intussusception - Intussusception is defined as the telescoping of one segment of the intestine into another. It is the most common cause of obstruction
... [Show More] in children younger than 2 years of age. The classic triad of intussusception is abdominal pain, palpable mass and bloody stools but all three features are only present in about 33% of patients. Palpation of the abdomen may reveal a sausage-like mass in the right upper quadrant representing the actual intussusception. The lead point for the telescoping may be due to Henoch-Schonlein purpura vasculitis, Meckel's divericulum, lymphoma or polyps in children over 5 years of age. In younger children, enlarged Peyer's patches may be the culprit. These occur after viral infections. Ultrasound of the abdomen is the best initial modality for identifying the intussusception. It may reveal the classic findings of a target sign or "pseudokidney" sign. Sensitivity and specificity of ultrasound approach 100%.
Pathophysiology of hepatorenal syndrome - Hepatorenal syndrome is a cause of acute kidney injury in patients with acute or chronic liver disease. It occurs secondary to splanchnic arterial vasodilation mediated by nitric oxide and prostaglandins in response to portal hypertension. This effective "sequestration" of blood volume to the splanchnic circulation results in the activation of the renin-angiotensin-aldosterone pathway, resulting in systemic vasoconstriction that is most prominent in the kidneys. The resulting decline in renal perfusion leads to decreased glomerular filtration rate and decreased sodium excretion. Histologically, however, the kidneys are not affected and can function normally if the liver function improves. Hepatorenal syndrome is typically precipitated by an acute insult, such as a bacterial infection (spontaneous bacterial peritonitis being an important cause in cirrhotic patients) or gastrointestinal bleeding. Hepatorenal syndrome presents with an increased serum creatinine with minimal proteinuria and low sodium excretion in the setting of acute or chronic liver disease. Oliguria is typically present. It is a diagnosis of exclusion and other causes of renal injury, such as acute tubular necrosis or glomerulonephritis, should be excluded. Treatment should focus on improvement of liver function, including resolution of acute insults.
Blood pressure management for hypertensive urgency - Hypertensive urgency is not an indication for the initiation of parenteral therapy for rapid reduction of blood pressure. Moreover, rapid reduction in blood pressure may result in complications secondary to underperfusion of vascular beds that have become accustomed to much higher perfusion pressures. To avoid these complications, patients with hypertensive urgency should have a gradual reduction in their blood pressure over days to weeks, most commonly accomplished through the initiation of an oral antihypertensive agent either in the ED or by their primary care provider.
Question: What is the first-line oral treatment for hypertension in African American individuals? - A calcium-channel blocker or thiazide diuretic alone or in combination.
ACC/AHA 2017 Hypertension
Elevated BP: systolic 120-129 mmHg or diastolic > 80 mmHg
Stage I HTN: systolic 130-139 mmHg or diastolic 80-89 mmHg
Stage II HTN: systolic >140 mmHg or diastolic >90 mmHg
1st line treatment is ALWAYS lifestyle modifications then
1st line rx: thiazide
1st line rx for African-Americans: CCB or thiazide
1st line rx for CKD patients: ACEI or ARB -
Precipitating factors or causes of myxedema coma in patients with hypothyroidism? - infection (most common), cold exposure, stroke, or medications, such as amiodarone or lithium.
Role of ketamine use in patients with hyperthyroidism? - If properly treated hyperthyroidism, not an issue.
Can cause sympathetic surge and should be used with caution in those with untreated or poorly treated hyperthyroidism
What hapens when you give iodine to patientswith uncontrolled hyperthyroidism? Role of IV contrast in patients with hyperthyroidism - Can precipitate thyroid storm
Aspiration pneumonitits - -The chest radiograph usually shows unilateral focal or patchy consolidations in the dependent lung segments.
-Prophylactic administration of antibiotics (A) is not recommended - does improve symptomatic outcomes and risks of infections. and may lead to increased resistance.
Subacute thyroiditis - -Subacute thyroiditis is suspected to be caused by a viral infection or a post-viral inflammatory process.
-Common symptoms include fever, myalgias, fatigue, and malaise.
-Anterior neck pain
- The hallmark physical exam finding is tenderness over the thyroid gland. If tenderness is absent, another diagnosis should be considered
-Subacute thyroiditis is ultimately a clinical diagnosis, but thyroid studies will reveal a suppressed thyroid-stimulating hormone with an elevated T3 and T4 in the early phases in illness.
- In a patient allergic to NSAIDs, what alternative medication can be prescribed to a patient with subacute thyroiditis? Prednisone
Hemolytic Uremic Syndrome - -Causes: cause of HUS is shiga toxin-producing E. Coli. Other potential causes include dysregulation or mutations in complement proteins and Streptococcus pneumoniae.
-Presents as abdominal pain, diarrhea, and vomiting approximately one week before the development of hemolytic uremic syndrome
-Platelet counts are usually around 40,000/L and the degree of renal involvement ranges from hematuria or proteinuria to oliguria.
-Treatment: supportive care, no antibiotics
Patients at risk for sigmoid volvulus? - patients in long-term care facilities and those with neurologic and psychiatric conditions are also at risk
Question: What is the most common trigger associated with thyroid storm? - Infection
Features of hypothyroidism? - -Thinning hair, hair loss
-puffy face
-loss of eyebrow hair
-enlarged thyroid
-bradycardia
-poor appetite
-infertility
-heavy menstruation
-carpal tunnel snydrome
-hypothyroidism [Show Less]