Case Files Flashcards by Meg Dolohanty

who is the influenza vaccine recommended for?

Every adult >50 years, health care workers, chornic CV, pulmonary, reanl or metabloic dsiease

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Who gets a 1 time revaccination after 5 years of the pneumococcal polysaccharide vaccine?

chronic kidney, hepatic disease, immunodeficiency or asplenia

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who is Hep A vacciene recommended for?

chronic liver dz, use clotting factors, IV drugs, men who have sex w/ men, travel to countries where hep A is endemic

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when should lipid screening happen

men >35 years old and women >45 years old

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Who is screening for AAA recommended for?

men aged 65-75 who ahve ever smoked

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mainstay of meds w/ COPD exacerbations

oxygen, bronchodilators, steroids

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In COPD the FEV1/FVC is less than what?

0.7

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when is O2 therapy recommended w/ COPD

PaO2 <88% at rest . needs to be worn at least 15 hours a day

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steroid dose recommended w/ COPD exacerbation

40 mg prednisone for 10-14 days

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Condition of joint pain and inflammation due to calcium

pyrophosphate dehydrate crystals in the joints, which can be diagnosed by

noting rod-shaped, rhomboid, weakly positive birefringence by crystal analysis.

Pseudogout

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major finding w/ a septic joint

very limited ROM due to pain

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morning joint stiffness, involves 3 or more joint and have x ray chagnes such as erosions or decalcifications

rehumatoid arthritis

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Tx for septic joint

Surgery for drainage than IV abx

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tx for infectious diarrhea

cipro for adults

azithromycin for children/ pregnant women

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when should women be screened for lipid disorders?

age 45

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a stectching or tearing injury of a ligament

sprain

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a stretching or tearing injury of a muscle or tendon

strain

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pain with internal rotation when the arm is flexed to 90 degrees with the elbow bent to 90 degrees

Hawkin’s impingmenet (subacrominal impingement)

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examiner pulls forward on patient’s heel while stabilizing lower leg w/ other hand

anterio rdrawer. if abnormal suggests anterior talofibular ligament injury

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Examiner inverts ankle with one hand while stabilizing the lower leg w/ the other

inversion stress test. abnormal or clunk suggests tear of calcaneofibular ligament

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Examiner compresses tibia/ fibula at midcalf

Pain at anterior anle joint (below where squeeezing) suggests syndesmotic injury

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ottawa knee rules (for knee x ray)

>55 years old
2- isoalted patella tenderness
3- tenderness of head of fibula
4- inability to flex knee to 90 degress
5- inability to bear weight for four steps immendaitely and in the exam room

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most important risk factor for skin cancer devleopment

exposure to ultraviolet radiation

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most common skin cancer

basal cell carcinoma

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Present as pearly papules often w/ central ulceration/ multiple telangiectasias

basal cell carcinoma

irregularly shaped plaques or nodules w/ raised borders that are often scaly, ulcerated and bleed easily

squamous cell carincoma

what in the urinary sediment is suggestive of renal glomerular disease

red cell casts and dysmorphic red blood cells

presence of hemamaturia and what suggests interstitial nephritits

eosinophils

most common cause of hyperthyroidism

Graves dz (autoimmune)

definitive treatment for hyperthyroidism

radioactive iodine

Thyroid storm treatment

Beta blockers high doses of PTU hydrocortisone or prevent adrenal crisis

most common cause of hypothyroidism

Hashimoto thyroiditis

most sensitive and sepcific test for thyroid nodules to determien malignancy

FNA

if a person has hypercalcemi with a suppressed PTH waht should you immediately think of

malignancy

leading cause of blindness worldwide

cataracts

hypomagnesemia can incfease the incidence of what type of v-tach?

torsade de pointes

what can chest pain plus unequal carotid pulses of unequal UE pulses

aortic dissection

sharp pain that radiates to the trapezius, increaes w/ respiration and decreases when sitting forward

pericarditits

sudden onset of pleuritic pain, tachycardia, tachypnea, hypoxemia

how to treat high K+ in patients with chronic kidney diesase?

Polystyrene sulfonate (Kayexalate)

what causes occasionally emesis w/ CKD?

high levels of urea and other toxins

Most common casues of CKD

HTN, DM, glomerulonephritits

GFR of 30-59 indicated what stage?

Satege 3

Stage 5 of CKD

GFR <15

Drugs that can affect kidney function

NSAIDs, aminoglycosides at full strength, radiographic contrast material

are small kidneys good or bad with CKD

Bad, reflect irresversible disease. shoudl rarely be bsiopsied

best tx for outpatient PID

IM ceftriaxone and oral doxycycline

Diverticulitits tx

bowel rest, quinolone _ metronidazole may need surgery

which IBD is a risk factor for colon cancer?

Ulcerative colitits

most common cause of community acquired pneumo?

Steptococcus pneumoniae (pneumococcus) then H flu then moraxella catarrhalis

who are atypical pneumo organisms (Mycoplasma, chlaymdia, legionella) more common in

the young and the old

how do atypical pneumos typically appear on x-ray

bilateral, diffuse infiltrates

who is the pneumococcal vaccine recommended for

all persons >65 years old

what is a common cause of pneumonia after a person has had flux

S aureus

2 years of low mood. less acute but longer in duraiton than major depression.

dysthymic disorder

main causes of CHF

CAD or HTN

main meds for CHF

furosemide ACEI Beta blockers (decrease preload and afterload)

CHF when there is a dilated left ventricle with impaired contractility.

systolic dysfunction

S/S of Right sided HF

Venous congestion, N/V, bloating, abomdinal pain, fluid retention, peripheral edema, JVD

LEft sided CHF manifestations

Pulmonary congestion (DOE), wheezing, cough, tachypnea , S3 gallops rythm

elevation in what lab indicate CHF

BNP

a BNP greater than what is consisitent with a diagnosis of CHF

110-500

one of the earliest chest x-ray findings in CHF

cephalization of the pulmonary vasculature

gold standard of diagnostics for CHF

echocardiography

first line therapy in patients w/ CHF and reduced LV function

ACEI

benefits for ACEI in CHF

reduces preload, afterload, improves cardiac output, inhibits tissue renin-angiotensin systems

When are ACEI contraindicated?

pregnancy, HPOTN, hyperkalemia, B/ renal artery stenosis , caution w/ renal insufficiency

when are BB indicated/ w CHF

NYHA class II or III or w/ CAD

when should the aldosterone antagonist spironolactone be considered w/ CHF

Class III and IV

ADR of spironolactone

hyperkalemia

medication used in diastolic dysfunction as they promote increased cardiac output by lower HR which allows for more ventricular filling time

Nondihydropyridine calcium channel blockers (diltiazem, verapamil)

we should you recheck lipids after starting a statin?

6 weeks

what try fracture is a sign of abuse?

corner or "bucket handle" fractures of metaphysis of long bones, sprial fracture, scauplar fracture, spinious process, sternal fractures

5 Ws of post op fever

``` Wind (pneumo) Water (UTI) Wound (SSI) Walk (DVT) Wonder drugs (drug fever ```

alarm features w/ abominal pain and bowel changes that suggest underlying pathology

``` weight loss fever melena blood in stool excessive diarrhea older age anemia family xh of colon cancer, IBD ```

antispasmodics that can be used for IBS

dicyclomine and hyoscyamine

tx for constipation predominant IBS

intake fiber

tx for diarrhea predominant IBS

loperamide

At risk drinking

Men >14 drinks / week >4 per occasin | Women >7 drinks per week >3 for occassion

most common valvular heart defect in the US

mitral valve prolapse

caused by a cardiac source of the arrhyth- mia that is not in the ventricle. This category includes atrial fibrillation, atrial flutter, focal atrial tachycardia, multifocal atrial tachycardia (MAT), and AV nodal reentrant tachycardia.

supraventricular tachycardia

most common of all arrhythmias, becomes more common w/ older age and cardiomyopathy

A-fib

arrhythmia found w COPD

MAT (multifocal atrial tachycardia)

caused by an accessory track between the atria and ven- | tricles that conducts electrical impulses in addition to the AV node.

Wolf Parkinson White (WPW)

classic finding on a ECG w/ WPW.

slurring on teh upstroke of the QRS complex (delta wave)

ion channel disorder that is most common in Asian males. On an ECG, it presents as ST-segment elevation in leads V1 , and it too can cause dangerous arrhythmias that result in death.

Brudaga syndrome

dysfunction of the SA node that leads to bradycardia and can cause fatigue and syncope. Patients, however, can also have a tachycardia-bradycardia variety of sick sinus syndrome in which they also experience supraventricular tachycardia with its associated symptoms of palpitations and angina pectoris.

sick sinus syndrome

patients w/ long QT interval syndrome are at most risk for waht

ventricular arrhythmias and sudden cardiac death

Cause of long QT syndrome

mutations in multiple genes, can have an autosomal dominant pattern , more common in females

most common cause of sudden cardiac death in adolescents in the US

hypertrophic cardiomyopathy

what makes the murmur w/ hypertrophic cardiomyopathy louder?

valsalva manuever

Gold standard for diagnoseis of hyertrophy cardiomyopathy

thickened intraventricular septum

noncardiac causes of palpitations

anemia, electrolyte disturbances, hyperthryoidism or hypothyroidism, hypoglycemia, hypovolemia, fever, pheo, vasovagal syncope

who should not get exercise stress tests?

patient w/ suspected hypertrophic cardiomyopathy or severe aortic stenosis

non pharm tx for SVT

carotid massage, valsalv menuever, cold applications to the face

Pharm tx for episode of SVT

IV adenosine

tx for chronic a-fib

beta blockers or CCB to keep HR below 100, warfarin

most common causes of ventricular arrhythmias

ischemia

most common cause of palpiattions

primary rhythm disturbances

most common bacteria from fist injuries

Eikenella

single most important risk factor for stroke

HTN

if a patient has stroke that affects the middle cerebral artery what will they experience

aphasia (dominant hemisphere), C/L hemiparesis, sensory loss, spatial neglect.

When the anterior cerebral artery is affected what symptoms will the patient have?

Foot and leg deficiets more than arm. Cognitive and personality changes

A stroke that affects the vertebrobasilar stokre what are the symptoms

include motor or sensory loss in all four limbs, crossed signs, disconjugate gaze, nystagmus, dysarthria, and dysphagia.

If the cerebellum is affected w/ a stroke what symptoms will there be

Ipsilateral limb ataxia

initital imaging of choice for stroke

CT scan of brain w/o contrast (helps r/o intracrnail hemorrhage, tumors, abscesses)

when is carotid endartectomy indicated?

carotid stenosis >70% , symptomatic patients w/ 50-70% stenosis

alarm symptoms w/ dyspepsia which warrant an early upper GI endoscopy

``` weight loss progressive dyphagia recurrent vomitting GI bleeing family Hx of cancer ```

preferred non-invasive office test for H pylorie

stool antigen testing (need to not have had PPIs for at laeast 2 weeks before )

can serologic testing for H pylori distinguish between acute and treated infections

gold standard for H Pylori testing

endoscopy w/ biopsy testing

tx for RMSF

doxycycline