Académique Documents
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Culture Documents
Te
st
Pi
ra
Epi:
For
a
cross-sectional
study:
null
means
that
there
is
simply
no
relationship
o For
a
cohort:
null
means
for
both
groups
there
is
no
diff
btwn
their
outcomes
Musc/Derm:
Cellulitis:
obesity,
tinea
pedis
(barrier
disruption),
regional
LAD,
strep
&
staph
Erysipeloid:
occupational
dz,
affects
fingers
&
hands
Felty
syndrome:
form
of
RA
w/splenomegaly
&
granulocytopenia
Sarcoid
Tx
thats
Symptomatic:
glucocorticoids
SLE
w/renal
involvement
tx:
cyclophosphamide
Anti-phospholipid
syndrome:
hypercoag,
manage
w/heparin
when
preg,
longer
PTT
paradox
Anserine
bursitis:
just
below
knee
joint
medially,
valgus
stress
doesnt
reproduce
pain,
norm
XRAY,
worse
at
night
when
knees
touch
RA:
periarticular
osteopenia
and
joint
margin
erosions
MC
site
for
ulnar
nerve
compression
is
at
elbow:
presents
as
hand
weakness
(interosseus
muscles)
and
decreased
sensation
in
4th
and
5th
digits
Erysipelas:
MC
from
GAS;
Sudden
onset
sharply-demarcated,
erythematous,
edematous,
tender
skin
w/raised
border,
febrile
Hi-dose
steroids
myopathy:
diffuse
muscle
weakness
and
rhabdomyolysis
Reactive
arthritis:
asymmetric
oligoarthritis
a/w
urethritis,
conjunctivitis,
mouth
ulcers
Disc
herniation
tx:
NSAIDs
&
early
mobilization
(exercise
not
shown
to
be
beneficial),
and
if
still
bad
4-6wks,
get
MRI
or
CT.
HIV
drug
SE:
o Didanosine:
induced
pancreatitis
o Abacavir:
Hypersensitivity
o Lactic
acidosis
from
NRTIs
o S-J
syndrome
from
NNRTs
o Nevirapine:
liver
failure
Impingement
is
present
in
all
rotator
cuff
tendonitis
and
improved
ROM
after
lidocaine
injection
distinguishes
it
from
rotator
cuff
tear.
MRI
Non-inflmm
comedones:
topical
retinoids
Inflmm
acne:
topical
benzyl
or
topical
AB
Mod-severe
inflmm
acne:
oral
AB
Recalcitrant
acne,
nodulocystic,
scars
present:
isotretinoin
Wegeners:
since
its
a
vasculitity,
goes
w/subQ
nodules
(painful),
palpable
purpura,
and
pyoderma
gangrenosum-like
non-healing
ulcerative
lesions
;
c-anca
against
proteinase-#
Warning
signs
for
back
pain:
weight
loss,
>50yo,
nighttimepain,
greater
than
1mo
first
step
is
plain
XRAY
to
see
lytic
lesions
or
spinal
infection
Gout
xray:
punched
out
erosion
w/rim
of
cortical
bone
OA:
narrow
space
w/osteophytes,
subchondral
sclerosis/cysts
RA:
periarticular
osteopenia
&
joint
margin
erosions
Hearing
loss
in
pagets:
from
bone
mineral
density
loss
in
the
cochlea
capsule
Hypervitaminosis
A:
abundant
mineralization
of
the
periosteum
Asymmetric
polyarthritis
in
teen:
gonococcal
arthritis
(sometimes
comes
with
tenosynovitis
and
skin
rash);
Dx:
gram
statin
of
synovial
fluid,
bl
cultures
and
urethral
cultures
Hydroxychloroquine:
for
pts
w/SLE
w/arthritis
and
skin
manifests
chk
eyes
(retina)
every
6mos.
te
s
Heat
stroke:
>105;
seizures,
ARDS,
DIC,
hepatic/renal
failue
can
occur
PE:
scattered
rales
+
low
plates
and
PT/PTT
prolonged
Malignant
melanoma:
excisional
biopsy
with
narrow
margina
and
depth
thru
subQ
fat
if
bad
after
this
biop,
then
take
wider
margins
of
1cm
if
<1mm
deep
if
deeper
than
1mm,
sentinel
LN
study
Lupus
arthritis
MC
affects
MCP
and
PIP
like
RA!
Acrochordon:
a
skin
tag
Micro:
HIV
TB
positive
PPD
Tx:
requires
prophylaxis
in
form
of
ISN
+
pyridoxine
for
9mos
(CXR
unremarkable)
Disseminated
fungal
infection
test:
urine
antigen
test
Histo
tx:
itraconazole
preferred
tx
Actinomycosis:
GP
branching
bacilli;
Tx
is
hi-dose
penicillin
for
6-12
wks
G-B
is
opposite
in
presentation
of
botulism
in
that
one
ascends
the
other
descends
Inactive
vaccines
for
HIV
pts:
Tdap,
pneumo,
flu,
Hep
A,
Hep
B,
meningococcal,
HPV,
Hib,
and
live
if
CD4>200:
MMR,
Varicella,
Zoster
(>60yo)
o No
BCG
vac
(live),
anthrax,
typhoid,
oral
polio
o Recommendation
for
meningitis
is
the
same
as
for
non-HIV
pts:
college
age,
asplenia,
travel
exposures
Legionnaires
dz
tx:
erythromycin
(Z-pak)
Clindamycin:
covers
GP,
anaerobes
but
not
GN
First
line
tx
for
human
bite:
amox-CA
to
cover
GP,
GN,
anaerobes
EBV:
lymphs
are
convoluted
nuclei
with
vacuolated
cytoplasm,
maculopapular
rash
(mebe),
palatal
petechial
Rubella:
erythematous
maculopapular
starts
on
face
and
progresses
down;
occipital
&
posterior
cervical
LAD,
arthritis
also
in
adults,
mild
coryza
&
conjunctivitis
pneumovax
<65yo:
lung,
CVD,
DM,
chronic
liver
disease,
alcoholism,
cochlear
implants
Vaccines
that
have
peptides
(not
polysacharrides)
can
illicit
T
cell
response
b/c
can
be
presented
to
T
cells
(not
polysacharrides).
Pneumovax
is
only
a
poly
so
it
creates
a
B
cell
response
that
doesnt
use
T
cells;
things
are
conjugated
to
tetanus
toxoid
protein
to
illicit
T
and
B
cell
response
for
longer
memory
Disseminated
gonorrhea:
polyarthritis,
tenosynovitis,
painless
vesculopustular
skin
lesions
on
shins,
ankles
and
wrists.
IV
ceftriaxone
for
Lyme:
for
early
diss
dz
or
late
dz
oral
doxy
is
good
for
EM
Allergic
to
penicillin
for
syphilis
tx:
doxycycline
for
14d
Cocci:
arthralgias
&
erythema
multiforme
Trichinosis:
from
pig,
starts
as
diarrhea/vomit
infection;
then
splinter
hemorrhages,
conjunctival
and
retinal
hemorrhages,
periorbital
edema,
chemosis,
jaw
and
neck
pain;
then
muscle
pain,
tenderness,
swelling
&
weak
Treatment
of
malignant
otitis
externa
(pseudomonal
infection
in
DM2
pts):
ciprofloxacin
Trimethoprim
SEs:
hyperK
and
increased
Cr
b/c
inhibits
ENAC
channels
like
amiloride
in
CDs
and
competes
with
Cr
secretion
in
the
PTs
Serous
otitis
media
(non-infectious)
in
HIV:
the
MC
middle
ear
pathology
in
AIDS
All
chronic
liver
dz
pts:
vaccine
w/hep
A
and
B
HIV
vaccines:
pneumococcus
recommended
for
pts
w
CD4
>200
(also
MMR);
hepA
only
if
pt
suffering
from
hepB
or
IVDU,
homosexuals;
no
meningitis
CMV
and
EBV
both
have
atypical
lymphs
but
EBV
only
heterophile
+
o CMV
lacks
pharyngitis
and
cervical
LAD
of
EBV
CSF
analysis
in
meningitis
2
Te
st
Pi
ra
te
s
Te
st
Pi
ra
o
WBC
Glucose
Protein
Normal
0-5
45-80
18-58
Bacterial
>1000
<40
>400
meningitis
TB
5-1000
<40
>400
Viral
100-1000
45-80
(N)
<100
G/B
0-5
45-80
45-1000
Herpes
enceph
High
+
RBCs
norm
norm
Syph
tx
if
allergic
to
penicillin:
doxycycline
oral
or
z-pack
but
resistance
w/Z
o Secondary
syph
Sx:
rash
inc.
palms
and
soles,
generalized
LAD,
fever,
sore
throat,
malaise
(constitutional
Sx)
Rash
starts
on
trunk
and
moves
to
extremities
(whereas
rickettsia
rash
starts
on
extremities
and
moves
inwards
these
pts
also
have
severe
headache
and
myalgias)
Crypto
meningitis
tx:
amp
+
flucytosine
an
w/clinical
improvement,
d/c
and
start
fluconazole
PO
HIV
pt
w/esophagitis:
most
likely
candida
so
give
fluconazole,
but
if
doesnt
respond
in
3-5d,
esophagoscopy
w/cytology,
biopsy
and
culture
cld
be
HSV
(give
acyclovir)
or
CMV
(give
ganciclovir)
Ocular
toxo:
necrotizing
retinochoroiditis
looks
white,
fluffy
lessions
surr
by
retinal
edema
and
vitritis
HIV
retinopathy:
benign,
cotton
wool
spots
on
retina
that
remit
spontaneous
CMV
retinitis:
yellow-white
patches
of
retina
opacification
+
retinal
hemorrhages;
tx:
ganciclovis
or
foscarnet
Can
get
reactive
arthritis
after
chlamydia
but
also:
shigella,
salmonella,
yersinia,
campylobacter
and
c-dif
MAC
vs.
whippeli:
acid-fast
vs.
non-acid
fast
(both
PAS-positive
macrophages
Osteomyelitis
a/w
nail
puncture
wound:
PSEUDOMONAS
o Tx:
quinolones
and
surgical
debridement
aggressively
Ehrlichiosis:
spotless
rocky
mtn
lone
star
tick
fever,
malaise,
h/a,
n/v,
leukopenia
&
thrombocytopenia
Babesia
tx:
atovaquone-azithromycin
or
quinine-clindamycin
Cardio
CHF:
respiratory
alkalosis
w/hypoxia
-
highly
suggestive
of
CHF
vs
COPD
OD
beta-blockers:
brady,
AV
block,
hypotension,
diffuse
wheezing;
TX:
glucagon
PVCs
aSx:
observation;
Sx:
Amiodarone
Cold
leg
without
pulses
means
a
arterial
occlusion
most
likely
from
thrombus
from
large
MI
creating
ventricular
aneurysm
Enterococci
endocarditis:
in
pts
with
genitourinary
manipulation
Hypokalemia
Sx:
hyporeflexia,
decreased
muscle
strength,
imbalance,
broad/flat
T
waves,
U
waves,
ST
depression,
premature
ventricular
beats
(a-fib,
torsades
de
pointes,
v-fib
can
occur)
Diastolic
HF:
S4,
exertional
dyspnea,
prolonged
HTN
Lidocaine:
given
to
prevent
ventricular
tachy
and
v-fib
in
post-MI
pts
(or
ACS);
SE:
asystole
Pulseless
electrical
activity
(w/
a-fib):
CPR
&
epinephrine
(Tx)
o Pulseless
vent
tachy/v-fib:
non-perfusing
rhythm
therefor
defib
(Tx)
o Less
severe:
v-tachy,
a-fib
w/rapid
ventricular
response
not
yet
pulseless:
synchronized
electrical
cardioversion
(Tx)
Septic
shock:
low
bl
flow
back
to
heart
dec
RA,
pulm
artery
and
PCW
pressures;
CO
increases
to
maintain
tissue
perfusion;
early
on,
warm/flushed
extremities
3
Hypovolemic
shock:
dec
RA,
RV,
pulm
A,
and
PCW
pressures;
SVR
inc
to
maintain
perfusion
LAD
occlusion:
cardiogenic
shock
due
to
LV
damage,
inc
PCWP,
dec
CO,
inc
SVR
Hemochromatosis-induced
cardiomyopathy:
reversible
(sarcoid
and
amyloid
are
not
but
sarcoid
can
be
controlled
w/glucocorticoids)
1st
line
for
stable
angina
tx:
beta
blocker,
then
Ca-C
blocker,
nitrates
for
acute
setting
Electrical
alterans
(or
beat-to-beat
variation
in
QRS
axis):
pericardial
effusion
(or
low-voltage
QRS);
diffuse
ST
segment
elevation:
pericarditis
Ventricular
aneurysm:
persistent
ST-segment
elevation
after
recent
MI
or
Q
waves
in
same
leads;
can
cause
mitral
regurg,
embolism
o Dx
of
ventricular
aneurysm:
echo
showing
dykinetic
wall
motion
of
portion
of
LV
Pulsus
bisferiens
(biphasic):
AR
w/
or
w/o
AS
and
in
HCM
hyperK
=
bradycardia,
sine
wave
pattern;
immediate
tx
is
Ca
gluconate
aortic
coarctation:
ECG
shows
inc
voltate
of
QRS
(due
to
LVH)
and
ST
and
T
wave
changes
in
left
precordial
leads
(like
depression
and
inversion,
respectively)
Beta
blocker
OD:
bradycaria
&
hypotension,
AV
block
wheezing
Dig
toxicity:
bradycardia
&
normotensive,
blurred
vision,
disturbed
color
perception,
headache
&
ab
pain;
tx
w/
anti-dig
ABF
o Arrhythmia:
atrial
tachy
w/AV
block
MI
can
cause
S4:
ischemic
damage
from
MI
diastolic
dysfunction
&
stiff
LV
Angiodysplasia:
a/w
end-stage
renal
dz
and
AS
AS
causes
turbulent
blood
flow
to
break
von
wilibrand
multimers
(acquired
vWD)
=
inc
risk
of
bleeding.
o Diverticulosis
MCC
painless
lower
GI
bleeding
PACs
risk
factors:
smoking,
alcohol,
caffeine,
stress
only
tx
if
SVT
w/Beta-blockers
MVP:
disappears
w/squatting
b/c
increases
preload;
can
cause
atypical
cardiac
pain
lasting
5-
10s
that
is
unrelated
to
anything.
Differ
NSTEMI
from
unstable
angina:
NSTEMI
has
changes
in
troponin
and
angina
has
no
changes
Thrombolytics
contraindications:
cardiogenic
shock
(use
PCI),
prior
intracerebral
hemorrhage,
ischemic
stroke
<3
mos,
suspected
aortic
dissection,
active
bleed
o PCI
good
within
12
hrs
of
onset
Tx
for
right
ventricular
infarction
that
presents
w/hypotension:
normal
saline
to
increase
BP,
then
if
still
low,
dobutamine
Heart
block
(3rd
is
a/w
Lyme
dz)
o 1st:
PR
greater
than
0.2
s
o 2nd
I:
longer
and
longer;
II:
dropped
beat
w/no
elongation
o 3rd:
MCC
bradycardia
w/rates
30-50;
no
atrial
conduction
to
ventricles;
very
symptomatic
w/weakness,
syncope
and
ventricular
arrhythmia;
uncoordinated
p
and
QRS
complexes
descending
thoracic
AA
a/w:
splenic
ischemia,
renal
insufficiency,
lower
extremity
ischemia,
focal
neuro
deficit
due
to
spinal
cord
ischemia
PE:
presents
w/increased
JVD,
edema,
tachycardia
Tx
increasing
angina
with
increased
beta-blocker
&
increased
nitrates
o If
still
bad:
coronary
angiography
First
step
in
chest
pain
evaluation
(even
if
atypical):
stress
test
>
pharma
stress
test;
adenosine
nuclear
perfusion
stress
test
is
contraindicated
in
ppl
w/asthma
V-tachy:
QRS
>0.12;
a/w
previous
MI
causing
structural
heart
changes,
canon
waves
in
JVD
b/c
of
disorganization
btwn
ventricles
and
atria
WPW:
a
type
of
AV
reentrant
tachycardia
syncope
shortened
PR
delta
wave
ACD
NSTEMI
tx:
beta
blockers
IV
improve
filling
and
perfusion,
also
use
aspirin,
IV
nitrates,
LMWH,
clopidogrel,
statin;
dont
use
warfarin
4
Te
st
Pi
ra
te
s
Sick-sinus
syndrome
(aka
SA
node
dysfunction):
a-fib
or
flutter
alternates
with
bradycardia
A-fib
tx:
warfarin
&
metoprolol
Digoxin
tx
for
HF:
no
improvement
on
survival
but
good
for
Sx
and
decreases
hospitalizations
so
good
to
add
to
regimen
in
someone
w/class
IV
Prolonged
QT
Sx:
syncope
and
cardiac
arrest
due
to
torsade
de
pointes
AR
valve
replacement:
LV
enlargement
signs,
adverse
hemodynamic
effects
on
LV,
EF
<50-55%
Cardiogenic
vs
hypovolemic
shock:
PCWP
is
low
in
hypovolemic
shock
(with
inc
SVR,
dec
BP,
dec
CO,
inc
HR)
and
HIGH
in
cardiogenic
shock
(b/c
of
the
back-up
of
blood)
Ventricular
fibrillation
as
cause
of
death
during
MI:
ischemia
creates
re-entrant
pathways,
and
reentrant
arrhythmia
is
ultimate
cause
of
death
in
pts
with
v-fib.
Theophylline
toxicity:
headache,
insomnia,
seizures,
nausea/vomit,
arrhythmias
Pt
w/acute
HF
due
to
diastolic
dys
(i.e.
HTN):
give
nitrates
even
better
than
morphine
and
loops
b/c
work
FASTER
(and
faster
than
hydralazine)
dont
give
thou
if
pt
hypotensive
Beta-blocker
OD:
brady,
AV
block,
hypotension,
diffuse
wheezing
o Antidote:
glucagon
Septic
shock:
low
PCWP
and
higher
than
normal
mixed
venous
O2
amount
due
to
hyperdynamic
circulation;
preload
pressure
is
also
down,
SVR
is
down,
cardiac
index
(pump
function)
is
up
while
in
hypovolemic
and
cardiogenic
shock
the
index
is
DOWN
(also
in
these
two,
O2
extraction
is
high
and
return
of
venous
blood
shows
LOW
O2
conc.)
Aortic
dissection:
if
involved
spinal
arteries
can
result
in
SC
ischemia
which
presents
as
LE
weakness;
also
pleural
cavity
can
cause
hemothorax
seen
as
pleural
effusion
XRAY;
Dx:
TEE,
or
contrast
CT
too
see
blood
flowing
PE
can
cause:
RV
dilation,
RBBB,
RV
strain,
RV
hypokinesis,
decreased
CO,
decreased
coronary
perfusion
and
RV
myocardial
O2
supply,
elevated
JVD,
accentuation
of
2nd
heart
sound
Lidocaine
and
ACS:
can
stop
v-tachy
or
v-fib
in
pts
w/ACS
(MI),
but
shouldnt
be
given
as
prophylaxis
in
even
someone
with
ventricular
premature
beats
b/c
also
it
decreases
the
risk,
and
increases
the
risk
for
ASYSTOLE
Cholesterol
emboli
after
angio
and
catheter
placement:
blue
toe
syndrome,
livedo
reticularis
with
reddish
to
cyanotic
reticular
discoloration
of
skin,
acute
renal
failure,
GI
pain
and
nausea,
pancreatitis,
increased
eosinophils
in
blood,
+
low
complement
levels
Dig
toxicity
Sx:
nausea,
vomit,
diarrhea,
vision
changes,
arrhythmias
felt
as
palpitations
=
has
narrow
TI
Acut
hemolytic
transfusion
rxtn:
sx
of
fever,
chills
and
flank
pain
and
can
lead
to
DIC
and
renal
failure
and
shock;
due
to
preformed
ABs
to
donor
RBCs
as
a
result
of
ABO
mismatching
A-flutter
mech:
reentrant
circuit
that
rotates
around
tricuspid
annulus
Ddx
for
hypoxemia
and
bilateral
infiltrates
on
CXR
inc
cardiogenic
pulm
edema
and
ARDS
diff
based
on
PCWP
w/<18
means
ARDS
and
>
is
heart
o Tx
ARDS
w/PEEP
b/c
of
dec
lung
compliance
AAA:
strongest
prediction
of
growth
and
rupture
is
large
diameter
and
cig
smoking;
surg
is
>5.5cm,
>1cm/yr
or
Sx
i.e.
ab,
back,
flank
pain,
limb
ischmia
regardless
of
an
size
Becks
triad:
hypoT,
distended
neck
veins,
muffled
heart
sounds
Constrictive
pericarditis:
signs
of
venous
overload
b/c
of
impaired
filling
like
elevated
JVD,
ascietes,
pedel
edema;
kussmauls
signs,
pericardial
knock
(early
heart
sound
after
S2),
sharp
X
and
Y
descents
b/c
pericardium
collapses
Giant
cell
arteritis
(temporal
arteritis):
can
involve
large
vessels
of
aorta
and
aortic
aneurysm
is
a
common
complication.
hypoCa:
hyperactive
DTRs,
muscle
cramps,
convulsions
(i.e.
blood
transfusions
with
citrate
as
preservative)
During
stress
test
hold
meds:
BBs,
CCBs,
and
nitrates;
continue
ACE,
diuretic
Te
st
Pi
ra
te
s
te
s
Marfans
suffer
from
MVP
&
AR
(which
can
be
result
of
aortic
dissection!)
Rate-control
Rx
for
A-fib:
diltiazem,
verapamil,
metoprolol,
digoxin
CHADS2
is
for
anti-coagulation
score:
1
point
for
age
>=75,
HTN,
DM,
CHF,
prior
stroke
(2pts);
>2
is
warfarin/dabigatran
Differentiate
restrictive
from
hypertrophic
(b/c
both
cause
diastolic
dysfunction)
via
symmetric
or
aSym
thickening
of
ventricles
Beta-blockers
improve
mortality
in
STEMI:
dec
O2
demand
and
inc
diastole
thereby
increases
coronary
perfusion
o Also
in
STEMIs
always
give
heparin,
ACE-I
(shown
to
improve
mortality
in
STEMI),
and
aspirin
(also
improves
survival)
o Never
use
CCBs
in
STEMI
b/c
cause
reflex
tachy
and
inc
O2demand
PVC;s:
can
occur
after
MI
with
more
frequency,
just
observe
then
suppressing
them
w/anti-
arry
meds
worsens
survival;
look
like
wide
QRS,
bizarre
morphology
and
compensatory
pause
o 1st
line
tx
for
Sx
pts:
beta-blockers
to
delay
conduction
to
ventricles
o 2nd
line:
amiodarone
Digoxin
tx:
for
a-flutter
and
a-fib
(any
atrial
arry
to
delay
conduction
down
to
ventricles)
o Digitalis
toxicity:
atrial
tachycardia
(due
to
increased
ectopy)
and
AV
block
occurring
at
the
SAME
TIME
Adenosine:
1st
line
pharma
(after
vagal
maneuver)
for
PSVT.
If
fail,
try
dig
DC
cardioversion:
[P]SVT
w/unstable
vitals
(low
BP),
refractory
chest
pain
Endocrine:
The
single
MCC
aSx
isolated
elevated
alk
phos
in
elderly
is
Pagets
(osteitis
deformans)
o Bone
pain
due
to
prostate
mets:
elevated
alk
phos,
higher
>4
PSA
and
hyperCa
Glucagonoma:
DM,
necrolytic
migratory
erythema
(like
eczema),
weight
loss,
diarrhea,
anemia
of
chronic
disease;
dx:
hyperglycemia
w/elevated
glucagon>500,
CT/MRI
to
localize.
Hyperthyroidism:
proximal
musc
myopathy
that
can
look
like
polyomyositis
Pancreatitis
due
to
GS:
even
if
stone
passes,
and
itis
resolves,
must
take
GB
OUT
MC
side
effect
of
radioactive
Iodine
tx
for
graves:
hypoT
hyperT
tx:
before
giving
radioactive
therapy,
give
methimazole
to
deplete
thyroid
hormone
Acute
panc
management:
conservative
w/analgesics
(meperidine,
fentanyl),
IV
fluids,
NPO
o ERCP:
only
if
a
stone
is
causing
the
panc,
not
if
its
alcohol
causing
it
hypoCa:
prolonged
QT
autoimmune
hypoparathyroidism:
APECED
=
autoimmune
epolyglandular
endocrinopathy
candidiasis
&
ectodermal
dysplasia;
in
pts
w/mucocutaneous
candidiasis
Intensive
BP
control
is
the
only
thing
shown
to
slow
renal
decline
in
diabetics
once
AZOTEMIA
develops
why
they
are
put
on
ACE
and
goal
is
<130/80
Cushing:
hypertension
due
to
vasoconstriction
from
cortisol,
insulin
resistance
and
increased
mineralocorticoid
activity
(low
K)
SIADH
cause:
NSAIDs!!!!
o Suspect
w/low
plasma
osmolality
(<280)
and
high
urine
osmolality
(>100)
&
hypoNa
Steroid-induced
myopathy:
sounds
like
polyomyositis
w/prox
musc
weakness,
but
with
normal
CK
levels
&
ESR
Addisons:
eosinophilia
present
o Dx:
early
morning
cortisol
(should
be
high
>15,
5-15
is
intermediate),
ACTH
(if
high
is
diagnostic)
and
cosyntropin
test
Cosyntropic
is
like
ACTH,
and
an
inc
in
cortisol
>20
in
30-60m
rules
out
AI
If
adrenal
gland
atrophy,
could
be
ACTH
deficiency
(central
AI)
Cushings
Dx:
24
hour
free
cortisol
and
low-dose
dexamethasone
suppression
test
Te
st
Pi
ra
Hearing
loss
in
pagets:
correlates
w/loss
of
bone
mineral
density
in
cocholear
capsule;
also
inc
headaches,
inc
hat
size
Acromegaly:
#1
cause
of
death
is
congestive
heart
failure;
inc
risk
for
LVH;
also
inc
risk
for
hypertension
&
hyperglycemia
3
causes
of
reduced
iodine
uptake
in
thyroid
test
w/thyrotoxicosis:
subacute
granulomatous
thyroiditis
(painful),
subacute
lymphocytic
thyroiditis
(painless),
levothyroxine
OD
(exogenous),
iodine-induced
thyrotoxicosis
hyperCa
due
to
metastatic
dz
tx:
bisphosphonates
for
long-term
tx
Resistance
to
thyroid
hormones
causing
hypoT:
elevated
T3/4
and
normal
TSH
Organophosphate
poisoning:
remove
clothes
to
prevent
abs
from
skin
if
vomited
on
self
Acute
panc:
complications
inc
pleural
effusion,
atelectasis,
elevated
hemidiaphragm,
pulm
infiltrates,
ARDS;
Sx
relieved
by
leaning
forward
Viralzing
tumor:
test
testosterone
(meanin
ovary
origin)
and
DHEAS
(meaning
adrenal
origin);
DHEA
is
secreted
from
both
the
adreneal
and
ovaries
Follicular
thyroid
CA:
early
hematogenous
spread
to
lung,
brain,
bone
must
show
invasion
of
capsule
and
blood
vessels
to
differentiate
from
follicular
adenoma
o Papillary:
unencapsulated
and
spread
via
lymphatics
Diabetic
head
infections:
rhizor
is
in
the
nasal
and
goes
up
to
orbit
thru
brain;
pseudomonas
is
in
ear
with
granulations
and
can
go
into
jaw
and
skull
base
and
cause
cranial
nerve
lesions
Metabolic
syndrome
is
3
of
5:
o Waist
in
men
>40in
and
women
>35in
o Fasting
glucose
>100
o BP>130/80
o TG>150
o HDL
<40
in
men
and
<50
in
women
Insulin
resistance
causes:
dyslipidemia,
endothelial
dysfunction
prevents
endothelial-
dependent
vasodilation,
procoag
state,
inc
sympathetic
activity,
inc
inflmm
markers,
dec
uric
acid
excretion,
inc
Na
absorption,
inc
testosterone
from
ovaries
(hairy
fat
ladies)
Cortisol
def:
eosinophilia!
Most
GS
are
radiolucent
b/c
most
are
of
cholesterol!
Acromegaly
Dx:
IGF-1
level
if
elevated
oral
glucose
suppression
test
if
GH
not
suppressed
MRI
of
brain
if
mass
in
pituitary
then
surgically
resect
or
manage
medically
Decreased
Iodine
uptake
test:
painless
thyroiditis,
subacute
granulomatous
thyroiditis
(De.
Quervains,
which
is
painful),
too
much
thyroid
meds,
iodine-induced
thyrotoxicosis.
Lipid
screening:
45
for
women
and
35
for
men
20
for
DM,
family
Hx
of
premature
CAD,
familial
hyperlipidemia,
several
risk
factors
Bechets:
also
get
erythema
nodosum
Sick
euthyroid
syndrome:
in
pts
w/chronic
illness
from
inc
in
IL1,
IL6
and
decrease
in
calories
low
T3,
normal
T4
(decreased
conversion
to
T3),
normal
TSH
if
prolonged,
TSH
and
T4
can
increase
Graves
dz
best
tx:
radioactive
iodine
contraindicated
in
pregnancy
and
severe
ophthalmopathy
o Surgery:
for
large
goiter
or
nodule
susp
of
CA;
also
risk
of
laryngeal
nerve
palsy,
hypoparathyroidism,
hypoT
Cushing
Sx:
central
obesity,
wasting
of
limbs
w/proximal
musc
weakness,
purple
striae,
easy
brusing,
HTN,
skin
pigmentation
(due
to
ACTH
increase)
on
sun-exposed
area,
if
ectopic,
can
act
like
mineralcorticoid
and
cause
HTN
and
low
K+
hypoT
is
a/w
hyperlipidemia
esp
increased
LDL
Te
st
Pi
ra
te
s
te
s
IF
there
is
an
enlarged,
palpable
GB!
And
its
NOT
PAINFUL,
then
its
PANCREATIC
CA
until
proven
otherwise
o Or
PAINLESS
JAUNDICE
Glucocorticoids
for
vit-D
caused
hyperCa
of
sarcoid
and
lymphoma
hyperT
on
PE:
goiter,
HTN,
tremors
in
fingers/hands,
hyperreflexia,
prox.
Musc.
Weakness,
lid
lag,
a-fib
GI/Liver:
Infectious
endocarditis:
can
cause
septic
emboli
to
spleen
(IVDA
can
get
right
or
left
sided
endocarditis)
left
also
carries
a
worse
prognosis
Hepatitis
C
a/w:
cryoglobulinemia,
B-cell
lymphomas,
plasmacytomas,
sjogrens
syndrome,
thyroiditis,
lichen
planus,
porphyria
cutanea
tarda,
ITP
Corrected
Ca++
=
0.8(normal
albumin
(4)
measured
albumin)
+
measured
Ca++
SAAG:
serum
ascites
albumin
gradient
=
serum
albumin
ascites
albumin;
if
>1.1
its
prb
transudate
process
consistent
w/portal
HTN,
if
<1.1,
its
exudative
Mallory-weiss:
submucosal
arteries
of
distal
eso
and
prox
stomach;
versus
varices
is
submucosal
vein
at
G-E
junction
hepB
acute:
most
recover,
few
go
crhonic
and
fewer
go
FHF
o FHF:
hepatic
encephalopathy
w/in
8-wks
onset
acute
liver
failure,
also
w/ALT
high,
inc
PT,
coagulopathy
(active
bleeding);
high
mortality
so
transplant
ASAP
o Contraindications
to
Transplant;
cardio-pulm
dz,
incurable/recent
(<5yrs)
malignant
external
to
liver,
active
alc
or
drug
abuse
Evolution
of
appendicitis
pain:
first
visceral
pain
(dull,
peri-umbilial),
then
as
inflmm
increases,
parietal
peritoneum
and
skeletal
musc
gets
inflmm
causing
localized,
more
severe
pain
Tx
for
dermatitis
herpatiformis:
dapsone
MC
complication
of
peptic
ulcer:
hemorrhage
aka
bleeding
ulcer
SBO:
colicky
pain,
vomit,
no
bowel
mvmt
or
gas
(obstipation),
ab
distention,
diffuse
tenderness,
positive
BS,
air-fluid
levels
on
imaging;
labs:
mild
leukocytosis
and
modest
inc
in
amylase
o if
metabolic
acidosis,
tachy,
fever
=
urgent
surgical
exploration
tx
of
toxic
megacolon:
IV
fluids,
Antibiotics,
bowel
rest;
for
IBD-induced
dz
=
IV
corticosteroids
zinc
def:
presents
as
alopecia,
abnormal
taste,
bullous/pustulous
lesions
around
orificies
inc
mouth;
common
in
TPN
b/c
lacks
Zinc
SBO:
fever
and
leukocytosis
can
occur;
no
bowel
mvmt,
vomit,
relieve
by
NG
tube
and
if
not
better,
surgery;
also
hyperactive
bowel
sounds
(vs.
ileus
which
is
absent
bowel
sounds),
pain
in
all
4Qs
w/no
guarding
or
rebound
tenderness
Malabsorption
in
alcoholics:
due
to
chronic
pancreatitis,
cant
absorb
fat-soluble
vitamins
i.e.
D,
A,
E,
K
low
Ca
b/c
D
is
down;
also
when
albumin
drops
it
doesnt
make
iononized
Ca++
drop,
which
remains
the
same
SAAG:
>1.1
means
transudate
o Exudate
is
<1.1;
from
inc
capillary
permeability
pANCA
is
positive
in
UC;
also
UC
arthritis
similar
to
AS
arthritis
ursodeoxycholic
acid
tx:
for
cholestasis
of
pregnancy
and
PBC
lye
toxicity:
epi
pain,
hypersalivation,
odynophagia;
tx:
hydration,
serial
ab
and
chest
XRAYS,
endoscopy
to
see
extent
of
esophageal
damage;
strongly
alkaline
and
can
lead
to
perforation
or
mediastinitis
thumbprinting
and
ischemic
colitis
wilsons:
can
get
liver
changes
that
look
like
they
are
from
alcohol
w/Mallory
bodies
&
macrovesicular
steatosis
Z-E
syndrome
test
(gastrinoma):
measure
serum
gastrin
ischemic
hepatic
injury:
can
inc
Liver
enzymes
into
thousands!
Te
st
Pi
ra
te
s
UC
and
colonoscopy:
peak
incidence
is
15-25
and
8-10
years
post
dx
=
yearly
colonoscopies
to
look
for
CA
(1%
if
incidence)
Severe
panc:
panc
+
end
organ
damage
to
at
least
1
organ;
can
lead
to
vessel
dilation,
capillary
leak
and
shock;
indicated
for
CT/MCRP
to
look
for
panc
necrosis
and
extrapancreatic
inflammation;
tx:
several
liters
of
lost
fluid
Someone
who
gets
panc
from
no
other
risk
factors
must
have
gallstones,
an
indication
for
taking
GB
out
once
stable
Severe
B12
def:
vitiligo,
glossitis,
thyroid
ab,
neuro
dz,
thrombocytopenia,
leukopenia
Active
GI
bleed
(varices)
in
cirrhotic
pt:
administer
FFP
b/c
has
all
clotting
factors
and
cirrhotic
pts
have
coagulopathies
(spontaneous
bleeds
only
occur
when
plates
<10,000)
hepC
a/w:
cryo,
b-cell
lymphoma,
sjogrens,
lichen
planus,
porphyria
cutanea
tarda,
ITP
Gastric
outlet
obstruction
(i.e.
from
an
ulcer)
tx:
NG
tube
to
decompress
stomach,
NaCl
for
hydration,
KCl
b/c
low
K
from
vomiting
Heme/Onc:
Lead
poisoning:
interstitial
nephritis,
extensor
weakness
(peripheral
neuropathy),
abdominal
pain,
constipation,
difficulty
concentrating,
fatigue,
myalgias,
anemia
RA
pt
on
Methotrexate:
joint
stiffness
symmetrically,
then
gets
mouth
ulcers
(stomatitis),
anemia
(megaloblastic),
hepatotoxicity,
nausea,
fever,
enlarged
spleen,
myelosuppression
Prostate
CA
w/lumbar
spine
involvement:
MRI
but
first
dexamethasone
if
evidence
of
neurological
involvement
Tx
for
autoimmune
hemolysis
due
to
NHL/CLL:
pt
has
large
liver,
axillary
LAD,
tx
w/prednisone
Corrected
retic
count
=
%
reticXHCT
/
normal
HCTXretic
maturation
time
Waldenstroms:
aneimia,
IgM,
hyper
viscosity
=
visual
defects,
pain
&
numbness
in
extremities
due
to
demyelinating
sensorimotor
neuropathy
CT
scan:
for
staging
disease
after
a
biopsy
is
perform
&
a
malignancy
discovered
good
for
revealing
mets
esp
to
liver
(gastric
CA
question)
o H-pylori
is
only
w/MALT,
not
adenocarcinoma
Autoimmune
conditions
a/w
vitiligo:
pernicious
anemia,
graves,
thyroiditis,
DM1,
primary
adrenal
insufficiency,
hypopituitarism,
alopecia
areata
MM:
elevated
ESR
>100,
can
have
normal
leukocyte
count
or
be
leukopenic,
kidney
failure,
elevated
Ca++
Sickle
cell
pts
often
suffer
from
folate
def
b/c
their
BM
is
trying
to
compensate
for
the
chronic
hemolysis
Desired
INR
range
for
someone
with
prosthetic
heart
valve:
2.5-3.5
Breast
cancer
HER2
detection:
FISH
or
immunohistochemical
staining
hyperCa:
hyperactive
DTRs,
muscle
cramps,
convulsions
o hypoMg
can
mimic
b/c
causes
dec
PTH
secretion
hyperMg:
decreased
DTRs,
musc
paralysis,
apnea
&
cardiac
arrest
G6PD
activity
is
often
normal
during
hemolytic
episode
Cachexia
in
CA
tx:
megestrol
acetate
(progesterone
analog)
for
inc
appetite
and
weight
gain
tx
of
hodgkins
w/chemo+rad:
MC
secondary
malignancies
from
the
tx
are
breast
and
lung
CA
3.2%
w/in
20y
get
CA
autoimmune
hemolytic
anemia
tx
(like
from
NHL):
prednisone
first
line
and
then
splenectomy
if
not
working
Spherocytes:
in
both
AIHA
and
hereditary
spherocytosis
(strong
family
Hx
b/c
AD)
PNH:
complement-mediated
(not
Ig)
hemolysis
so
Coombs
negative
test.
Due
to
lack
of
cell
membrane
anchor.
Causes
venous
thrombosis
and
episodic
intravascular
hemolysis
Anti-phospholipid
syndrome
tx:
sx
inc
thrombocytopenia
and
prolonged
PTT;
tx
during
pregnancy:
LMWH
(not
prednisone)
9
Te
st
Pi
ra
te
s
Te
st
Pi
ra
10
Fluphenazine
(typical
anti-psych):
can
inhibit
bodys
thermoregulation
and
cause
hypothermia
especially
in
the
cold
setting.
Withdrawl
from
opiods
in
hospital
tx:
methadone
o Sx:
vomit,
ab
pain,
diarrhea,
restlessness,
muscle
and
joint
pain,
mydriasis,
piloerection,
hyperactive
bowel
sounds
Shy-Drager
syndrome
(mult
system
atrophy):
parkinsonism,
autonomic
dysfunction
(postural
hypotension,
abnormal
sweating,
disturbed
bowel/bladder
control,
salivation/lacrimation,
impotence,
gastroparesis),
other
neuro
signs
(cerebellar,
pyramidal
or
LMN)
o Tx:
intravascular
volume
expansion,
salt,
alpha-adrenergic
ag
Riley-Day
(familial
dysautonomia):
AR,
autonomic
nervous
system
w/severe
orthostatic
hypotension
Pseudotumor
cerebri
dx:
must
get
LP
to
show
opening
pressure
>20
(must
be
done
to
remove
CSF,
show
hi
pressure
and
r/o
meningitis,
encephalitis,
and
subarachnoid
hemorrhage)
o Also
dx
criteria
inc:
ICP
hi
in
alert
pt,
no
neruo
deficits
except
for
6th
nerve
palsy,
no
ventricle
abnormality
except
for
slit-like
ventricles
due
to
ICP
Types
of
stroke
o Subarachnoid
hem:
sudden,
thunderclap
h/a
o Ischemic:
a/w
previous
TIAs,
no
impaired
conscious
o Hem
stroke:
focal
neuro
that
gradually
worsen
until
h/a
+
vomit
+
altered
mental
status
develops
Te
st
Pi
ra
te
s
Renal
Rhabdo:
first
hypoCa
then
HyperCa
weeks
after
during
recovery
Tubulointerstitial
nephritis:
seen
with
white
casts,
WBCs
and
sterile
pyuria
(so
chlamydia
and
nephritis
are
2
causes
of
sterile
pyuria)
Membranous
glomerulonephritis:
the
MC
nephrotic
syndrome
cause
of
renal
vein
thrombosis
due
to
antithrombin
III
lost
in
urine
o Renal
vein
thrombosis
Sx:
sudden
onset
ab
pain,
fever,
hematuria
Anion
gap:
Na-Ca
+
HCO3
Hypokalemia:
from
alcoholism
and
vomiting
Methanol
damages
eyes,
ethylene
glycol
damages
the
kidneys
Vomit
causes
alkalosis
so
replace
w/KCl:
due
to
contraction
alkalosis
(hyperaldoism),
and
renal
K
wasting
in
an
effort
to
reabsorb
H+
instead
RCC
triad:
hematuria,
flank
pain
and
palpable
abdominal
mass
IgA
versus
PSGN:
complement
levels
normal
in
IgA,
IgA
usu
5d
or
less
after
infection,
adults
Hypernatremic:
means
free
water
deficit,
so
first
replace
w/isotonic
saline
(0.9%)
b/c
this
is
hypotonic
to
the
person,
and
is
replacing
vol.
Then
add
normal
saline
for
more
free
H20
o 5%
dextrose:
for
euvolemic,
hypervolemic
hyperNa
(above
was
hypovol,
hyperNa)
chloride-resistant
metabolic
alkalosis:
urinary
Cl
>20
with
ECF
volume
expanision;
not
corrected
by
giving
normal
saline
primary
hyperaldoism,
bartters,
gitelmans,
excessive
black
licorice
ingestion
Pathophys
of
membranoproliferative
nephrotic
syndrome:
antibodies
against
C3
convertase
lease
to
perssiten
complement
activation
and
deposition
within
kidney
causing
damage
Renovascular
HTN
tx:
angioplasty
w/stent
placement
Below
the
umbilicus
=
SUPRAPUBIC
nephrogenic
DI:
if
lithium
give
amiloride
b/c
blocks
Li
accumulation
in
kids;
if
low
BP
and
hypernatremic
correct
volume
status
first
with
normal
saline
than
water
loss
with
0.45%
saline;
if
normotensive,
correct
only
water
loss
w/0.45%
saline
If
chloride
is
low,
prb
an
anion
gap
meta
acidosis
(aka
hypochloremic
met
acidosis);
if
chloride
is
high
its
a
non-gap
i.e.
with
RTAs
11
te
s
Te
st
Pi
ra
12
te
s
Te
st
Pi
ra
13
te
s
Te
st
Pi
ra
Emergency
CPR
In
pulseless
electrical
activity:
there
is
organized
rhythm
on
cardiac
monitoring
w/o
measureable
or
palpable
pulse
in
a
cardiac
arrest
pt
do
CPR
or
vasopressor
therapy
to
achieve
cerebral
and
coronary
perfusion
V-fib
or
pulseless
VT:
early
d-fib
Use
cardioversion
in:
o Symptomatic
or
sustained
(VT)
v-tachy
o Hemodynamically
unstable
a-fib
w/RVR
(rapid
ventricular
response)
14