Peds Interstitial Kidney Diseases
-Acute Interstitial Nephritis-Malignancy
Acute Tubular Necrosis
-Nephrotoxins (aminoglycosides)-Prolonged ischemia, hypotension-Sepsis
Glomerulonephritis
-IgA nephropathy-Post-strep glomerulonephritis
Renal vascular disease
-Hemolytic uremic syndrome-Vasculitis-Renal artery thrombosis
Manic episode treatment
-Antipsychotics (olanzapine)-Lithium-Anticonvulsant mood stabilizers (valproate)
Reactive arthritis Tx
NSAIDs
ALS tx
RiluzoleRespiratory supportNutritional Support
UMN sx
-spasticity-hyperreflexia-upward Babinski reflex-jaw jerk reflex
LMN sx
-atrophy-fasciculations
Alcohol withdrawal tx
benzos
hepatic encephalopathy tx
-lactulose/rifaximin (dec blood ammonia concentration)-fluids/abx
cyanide toxicity tx
hydroxocobalamin or sodium thiosulfate
methemoglobinemia etio
dapsone, nitrates, topical/local anesthetics (oxidizing agents)functional anemia w/dec O2 delivery to tissues
When to do US in prenatal care
-unknown LMP-size discrepancy-any bleeding-suspect of multiple pregnancies
Prenatal labs
-CBC-type and screen-rubella titers-infexn: HIV, HBV, syphilis, G/C-UA-urine cx
optimal screening for trisomy
1st trimester-nuchal translucency and PAPP-A test and beta-hCG (10-13 wks)OR2nd trimestser-wk 16-18-triple or quad screen (hCG, aFP, estradiol, inhibin-A)Other tests: villous sampling (1st trimester)amniocentesis (later)
glucose tolerance test for preg women not at risk
24 wks gestation -oGTT
when to give Rhogam
28 wks gestation and at delivery (if mom is negative and baby is positive)
GBS positive abx
first-line = penicillinif low risk allergy --> cefazolin if high risk allergy --> clindamycin
50 y/o health maintenance
Shingles vaxTetanus +/- pertussisFlu vaxCovid vaxColonoscopy or FIT testing (q10 or 1 yr)If female:Pap+HPV co-testing (q5 yr)Mammogram (q every other year)
60 y/o health maintenance
Tetanus +/- pertussisFlu vaxCovid vaxPneumococcal vax
hemolysis labs
inc reticulocytesinc LDHlow hgblow haptoglobinindirect hyperbilirubinemia
Aldosterone MoA
inc Na+ reabsorptioninc K+ and H+ excretion
ADH
inc water reabsorption and Na+ follows
adrenal crisis w/hypotension tx
glucocorticoids (IV hydrocortisone or dexamethasone)
subarachnoid hemorrhage dx
noncontrast CTthen Lumbar puncture - inc opening pressure, xanthochromia, and high rbc count
Cushing syndrome vs ACTH-induced adrenal androgen production
1- late night salivary cortisol assay; 24-hr urine free cortisol measurement; and/or overnight low-dose dexamethasone testThen measure ACTH levels to differentiate dependent vs independent
upper-airway cough syndrome tx
eliminate nasal discharge and cough-H1 histamine receptor antagonist (chlorpheniramine)
Cryptococcus neoformans dx test of choice
Lumbar puncture + India ink stain (or capsular polysaccharide antigen testing)
Cryptococcus neoformans tx
antifungal therapy- ampho B, fluconazole, and 5-flucytosine
Toxoplasmosis in adults tx
First-lineSulfadiazine and Pyrimethamine2nd line = TMP-SMX
The Bends tx (decompression sickness)
IV fluids100% O2hyperbaric O2 therapy ASAP
Airborne isolation precautions (negative pressure room, N95 respirator)
TBVZVShinglesCOVID-19Measles
Contact precautions (gown and gloves, single-use equipment)
MRSA, VRE, ESBL producingC diff, E coli O157:H7RSVVSVShingles
Droplet precautions (mask w/in 1-2m of pt)
N meningitidisHiBMycoplasma pneumoniaeInfluenzaAdenovirus
ESBL (extended-spectrum beta-lactamase) - producing bacteria
PEKKProteus MirabilisE coliKlebsiella pneumoniaKlebsiella oxytoca
Premenopausal women with adnexal mass dx
related to ovulationsimple-appearing masses -observation and repeat exam in 6 wks
lithium side effects
fatigue, constipation, myalgias, dec T4
anterior urethral injury (penile trauma) next step
retrograde urethrography (XR of urethral tract, then contrast through urethral meatus)- extravasation of contrast is positive
posterior urethral injury *pelvic fracture* next step
prostate exam - high riding prostate
Huntington dz
trinucleotide repeat on chromosome 4p
Rett syndrome
MECP2 gene mutation
Aflutter appearance on ECG
saw toothed waves w/irregular rhythm
Aflutter tx
chronic anticoagulation (depending on CHADSVASC)
Waldenstrom Macroglobulinemia next step
SPEP and bone marrow biopsy
correlates w/dx of diabetic nephropathy
retinal neovascularization
essential tremor tx
beta blockers (propranolol)- contraindicated if pt has COPD or asthmaor anticonvulsants (primidone)
bronchopulm dysplasia histo
decreased septation of alveoli
bronchiectasis patho/histo
cystic dilation of the bronchial wall with mucus plugging
UTI in kids mgmt.
abx- 3rd gen cephalosporin imaging - renal US and VCUG (voiding cystourethrogram) if < 2 y/o
when to get voiding cystourethrogram in kids
-hydronephrosisor scarring on renal US-recurrent febrile UTIs
uterine rupture tx
laparotomy and cesarean delivery
shoudler dystocia first step (turtle sign)
McRoberts maneuver w/suprapubic pressure
MS tx for spasticity
baclofen or tizanidine
MS tx for neuropathic pain
gabapentin or duloxetine
MC cause of amyloidosis (AL)
Multiple Myeloma
MC cause of AA amylodiosis
Rheumatoid arthritis
amyloidosis on renal biopsy
glomerular deposits seen after special staining
HTN nephropathy on renal biopsy
hyalinosis that affects both afferent and efferent arterioles
Triglyceride-induced pancreatitis mgmt.
IV fluids, pain controllipid panel
autoimmune hepatitis tx
prednisone
primary biliary cholangitis tx
ursodeoxycholic acid
SIADH labs
electrolytesurine osmolalityurine sodium
Amp C organisms
Enterobacter cloacaeKlebsiella aerogenes (formerly Enterobacter aerogenes)Citrobacter freundii
ESBL org tx
Carbapenems
Amp C org tx
Cefepime
olanzepine ADRs
wt gaindyslipidemiahyperglycemiainc risk of DM**ADRs of a drug
clozapine ADRs
wt gaindyslipidemiahyperglycemia (new-onset DM)neutropeniaagranulocytosis**ADRs of a drug
Ziprasidone ADRs (2nd gen antipsychotic)
QT prolongation
pulmonic regurgitation
decrescendo, diastolic murmurloudest at LSB, inc w/inspirationone S2 sound
atrial septal defect
systolic murmur at LUSBfixed splitting of S2
hydatidiform mole tx
D&Cserial serum beta-hCGcontraception for 6 monthsdo NOT use misoprostol- contraindicated
toxic megacolon dx
CT w/oral contrastlooking for colonic dilatation > 6cmloss of haustral patternirregular mucosal pattern
orbital compartment syndrome tx
emergent surgical decompression
thrombus
blood clot w/in a vein
embolus
part of a blood clot that breaks away and travels through circulation
risks d/t short interpregnancy intervals (<6-18 mo from delivery to next pregnancy)
inc risk of low birthweight, preterm labor, preterm PROM, maternal anemia
tx for chemo-induced n/v
serotonin receptor antagonist (5HT antagonist blocks 5HT3 receptors)
cerebellar hemorrhage mgmt.
reverse ACBP mgmt.ICP mgmt. - elevate head of bed, mannitolsurgical decompression if:hemorrhage >3cmimpaired consciouesnessbrainstem compression, obstructive hydrocephalus
Riboflavin (B2) s/sx
angular cheilosisstomatitisglossitisnormocytic anemiaseborrheic dermatitis
B6 (pyridoxine) def
cheilosis, stomatitis, glossitisirritability, confusion, depression
B9 (folate) def
megaloblastic anemianeural tube defects (fetus)
Ascorbic acid (vit C) def
scurvy- punctate hemorrhage, gingivitis, corckscrew hair
mgmt. of postpartum thyroiditis
self-resolvesno need for PTU or methimazole
mixed connective tissue disease abd
anti-U1 ribonucleoproteinANARFanti-cyclic citrullinated peptide
risks of distal tibial fracture
limb-length discrepancy
cohort study
identifies individuals based on exposure status to risk factorfollows both groups over time to assess development of dz
cross sectional study
snapshot of pop'n in time to est prevalence of risk factors and disease simultaneously
case-control study
potential participants are initially identified based on dz status and pts w/dz and w/o dzthen presence of past exposure to >/= 1 risk factors of interest is determined in each group
bile acid diarrhea tx
cholestyramine or colestipol
Crohn disease association w/kidneys
inc oxalate absorption (but fat malabsorption)oxalate stone formation
teratogenic effects of ACEi and ARBs
fetal renal hypoplasia- small fetal bladder w/minimal urine, oligohydraminos, and dec GFR in fetus
mastoiditis dx
opacification of air cells on CT/MRI of brain
pt w/inc ICP-- kid - what is contraindicated?
LP - risk of cerebral herniation and death!
vascular dementia neuroimaging findings
cortical and/or subcortical infarctions
Rh (D) alloimmunization in pt w/ectopic pregnancy mgmt.
anti-D immunoglobulin
Acanthosis nigricans assoc dz
insulin resistanceGI malignancy
multiple skin tags - assoc dz
insulin resistancepregnancycrohn dz
Hep C assoc skin conditions
porphyria cutanea tardacutaneous leukocytoclastic vasculitis (palpable purpura) secondary to cryoglobulinemia
dermatitis herptiformis assoc dz
Celiac dz
HIV infexn assoc skin dz
sudden-onset severe psoriasisrecurrent herpes zosterdisseminated molluscum contagiosumbacillary angiomatosis
Severe seborrheic dermatitis assoc dz
HIV infexnParkinson dz
explosive onset multiple itchy seborrheic keratoses assoc dz
GI malignancy
pyoderma gangrenosum assoc dz
Inflammatory bowel disease
recommended vax for adults w/HIV
HAVHBVHPVInfluenzaMeningococcus (ACWY)PneumococcusVZV
PTU and Methimazole ADR
agranulocytosis - fever and sore throat in pt taking antithyroid drugs
polymyositis dx
muscle biopsy
polymyalgia rheumatica dx
electromyelogram
negative skew
bottom of hill on L side, mode on R sidemean < median
positive skew
bottom of hill on R side, mode on L sidemean > median
rhabdomyolysis dx
creatine phosphokinase
nephrotic syndrome dx
24-hour urine protiein measurement
renal artery stenosis dx
renal vascular imaging (doppler US)
wbc casts on UA
AIN (acute interstitial nephritis)
rbc casts on UA
glomerular damage
hyaline casts on UA
prerenal AKI
rosacea tx
1st line - topical metronidazole, azelaic acid, ivermectin2nd line - oral tetracyclines