Term
Insulin dosing:
3 Long acting, 2 intermediate acting, 1 short acting, 3 meal time, 4 pre-mixed |
|
Definition
long acting: glargine (lantus), detemir (levemir), ultralente (novolin U)
intermediate acting: NPH (novolin N), Lente (novolin L)
Short acting: Regular (novolin)
meal time: aspart (novolog), glulisine (apidra), lispro (humalog)
premixed:
70/30: 70% NPH, 30% regular
Aspart 70/30: 70% NPH, 30% aspart
Lispro 75/25: 75% NPH, 25% lispro
Lispro 50/50: 50% NPH, 50 % Lispro
|
|
|
Term
Insulin calculations:
TDD
Basal dose
Pre-meal dose
Correction dose |
|
Definition
TDD:
Type 1: 0.5 U/kg/day
Type 2: 0.7 U/kg/day
basal dose:
glargine/detemir/ultralente: 1/2 TDD
NPH/lente: AM 0.4xTDD, PM 0.2xTDD
premeal:
aspart/glulisine/lispro (if using long acting insulin as basal): 1/2 TDD divided equally between 3 meals
Regular insulin (if using NPH as basal): 0.2xTDD in AM and PM
Correction dose:
sensitivity factor: 2000/TDD
Correction dose: (blood sugar - target blood sugar)/sensitivity factor
Target blood sugar: 140-150 |
|
|
Term
Hyperthyroidism:
1. ___ causes most cases in young pts
2. ___ causes most cases in elderly pts
3: s/s ?
4. PE findings
5. Tx: in pregnancy and not in pregnancy |
|
Definition
1. grave's in young pts
2. toxic nodular goiter in elderly
3. s/s: heat intolerance, weight loss, weaknes, palpitations, oligomenorrhea, anxiety, a fib, heart failure
4. PE: brisk tendon reflexes, fine tremor, proximal weakness, stare, lid lag, tachy, a fib, heart failure, proptosis, pretibial myxedema, non-tender goiter
5. labs: TSH low, T4 high, T3 may be high
6. Tx:
- beta blockers (atenolol) for tremors, palpitations, anxiety
- verapamil: control tachy in pts who can't take BBs
- radioactive iodine (definitive): tx for graves, contraindicated in pregnancy
- PTU (propylthiouracil, a thionamide - definitive): tx of choice in pregnancy
- subtotal thyroidectomy |
|
|
Term
Definition: hypofunctioning of the adrenal cortex causing a deficiency of cortisol and aldosteronee
Causes: auto-immune disease, granuloma (TB), tumor, amyloid, hemorrhage, inflammatory necrosis
s/s?
PE?
Labs: BMP, CBC, cortisol, ACTH
Imaging
tx |
|
Definition
primary adrenal insufficiency (Addison's disease)
s/s: weakness, fatigue, hyperpigmentation, anorexia, nausea, vomiting, diarrhea, decreased cold tolerance, dizziness, weight loss, syncope, arthralgia, adrenal crisis/shock, dehydration, salt craving, myalgia
PE: orthostatic hypotension, hyponatremia, hyperkalemia, mild hyperchloremic acidosis, hypoglycemia, amenorrhea depression, psychosis, decreased axillary/pubic hair
BMP:
Low sodium, glucose, HCO3
High Potassium and BUN
CBC: high HCT, low WBC, lymphocytosis, high eosinophils
Low cortisol
High ACTH
ACTH stimulation test: failure of cortisol to rise even with the administration of exogenous ACTH
Imaging: calcification in adrenal, renal and Pulmonary TB
Tx: hydrocortisone or prednisone, florinef |
|
|
Term
secondary: failure of anterior pituitary to produce ACTH - could be due to panhypopituitarism due to pituitary tumor/trauma/infection
tertiary: failure of hypothalamus to stimulate pituitary to make ACTH
s/s? |
|
Definition
s/s: similar to Addison's with fatigue, weakness, myalgia, arthrlagia, psych sx but NO hyperpigmentation, dehydration, hypotension, hyperkalemia
tets:
low cortisol, low ACTH
ACTH stimulation test: prolonged. cortisol continues to rise for >24 hours
Must image CNS to r/o tumor
tx: hydrocortisone or prednisone, needs to be increased during illness |
|
|
Term
Cushing's Syndrome: clinical abnormalities due to chronic high blood levels of cortisol or related corticosteroids
Cushing's disease: cushing's syndrome due to excess pituitary production of ACTH due to a pituitary adenoma
ACTH-dpenedent hyperfunction - 3 causes
ACTH-independent hyperfunction - 2 causes
S/S?
Labs - 24 hr urine cortisol, dexamethasone suppression, ACTH level
Imaging
tx? |
|
Definition
ACTH- dependent: hypersecretion of ACTH from pituitary, ectopic ACTH syndrome from a tumor elsewhere, exogenous ACTH
ACTH-independent: exogenous corticosteroids, adrenal adenoma/carcinoma
s/s: weight gain (esp face, supraclavicular fossa, upper back), purple stretch marks, easy bruising, skin thinning, proximal muscle weakness, irregular periods, decreased libido, depression
PE: truncal obesity, moon facies, acanthosis nigricans, HTN, hirsuitism, amenorrhea, depression, osteoporosis, DM
labs:
24 hr urine cortisol: + if >4x nl
dexamethasone: + if cortisol is not suppressed after giving dexamethasone
ACTH: low = adrenal cause, high = pituitary cause
CBC: high WBC and glucose
MRI of head if pituitary cause
CT of chest, pancreas, adrenals if non-pituitary cause
tx:
- tumor: surgery or radiation
- exogenous steroids: gradual withdrawal
- endogenous glucocorticoids: ketoconazole, metyrapone, aminoglutethimide |
|
|
Term
definition: atrial tachyarrythmia, uncoordinated activation of atria
4 forms:
1. 1st occurrence
2. paroxysmal: recurrent, <7 days, >48 hrs
3. persistent: recurrent >7 days, requires cardioversion to terminate
4. permanent: long lasting, failed attempts to cardiovert
risk factors?
s/s?
tests?
tx |
|
Definition
a fib
risk factors: male, DM, CHF, valvular heart dz, htn, previous MI, obesity, OSA
S/S: due to rapid ventricular rate
non-specific fatigue
severe: acute pulmonary edema, palpitations, angina, syncope
12 lead EKG: no p waves, rapid low amplitude oscillations/fibrillatory waves, ventricular rate irregular and rapid
tx:
1. prevent thrombotic evens with warfarin. INR 2-3
2. rate control with diltiazen, verpamil, beta blockers, digo
3. rhythm control: cardioversion with ibutilide, antiarrythmics (flecanide, propatenone, sotalol, amiodarone), catheter ablation |
|
|
Term
what drug?
suppresses SA node, prolongs AV conduction, positive inotrop
Indications: heart failure and afib
Contraindications: v fib
caution with: MI, av block, bradycardia, severe HF, sick sinus syndrome, vtach, WPW, renal disease
Adverse effects: dizziness, diarrhea, HA, nausea, vomiting, rash
interactions: erythromycin, TCN, quinidine, verapamil, flecanide, amiodarone
very low therapeutic range |
|
Definition
|
|
Term
urinary obstruction/obstructive uropathy
general: structural or functional hindrance of normal urine flow
s/s: flank pain or labial/testis pain, n/v
PE: pain along T11-12, anuria,
tests?
tx? |
|
Definition
tests: urinalysis, serum electrolytes (hyperkalemia), BUN/Cr, bladder catheterization, cystourethroscopy, US, CT, IVP, radionucleotide, MRI
tx: eliminate obstruction: surgery, endoscopy, lithotrisy, drug therapy |
|
|
Term
s/s: palpable flank mass, gross hematuria, HTN, ESRD by 65 y/o
tests?
tx? |
|
Definition
polycystic kidney disease
tests: US shows cysts
tx:
- no preventative tx
- aggressive control of HTN with ACE/ARB
- gross hematuria: bedrest and hydration
- cyst infection: bactrim or cipro
- MRI/MRA to check for cerebral aneurysms
common comorbidities: cerebral aneurysms, hepatic cysts, colonic diverticula |
|
|
Term
syncope associated with exercise:
ddx's:
1. abnormal cerebral metabolic/electrical activity
2. abnormal arterial perfusion pressure
A. syncope during exercise (as opposed to before or after) suggests ___ etiology
PE |
|
Definition
1. seizure, hypocapnia, hypoxia, hypoglycemia, hyperthe
2. LV EDV too low (pulmonary hypertension, pulmonic stenosis, dehydration, hemorrhage), LV ESV too high (aortic stenosis, hypertrophic cardiomyopathy, ischemia), HR too fast (a fib, WPW, vtach, Vfib) or too slow, TPR too low (vasodepressor reflex, anaphylaxis, functional sympatholysis
A. cardiac
PE:
- vitals
- assess body habitus for marfans
- carotid and radial pulse for bifid pulse (hypertrophic cardiomyopathy) or slow rising pulse (aortic stenosis)
- extensive cardiac exam
- EKG: long QT, WPW, L or R ventricular hypertrophy, ischemic dz
- Echo: murmurs
- exercise stress test |
|
|
Term
most common cause of obstruction of flow from LV
s/s: classic triad of angina, syncope, and heart failure
PE: harsh systolic crescendo-decrescendo murmur at L upper sternal border that radiates to carotids
EKG: LAE and LVH
CXR: LVH, cardiomegaly, calcification of aorta
TTE
CTA
cath
tx? |
|
Definition
aortic stenosis
treat HTN, ACE-I, statins, balloon valvuloplasty, AVR
once symptomatic: avg survival is 2-3 years with high risk of sudden death |
|
|
Term
RVH secondary to a lung disorder (most commonly COPD) that causes pulmonary HTN and RV failure
s/S: DOE, fatigue, letahrgy, exertional syncope, exertional angina, RUQ pain
PE: loud S2, tricuspid insufficeincy murmur at left lower sternal border, JVD, ascites, S3, S4, lower ext edema
CXR: RV and pulmonary artery enlargement
EKG: RVH, RAE, RAD
___ is gold standard for diagnosis
tx? |
|
Definition
cor pulmonale (Right heart fialure)
right heart cath --> gold standard
tx:
supplemental O2
treat underlying disease
pulmonary vasodilator
diuretics
dig
dobutamine or milrinone
anticoagulation
|
|
|
Term
begins with injury/stress on heart causing LV dilation/hypertrophy/change in shape.
pathophys: decreased CO, increased pulmonary venous pressure
fluid leaks from pulmonary capillaries into interstitial space
CAD: most common cause
Other causes: valvular heart disease, cardiomyopathy, myocarditis,
s/s: dypsnea, fatigue, exercise intolerance, orthopnea, PND, LE edema, cough, wheezing, presyncope, palpitations, angia,
PE: LE edema, pulmonary crackles, JVD, diminished carotid upstrokes, pleural and pericardial effusions, hepatic congestion, ascites, 3 or 4 heart sounds, tricuspid or mitral regurg
workup?
tx? |
|
Definition
left heart failure
workup: CBC, CMP, lipid profile, UA, thyroid tets, BNP
EKG: q waves, STT abnormalities, conduction delays, arrhythmias, LVH
CXR: pulmonary edema, cardiomegaly
Echo: assess LV fxn or cardiomyopathies
coronary angiography
tx:
cornerstone: vasodilator + BB + diuretic
|
|
|
Term
causes of heart failure:
classic exertional angina indicates ____
acute HF after flu-like illness suggests ____
long standing HTN or alcohol use |
|
Definition
ischemic heart disease
viral myocarditis
htn or alcoholic cardiomyopathy |
|
|
Term
Management of HTN in a pt with DM
PE should include?
Labs should include?
Goal BP?
treatment? |
|
Definition
PE: height, weight, fundoscopy, careful exam of arterial circulation
Labs: creatinine, electrolytes, A1C, fasting lipids, urine albumin
Goal: <130/80
Behavioral tx: salt restriction, weight loss, moderately intense physical activity, smoking cessation, moderation of alcohol
Drugs: ACE-I -->first line, followed by ARBs |
|
|
Term
Arrhythmias:
1. early extra beats that originate in atria
2. rapid, regular rhythm originating above ventricle. begins and ends suddenly
3. rapid heart rate due to more than 1 pathway through AV node
4. rapid heart rhythm originating in atria
5. atrial arrythmia caused by 1 or more circuits in the atrium. more organized and regular than a fib
6. early extra beats from the ventricles. mostly asymptomatic. can be related to stress, caffein, nicotine, or exercise
7. rapid rhythm from the ventricles that prevents heaert from filling adequately with blood therefore less blood is able to pump through the body
8. erratic, disorganized firing of impulses from ventricles. the ventricles quiver and are unable to pump blood through the body
9. QT interval elongated - increases risk for torsades
10. slow heart rhythm due to abnormal SA node
11. delay or complete block of electrical impulse as it travels from the sinus node to the ventricles |
|
Definition
1. PACs
2. PSVT
3. Av nodal reentral tachy
4. atrial tach
5. a flutter
6. PVCs
7. v tach
8. v fib
9. long QT syndrome
10. sinus node dysfunction
11. heart block
|
|
|
Term
most common accessory pathway causing supraventricular tachycardia
s/s: young adult or middle age, sudden onset/offset rapid regular palpitations associated with dyspnea, chest discomfort, light headedness
PE: unremarkable except for a HR of 160-240
EKG: rapid, regular tachycardia. short PR interval. slurred upstroke with delta wave to QRS complex
tx? |
|
Definition
WPW syndrome
tx:
vagotonic maneuvers - valsalva, carotid sinus massage, ice water facial immersions, swallow ice water
adenosine
verapamil
diltiazem
radiofrequency ablation |
|
|
Term
|
Definition
renal parenchymal disease
renovascular disease
pheochromocytoma
cushing's syndrome
primary aldosteronism
congenital adrenal hyperplasia
hyperthyroidism
OSA
myxedema
coarctation of aorta |
|
|
Term
increased production of aldosterone by the adrenal cortex due to hyperplasia, adenoma, or carcinoma. causes Na and water retention and K loss
s/s: hypernatremia, hypervolemia, hypokalemic alkalosis, weakness, paresthesias, transient paralysis, tetany, htn, nephropathy, polyuria, polydipsia
tests:
- high Na, low K
- high plasma aldosterone >15 ng/dl
- low renin
- CT/MRI: hyperplasia of adrenal gland
tx? |
|
Definition
primary aldosteronism
tx: surgical removal of tumors. spironolactone or eplernone for hyperplasia |
|
|
Term
catecholamine secreting tumor of the adrenal medulla. 10% malignant
s/s: caused by hypersecretion of NE, epinephrine, and dopamine with increased sympathetic nervous system response
classic triad: episodic headache, sweating, tachycardia
- sustained or paroxysmal htn
- forceful palpitations, tremor, pallor, dyspnea, generalized weakness, panic attack, orthostatic hypotension, visual blurring, papilledema, weight loss, polyuria, polydipsia, constipation, increased sed rate, hyperglycemia, leukocytosis, psych disorders
should be suspected in pts with one of the following:
1. episodes of nonexertional palpitations, diaphoresis, HA, tremor, pallor
2. resistant HTN
3. familial syndrome like multiple endocrine neoplasia (MEN)
4. family hx of this disease
5. an adrenal mass
6. HTN and new onset or atypical DM
7. HTN at a young age
8. idiopathic dilated cardiomyopathy
tests:
- 24 hr urine fractionated catecholamines and metanephrines
- plasma fractionated metaneprhines
- CT/MRI of abd and pelvis
- octreotide or PET scan
tx? |
|
Definition
pheochromocytoma
tx:
- alpha and beta blockers
- high sodium diet
- phenoxybenzamine for BP and arryhtmias
- CCB
- metyrosine to inhibit catecholamines synthesis |
|
|
Term
Complications of MI:
1.
2. occurs 24-96 hrs after. pleuritic pain, friction rub, EKG shows diffuse ST elevation
3. autoimmune process with malaise, fever, pericardial pain, leukocytosis, elevated sed rate, pericardial effusion. occurs 1-8 weeks after MI
4. include conduction block, atrial arrhythmias, ventricular arrhythmias. needs transcutaneous or transvenous pacing
5.
6. affected area of heart undergoes infarct and expansion and thinning. wall motion can become dyskinetic and they are at high risk of mural thrombus formation. EKG shows persistent ST elevation. pt needs anticoagulation and possibly surgery
7. incomplete rupture of myocardial free wall leads to blood escaping and being contained w/in the visceral pericardium
8. often causes death due to hemopericardium and cardiac tamponade. causes right heart failure and shock, PEA, and death. associated with large transmural infarcts. more common in pts that have never had an MI or angina, pts with ST elevation or Q wave on first ekg, and pts with CK >150. occurs 1-5 days after MI.
9. occurs 3-5 days after MI. more common in pts wtih LAD MI, extensive Myocardial damage, and poor septal collateral circulation. presents with hypotension, biventricular failure, a new harsh loud holosystolic murmur and right lower sternal border
10. caused by ischemic papillary muscle displacement, LV dilation, aneurysm in LV, papillary muscle rupture. |
|
Definition
1. reccurent CP
2. acute pericarditis
3. Dressler Syndrome
4. arrhythmias
5. cardiogenic shock
6. aneurysm
7. ventricular pseudoaneurysm
8. rupture of LV wall
9. rupture of interventricular septum
10. development of acute mitral regurg |
|
|
Term
how to assess efficacy of bronchodilator therapy
__ is most useful measurement
__ measures longer term drug effects on lung fxn
__ provides info about resistance of small airways |
|
Definition
considered successful if sx are alleviated, if pt has increased exercise capacity, and improved quality of life
FEV1 is most useful measurement
PEF measures longer term drug effects on lung fxn
FEF provides info about resistance of small airways
|
|
|
Term
definition: disease characterized by chronic inflammation, hyperresponsiveness, obstruction wtih variable airflow limitation. leads to paroxysms of dyspnea, chest tightness, and wheezing. chronic disease with acute exacerbations.
PE: wheezing in expiratory phase. presence of atopic dermatitis
PFT:
decreased ___, which improves with bronchodilator
tx? |
|
Definition
asthma
decreased FEV1/FVC ratio
1st line tx:
SABA (albuterol) + ICS (fluticasone, budesonide) + LABA (salmeterol, formeterol) + systemic corticosteroids for acute exacerbation
2nd line tx:
leukotriene modifier (motelukast, zafirlukast) OR cromolyn sodium (alternative to ICS for exercise induced) OR anti-IgE therapy (omalizumab) OR methyxanthine (theophylline)
abx for acute exacerbation |
|
|
Term
Acute asthma exacerbation:
1. PaO2 < ___ is a sign of severe bronchoconstriction, pulmonary edema, or pneumonia
2. initially ___ is low due to increased resp rate but then increases with respiratory failure
measure of airflow obstruction:
1. Mild: FEV1 > __%
2. Moderate: FEV1 > ___%
3. Severe: FEV1 <__%
4. Life threatening: FEV1 < __% |
|
Definition
1. PaCO2 < 60 mmHg
2. PaCO2
1. Mild: FEV1 >70%
2. Mod: FEV1 40-69%
3. severe: FEV1 <40%
4. life threatening: FEV1 <25% |
|
|
Term
|
Definition
1. assess RR, FEF, auscultate, signs of distress
2. keep O2 >95% with O2. Give nebulized SABA, start glucocorticoids
3. repeat assessment
4. If O2 sat <90% or if not responding to SABA + O2 after 1 hour, admit to hospital |
|
|
Term
COPD:
1. chronic productive cough for 3 mos in 2 successive years in a pt where other causes of chronic cough are excluded
2. abnormal and permanent enlargement of airspaces that are distal to the terminal bronchioles with destruction of airspaces walls w/o fibrosis
3. chronic inflammatory disorder of airways that leads towheezing, breathlessness, chest tightness, coughing.
most common sx? (4)
___ progresses over time
PE findings?
PFTS:
FEV1/FVC < __
Mild: FEV1 > ___
Mod: FEV1 __-__%
Severe: FEV1 __-__%
Very severe: FEV1 <__%
__, ___, and ___ often increase to supernormal values which indicates lung hyperinflation and air trapping
t? |
|
Definition
1. chronic bronchitits
2. emphysema
3. asthma
most common sx: dyspnea, cough, sputum production, wheezing
DOE progresses over time
PE: prolonged breath sounds on max forced exhalation, decreased breath sounds, use of accessory muscles, chest hyperresonance, enlarged thoracic volume. signs of pulmonary HTN or cor pulmonale
PFT:
FEV1/FVC <0.7
Mild: FEV1 >80%
moderate: 50-79%
severe: 30-49%
very severe: <30%
TLC, FRC, and RV often increase
tx:
MIld: smoking cessation, vaccines, SABA prn
moderate: smoking cessation, vaccines, SABA, LABA, pulmonary rehab
Severe: all of the above + ICS and oxygen prn
Very severe: all of the above + possible surgical tx |
|
|
Term
Hep B serology:
1. ___ - hallmark of Hep B infection. appears 1-10 weeks after acute exposure to HBV, prior to sx or elevated ALT. in pts who recover, if usually becomes undetectable after 4-6 mos. If it is present >6 mos, then pt has chronic infection
2. ___ - antibody that persists for life in most pts and confers long term immunity.
3. ___ - sole marker of HBV infection during the window period disappearance of HBsAg and the appearance of Anti-HBs. detection of this = acute HBV infection.
4. ___ - antigen expressed in infected hepatocyte but not detectable in serum
Diagnostic algorithms:
Acute Hep: ___ + ___
Past HBV infection: ____ + ___
Immunization: ___ only
Chronic HBV: ___ |
|
Definition
1. HBsAg
2. anti-HBs
3. IgM anti-HBc
4. HBcAg - Hep B core antigen
Algorithms:
Acute infection: HBsAg and IgM anti-HBc
Past infection: Anti HBs + IgG anti-HBc
Immunization: Anti-HBs only
Chronic HBV: HBsAg > 6 mos |
|
|
Term
chronic inflammatory disease of the axial skeleton. peak onset 20-30 y/o. associated with HLA-B27
s/s: low back pain and stiffness that improves w/ exercise, progressive fusion of spine, buttock pain, limited spinal mobility and chest expansion, hip pain, shoulder pain, peripheral arthritis, TMJ pain, fatigue
4/5 = dz: onset of back discomfort <40 y/o, insidious onset, improvement with exercise, no improvement with rest, pain at night
PE:
1. modified schober test: assesses spinal mobility and shows reduction in range of motion
2. increased occiput to wall distance: indicates lumbar lordosis and thoracic kyphosis
3. chest expansion < 2.5 cm
4. sacroiliac tenderness
5. hip flexion abnormalities
6. pain/stiffness in peripheral joints
7. dactylitis (swelling of fingers and toes)
8. pain/swelling at achille's insertion
Labs: CRP, ESR, HLA-B27
Imaging: abnormal SI joint on xray - hallmark of dx
tx? |
|
Definition
ankylosing spondylitis
tx:
- PT to emphasize extension exercises and posture
- sleep supine on a firm bed w/o a pillow
- no smoking
- NSAIDs and COX-2 for sx relief
- mtx and sulfasalazine help tx peripheral joint disease
- TNF-a blockers
- glucocorticoids and immunosuppression
|
|
|
Term
Essentials of Dx:
- serum and urine Ca elevated, >10.5 and >250 mg/g
- Urine P high, serum P low/normal (<2.4 mg/dl)
- alk phos normal/high due to bone dz
- all due to increased secretion of PTH
sx: half are asymptomatic, otherwise sx due to hypercalcemia - bone pain, polyuria, HTN, constipation, fatigue, mental changes, renal stones, pathologic fx (osteitis fibrosa cystica)
most common cause: single adenoma
all pts should be screened for familial benign hypocalciuric hypercaclemia w/ 24 hr urine Ca screen
tx? |
|
Definition
primary hyperparathyroidism
tx:
parathyroidectomy
fluids
bisphosphonates
calcimimetics
Vit D
calcitriol
|
|
|
Term
sx: weight loss, hyperactivity, nervousness, irritability, easy fatigue, insomnia, impaired concentration, fine tremor, hyperreflexia, muscle wasting, proximal myopathy w/o fasciculation, palpitations, tachy, a fib, CHF, sweating, heat intolerance, lid lag, stare, exophthalmos, double vision, oncholysis, hyperpigmentation, thin hair, vomiting, abd pain, apathetic hyperthyroidism
TSH low
T4 high
tx? |
|
Definition
thyrotoxicosis
tx: beta blockers + PTU, thyroid ablation, or thyroidectomy |
|
|
Term
hypercalcemia
1. serum ca > ___
2. 2 most common causes
3. sx?
4. other causes
5. tx? |
|
Definition
1. >10.5
2. primary hyperparathyroidism and malignancy
3. sx: bones, stones, groans, moans, psych undertones
4. vit A and D intox, hyperthyroidims, immobilization, thiazides, renal failure, paget's
5. mild: hydration, mod: hydration + LOOP diuresis, if due to malignancy: bisphosphonates
do NOT give thiazides |
|
|
Term
Hypocalcemia:
1. Ca <___
2. Most common causes?
3. s/s?
4. Low Ca + high P = ?
5. tx? |
|
Definition
1. <9 mg/dl
2. hypoalbuminemia or renal failure
3. perioral numbness, Cvostek's sign (contraction of facial muscles by tapping), Trousseau's sign (carpal sapsm with inflation of bp cuff), seizure, myopathy, prolonged QT, intellectual impairment, dry skin, dental hypoplasia
4. hypoparathyroidism, pseudohypoparathyroidism (KKD sign), renal failure
5. out pt: 1-2 g ca/day + 600-1K IU Vit D/day
inpt: IV Ca - monitor every 4-6 hours
hypoparathyroid: call endocrinology |
|
|
Term
Coumadin:
1. MOA
2. uses?
3. dosing |
|
Definition
1. anticoagulation by inhibiting Vit K-dependent factors (II, VII, IX, X)
2. Uses: heart valve replacement, after ortho surgery, chronic afib, hx of DVT/PE, factor V leiden mutation, post-MI, CVA, TIA
3. start at 5 mg/day then adjust
maintenance dose: 5-7 mg/day
target INR: 2.0-3.5
prevention: 1-2 mg/day |
|
|
Term
| microcytic/normocytic/macrocytic anemias |
|
Definition
micro: iron deficiency, thalassemia, sideroblastic, chronic disease
normo: chronic disease, aplastic, hemolytic, hemorrhagic
macrocytic: megaloblastic (B12 def, folate def), pernicious, myxedema, reticulocytosis, liver disease, chemo, myelodysplasia |
|
|
Term
Sickle cell anemia:
1. definition
2. 2 abnormal hgb's?
3. s/s
4. tx? |
|
Definition
1. autosomal recessive disorder
2. hgb S and hgb F
3. jaundice, pigment gallstones, hepatosplenomegaly, poorly healing ulcers, acute painful episodes due to vaso-occlusion of vasculature supplying organs, hemolytic/aplastic crises
4. maintenance: folic acid supplement
crises: transfusions
vaccines to prevent infection
pain crises: exchange transfusion
pain: hydroxyurea |
|
|
Term
|
Definition
1. PE: IHATEFALLING:
Inflammation of joints
HTN
auditory/visual abnormalities
tremor
equilibrium
foot problems
arrhythmia
leg length discrepancy
lack of conditioning
illness
nutrition
gait disturbance
|
|
|
Term
urinary retention
causes
results
workup |
|
Definition
causes: obstructive renal failure, meds, phimosis, prostatitis
results: vesical pain, overflow incontinence
workup: US |
|
|
Term
a malignancy of plasma cells characterized by replacement of bone marrow, bone destruction, and paraprotein formation
- eventually leads to bone marrow failure
- tumors in bone marrow (plasmacytomas) can put pressure on spinal cord
s/s: most common presenting sx: anemia, bone pain, infection
others: osteoporosis, bone pain, lytic lesions, pathologic fx, hypercalcemia.
commonly recurrent infections with encapsulated organisms (strep pneumo and H. flu)
PE: pallor, bone tenderness, soft tissue masses, neuropathy, fever, hepatosplenomegaly, enlarged tongue, CHF
electrophoresis (SPEP): paraproteins
Xrays: lytic lesions
tx? |
|
Definition
multiple myeloma
tx:
thalidomide + dexamethosone --> initial chemo induction therapy
pts <70: autologous stem cell transplant
allogeneic transplant can be curative
localized radiation
bisphosphonates
median survival 3 years |
|
|
Term
|
Definition
|
|
Term
spontaneous rotational vertigo. horizonto-rotary always present
due to a distention of endolymph space w/in balance organs of inner ear
s/s: intense, episodic vertigo lasting 1-8 hrs, low frequency sensorineural hearing loss, tinnitus, aural pressure
tests: audiologic, caloric (loww or impairment of thermally induced nystagmus on the involved side)
tx? |
|
Definition
meniere's disease
tx: salt restriction and thiazides
instillation of ototoxic meds
nerve resection, labyrinthectomy |
|
|
Term
50-80% are HLA-B26 positive
- clinical tetrad: aseptic oligoarthritis, conjunctivitis, urethritis, mouth ulcers
- usually follows dysentery (shigella, salmonella, campylobacter, yersinia) or STD infection
other sx: fever, weight loss
tx? |
|
Definition
reiter's syndrome (reactive arthritis)
tx: NSAIDs, abx at time of infection, sulfalazine or MTX, Anti-TNF as last resort |
|
|
Term
| Cranial nerves affected by a large pituitary adenoma |
|
Definition
|
|
Term
Sjogren's:
- most common sx?
- increased incidence of ___
- def: autoimmune disorder as a result of chronic dysfunction of exocrine glands
s/s?
labs?
tx? |
|
Definition
most common sx: sicca components: dryness of eyes and mouth
increaesed incidence of lymphoma
s/s: keratoconjunctivitis sicca, xerostomia, dry nose/throat/larynx/bronchi, vagina, skin
systemic: dysphagia, vasculitis, pleuritis, obstructive lung disease, neuropsych dysfunction (peripheral neuropathies), pancreatitis, renal tubular acidosis
labs:
CBC: mild anemia, leukopenia, eosinophilia
+ Rheum factor and ANA
SSB and SSA
+ schirmer test
tx: sympatomatic and supportive. avoid atropinic drugs and decongestants |
|
|
Term
inflammatory autoimmune dz that affects multiple organ systmes
s/s due to trapping of antibody/antigen complexes in vascular structures of various organs- characterized by relapses and remissions
- malar rash, discoid rash, photosensitivity, oral ulcers, arthritis, serositisi, renal disease, + dipstick proteinuria, cellular casts, CNS disease, hematologic disease, immunologic abnormalities, positive ANA
labs: ANA, anemia, hypocomplementemia, anti-native DNA, leukopenia, thrombocytopenia, proteinuria, hematuria, anti-Sm, anti-phospholipid antibodies, biologic false positive for syphilis
tx? |
|
Definition
SLE
tx: sunscreen, NSAIDs, antimalarials (hydrochloroquine)
prednisone - if glomerulonephritis, anemia, CNS dz, or TTP
Prognosis: early death from infection, organ impairment |
|
|
Term
widespread thickening of skin in diffuse systemic scerlosis including truncal involvement with areas of increased pigmentation and depigmentation
- thickenng confined to face and neck, distal arms, feet and hands in limited disease
- raynauds and ANA always present
- systemic features: dysphagia, hypomotility of GI tract, pulm fibrosis, cardiac and renal involvement
labs:
CBC: anemia, microangiopathic hemolytic anemia
Elevated ESR
UA: proteinuria, cylindruria
+ ANA
SCL-70 antibody against topoisomerase III
tx? |
|
Definition
scleroderma
tx: symptomatic
CCB for raynauds
PPI for GI sx
NOT prednisone
40% 9 year survival rate |
|
|
Term
Characterized by HA, jaw claudication, polymyalgia rheumatica, visual abnormalities, and markedly elevated ESR and other acute phase reactants
tx? |
|
Definition
temporal arteritis
60 mg Prednisone
Temporal artery biopsy
|
|
|
Term
pain and stiffness of shoulder and pelvic girdle, frequently associated with fever, malaise, and weight gain
sx: trouble combing hair, rising from chair, and putting on a coat
labs:
elevated acute phase reactants (ESR, CRP)
Anemia - normocytic, normochromic
thrombocytosis
tx? |
|
Definition
Polymyalgia Rheumatica
tx:
10-20 mg Prednisone, taper after 2-4 weeks |
|
|
Term
| 5 pathophysiologic processes that account for most pleural effusions |
|
Definition
increased production of fluid in normal capillaries due to increased hydrostatic or decreased oncotic pressures (transudates)
increased fluid production due to abnormal capillary permeability (exudates)
decreased lymphatic fluid from pleural space (exudates)
empyema - infection in pleural space
hemothorax |
|
|
Term
Which are exudates, which are transudates?
1. alteration in SYSTEMIC factors that affect formation and absorption of pleural fluid
- occur in the setting of normal capillary integrity and suggest the absence of local pleural disease
- increased hydrostatic pressure (CHF accounts for 90% of these)
- decreased oncotic pressures (hypoalbuminemia, cirrhosis)
- greater negative pleural pressure (acute atelectasis)
2. LOCAL factors that influence the formation and absorption of pleural fluid are altered
- 2 types: increased production of fluid due to abnormal capillary permeability & decreased lymphatic clearance of fluid from the pleural space |
|
Definition
1. transudates
2. exudates |
|
|
Term
| examples of transudates vs. exudates |
|
Definition
transudates: CHF, cirrhosis w/ ascites, neprhitic syndrome, peritoneal dialysis, myxedema, acute atelectasis, constrictive pericarditis, superior vena cava obstruction, PE
exudates: pneumonia, cancer, PE, bacterial infection, TB, CTD, viral infection, fungal infection, rickettsia, asbestos, chronic atelectasis, trapped lung, chylothorax, sarcoid, post-MI, drug rxn, uremia, pancreatic disease, Meig's syndrome |
|
|
Term
Dyspnea, cough, respirophasic CP (pain with inspiration)
possible PE findings: chest dull to percussion, diminished/absent breath sounds, egophony, pleural friction rub
risk factors: existing cardiopulmonary disease
tests?
tx? |
|
Definition
pleural effusion
labs: thoracentesis
- get pH, description of fluid, protein, glucose, LDH, total WBC count, differential WBC count, microbiologic studies, cryology
CXR
tx:
treat underlying cause
probably abx
|
|
|
Term
Interpreting pleural fluid:
1. ratio of pleural fluid protein to serum protein: >0.5
- ratio of pleural fluid LDH to serum LDH >0.6
- pleural fluid lDH >2/3 the upper lipid of normal serum LDH
2. glucose = serum glucose
- pH 7.4-7.55
- <1000 WBC w/ predominance of PMNs |
|
Definition
1. exudates (pleural disease)
2. transudates (non-pleural disease) |
|
|
Term
|
Definition
measure the severity of pancreatitis
3 or > indicates SEVERE pancreatitis
On admission:
Age >55
WBC >16K
Glucose >200
LDH >350
AST >250
During first 48 hrs:
Hct decreased by >10% with hydration
BUN increased by >5 mg/dl
Ca <8
pO2 <60 mmHg
Evidence of fluid sequestration
Mortality increases with # of criteria:
0-2 - 1%
2-4 - 15%
5-6 -40%
7-8 100% |
|
|
Term
acute hepatitis
3 general phases
Labs |
|
Definition
1. prodrome: abrupt or insidious onset w/ general malaise, myalgia, arthralgia, fatigue, URI, anorexia, n/v/d, RUQ pain
2. Icteric phase: Jaundice - 5-10 days later
3. Convalescent phase: all sx disappear over 2-3 weeks
labs:
CBC: leukopenia, large atypical lymphs, aplastic anemia
UA: proteinuria, bilirubinemia
LFT: elevated AST, ALT, bilirubin, alk phos
A & B can be acute |
|
|
Term
Hepatitis A:
1. route?
2. vaccine?
3. test?
4. tx? |
|
Definition
1. fecal-oral route
2. vaccinated after age 1
3. serum tests: IgM anti-HAV for first 3-6 mos
then IgG anti-HAV
4. tx: no tx, will resolve on its own |
|
|
Term
Chronic Hep B:
1. 4 phases?
2. spread?
3. tx? |
|
Definition
1. a. immune tolerant phase - HBeAg and HBV DNA. active viral replication
b. immune clearance phase. ALT/AST elevated. necroinflammation with risk of progression to cirrhosis/CA
c. inactive Hep B surface antigen (HBsAg) carrier state. pt improves. HBV gets into pt's genome
d. reactive chronic hep B. HBV DNA rises. reactivation. cirrhosis/CA
2. spread by blood/body fluids
3. tx: to reduce serum HBV DNA and normalize ALT
- pegylated interferon a-2a
- nucleoside analog (lamivudine, entecavir)
- nucleotide analge (adefovir dipivoxil, tenofovir) |
|
|
Term
Chronic Hep C - most common chronic hep
1. dx?
2. tx? |
|
Definition
1. dx:
- detection of Anti-HCV or HCV RNA by PCR or enzyme immunoassay.
2. tx:
pegylated interferons
ribaviron
protease inhibitors |
|
|
Term
| What meds might cause hyperkalemia in a pt wtih renal insufficiency? |
|
Definition
ACE-I
Beta-2 antagonists
Dig
renin-inhibitors
ARBs
K-sparing diuretics
NSAIDs |
|
|
Term
Clinical syndrome in which CP occurs without the usual precipitating factors and is associated with ST segment elevation rather than depression
- reversible transmural ischemia due to coronary vasospasm, may cause transient ST-segment elevations w/o development of Q waves
s/s: severe CP at rest
- onset of CP presents w/ no or very few predisposing factors
- cardiac exam generally normal in absence of ischemia
risk factors: younger, smoker
EKG: ST elevation
CK-MB/troponin: elevated
tx? |
|
Definition
Prinzmetal's angina
tx:
nitrates & CCBs - mainstay
aspirin
|
|
|
Term
COPD lab findings:
1. spirometry
2. ABGs
3. CBC
4. Sputum culture
5. EKG
6. CXR |
|
Definition
spirometry: reduced FEV1 and FEV1/FVC
- increased RV, TLC, and RV/TLC --> indicate air trapping
ABGs: non early in dz
- advanced: hypoxemia, compensated acidosis (PaO2 and PaCO2 reduced)
CBC: elevated Hgb
Sputum culture: strep pneumo, H flu, catarrhalis
EKG: sinus tach, cor pulmonale, SVT, afib/flutter, ventricular irritability
CXR:
emphysema: hyperinflation, flattened diaphragns, decreased vascular markings
Chronic bronchitis: increased interstitial markings (dirty lungs). NO flattened diaphragms |
|
|
Term
Causes: altered gut motility, gastrocolic reflex, visceral hyperalgesia, central hypersensitivity, neuroendocrine dysregulation, cellular immune system dysregulation, psychosocial dysfunction, altered microbiota, or purely psych
2nd most common reason for absenteeism
4 types:
Colic: younger kids, sporadic intermittent cramping pain
Constipation predominant: kids, colic + const, female pelvic floor disorders
Diarrhea predominant: typically mid or late life
Episodic/explosive: possibly antigen sensitization
s/s: diarrhea, constipation, colicky pain, abnormal stools
Alarm sx?
diagnostic studies: Rome II criteria or Manning criteria, endomysial antibody w/ diarrhea, route labs
tx? |
|
Definition
IBS
alarm sx: constant, unrelenting, localized pain; weight loss; anorexia; vomiting; sweats; bleeding; nocturnal sx; no prior hx of pain or evaluation; mid or late life onset; fam hx of GI cancer or lynch syndrome/
tx: cognitive behavioral therapy
- dietary modifications: restrict gas, gluten, lactose, glucose, sorbitol, caffeine, fiber, allergies
- keep food diary
- antispasmodics
- bulk
- TCAs/SSRIs
- CCAs
- Probiotics |
|
|
Term
| Rome II and Manning criteria for IBS |
|
Definition
Rome II:12 weeks duration in past 12 mos of:
- abd pain relieved by defecation
- change in frequency of bowel movements
- altered stool frequency (at least 3 stools a week, no more than 3/day)
- altered stool form
- altered stool passage
- passage of mucus
- bloated or feeling of abd distention
- absence of alarm sx
Manning criteria:
- pain relief w/ defecation
- more frequent or looser stools after onset of pain
- abd distention
- mucus in stools
- feelings of incomplete evacuation
|
|
|
Term
Mitral valve prolapse (MVP):
- can cause a hyperadrenergic syndrome called ____
- associated with systemic collagen abnormalities like?
- s/s?
- complications?
- murmur?
- dx? |
|
Definition
- postural orthostatic tachycardia syndrome (POTS)
- marfans and ehlers-danlos
-s/s: usually asymptomatic. may be associated with CP, fatigue, palpitations, low body weight, straight back syndrome, pectus excavatum, scoliosis, narrow thoracic AP
- complications; endocarditis, embolic events
- murmur: mid systolic click
- dx: echo is gold standard (thickened mitral valve)
tx: low dose BB for hyperadrenergic state and arrhythmia
- aspirin for atrial tach
- surgery: mitral vavle repair
|
|
|
Term
DEMENTIA: cognitive impairment that significantly interferes w/ daily functioning. may coexist w/ depression and delirium
types:
1. most common cause (50-75%). risk factors - age, FHx, lower education level, female.
2. 10-20%. risk factors - age, HTN, smoking, a fib, DM, hyperlipidemia. often sudden onset and can spare memory. cortical and subcortical infarctions
3. 10-15%. visual hallucinations, REM sleep disorder, delirium, parkinsonism, rigidity and bradykinesia, rarely tremor. spares the memory
4. 5-15%. autosomal dominant. <65 y/o. usually begins w/ judgement, mood, sppech, and behavior changes.
s/s?
dx?
tx? |
|
Definition
1. alzheimer's
2. vascular dementia
3. dementia w/ Lewy bodies
4. frontotemporal
s/s: memory loss, loss of cognitive abilities (executive functioning, planning, judgement, confusion, psychosis), behavior disturbances (agitation, personality change)
dx: SPECT/PET scans. search for reversible causes: CBC, TSH, B12, folic acid, CRP, CMP
tx:
- treat underlying cause
- cognitive impairment: ACE-I, memantine
- Behavioral problems: antidepressants, antipsychotics
- treat to make pt comfortable and safe |
|
|
Term
VASCULITIS: heterogeneous groupd of disorders characterized by inflammation w/in walls of affected blood vessels
Large vessel vasculitis: (3)
small vessel vasculitis (3)
medium vessel vasculitis (2)
ANCA-associated disorders (3) |
|
Definition
large vessel vasculitis: takayasu arteritis, GCA, Behcet disease
medium vessel: polyarteritis nodosa, buerger disease
small vessel: immune complex mediated. cutaneous leukocytociastic arteritis, henoch-schonlein purpura, essential cryoglobulinemia (hep C)
ANCA-associated: wegener's, microscopic polyangiitis, churg-strauss syndrome |
|
|
Term
most common vasculitis in children
s/s: purpura, abd pain, arthritis, hematuria |
|
Definition
|
|
Term
sx triad: upper resp disease, lower resp disease, glomerulonephritis
pathology triad: small vessel vasculitis, granulomatous inflammation, necrosis
results in progressive kidney disease
suspect if nasal congestion/sinusitis |
|
Definition
|
|
Term
| typical manifestations of vasculitides |
|
Definition
all involve constitional sx wtih fever, weight loss, malaise, arthritis, arthralgias
large: limb claudication, asymmetric BPs, absence of pulses, bruits, aortic dilation
Medium: cutaneous nodules, ulcers, livedo reticularis, digital gangrene, mononeuritis multiplex, microanuerysms
small: purpura, vesiculobullous lesions, urticaria, glomerulonephritis, alveolar hemorrhage, cutaneous extravascular necrotizing granulomas, splinter hemorrhages, uveitis, episcleritis, scleritis |
|
|
Term
| Risk factors for development of COPD |
|
Definition
smoking (80%)
environmental exposures
air pollution
airway infection
z1-antitrypsin deficiency
allergy |
|
|
Term
RA:
1. hallmark: ___ inflammation causing cartilaginous damage, bone erosions, and subsequent changes in joint integrity. increased # of synovial cells
2. s/s?
3. tx and monitoring |
|
Definition
1. synovial
2. s/s: systemic inflammatory arthritis, involving characteristic joint (PIP, MCP, c1-3, elbows, wrists, toes, ankles, hips), morning stiffness >1 hr, diffuse fatigue and aching. swan neck and boutonniere deformity. foot drop of MTP
extra-articular features: subcu nodules, eye involvement, pulm involvement, vasculitis
3. tx:
synthetic or biologic DMARDs:
MTX - need to check liver and kidney function
arava (leflunomide) - monitor BP
hydroxychloroquine (plaquenil) - yearly eye exams
TNF inhibitors - increased chance of infection |
|
|
Term
SEPTIC ARTHRITIS: usually involves a single joint. causes rapid destruction of articular cartilage. if untreated, bacteria enter bloodstream and can cause sepsis
A. common pathogens in each age group, after surgery, and prosthesis
B. s/s?
C. most common joints?
D. Work up?
E. tx |
|
Definition
1. infants: group B strep, gram neg enteric bacilli, S. aureus
2. young adults: n. gonorrhea
3. adults: s. aureus or gonorrhea
4. older adults: gram neg bacilli, pneumococci, GABHS
5. after surgery: s. aureus
6. prosthetic joints: s. epi or MRSA
s/s: moderate to severe joint pain that is uniform around joint, effusion, warmth, muscle spasm, and decreased ROM, fever
most common joints: knee, hip, shoulder, wrist, elbow, hands, feet
IV drug users: infection of spine, SI joint, SC joint
work up: CBC w/ gram stain and diff
xrays - bony erosion, joint narrowing, osteomyelitis, periostitis,
joint aspiration: synovial cell counts ~100K with >90% neutrophils
tx:
- IV abx - 3rd gen cephs (cefotaxime, ceftriaxone), vanc
- drainage of joint
- ROM |
|
|
Term
|
Definition
sx: pain in joints aggravated by activity, morning stiffness <15 min, onset gradual and additive, acute intermittent flares
labs: ESR and rheum factor elevated
xray: joint space narrowing, osteophyte formation, loss of cartilage, sclerotic change
tx: NSAIDs, cox-2 inhibitors, analgesics, joint injections (steroid, hyalin, synvisc, supartz) |
|
|
Term
GOUTY arthritis: urate crystal deposition in joints and other tissues, acute and crhonic inflammation, peaks in 5th decade,
sx?
labs
tx |
|
Definition
sx: acute arthritis with sudden onset, monoarticular, MTP of feet most common
tophi: deposits of urate crystals, can be chronic tophageous gout
uric acid stones in kidneys
serum uric acid >6.8 mg/dl
Labs:
- uric acid
- joint aspiration: negative birefringent crystals
- gram stain and culture
- xray: soft tissue swelling, bony erosions, soft tissue calcification
tx:
acute flares: NSAIDS, indomethacin, colchicine
chronic management: allopurinol, uloric, colchicine |
|
|
Term
HEMOPHILIA: x-linked bleeding disorder
s/s?
dx?
tx? |
|
Definition
s/s:
moderate to severe: spontaneous bleeding into joints (hemarthrosis), soft tissue bleeding (hematoma), abnormal blleding or bruising. females usually asymptomatic
dx:
- low factor VIII or IX
- prolonged PTT that corrects wtih mixing of normal plasma
- normal PT and vWF
tx:
- mainstay: plasma-derived or recombinant factor concentrates
- mild: IV or intra-nasal DDAVP or desmopressin PRN + antifibrinolytics for mucosal bleeding, Cox2 for arthritis
- avoid NSAIDs and ASA
- kids: prophylactic 2-3x/week infusions of required factor
- adults: factor concentrates as needed |
|
|
Term
|
Definition
CD4 <200
viral load >50/ml
opportunistic infection
malignancy (condyloma, HPV, verrucae, syphilis, HSV, scabies, acute retroviral rash, kaposi's sarcoma, herpes zoster, seb derm, mulloscum, candidiasis, multiple oral apthous, leukoplakis, atypical pneumonias, toxoplasmosis, cryptococus, neurosyphilis, CMV retinitis) |
|
|
Term
Form of intrinsic acute or chronic renal failure
typical patho finding: interstitial inflammatory response w/ edema and possible tubular damage
3 forms:
1. includes b-lactams, sulfas, thiazides, NSAIDs, and allopurinol
2. includes pyelonephritis, streptococcal disease
3. includes sarcoid, lymphoma, and leukemia
s/s
tx |
|
Definition
acute interstitial nephritis
1. allergic
2. infection
3. infiltrative
s/s: fever, transient maculopapular rash, arthralgias, peripheral blood eosinophilia, hematuria, pyuria, proteinuria w/ WBC casts
tx: supprotive, corticosteroids
recovery usually over weeks to months |
|
|
Term
ACUTE RENAL FAILURE
sudden decerease in renal function, usually over about 48 hrs
- inability to maintain fluid/electrolyte balance or to excrete nitrogenous waste
labs - Cr, BUN, UA
s/s?
tx? |
|
Definition
labs:
Cr: increased by 0.5 if baseline <2.0 or by 0.1 if baseline >2.0
BUN: increased
UA: <0.5 ml/kg/hr for 6-12 hours
s/s: rapid increase in BUN and Cr
asterixis
oliguria (usually first sign)
hyper/hypovolemia
metabolic acidosis
pericardial rub
hyperkalemia
efusions
malaise
AMS
edema
N/V
dyspnea
tx: correct the cause
supportive care
dialysis if AEIOU - acidosis, electrolyte abnormalities (hyperkalemia), intoxication, overload w/ fluid, Uremia
|
|
|
Term
causes of acute renal failure:
1. pre-renal. Most common.
- won't see ___ in UA
- hallmark?
- 4 causes?
2. intrinsic renal - 40% of cases
3. post renal - 5% |
|
Definition
1. pre-renal
- won't see hematuria
- hallmark: BUN/Cr >20
- causes: faill in intravascular volume (dehydration, hemorrhage, excessive diuresis, pancreatitis, third spacing)
- fall in intravascular resistance (hypotension, vasodilation, sepsis, ACEI/ARBs
- renal vasoconstriction due to NSAIDs, amphotericin B, calcineurin inhibitors, NE, radiocontrast agents
- low CO due to cardiogenic shock, CHF, CAD, HTN, PE, tamponade
2. Intrinsic renal
- vascular disease - atherosclerosis, HUS, TTP, DIC, preeclampsia, malignant HTN
- glomerular disease
- tubular disease (ATN)
3. post-renal: ureteral occlusion, outflow obstruciton
|
|
|
Term
what dz?
- massive proteinuria >3.5 g/day
- hypoalbuminemia
- edema
- hyperlipidemia
4 types?
tx? |
|
Definition
nephrotic syndrome
4 types
1. minimal change disease: prednisone tx
2. focal segmental glomerulosclerosis: males w/ HTN. Tx: prednisone + cyclophosphamide
3. membranous GN (most common): prednisone + cyclophosphamide. 50% = ESRD
4. membranoproliferative GN: Prednisone + plasmapharesis
general tx: decrease NA and protein intake
ACE/ARB to decrease proteinuria |
|
|
Term
what dz?
myeloproliferative disorder w/ overproduction of myeloid cells that can differentiate
bone marrow fxn remains
characterized by chromosomal and molecular abnormalities - philadelphia chromosome and Bcr-Abl
3 phases:
1. chronic phase: often asymptomatic. fatigue, malaise, weight loss, night sweats, abd fullness, splenomegaly
2. accelerated phase: refractory leukocytosis, worsening systemic sx, bone pain, bleeding, infection
3. Blastic phase: acute leukemia. infection, bleeding, leukostasis (wbc >100K)
labs:
peripheral smear: leukocytosis w/ left shift
bone marrow: hypercellularity w/ increased myeloid to erythroid ratio
tx? |
|
Definition
CML
tx: imatinib
allogeneic hematopoietic stem cell transplant |
|
|
Term
clonal malignancy of B lymphocytes. slowly progressive accumulation of long lived small immunoincompetent lymphs manifested by immunosuppression, bone marrow failure, organ infiltration w/ lymphocytes.
typically older pts
Rai staging system:
- stage 0: lymphocytosis only
- stage 1: + lymphadenopathy - 7 yr survival
- stage 2: + hepatosplenomegaly - 7 yrs
- stage III: + anemia - 1-2 yrs
- stage IV: thrombocytopenia - 1-2 yrs
s/s: weight loss, fatigue, malaise, night sweats
labs:
perippheral smear: lymphocytosis >20K, SMUDGE CELLS
bone marrow: normo or hypercellularity, infiltrated with B lymphs
Lymph nodes: infiltrated w/ small lymphocytic or diffuse small cleaved cells
tx? |
|
Definition
CLL
tx:
stage III-IV only: chemo w/ fludarabine + rituximab +/- cyclophosphamide
thrombocytopenia: rituximab, prednisone, splenectomy
allogeneic transplant
|
|
|
Term
GLOMERULONEPHRITIS: uncommon cause of intransic renal failure
- pathology: inflammatory glomerular lesions
types:
1. GN with anti-GBM antibodies and NO pulmonary involvement
2. GN with anti-GBM antibodies and pulmonary hemorrhage
3. GN with c-ANCA
4. GN with p-ANCA
5. 4 types that have IC deposition
s/s?
labs: Cr, dipstick urine, FeNa - others?
tx? |
|
Definition
1. Anti-GBM disease
2. Goodpasture's
3. Wegener's granulomatosis
4. microscopic polyangitis and Churg-Strauss syndrome
5. post-strep GN, membranoproliferative GN, fibrillary GN, IgA nephropathy
s/s: HTN, edema, abnormal urine sediment, oliguria, cola colored urine
Cr rises over days/mos
dipstick urine: hematuria, moderate proteinuria, RBC casts, WBC
FeNa low
others: complement, ASO titer, anti-GBM antibodies, ANCA, ANA titer
tx: depends on cause and severity
corticosteroids
cytotixic agents (cyclophosphamide)
plsama exchange (goopaster's and pANCA)
|
|
|
Term
|
Definition
anemia
neutropenia
nausea
malaise
HA
insomnia
myopathy
|
|
|
Term
CHRONIC RENAL FAILURE:
1. definition - duration and GFR
2. causes?
3. stages?
4. s/s? |
|
Definition
1. definition: >3 mos of reduced GFR <60 ml/min and/or kideny damage
2. causes: DM, HTN, GN, polycystic disease, drugs
most common: DM
3.
stage 1: GFR >90: find out why
2 (mild): GFR 60-89
3 (moderate): GFR 30-59 - evaluate and tx cmoplications
4 (severe): 15-29 - prepare for renal replacement (transplant or dialysis)
5: GFR <15 - dialysis
4. s/s: those of uremia:
nausea, anorexia, malaise, metallic taste, pruritis, uremic frost, encephalopathy, seizures, neuropathy, pericarditis, accelerated atherosclerosis, HTN, hyperlipidemia, CHF, volume overload, cardiomyopathy, pericarditis, atherosclerosis, HTN, hyperlipid, CHF, volume overload, cardiomyopathy, anemia, bleeding, hyperkalemia, hyperphosphatemia, acidosis, hypocalcemia, hyperparathyroid, osteodystrophy
tx:
Na restriction (<2 g/day)
water restriction <1-2 L/day)
protein restriction
glucose control
BP <130/80
treat sx
4: GFR 15-29 |
|
|
Term
causes of bradycardia
1. imprecise dx for sinus arrest, SA exit block, or persistent sinus brady. common in elderly
2. dig, CCB, B-blocker, sympatholytics, amiodarone, lithium
3.SVT, a flutt/fib
4. due to MI
5. hypoxia, sepsis, hypothermia
6. |
|
Definition
1. sick sinus sydrome
2. drugs
3. reccurent sypraventricular tach
4. increased vagal tone
5. metabolic
6. increased ICP |
|
|
Term
|
Definition
Stage A: high risk for HF. no structural disease. asymptomatic.
- treat underlying disease, diet/exercise, smoking cessation, ACE/ARB
Stage B: structural disease. asymptomatic
- ACE/ARB + BB
Stage C: structurald isease. symptomatic
- ACE/ARB + BB + Na restriction + spironolactone + dig + pacer/difibrilator
Stage D: refractory HF
- everything mentioned above + mechanical assist device, transplant, or IV inotropes |
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Term
obstructive lung disease
1. causes:
2. PFT findings
3. ___ - helps diagnose asthma if spirometry is normal
4. if pt improves with bronchodilator, then? |
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Definition
1. asthma, COPD, bronchiectasis, tumor, foreign body
2. PFT: flow-volume loops, >20% decrease in FEV1, FEV1/FVC <0.75
4. improvement with bronchodilator = asthma
no/minimal response = COPD
3. methacholine challenge
4. |
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Term
PERCUTANEOUS CORONARY INTERVENTION (PCI):
includes?
indications?
labs after?
drugs?
complication? |
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Definition
includes: balloon angioplasty & coronary stenting
indication: when CABG is contraindicated
labs: check CK-MB and troponin
need to be on asa + clopidogrel for at least 1 year
complication: restenosis |
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Term
what dz?
malignant disorder of lymphoid cellst hat reside predominantly in lymphoid tissues; affected nodes show REED STERNBERG CELLS (bilobed nucleus and prominent nucleoli w/ surrounding clear space 'owl eyes')
- bimodal age peak: 20's and >50
- s/s: fatigue, malaise, night sweats, weight loss
- appears in a single lymph node first then spreads in an orderly fashion
Staging with Ann Arbor system?
Labs:?
tx? |
|
Definition
Hodgkin's Lymphoma
Staging:
1: single lymph node region
II: <2 LN regions on same side of diaphragm
III: LN regions on both sides of diaphragm
IV: disseminated involvement of extralymphatic organs
labs:
excisional lymph node biopsy
bone marrow biopsy
Chest/abd/pelvic CT
CBC
BUN/Cr
LFTs
ESR
LDH
uric acid
Ca
albumin
HBV
HCV
HIV
EBV
tx:
stage IA: radiation
stage I/II: short course chemo + radiotherapy
III-IV: full course therapy |
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Term
what dx?
multisystem inflammatory autoimmune disease w/ broad spectrum of clinical manifestation in association with ANA production
- females in 2-4th decade
sx: malar or discoid rash, photosensitivity, non-erosive arthritis, proteinuria, seizures, psychosis, hemolytic anemia, leukopenia, lymphopenia, thrombocytopenia,
labs:
+ ANA
+ anti-phospholipid antibody
increased ESR, CRP, RF
tx? |
|
Definition
SLE
tx:
- NSAIDs
- antimalarials
- Prednisone
- cyclophosphamide
- MTX
- rituximab for refractory disease
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|
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Term
multiple organ disease most commonly affecting the lungs and lymph nodes
also affects eyes, skin, CNS, heart, rheum, endocrine
lung disease: noncaseating granulomatous inflammation that damages alveoli. causes irreversible lung impairment due to progressive fibrosis, bronchiectasis, and cavitation
highest incidence in north american blacks and northern european whites
s/s: malaise, fever, cough, dyspnea, papules, plaques, erythema nodosum, anterior uveitis, optic neuritis, arrhythmias, CHF, conduction abnormalities, mass lesions, seizures, meningitis, encephalitis
Labs: leukopenia, high ESR, hypercalcemia, hypercalciuria, ACE levels high, airflow obstruction, restrictive lung changes (decreased TLC)
biopsy: noncaseating granulomas
staging?
tx? |
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Definition
Sarcoidosis
stage I: hilar adenopathy
Stage II: hilar adenopathy + parenchymal involvement
stage III: parenchymal involvement alone
tx: oral prednisone is first line
MTX, azathioprine, leflunomide - 2nd line
anti-TNF (infliximab) |
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Term
What kind of MI?
1. ST elevation in leads I, aVL, and V5-V6
2. ST elevation in leads v3-v4, sometimes v1-v2
3. ST elevation in leads II, III, aVF |
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Definition
1. lateral * LCx, proximal LAD
2. anterior (LAD)
3. Inferior (RCA) |
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Term
holosystolic murmur heard best at apex. radiation reflects direction of regurgitant jet
also associated with systolic thrill, soft S3, diastolic rumbling decreased w/ valsalva |
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Definition
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Term
DDX for persistent ST elevation on EKG after MI
1. recognized beyond 4-8 weeks
2. occurs 1-12 weeks after MI. autoimmune response w/ fever, luekocytosis and occassionally pericardial or pleural effusion |
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Definition
1. LV aneurysm
2. Dressler's syndrome (pericarditis) |
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