Case Files Flashcards
who is the influenza vaccine recommended for?
Every adult >50 years, health care workers, chornic CV, pulmonary, reanl or metabloic dsiease
Who gets a 1 time revaccination after 5 years of the pneumococcal polysaccharide vaccine?
chronic kidney, hepatic disease, immunodeficiency or asplenia
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
when should lipid screening happen
men >35 years old and women >45 years old
Who is screening for AAA recommended for?
men aged 65-75 who ahve ever smoked
mainstay of meds w/ COPD exacerbations
oxygen, bronchodilators, steroids
In COPD the FEV1/FVC is less than what?
0.7
when is O2 therapy recommended w/ COPD
PaO2 <88% at rest . needs to be worn at least 15 hours a day
steroid dose recommended w/ COPD exacerbation
40 mg prednisone for 10-14 days
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
major finding w/ a septic joint
very limited ROM due to pain
morning joint stiffness, involves 3 or more joint and have x ray chagnes such as erosions or decalcifications
rehumatoid arthritis
Tx for septic joint
Surgery for drainage than IV abx
tx for infectious diarrhea
cipro for adults
azithromycin for children/ pregnant women
when should women be screened for lipid disorders?
age 45
a stectching or tearing injury of a ligament
sprain
a stretching or tearing injury of a muscle or tendon
strain
pain with internal rotation when the arm is flexed to 90 degrees with the elbow bent to 90 degrees
Hawkin’s impingmenet (subacrominal impingement)
examiner pulls forward on patient’s heel while stabilizing lower leg w/ other hand
anterio rdrawer. if abnormal suggests anterior talofibular ligament injury
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
Examiner compresses tibia/ fibula at midcalf
Pain at anterior anle joint (below where squeeezing) suggests syndesmotic injury
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
most important risk factor for skin cancer devleopment
exposure to ultraviolet radiation
most common skin cancer
basal cell carcinoma
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
PE
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
No
gold standard for H Pylori testing
endoscopy w/ biopsy testing
tx for RMSF
doxycycline
