
tx: supportive therapy
- short term drugs can be used but are not first line |
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Term
Personality disorders:
1. ____, ___ patterns of relating to others that are maladaptive and cause significant impairment of functioning. Patients are egosyntonic and lack insight regarding their problems.
2. On Axis __
3. 3 clusters? |
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Definition
1. deeply ingrained, inflexible patterns of relating to others that are maladaptive and cause significant impairment of functioning. Patients are egosyntonic and lack insight regarding their problems.
2. On Axis II
3. 3 clusters:
Cluster A (MAD):
- schizoid, schiotypal, paranoid
- pts viewed as weird or peculiar
- associated with psychotic disorders
Cluster B (BAD):
- antisocial, borderline, histrionic, narcissistic
- Pts viewed as emotional and inconsistent
- associated with mood disorders
Cluster C (SAD):
- avoidant, dependent, OCD
- Pts viewed as fearful or anxious
- Associated with anxiety disorders |
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Term
Cluster A personality disorders (MAD):
1. characterized by pervasive distrust, suspicion, reluctance to confide in others, interpretation of normal thigns to be threatening or demeaning, persistent grudges, quick to counterattack beginning in early adulthood. Pts blame their problems on others and seem hostile and angry. Males>Females
2. Characterized by a lifelong pattern of voluntary social withdrwawal often percieved as eccentric or reclusive. Pts are quiet, unsociable, have constricted affect, no desire for close relationships, little or no interest in sex, indifferent to praise or criticism. Males>females
3. characterized by pervasive pattern of eccentric behavior and peculiar thoughts beginning in early adulthood - ideas of reference (beliefs that are irrelevent, unrelated, innocuous are referring to them directly); odd behaviors, thoughts, speech, beliefs, magical thinking inconsistens with cultural norms (clairvoyance, telepathy, bizarre fantasies, superstitions); suspicious and antisocial behavior, inappropriate and restricted affect. |
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Definition
1. paranoid personality disorder
2. schizoid perosnality disorder
3. schizotypal personality disorder
tx for all of them is psychotherapy and short courses of antipsychotics/antidepressants/antianxiety |
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Term
Cluster B (BAD) Personality Disorders:
1. inability to conform to social norms, pervasive pattern of disregard for and violation of rights and feelings of others, manipulative, decietiful, impulsive, lack empathy or remorse but seem exceedingly charming on interview; may be a conduct disorder in childhood and may have started with sexual or physical abuse; lie and con others, irritable and aggressive, get in fights, recklessness
2. unstable and unpredictable mood, affect, behavior, poor self image, mood swings, impulsivity, pt always in "state of crisis", short and transient psychotic episodes, paranoid ideation, dissociative sx, self-mutilation, manipulative suicide attempts, cannot tolerate being alone yet exhibit intense anger toward friends, females>males
3. overly emotional, dramatic, seductive, excitable, attention-seeking, exaggerated thoughts and feelings, flamboyant, extroverted, rapidly shifting emotions, easily influenced by others, need to be center of attention, somatization and subtance use common
4. inflated self image, pattern of grandiosity, need for admiration, lack of empathy; consider themselves to be special and expect to be treated as such; arrogant, preoccupations with thoguhts of beauty and success - makes them prone to midlife crisis |
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Definition
1. antisocial personality disorder --> Like ODD
2. borderline personality disorder
3. Histrionic
4. Narcissistic
tx: psychotherapy for all
- drugs: SSRI, lithium, antianxiety, antipsychotics for borderline |
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Term
Cluster C personality disorders (SAD):
1. characterized by exereme sensitivity to rejection (inferiority complex), see themselves as unappealing, social anxiety, feelings of inadequacy, interpersonal withdrawal, shy but great desir for companionship, show great restraint with interpersonal relationships, social phobia
2. enduring pattern of dependent, clingy, submissive behavior. cannot make decisions without help from othres, dificulty disagreeing, lack self confidence, avoid positions of responsibility, dislike being alone, passive, self-doubtful, reliant on others, depression is common
3. characterized by pervasive pattern of orderliness, perfectionism, and inflexibility. Pts are aware of their disorder and often seek tx on their own, reluctance to delegate tasks fo fear they are not done the way they want, miserly hoarding of money |
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Definition
1. avoidant personality disorder
2. dependent personality disorder
3. OCD
tx: psychotherapy & SSRIs for all
- BB and benzos for avoidant
- anxiolytics for dependent
- clompiramine and clonazepam for OCD
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Term
NOS personality disorders:
1. characterized by procrastination, irritability, stubbornness, negativity, pssive resistance to demands for adequate performance, sullen, argumentative, envious/resentful toward those who seem more fortunate. Lack self confidence, find fault with others, complain of being misunderstood and unappreciated.
2. chronic unhappiness similar to dysthymic - gloomy and pessimistic, low self esteem, may be overly conscientious with work, critical of self and others
3. pervasive pattern of demeaning, humiliating, and cruel behavior, fascinated with violence, torture, weapons and are aggressive without gain
4. Desire to cause pain to others by being sexually, physically, or mentally abusive |
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Definition
1. passive-aggressive
2. depressive
3. sadistic
4. sadomasochistic |
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Term
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Definition
| SSRI, buspirone, low dose TCA as second line |
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Term
Panic attack:
1. peak in __ min and subside in __ min
2. ___ is recurrent panic attacks with debilitating fear of having another attack
3. tx? |
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Definition
peak in 10 min, subside in 30 - rarely last >1 hr
panic disorder
tx:
- attacks: benzos
- maintainence: SSRI
- psychotherapy |
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Term
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Definition
SSRI first line
TCA second line
- others: lithium, venlafaxine, buspirone, clonazepam, anti-psychotic |
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Term
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Definition
SSRI is first line
TCAs, buspirone, MAOIs, anticonvulsants may work
Counseling |
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Term
sx occur wihtin 1 mon of the traumatic event and last from 2 days to 4 weeks (PTSD can start any time and lasts >1 mon)
sx: three or more - sens of numbing or detachment, reduced awareness of surroundings (in a daze), derealization, depersonalizaiton, dissociative amnesia, ecessive anxiety or arousal (insomnia, poor concentraiton, exaggerated startle response)
distressing event is experienced in one or more: recurrent dreams, images, thoughts, flashbacks, sensation of reliving the event, exposure to reminers of the trauma --> results in impairement
tx? |
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Definition
acute stress disorder
tx: counseling
- anxiolytics (lorazepam, clonazepam)
- SSRIs, TCAs, anticonvulsants |
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Term
most common mental disorders in the US - characterized by irrational fear and persistent excessive anxiety when presented with an object or a situation
- exposure can precipitate a panic attack
- pts know the fear is unreasonable
- dx is made if fear interferes with life
types?
tx? |
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Definition
Phobias
Types:
1. specific - animas, natural environment, blood-injection-injury, situational, other
2. social - fear of social situations that could result in embarassment
3. agoraphobia - fear of putting yourself into a sitaution in which an incapacitating problem could occur and no help would be available
Tx:
1. SSRIs, BB
2. desensitization for specific phobias |
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Term
Anorexia:
1. generally <__% expected weight for height
2. two types
3. what acid-base abn can be present?
4. tx |
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Definition
1. generally <85% expected weight for height
2. two types - restricting or binging/purging
3. what acid-base abn can be present - metabolic alkalosis
4. tx:
- restore nutritional state - often need hospitalization
- behavioral therapy, supervised weight gain
- SSRIs - NOT bupropion (lowers seizure threshold in people with eating disorder)
- appetite stimulate or drug that has weight gain as a SE |
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Term
Bulimia:
1. two types
2. acid/base abn
3. tx |
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Definition
types: purging and nonpurging (excessive exercise or fasting)
acid/base: hypochloremic hypokalemic alkalosis
tx: SSRI, NOT bupriopion, therapy |
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Term
Obesity:
1. definition
2. dx of binge eating disorder
3. tx |
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Definition
Definition: 20% or more over ideal body weight
BMI >30
Binge eating disorder: binge eating episodes 2 days/week for 6 months - eating a larger amt of food than most people in a 2 hr period
- associated with 3 or more: eating fast, eating until feeling uncomfortably full, eating to excess even when not hungry, eating alone out of embarassment, feeling disgusted, guilt, or depressed after the episdoe
- eating is not associated with a compensatory mechanism (binging, exercise)
- pts are not obsessed with body image
tx: behavior modificiation
- food diarrheas
- new eating patterns (slowly, no eating between meals, only eating when seated)
- low calorie, balanced diets
- exercise plan
- Drugs: sympathomimetics (amphetamines), orlistate (xenical) - a lipase inhibitor, sibutramine (meridia) - neurotransmitter reuptake inhibitor
- Surgery: gastric bypass, gastroplasty |
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Term
Drug abuse:
1. ___ - nonscientific nonmedical term denoting psychologic and/or physical dependence that results in substance-seeking behavior that may or may not pose risks to the individual
2. ___ - physiologic changes that result in withdrawal sx on termination of use
3. ___ - refers to the craving or desire for the substance independent of the phsyiologic withdrwawal sx
4. substance dependence - occurs when substance use result in impairment manifest by three of the following within a 12 month period ??
5. substance abuse - substance use that has not met the criteria for dependence but has resulted in impairment as manifested by at least one of the following in a 12 month period
6. ___ - refers to the maladaptive behavioral or psychological changes attributed to recent ingestion of a substance. It is reversible |
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Definition
1. addiction
2. physical dependence
3. psychological dependence
4. tolerance, withdrawal, increasingly larger amounts of substance over a longer time than desired, unsuccessful efforts to stop, signiciantly larger amounts of time spent in attempts to aquire the substance or recover from the effects, social/occupational/recreational impairment, continued use despite adverse consequences
5. fails to meet home/school/work obligations, repeatedly uses the substance in hazardous situations (driving), recurrent substance-related legal problems, continued use of the substance despite interpersonal or social problems
6. intoxication |
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Term
| CAGE questions for alcohol abuse or drug use |
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Definition
Cut down
Annoyed
Guilty
Eye opener |
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Term
Treatments for substance abuse:
1. alcohol withdrawal
2. Alcoholism
3. CNS depressant withdrawal
4. reverse effects of opioids
5. nicotine/tobacco
6. marijuana/PCP, and hallucinogenic withdrawal
7. Opioid abuse/withdrawal |
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Definition
1. alcohol withdrawal: benzos (diazepam, chlordiazepoxide), thiamine, folic acid, and multivitamins
2. Alcoholism - disulfiram
3. CNS depressant withdrawal: phenobarbital
4. reverse effects of opioids: naloxone
5. nicotine/tobacco: bupriopion or vareniclin + pathches, gums, etc
6. marijuana/PCP, and hallucinogenic withdrawal: usually no tx. can use anxiolytics or neuroleptics/haldol if psychotic sx
7. Opioid abuse/withdrawal: methadone or clonidine taper ibuprofen for muscle cramps, loperamide for diarrhea, promethazine for nausea |
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Term
| Dx criteria and Tx for ADD/ADHD |
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Definition
1. sx of hyperactivity, impulsivity, or inattentivness resulting in impairment must manifest before 7 y/o
2. sx must occur in at least two settings (home and school)
3. at least six sx are developmentally inappropriate and present for at least 6 mos:
a. inattention sx: makes carless misktakes, trouble seeking detail, problems sustaining attention, does not seem attentive when directly addressed, forgetfly, does nto follow throguh or complete assigned work, easily distracted, loses items, avoid activities requiring sustained mental effort, difficulting organizing tasks
b. hyperactivity/impulsivity sx: fidges, leaves seat often, restlessness, difficulty playing quietly, talking excessively, blurting out, difficulty waiting their turn, interrupts/intrudes on others
Tx:
1. CNS stimulants - methylphenidate (ritalin, concerta, metadate), dexmethylphenidate (focalin), amphetamine/dextroamphetamine (Adderall, dexedrine)
2. SNRI (atomoxetine/straterra) - same efficacy, less SE, not controlled
3. Can add antidepressants
4. behavioral therapy |
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Term
Childhood disruptive disorder with 40% chance of antisocial personality disorder in adulthood
- dx: pattern of behavior that involves violation of the basic rights of others or social norms with at least three acts of the following types: aggression toward people or animals, destruction of property, deceitfulness, serious voiolations of rules
tx? |
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Definition
| Conduct disorder: thearpy, haldol/lithium/risperidone/olanzapine, SSRIs |
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Term
Disorder that may progress to conduct disorder
- dx criteria: 6 mos of negativistic, hostile, defiant behavior with at least 4 of the following: frequent loss of temper, arguments with adults, defying adults' rules, deliberately annoying others, easily annoyed, anger/resentmen, spitefulness, blaming others for mistakes/misbehavior
tx? |
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Definition
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Term
Pervasive developmental disorders
1. ___: characterized by impaired social interaction, impaired communication, repetitive stereotyped behaviors/activities
2. ___: charactrized by impaired social interaction and restricted or stereotyped behavior, interests, and activities
3. ___: characterized by decreasing head circumference per height and weight advances as well as loss of previously learned behaviors, social interactions, motor and language deelopment. Almost exclusively in girls |
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Definition
Pervasive developmental disorders
1. Autism: characterized by impaired social interaction, impaired communication, repetitive stereotyped behaviors/activities
2. Asperger's: charactrized by impaired social interaction and restricted or stereotyped behavior, interests, and activities
3. Rett's: characterized by decreasing head circumference per height and weight advances as well as loss of previously learned behaviors, social interactions, motor and language deelopment. Almost exclusively in girls |
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Term
Child abuse:
1. ___ or ___ should raise suspicion for shaken baby syndrome
2. Corporal punishment becomes abuse when ? |
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Definition
1. retinal hemorrhage or hyphema should raise suspicion for shaken baby syndrome
2. corporal punishment becomes abuse when the perpetrator indicates satisfaction when administering the punishment |
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Term
Dermatological diagnosis:
1. MAD criteria for describing lesions
2. ___ sign: rubbing a lesion causes urticarial flare
3. ___ sign: pinpoint bleeding after scale is removed
4. ___ sign: pushing a blister causes further separation of dermis
5. ___ test: documents photoallergy
6. ___ test: demonstrates hypersesitivity reaction
7. ___ phenomenon: minor trauma leads to new lesions at site of trauama
8. ___ skin: oval-shaped nevoid plaque wiht skin that is pigmented on the trunk/back and is associated with tuberous sclerosis. |
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Definition
1. MAD criteria for describing lesions: Morphology, Arrangement, Distribution
2. Darier's sign: rubbing a lesion causes urticarial flare
3. Auspitz's sign: pinpoint bleeding after scale is removed
4. Nikolsky's sign: pushing a blister causes further separation of dermis
5. photopatch test: documents photoallergy
6. Patch test: demonstrates hypersesitivity reaction
7. Koebner's phenomenon: minor trauma leads to new lesions at site of trauama
8. Shagreen skin: oval-shaped nevoid plaque wiht skin that is pigmented on the trunk/back and is associated with tuberous sclerosis. |
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Term
Dermatologic Diagnostic studies:
1. a glass slide is pressed against the skin, blanching indicates intact capillaries, extravasated blood (purpura) does not blanch
2. Method to identify dermatophytes (fungal infection)
3. used to assess changes in pigment or to fluoresce infectious lesions
4. using acetic acid to facilitate examination of warts |
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Definition
1. diascopy
2. KOH prep
3. Wood's light
4. Acetowhitening |
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Term
Common skin lesions:
1. Solid, palpable lesion <10mm in diameter
2. Solid, palpable lesion >10mm in diameter
3. flat, nonpalpable lesion <10 mm in diameter
4. flat, nonpalpable lesion >10 mm in diameter
5. plataeu-like lesion >10 mm in diabeter, may be a group of confluent papules
6. circumscribed elevated lesion containing serous fluid <5 mm in diameter
7. circumscribed elevated lesion containing serous fluid >5 mm in diameter
8. transient elevated lesion caused by local edema
9. minute hemorrhagic spots that cannot be blanched
10. hard, rough surface formed by dried sebum, exudate, blood, necrotic skin
11. heaped-up piles of horny epithelium with dry appearance
12. Vesicle or bulla containing purulent material
13. defect in epidermis that heals w/o scar
14. defect that extends into dermis and heals with scar
15. swollen and softened by water - appearance the skin gets when left in water too long
16. irregular, rough, convoluted surfaces |
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Definition
1. papule
2. nodule
3. macule
4. patch
5. plaque
6. vesicle
7. bulla
8. wheal
9. petechiae
10. crust
11. scale
12. pustule
13. erosion
14. ulcer
15. macerated
16. verrucous
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Term
eczematous disorder caused by contact with an irritant or allergen
- includes diaper dermatitis
- sx: itching and burning in affected areas; well-demarcated areas of erythema and possibly exudateive lesions, vesicles, erosions, crusts
dx: if allergic, patch test
tx? |
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Definition
Contact dermatitis
tx: remove offending agent
- Burrow's solution (aluminum acetate in water) and topical corticosteroids
- Diaper rash: petrolatum or zinc oxide barrier creams
- Systemic steroids for severe cases
- Topical steriods for chronic cases
- Antihistamines for itching |
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Term
Allergic contact dermatitis is a type ___ reaction
Atopic dermatitis is a type ___ reaction |
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Definition
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Term
Eczemetous chronic, relapsing skin disorder characterized by papules and plaques with or without scales, pruritis, dry/itcy skin, lichenification or fissures due to itching --> more common in flexural surfaces, neck, eyelids, forehead, feace, dorsum of hands and feet
- Dermatographism is characteristic
associated with asthma and allergies
tx? |
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Definition
Atopic dermatitis
tx: antihistamines
- topic corticosteroids are mainstay
- Tacrolimus and Pimecrolimus (topical calcitonin inhibitors)
- Hydration and topical emolients
- UVB therapy
- cyclosporine if systemic |
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Term
Pruritic inflammatory eczematous disorder that typically affects young adults and the elderly during fall and winter - small grouped vesicles coalesce into coin-shaped plaques with an erythematous base and clearly demarcted border - crusting and excoriations
txx? |
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Definition
nummular dermatitis
tx: moisturizers and topical steroids
- tar baths and UVB for refractory cases |
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Term
eczematous disorder common during infancy, puberty, and young-middle aged adults - occurs where sebaceous glands are most active
sx: scattered yellowish or gray, scaly macules and papules with a greasy look
- sticky crusts and fissures
- cradle cap in infants, dandruff in adults
tx? |
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Definition
seborrheic dermatitis
tx: UV radiation
- Cradle cap: olive oil compresses, baby shampoo, ketoconazole wtih hydrocortisone
- Dandruff: selenium or azinc and ketoconazole shampoos
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Term
eczematous disorder characterized by papulopustules on erythematous bases that may become confluent wtih plaques and scales.
- vermillion border is spared
- satellite lesions common
- most common in young women
- untreated lesions fluctuate over time
tx? |
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Definition
perioral dermatitis
tx: avoid steroids
- topical metronidazole or erythromycin or oral minocycline, doxycycline, tetracycline |
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Term
eczematous disorder characterized by edema, stasis dermatitis, hyperpigmentation, fibrosis, ulcerations
- heaviness or aching in legs
- stippled pigmentation, inflammatory papules, scales, crusts |
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Definition
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Term
Long-term manifestation of atopic dermatitis due to repetitive scratching or rubbing
- well-circumscribed plaques that are highly pruritics which sets up a cycle of itch-scratch lesions
solid, firm, thick plaques with little to no scaling
- light touch precipitates strong desire to itch
- common areas: nuchal area, scalp, ankles, lower legs, upper thighs, exterior forearms, genital
- follicular pattern on blacks
bx shows hyperplasia and hyperkeratosis
tx? |
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Definition
lichen simplex chronicus
tx: occlusive dressings with or without steroids and tar preparations + anthistamines to stop itch-scratch cycle |
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Term
Herald patch and then widespread symmetrical papular eruption
- unknown cause, maybe viral
- most common in teens and young adults
tx: mild URI produrome before rash then solitary roung or oval pink plque with raised border and fine adherent sclaes
- after a week or two: rash on trunk - round oval salmon colored slightly raised papular and macular rash that follows skin folds resulting in Christmas tree distribution
- scale desquamates, resulting in inverse collaratte scale
- lasts 3-8 weeks and then disappears spontaneously
tx? |
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Definition
Pityarisis Rosea
tx: non other than emollient for scales
- UVB is helpful if started in first week
- antipruritics/antihistamines for itching |
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Term
common viral diseaess of skin and mucus membranes caused by poxvirus
- adults: lesions in groin and lower abd
- can be sexually trasnmitted
- more common in kids
- lesions can be on head and neck in immunocompromised
discrete, flesh-colored, waxy, dome-shaped papules with central umbilication from 3-6 mm
- white, curd-like material can be expressed from center
tx? |
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Definition
molluscum contagiosum
tx: self-limited
- can destroy lesiosn with electrodessication, curettage (first like), cryotherapy, or acid/exfoliative peel |
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Term
Acute inflammatory dermatitis that occurs in adults. females>males
- may occur in graft vs. host disease, malignant lymphoma, and drug reactions
4 P's: purple, polygonal, pruritic, papule
- Flat topped shint, violaceous papules with fine white lines on the surface (Wickham's striae). Typically are grouped and most commonly occur on the flexor aspect of the wrists, lumba, eyelids, shins, scalp.
- Koebner's phenomenon is seen
- Can be mucosal lesions
- lesions may affect hair or nails
dx via bx and immunofluorescence
- Should screen for Hep C
tx? |
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Definition
Lichen Planus
tx: topical steroids with occlusive dressings
- intralesional steroids or topical tretinoin
- cyclosproine mouthwash for oral lesions
- may need systemic steroids, retinoids, or cyclosporine if severe
- PUVA radiation |
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Term
dermatitis that develops in people <40 y/o
- 50% of pts have atopic background
- eruptions follow stress or hot/humid weather
sx:
- early: prurutic vesicles in clusters (TAPIOCA APPEARANCE), ocassionally bullae
- late: papules, scaling, lichenification, erosions from ruptured vesicles, painful fissures
- prediclectio for hands and feet
Dx tests only to r/o other causes (KOH prep, culture)
tx? |
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Definition
Dyshidrosis (pompholyx)
tx:
- Wet dressings with Burrow's solution
- topical collodion for fissures
- topical steroids
- systmic steroids for severe cases
- PUVA
- secondary infx may need abx |
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Term
chronic inflammatory scaling condition of skin that may also involve mucus membranes
- pathophys: enganced epidermal cell turnover rate
sx: raised, pink to red papules and plaques with distinct margins and loosely adherent silvery scales
- Peeling away a scale produces bleeding (Auspitz's sign)
- scalp, extensor surfaces
- pruritis is common, scratching leads to more lesions (Koebner's phenomenon)
- can have oncholysis and oil spots
- arthritis occurs in 5-10%
tx |
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Definition
Psoriasis
tx: topical steroids and vit D (calcipotriene)
- systemic steroids
- coal tar, salicylic acid dressings
- tazarotene gel (retioid)
- UVB, PUVA, MTX
- Pustular: acitretin
- Cyclosporine
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Term
Types of Psoriasis:
1. ____ - most common. "normal" psoriasis
2. ____ - lesions involve entire skin surface; exfoliative, serious
3. ____ - acute eruption of typical and atypical lesions in disseminated pattern. spares plams and soles. occurs after strep throat
4. ____ - abrupt, life-threatening condition characterized by widespread pustules that coalse to form lakes of pus, fever, malaise, leukocytosis |
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Definition
1. psoriasis vulgaris
2. psoriatic ertyhroderma
3. guttate psoriasis
4. pustular psoriasis |
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Term
a serious bullous autoimmune disease where IgG abs induce acantholysis, resulting in loss of cell to cell adhesions
Lesions begin in oral mucosa with skin lesions 6-12 mos later. Pain or burning but not pruritis
- weakness and malaise are common
- Lesions: round vesicles or bullae that contain clear liquid and easily rupture. Discrete, randomly scattered. Erosions and crusts due to fragility of blisters.
- Nikolsky's sign (lateral extension of lesions when pushed)
Dx via bx - revelas acantholysis
tx? |
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Definition
Pemphigus vulgaris
Tx: systemic
1. prednisone
2. immunosupressants (azathioprine or MTX)
- Refractory cases: dapsone, gold, cyclophosphamide
- Topical and supportive tx as neededysis |
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Term
Autoimmune disorder where autoantibodies, completmend fixation, nuetrophils, and eosinophils cause bullous formation
sx:
1. prodrome: urticaria or papular lesions
2. Bullae: tense, large, oval or round with serous or hemorrhagic fluid - do not rupture as easily as pemphigus but do eventually collapse and crust --> axillae, groin, thighs, abdomen, maybe mucus membranes
3. less painful than pemphigus vulgaris
dx via bx and immunofluorescence
tx? |
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Definition
Bullous Pemphigoid
tx:
- Prednisone at high dose til remission then low maintenance dose
- may add azathioprine
- topical steroids |
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Term
Acne:
1. Definition: inflammatory follicular, papular, pustular eruption involving the ___ apparatus
2. ___ comedones are referred o as "blackheads" because of the melanin deposition on a keratin plug
3. ___ comedones are referred to as "white heads" because they are flesh colored 1 mm papules
4. Sinus tracts can occur in ___ acne - leading to hyperpigmentation and scarring
5. workup
6. tx |
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Definition
1. Definition: inflammatory follicular, papular, pustular eruption involving the pilosebaceous apparatus
2. open comedones are referred o as "blackheads" because of the melanin deposition on a keratin plug
3. closed comedones are referred to as "white heads" because they are flesh colored 1 mm papules
4. Sinus tracts can occur in nodular acne - leading to hyperpigmentation and scarring
5. workup: testosterone, FSH, LH, DHEA
6. tx:
- Mild: topical retinoids, azelaic acid, salicylic acid
- Inflammatory: topical benzoyl peroxide, tretinoin, erythromycin, clindamycin, sodium sulfacetamide
- Cystic: oral abx + topical - TCNs, erythromycin, doxy, minocycline, bactrim, clindamycin
- Accutane: serious SE - early closure of long bones, visual changes, elevated LFTs, leukopenia, trigs, teratogenicity |
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Term
chronic acneiform disorder mainly affecting females between 30 and 50
- disease of the pilosebaceous units associated with increased activity of capillarries, which leads to flushing and telangiectasias
- episodic outbreaks in response to heat, alcohol, sun, hot/spicy foods, coffee, hot tea
sx: scattered small papulopustules and sometimes nodules but no comedones, face is red or flushed, symmetric distribution - face, back, chest;
- Later: telangiectasia, hyperplasia, lymphedema
- Rhinophyma (enlarged nose), blepharophyma (eyelids), metophyma (forehead), otophyma (ears), gnathophyma (mouth)
tx? |
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Definition
Acne rosacea
tx: reduce triggers
- topical metronidazole, sodium sulfacetamide, erythromycin
- systemic abx if topical fails
- May need oral isotretinoin from a dermatologist |
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Term
Folliculitis:
1. common organism
2. noninfectious folliculitis occurs in what populations
3. ___ is defined as ingrown hairs occuring in the beard area
4. severe, deep-seated, recalcitrant folliculitis
5. tx? |
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Definition
1. common organism: s. aureus
2. noninfectious folliculitis occurs in what populations - sweaty, hot, oily workers
3. pseudofolliculitits is defined as ingrown hairs occuring in the beard area
4. Sycosis - severe, deep-seated, recalcitrant folliculitis
5. tx:
- good cleansing
- topical clinda or erythromycin, mupirocin (bactroban)
- oral abx |
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Term
Can be induced by drugs (sulfonamides, phenytoin, barbituates, penicillin, allopurinol) and infections (HSV, mycoplasma) or may be idiopathic
- half of all cases happen in <20 y/o
Sx: macules becoming papules then vesicles then bullae in the center of the papules
- TARGET OR IRIS lesions
- Localized to hands and feet or generalized
- Mucosal lesions or hallmark - painful, erode
- Fever, weakness, malaise, lungs and eyes may be affected
tx? |
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Definition
Erythema Multiforme
tx: avoid precipitating substances
- Tx herpes witth acyclovir
- may need systemic steroids |
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Term
mucocutaneous blistering reactions most often caused by drugs - sulfonamides, aminopenicillin, quinolones, cephalosporins, TCNs, phenobarbitol, carbamazepine, phenytoin, valproic acid, oxicam, allopurinol, corticosteroids
complications are fluid loss, electrolyte imbalance, secondary infx, ATN, erosions of lung and gut, death
sx: fever, photophobia, sore throat, mucosal inflammation, sore mouth
- Lesions: painful, start on trunk and progress over 4 days - diffuse erythema, morbilliform lesions, necrotic epidermis, wrinkled surfaces, sheetlike loss of epidermis, rised/flaccid blisters (Nikolsky's sign)
- The more severe form exhibits high fever and more severe epidermal separation
- Regrowth of skin takes 3 weeks
dx via bx
tx? |
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Definition
Stevens-Johnson Syndrome and Toxic Erythema Necrolysis (TEN)
TEN is more severe
tx:
- withdrawal of offending agent
- transfer to burn unit if bad
- tx complications
- IVIG and steroids are controversial |
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Term
disease of the apocrine gland in the axilla, genitals, and sclap
- predisposing factors: obesity, hx of acne, apocrine duct obstruction, bacterial infection
Sx: gtender inflammatory nodules or abscesses not related to hair follicles
- open comedones and sinus tracts form and may drain purulent material
- fibrosis, scarring, and contractures may occur
- should culture for secondary bacterial infx
tx? |
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Definition
Hidradenitis Suppurativa
tx: intralesional triamcinolone, I&D, excision of sinus tracts
- oral abx may be needed, also prednisone |
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Term
Localized skin infections:
1. referred to as boils or risens - deep seated infx of the hair follicles, usually s. aureus. presents as hard red, tender lesion. may progress to spontaneously draiaing pus and necrotic tissue
2. same as above but involves more than one follicle as a conglomerate mass
3. acute, spreading inflammation of the dermis and subcu tissue - red, how, sweollen, tender. may have lymphadenopathy, fever, chills
4. localized infx characterized by collection of purulent material in a cavity formed by necorisis or disintegration of tissue - tender, erythematus, fluctuant
tx for each? |
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Definition
1. furuncle - tx abx, I&D
2. carbuncle
3. cellulitis - cover h. flu, strep, and staph - penicillinase-resistant penicillin (dicloxacillin) or a cephalosporin. Erythromycin for penn allergy
4. abscess - hot soaks --> I&D with packing --> oral abx (dicloxacillin, cephalosporin, erythromycin) if pt has fever or cellulitis |
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Term
superficial fungal infection that can affect hair, nails, and skin
- 3 most common organisms: trichophyton (most common in US), microsporun, epidermophyton
sx: erythematous annular patch with distinct borders and a central clearing - fine scale covers patch
- burning, itching, stinging. maceration or peeling fissures is common btwn digits
- thickening discoloration or onychomycosis of nails
- broken hair shafts (seen as black dots) - tinea capitis
- kerion (injdurated, boggy, inflammatory plaque with pustules) can appear.
dx via KOH prep
tx? |
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Definition
Dermatophytosis
tx:
1. topical creams BID for 4 weeks or more
2. nail infection or chronic/resistant infx: oral griseofulvin, itraconazole, terbinafine, ketoconazole for up to 3 mos
3. Fluconazole or griseolfulvin for kerions
- AVOID STERIODS
- Wear cotton socks and loose fitting underclothes to keep skin dry and clean |
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Term
caused by malassezia furfur - a yeast
- hypo and hyperpigmented macules that do not tan - most pts notice infx only in summer
- upper trunk most common
KOH prep shoes hyphae and spores - spaghetti and meatballs
tx? |
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Definition
tinea versicolor (pityriasis versicolor)
tx:
- daily applications of selenium sulfide shampoo from neck to waiste for 15 min x 7 days |
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Term
| what advice to give pts when taking griseofulvin (antifungal) |
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Definition
| do not drink alcohol - has antibuse reaction |
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Term
Scabies:
1. organism
2. dx
3. tx |
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Definition
1. sarcoptes scabiei
2. scraping with minerol oil microscopy - mites, eggs, feces
3. tx: 1% lindane or 5% permethrin cream from chin to bottom of feet for 8 hrs - repeat in 7 days |
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Term
Venomous spider bites:
1. pt will feel pain __ hrs after a bite. Systemic sx begin __-__ hrs after a bite.
2. ___ spiders can cause neuro overstimulation - muscle aches/spasms/rigidity
3. ___ can cause an infarct via rapid blood coagulation - sinking macule, pale gray, slightly eroded in center, halo of tender inflammation and hemorrhage. can extend into muscle
4. tx? |
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Definition
1. pt will feel pain 3 hrs after a bite. Systemic sx begin 4-6 hrs after a bite.
2. black widow spiders can cause neuro overstimulation - muscle aches/spasms/rigidity
3. brown recluse can cause an infarct via rapid blood coagulation - sinking macule, pale gray, slightly eroded in center, halo of tender inflammation and hemorrhage. can extend into muscle
4. tx:
- Black widow: diazepam and calcium gluconate
- Brown recluse: cleansing, analgesia |
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Term
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Definition
permethrin, pyrethrins, malathion
- lindane and ivermectin are alternatives |
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Term
Warts:
1. cause
2. dx
3. tx |
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Definition
1. cause: HPV
2. dx: immunofluorescence for HPV
- microscopy: koilocytotic squamous cells, hyperplasia, hyperkeratosis
3. tx: spontaneous regression, salicylic acid plaster, cryosurgery, eletrodessication, imiquod, podphyllin |
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Term
generalized thickenng of the horny layer of epidermis
Types:
1. punctate - found on hands and feet, prevalent in african americans, develop central plugs
2. premalignant condition caused by cumulative exposure to sun - can progress to SCC or cutaneous horn
3. actinic dermatosis of the lip
4. benign plaque, beige to brown or black, velvety warty surface that appears "stuck on". common in older pts
tx? |
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Definition
keratoderm
1. punctate keratoderma
2. solar keratoderma (AK)
3. actinic cheilitis
4. seb K
tx: liquid nitrogen
- electrodessication/curettage
- mild acid tx
- Monsel's solution
- 5FU |
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Term
bright red, raspberry like nodules present on exposed parts of body may appear after injury or surgery
tx? |
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Definition
pyogenic granuloma (capillary hemangioma)
tx: elctrodessication, curettage, or excision |
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Term
| 4 stages of decubitus uclers: |
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Definition
I: nonblanching erythema of intact skin
II: necrosis, superficial, or partial thickness of epidermis/dermis; shallow ulcer
III: deep necrosis with crate ulcersw ith full-thickness skin loss, damage can extend to but not through fascia
IV: full thickness ucleration with extensive damage and necrosis to muscle, bone, supporting structures |
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Term
| When to give tetanus shot |
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Definition
Any open wound with last booster >10 years ago; sooner if the wound is particularly dirty
- If tetanus status is unknown: tetanus immunoglobulin + vaccine |
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Term
Alopecia:
1. male pattern baldness
2. unknown cause - may be seen in thyroiditis, pernicious anemia, SLE, Addison's. Tiny hairs are found. loss is patchy, only on scalp or entire body
3. drugs that may induce alopecia?
tx? |
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Definition
1. androgeneitc alopecia - minoxidil or finasteride
2. alopecia areata - systemic steroids
3. thallium, vit A, retinoids, antimitotics, anticoagulants, oral contraceptives |
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Term
Nail issues:
1. distal separation of the nail plate from the nail bed
2. infection with fungi or yeast
3. discoloration and crumbly nails seen in ___ and ___
4. inflammation of nail fold
5. subcu infx of pulp space. must be drained to prevent osteomyelitis |
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Definition
1. onycholysis
2. onychomycosis
3. dermatophytosis and psoriasis
4. paronychia
5. felon |
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Term
acquired hyperpigmentation disorder of sun exposed areas - may be associated with pregnancy or oral contraceptives
tx? |
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Definition
melasma (chloasma)
tx: 3% hydroquinone with 0.025% tretinoin or glycolic acid
- sunblock |
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Term
destruction of melanocytes associated with thyroid disease, pernicious anemia, DM, Addision's, or idiopathic
- macules of hypopigmentation
tx? |
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Definition
vitiligo
tx: sunscreen, cosmetics, possibly repigmentaiton |
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Term
raised red areas on skin or mucus membranes caused by release of histamines, bradykinin, kallikrein, or other substances from mast cell and basophils
- ususally pruritic
- usually IgE reaction to allergy due to allergens that are ingested (drugs, foods)
- acute lasts minutes to hours
- chronic lasts >6 weeks - idiopathic
- can be caused by a reaction to heat, cold, water, infx, exercise, sun
tx? |
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Definition
urticaria (hives and wheals)
tx: eliminate cause
- acute idiopathic: H1 antihistamines - diphendydramine, hydroxizine, fexofenadine, cetirizine
- chronic or acute that doesn't respond: H2 antihistamines - famotidine, ranitidine + H1
- recurrent or chronic may require steroids
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Term
Fever:
1. Normal range of body temp
2. physiologic process of causing fever
3. Temp >___ can cuase irreversible brain damage
4. definition of FUO |
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Definition
1. Normal range of body temp: 97-99.5 F (36-37.4C)
2. physiologic process of causing fever: stimulation of monocyte-macrophage cells elaborates pyogenic cytokines, which cause elevation of set point of body temp
3. Temp >106.8 (41.1C) can cuase irreversible brain damage
4. definition of FUO: >101.8 (38.3C) for 3 weeks with no discernible cuase despite at least 1 week of workup - most common causes are infx and multisystem disease (autoimmune or neoplasm) |
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Term
Gram pos catalase producing cocci that appear in chains - can be aerobic, anaerobic, or facultative
- complete hemolysis is alpha-hemolytic
- incomplete hemolysis is beta-hemolytic
- no hemolysis is gamma-hemolytic |
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Definition
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Term
Painful macular rash with well-defined margins characterized by abrupt onset and rapid progression
- confined to face - fiery red, may progress to extremities
- may develop flaccid bullae
- desquamates in 5-10 days
- caused by strep |
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Definition
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Term
thick, crusted, "HONEY COLORED" lesions
- strep pyoderma
- colonize unbroken skin, skin with abraisons or bites, inoculate intradermal space
If caused by staph it's called ? |
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Definition
Impetigo
Staph- bullous impetigo |
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Term
| Most common cause of cellulitis in US |
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Definition
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Term
Deep subcu infx resulting in destruction of fascia and fat - swelling, heat, erythma, pain spread proximally and distally
- skin darkens, blisters, bullae with clear yellow fluid form
- gangrene and necrosis
- mental status change, delirium
- high mortality rate
Caused by strep |
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Definition
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Term
bacteremia following deep soft tissue infeection
- viral prodrome with hx of minor trauma, surgery, varicella
- abrupt severe pain in an extremity or abdomen - may mimic peritonitis, PID, MI, pericarditis
- fever, ypothermia, confusion, combativeness, coma, shock, organ failure
- Rash: violaceous or blue bullous rash - ominous
- 30% mortality rate
- complications: endophthalmitis, myositits, peritonitis, septic arthritis, myocarditisi, perihepatitis, meningitis, sepsis
Labs: hemoglobinuria, elevated Cr, low albumin and Ca, leukocytosis with left shift, low platelets
tx? |
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Definition
Toxic Shock Syndrome
Tx: IV fluids, abx, pressors, ventilation, surgery |
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Term
| Jones Criteria for Acute Rheumatic Fever |
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Definition
Must have 2 major crietria OR one major and two minor PLUS evidence of recent GABHS infection - culture or ASO titer
Major: carditis, erythema marginatum, subcu nodules, syndeham's chorea, arthritis
Minor: fever, polyarthralgia, prolonged PR, high ESR, high CRP, leukcytosis, hx rheumatic fever |
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Term
|
Definition
Penicillins are choice
Cephalosporins
Macrolides for Penn allergy |
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Term
strictly anaerobic, spore forming bacillus in the soil - may be inadvertently packed into food where the toxin is produced
- toxin inhibits release of acetylcholine at neuromuscular junction
- infants should not be fed honey due to this risk
- IV drug users are at increased risk
sx: visual changes 12-36 hrs after ingestion, then ptosis, impaired EOM, fixed/dilated pupils, CN palsies, dysphonia, dry mouth, dysphagia, n/v, respiratory paralysis leads to death
- NO mental status change or sensory deficit
dx: inject mouse with pt's serum to identify toxin
tx? |
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Definition
Botulism
tx: antitoxin
- supportive - nutrition, mechanical ventilation |
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Term
spore-forming gram pos aerobic rod found in sheep, cattle, horses, goats, and swine
- transmitted to humans via inoculation of broken skin/mucus membranes, or inhalation
- Farmers, vets, and tannery and wool workers are at highest risk
- likely candidate for biologic warfare
Sx:
1. derm: 2 weeks after exposure - erythematous papule becomes vesicular with purple-black center which ulcerates and becomes necrotic (eschar) and eventually lsoughs. Surround skin is edematous and vesicular. Painless
2. Regional lymphadenopathy, fever, malaise, HA, n/v
3. hematogenous spread can result in hemorrhagic memngitis 10 days-6 weeks after exposure.
4. Pulmonary: URI sx --> pneumonia and mediastinitis
5. GI: abd pain, rebound tenderness, vomiting,d iarrhea, constipation, ulcers, obstruction, sepsis, meningitis
dx via isolation of organism from skin culture, csf, blood, or sputum
tx? |
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Definition
anthrax (bacillus antrhacis)
tx: Cipro (or other fluoroquinolone)
- Doxy is alternative
- vaccine for people with high likelihood of expsoure
85% mortality rate for GI or pulmonary anthrax |
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Term
this bacteria produces a toxin that activates adenylyl cyclase in the intestinal epithelial cells of the small intestine which results in hypersecretion of water and Cl and massive diarrhea
- death from hypovolemia
- Epidemics due to war, overcrowding, famine, inadequate sanitation
Sx: sudden onset RICE WATER diarrhea
dx via stool culture
tx? |
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Definition
Cholera
tx: rehydration
- TCN, amp, chloramphenicol, Bactrim, and fluoroquinolones are abx options
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Term
caused by a clostridium species found in soil - produces a neurotoxin which interferes with inhibitory neurons
- puncture wounds most susceptible
- incubation 5 days - 15 weeks
Sx: spasticity o fmuscle, jaw/neck stiffness, dysphagia, hyperreflexia, muscle spasms, tonic convulsions, glottis and respiratory spasm, asphyxia
tx? |
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Definition
Tetanus (clostridium tetani)
Tx: tetanus immune globulin IM + penicillin
- bed rest, sedation, ventilation
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Term
transmitted via contaminated food/water
3 Sx patterns:
1. enteric fever (typhoid fever): organisms replicate in Peyer's patches. insidious onset of fever, HA, sore throat, abd pain, constipation, "PEA SOUP" diarrhea, septicemia, splenomegaly, bradycardia, rash during second week. Resolves in 14-20 days but relapses are common. Many complications can be deadly. Tx?
2. Most common form. 8-48 hr incubation - fever, n/v, bloody diarrhea, for 3-5 days. Self limited. Tx?
3. Bactermia: prolonged or recurrent fever with local bone, joint, pleura, cardiac, lung infection. tx? |
|
Definition
Salmonella
Tx:
1. Typhoid: ampicillin, chloramphenicol, Bactrim
- If resistant (common): ceftriaxone, Cipro for 2 weeks
- immunization for household members of pt, traveling to endemic areas, or during epidemics
2. Gastroenteritis: Bactrim or Cipro
3. Bacteremia: drain abscesses, Bactrim, amp, or chloramphenicol - add Cipro if immunocompromised |
|
|
Term
Caused by shigella species -- sonnei, flexneri, dysenteriae
Sx: abrupt onset bloody and mucusy diarrhea, cramping, tenesmus, fever, chills, anorexia, HA, malaise
- HLA-B27 pts may get reactive arthritis
dx via stool culture
Tx? |
|
Definition
Dysentery
Tx: rehydration
- Bactrim |
|
|
Term
transmitted via resp secretions - prodcues an exotoxin that causes myocarditiis and neuropathy
Sx: nasal discharge, upper or lower airway obstruction, GRAY MEMBRANE covers tonsils and pharynx, sore throat, fever, malaise, myocarditis, neuropathy of CN - could progress to toxemia and prostration
tx? |
|
Definition
Diphtheria (corynebacterium diphtheriae)
tx: horse serum antitoxin
- may need to remove membrane via laryngoscope
- PCN or erythromycin |
|
|
Term
Gram negative pleomorphc bacillus. humans are only reservoir
sx in 3 stages:
1. catarrhal stage: insidious hacking cough worse at night, sneezing, coryza, losso of appetite, malaise - most infectious stage
2. paroxysmal stage: rapid coughing fits followed by deep, high-pitched inspiration lasting for several minutes. ifants at risk for apnea
3. convalescent stage: decrease inf requency and severity of paroxysms, lasts several weeks
Should be consdiered for any cough lasting >2 weeks with no other cause
- Fever is rare
Dx via culture
tx? |
|
Definition
Pertussis (bordatella pertussis)
Tx: erythromycin
- close contacts should get abx too
Prevention via vaccine |
|
|
Term
Epstein-Barr Virus:
1. this is herpes virus #?
2. causes what diseases?
3. labs
4. tx |
|
Definition
1. HHV 4
2. mono, Burkitt's lymphoma, nasophryngeal carcinoma, pediatric leiomyomas, collagen vascular diseases
- Sx of mono: sore throat, exudativ ephyarngitis, palatal petechiae, maculopapular rash (worse with amoxicillin), splenomgaly
3. Lymphocytosis, hemolytic/thrombocytopenic anemia
- heterophile ab test pos after 4 weeks
- false pos RPR in 10%
4. Tx: symptomatic, avoid contact sports, steroids if anemic |
|
|
Term
a group of noneveloped icosahedral virions - 77 known types
- invade mucus mmebranes and skin to cause warts
Laryngeal warts are caused by #11
Anogenital warts are caused by #6 and 11
Cervical warts are caused by 16 and 18
Dx: hyperplastic prickle cells with excess keratin on skin warts
- cervical warts: koilocytotic or vacuolated squamous cells in clumps on pap smear OR HPV DNA on probe
tx? |
|
Definition
HPV
tx: nothing, cut it off |
|
|
Term
fatty liver with encephalopathy
- rapidly progressive, 30% mortality rate
- 2-3 weks after flu or varicella esp if aspirin is ingested
Sx: vomiting, letharyg, jaundice, seizure, mental status change
Labs: hypoglycemia, elevated LFTs and ammonia, prolonged PT
tx? |
|
Definition
Reye Syndrome
tx: supportive |
|
|
Term
|
Definition
| zoster on tip of nose - involves trigeminal nerve - could get into eye |
|
|
Term
Rhabdovirus transmitted via infected saliva from animal bite or open wound
Vectors: dogs, bats, skunks, foxes, raccoons, coyotes, NOT RODENTS
- 10 day incubation
sx: pain and paresthesia at site, muscle spasms, bizarre behavior, convulsions, paralysis, thich, tenacious saliva, hydrophobia (painful spasms when drinking water), acending paralysis
dx: immunofluorescent ab marker in infected animal's brain
- quarantine domestic animals and watch for bizarre behavior
- CSF: reverse transcriptase PCR may show virus
tx? |
|
Definition
Rabies
tx: none specific
- supportive
- rabies vaccine immunoglobulin w/ monoclonal abs, ribaviron, interferon alpha, ketamine
- Prevention: cleansing of wounds, do not close animal bites, postexpsure immunization - 5 injections on days 0, 3, 7, 14, 28, pre-expsoure immunization for hgih risk (vets, park rangers) |
|
|
Term
HHV 5
- usually asymptomatic
pernatal infx: 10% of babies born to infected moms
- asymptomatic til later in life
- jaundice, hepatosplenomegaly, thrombocytopenia, periventricular CNS calcification, MR, motor disability, purpura
Acquired: sexual, breast milk, blood transufison, resp droplets: fever, malaise, myalgia, arthralgia, splenomegaly, LFT elevate, leukopenia
Pts at risk for sx: post-transplant or immunocompromised - retinitis with "pizza pie" neovascularization, esophagitis, odynophagia, pulmonary dz, neuro disease, IBD, atherosclerosis, breast cancer
Dx via antigens in blood, urine, CSF via PCR
Tissue bx: "OWLS' EYES"
tx? |
|
Definition
CMV
tx: ganciclovir, valganciclovir, foscarnet, cidofovir
- retinal infx require sustained release ganciclovir implants |
|
|
Term
dysmoprhic fungus found in bird and bat droppings - inhaled
acute: prostate and febrile. happens in epidemics
progressive diseeminated: fatal in 6 weeks. fever, dyspnea, cough, weight loss, prostrate, ulcers in mouth/pharyn/liver/spleen/adrnelas
chornic progressive pulmonary: older ptss with COPD. calcified nodes and pericarditis
disseminated disease: HIV. Miliary pulmonary infiltrates
dx via urine antigen assay
tx? |
|
Definition
Hisotplasmosis capsulatum
itraconazole orally for weeks to months
- amphotericin B if fail itraconazole or meningitis
- lifelong itraconazole for HIV |
|
|
Term
encapsulated budding yeast found in soil contaminated with pigeon dung - inhaled
- happens in immunosuppressed or COPD
sx:
1. Pulmonary disease - fever, cough, dyspnea. nodules or pneumonitis on CXR
2. CNS disease: HA, meninigits. CD4 <50. AMS, CN, visual probs
3. sepsis: causes obstructive hydrocephalus
4. disseminated disease
CSF: pleocytosis, increased protein, decreased glucose
- culture shows organism if cultured with india ink stain
- CRAG assay
tx? |
|
Definition
Cryptococcus
tx: oral fluconazole for 10 dweeks
- may need amphotericin B |
|
|
Term
cysts found in water and soil - transmitted by fecal-oral, fly dropings, human to human contact
- Cysts travel through intestines and hatch - Trophozoites invade mucosa and induce necrosis - FLASK-SHAPED ULCERS in intestine
sx:
1. Intestinal: asymtpomatic, colitis, severe diarrhea, fever, tenesmus, vomting
2. Extra intestinal: hepatic abscess (fever, pain, hepatomegaly, prostraition, sweating, chills, weight loss); pulmonary sx can occur if abscess is in superior liver - can be fatal
dx:
- stool specimen reveals cysts or trophozoites
- abs on serology
tx? |
|
Definition
Amebiasis - Entamoeba histolytica
tx:
1. asymptomatic: luminal amebicide (dilxoamide furoate, iodoquinol, paromomycin)
2. Mild-mod: tinidazole or flagyl + luminal amebicide
3. Severe: fluids and electrolytes, narcotics (control bowel activity and decrease risk of toxic megacolon)
4. Hepatic abscess: tinidazole or flagyl with luminal amebicide then chloroquine; drain abscess if no response in 3 days
at least 3 stool exams needed for follow up at 2-3 day intervals starting at 2-4 weeks after end of tx |
|
|
Term
endemic to moist tropics and subtropics, sporadic cases in SE US
- 25% of world is infeected
Eggs are passed into stool and hatch in soil
- Larvae penetrate skin and migrate into bloodstream to pulmonary capillaries where they destroy alveoli, carried by cilia to mouth and swallowed where they get blood from small bowel mucosa and then produce their own eggs
Sx: pruritic site of penetration, erythematous dermatitis with maculopapular or vesciular eruption
- cough, wheeze, blood-tinged sputum, low grade fever
- may be asymptomatic if enoguh iron intake
- anorexia, diarrhea, vague pain, ulcer-like epigastric sx, anemia, protein loss, malabsoprtion
dx: eggs in feces
tx? |
|
Definition
Hookworms
tx: mebendazole BID x 3 days or pyrantel or albendazole qday for 2-3 days
- high protein diet, vitamins, ferrous sulfate |
|
|
Term
entaerobius vermicularis
- chidlren more commonly infected than adults
- more common in cecum - gravid females pass through the anus to lay eggs on perianal skin.
dx: tape over anus at night
tx? |
|
Definition
pinworms: albendazole, mebendazole, pyrantel single dose then repeated 2-4 weeks later
- treat all members of ohuse, hand washing, linens should be washed |
|
|
Term
Malaria:
1. vector
2. ___ invade hepatocytes and mature as ___, which escape the liver and invade RBCs
3. sx
4. dx
5. tx |
|
Definition
Organism: plasmodium species (falciparum is worst)
1. vector: anophales mosquito
2. sporozites invade hepatocytes and mature as tissue schizonts, which escape the liver and invade RBCs
3. sx: shaking chills (cold stage) then fever (hot stage0 the sweating
- fatigue, HA, dizziness, GI sx, mayglia, backache, dry cough, hepatosplenomegaly
- Falciparum: cerebral malaria - hyperpyrexia, noncardiogenic pulmonary edema, ATN, adrenal insufficiency, cardiac dysrhtymias
4. dx: Giemsa or Wright stain - 5-20% infected RBCs
5. tx
1. prevention: avoid mosquito bites
2. chloroquine prophylaxis if traveling to endemic area
3. Tx: quinine, quinidine, chloroquin + doxy, clinda, or TCN |
|
|
Term
Syphilis:
1. organism
2. primary syphilis sx
3. secondary sx
4. late sx
5. congenital syphilis |
|
Definition
Organism: teponema pallidum - a spirochete
primary: chancre (painless ulcer) + regional adenopathy
Secondary: lesions may involve skin, mucus membranes, eyes, bone, kidneys, CNS, liver
LATENT PERIOD
Tertiary (late) syphilis: gummetous lesions of skin, bones, viscera, cardiovascular disease, CNS, ophthalmic lesions
- Neurosyphilis: meningovascular syphilis (chronic meningitis), generalized paresis, tabes dorsalis (chronic progressive degeneration of parenchyma) with loss of vibratory sense, argyll robertson pupils, crises
Congenital syphilis: abn of skin or mucus membranes, nasal discharge, hepatosplenomgealy, anemia, osteochondritis, intersitial keratitis, Hutchinson's teeth, saddle nose, deafness, CNS abn
dx via serologic testing - RPR and VDRL pos 4-6 weeks after infections
- treponemal ab tests: FTA-ABS (fluorescent treponemal ab absorption) - may be falsely pos in lyme disease, SLE, malaria, or leprosy
Tx: benathine pencillin G 2.4 million U IM x1 if primary, x3 (weekly) if late latent or tertiary
- Neuro: aqueous penicillin q 4hr for 10-14 days |
|
|
Term
| Jarisch-Herxheimer reaction - sudden massive destruction of spirochetes - fever, toxicity |
|
Definition
|
|
Term
gram neg intracellular diplococci
- incubation 2-8 days
Men: urethritis, burning on urenation, urethral discharge
- can progress to epididymitis, prostatitis, periurethral galnds
Women: asymptomatic, dysuria, frequency/urgency, purulent urethral discharge, vaginitis, cervicitis --> PID, infertility
Bacteremia: peripheral skin lesions + septic arthritis
Conjunctivitis: direct inoculation with unilateral copious purulent discharge - globe rupture is risk
dx via gram stain of urethral discharge or pap smear
tx? |
|
Definition
Gonorrhea
tx: IM ceftriaxone or oral cefixime + doxy/azithro/erythro (for chlamydia coverage) |
|
|
Term
| STD that starts as an ulcer and then progresses to the lymph nodes to cause Buboes - caused by chlamydia |
|
Definition
|
|
Term
Flagellated protozoan causing frothy yellow-green d/c and red lesions on cervix
dx: wet mount
tx? |
|
Definition
trichomonas
Flagyl 2g single dose
|
|
|
Term
borrelia burdorferi transmitted via the tick Ixodides
Stage 1: erythema migrans "bull's eye" lesion +/- flu-like illness
Stage II: early disseminated infx - meningitis type sx
Stage III: late persistent - arthritis, acrodermatitis chronicum atrophicans (blue/red discoloration of extremiites), neuropathy
dx: Elisa with western blot confirmation
tx? |
|
Definition
|
|
Term
rickettsia reicketsii via wood tick
common in eastern US
sx: fever, myalgia, HA, n/v
Rash: flushed face --> macules --> maculopapular --> petechia starting at wrists at ankles and progressess to trunk
dx: CSF or serum antibody titers in the second week of infection
tx? |
|
Definition
|
|
Term
Trauma:
1. ___ is characterized by paradoxical breathing - free-floating rib segments that move opposite to normal respiratory patterns
2. persistent hypotnesion - r/o what 3 causes?
3. Beck's triad
4. 95% of penetrating chest traumas can be managed with ___
5. Blunt abdominal trauma management
6. Penetrating abdominal trauma - indications for immediate laparotomy
7. penetrating flank trauma management
8. Signs of vascular trauma
9. Signs of basilar skull fx |
|
Definition
1. flail chest is characterized by paradoxical breathing - free-floating rib segments that move opposite to normal respiratory patterns
2. persistent hypotnesion - r/o what 3 causes - tension pneumo, MI, cardiac tamponade
3. Beck's triad: hypotension, JVD, muffled heart sounds - for cardiac tamponade
4. thoracostomy tube
5. FAST exam: focused assessment with sonography for trauma: perihepatic, perisplenic, pericardial, pevic regions - confirm wtih CT if pt is hemodynamically stable
6. Immediate laparotomy: shock, peritoneal irritation, evisceration, intraperitoneal air on FAST exam --> otherwise wait for pt to stablize
7. penetrating flank trauma: CT with orla nd IV contrast if stable. May have retroperitoneal injury.
8. Signs of vascular trauma: pulsatile mass or hemorrhage, expanding hematoma, significant hemorrhage, thrill or bruit, acute ischemia to an extremity - arteriopgraphy and ABI
9. Basilar skull fx: otorrhea, rhinorrhea, eccymosis of eye lids (raccoon eyes), ecchymosis behind ears (battle's sign) |
|
|
Term
| Indications for thoracostomy |
|
Definition
1. caked hemothorax unable to drain via thoracostomy tube
2. evacuation of 1,500 mL blood in injury <3 hr old
3. evacuation via tube thoracostomy of 200 mL blood for 3 consecutive hours
4. Signs of cardiac tamponade
5. signs of esophageal perforation
6. bowel sounds in chest - indicate diaphragm injury
7. persistent leakage of air
8. development of bronchopleural fistula |
|
|
Term
Epidural hematoma:
1. injury to ___ artery
2. sx
3. dx
4. tx |
|
Definition
middle meningeal artery
sx: brief unconsciousness then lucid interval
Herniation: coma, fixed/dilated pupils, decerebrate posturing
dx: CT
tx: emergency craniotomy |
|
|
Term
Subdural hematoma:
1. what structure is injured?
2. sx
3. MOI
4. dx
5. tx |
|
Definition
Tethered bridging veins
sx: mental status change, focal neuro signs
MOI: alcoholics and elderly with relatively minor trauma
dx via CT
tx: burr holes to evacuate clot |
|
|
Term
Burns:
1. first degree
2. superficial second degree
3. deep second degree
4. third degree
5. fourth degree
6. In ___ burns, the skin invovlment does not correlate with extent of burn
7. workup |
|
Definition
1. first degree: epidermis only - erythema, tenderness, no blister
2. superficial second degree: extends into papillary dermis. thin-walled fluid-filled blisters that blanch and are painful
3. deep second degree: extends into reticular dermis: thick-walled blisters with erythema and pallor, painful
4. third degree: full thickness - through dermis. white, leathery, charred, no sensation
5. fourth degree: invovle fascia, muscle, bone. No sensation
6. In electrical burns, the skin invovlment does not correlate with extent of burn
7. workup: HCt, electrolytes, BUN and Cr, UA, CXR, ABC, AKG, carboxyhemoglobin, glucose
|
|
|
Term
|
Definition
% body burned x body weight (kg) x 4 ml/hr = total LR over next 24 hr
- half over first 8 hrs
- half over next 16 hrs |
|
|
Term
| % body burned calculation |
|
Definition
Anterior torso: 18%
Posterior torso: 18%
Each Leg: 18%
Each arm: 9%
Head: 9%
Genitalia: 1% |
|
|
Term
|
Definition
Wind: 24-48 hrs - Atelectasis
Water: 48-72 hrs - UTI
Wound: >72 hrs - Infection
- s. aureus
Walk: >72 hrs - DVT or IV thrombophlebitis
Wonder drug: >1 week - dx of exclusion after neg sepsis workup
Whopper: >1 week - abscess
- requires surgical debridementa nd abx |
|
|
Term
Necrotizing fasciitis:
sx
laboratory triad
tx |
|
Definition
Sx: progressive erythema, tissue crepitus, tenderness, high fever, tachycardia, hypotension, AMS
Triad: WBC >14K, BUN >15, NA <135
Tx: surgical debridement + Pen G 24 M units IV per day (clinda or gentamycin for penn allergy)
- Monitor kidney function |
|
|
Term
| Classic regimen for coronary artery disease/angina pectoris |
|
Definition
daily ASA
sublingual NTG prn for pain
daily BB
statin (if increased LDL) |
|
|
Term
| DOC for acute management of acute symptoms of angina |
|
Definition
|
|
Term
|
Definition
SBP < 90
right ventricular infarction
use of viagra (sildenafil) & other PDE-5 inhibitors |
|
|
Term
| 1st line drug for chronic treatment or coronary artery disease |
|
Definition
|
|
Term
| MCC of coronary artery disease |
|
Definition
|
|
Term
| substernal chest pain often brought on by exertion (d/t decreased supply & increased demand) |
|
Definition
|
|
Term
| what is the most useful noninvasive screening tool for CAD/angina pectoris? |
|
Definition
|
|
Term
| what is the definitive diagnosis tool for CAD/angina pectoris? |
|
Definition
|
|
Term
| Initial stress test of choice for most patients w/ normal resting ECG |
|
Definition
treadmill test
DOESNT assess region of ischemia |
|
|
Term
| MC used to test puts w/ baseline ECG abnormalities |
|
Definition
radionuclide myocardial perfusion imaging (MPI)
DOES identify regions of ischemia
Adenosine or Dipyridamole (Persantine) |
|
|
Term
| CI to radionuclide myocardial perfusion imaging (MPI) |
|
Definition
| asthmatics (causes bronchospasm) |
|
|
Term
| Stress testing done in patients unable to exercise |
|
Definition
Pharmacologic stress testing
Adenosine or dipyridmaole
vasodilators preferred with MPI
caution: avoid vasoconstrictors 24h prior |
|
|
Term
|
Definition
usues dobutamin
used in pts w CI to vasodilators or w/ recent vasoconstrictor use
|
|
|
Term
| Revascularization techniques for management of angina |
|
Definition
1. PTCA (percutaneous transluminal coronary angioplasty)/ PCI (Perc coronary intervention)
2. CABG (coronary artery bypass graft) |
|
|
Term
|
Definition
1 or 3 vessel dz NOT involving main left coronary artery + normal or near normal left ventircular function
combo of ASA + clopidogrel (Plavix) used after |
|
|
Term
|
Definition
| left main coronary artery disease, symptomatic 3 vessel dz, left ventricular ejection fraction < 40% |
|
|
Term
|
Definition
ARMS rest
Aortic regurg, Mitral stenosis |
|
|
Term
|
Definition
Apple Pies Taste Mmmmm
Aortic : R 2nd ICS
P : L 2nd ICS
Tricuspd: L 4th ICS (erbs @ 3 ICS)
Mitral : 5th ICS (mid clavicular line) apex |
|
|
Term
| radiation of aortic stenosis |
|
Definition
|
|
Term
| radiation of mitral stenosis |
|
Definition
|
|
Term
| radiation of aortic regurg |
|
Definition
|
|
Term
| radiation of mitral regurg |
|
Definition
|
|
Term
| _____ murmurs are intensified when patient sits up and leans forward |
|
Definition
|
|
Term
| _____ murmurs are intensified when patient lays on left side (decubitus position) |
|
Definition
|
|
Term
| Increased venous return INCREASES _____ |
|
Definition
ALL MURMURS/ opening snap
ie squatting, leg raise, laying down
****exceptions: decreased murmur of HCM & delayed ejection click (decreased prolapse/shorter murmur duration) of MVP |
|
|
Term
| Inspiration increases venous return on the right side---? |
|
Definition
increases ALL murmurs/opening snap on the R side (decreased ejection click R side)
right sided murmurs heard best w/ inspiration |
|
|
Term
| expiration increases venous return on left side |
|
Definition
increase all murmurs/opening snap on the L side
(delayed ejection click on the L side)
left sided murmurs best heart after maximal expiration |
|
|
Term
| Handgrip increases after load (by compressing arteries of UE) leading to decreased LV emptying (decreased forward flow & increased backward flow) |
|
Definition
AR, MR, increases with hangrip d/t backward flow
MS increases d/t to afterload |
|
|
Term
| amyl nitrate decreases afterload (direct arteriolar vasodilator) leading to increased LV emptying (increases forward flow & decreases backward flow of blood |
|
Definition
AR, MR decreases with amyl nitrate
(this is why afterload reducers like ACEI are used in tx) |
|
|
Term
| CXR classic triad : egg on a string appearance of heart, increased pulmonary vascular congestion, mild cardiomegaly |
|
Definition
| transposition of the great vessels |
|
|
Term
|
Definition
| ventricular septal defect |
|
|
Term
| Harsh holosystolic murmur @ L sternal border, LVH + RBH (biventricular hypertroph) |
|
Definition
|
|
Term
|
Definition
35% close spontaneously
sx
diuretic
digoxin early |
|
|
Term
|
Definition
LV outflow obstruction --> fixed CO
increased afterload --> LVH |
|
|
Term
| causes of aortic stenosis |
|
Definition
degeneration >70
congenital <70
rheumatic fever |
|
|
Term
| clinical manifestations of aortic stenosis |
|
Definition
|
|
Term
systolic "ejection" crescendo-decrescendo @ RUSB
later peaking murmur = increased severity |
|
Definition
|
|
Term
pulsus parvus et tardus (weak, delayed pulse)
narrow pulse pressure |
|
Definition
|
|
Term
|
Definition
|
|
Term
paradoxically split S2 (if severe)
S4 if LVH |
|
Definition
|
|
Term
| Treatment of aortic stenosis |
|
Definition
aortic valve replacement (AVR) once sxatic
severe AS is preload dependent --> avoid exertion, venodilators, & negative inotropes (CCB, BB) |
|
|
Term
| obstruction of flow from LA to LV --> LAE & increased LA pressure --> pulm HTN |
|
Definition
|
|
Term
|
Definition
rheumatic heart disease (RHD)
MC cause by far |
|
|
Term
| Clinical manifestations of mitral stenosis |
|
Definition
- R-sided heart failure
- pulmonary HTN - hemoptysis
- ATRIAL FIBRILLATION
- mitral facies (flushed cheeks)
|
|
|
Term
diastolic rumble @ apex (low) in LLD - may be preceded by opening snap
shorter A2-OS duration = increased severity |
|
Definition
|
|
Term
|
Definition
|
|
Term
Prominent S1 (closing snap) +- diminish w/ increased severity
OPENING SNAP (OS) |
|
Definition
|
|
Term
| treatment of mitral stenosis |
|
Definition
valvotomy in young pts
if rheumatic dx, sxatic, & valve orficie < 1.0 cm
repair preferred over replacement |
|
|
Term
| back flow from aorta to LV --> LV volume overload |
|
Definition
|
|
Term
| Causes of aortic regurgitation |
|
Definition
rheumatic dz, HTN
endocarditis, Marfan
Syphilis
Anklyosing Spondylitis |
|
|
Term
| Clinical presentation of aortic regurgitation |
|
Definition
|
|
Term
diastolic decrescendo blowing @ LUSB - increases w/ handgrip, decreases w/ amyl nitrate
+- Austin Flint Murmur: mid-late diastolic rumble @ apex |
|
Definition
|
|
Term
Bounding pulses (increased SV)
WIDE pulse pressure |
|
Definition
aortic regurgitation
pulse bisferiens (if combined AS+ AR) |
|
|
Term
| PE findings of aortic regurgitation |
|
Definition
Hill- popliteal mmHg > brachial pressure
Demussets- head bobbing
Quincke pulses - nailbed pulsations
water hammer pulse
pistol shot over fem art. |
|
|
Term
| Treatment of aortic regurgitation |
|
Definition
Meds: vasodilators (decreased afterload increases forward flow)
Sx: acute or sxatic AR or decreased LV <55% (need hyperdynamic ventricle to maintain CO) |
|
|
Term
| back flow from LV into LA --> LV volume overload --> decrease CO |
|
Definition
|
|
Term
| Causes of mitral regurgitation |
|
Definition
MVP is MCC
RHD, endocarditis
ischemia (ruptured papillary muscle/chordae s/p MI) |
|
|
Term
| Clinical manifestations of mitral regurg |
|
Definition
Acute: pulm edema, dyspnea
Chronic: A fib, CHF. Maybe pulm HTN (not as often as MS) |
|
|
Term
blowing holosystolic murmur @ apex
increases with handgrip, LLD
decreases with amyl nitrate |
|
Definition
|
|
Term
| may have a brisk upstroke d/t hyper dynamic ventricle from increased preload & decreased after load |
|
Definition
|
|
Term
widely split S2
+- S3, decreased S1 |
|
Definition
|
|
Term
| Treatment of mitral regurgitation |
|
Definition
Meds: vasodilators-decrease afterload increases forward flow (ACEI)
SX: valve repair preferred vs valve replacement (acute/sxatic or LV < 55%) |
|
|
Term
| myomatous degeneration of mitral valve (floppy, redundant valve) |
|
Definition
|
|
Term
| causes of mitral valve prolapse |
|
Definition
MC in young women
connective tissue dz (Marfan, Ehlers Danlos) |
|
|
Term
| Clinical manifestations of mitral valve prolapse |
|
Definition
Most asymptomatic
1. autonomic dysfunction: CP, panic attacks; arrhythmia --> fatigue
2. sx assoc w/ MR progression: fatigue, dyspnea, PND, CHF
3. stroke, endocarditic, PVC's |
|
|
Term
Midsystolic ejection click @ apex
decreased venous return (valsalve, standing, inspiration) --> earlier click & longer murmur |
|
Definition
mitral valve prolapse
+- mid-late systolic murmur (MR) |
|
|
Term
Narrow AP diameter
Low body weight (thin)
hypotension
scoliosis, pectus excavatum |
|
Definition
|
|
Term
| Treatment for mitral valve prolapse |
|
Definition
reassurance good prognsis in asymptomatic pts or mild sx
BB for autonomic dysfunction |
|
|
Term
| R ventricular outflow obstruction of blood across the pulmonic valve |
|
Definition
|
|
Term
| almost always congenital & a disease of the young (ex congenital rubella syndrome) |
|
Definition
|
|
Term
harsh mid systolic ejection crest-decrescendo murmur (maximal @ LUSB) radiates to neck
murmur increases w/ inspiration
signs of R -sided HF. Systolic ejection click |
|
Definition
|
|
Term
| tx of choice for pulmonic stenosis |
|
Definition
|
|
Term
| MCC of pulmonic regurgitation |
|
Definition
|
|
Term
| Graham Steell murmur: brief, decrescendo early diastolic murmur @ LUSB with full inspiration |
|
Definition
|
|
Term
mid-diastolic rumble @ LLSB (xyphoid border)
opening snap |
|
Definition
|
|
Term
holosystolic murmur high pitched @ subxyphoid area (L mid sternal border)
Carvallo's sign: increased murmur intensity w/ inspiration |
|
Definition
tricuspid regurgitaiton
Carvallo's sign helps to distingush TR from MR |
|
|
Term
| ideal weight with abnormal eating behaviors |
|
Definition
|
|
Term
| below ideal body weight with abnormal eating behaviors |
|
Definition
|
|
Term
| Neural basis: serotonergic dysfunction strongly associated along with altered dopamine, NE and opiate systems. |
|
Definition
Eating disorders
High comorbidity with body dysmorphic disorder and OCD. |
|
|
Term
| Defining a healthy weight |
|
Definition
- In PEDATRICS 50th percentile
- In adults, use BMI [a screening tool. Higher than 30 is predisposition for many diseases. OBESE].
- BMI -Correlates to measures of body fat -- Under 17.5 significant risk for anorexia associated health problems
|
|
|
Term
| DSM-IV criteria for anorexia nervosa |
|
Definition
SELF imposed starvation : BMI < 17%
- Refusal to maintain body weight at or above that expected for age & height (<85% of Ideal Body Weight).
- Intense fear of gaining weight or becoming fat despite being severely underweight
- Distortion in the way one’s body size is experienced and denial of seriousness of low weight.
- Amenorrhea from ↓LH and FSH in post-menarcheal females (absence of 3 or more consecutive menstrual cycles)
|
|
|
Term
| is anorexia nervosa hereditary? |
|
Definition
| biologic, familial, and genetic data support a biologic and heritable basis |
|
|
Term
|
Definition
- restricting - eating very little and not regularly engaging in binge eating or purging behavior. often substantially increasing exercise
- binge eating/purging (less frequent) - excessive caloric intake. Then vomits or uses diuretics/laxatives
|
|
|
Term
| What are some clinical signs of anorexia nervosa? |
|
Definition
- Vital signs: emaciated, hypotension, bradycardia, skin/hair changes (lanugo), dry skin, salivary gland hypertrophy, amenorrhea
- Labs: CBC: leukocytosis, leukopenia, anemia; hypokalemia, ↑BUN (pre-renal dehydration), hypothyroid, arrhythmias
|
|
|
Term
| Treatment of anorexia nervosa? |
|
Definition
- hospitalization for < 75% expected body weight to stabilize medically
- psychotherapy: CBT
- pharmacotherapy: if depression SSRI, atypical anti-psychotics (may help with weight gain as well)
|
|
|
Term
| DSM-IV criteria: Bulimia nervosa |
|
Definition
- recurrent episodes of binge eating - objectively a large amount of food, individual feels "out of control" and eats to point of discomfort
- recurent compensatory mechanisms to avoid weight gain - self induced vomiting, laxative use, fasting, excessive exercise
|
|
|
Term
| How often to binge/purge episodes occur on average in a pt with bulimia nervosa |
|
Definition
| at least 2 or more times a week for at least 3 months |
|
|
Term
| Is bulimia nervosa hereditary? |
|
Definition
| familial and genetic studies do support familial linkages |
|
|
Term
|
Definition
| binge eating can occur in MDD and borderline PD but is no tied to a compulsion to reduce weight |
|
|
Term
| two types of bulimia nervosa |
|
Definition
- purging-self-induced vomiting, misuse of laxatives, enemas or diuretics
- non-purging-using compensatory behaviors like excessive exercising or fasting
|
|
|
Term
| Diagnostic criteria binge eating - associated with overweight or obesity (bulimia nervosa) |
|
Definition
- Recurrent episodes of Binge eating for at least a period of 2 days/week for 6 MONTHS
- Characterized by the consumption of a larger amount of food in 2 hours than the average person would consume
- Binge eating episodes are associated with 3 or more of the following:
1. Eating faster than normal
2. Eating until feeling uncomfortably full
3. Eating to excesssssssss
4. Eating even though not hungry
5. Eating alone out of embarassment with feelings of disgust, guilt, or depression after the episode
|
|
|
Term
| Treatment of bulimia nervosa |
|
Definition
- psychotherapy: CBT
- pharmacotherapy:fluoxetine shown to reduce binge-purge cycle
|
|
|
Term
| Common medical issues with eating disorders |
|
Definition
- Binge eating: gastric dilation and rupture; obesity
- Vomiting:
· Esophageal rupture
· Parotiditis with hyperamylasemia
· hypokalemic, hypochloremic metabolic alkalosis (with cardiac arrhythmias)
· Constipation (from dependence)
· Dehydration
- Cardiovascular – just know that it can cause arrhythmias
· Orthostatic hypotension (starvation)
· Bradycardia (starvation)
· Prolonged QT and T-wave abnormalities on EKG (purging behaviors)
· Mitral valve prolapse (diminished muscle mass)
· Cardiomyopathy (Ipecac toxicity)
· Low WBC (starvation and stress)
· Anemia (starvation)
· Dehydration (starvation, purging)
· *Decreased albumin (starvation)
· Peripheral edema and effusions (starvation)
· Electrolyte disturbances (purging)
· Hair loss (stress, starvation)
· Dull hair (decreased fat)
· *Lanugo hair (starvation)-a fine, pale hair appearing in the setting of protein-calorie malnutrition
· Dry skin (decreased fat)
· Calloused or scarred knuckles (purging)
· Acrocyanosis (starvation)-blueness of hands and feet
- Dental (purging)
- Re-feeding syndrome: when treating severely underweight (<75% of IBW), watch for this. State caused by sudden carbohydrate intaked severely depleting body phosphate stores (hypophosphatemia) resulting in rhabdomyolysis, delerium, seizures and eventual cardiovascular collapse. Look for signs of CHF, AMS, and signs of edema
|
|
|
Term
| What are common signs associated with high morbidity in ppl with eating disorders |
|
Definition
amenorrhea
bone health (decrease in peak bone mineral density) |
|
|
Term
| Indications for inpatient care in pt's with eating disorders |
|
Definition
- *Hypokalemia: Serum potassium < 3.2 mmol/L
- *Hypochloremia: Serum chloride < 88 mmol/L
- *Cardiac arrhythmias, including prolonged QTc interval
- Syncope
- Intractable vomiting
- Hematemesis
- Failure to respond to outpatient treatment
- Severity of psychiatric comorbidities (Major depression, anxiety disorders, substance abuse disorders)
|
|
|
Term
| Which meds should you stay away from with patients with eating disorders |
|
Definition
- stimulants - increase risk of cardiac arrest, risk of abuse to lose more weight. also reduce appetite
- buproprion (wellbutrin) decrease seizure threshold which can increase risk of seizures
- TCA's - increase risk of cardiac dysfunction
|
|
|
Term
|
Definition
depressant and functions by releasing dopamine
overstimulation of the reward d/t to brain "soaked in dopamine" produces euphoric effects |
|
|
Term
|
Definition
substance dependence
1. compulsive use
2. inability to control use
3. continued use despite consequences |
|
|
Term
|
Definition
- Has not met criteria for dependence, but results in impairment
- Maladaptive pattern of substance use, characterized by one (or more) of the following symptoms in a 12 month period
- 1. Recurrent substance use leads to failure of major obligations (home, school, work)
- 2. Repeated substance use in situations in which it is physically hazardous
- 3. Recurrent substance-related legal problems
- 4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance
|
|
|
Term
|
Definition
- Physical: physiologic changes that occur with drug abuse and result with withdrawal on termination
- Psychological: craving or desire for substance independent of withdrawal symptoms
- Maladaptive pattern of substance use, characterized by 3 (or more) of following symptoms in a 12-month period:
-
1. ***TOLERANCE***: need for more or diminished effect.
o As a person continues to abuse drugs, the brain adapts to the overwhelming surges of dopamine by:
§ Producing less dopamine
§ Reducing the number of dopamine receptors in the reward circuit
2. ***WITHDRAWAL***
o 2 or more of the following developing within a few hours to a few days of reduction in heavy or prolonged alcohol use
· Sweating or rapid pulse
· Increased hand tremor
· Insomnia
· Nausea or vomiting
· Physical agitation
· Anxiety
· Transient visual, tactile, or auditory hallucinations or illusions
· Grand mal seizures
o Delirium tremens is severe form of withdrawal 2-3 days after stopping: delirium, tremors, seizures, visual hallucinations
3. Substance taken in larger amounts or over a longer period than intended
4. Persistent desire or unsuccessful efforts to cut down or control substance use
5. Great deal of time spent obtaining, using, or recovering from effects of the substance
6. Important social, occupational, or recreational activities are given up or reduced
7. Substance use continued despite knowledge of having a persistent or recurrent physical or psychological problem that was likely caused or exacerbated by the substance
|
|
|
Term
| Substance abuse neural basis |
|
Definition
- Addictive substances and behaviors like nicotine, food, caffeine, and perhaps sex and gambling act by a final common pathway influencing neurons of the ventral striatum/nucleus accumbens.
- this structure is a target of the mesolimbic dopamine pathway that mediates reward system function.
- Rewards like feeding, sex, exercise produce associate memories linked to the rewards that reinforce the probability of rewarding behavior.
- Drugs, via direct synaptic effects, produce similar powerful associated memories strongly reinforcing behavior associated with drug use.
|
|
|
Term
|
Definition
- happens when tolerance and withdrawal symptoms develop
- There is persistent desire to cut down/ control intake without success
- Compared with control subjects, the relatives of alcoholics are more likely to have higher rates of depression and antisocial PD.
|
|
|
Term
| PE in a patient with alcohol dependance |
|
Definition
- Early signs→ acne rosacea, palmar erythema, painless hepatomegaly (from fatty infiltration)
- Advanced signs→ cirrhosis, jaundice, ascites, testicular atrophy, gynecomastia, Dupuytren contracture
- Cirrhosis can lead to: variceal bleeding, hepatocellular carcinoma, hepatic encephalopathy
- Increased risk for pneumonia, TB, HTN, cardiomyopathy, GI cancers
|
|
|
Term
| DX studies for alcohol dependance |
|
Definition
- Blood alcohol levels confirm alcohol in the blood and provide rough estimate of tolerance (higher levels without intoxication indicate higher tolerance)
- Elevated MCV
- Elevated glutamic oxaloacetic transaminase
- Elevated glutamic-pyruvic transaminase
- May have evidence of rib fractures on CXR
|
|
|
Term
| Mental status exam --> complications of alcohol dependence |
|
Definition
- Wernicke- Korsakoff’s syndrome (Wernicke’s encephalopathy) due to thiamine deficiency
- alcoholic hallucinations
- alcohol induced dementia
- peripheral neuropathy
- alcohol induced depression
- Suicide
|
|
|
Term
| Treatment of alcohol dependance |
|
Definition
- Supportive and withdrawal of the alcohol source
- Intensive care if complicated by respiratory compromise
- Vitamin supplementation with folate 1mg QD and 100mg thiamine QD for all patients
- If early signs of Wernicke's give thiamine before glucose→ glucose depletes thiamine stores. So rule this out before considering hypoglycemia treatment!!!
- Magnesium replacement
|
|
|
Term
|
Definition
- slurred speech, incoordination, unsteady gait, nystagmus, impairment in attention/memory, stupor/coma
- clinically significant maladaptive behavioral or psychological changes (inappropriate sexual or aggressive behavior, mood lability, impaired judgment, impaired social or occupational functioning)
- dx has to be differentiated from other medical/neuro states like diabetichypoglycemia, medication toxicity with ethylene lycol, lithium, and phenytoin; medication intoxication with benzos or barbituates.
- Dx by blood alcohol level
|
|
|
Term
|
Definition
- the presence of symptoms after a prolonged period of heavy alcohol use is stopped.
- tremor (especially of the hands), tachycardia, HTN, sweating, GI sx (N/V), insomnia, sensory disturbances like perceptual distortions and hallucinations, psychomotor agitation, anxiety; may have grand mal seizures.
|
|
|
Term
| Alcohol Dependance --Wernicke's encephalopathy, delirium, grand mal seizures in more severe cases |
|
Definition
- delirium tremens: delirium (perceptual disturbances, confusion, disorientation, agitation etc), autonomic hyperarousal, fever.
- Typically presents 2-3 days after alcohol cessation and can persist for few days to weeks
- Tx: IV benzos, supportive care
|
|
|
Term
| Alcohol induced persisting dementia |
|
Definition
- when alcohol is determined to be the cause of deficits in memory, aphasia, apraxia, agnosia, impaired executive functions
|
|
|
Term
| alcohol induced persisting amnestic disorder |
|
Definition
- AKA korsakoff's syndrome
- often irriversible
- development of memory impairement in learning new memories or recalling old information w/ hx of alcohol dependence
- confabulation (making up information to fill gaps in memory) is common
|
|
|
Term
|
Definition
|
|
Term
| Medication therapy for alcohol dependance |
|
Definition
- Disulfram (Antabuse) inhibits alcohol dehydrogenase causing acetaldehyde to build up in the body causing adverse side effects like flushing, n/v, hypotension and palpitations making the patient more inclined not to drink. Very dangerous if pt continues to drink or relapses on this medication. Starting dose is 250mg QD
- Naltrexone (Revia) opiate antagonist to reduce cravings of alcohol intake by reducing the “high” feeling of alcohol. Starting dose is 50mg QD; is okay to take if relapse occurs
- both of these meds are used for maintenance therapy and do not prevent withdrawal
- Benzos are used in acute detoxification to prevent life-threatening complications of withdrawal
|
|
|
Term
| CAGE questionnaire - pg 28 |
|
Definition
|
|
Term
| Substance abuse (sedatives, anxiolytics, hypnotics) |
|
Definition
- All are cross tolerant with each other and alcohol; include barbiturates and benzos(most widely prescribed and available)
- phenomenon that occurs when someone who is tolerant to the effects of a certain drug also develops a tolerance to another drug.
- Barbituate and benzodiazepines can produce a life-threatening withdrawal syndrome
|
|
|
Term
| MOA of substance abuse (sedatives, anxiolytics, hypnotics, ect) |
|
Definition
|
|
Term
| PE for substance abuse pt (sedatives, anxiolytics, hypnotics, ect) |
|
Definition
| can distinguish from alcohol intoxication by BAC, urine screen, breath test |
|
|
Term
| Which are more likely to cause respiratory compromise....benzos or barbiturates? |
|
Definition
|
|
Term
| How to diagnose substance abuse (sedatives, anxiolytics, hypnotics, ect) |
|
Definition
- quantitative and qualitative urine/serum tox screen for barbiturates, benzos
- minor withdrawal sx : restlessness, apprehension, anxiety
- more severe withdrawal: coarse tremors, weakness, N/V, sweating, hyperreflexia, ohTN, seizures
- Dependence evident by 3 or more withdrawal s/s
|
|
|
Term
| Treatment of substance abuse (sedatives, anxiolytics, hypnotics, ect) |
|
Definition
- Inpt detox done in more high risk cases (comorbid psych dz, prior treatment failure, lack of support etc)
- Benzos/barbiturates can be given on a scheduled dose and slowly tapered off in controlled manner
- Withdrawal from short acting drugs is more severe than that of long acting drugs which is prolonged
- Barbiturate withdrawal more severe than benzos- hyperpyrexia, seizures, death happens more easily
- If alcohol abuse occurring also, can do phenobarbital challenge test to see how tolerant the patient is to know how much drug to give and taper to reduce withdrawal problems
- Treatment: detox and therapy/rehab
|
|
|
Term
| Opioid abuse (morphine, heroine, codeine, meperidine, hydromorphone) - history |
|
Definition
- History: most users take drugs IV; initial rush followed by psychomotor retardation, drowsiness, inactivity and impaired concentration
- Flushing, and intensely pleasurable bodily sensation that resembles orgasm, followed by sense of well being, then coming down
|
|
|
Term
| Opioid abuse (morphine, heroine, codeine, meperidine, hydromorphone) - Physical Exam |
|
Definition
- after immediate administration pupillary constriction, respiratory depression, slurred spech, hypotension, bradycardia, hypothermia
- N/V, constipation common after opiate use
|
|
|
Term
| Opioid abuse (morphine, heroine, codeine, meperidine, hydromorphone) - lab tests |
|
Definition
| urine or serum tox screen |
|
|
Term
| How often do patients with Opioid abuse (morphine, heroine, codeine, meperidine, hydromorphone) use? |
|
Definition
- dependent addicts use 3+ times a day
- withdrawal happens 10 hours after last dose and lasts 7-10 days with short acting opiates and 2-3 weeks with long acting
|
|
|
Term
| Withdrawal symptoms of Opioid abuse (morphine, heroine, codeine, meperidine, hydromorphone) |
|
Definition
- can be highly uncomfortable but is rarely medically complicated or life threating
- mild withdrawal - dysphoric mood, anxiety, & restlessness, lacrimation or rhinorrhea, pupillary dilation, piloerection, sweating, tachycardia, fever, diarrhea, insomnia, yawning
- more severe withdrawal - N/V, muscle aches, seizures (in meriperidine withdrawal), abdominal cramps, HTN, hot and cold flashes, severe anxiety
|
|
|
Term
| Comorbidities with Opioid abuse (morphine, heroine, codeine, meperidine, hydromorphone) |
|
Definition
- opiate addicts often have comorbid substance use disorder, antisocial or borderline personality disorder and mood disorders.
- Addicts more prone to commit crimes because of $$$ of opiates
- Addiction associated with high mortality rates from OD, accidents and suicide
- Higher risk for medical problems from poor nutrition and dirty needles
- Medical problems: hepatitis, HIV, endocarditis, pneumonia, cellulitis
|
|
|
Term
| Treatment for Opioid abuse (morphine, heroine, codeine, meperidine, hydromorphone) |
|
Definition
- Methadone- weak mu opiate receptor agonist with longer half-life so less intoxicating/withdrawal effects
- Buprenorphine (Buprenex)- mu and k opioid receptor antagonist approved for outpatient detox
- Naloxone(Narcan)-opioid antagonist
- Clonidine- centrally acting alpha 2 agonist that decreases central noradrenergic output used to treat the autonomic sx but doesn’t curb the craving; risk of hypotension limits use in outpatient setting
- Promethazine (for nausea), quinine (for muscle aches) and dicyclomine (for abd. cramping)
- Long term rehab involves Narcotics anonymous and methadone administration 60-100mg QD in approved clinics
|
|
|
Term
| MOA of CNS stimulant abuse (cocaine, amphetamines) |
|
Definition
- psychoactive & sympathomimetic effects
- cocaine - adrenergic agonist that blocks re-uptake of NE at storage site (nerve terminal). Rapid onset of action & short half life, requiring frequent dosing
- amphetamine - gets into n. terminal & causes release of NE. longer half life so taken less frequently
|
|
|
Term
| Which substance abuse disorder has high rates of depression? |
|
Definition
- CNS stimulant abuse (cocaine, amphetamines)
- can use anti-depressants affecting catecholamine function like buproprion (atypical antidepressant), better than SSRI's for cocaine depression
|
|
|
Term
| Intoxication sx of CNS stimulant abuse (cocaine, amphetamines)? |
|
Definition
- Maladaptive behavioral changes (ex: euphoria or hypervigilance)
- tachy/bradycardia
- pupil dilation (constriction in opioid use)
- Hyper or hypotension
- Perspiration or chills
- n/v
- tactile hallucinations(coke bugs)
- psychomotor agitation/retardation
- confusion/seizures/dyskinesias,coma
- muscle weakness, resp depression, CP, cardiac dysrhythmias
- agitation, impaired judgment
- transient psychosis-paranoia, visual hallucinations
|
|
|
Term
| withdrawal sx of CNS stimulant abuse (cocaine, amphetamines) |
|
Definition
- fatigue, depression, nightmares, HA, sweating, muscle cramps, hunger
- sx peak in 2-4 days
|
|
|
Term
| Treatment of CNS stimulant abuse (amphetamines, cocaine) |
|
Definition
self limited, no inpatient detox required
antipsychotics can be used to treat agitation
main goal is rehab |
|
|
Term
|
Definition
doesn't require treatment
sx are self-limited |
|
|
Term
|
Definition
- Ecstacy (MDMA) → stimulant/ hallucinogenic properties and enhances desire for intimacy;long term use associated w decreased serotonin in the brain
- Methamphetamine → psychostimulant neurotoxic to dopamine and serotonin axons; highest use in young adults
- GHB → low doses used by bodybuilders and those seeking increased muscle mass as it promotes the release of GH, high doses used to get high and can cause rep arrest
- Ketamine →a dissociative anesthetic that is hallucingenic
- Rohypnol→ a benzo that has strong amnestic properties, and is frequent culprit in drugging others for purpose of theft or sexual assault. hypnotic, sedative, anticonvulsant, anxiolytic, and skeletal muscle relaxant drug
- LSD→ hallucinogenic
|
|
|
Term
| Tobacco abuse/dependence CNS and peripheral signs? |
|
Definition
- CNS: Induces feelings of pleasure, improved performance and vigilance, relaxation, perceived improvement of mood and curbing hunger
- Peripheral: Increase BP/rate, decreased coronary blood flow (induces vasoconstriction), increased bowel motor activity
|
|
|
Term
| MOA of tobacco abuse/dependence |
|
Definition
| nicotinic receptor agonist |
|
|
Term
| adverse effects of tobacco abuse/dependence |
|
Definition
| anxiety, agitation, insomnia, HA |
|
|
Term
| Complications of tobacco abuse/dependance |
|
Definition
toxic to heart, lungs
is carcinogenic |
|
|
Term
| Cessation of tobacco abuse/dependence |
|
Definition
- nicotine patch
- buproprion (dopa/NE reuptake inhibitor)
- varenicline (Chantix-N receptor parital agonist, most effective) - less euphoria than nicotine . + dopamine reward
|
|
|
Term
| represent a group of disorders characterized by physical symptoms suggesting a medical disorder. |
|
Definition
|
|
Term
| represent a psychiatric condition because physical symptoms in the disorder cannot be fully explained by a medical disorder, substance use, or another mental disorder |
|
Definition
somatoform disorders
(not willfully produced by the individual) |
|
|
Term
| 3 criteria needed for somatoform diagnosis |
|
Definition
- a medical condition, other psychiatric illness, or the effects of a stubstance (ie alcohol or a medication) will not explain the entirety patient's symptoms
- the patiend does not meet the criteria for malingering or factitious disorder
- at least one primary area of the patients life (ie work or social functioning) is significantly disrupted by thes ymptoms or the symptoms cause a lot of distress
|
|
|
Term
| individual has multiple medical complaints that are not the result of medical illness |
|
Definition
|
|
Term
|
Definition
- Long hx of going to doctor (even multiple physicians) for unexplainable symptoms. No medical disorder ever found
- Pattern of symptoms prior to 30 years old
- More common in females.
- May seek disability b/c of their conviction that they are severely and chronically medically ill
- Vague physical complaints involving many organ systems
- 50% have a comorbid mental disorder
|
|
|
Term
| Somatization disorder patients commonly complain of symptoms related to: |
|
Definition
GI tract
reproductive tract
neurologic symptoms
pain |
|
|
Term
| Somatization disorder criteria |
|
Definition
- Must have reported at least 4 occurrences of pain in different areas of the body
o 2 symptoms involving digestion/GI (other than pain)
o 1 symptom involving sexual function (other than pain)
o 1 symptom imitating disease of CNS [pseudoneurologic] (other than pain)
|
|
|
Term
| treatment for somatization disorder |
|
Definition
- CBT is the best tx
- anti-depressants may help if they have co-morbid depression
|
|
|
Term
| Undifferentiated somatoform disorder: |
|
Definition
| a less severe form of somatization disorder, involves fewer complaints and briefer course. |
|
|
Term
| Preoccupation with the belief of having or the fear of contracting a serious illness. This belief is not of delusional intensity, normal bodily sensations/functions are misinterpreted as manifestations of |
|
Definition
hypochondriasis
duration of disturbance @ least 6 months |
|
|
Term
| episodic and exacerbated by major stressor |
|
Definition
|
|
Term
| Taken from the medical term meaning "below the ribs".....Appropriate because patients w/this disorder frequently center on abdominal symptoms such as pain or digestive problems. |
|
Definition
|
|
Term
| Does not involve imaginary or exaggerated new symptoms, but rather person’s interpretation of sxs being indications of serious disease or injury. |
|
Definition
|
|
Term
| Hypochondriasis can cause... |
|
Definition
anxiety, panic attacks, depression, & chronic fatigue
poor insight |
|
|
Term
| Treatment for hypochondriasis |
|
Definition
CBT is the most useful of the psychotherapies
can use SSRI's if comorbid anxiety and/or depression |
|
|
Term
| Preoccupation with an imagined defect in physical appearance or an exaggerated distortion of a minor flaw. The MC concerns are facial flaws. |
|
Definition
|
|
Term
|
Definition
- If a slight physical anomaly is present, the person’s concern is markedly excessive.
- Patient feels self-conscious and fears humiliation
- Patients can go to great lengths to hide or correct their perceived anomaly
- Visits to dermatologist or plastic surgeon are common
|
|
|
Term
| treatment of body dysmorphic disorder |
|
Definition
- serotonin-modulating drugs (fluoxetine, clomipramine) are efficacious in majority of cases
- SSRI
|
|
|
Term
| A disorder where an individual willfully produces s/s of a medical illness to assume the sick role and receive its gratifications (such as sympathy/care/ affection from others) |
|
Definition
|
|
Term
| Epidemiology: Usually begins in early adulthood and carries a poor prognosis. Higher rate in pts with hx of child abuse or neglect. |
|
Definition
|
|
Term
| clinical manifestations of factitious disoder |
|
Definition
- Often patient will seek hospital admission under different names and by feigning different illnesses.
- When (or if) confronted with their ruse, they usually become angry and sign out.
- Patients usually familiar with the disease process and they are feigning, however, true disease processes must be ruled out
|
|
|
Term
Motivation is to assume the sick role, many times seeking hospital admission under different names
They can be demanding, and medically sophisticated (patient usually familiar with disease process they are feigning) |
|
Definition
|
|
Term
| Is a factitious disorder. This person has a deep need for attention and pretends to be sick or intentionally gets injured. May make up symptoms or rig laboratory results. |
|
Definition
|
|
Term
| Risk factors for munchausen syndrome |
|
Definition
had a serious illness in childhood (they get used to the attention and are comfortable in this role), they have a sick relative
|
|
|
Term
| Munchausen by proxy (factitious disorder) |
|
Definition
- Parent abusing the child by seeking unneeded medical attention for the child.
- Parent may fake symptoms of illness in child by:
· adding blood to the child's urine/stool
· withholding food
· falsifying fevers
· secretly giving child drugs to make the child throw up or have
diarrhea
· adding toxic materials that will create difficult diagnosis
- The parent is usually female and appears very helpful at the hospital. Appears very devoted and caring.
|
|
|
Term
| treatment of factitious disorder |
|
Definition
- collaberate w/ medical staff to avoid unnecessary procedures
- once dx is confirmed, approach pt in non-threatening manner
- psychotherapy (individual, family) suggested
- SSRI useful in reducing impulsive tendencies seen in acting-out factitious disorder
|
|
|
Term
involves the deliberate production of physical or psychological symptoms, motivated by external gain. Some of these obvious definable goals are avoiding responsibility, police or legal action, punishment or dangerous or difficult situations; receiving monetary compensation (ie in a lawsuit) or free hospital room and board; obtaining drugs.
Basically, lying about signs or symptoms to obtain gains different from those obtained by assuming the sick role (avoiding military, monetary gain) |
|
Definition
|
|
Term
| Clinical manifestations of malingering |
|
Definition
- patients tend to express vague, poorly defined complaints and claim that these symptoms cause great distress and impaired functioning
- Injuries often found to be self inflicted
- History reveals multiple undiagnosed illnesses or previous injuries and even tampering with laboratory results
- Patients uncooperative and refuse to accept clean bill of health
- Symptoms typically improve when the objective has been met or the ruse has been exposed
|
|
|
Term
|
Definition
| collaborate w/ medical staff to avoid unnecessary procedures |
|
|
Term
| Attention deficit hyperactivity disorder |
|
Definition
- ADHD usually persists through a person's lifetime. Not limited to children
- ADHD seems to run in families
- hypothesized d/t deficient dopamine availability
|
|
|
Term
|
Definition
- Syndrome characterized by persistent inattention, hyperactivity and impulsivity compared with what is expected for a child at a particular developmental level.
- The 3 subtypes are hyperactive impulsive, inattentive, and combined (most children demonstrate combined type).
- To meet criteria 6 of the listed symptoms must persist for 6 months -- pg 33
|
|
|
Term
| general characteristics of ADD/ADHD |
|
Definition
- Can Manifest as Hyperactivity and Impulsivity or as Inattentiveness
- Most children manifest sxs of both attention deficit and hyperactivity
- Secondary sxs: emotional immaturity, poor social skills, sometimes motor incoordination, disruptive behaviors
- Between 2-20% of children of school age may be affected.
- 2-5X more common in boys than girls with the firstborn son most commonly affected
|
|
|
Term
| Characteristics by age for ADHD : pre-school aged |
|
Definition
- staying up late
- waking up early
- spending most of the waking hours in various hyperactive and impulse activities
|
|
|
Term
| characteristics by age of ADHD : school aged |
|
Definition
- appear not to follow directions
- forget important school supplies
- fail to complete homework or in class assignments
- attempts to blurt out answers to teachers' questions before called on
|
|
|
Term
| ADHD : inattention/hyperactivity/impulsivity |
|
Definition
- Inattention-fails to pay close attention to details, easily distracted, difficulty persisting to task completion
- Hyperactivity and impulsivity-fidgety, squirmy, talking excessively, interrupting
|
|
|
Term
| inclusion criteria of ADD/ADHD |
|
Definition
- Meets symptom criteria
- Some inattention or hyperactivity-impulse symptoms causing impairment are present before age 7 years
- Some impairment from symptoms present in two or more settings (e.g., home, school or work, social)
- Clear evidence of clinically significant impairment in social, academic, or occupational functioning
|
|
|
Term
| The feature that distingue ADHD from other causes of inattention is... |
|
Definition
| a lifelong pattern of the behavior-symptoms complex |
|
|
Term
|
Definition
| involves gathering a careful history from parents and teachers (report cards and written reports) |
|
|
Term
|
Definition
BPD
oppositional defiant d/o (unwillingness to comply w/ demands, but not out of difficulty of attention) |
|
|
Term
| Likely associated neurobehavioral disorders with ADHD |
|
Definition
anxiety
depression
substance use disorders
conduct disorder
ODD
learning disabilities |
|
|
Term
|
Definition
- behavioral management program
- positive reinforcement
- firm limit setting
- techniques for reducing stimulation (like 1 playmate at a time, short/focused tasks)
- educational assessment (school underperformance) d/t learning disability
- oppositional defiant disorder (MC)
- conduct disorder
- mood disorder
- anxiety
- neuro issues: epilepsy or tourette syndrome
- Medications with combination of behavioral modifications is the best TX
- Psychostimulants: these are controlled substances that increase dopamine and norepinephrine
- First line: methylphenidate (concerta, Ritalin, Quillivant XR)
- dextroamphetamine
- lisdexamfetamine (vyvanse)
- Adderall (amphetamine and dextroamphetamine)
- Side effects of sleep difficulty, stomach aches, headaches, appetite reduction, growth retardation, weight loss, drowsiness, irritability, nervousness, excessive starring
- atomoxetine (Strattera) is a non-stimulant SNRI. Not methamphetamine based so non habit forming
- clonidine (α2 agonist)
- guanfacine (Intuniv-α2 agonist)
- Wellbutrin-first resort if non-stimulant is desired and patient has a co-occurring mood disorder
|
|
|
Term
**Children are not diagnosed with personality disorders, therefore conduct disorders are more applicable
These kids are often viewed by other peers, adults and social agencies as "bad" or delinquent, rather than medically ill. |
|
Definition
|
|
Term
| Essentials of conduct disorder |
|
Definition
- A persistent pattern of behavior that includes the following
- defiance of authority
- violating the rights of others or society's norms
- aggressive behavior towards persons, snimals, or property
|
|
|
Term
| repetitive and persistent pattern of behavior in which the basic rights of others or important age-appropriate societal norms or rules are violated. |
|
Definition
|
|
Term
| Conduct disorder : General |
|
Definition
- Overlap with ADHD, substance abuse, learning disabilities, neuropsychiatric disorders, mood disorders and family dysfunction
- May come from homes with domestic violence, child abuse, drug abuse, shifting parental figures, and poverty
- Of the children with conduct disorder, 25-40% go on to have antisocial personality disorder.
|
|
|
Term
| Clinical findings of conduct disorder |
|
Definition
- Diagnosis is established on the basis of a pattern of behavior that involves violation of the basic rights of others or of social norms and at least 3 acts of the following types
- Aggression to people and animals
- Bullies/threatens
- Intimidates others often initiates physical fights
- Has used a weapon that could cause serious physical harm to others (bat, brick, knife or gun)
- Physically cruel to people or animals
- Steals from a victim while confronting them (e.g. assault)
- Forces someone into sexual activity
- fire setting
- Deliberately destroys other's property
- Deceitfulness, lying, or stealing
- has broken into someone else's building, house, or car
- lies to obtain goods, or favors or to avoid obligations
- steals items without confronting a victim (e.g. shoplifting, but without breaking and entering)
- Serious violations of rules
- often stays out at night despite parental objections
- runs away from home
- often truant from school
|
|
|
Term
| boy with a turbulent home life and academic difficulties. |
|
Definition
| typical child with conduct disorder |
|
|
Term
| Hyperactive, aggressive and uncooperative behavior patterns in the preschool and early school years tend to predict conduct disorder in adolescence with a high degree of accuracy, especially when ADHD goes untreated. |
|
Definition
|
|
Term
| Treatment for conduct disorder |
|
Definition
- Efforts to stabilize the environment and improve functioning in the home [Family therapy] (particularly parental functioning and disciplinary techniques)
- ID learning disabilities and place in optimal school environment
- Juvenile justice system involvement is common in cases where conduct disorder behaviors lead to illegal activities, theft or assault
Medication Treatment of Conduct Disorders:
- Risperdol (most common)
- Haloperidol
- Lithium
- Olazapine
- ^^^All used to treat aggressivity and mood
- SSRI-Prozac, Paxil, Zoloft (reduces impulsivity and mood lability/ irritability.)
- Stimulants (dextroamphetamine, methylphenidate), bupropion, clonidine, Lithium, and valproic acid can be used to treat aggressive/assaultive behavior
3 empirically supported treatments
- 1. Parent management training
- 2. Problem solving skills training
- 3. Multi-systemic therapy: used increasingly as an intervention for youth with conduct disorders and involvement in the legal system. It is an intensive home based model of care that seeks to stabilize and improve the home environment and to strengthen the support system and coping skills of the individual and family
- Parent-child interaction therapy
|
|
|
Term
| Oppositional defiant disorder information |
|
Definition
- Generally begins before age 8 and affects 16-22% of children
- Will remit in 25%, but may progress to conduct disorder
- High comorbidity with substance abuse disorders, mood disorders and ADHD
|
|
|
Term
| Oppositional defiant disorder clinical manifestations |
|
Definition
Age-inappropriate, stubborn, hostile, and defiant behavior, including:
- losing temper
- arguing with adults
- active defiance or refusal to comply
- deliberately annoying others
- blaming others for mistakes or misbehavior
- being “touchy” or easily annoyed
- anger and resentfulness
- spitefulness or vindictiveness
- 4 of the above must be present
- the dx includes at least 6 months of negativism, hostile, and defiant behavior
|
|
|
Term
| treatment of oppositional defiant disorder |
|
Definition
- family intervention using training skills in child management for the parents/caregivers
- individual psychotherapy focusing on behavioral modification and problem solving skills
- treat comorbid psychiatric disorder with meds as needed
- PG 37!!
|
|
|
Term
| How many parathyroid glans are typical in a person and where are they found? |
|
Definition
| 4 +/- 1 and they are found posterior to the thyroid gland |
|
|
Term
| What is the function of the parathyroid glands? |
|
Definition
| to maintain extracellular Calcium concentrations by secretion of PTH-- secretion of PTH is directly related to the plasma concentration of ionized calcium |
|
|
Term
| Does PTH increase or decrease serum calcium levels? |
|
Definition
|
|
Term
| What are the three ways in which PTH increases serum calcium? |
|
Definition
1. increasing the release of Ca and Phosphate from the bone matrix
2. increasing Ca reabsorption by the kidneys
3. Increasing renal production of 1,25-dihydroxyvitamin D3 (calcitriol) which increases intestinal absorption of Ca |
|
|
Term
| in hyperparathyroidism, we see increased or decreased levels of Ca and Phosphorous? |
|
Definition
increased Ca
decreased Phosphorous due to a PTH induced phosphaturia |
|
|
Term
| What is the MC cause of a primary hyperparathyroidism? |
|
Definition
| ademona 80%> hyperplasia> carcinoma |
|
|
Term
| What familial disorder is known to be a cause of hyperparathyroidism? |
|
Definition
|
|
Term
| What is the common saying that correlates with the s/sx of hyperparathyroidism? Name the s/sx |
|
Definition
-bones, stones, abdominal groans, psychic moans, and fatigue overtones
-bone pain and arthralgias, renal stones, N/V and abd pain and constipation, depression and disorientation, fatigue and depressed DTRs |
|
|
Term
| a serum calcium level of what is considered suspicious for hyperPTH |
|
Definition
|
|
Term
| What may be seen on an xray of the hands in a pt with hyperPTH |
|
Definition
| osteitis fibrosa cystica aka "brown tumors" |
|
|
Term
| What is the chloride/phosphorous ratio rule of hyperPTH |
|
Definition
| > 33 to 1. This is because there is an increase in chloride secondary to renal bicarb wasting (which is a direct effect of PTH), and because P is low due to a phosphaturia (direct effect of PTH) |
|
|
Term
| What are some findings on EKG of a pt with hyperPTH? in terms of PR, QT, and rate? |
|
Definition
prolonged PR
short QT
bradycardia-->heart block---> asystole |
|
|
Term
| Why should thiazide diuretics be avoided in a pt with hyperparathyroidism? |
|
Definition
| bc they work on the distal renal tubule where Ca is reabsorbed, which causes a decrease in Ca in the blood which will exacerbate the problem |
|
|
Term
| What are two causes of secondary hyperparathyroidism? |
|
Definition
chronic kidney disease
Vit D deficiency |
|
|
Term
| What is another cause of bone destruction besides hyperPTH that would cause increased Ca? How can you differentiate? |
|
Definition
metastatic disease to the bone
measure levels of PTH! |
|
|
Term
| What is the most common tx for symptomatic hyperPTH |
|
Definition
| surgical excision of the parathyroid glands |
|
|
Term
| What is the most common cause of primary hypoPTH |
|
Definition
|
|
Term
| What is pseudohypoparathyroidism? what are the lab values associated with it? |
|
Definition
can be due to a number of diseases characterized by hypocalcemia caused by renal resistance to PTH
-labs: high PTH, low Ca, High P, low urine cAMP |
|
|
Term
| what is DiGeorge's syndrome? |
|
Definition
| congenital hypoPTH with congential facial and cardiac anomalies |
|
|
Term
| Name some of the s/sx of hypoPTH |
|
Definition
| -muscle cramps and spasms, convulsions, parasthesias, cataracts, hair loss, brittle nails, fatigue, anxiety, hoarseness (laryngospasm), wheezing (bronchospasm), HYPERactive DTRs |
|
|
Term
| What are the two signs on PE that are characteristic of hypocalcemia and therefore hypoPTH |
|
Definition
-Chivostek's sign: tapping the facial nerve anterior to the ear produces ipsilateral facial twitching
-Trousseau's Phenomenon: inflation of a BP cuff to 20 mmHg above the obliteration of a radial pulse and holding for 3-5 minutes will cause a carpal spasm |
|
|
Term
| HyperPTH and HypoPTH, describe the DTRs in each |
|
Definition
HyperPTH: hypoactive DTRs
hypoPTH: hyperactive DTRs |
|
|
Term
| what are the lab results for a patient with hypoPTH |
|
Definition
-low serum ionized Ca
-low PTH
-low Mg
-high P
-low urine cAMP |
|
|
Term
| what are the EKG results for a pt with hypocalcemia and therefore the same would be seen for a pt with hypoPTH |
|
Definition
| long QT and T wave abnormalities |
|
|
Term
| What is the treatment for hypoPTH? |
|
Definition
| Calcium (1-2 g/day) and Vitamin D (0.25-1 mcg/d) |
|
|
Term
| in an emergency situation with a pt with hypoPTH, what are the first lines of action |
|
Definition
protect airway
SLOW administration of IV ca gluconate |
|
|
Term
| When a patient presents with new onsetAfib, what endocrine labs must always be ordered? |
|
Definition
|
|
Term
| Describe the chain of thyroid hormone stimulation |
|
Definition
-Hypothalamus produces TRH
-Anterior Pituitary produces TSH
-Thyroid gland produces mostly T4 and a little T3, T3 is the active metabolite and it is converted from T4 mostly in the liver (removal of an iodine atom) |
|
|
Term
| The amount of TSH that the pituitary releases is depended on the level of _______ |
|
Definition
| T4 circulating in the blood |
|
|
Term
| What are the two forms that T4 circulates in the blood? What tests need to be ordered to get an accurate measure of T4? |
|
Definition
bound to protein (so these guys won't enter cells and act as thyroid hormone)
AND free, measurement of the free T4 or the Free T4 Index is the best measurement for T4 |
|
|
Term
| individuals with hyperthyroidism will have _________ Free T4 |
|
Definition
|
|
Term
| an elevated TSH and a low FT4 indicates what? |
|
Definition
| primary hypothyroidism due to disease in the thyroid gland |
|
|
Term
| a low TSH and a low FT4 indicates what? |
|
Definition
| secondary hypothyroidism due to a problem in the pituitary |
|
|
Term
| a low TSH with an elevated FT4 is seen in a pt with what? |
|
Definition
|
|
Term
| What is the last test in the thyroid panel to become abnormal? |
|
Definition
T3, so it is not super helpful.
Can be used to determine severity of hyperthyroid
but rarely helpful in a pt with hypothyroid |
|
|
Term
| In many patients with hypo- or hyperthyroidism, lymphocytes make ___________ against their thyroid that either __________ or __________ the gland |
|
Definition
antibodies
stimulate
damage |
|
|
Term
| What are the two common antibodies that cause thyroid problems and are directed against thyroid cell proteins? |
|
Definition
thyroid peroxidase
thyroglobulin |
|
|
Term
| If a pt with hypothyroidism has positive anti-thyroid peroxidase and/or anti-thyroglobulin antibodies this makes a diagnosis of _____________/_____________ |
|
Definition
|
|
Term
| if a pt with hyperthyroidism has positive anti-thyroid peroxidase and/or anti-thyroglobulin antibodies this makes a diagnosis of _____________/_____________/___________ |
|
Definition
| autoimmune thyroid disease |
|
|
Term
| How does a radioactive iodine uptake test work? |
|
Definition
| Since T4 contains much iodine, the thyroid has to pull a lot of iodine out of the blood in order for it to make the right amount of T4. If a pt swallows a small amount of radioactive iodine it can be determined if the thyroid is functioning well. High RAIU is seen in pts with hyper- and low is seen in those with hypo- |
|
|
Term
| What are the three top causes of hyperthyroidism? |
|
Definition
1. graves disease
2. diffuse multinodular goiter (Plummer's disease)
3. Adenomas |
|
|
Term
| What are some s/sx of hyperthyroidism? |
|
Definition
-anxiety/nervousness
-heat intolerance/sweating
-weight loss with increased appetite
-loose stools, frequent urination
-fatigue
-heart palpitations/tachycardia
-resting tremor |
|
|
Term
| What are the signs and sx of a thyroid storm and the tx? |
|
Definition
-fever, tachy, v/d, dehydration, marked weakness, delerium, confusion
-BBs, hydrocortisone (impairs peripheral generation of T3 from T4 and provides adrenal support) , thiourea drug (inhibit thyroid hormone release), and iodine (inhibit thyroid hormone release) |
|
|
Term
| What is the best lab to detect hyperthyroid? What else should be ordered? |
|
Definition
|
|
Term
| In a pt with graves disease, an MRI of what should be ordered? |
|
Definition
| the orbits, due to high likelyhood of exopthalmos |
|
|
Term
| How would Graves disease look on a RAIU scan? What would a palpable thyroid gland feel like? |
|
Definition
| -it would show diffuse uptake because every thyroid cell is hyperfunctioning. The thyroid is diffusely enlarged and non-tender |
|
|
Term
| What would a RAUI scan look like on a pt with Plummers (diffuse multinodular toxic goiter)? |
|
Definition
-Hyperfunctioning areas that produce high T4 and T3 levels which results in decreased TSH levels---> this also results in the rest of the thyroid not function (atrophy due to decr TSH)
-patchy uptake on thyroid scan
-gland is bumpy and nodular |
|
|
Term
| What is the pathophysiology of Thyroid Disease? |
|
Definition
| circulating autoantibodies against thyrotropin receptor provides continuous stimulation of the thyroid gland. These antibodies cause release of thyroid hormones and thryoglobulin, and they also stimulate iodine uptake, protein synthesis, and thyroid gland growth |
|
|
Term
| What are the mainstays of tx for hyperthyroidism? |
|
Definition
-Thionamides for children and women who are pregnant (Methimazole and PTU (Propylthiouracil- safe in pregnancy)
-Beta blockers for sx
-Radioactive iodine is the tx of choice in nonpregnant women and adult men
-Surgery for pt's that have contraindication to radioactive iodine or pregnant women who did not take/ could not tolerate PTU |
|
|
Term
| What is the most common cause of hypothyroidism in the US? Worldwide? |
|
Definition
Hashimotos thyroiditis (autoimmune)
Iodine deficiency |
|
|
Term
| What are some signs and symptoms of a pt with hypothyroid? |
|
Definition
-fatigue, lethargy
-anorexia, weight gain
-constipation
-cold intolerance
-menstrual abnormalities
-dry skin and coarse hair
-bradycardia and systolic hypotension and diastolic hypertension
-hyporeflexia |
|
|
Term
| For a patient coming in with sx of hypothyroid, what are the labs and rads that should be ordered? |
|
Definition
-TSH, free T4, T3
-anti-thyroid peroxidase and anti-thyroglobulin ab's
-monospot (fatigue)
-pregnancy
-blood glucose
-CBC (anemia), B12
-CMP (swelling? what the PRO status)
-EKG (fatigued female) |
|
|
Term
| What is the tx for hypothyroidism? |
|
Definition
Levothyroxine (Synthroid) 50-200 mcg/ day
-results are not seen for up to 6 weeks
-start low and go slow |
|
|
Term
| What is myxedema coma? what are the emergent tx? |
|
Definition
a rare condition that can develop after years of untreated hypothyroidism
-pt presents with decr LOC, hypothermia, and respiratory depression
-tx: maintain BP and airway, give IV synthroid and hydrocortisone |
|
|
Term
| What cardiac combination in hypothyroid causes dizziness? |
|
Definition
| bradycardia with systolic hypotension |
|
|
Term
| Describe the edema seen in myxedema? |
|
Definition
|
|
Term
| Describe cholesterol levels in a pt with hypothyroid? |
|
Definition
|
|
Term
| What is a great clinical test to measure DTR relaxation time in a pt with hypothyroid. describe the elicited response |
|
Definition
-check at the brachioradialis tendon
-the contraction will be normal and the relaxation will be slow! |
|
|
Term
| If you can only order one test to diagnosis hypothyroidism, what should you pick? |
|
Definition
|
|
Term
| What is the most common and also least aggressive type of thyroid cancer? |
|
Definition
|
|
Term
| WIll you see iodine uptake with a papillary carcinoma? |
|
Definition
|
|
Term
| What is the second most common type of thyroid cancer which has a worse prognosis and is more malignant than papillary cell? |
|
Definition
| follicular cell carcinoma |
|
|
Term
| What is a variant tumor of follicular that does not uptake iodine? Most follicular carcinomas do avidly absorb iodone |
|
Definition
|
|
Term
| What type of thyroid cancer is associated with Men II? What hormone does it produce? How malignant is it? |
|
Definition
-Medullary carcinoma
-Associated with MEN II so check for pheochromocytoma
-Produces calcitonin
-more malignant than follicular and papillary but less than..... |
|
|
Term
| What is the most malignant type of thyroid cancer? |
|
Definition
| Anaplastic, seen in the elderly and death is likely within a few months |
|
|
Term
| What type of test is a must in a pt with possible thyroid cancer? |
|
Definition
|
|
Term
| List the types of thyroid carcinoma in order from most to least malignant? |
|
Definition
| anaplastic, medullary, follicular, papillary |
|
|
Term
| What is a pearl to remember when prescribing levothyroxine? |
|
Definition
| formulations vary tremendously between manufacturers and generics, so always prescribe the same type the patient has always taken |
|
|
Term
| Name everything you know about Hashimoto's thyroiditis? hormone levels? abs? tx? goiter? |
|
Definition
-most common autoimmune cause of do
-goiter is common
-thyroid studies are either NL or hypo-
-antiperoxidase abs (90%), antithyroglobulin abs (50%)
-Tx: levothyroxine to acheive Eu state |
|
|
Term
| Name all you can about subacute (viral) thyroiditis. Prodrome? Hormone levels? Goiter? Tx? |
|
Definition
-follows viral illness, prodromal: fever and flu like sx
-can cause transient hyper-t, then eu, then hypo-
-painful, tender gland that may be englarged
-Tx; NSAIDs and ASA, steroid if pain is severe |
|
|
Term
| What is fibrous (Riedel's) thyroiditis? |
|
Definition
fibrous tissue replaces the thyroid tissue and the gland becomes firm
-pts may be hypo-T |
|
|
Term
| When does postpartum thyroiditis show up and how long does it last? |
|
Definition
1-6 m post
lasts 2-3 m
give BBs if they have sx |
|
|
Term
| What is suppurative thyroiditis? |
|
Definition
an infection of the thyroid. rare. fluctuant neck mass
tx is ABX and drainage |
|
|
Term
| What are two other names for subacute (viral) granulomatous thyroiditis? |
|
Definition
|
|
Term
|
Definition
| adrenocortical insufficiency due to the destruction or dysfunction of the entire adrenal cortex-- affecting glucocorticoid and mineralocorticoid function |
|
|
Term
| What are the 3 S's used to remember the function of the adrenal glands? |
|
Definition
|
|
Term
| At what percentage of destruction/dysfunction of both adrenal glands are s/sx of addison disease seen |
|
Definition
|
|
Term
| What are some s/sx of a pt with chronic addison dz? |
|
Definition
-hyperpigmentation which may have been present for months to years
-salt craving
-weakness, fatigue, poor appetite, weight loss
-N/V/D
-myalgias and flaccid muscles due to hyperkalemia |
|
|
Term
| what are some s/sx of an addisonian crisis? |
|
Definition
-prominent N/V and pain that may present like an acute abd
-vascular collapse- looks in shock, cyanotic, confused |
|
|
Term
| WHat is a PE finding in females with addison dz? |
|
Definition
| decreased axillary and pubic hair, even total overall body hair, due to loss of adrenal androgens (which are the major source of androgens in the female body) |
|
|
Term
| What is the MCC of chronic primary Addison Disease? |
|
Definition
-idiopathic autoimmune adrenocortical insufficiency resulting from autoimmune atrophy, fibrosis, and lymphocytic infiltration of the adrenal cortex (rarely medulla) causes 80%
-TB is also a cause in areas of the world where it is prevalent |
|
|
Term
| What is the MC cause of secondary adrenal insufficiency? stressed topic by kim lay... |
|
Definition
| cessation of corticosteroid medication |
|
|
Term
| What is the work up for Addison disease? what would a CMP, CBC, CXR, and CT scan show? |
|
Definition
-GOLD STANDARD: rapid ACTH test
-AM plasma cortisol testing
-CMP: low Na, high K, low glucose, high BUN and high Cr
-CBC: normocytic, normochromic anemia
-CXR: small heart in some
-CT: enlarged or atrophic adrenals depending on cause |
|
|
Term
| What is the long term tx for a pt with Addison disease? |
|
Definition
PO gluco- and mineralocorticoids
-Hydrocortisone
-Fludrocortisone (not all pts will need mineral- supplementation each day) |
|
|
Term
| What are the main steps in an emergency situation with a pt with Addison disease? |
|
Definition
-IV NaCl to replace fluid and increase BP
-IV hydrocortisone
-IV glucose |
|
|
Term
| What is the cause cushing syndrome? |
|
Definition
| it is hypercortisolism and it is caused by prolonged exposure to elevated levels of either endogenous glucocorticoids or exogenous glucocorticoids |
|
|
Term
| What are the characteristic physical findings of a pt with Cushing Syndrome? |
|
Definition
| moon facies, buffalo hump, purple striae, supraclavicular fat pads, truncal obesity, thin skin |
|
|
Term
| What are some common complaints of a pt with cushing syndrome |
|
Definition
| proximal muscle weakness, easy bruising, weight gain, hirsutism |
|
|
Term
| What is the MCC of cushing syndrome |
|
Definition
| use of exogenous steroids |
|
|
Term
| What is classic cushing disease? |
|
Definition
| ACTH secreting neoplasms usually due to an anterior pituitary tumor that causes ACTH dependent disease |
|
|
Term
| A pt who has classic cushing disease (due to ant pituitary tumor) might have what extra s/sx not seem in other pts? |
|
Definition
| HA's, nocturia, polyuria, galactorrhea, and visual disturbances |
|
|
Term
| What will be seen on a CMP of a pt with Cushing Disease? |
|
Definition
incr WBC
hyperglycemia
hypokalemia |
|
|
Term
| What are two methods for dx cushing's |
|
Definition
urinary free cortisol level
low-dose dexamethasone suppresion test |
|
|
Term
| what is the tx for cushing's |
|
Definition
based on the primary cause and goal is to reduce cortisol secretion to NL to reduce risk of comorbidities associated with hypercortisolism
-Tumor? surg
-Cant do surg? meds, but they often fail
-Endogenous steroids? Gradually withdrawal them |
|
|
Term
| If a patient has increased cortisol production and abnormal suppression after the dexamethasone suppression test, what would it mean if they also had decr plasma ACTH ? |
|
Definition
| probably an adrenal adenoma or carcinoma |
|
|
Term
| If a patient has increased cortisol production and abnormal suppression after the dexamethasone suppression test, what would it mean if they also had normal or incr ACTH? |
|
Definition
| pituitary or ectopic source |
|
|
Term
| At what size on CT or MRI does an adrenal mass need further investigation? |
|
Definition
|
|
Term
| The majority of benign adrenal nodules are endocrine (active/inactive) adrenocortical (adenoma/carcinoma). what percentage of all masses are these? |
|
Definition
|
|
Term
| What is a pheochromocytoma? what does it produce and what is the main side effect? |
|
Definition
| a catecholamine producing tumor that may precipitate life threatening HTN |
|
|
Term
| What are the three syndromes that are classically associated with a pheochromocytoma? |
|
Definition
-von Hippel-Lindau (VHL) syndrome
-MEN 2
-NF 1 |
|
|
Term
| What are some s/sx of a pheochromocytoma? |
|
Definition
HA, palpitations, diaphoresis, severe HTN
*the spells follow patterns |
|
|
Term
| What is measured in the urine of a pt with suspected pheochromocytoma? |
|
Definition
| catecholamines and metanephrines |
|
|
Term
| What is the tx for a pheochromocytoma? |
|
Definition
|
|
Term
| What are the six H's of pheochromocytoma? |
|
Definition
HTN
HA
Hyperhidrosis
Heart Consciousness (palpitations)
Hypermetabolism
Hyperglycema |
|
|
Term
| What is the rule of 10 for pheochromocytoma? |
|
Definition
| 10% for the following: familial, malignant, multiple/bilateral, extra adrenal, childhood onset, recurrence after surgery |
|
|
Term
| What is released in each part of the Hypothalamic-Pituitary-ADrenal axis?> |
|
Definition
Hypothalamus: CRH (corticotrophic releasing hormone)
Pituitary: ACTH (Adrenocorticotrophic Hormone)
Adrenals: Adrenaline, Noradrenaline, Progesterone--Cortisol, DHEA--testosterone and estrogen, ALdosterone |
|
|
Term
| What is the cause of >95% of the cases of acromegaly/gigantism ? |
|
Definition
| pituitary adenomas that secrete excess amounts of GH |
|
|
Term
| Growth hormone in the circulation stimulates the production of what? What is the main source of this? |
|
Definition
Insulin like growth factor
liver |
|
|
Term
| Name some of the s/sx of acromegaly, and the s/sx associated with a pituitary adenoma |
|
Definition
-facial bossing, arthralgia and large joints, glucose intolerance, cardiomyopathy and HTN, OSA
-HA and bitemporal hemianopsia due to pressure on the optic chasm |
|
|
Term
| What are some labs that may be elevated in addition to GH in a patient with acromegaly? |
|
Definition
| GLUCOSE! liver enzymes, calcium and phosphate |
|
|
Term
| What is diabetes insipidus? What are the two main causes? |
|
Definition
-metabolic DO characterized by defective ability to concentrate urine in the kidneys- resulting the production of large quantities of dilute urine.
-Central: Due to def. of arginine vasopressin (AVP) AKA ADH.
-Nephrogenic: due to renal insensitivity to or resistance to AVP with a reduction in the permeability of the collecting duct to water |
|
|
Term
| What are some strong RFs for the development of DI? |
|
Definition
| pituitary surgery, TBI, pituitary stalk lesions, medications, autoimmune diseases |
|
|
Term
| What part of the pituitary secretes ADH? |
|
Definition
|
|
Term
|
Definition
| extreme thirst and excretion of an excessive amount of dilute urine. Polyuria, polydipsia, nocturia |
|
|
Term
| What are some lab results for DI? |
|
Definition
-urine osmolality low and serum osmolality reg or elevated
-urine dipstick negative for glycosuria
-24 hr collection for vol, >3L per 24 hr
-serum glucose NORMAL |
|
|
Term
| What is the gold standard of tx for central DI? |
|
Definition
|
|
Term
| Dwarfism (achondroplasia) is caused by specific mutations in what gene? |
|
Definition
| fibroblast growth factor receptor 3 (FGFR3) gene |
|
|
Term
| Describe the limb shortening observed in dwarfism (achondroplasia) |
|
Definition
|
|
Term
| What is the most common visual symtpom associated with neoplastic pituitary disease? |
|
Definition
|
|
Term
| Any pt that presents with a pituitary neoplasm should be tested for what? |
|
Definition
| MEN1 (multiple endocrine neoplasia type 1) bc 25% of MEN1 pts get these tumors |
|
|
Term
| What is the most common hormone producing pituitary adenoma? |
|
Definition
|
|
Term
| What hormones are secreted by the ant. pituitary? |
|
Definition
| TSH, ACTH, FSH/LH, GH, Prolactin, Endorphins |
|
|
Term
| Describe the sx associated with the a pituitary adenoma that secretes: prolactin, GH, ACTH, or TSH? |
|
Definition
prolactin- amenorrhea and milk production
GH- acromegaly, gigantism
ACTH- cushing's disease
TSH- hyperthyroidism |
|
|
Term
| What is the MC tx for a pituitary adenoma? |
|
Definition
|
|
Term
| What hormones are secreted by the posterior pituitary? |
|
Definition
|
|
Term
| What is desirable total Cholesterol? LDL cholesterol? HDL cholesterol? |
|
Definition
-<200
-<100, or 70 if at high risk for heart disease (diabetics)
->60 |
|
|
Term
| What is a normal triglycerides level? |
|
Definition
|
|
Term
| What are three endocrine do's that can cause secondary hypercholesterolemia? |
|
Definition
| hypothyroidism, cushing's, hyperparathyroidism |
|
|
Term
| At what age does the USPSTF recommend screening men for lipid DOs? women? those at high risk? |
|
Definition
|
|
Term
| what are some CHD risk equivalents? |
|
Definition
-coronary artery disease
-hx of stroke TIA
-AAA
-DM
-carotid artery disease (>50% stenosis)
-framingham risk score >20% risk in ten years
-peripheral arterial disease |
|
|
Term
| What type of kidney stone is likely to form in acid urine? What medication can be used to prevent the formation? |
|
Definition
-calcium oxalate
-K citrate |
|
|
Term
| What type of kidney stone should HCTZ be used to treat and why? |
|
Definition
| Calcium stones should be tx by hydrochlorothiazide bc it blocks the sodium-chloride transport in the distal convoluted tubules of the nephrons, impairing the secondary passive calcium transport and decreasing urinary calcium. |
|
|
Term
| In utero, what maternal hormone causes the testes to descend |
|
Definition
|
|
Term
| At what age should a child with cryptorchidism be evaluated by a specialist, bc after this point spontaneous descent is unlikely |
|
Definition
|
|
Term
| What are 5 predisposing factors to cryptorchidism ? |
|
Definition
-prematurity
-low birth weight
-small size for gestational age
-twinning
-maternal exposure to estrogen during 1st trimester |
|
|
Term
| What s/sx in cryptorchidism signal a possibly life threatening condition and require urgent consult with a peds endocrinologist or geneticist |
|
Definition
| BL nonpalpable testes with hypospadias or ambiguous genitalia |
|
|
Term
| How is anorchia evaluated in BL nonpalpable gonads? |
|
Definition
Measure testosterone levels before and after stimulation with hCH along with basal LH and FSH
-anorchia suspected with elevated basal androgen levels and negative testosterone response to hCG |
|
|
Term
| What is the efficacy rate of hormonal tx in cryptorchidism? |
|
Definition
< 20%
Surgery yields more efficacious results |
|
|
Term
| What are the two types of hydroceles |
|
Definition
-communicating- due to latency of the processus vaginalis which allows peritoneal fluid to fellow into the scrotum--> particularly during valsalva
-non communicating- balance between fluid production within the tunica and fluid absorption is altered. Better in the AM and worsens as the day progresses |
|
|
Term
| What is the MCC of hydroceles worldwide |
|
Definition
Wuchereria bancrofti (filarial)
Almost non existent in the US |
|
|
Term
| What are the results of transillumination in a patient with a hydrocele |
|
Definition
| Scrotum will light up! 10% of testicular teratomas will as well, so order labs (AFP and hCG) If there is any suspicion |
|
|
Term
| What's the best rad for evaluation of a varicocele and a hydrocele |
|
Definition
|
|
Term
|
Definition
| Dilatation if the pampiniform venous plexus and internal soermatic vein |
|
|
Term
| What is the MCC of poor sperm production and decreased sperm quality |
|
Definition
|
|
Term
| If surgery is indicated in a patient with a varicocele how long after the procedure should sperm analysis be conducted |
|
Definition
| 3-4 months because spermatogenesis takes 72 days |
|
|
Term
| What is the difference between paraphimosis and phimosis ? |
|
Definition
Para: entrapment of the foreskin BEHIND the glans penis
Phimosis: inability to retract the foreskin over the glans |
|
|
Term
| At about what age does congenital phimosis recede |
|
Definition
| About three years of age. Trying to retract the foreskin before this can cause injury |
|
|
Term
| Paraphimosis is a urologic emergency, what can be done to tx |
|
Definition
-manual reduction
-ice packs, penile wraps, sugar in a condom (hypertonic gradient effect)
-lidocaine withOUT Eli
-1 mL hyaluronidase injected into prepuce (breaks down hyaluronic acid in CT and enhances fluid diffusion between tissue planes, decreasing swelling) |
|
|
Term
| Describe the difference between a neonate and an adolescent/adult with testicular torsion |
|
Definition
Neonate: extravaginal
Older: infra signal |
|
|
Term
| What happens with the cremaster reflex in testicular torsion |
|
Definition
| It is absent, most sensitive finding |
|
|
Term
| Is there relief in testicular torsion with elevation of the testicle? What is the name if this sign? |
|
Definition
|
|
Term
| What type of deformity, present in12% of males, predisposes to testicular torsion |
|
Definition
|
|
Term
| What is the tx for testicular torsion? |
|
Definition
SURGICAL EMERGENCY
Analgesics and antiemetics and anti anxiety meds can help with sx |
|
|
Term
| What is the time frame for detonation of a testicular torsion that shows 90-100% salvage rate |
|
Definition
| If its done within 6 hours of onset of pain |
|
|
Term
| What is the most common solid renal tumor of childhood |
|
Definition
| Wilms tumor AKA nephronlastoma |
|
|
Term
| Give some general sx that may be present when a pt presents with a wilms tumor |
|
Definition
| Anorexia, nausea, vomiting, fever, abdominal pain, hematuria |
|
|
Term
| Do patients with wilms rumors sometimes resent with HTN or hypotension? |
|
Definition
| HTN due to increased renin levels |
|
|
Term
| Describe the obstructive and irritative sx of BPH |
|
Definition
-obstructive: hesitancy, feeling of incomplete void, decr force of stream, straining, post void dribbling
-irritative: dysuria, nocturia, urgency, frequency |
|
|
Term
| What are the two classes of medication used to tx BPH. Give an ex and the MOA for each. |
|
Definition
-Alpha adrenergic antagnosits, Terazosin (Hytrin), make urination easier by relaxing smooth muscle tissue in prostate and outlet of bladder
-5 alpha reductase inhibitors, Finasteride (Propecia) shrink the prostate by hormone suppression |
|
|
Term
| What specific hormones are manipulated in the MOA of 5 alpha reductase inhibitors |
|
Definition
| BLOCKS The enzymatic conversion of testosterone to DHT |
|
|
Term
| what is the class of medications used to tx ED? Examples? MOA? Do no take these with what other med? |
|
Definition
-Phosphodiesterase type 5 Inhibitors
-Sildenafil (Viagra), Vardenafil (levitra), Tadalafil (Cialis)
-Relax smooth muscle in the penis to allow for more blood flow to get and maintain an erection
-Do not take if they are taking nitrates |
|
|
Term
| what amount of urine classifies as polyuria? |
|
Definition
|
|
Term
| Describe the causes of stress, urge, and overflow incontinence |
|
Definition
-Stress: dysfunction of the sphincter (loss of pelvic support) causes urine loss with increases in intra-abdominal pressure
-Urge: Overactive bladder sends signals of contraction to the brain that the brain cannot overcome
-Overflow: bladder distention leads to overflow of urine in the urethra |
|
|
Term
| what post void residual value would signal that a pt has overflow incontinence |
|
Definition
|
|
Term
| what is the DDX for transient, acute incontinence (think of the mnemonic) |
|
Definition
-DIAPPERS
-Delerium
-Infection
-Atrophic urethritis or vaginitis
-Pharmaceuticals
-Psych causes
-Excessive urine output
-Restricted mobility
-Stool impaction |
|
|
Term
| What are some drugs implicated in the tx of urge incontinence |
|
Definition
antimuscarinincs that help decr. the overactive spasms of the bladder
-Oxybutynin
-Tolterodine |
|
|
Term
| what is the gold standard for dx a kidney stone |
|
Definition
| helical CT of the abdomen without contrast |
|
|
Term
| What size of stone will be most likely to pass spontaneously, what size will most likely not and should undergo surgical intervention |
|
Definition
|
|
Term
| What is the most common type of kidney stone? |
|
Definition
|
|
Term
| what drug can be given to tx uric acid stone? |
|
Definition
|
|
Term
| What are the two signs on PE that would lead you to believe that testicular torsion was the dx |
|
Definition
-Cremaster reflex absent: Stroking the side of the testes does not illicit elevation of the testicle
-Negative phren's sign: no relief with elevation of the testes |
|
|
Term
| What type of anatomic deformity is associated with 90% of cases of testicular torsion? |
|
Definition
|
|
Term
| What is the tx for a testicular torsion? |
|
Definition
SURG emergency
experienced clinician can left the testes outward and laterally
consult Urology for emergency surg |
|
|
Term
| what type of organism may be associated with a rancid or ammonia smell in a pt with a UTI |
|
Definition
| a urea splitting organism such as proteus |
|
|
Term
| What does positive leukocyte esterase mean on a urine dipstick |
|
Definition
| it measures the enzyme, when its positive it means that there is neutrophils >4 wbc/hpf and this is a sign of infection |
|
|
Term
| When are nitrites positive? |
|
Definition
| in the presence of a gram negative organism (proteus or e coli) |
|
|
Term
| what is the avg ph of urine? what if the urine is alkaline in a pt with UTI sx, what does this mean? |
|
Definition
avg is 5-6
alkaline means that there is a urea splitting organism present (proteus) that is splitting urea into ammonia and CO2 which will cause an increase in pH |
|
|
Term
| what is the only drug on the market specific for the tx of interstitial cystitis |
|
Definition
|
|
Term
| what is the MC organism assoc with epididymitis in men <35, men >35? |
|
Definition
<35 chlamydia and gonorrhea
>35 e coli |
|
|
Term
| what are the signs and sx of epididymitis? |
|
Definition
| heaviness and dull aching discomfort in the affected hemiscrotum that can radiate up the ipsilateral flank. The epididymis is markedly swollen and tender to touch, may eventually become warm, erythematous, scrotal mass |
|
|
Term
| What occurrence in a pt's history may be elicited in a pt with epididymitis? |
|
Definition
| hx of heavy lifting, trauma, or sexual activity |
|
|
Term
| What is the PE sign that is often positive in a pt with epididmytis? |
|
Definition
| positive phren's sign, relief with elevation of the testes. this test is negative in a testicular torsion |
|
|
Term
|
Definition
UA positive for pyuria and bacteriura
cx grow organism |
|
|
Term
| What is the tx for epididymitis based on the MC organisms for age group? |
|
Definition
<35: ceftriaxone 250 mg IM one time + doxycycline 100 mg BID x 10 days
>35: ciprofloxacin 500 mg BID x 10-14 days |
|
|
Term
| what is the MC viral C of orchitis |
|
Definition
|
|
Term
| what is the most common type of prostatitis |
|
Definition
|
|
Term
| what are the sx of prostatitis? |
|
Definition
-Irritative bladder sx (should help differentiate dx) frequency, urgency, dysuria
-fever, chills, low back pain
-perineal pain
-dyspareunia |
|
|
Term
| what are the most common organisms implicated in acute bacterial prostatisis |
|
Definition
| ascending infection of gram negative rods ( E coli or Klebsiella) |
|
|
Term
| What is a test to figure out the nidus of infection in a man with sx of prostatitis, UTI, etc |
|
Definition
| the glass test (either 4 or 2 glass test) |
|
|
Term
| What is the tx for prostatitis? |
|
Definition
| While waiting for cx, tx with parenteral abx then pick appropriate drug when cx come back |
|
|
Term
| what are the most common causative agents in pyelonephritis? iN DM? |
|
Definition
-gram negative bacteria (e coli, proteus, klebsiella, enterobacter, and pseudomonas)
-Klebsiella is the MC in DM |
|
|
Term
| what will be seen on a UA that will distinguish pyelo from any other UTI? |
|
Definition
|
|
Term
| What is the PO abx treatment for gram negative bacteria in pyelo? gram positive? |
|
Definition
quinolones or bactrim
amoxicillin |
|
|
Term
| what are the guidelines in terms of rx pyridium |
|
Definition
warn the patient that it will turn the bodily fluids orange
do not give for longer than 3 days, bc after 3 days there should be improvement in sx if the abx choice was correct and we want the pt to be able to see improvement
-200 mg TID is the dosage |
|
|
Term
| what is the MC RF for bladder cancer |
|
Definition
tobacco use
it is also 3x more common in men |
|
|
Term
| what is the most common type of bladder cancer? |
|
Definition
| transitional cell carcinoma |
|
|
Term
| what is the MC presenting sx in bladder cancer |
|
Definition
|
|
Term
| what is the definitive diagnostic procedure for dx of bladder cancer? |
|
Definition
|
|
Term
| what is a non GU symptom that could be the first presenting sx for a pt with prostate cancer |
|
Definition
| back pain d/t spinal cord mets |
|
|
Term
| what is the mc area of the prostate for a tumor to arise from? |
|
Definition
|
|
Term
| what non renal sx may renal cell carcinoma present as? |
|
Definition
| PNA in the lung from mets to the lung |
|
|
Term
| what is a major rf of renal cell carcinoma? |
|
Definition
|
|
Term
| what is the best tx for renal cell carcinoma |
|
Definition
| surg, chemo and rad do not work well |
|
|
Term
| what is the MC malignancy in young men |
|
Definition
|
|
Term
| what two labs will be elevated in a nonseminomatous germ cell tumor of the testicle |
|
Definition
| increased AFP and increased hCG |
|
|
Term
| what are the two major types of testicular cancer and which is MC |
|
Definition
-seminomatous (35)
-nonseminomatous (^%) |
|
|
Term
| what is a major RF for testicular cancer? |
|
Definition
|
|
Term
| what is the MC presentation of testicular cancer |
|
Definition
| painless solid testicular swelling |
|
|
Term
| what are some major differences between post streptococcal glomerulonephritis and IgA nephropathy (Berger Disease) |
|
Definition
-PSGN: 1-4 weeks after strep infection of throat or skin, sub epithelial immune complexes "humps" seen on bx, "sore throat, face bloat, pee coke"
-Bergers: occurs 1-2 days after URI, hematuria |
|
|
Term
| What is a total s/o to nephritic syndrome on UA? |
|
Definition
|
|
Term
| Which has more protein in the urine, nephritic or nephrotic? |
|
Definition
-Nephrotic! >3.5g/24 hrs is the magic number
-nephritic has proteinuria but it is <3.5 g/24 hr |
|
|
Term
| What is different about the PRO lost in nephrotic vs nephritic besides the amount? |
|
Definition
-nephrotic: you're losing actual PRO
-nephritic: you're losing cells which are made of PRO so you get an incr in PRO on UA |
|
|
Term
| which will always cause HTN, nephrotic or nephritic? |
|
Definition
|
|
Term
| What lab must be ordered to R/O wegeners in a pt with nephritic syndrome |
|
Definition
| ANCA (antineutrophiliccytoplasmic AB) |
|
|
Term
| Which has FOAMY urine, nephrotic or nephritic? |
|
Definition
| nephrotic due to the have proteinuria |
|
|
Term
| Which has changes in lipids, nephrotic or nephritic? |
|
Definition
| -Nephrotic has lipiduria and hyperlipidemia. This is bc you lose a lot of PRO and albumin in blood is low, the liver goes into overdrive to replace the albumin in the blood but at the same time starts making a ton of lipids. You're not "losing" the lipids, so you have an inadvertent hyperlipidemia with spillage into the urine |
|
|
Term
| What are the two terms that are used that are pathognomonic one for nephritic and one for nephrotic |
|
Definition
-Membranous: nephrotic
-Proliferative: nephritic
ONE EXCEPTION: membranoproliferative has features of both |
|
|
Term
| What can happen to a pt with nephrotic syndrome in terms of coagulability? |
|
Definition
| THey can become HYPERcoagulable bc they lose ANTI-clotting PRO (like C and S) |
|
|
Term
| What will be seen on microscopic exam of the urine in a pt with nephrotic syndrome? |
|
Definition
| oval fat bodies and maltese cross formations |
|
|
Term
| What is the MCC of nephrotic syndrome in kids? in adults? |
|
Definition
-Kids: minimal change disease
-Adults: Focal and segmental glomerulosclerosis (FSGC) |
|
|
Term
| What is the rad of choice for dx PCKD |
|
Definition
|
|
Term
| What is formula for anion gap? What is a normal anion gap? |
|
Definition
Na - (Cl + HCO3)
normal is 12-16 |
|
|
Term
| what acid base DO is seen in renal failure? |
|
Definition
| Metabolic acidosis with an incr. anion gap |
|
|
Term
| What is formula for anion gap? What is a normal anion gap? |
|
Definition
Na - (Cl + HCO3)
normal is 12-16 |
|
|
Term
| what acid base DO is seen in renal failure? |
|
Definition
| Metabolic acidosis with an incr. anion gap |
|
|
