Features of tabes dorsalis
- neurodegenerative condition that interferes with posterior spinal column and nerve roots
- treponema pallidum infx
- argyll robertson pupils (normal pupillary constriction w/ accomodation but not w/ light)
- sensory ataxia
- lancinating pain
- neurogenic urinary incontinence
late dementia is associated with what dz
alzheimers and vascular dementia
budd chiari syndrome signs sx tx
- ascites on imaging
- severe abdominal pain
- hepatic vein obstruction usually from thrombosis
- young and middle aged women
acute hep b treatment
- supportive measures, unless infected with concurrent hep c, immunosuppression, or severe disease
- then, requires antiviral therapy
- hep b ig and hep b vaccine usually given within 24 hours postexposure
acute to chronic hepatitis progression rates
- if perinatally acquired, then 90%
- for hep b, 5% of adults get chronic
- for hep c, 50%
- infected at age 1-5, 20-50% rate
Causes of long QT syndrome
- meds (diuretics, anti-emetics, anti-psychotics, TCA, SSRI, antiarrthymics, antianginal drugs, anti-infective drugs)
- metabolic disorders (electrolytes, hypothyroidism)
- bradyarrhythmias (SA node dysfx, AV node)
- Others (infection, hypothermia, MI)
torsades de pointes treatment
- IV mag
2. temporary transvenous pacing
Acute mitral regurgitation causes, sx, heart sound, diagnostic test
causes: mitral valve prolapse, IE, trauma, rheumatic heart dz
- sx: pulmonary edema, cardiogenic shock, pulm HTN–> right heart failure
- descrescendo systolic murmur, silent murmur 50% of the time
- need ECHO
Ehlers Danlos syndrome
- joint hypermobility
- velvety hyperextensible skin
- atrophic scars
- AD
Marfan’s syndrome
- pectus carinatum
- increased arm span to height
- aortic root dilation, MVP
- lens dislocation
- spontaneous pneumothorax
- AD
Refeeding syndrome clinical fx
- arrhythmia
- CHF (pulmonary edema, peripheral edema)
- seizures
- wernicke’s encephalopathy
- decreased phos, potassium, mg, thiamine, increase in sodium, water retention
hyperthyroidism treatment
- beta blockers if symptomatic
- methimazole, PTU if thyroid storm (fever, AMS, CHF, liver disease)
- surgery/RAI if oral drug therapy fails
thyrotoxicosis in elderly
- neuro: apathy, confusion, tremor, proximal muscle wasting
- CV: afib, tachycardia, HF
- endocrine: proptosis, lid lag, thyromegaly (often absent)
- GI: decreased appetite, constipation
suicide assessment
ideation, intent, plan
when to start antivirals for flu (ostelmavir)
- hospitalization
- less than 48 hours of sx onset
- age over 65 or pregnant
- other high risk medical condition; pulmonary, cardiac
Indications for stress ulcer prophylaxis (PPI)
any 1 factor:
- coagulopathy (low platelets, high INR etc)
- mech vent > 48 hours
- GI bleeding/ulceration in the past year
any 2 factors:
- sepsis
- 1 week ICU stay
- glucocorticoid therapy
- occult GI bleeding > 6 days
presentation of acute ischemic colitis
- pt usually has atherosclerotic disease
- abdominal pain followed by bloody diarrhea (splenic flexure or rectosigmoid jx)
- x-ray/sigmoidoscopy show mucosal edema or mucosal ulceration
How to assess HIV progression
- CD4 count: damage that has already occurred
- viral load: disease activity/ damage that is about to occur
when to start statin therapy
- atherosclerotic disease
- LDL >190
- age 40-45 w/ diabetes
- estimated 10 year ASCVD risk >7.5%
management of symptomatic PAD
- risk factor management: start statin, antiplatelet therapy, bp, diabetes, smoking cessation
- exercise program
- meds: cilostazol
- revascularization (stents, surgery)
management and treatment of familial adenomatous polyposis (FAP)
- colectomy
- need upper GI endoscopy to see if gastric and duodenal adenomas/carcinomas exist
- nearly all patients get Colon CA by age 45
management and treatment of acute pancreatitis
- check amylase and lipase levels
- look for etiology: lipid test, US for gallstones, calcium levels
- treat with IV fluids (third spacing), pain control
- acute pancreatitis with deterioration after 72 hours needs CT SCAN
when should wounds be left open?
- puncture wounds
- dog bite, cat bite, human bite hand injury
neonatal jaundice presentation normal vs abnormal
- physiologic jaundice presents 24 hours after birth
- coombs negative unconjugated hyperbili in first 24 hours represents hemolysis (G6PD in Af. Am, Mediterranean, Asian male infants as it is X-linked)
