Term
Hemispherical spinal column-penetrating injury or unilateral lesion with:
1. ipsilateral motor and proprioception (position and vibration) loss and
2. Contralateral pain and temperature loss |
|
Definition
|
|
Term
| Risk factors, sx (acute and chronic), labs, tx, and prognosis for arterial insufficiency |
|
Definition
Risk factors: smoking, HTN, high cholesterol, obesity, DM, >70 y/o, >50 y/o and smoker, family hx
Sx:
1. acute: due to embolus or thrombus - sudden onset extremity pain, loss or decreased pulses, neuro dysfunction, pallor on elevation, coolness, mottling
2. Gradual: due to atherosclerosis: pain w/ exercise, pain on and off with activity, pain at rest, skin ulcerations, blue toes, gangrene
Workup: pulses, ABI, doppler, angiography
Tx: heparin, Statin
- surgery: tpa, emoblectomy, angioplasty, stent, bypass with graft
Prognosis: acute occlusions have 10-25% risk of amputaiton |
|
|
Term
| Venous insufficiency - causes, sx, ddx, workup, tx, prognosis |
|
Definition
Causes: Leg trauma, deep vein phlebitis, obesity, post-thrombotic syndrome
Sx: PROGRESSIVE PITTING EDEMA is first sx, shiny/thin/brown kskin at ankle (hemosiderin), itching, dull discomfort with standing or walking, ulcerations meaial and just anterior to ankle, varicose veins, cellulitis
DDX:
1. CHF, Liver dz, kidney dz --> all have chronic edema
2. Lymphedema --> typically unilateral and no varicosities
3. Lipedema --> stops at ankle
4. Arterial insufficiency
Workup: US
Tx:
1. acute: heparin, tPA
2. Chronic: stockings, avoid long period of standing and sitting, surgery |
|
|
Term
| Pressure ulcers: Majority develop in what setting?, Risk factors, stages, workup, tx |
|
Definition
Majority develop in hospital stay for acute illness
Risk factors: immobility, moisture (incontinence), decreased sensation, poor nutrtion, shear force, friction
6 stages:
1. Blanchable hyperemia
2. extends through epidermis
3. full thickness skin
4. extension into muscle, bone, supporting structures
5. unstagable: eschar tissue
6. suspected deep tissue injury in area of discolored/blistered skin
workup: braden or norton scale for pt environment
Bx if poorly healing
Tx: repositioning, special mattress, good nutrition, remove necrotic debris, keep moist, dressings
|
|
|
Term
| Causes/risk factors for DVT |
|
Definition
Pacemaker catheter
Bedrest
Fm hx
Leg/pelvic fx
6 mos Post Partum
obesity
recent surgery, esp ortho
polycythemia
cancer
autoimmune dz
smoking
OCP or estrogen therapy
prolonged sitting |
|
|
Term
|
Definition
Sx: changes in leg skin color, warm skin, edema
workup:
1. For dx: d-dimer, doppler
2. For workup: CRP, antithrombin III, APA, CBC, gene mutations, Protein C and S levels
Tx: heparin the coumain, pressure stokcings, surgery
|
|
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Term
| 3 sources of infection in osteomyelitis |
|
Definition
1. Bacterial infection disseminated in blood
2. invasion from contiguous focus of infection (most common is joint replacement)
3. Skin breakdown from vascular insufficiency |
|
|
Term
| OSteomyelitis Sx, workup, tx |
|
Definition
Sx: fever, chills, pain/tenderness
- NO fever in local or vascular insufficiency
- No pain in vascular insufficiency
Workup:
1. nuclear bone scan is most sensitive
2. xray: neg for first two weeks, then soft tissue swelling, loss of soft tissue planes, bone demineralization
3. MRI/CT |
|
|
Term
| Causes of pre, intrinsic, and post renal failure |
|
Definition
Prerenal: decrease in intravascular volume, change in PVR, low cardiac output
Intrinsic: occurs after pre or post failure due to injury to tubules, interstitium, vasculature, and glomeruli
Postrenal: urinary outflow obstruction |
|
|
Term
| Nephrotic syndrome sx & workup |
|
Definition
Sx: proteinuria >3 g/day, hypoalbuminemia, edema (3rd spacing), hyperlipidemia, lipiduria, prone to hypercoagulability
workup: serum albumin, CBC, BUN/Cr, ANA, cryoglobulins, hepatitis, ANCA, Anti-GBM antibodies, ASO titers, UA, renal bx |
|
|
Term
#1 cause of nephrotic syndrome in kids.
unknown cause
treatment? |
|
Definition
minimal change disease
tx: STEROIDS, ACE/ARB |
|
|
Term
| secondary causes of nephrotic syndrome |
|
Definition
DM - MOST COMMON
lupus nephritis
paraproteinemias (multiple myeloma, amyloid)
HIV
Hep B
preeclampsia
tx: ACE/ARB, low protein, salt, diuretics |
|
|
Term
Pyelo:
1. most common organisms
2. sx
3. tx |
|
Definition
gram neg most common - e. coli, klebsiella, proteus, enterobacter, pseudomonas
sx: irritative voiding (urgency, freq, dysuria) + fever + flank pain
tx: outpt - quinolones (cipro) or macrobid
inpt - IV ampicillin or aminoglycoside |
|
|
Term
hematuria, dysmorphic red cells, red cell casts, mild protienuria, dependent edema (periorbital, scrotal), HTN, high Creatinine
cause: typically autoimmune, strep, Goodpasture's, hepatitis
tx? |
|
Definition
glomerulonephritis
tx: high dose corticosteroids, cytotoxic agents (cyclophosphamide) and treat underlying cause |
|
|
Term
Cause of 85% of intrinsic kidney injury
2 main causes: ischemia (hypotension, hypoxemia, volume depletion, shock, sepsis) and nephrotoxin exposure (aminoglycosides, amphotericin, vancomycin, acyclovir, cephalosporins, rhabdomyolysis, contrast media, heavy metals, hyperuricemia, bence jones proteins)
sx: n/v, AMS, HTN, azotemia, encephalopathy, pericardial effusion, arrhythmias
Labs: hyperkalemia, hyperphosphatemia, BUN:Cr <20:1, "muddy brown" casts on UA
Tx? |
|
Definition
ATN
tx: loop diuretics, dietary protein restriction, may need dialysis |
|
|
Term
Fever, transient maculopapular rash, acute or chronic kidney injury, pyuria, WBC casts, hematuria, arthralgias, eosinophilia
70% cuase is drugs
tx? |
|
Definition
Interstitial nephritis
tx: urgent dialysis, remove inciting agent, short course corticosteroids (methylprednisone or prednisone) |
|
|
Term
vomiting and diarrhea (sometimes bloody), fever, irritability, lethargy, seizures + acute renal failure with anuria and microangiopathic hemolytic anemia and thrombocytopenia
Occurs after GI infx with e. coli in kids
renal bx: occlusive lesions of the arterioles and small artries and consequent tissue microinfarctions
treatment |
|
Definition
Hemolytic uremic syndrome
treatment: supportive care, fluid and electrolytes, BP control, phenytoin for seizures, azotemia, optimal nutrition, may need renal transplant
mainstay: corticosteroids, blood transfusion, dialysis |
|
|
Term
Disease caused by changes in the tau protein, causing microtubule collapse in neurons, which causes neurofibrillary tangles. These tangles disrupt neuronal transmission.
Another characteristic: amyloid plaques
Sx?
Workup?
tx? |
|
Definition
Alzheimer's
sx: loss of executive functioning (planning, organizing, sequencing), difficulty learning new things, memory impairment, aphasia, agnosia, significant social/occupation impairment -> gradual and continuous
Workup: MMSE
- R/o other causes: PET scan, eEG, CSF studies, labs
tx:
1. acetylcholinesterase inhibitors: aricept, exelon
2. reduce oxidative stress (n-acetylcysteine)
3. NMDA receptor stabilizer (Namenda)
4. Anticonvulsants: Keppra
|
|
|
Term
Dementia:
1. strongest risk factor
2. Most common cause
3. Sx
4. Tx
5. always r/o? |
|
Definition
strongest risk factor: age
most common cause: alzheimer's (50-75%)
Sx: memory loss, loss of cognitive ability, behavior disturbances
tx underlying cause, ACHe inhibitors, antidepressants, antipsychotics
always r/o drugs and metabolic d/o |
|
|
Term
| Dementia caused by HTN, A-fib, DM, CAD, CVD, JC virus - usually sudden onset that spares the memory |
|
Definition
| vascular (AKA multi-infarct) dementia |
|
|
Term
| Dementia that causes visual hallucinations, REM sleep disorder, delirium WITH rigidity, bradykinesia, tremor -- due to posterior parietal atrophy |
|
Definition
|
|
Term
| autosomal dominant dementia, usually seen in pts <65 with changes in judgement, mood, speech, behavior |
|
Definition
|
|
Term
degeneration of dopaminergic nigrostriatal system leading to imbalance of dopamine and Ach in the corpus striatum
3 cardinal signs: rest tremor, rigidity/cogwheeling, bradykinesia
Appearance: camptocormia (loss of extensor tone), stooped posture, flexion of arms, en-block turning, festination (shuffling feet), seb derm
Autonomic sx: orthostasis, urinary urgency, constipation
Non-motor: depression, anxiety, cognitive impairment, anosmia, sleep disturbance
Tx? |
|
Definition
Parkinson's
Tx:
1. Sinemet (Levodopa/carbidopa)
2. Dopamine agonists: prmipexole, ropinirole
3. Others: MAO-B, TCAs, COMT, amantidine, anticholinergics, surgery |
|
|
Term
| A rhythmic purposeless shaking of the muscles that begins with purposeful (voluntary) movement. This tremor does not affect muscles that are resting. The tremor actually gets worse when the pt. gets close to the object that they want to touch. |
|
Definition
|
|
Term
• Symptoms:
o Apprehension
o Worry
o Irritability
o Difficulty in concentration
o Insomnia
o somatic complaints (tachycardia, HTN, increased acidity, nausea, epigastric pain, HA near-syncope |
|
Definition
Anxiety
tx: benzos (for acute)
antidepressants (long-term) |
|
|
Term
· S/S: unpredictable mood swings from mania to depression
· Men and women affected at same rate. Men more likely to have more manic episodes, women more likely to have more depressive episodes.
o Mania: increased psychomotor activity, excessive social extroversion, decreased need for sleep, impulsivity and impairment in judgment, grandiose, irritable mood. Some may have delusions and paranoia indistinguishable from schizophrenia.
· Cyclothymic disorder: milder form of bipolar disorder |
|
Definition
Bipolar
tx: lithium is mainstay
valproic acid good for manic phase
olanzapine/carbamazepine/oxcarbazepine - good for manic
lamotrigene - good for depressive |
|
|
Term
A group of severe, disabling psych disorders marked by withdrawal from reality, illogical thinking, delusions, and hallucinations
- have trouble distinguishing reality from fantasy
5 subtypes:
1. distinguished by marked psychomotor disturbance of either excitement or rigidity with mutism. may be rapid alteration between excitement and stupor
2. marked persecutory or grandiose delusions, often consonant with hallucintaions or similar content with less marked disorganization of speech and behavior
3. marked incoherence and incongruous or silly affect
4. includes persons who have clearly had an episode warranting dx without current sx
5. sx are not specific enough to fit other subtypes
sx begin in late teens, early 20's - usually present for 12-24 mos before pt presents to dr
sx: clang associations (words that rhyme), echolalia, flight of ideas, word salads, neologisms (pt makes up own words)
- positive sx: hallucinations and delusions
- negative sx: deficits of normal functions
tx? |
|
Definition
schizophrenia
1. catatonic
2. paranoid
3. disorganized
4. residual
5. undifferentiated
tx:
1. B52 (haldol, ativan)
2. Respirdal
3. clozapine |
|
|
Term
pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings as indicated by 4 or more:
- does not desire or enjoy close relationships
- almost always chooses solitary activities
- has little interest in sex
- takes pleasure in few if any activities
- lack close friends
- appears indifferent to praise or criticism
- shows emotional coldness, detachement, flattened affect
- does not occur during course of schizophrenia |
|
Definition
|
|
Term
Pervasive pattern of social and interpersonal deficits marked by acute discomfort with and reduced capacity from closer relationships as well as cognitive or perceptual distortions and eccentricities of behavior as indicated by 5 or more:
- ideas of reference
- odd belief or magical thinking that influences behavior
- unusual perceptual experiences - "odd and eccentric"
- odd thining and speech
- suspiciousness or paranoia
- inappropriate or restricted affect
- lack of close friends
- excessive social anxiety that does not diminish wiht familiarity |
|
Definition
|
|
Term
| similar to schizophrenic disorders except that the duration of prodromal, acute, and residual sx >1 week but <6 mos |
|
Definition
|
|
Term
| pts with schizophrenia sx who do not fit in any of the schizophrenic or affective categories |
|
Definition
|
|
Term
| Stimulant (amphetamine) that is used as short-term treatment of depression. This can cause tachycardia, sweating, HTN, mydriasis, hyperactivity, and acute brain syndrome with confusion and disorientation. Tolerance develops quickly and as the dose is increased can lead to hypervigilance, paranoid ideation, stereotypy, bruxism, tactile hallucinations, and full-blown psychosis. |
|
Definition
| methylphenidate (ritalin) |
|
|
Term
TCA used to treat depression, chronic pain, and HA
CI: MI, abrupt withdrawal, hypersensitivity, <25 y/o, old, cardio dz, GI dz, urinary retention, BPH, seizure, thyroid d/o, DM, bipolar, alcohol abuse
SE: drowsy, dizzy, cosntipation, tachy, palpitations, increased appetite lots of other crap
black box warning? |
|
Definition
imipramine
black box: suicidality |
|
|
Term
TCA used for depression, neuropathic pain, DM, HA, post-herpetic neuralgia
CI: MI, abrupt withdrawal, hypersensitivity, <25 y/o, old, cardio dz, GI dz, urinary retention, BPH, seizure, thyroid d/o, DM, bipolar, alcohol abuse
SE: drowsy, dizzy, cosntipation, tachy, palpitations, increased appetite lots of other crap
black box warning? |
|
Definition
amitryptilline (elavil)
black box: suicidality |
|
|
Term
• SSRI
• Contraindications:
o There are no contraindications to this but there are a lot of “use with caution”… Caution if elder, pregnant, hepatic impairment, volume depletion, hyponatremic, suicide history, alcohol use.
• Black Box: suicidality
• Used to Treat: Major Depressive Disorder, OCD, Bulimia, and Panic Disorder
• Side Effects:
o Nausea
o HA
o Insomnia
o Nervousness
o Anxiety
o Diarrhea
o Anorexia
o Tremor
o Ejaculatory dysfunction
o Flu syndrome
o Priapism
o Seizures
o Mania |
|
Definition
|
|
Term
Antipsychotic
Contraindications:
o Hypersensitivity
o Parkinson’s
o Coma
o CNS Depression
o Avoid Abrupt withdrawal
o Caution if electrolyte abnormalities, hepatic impairment, hypothryroidism, dementia, leukopenia, dementia, QT prolongation.
Used to Treat: Psychosis, Tourette Syndrome, Acute agitation.
Side Effects: Extrapyramidal sx, tardive dyskinesia, insomnia, anxiety, drowsiness, lethargy, weight changes, anticholinergic effects, gynecomastia, breast tenderness, galactorrhea, heat stroke, dystonia, hyperpyrexia, HTN, QT prolongation. |
|
Definition
|
|
Term
|
Definition
|
|
Term
2nd gen antipsychotic
used to treat: resistant schizophrenia
black box warnings: agranulocytosis, seizures, myocarditis, cardiovascular/respiratory effects, dementia-related psychosis |
|
Definition
|
|
Term
| benzo used to treat anxiety, alcohol withdrawal, seizures |
|
Definition
|
|
Term
Used as 3rd line treatment of depression. These may cause symptoms of orthostatic hypotension, tachycardia, sweating, and tremors. Insomnia, nausea, and sexual dysfunction can also occur. Most common used…
1.Phenelzine (Nardil)
2.Tranycypromine (Parnate)
3.Selegiline transdermal (Emsam) |
|
Definition
|
|
Term
antipsychotic that blocks some serotonin and dopamine receptors
used to treat most resistant forms of psychosis
fewer extrapyramidal side effects than other typical antipsychotics
SE: hyperprolactinemia |
|
Definition
|
|
Term
MOAI used to treat depression and bulimia
black box: suicidality |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| SNRI used to treat major depression, SAD, smoking, ADHD |
|
|
Term
| narcotic antagonist used to treat narcotic overdose |
|
Definition
|
|
Term
|
Definition
| typical neuroleptic - lots of autonomic SE and markedly lower arousal levles |
|
|
Term
small red, conical, hard nodules that occassionally ulcerate in sun-exposed areas
may arise de novo or from AK
tx? |
|
Definition
squamous cell carcinoma
tx: excision with mohs - follow up q 3 mos initially - examine lymph nodes and mucus membranes |
|
|
Term
pearly papule or erythematous patch >6 mm with telangiectasias often with central scab or erosion. may have stipled pigment. in sun-exposed area.
tx? |
|
Definition
basal cell
tx: shave/punch bx |
|
|
Term
Melanoma:
1. most important prognostic factor
2. most important sx to distinguish it
3. other sx
4. tx |
|
Definition
1. most important prognostic factor: tumor thickness
2. most important sx to distinguish it: evolution
3. other sx: color variation, ABCDE, ugly duckling sign
4. tx: excision with wide margins, sentinel node bx, may need chemo |
|
|
Term
0.2-0.6 mm papules - "flesh colored and sandpapery" - considered pre-malignant
tx? |
|
Definition
actinic keratosis
tx: liquid nitrogen, fluorouracil ceram (5FU), imiquimod cream |
|
|
Term
sudden, severe eye pain and blurred vision with halos around lights, nausea, abd pain, red/steamy cornea, dilated/non-reactive pupil
IOP >50 mmHg
tx? |
|
Definition
acute angle-closure glaucoma
tx:
1. acute: IV aceetazolamide
2. reverse angle closure with topical pilocarpine then iridotomy/iredectomy |
|
|
Term
General: gradually progressive cupping of optic disc. 2 types:
a.Chronic angle-closure glaucoma: flow of aqueous humor into anterior chamber is obstructed
b.Chronic open-angle glaucoma: increased IOP due to decreased drainage of aqueous humor through trabecular meshwork – usually bilateral
Sx: initially none. Then insidious BL loss of vision – first peripheral, results in tunnel vision. Preserved acuity
Dx: requires 2 of 3 parameters?
Prevention: Everyone >40 should have IOP measured and optic disc examined q2-5 years
Tx? |
|
Definition
Chronic glaucoma
Dx: requires 2 of 3 parameters:
a.Optic disc cupping: increased cup to disc ratio
b.Visual field loss
c.IOP >21 mmHg (ocular HTN)
Tx: prostaglandin analogs – Lantaprost, bimatoprost, travaprost
Topical B-adrenergic blockers – timolol
Topical alpha agonists – for pts w/ asthma who can’t have BB
Definitive: laser trabeculoplasty
Prognosis: blindness in ~20 years if untreated
|
|
|
Term
curtain of black spreading across visual field. sudden onset in one eye. may see flashes and floaters first.
ophthalmoscopy: retina hanging in vitreous or irregular retinal alelvation - "dome shaped retina" |
|
Definition
|
|
Term
leading cause of permanent blindness in older population
sx: central vision loss, distorted images, no pain or redness
precursor?
2 types?
tx? |
|
Definition
macular degeneration
precursor: macular drusen (yellow spots on macula)
2 types: atrophic, exudative (new vessel growth)
tx:
- exudative: laser coagulation or VEGF inhibitors
- atrophic: vision aids |
|
|
Term
sudden profound monocular visual loss with acuity limited to counting fingers or less. field preserved in temporal area
ophthalmoscopy: pallid swelling of retina with cherry red spot on fovea or box car segmentation of retinal artery
tx? |
|
Definition
retinal artery occlusion
tx: lay pt flat, ocular message, inhaled O2, IV acetazolaminde, anterior chamber paracentesis |
|
|
Term
| Age related hearing loss. Gradual, over time. Usually due to loss of hair cells from smoking and repeated exposure to loud noise. Dx via Lindsay Pape. Tx is hearing aids. |
|
Definition
|
|
Term
80% of strokes are ____
risk factors?
tx? |
|
Definition
ischemic
risk factors: DM, HTN, vascular dz, atherosclerosis, smoking, AIDS, hyperlipidemia, drugs/alcohol, fm hx, high homocysteine, previous stroke, afib
tx: rTPA, supportive, anticoagulation, statin |
|
|
Term
| contraindications for thrombolysis |
|
Definition
>3 hr since sx onset
recent hemorrhage
current abx
art stick at non-compressible site
>185/110 |
|
|
Term
| treatment for hemorrhagic stroke |
|
Definition
| supportive (ventilation), ICP monitoring, decompression, nutrition, seizure prophylaxis |
|
|
Term
Definition: Transient myocardial ischemia… Chest pain (or any other symptom of MI) that is induced by exertion and relieved by rest or nitro.
· When angina occurs with angiographically normal coronary arteries and without other identifiable causes, it is labeled Syndrome X.
Pathophys/etiology:
· Most commonly caused by a reduction in oxygen supply and/or by an increase in myocardial oxygen demand superimposed on an atherosclerotic coronary plaque.
Signs and Sx:
·Usually precipitated by activity (often reproducible) or stress/anger & **relieved quickly with rest or sublingual NTG
·Symptoms are usually not described as PAIN, but instead as pressure, tightness, squeezing, burning, choking, aching.
·Sharp, fleeting CP is rarely due to ischemia
·Typically located over or just left of sternum; may radiate, usually to left shoulder and arm and **goes away when they stop the activity
·Sxs of short duration, <15-20 min (usually less), if longer worry about MI
·PE often normal but may reveal evidence of atherosclerotic disease elsewhere, e.g.
oAbdominal or inguinal bruits
oCarotid bruits
oDiminished pulses in the LE
oXanthelasmas |
|
Definition
stable angina
tx: nitro, BB, CCB, aspirin, plavix |
|
|
Term
as angina pectoris or equivalent ischemic discomfort with at least one of 3 features.
i.Rest Angina – prolonged angina occurring at rest (or with minimal exertion), usually lasting > 10 minutes *worrisome*
ii.New-onset (within the piror 4-6 weeks according to Harrison’s) angina that causes marked limitations of ordinary physical activity (e.g. angina after walking 1-2 blocks or climbing 1 flight of stairs) and/or-
iii.Increasing angina – i.e. increasing in severity, frequency, duration, or lower threshold of precipitation |
|
Definition
|
|
Term
unstable angina wiht elevated cardiac biomarkers but wihtout ST elevation
tx? |
|
Definition
NSTEMI
tx: CABG, PCI, stents, MONABAH |
|
|
Term
Cardiac enzymes:
1. rises 4-6 hrs after injury, peaks at 24 hrs, remains elevated 36-48 hrs
2. rises 4-8 hrs after injury, may remain elevated for up to 2 weeks
3. rises within first couple hours of injury but is not cardiac-specific |
|
Definition
1. CKMB
2. Troponins
3. myoglobin |
|
|
Term
Westermark’s sign – focal oligemia (loss of blood flow)
Hampton’s hump – a peripheral wedge-shaped density above the diaphragm.
Palla’s sign – enlarged right descending pulmonary artery. |
|
Definition
|
|
Term
| PE: gold standard for dx, tx |
|
Definition
dx: CT w/ contrast
tx: parenteral antcoagulation for 5 days until 2 sequential normal INRs |
|
|
Term
sx: constipation/obstipation, colicky pain, lumbar radiation of pain, n/v, abd distention/tenderness
PE: abd distention/tympany, visual peristalsis, high pitched metallic tinkles, rushes and gurgles, localized tenderness, palpable mass, peritonitis
causes?
Imaging?
tx? |
|
Definition
large bowel obstruction
causes: cancer, diverticulitis
imaging: ct w/ water soluble rectal contrast
tx: surgery |
|
|
Term
Sx: vomiting, sometime feculent, abd pain/distention, constipation/obstipation, peristaltic rushes,
xray: dilated small bowel in "ladder" pattern
CT: "transition point"
PE: +/- fever, abd distention, tenderness
most common causes?
tx? |
|
Definition
small bowel obstruction
causes: adhesions #1, neoplasms, hernia
tx: treat expectantly as long as continued passage of stool and flatus
surgery if complete or incomplete but persists for several days - first do NG tube, fluid/electrolyte resuscitation, abx |
|
|
Term
DM2 drugs:
1. stimulate insulin release from beta cells. glyburide (glipizide), glimepiride (amaryl)
2. acts on liver to reduce hepatic gluconeogenesis by activating AMPK
3. sensitizes peripheral tissues to insulin by binding to PPAR-gamma receptor to regulate release of adipokines. Ex; rosiglitazone, pioglitazone
4. inhibit the enzyme that digests starch and sucrose
5. GLP-1 agonists (exenatide, byetta) and DPP-4 inhibitors (sitagliptin, januvia) |
|
Definition
1. sulfonylureas
2. metformin
3. thiazolidinediones
4. alpha-glucosidase inhibitors
5. incretins |
|
|
Term
| Leading cuase of death in pts with DM2 |
|
Definition
|
|
Term
•Sweating and heat intolerance
•Loosening of nail beds, hyperpigmentation, thinning of hair
•Eyes – lid lag and stare, proptosis with Graves’ opthalmopathy
•Tachy, palpitations, widened pulse pressure, afibb and CHF
•GI – vomiting
tx? |
|
Definition
hyperthyroidism
Tx: BB, radioiodine ablation, thyroidectomy
- Thionamides (propylthiouracil) |
|
|
Term
Defined as state of thyroid hormone excess and is not synonymous with hyperthyroidism, which is the resulf of excessive thyroid function. But the major etiologies are hyperthyroidism caused by Graves’ disease, toxic MNG, and toxic adenomas
• Hyperactivity, irritability, dysphoria
• Heat intolerance and sweating
• Palpitations
• Fatigue and weakness
• Diarrhea
• Polyuria
• Oligomenorrhea, loss of libido |
|
Definition
|
|
Term
| Hyperthyroid sx with positive TPO or TSH-R antibodies + low TSH and high T4 |
|
Definition
|
|
Term
•Weight gain, lethargy, fatigue, depression, weakness, dyspnea on exertion, arthralgias or myalgias
•Muscle cramps, menorrhagia, constipation, dry skin, headache, paresthesias
High TSH, low T3/4 |
|
Definition
|
|
Term
1.Definition: an opiate synthesized from morphine
2.Effects: euphoria, dry mouth, flushing, clouded mentation, alternating drowsiness and wakefulness, respiratory depression
3.Withdrawal: restlessness, muscle/bone pain, insomnia, diarrhea, vomiting, cold flashes with goosebumps (“cold turkey”) and involuntary kicking movements (“kicking the habit”), can be fatal – peak w/in 48-72 hrs of last dose and subside after about a week
4.Treatment? |
|
Definition
Heroine
overdose: naloxone
Detox: clonidine, buprenorphine
Maintanence: methadone, buprenorphine, naltrexone |
|
|
Term
1.Effects: brief stimulation, mood enhancement, increased HR, BP, temp, fever, HTN
2.Chronic: paranoid idealation, visual/auditory hallucination, decreased libido
3.Withdrawal: “crash” after high, craving irritability, depression – very intense
4.Overdose: diazepam for seizures, propanolol for arrhythmias |
|
Definition
|
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Term
1.Definition: condition in which a person has blindness, paralysis, or other neuro sx that cannot be explained medically. Sx are real, pts are not malingering. Formerly known as “hysteria”. Coping mechanisms are repression and isolation.
2.Sx usually begin after stressful experience. Usually sx begins suddenly and psychological condition that brought it on gets better. Usually lack of concern over the sx. |
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Definition
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Term
Depression disorders:
1. usually in response to an identifiable stressor, associated with anger and guilt, occurs within 3 mos of stressor and causes significant impairment in social or occupational function
2. at least one episode of serious depression. May be a physiologic or metabolic aberration. Anhedonia, withdrawal, guilt, inability to concentrate, guilt, anxiety, cognitive dysfunction, fatigue, worthlessness, decreased sexual drive, thoughts of death.
3. chronic depression for at least 2 years – milder
4. cycles of depression, mania, hypomania, and mixed-mood states
a.Mania: elation, hyperactivity, over involvement, irritability, flight of ideas, distractibility, little need for sleep
b.Cyclothymic disorder: chronic episodes of hypomania and depression for >2 years – milder |
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Definition
1. adjustment disorder with depressed mood
2. major depressive disorder (melancholia)
3. dysthymia
4. Bipolar |
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Term
Sx of stress, sadness, hopelessness, and physical sx after a stressful event due to inability to cope.
Dx based on identifiable stressor and no other diagnosis
Tx: psychotherapy, sx treatment |
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Definition
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Term
Definition: anxiety disorder that follows severe stress
Sx:
a. Reliving the event: flashbacks, repeated memories, repeated nightmares, strong reactions to situations that remind you of the event
b. Avoidance: numbing, feeling that you don’t care about anything, detachment, inbabilty to remember part of the trauma, avoiding people and places that remind you of the event
c. Arousal: difficulty concentrating, startling easily, exaggerated response to startling, hypervigilance, irritability, insomnia
d. Can also have physical sx
Dx: Sx last at least 30 days
Tx: desensitization, support groups |
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Definition
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Term
1.Definition: paroxysms of seizures that are related to stress and emotion – thus making them a type of conversion disorder OR due to malingering
Pathophys: Somatoform/conversion disorder. NOT related to abnormal electrical discharge from the brain. Can also be due to malingering.
Incidence: represents 20-30% of referrals for epilepsy
Sx: “grand mal” seizure, but without the tonic phase. Often shout obscenities while seizing.
Dx: EEG (normal), coexisting psychogenic conditions (fibromyalgia, chronic fatigue), hx of significant injury during seizures – esp ictal cry and tongue biting, lack of rising prolactin/CK levels after seizure
Tx: tell them to stop being crazy bitches |
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Definition
| pseudoepileptic/hysterical seizures |
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Term
| Definition: sexual arousal to objects, situations, or individuals that are not part of a normative stimulation. Extreme or atypical sexual behaviors. Typically involve: non-human objects, humiliation of oneself or one’s partner, children, non-consenting partners. Does NOT include Sharon and Darci. |
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Definition
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Term
erectile dysfunction:
1. more commonly psychogenic or organic
2. cause if loss of libido and ED?
3. cause of loss of erection?
4. loss of orgasm is usually?
5. tx |
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Definition
1. usually organic
2. loss of libido + ED: androgen deficiency - measure testosterone and gonadotropins
3. vascular, neurogenic, psychogenic
4. psychogenic
5. tx: hormones, phosphodiesterase inhibitors (viagra/sildenafil) |
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Term
| Tx for premature ejaculation |
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Definition
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Clomipramine (a TCA) 25 mg prior to intercourse
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Term
| most commonly used IV neuroleptic |
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Definition
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Term
| MOI of venlafazine (Effexor) and duloxetine (Cymbalta) |
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Definition
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Both of these are SNRIs – inhibit reuptake of serotonin and norepinephrine
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Term
Drug Dependency (or addiction) is a triad of compulsive drug use including:
a: craving and the behavior involved in the procurement of the drug
b: withdrawal sx on discontinuance of the drug
c: need to increase the dose to obtain the desired effects |
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Definition
psychological dependence
physiological dependence
tolerance |
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Term
1. Sx: confusion, ataxia, nystagmus with ophthalmoplegia, peripheral neuropathy.
2.Cause: thiamine deficiency, most commonly due to alcoholism. Can also occur in AIDS, hyperemesis gravidarum, and after bariatric surgery
3.Tx: thiamine 50 mg IV immediately then IM daily
IV glucose can make encephalopathy worse
If suspected, treat immediately while waiting for labs |
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Definition
| wernicke's encephalopathy |
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Term
| Acute, fluctuating disturbance of consciousness with change in cognition or development of perceptual disturbances – consequence of underlying medical disease |
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Definition
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Term
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Definition
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a. Denial and isolation – “I feel fine.” ; “This can’t be happening to me.”
b. Anger – “Why me?” ; “Who is to blame?”
c. Bargaining – “I’ll do anything to live for a few more years.”
d. Depression – “I’m going to die so what’s the point?”
e. Acceptance – “I can’t fight it, I may as well prepare for it.”
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Term
A hemispherical (half side) spinal column penetrating injury or unilateral cord lesion
•Ipsilateral motor and proprioception loss (position and vibration)
•Contralateral loss of pain and temperature sensation below the lesion
Refer: focal neuro defects
Hospitalize: Neuro defects, spinal cord injury, compression, acute epidural/subdural hematoma, fracture/ dislocation that could compress cord |
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Definition
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Term
| osteomyelitis in drug users typically happens where and what organisms? |
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Definition
spine
s. aureus, pseudomonas, serratia |
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Term
| Common sources of infection that lead to osteomyelitis |
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Definition
joint replacement
decubitus ulcers
neurosurgery
trauma
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Term
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Definition
| quinolones + rifampin IV x 6 weeks |
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Term
| 3 major causes of osteomyelitis |
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Definition
focus of infection
dissemination through blood
vascular insufficiency |
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Term
Iron deficiency anemia:
1. serum ferritin <___
2. caused by ___ until proven otherwise
3. sx
4. CBC w/ smear
5. tx |
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Definition
Serum ferritin <12 mcg/L
caused by bleeding until proven otherwise
sx: fatigue, tachy, tachypnea, smooth tongue, brittle nails, cheilosis, dysphagia, pica
CBC:
1. early: normocytic, normochromic anemia
2. later: hypochromic, microcytic
3. late: anisocytosis, poikilocytosis, target cells, pencil-shaped cells, nucleated RBC, thrombocytosis
tx: ferrous sulfate 325 mg TID |
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Term
oSoutheast Asia / China most common; least common in blacks
4 copies of α-globin chain - normal
3 copies = silent carrier
2 copies = minor/trait - mild microcytic anemia only
1 α chain- Major - chronic hemolytic anemia (hemoglobin H disease)
0 α chains= still born (hydrops fetalis)
oPeriods of hemolytic exacerbations caused by illness and stress
oPeripheral blood smear- microcytes,hypochromia,target cells, poikilocytes
oRetic count is normal
tx? |
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Definition
alpha thalassemia
tx: minor/trait - none
major - routine transfusion + folate, may need splenectomy or allogenic bone marrow transplant |
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Term
oMediterranian origin
oNormal at birth; Develop severe anemia at 6 months due to switching of hemoglobin F→A
oBony deformitites: abnormal facial structure, pathologic fractures
oHepatosplenomegaly
oJaundice
Labs:
basophilic stipling
tx? |
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Definition
B thalassemia
tx: minor/trait - none
Major: routine transfusions + folate
may need splenectomy or allogenic bone marrow transplant
tx may result in iron overload |
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Term
macrocytic/megaloblastic anemia with hypersegmented neutrophils
risk factors: GI surgery, tapework infx, vegan/vegeterian
sx: low hct, glossitis, diarrhea, anorexia, paresthesia, difficulty balancing, dementia
labs:
MCV 110-140
smear: macro-ovalocytes, hypersegmented neutrophils
low retic count
pancytopenia
elevated LDH and bili
tx? |
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Definition
B12 deficiency
100 mcg B12 IM
neuro sx reversible if treated quikcly |
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Term
macrocytic anemia with macro-ovaloctes and hypersegmented neutrophils
risk factors: diets low in frutis and veggies, alcoholism, overcooked foods, pregnancy, hemolytic anemia
sx: glossitis, no neuro abn
NORMAL B12
tx? |
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Definition
Folate deficiency
Tx: folic acid 1 mg/d PO |
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