pharmacotherapy for alcohol use disorder?

Naltrexone (mu-opiod receptor

antagonist)- contraindicated in acute hepatitis and liver failure<div>Acamprosate
(glutamate modulator)- avoid if pt w/ renal impairment</div>
breast cancer pt, which contraceptive? Copper IUD
AAA repair + CV &amp; foley catheters + 2 units blood, 1 hr after surg &gt; fever +
chills, cause? Transfusion reaction (febrile nonhemolytic)
causes of postop fever <b>within 2 hrs</b>? (immediate) 1. prior
trauma/infxn<div>2. blood products</div><div>3. malignant
hyperthermia&nbsp;</div><div><br></div><div>also inflamm from surg, meds
(anesthetics)</div>
causes of postof fever? The 5 Ws:&nbsp;<div>1. Wind: PE, Pneumonia,
Aspiration</div><div>2. Wound: SSI (surgical site infxn)</div><div>3. Water:
UTI</div><div>4. Walk: DVT&nbsp;</div><div>5. Wonder drugs/products: drug fever,
blood products, IV lines</div>
postop fever <b>1 day-1 week</b>? (Acute) 1. Nosocomial infection: pneumonia,
UTI<div>2. SSI¹: GAS, <i>C. perfringens</i></div><div>3. Non-infectious:
MI, PE/DVT</div>
postop fever <b>1w-1m</b>? (subacute) "1. SSI<span style=""font-size:
16.6667px;"">²</span>: <b>not</b> GAS/C. perfrigens<div>2. C
diff</div><div>3. Drug fever</div><div>4. PE/DVT</div>"
postop fever <b>&gt; 1 month</b>? (Delayed) 1. Viral Infection (from blood
products)<div>2. SSI³: indolent organisms&nbsp;</div><div>3. Infective
endocarditis</div>
transfusion rxn w/in <b>1-6 hours</b>, fever &amp; chills. Dx? cause? 1. Febrile
nonhemolytic (MC)<div>2. Cytokine accumulation during blood storage</div>
transfusion rxn <b>within 1 hour</b> &gt; fever, flank pain, hemoglobinuria, RF,
DIC. (+ Coombs, pink plasma). Dx &amp; cause? 1. Acute hemolytic&nbsp;<div>2. ABO
incompatibility</div>
transfusion reaction w/in<b> 2-10 days &gt;</b> mild fever, hemolytic anemia, +
Coombs + new ab screen. dx/cause? 1. Delayed hemolytic<div>2. Anamnestic Ab
response</div>
transfusion reaction w/in <b>seconds-minutes</b> &gt; rapid shock,
angioedema/urticaria, resp distress. Dx/cause? 1. Anaphylactic<div>2. Recipient
anti-IgA antibodies</div>
transfusion rxn w/in<b> 2-3 hrs </b>&gt; urticaria, flushing, angioedema, pruritus.
dx/cause? 1. Uricarial/allergic<div>2. Recipient IgE antibodies &amp; mast cell
activation</div>
Transfusion rxn <b>w/in 6 hrs </b>&gt; resp distress &amp; signs of noncardiogenic
pulmonary edema. Dx/cause? 1. TRALI (transfusion-related acute lung
injury)<div>2. Donor anti-leukocyte antibodies</div>
Postop fever &gt;40C/104F, muscle rigidity, rhabdomyolysis, metabolic acidosis, and
hemodynamic instability. dx/cause? 1. Malignant hyperthermia<div>2. Inhaled
anesthetics</div>
Periodic (bi- or tri-phasic) sharp wave complexes on EEG? Creutzfeldt-Jakob
disease (prions)<div><br></div><div>note: + 14-3-3 CSF assay</div>
newborn w/ sholder dystocia + clavicle fracture. Predisposing RF? <b>Fetal
Hyperglycemia </b>&gt; fetal hyperinsulinemia &gt; macrosomia (4.5kg/9.9 lb)&nbsp;
first trimester complications of maternal hyperglycemia (DM)? 1. Congenital
heart disease<div>2. Neural tube defects</div><div>3. Small left colon
syndrome</div><div>4. Spontaneous abortion</div>
2nd/3rd trimester complications of maternal hyperglycemia (DM)? Fetal
hyperglycemia &amp; hyperinsulinemia &gt;&nbsp;<div>1. polycythemia</div><div>2.
organomegaly</div><div>3. neonatal hypoglycemia</div><div>4. Macrosomia &gt;
shoulder dystocia &gt; brachial plexopathy, clavical fracture, perinatal
asphyxia</div>
UTI in G6PD def, which Abx to avoid? Nitrofurantoin (oxidative stress)
meds that cause hemolysis in G6PD 1. Diaminodiphenyl sulfone (dapsone)<div>2.
Isobutyl nitrite</div><div>3. Nitrofurantoin</div><div>4. Primaquine</div><div>5.
Rasburicase: tumor lysis syndrome</div>
3 yr old pain with chewing (happened 1 yr ago), PMHx of 2 sinus infxns, mult
episodes of cellulitis. Cultures:&nbsp;<i>S. aureus </i>and <i>S. pyogenes</i>. PE:
Periodontal inflammation w/ ulceration and necrosis, neutrophilia. dx? Defective
Leukocyte adhesion (LAD); defective integrins on leukocyte surface
alcoholic hepatitis. up or down &gt; AST, ALT, GGT, Ferritin. AST/ALT: increase
(&gt;2/1)<div>GGT: increase&nbsp;</div><div>Ferritin: increase</div>
transaminitis in the 1000's. Causes? 1. toxin-induced (acetaminophen)<div>2.
ischemic&nbsp;</div><div>3. viral hepatitis</div>
blood transfusion before 1992. Screen for? Hep C
Marked HTN + AKI in scleroderma. Dx? peripheral smear shows? 1. Scleroderma
renal crisis&nbsp;<div>2. Schistocytes&nbsp;</div><div>also thrombocytopenia</div>
spur cells (acanthocytes). dx? liver disease
burr cell (echinocytes). dx? liver disease or ESRD
Howell-Jolly bodies. dx? Splenectomy, functional asplenia
Target cells. dx? thalassemia or chronic liver disease (esp obstructive liver
disease)
Foodborne dx &gt; nongastrointestinal causes/symptoms 1. Botulism: descending
paralysis<div>2. Ciguatera toxin: paresthesia</div><div>3. Scombroid: flushing,
urticaria</div><div>4. Listeria: meningitis</div><div>5. Vibrio vulnificus:
cellulitis, sepsis</div><div>6. Hepatitis A: jaundice</div><div>7. Brucellosis:
fever, arthralgias</div>
foodborne dx &gt; inflammatory diarrhea predominant 1. Salmonella (both typhi
&amp; non-typhi)<div>2. Campylobacter</div><div>3. E. coli (shiga toxin producting
EHEC 0157:H7)</div><div>4. Shigella</div><div>5. Enterobacter</div><div>6. Vibrio
(usually parhaemolyticus)</div><div>7. Yersinia</div>
Foodborne dx &gt; Watery diarrhea predominant 1. Clostridium perfringens<div>2.
Enterotoxic E. coli</div><div>3. Enteric viruses</div><div>4.
Cryptosporidium</div><div>5. Cyclospora</div><div>6. Intestinal tapeworms</div>
Foodborne dx &gt; Vomiting predominant 1. S. aureus<div>2. Bacillus
cereus</div><div>3. Noroviruses (eg, Norwalk)</div>
Overdose pt: PMH CAD and HTN &gt; bradycardia, AV block, hypotension, diffuse
wheezing. Cause/treatment? 1. Beta-blocker overdose<div>2. Airway + NS fluid
boluses + IV atropine&nbsp;</div><div>&nbsp; - if refractory hypotension &gt;&gt;
IV glucagon</div>
disturbed color perception + cardiac arrhythmias Digoxin toxicity
Painful genital ulcer w/ small vesicles or ulcers on erythematous base +
mild/tender inguinal lymphadenopathy HSV
Painful large, deep ulcers w/ gray/yellow exudate + well-demarcated borders &amp;
soft, friable base + severe lymphadenopathy (may suppurate)Haemophilus ducreyi
(chancroid)
Painless single ulcer w/ regular borders &amp; hard base Treponema pallidum
(syphilis chancre)
Painless small, shallow genital ulcers (often missed) &gt; progress to painful
fluctuant adenitis (buboes) [suppurative inguinal lymphadenopathy] Chlamydia
trachomatis serovars L1-L3 (lymphogranuloma venereum)
Increased ALP and + antimitochondrial Ab. Dx/drug of choice to start immediately?
1. Primary biliary cholangitis<div>2. Ursodeoxycholic acid (UDCA): delays
histologic progression, improve symptoms, and possibly
survival.</div><div><br></div><div>note: early symptoms = Pruritus + fatigue</div>
secondary amenorrhea s/p suction and sharp curettage + postpartum hemorrhage
(4months ago), negative progesterone challenge, normal FSH &amp; LH lvls
Asherman syndrome (intrauterine adhesions)
falls, impaired vertical gaze, parkinsonism Progressive supranuclear palsy
if RR interval contains 1 <b>not </b>statistically significant
MR angiography in pt with mod-severe kidney disease nephrogenic systemic fibrosis
(due to gadolinium contrast)
pt with persistent fever &gt; central venous catheter, chronic indwelling urinary
catheter, white patches in mouth, and sacral pressure ulcer. Broad-spec Abx but
persistant fever + budding yeast on blood culture. Source? Central venous catherter
microalbuminuria value&nbsp; 30-300 mg/24hr
&gt;55 y/o w/ gait dysfxn, muscle atrophy of UE's with hyporeflexia, + babinski in
LE's, decreased proprioception/vibration/pain in both. Dx? test? treatment? 1.
Cervical myelopathy (advanced spondylosis of cervical spine &gt; cord
compression)&nbsp;<div>2. MRI cervical spine / CT myelogram&nbsp;</div><div>3.
surgical decompression</div>
RA is diagnosed. CI's to methotrexate and what to test for?1. Severe renal
insufficiency, liver disease, excessive alcohol intake<div>2. Test for Hep B, Hep
C, and TB</div>
RA with methotrexate but pt not responding after 6 months of treatment. What to
add? TNF-a inh (etanercept, infliximab)
painless, red ulcers without LAD (STI) granuloma inguinale (Klebsiella
granulomatis)
external cephalic version in Rh- mom prophylactic anti-D Ig
Idiopathic intracranial HTN (IIH) (pseudotumor cerebri) suspected. First test?
MRI +/- MRV to exclude secondary cause if inc. ICP (eg, mass, hemorrhage,
cerebral vein thrombosis)<div>- next LP to document opening pressure &gt;<b>250 mm
H2O</b></div>
Adolescent with LBP worse with lumbar extension (eg, gymnasts, divers) and a
palpable step-off of spine (L5) Spondylolisthesis (foward slip of L5 vertebral
body due to bilateral defects of pars interarticularis)
5 y/o AA, URI w fever &gt; persisting fever, fatigue, pale conjunctivae, LAD
cerv/ax/ing, enlarged spleen, tender at middle thigh b/l, pancytopenia. Dx? ALL
&gt; BM bx shows &gt;25% lymphoblasts confirmed dx
rapid ascension to high altitude &gt; hypoxemia.. causes? High-altitude cerebral
edema (HACE) + HA &amp; pulm edema
young middle-aged woman, fatigue, impaired concentration, tenderness at trigger
points (eg, mid-trapezius, costachondral jxn), normal labs for 3 months+. Dx?
Fibromyalgia
proximal muscle weakness, inc difficulty climbing stairs, no pain, ANA +, inc CK,
inc aldolase, inc AST (ie muscle enzymes). Dx? other findings? 1.
Polymyositis<div>2. Anti-Jo-1 +, biopsy shows endomysial infiltrate, patchy
necrosis</div>
&gt;50 y/o, system symptoms, stiffness in shoulder, hip girdle, neck, inc ESR, inc
CRP. Dx/Rx? 1. Polymyagia rheumatica<div>2. glucocorticoids (rapid
improvement)</div>
Major criteria for IE 1. + blood culture for typical organisms (S. aureus,
Enterococcus, viridans streptococci)<div>2. Echocardiogram show valvular
vegetation</div><div><br></div><div>Definite IE: 2 major OR 1 major + 3
minor</div><div>Possible IE: 1 major + 1 minor OR 3 minor</div>
minor criteria IE 1. Prediposing cardiac lesion<div>2. IV drug use</div><div>3.
temp &gt;38 C/100.4 F</div><div>4. Embolic phenomena</div><div>5. Immunologic
phenomena (eg, GN)</div><div>6. + blood culture not meeting major criteria</div>
recurrent high fevers, arthritis/arthralgias, salmon-colored macular or
maculopapular rash, inc ESR Adult Still disease (uncommon inflamm d/o)
open angle glaucoma (inc IOP + loss of periph vision) Rx? BB: timolol eye drops
<i>(trabeculoplasty adjunctive measure)</i>.
Diabetic retinopathy: types+? 1. non-proliferative: dilation of veins,
microaneurysms, retinal hemorrhages, edema, and hard exudates<div>2. Proliferative:
neovascularization</div><div><br></div><div>present late in dx &gt; poor night
vision, curtain falling w/ vitreous bleed, or floaters during resolution of
vitreous bleeds</div>
sudden blurred vision, severe eye pain, NV, PE: red eye w/ hazy cornea + fixed
dilated pupil Angle closure glaucoma
pelvic ultrasound shows 5-cm ovarian cyst on postmenopausal &gt; next step? Serum
CA-125 lvl
DVT treated with warfarin missed appt, cant keep diet &gt; switch to? Oral direct
factor Xa inhibitor (eg, <b>rivaroxaban, apixaban</b>): does <b>not</b> inc risk of
bleeding, no INR/lab monitoring or overlap with
heparin.&nbsp;<div><br></div><div><b>Do not use</b> in pt with<b> severely impaired
renal </b>fxn or if DVT/PE <b>secondary to malignancy&nbsp;</b></div>
2 weeks ago returned from Caribbean &gt; symptom onset &gt; 103F, macular skin
rash, mild cervical LAD, swelling &amp; tenderness of B/L hand, wrist, ankle
joints, leukopenia, thrombocytopenia. Dx? Chikungunya fever <i>(Rx is supportive;
methotrexate for chronic arthritis)</i>
diffuse atherosclerosis, refractory HTN, abdominal bruit&nbsp; RAS