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MEDICINE

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sweetiesc1's version from 2011-12-13 21:07

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Absolute Indications for HDA,E,I, O, U (Refractory Acidosis <7.2, Electrolyte disturbances ex: Hyperkalemia, Intoxications by MALE (Mg Laxatives, Aspirin, Lithium, Ethylene glycol), Overloaded - hypervolemia, pulmonary edema, Uremia - based on clinical presenation of pericarditis, encephalopathy, neuropathy)
MCCs of PericarditisMCC Viral infections, SLE/RA, Uremia, bacterial infections, Post MI (Dresslers)
Tx for anorexia secondary to increased cytokines in Ca patients + catabolic state (fat and muscle breakdown)1st line PROGESTINS (megestrol acetate, medroxyprogesterone acetate), 2nd line Steroids (NOTE SSRIs may be used in cases of anorexia secondary to depression)
Enthesitiscondition in which inflammation and pain occur at the site of tendon and ligament attachment to bone, often seen in AS. Typical sites include: heels, tibial tuberosities, iliac crests.
Initial Management for patient with DKAIV FLUIDS, regular insulin, K+
CHF Exacerbation protocolSodium Restriction, Diuretics (Lasix>Thiazides>Spirinolactone), ACE Inhibitors (Veno/Vaso dilation therefore decrease pre and afterload, dec mortality), B blockers (given to stable patients, decrease remodeling, decrease mortality), digitalis (short term symptomatic relief)
CHF patients that can NOT tolerate ACE IARBS or hydralazine/isosorbide dinitrate combo - combo shown to decrease mortality but not as good as ACE I)
CONSENSUS trail ACE I decrease mortality
SOLVD trialACE I prolong survival and alleviate symptoms in mild, moderate and severe CHF
COMET trialcompared Carvediol and Meroprolol in the treatment of CHF and showed that carvediol led to significant improvement of survival compared to metoprolol.
DIG TOX(Increased risk if patient is hypokalemic, on quinidine, or in renal failure). TOX includes cholinergic - nausea, vomiting, diarrhea anorexia; cardiac - ectopic ventricular beats, AV block, Afib; CNS - visual disturbances, disorientation, confusion, weakness)
Seborrheic KeratosisBenign derm tumor, asymptomatic, occurs in white older people, more of a cosmetic problem. Warty stuck on appearance. Can be flat or raised, usually on head, neck and extremities.
Basal CellMost Common. Slow growing papule with rolled edges w or w/o central ulceration, pearly, with telangiectasias.
Actinic Keratosissmall rough erythematous/brownish papules, precursor to squamous cell ca.
Squamous Cell CaVery Common. Commonly on hands and feet. Ulcerative RED lesion. Scaling, Crusty Surface.
Ataxic HemiparesisLacunar infarction in the posterior limb of the internal capsule. Weakness is more prominent in the lower extremity along w the ipsilateral arm and leg incoordination
Glomerular hematuria s/ 10-21 days post upper respiratory tract infection w/ low complement levelsPost strep glomerularnephritis
Glomerular hematuria s/ < 10 days post upper respiratory tract infection w/ normal complement levelsIgA nephropathy
SLEIM DAMN SHARP + Libman Sacks Endo, Tx: Hydroxychloroquine --> retinal damage therefore f/u w optho e/ months
Differentiating between Diabetes Insipidus and Psychogenic PolydipsiaDI (Na >142) and No change in Urine Osmolarity after water deprivation test vs PP(Na <137) and Inc in Urine Osmolarity after water deprivation test
Differentiating btwn Central and Nephrogenic DIBoth will show no change in urine osmol after water deprivation. Give exogenous ADH. Central will now be able to concentrate urine (>50% in urine osmol) while nephrogenic will still show no change in urine osmolarity.
Tx for Central DIVasopressin via nasal spral or PO
Tx for Nephrogenic DIIndomethacin, Hydrochlorathiazide (will induce volume depletion --> RAAS -->Inc in Na/H2O reabsorption at PT verse waiting till collecting duct) or if its lithium induced use Amiloride
ZOSYNPipercillin + Tazobactam - used for gram (-) rods + Pseudomonas + anaerobes (B. Fragilis)
Hamptoms Humpchest x-ray wedge shaped area, pathognomonic for PE.
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Infectious Disease

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Cestodes (Tapeworms) affecting humans1) Taenia Solium - Pig farmers/undercooked pork ingestion --> cysticercosis/neurocysticercosis (swiss cheese brain) 2) Diphyllobothrium latum - ingestion of larvae from freshwater fish (sushi) -->Vit B12 def --> anemia 3) Echinococcus - sheep strain --> dog feces ingested cysts in liver with daughter cysts (surgeons inject ethanol b4 removal to kill daughter cysts)
Cestodes treatment1) Taenia Solium - Praziquantel for cysticercosis, Bendazoles for neurocysticercosis 2) Diphyllobothrium latum - Praziquantel 3) Echinococcicosis - bendazoles
Neutropenic FeverNeutropenia = ANC <1500. Susceptibility to infection = ANC <1000. Risk of death by endogenous flora = ANC < 500. Get CBC, CMP, CXR, Pan culture, reverse isolation precautions, broad spectrum antobiotics (IV ceftazidime or IV cefepime), If fever presists beyond 4-5 days, give IV amphotericin B. (Fever is defined as a single temp >101.3 or a sustained temperature of >100.4)
Opputunistic Infections in HIV patients by CD4 countTOVS HIP-c CAN'T-h Cc-BIRDS (lower case are fungi)
AminoGlycoSides CaNot Kill AnaerobesNephrotoxespecially with Cepahlosporins, Ototoxic esp with Loop Diuretics
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Heme/Onc

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Malignant Bone Tumors1) Osteosarcoma (10-20) - Metaphysis of long bones, codmans triangle, sunburst pattern 2) Ewings (<15) - Diaphysis of long bones 11,22 translocation, aggressive but treatable 3) Chondrosarcoma (30-60) - Diaphysis of long bones, Expansive glistening mass within medullary cavity
Perivascular Connective Tissue atrophiesCauses senile purpura (ecchymoses ) as people age on extensor surfaces
HIT I vs IIHIT I is non-immune mech within first 2 days, HIT II is autoimmune disorder characterized by formation of Abs against PF4-Heparin Complex. Either one tx is STOP HEPARIN, switch to either danaparoid or lepirudin, argatroban
Possible complication of HITCan result in formation of arterial clot causing acute ischemic stroke.
Familial Adenomatous Polyposis (FAP)AD mutation of APC on 5q. 100% progression to CRC. Pancolonic, always involves rectum
GardnersFAP + Osseous/Soft Tissue Tumors, Retinal hyperplasia
Turcot's syndromeFAP + Malignant CNS tumor
Hereditary Nonpolyposis Colorectal Cancer (HNPCC/Lynch Syndrome)AD mutation of DNA mismatch repair genes. 80% progression to CRC. Proximal colon is always involved.
Squamous Cell Carcinoma vs Small Cell CarcinomaSCa++mous = PTHrP --> Hypercalcemia vs SCC = ACTH production and SIADH
Causes of Macrocytic AnemiaB12/Cobalamin Def, Folate Def, MDS, Alc/Liver Disease
Low Dietary Intake causesFolate deficiency (not b12) because "B12 lasts for 6 years".
MCC of B12/Cobalamin deficiencyPernicious Anemia - usually presents in elderly but can present in adults who have other autoimmune disorders such as vitiligo or autoimmune thyroid disease. This can present as new symptoms in a patient who recently decreased intake of B12 but probably had subclinical pern anemia for quite sometime.
High/Low Leukocyte Alkaline PhosphataseLOW LAP = CML, Paroxysmal Nocturnal Hemogolubinuria, Hypophosphatemia. HIGH LAP = LEUKOMOID REACTION.
Absence of measurable erythropoietin in urineDiagnostic feature of Polycythemia Vera.
Waldenstroms MacroglobulinemiaRare, Chronic Plasma cell neoplasm. Abnormal Plasma cells multiply out of control and invade peripheral lymphoid organs (Spleen, LNs, liver). There is alsoexcessive production of IgM antibody in the blood which causes hyperviscosity (thickening of the blood). Look for constitutional symptoms (tiredness, night sweats, headache, dizziness) and increased lymphoid organs, tendency to bleed or bruise, visual problems, pain/numbness in extremities due to a predominately demyelinating sensorimotor neuropathy.
Bite CELLSG6PD deficiency
MCC of Folate DeficiencyAlcoholism
Fanconis AnemiaAplastic Anemia, Congenitically aquired, presents <16 y/o, with abnormal thumbs, abn stature, abn ear/eyes, hypogonadism, hypo/hyperpigmentation. Dx via chrom breaks on genetic analysis + clinical findings, Tx with Stem Cell Transplant.
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Endocrine

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Causes of HypercalcemiaCHIMPANZEES (Ca Excess, HPTism, Iatrogenic Thiazide Diuretics, Malignancy(PTHrP from SCa++mous)/Mult Myeloma(Osteoclast Activating Factor), Pagets occasionally, ADDISONS (Enhanced absorbtion from the GI tract), Neoplasm, Zolliger Ellison(In combo with MEN I and HyperPT), Excess Vit D, Sarcoidosis (1 alpha hydroxylase expresed by granulomas - Tx with steroids)
Acute vs Chronic Tx of HypercalcemiaAcute (Fluids, Calcitonin, Lasix) vs Chronic (Bisphosphanates -->Zolendrate/Pamidronate approved for treating Hypercalcemia associated with malignancy)
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Respiratory

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Decreased FEV1/FVC rationCOPD
Using DLCO in distinguishing types of COPDDLCO is decreased in Emphysema while normal in chronic bronchitis.
Theophylline ToxUsed for COPD , Tox manifests as CNS STIM (headache/insomnia), GI (nausea/vomitting), CARDIO (arythmia)
Drugs leading to theophylline toxCipro & Erythromycin decreases clearance of theophylline and increases plasma concentration.
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Neuro

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RLS 4 symptoms and Tx1) Uncomfortable urge to move legs, 2) Increased night symptoms, 3) Increased symptoms at rest, 4) Alleviated by moving legs. Dopamine Agonist
Brown-Sequard Syndromedamage to lateral spinothalamic tracts causing contralateral loss of pain and temperature sensation beg'g two levels below the level of the lesion.
Dizzinesssensation of imbalance or unsteadiness.
Vertigoillusionary feeling of head movement, frequently described as head spinning. Typically occurs with disorders of the vestibular (labyrinth) system.
Two causes of vertigoAcute labyrinthine dysfunction/acute labyrinthitis/vestibular neuritis - usually unknwon etiology vs Benign Paroxysmal Positional Vertigo (BPPV) - precipitated by recumbent head position.
4 types of Lacunar stokes all caused by hypertensive lipohyalinosis (MC in DM/HTN)(1) pure motor hemiparesis with face, arm, leg equally affected; (2) pure hemisensory loss; (3) dysarthria-clumsy hand syndrome; (4) ataxic hemiparesis with ipsilateral incoordination out of proportion to degree of weakness.
Stoke/Lesion of VPL/VPM (Lacunar Infart)Pure Sensory Thalamic Syndrome - complete contralateral sensory loss
Stoke/Lesion of Base of Pons (Lacunar Infart)Ataxia/Hemiplegia with ipsilateral incoordination out of proportion to degree of weakness.
Stoke/Lesion of Base of Pons + Genu of ICDysarthria/Clumpsy Hand Syndrome
Stoke/Lesion of Posterior Limb of IC (Lacunar Infart)Motor impairment w/o any higher cortical dysfunction or visual field abnormalities
Middle Cerebral Artery Occlusion Superior divisioncontralateral arm/face greater than leg weakness, Broca's aphasia (left MCA stroke)
Middle Cerebral Artery Occlusion Inferior divisionmild or transient motor/sensory deficit, Wernicke's aphasia (left MCA stroke), neglect, sometimes visual field cut.
Anterior Cerebral Artery OcclusionContralateral weakness that predominately affects the lower extremity, abulia, akinetic mutism, emotional disturbances, deviation of head and eyes toward the lesion and sphincter incontinence
Vertebrobasilar system lesion (supplying the brain stem)'Alternate' syndromes, with contralateral hemiplegia and ipsilateral cranial nerve involvement.
Women with chronic headaches presents with painless hematuriaAnalgesic Nephropathy causing Papillary Necrosis
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ENT

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Tx for Glaucoma1)IV Mannitol 2) A.T.P. (Azetazolaminde, Timolol to decrease prod of aq humor, Pilocarpine to Pilopen Canals of Schlemm) 3) CI: Atropine or any anticholinergics that cause dilation.
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