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IM
Rounds-2
46
Medical
Graduate
01/23/2014

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Term
what is an empyema>
Definition
pus in the pleural space
Term
what is a parapneumic effusion
Definition
an effusion in the pleural space that occurs from pneumonia
Term
how do you decide if a parapneumonic effusion needs to be drained or will resolve on its own?
Definition
if the effusion is an empyema, you must drain it.

this can be determined by determining the pleural fluid pH. If low (less than 7.2), you gotta drain it
Term
pleural effusion with elevated lymphocytes means ___________
Definition
tb or lymphoma causing effusion
Term
what do you give to a pt with bone pain from bony mets from prostate cancer?
Definition
to treat the pain you can give etidronate disodium
Term
does p. jiroveci have a productive or non productive cough?
Definition
non
Term
cxr shows solid mass with radiolucent crescent?
Definition
monods sign
seen in aspergillosis
Term
sx of coarctation of the aorta
Definition
HTN
often asymptomatic...but may have:
HA, epistaxis, blurred vision, heart failure (all 2/2 blurred vision)
Term
what is found on PE of coarctation of the aorta?
Definition
-brachial femoral delay
-different bp in upper and lower limbs
-weakened lower body (esp in infants)
Term
what does ekg show in coarcation of the aorta?
Definition
-LVH
-big QRS
-ST and T wave changes in left precordial leads
Term
what does CXR show
Definition
-notching of 3rd-8th rib due to large intercostal arteries
-"3" sign of aorta
Term
anasarca
Definition
extreme generalized edema
Term
electolyte and abg changes in severe sleep apnea
Definition
1. hypventilation at night = hypercapnia that resolves during awake time (unless they have obesity related persistant hypoventilation)
2. to respond to the hi CO2, the kidneys retain HCO3 and dump Cl

In summary: hi pCO2 causing resp acidosis, compesatory hi HCO3, low Cl
Term
F/U after incidentally finding cyst on kidney?
Definition
no follow up necessary
Term
asbestos increases risk for what types of cancer?
Definition
1. broncogenic carcinoma (#1)
2. mesothelioma

both may have plaques, but bronchogenic will have a discrete mass
Term
signs of acromegally
Definition
-coarse facial features
-oily skin
-dough like palms
-skin tags
-carpal tunnel
Term
testing for acromegally
Definition
1. check IGF1 level. if normal acromegally is ruled out.
2. if IGF1 is hi, do oral glucose-growth hormone suppression test. if glucose supresses GH normally than RO acromegally
3. if glucose does not suppress GH...then do MRI of brain. Likely pituitary mass.
Term
what drug can cause acquired sideroblastic anemia
Definition
isoniazid
Term
how does isoniazid cause sideroblastic anemia?
Definition
its a pyridoxine antagonist which impairs protopophryin synthesis. sideroblastic anemia mimics iron def anemia.
Term
best way to tell sideroblastic anemia from IDA?
Definition
sideroblastic anemia will have: "dimorphic" RBC population, hi serum Fe and low TIBC
Term
confirmatin of sideroblastic anemia
Definition
bone marrow biopsy shows sideroblasts!
Term
tx of sideroblastic anemia
Definition
pyridoxine
Term
tx of hypertrophic cardiomyopathy in young ppl
Definition
Beta blockers
Term
management of supraventricular tachy
Definition
adenosisne
Term
major features of SVT
Definition
narrow complex tachycardia
about 160 bpm
Term
skin cancer that looks "punched out"
Definition
basal cell
Term
surgical guidelines for removing basal cell carcinoma
Definition
surgical excision with 1-2 mm with clear margins
Term
young person with htn who develops hypokalemia easily after starting thiazide
Definition
consider primary hyperaldosteronism
Term
best way to screen for primary hyperaldosteronism
Definition
1. early morning plasma aldosterone concentration
2. plasma renin activity
Term
parasthesias after blood transfusion
Definition
many blood products have citrate anticoagulant which chelates Ca and causes hypocalcemia --> paresthsia
Term
abg in COPD exacerbation
Definition
respiratory acidosis
Term
pathogenesis of carpal tunnel
Definition
accumulation of matrix substances
Term
currant jelly sputum
Definition
klebsiella
Term
who gets pseudomonas pneumonia?
Definition
CF pts
or pts with bronchiectasis
Term
pneumonia + cold agglutinins in blood
Definition
mycoplasma pneumoniae
Term
what kidney is easier to palpate? why?
Definition
R, its lower.
Term
palpable kidenys and htn
Definition
polycystic kidney disease
Term
tumors at the grey white matter jxn of the brain often are ___________
Definition
mets
Term
management of brain tumor from lung mets
Definition
surgical resectino followed by chemo
Term
Behcet syndrome
Definition
A multisystemic inflammatory disease
-oral ulcers
-genital ulcers
-anterior uveitis
-hyperpigmented erythema nodosum
Term
back paint hat radiates to butt and thighs that interferes with walking and lumbar extension
Definition
degenerative central canal stenosis
Term
what does erythema nodosum look like
Definition
painful, subcut nodules on anterior surface of lower legs.
Term
what is erythema nodosum assocaited with?
Definition
sarcoid, tb histoplasmosis and inflammatory bowel disease
Term
how do we calculate number needed to treat?
Definition
1/absolute risk reduction
Term
who can get mallory hyaline in liver?
Definition
alcoholics
those with wilsons disease
Term
what cancer goes with HNPCC besides colon cancer
Definition
endometrial carcinoma
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