ClinMed_test3 Flashcards
Define Medical emergency
An injury or illness that is acute and poses an immediate risk to a person’s life or long term health
Name the ABCDEFGHI in medical emergency
Airway Breathing Circulation Disability Exposure
What to do in a case of Airway
Make sure they have patent airway.
Not busting out the epinephrine
What is the leading cause of morbidity and mortality in the US
Acute myocardial infarction (Heart attack)
Heart attack In men vs heart in chicks
Men-Levine Sign
Females - heartburn, SOB, back pain, vomiting.
Name the two types of acute stroke
Ischemic - most common(perform carotid bruit-looking for plaques). There is blockage
Hemorrhagic(Bleeding in the brain)
What should u check if pt reports had a severe stroke?
Check VF
What does the FAST protocol consist of
Face - smile
Arms - raise them
Speech - say a sentence
Time- call 911
Define Orthostatic Hypotension
A sudden drop in BP when you change position. This can happen if you stand up too fast, get dehydrated, or take certain medicines, such as ones for high BP
T/F
Fever will always be present before a seizure
False
It can present itself afterwards.
What is the trt of choice for anaphylaxis?
Epinephrine
What is the goal for ppl suffering from seizures
Prevent secondary injury
What is the cause of seizure
Spontaneous epilepsy, drugs, metabolic disorders (hypoglycemia), rapidly increasing fever, brain tumor aneurysm med withdrawal, stroke
how often do u need to inject epinephrine in a pt suffering from anaphylaxis
`5 to 15 mins
what are some signs seen with anaphylaxis
Angioedema
Urticaria
hypotension
Bronchospasm
Name possible trt for anaphylaxis
Steroids
Antihistamines
Beta-adrenergics (epinephrine, albuterol)
what is the best place to insert epipen
Rectus femoris site
What is the entity for cluster headaches?
Horner’s syndrome
Where is the pain on Horner’s syndrome
Facial pain radiating to the ipsilateral eye
Name the worst HA of your life
Can be subarachnoid bleed
Retrobulbar
Pain on eye mvts
No retinopathy.
Name the evidence for a person with end organ damage
Chest pain
Severe HA
Nausea, vomiting
Define Hypertensive emergency
Severe HTN + End Organ Damage
How do you prepare for emergencies?
Staff training
Community resources
Office equipment
What is the leading cause of death in the US
CVD-cardiovascular disease
There are diff types of the disease.
CAD-coron art disease!!!!!
Name the top two Cardiovascular disease leading to death
Coronary heart disease akak coronary artery disease-coronary arteries is blocked.
Stroke
Name some uncontrollable factors for Cardiovascular disease (CVD)
Sex
Race
Age
Hereditary
Name some controllable factors for Cardiovascular disease (CVD)
Physical activity Obesity Smoking Stress and anger Diabetes High blood pressure(biggest risk) high blood cholesterol
Brittle diabetic
Their A1C is hard to control due to other factors like metabolic syndrome
T/F
Risk of cardiovascular disease double for every increase of 20 points over 115
True
name the most common type of heart disease?
Coronary heart disease aka Coronary artery disease
Define acute coronary syndrome
Umbrella term used to cover any grp of clinical symptoms compatible with acute myocardial ischemia
T/F
Woman are 5X more likely to die from cardiovascular disease than from breast cancer
True
Define angina pectoris
Uncomfy pressure, fullness, squeezing or pain in the center of the chest.
List the pts most likely to present w/o chest pain
Elderly Diabetes Neuropathy Stroke Female Non-white CHF
What is the most common time of day for MI
Common day of week?
6am to 12pm
Monday
Name the drug used as preventative care for CAD
Aspirin.
It thins the blood.
Side effects: Subconj Heme
List the medical management of CAD
Aspirin-antiplatelet Anticoagulants Beta blockers Thrombolytics Nitrates Morphine ACEI's
INR values
Less than 2 = too thin
2-3 = normal
More than 3 = too thick
What is the most common immediate cause of death in a myocardial infarction?
Arrhythmia
What should u suspect if u witness a roth spot heme?
Suspect endocarditis
Diabetes
HTN
Vascular
What is the white spot found in the center of the roth spot heme
CWS
Lymphoma
Septic Emboli
What are the top two things leading to bacterial endocarditis
Tooth extraction
Brushing teeth
Osler nodes
Small painful ischemia on the palm of the hand or feet
What do osler nodes indicate
Thrombocytopenia
Inflammatory disease
Diff b/w osler nodes and Janeway lesions
Janeway are Painless
Osler are painful
What kind of hypersensitivity rxn is Janeway lesion
Type III
Need to r/o Syphillis
Where do splinter hemes appear
What condition
Petech heme on inf plap conj or conj
Bacterial endocarditis
Name the most common arrhythmia that requires trt
Atrial Fibrillation
TQ: signs and symptoms of CHF
Periph Edema Pulmonary Edema SOB Dyspnea or exterion/exercise intolerance Paroxysmal nocturnal dyspnea Orthopnea
Medical management for CHF
Diuretics ACEI's or ARBS Beta Blockers Aldosterone receptor antagonists Digoxin
Look up Marfan Disease
Okee
Signs of Margan disease
Reduced upper to lower body seg Arm span exceeding ht Arachnodacyl of fingers and toes with pos thumb and wrist signs Scoliosis Dilation of the Aorta Aortic dissection Ectopia lentis Dural ectasia
Function of the normal kidney
Major waste management plant of the body
- Filters and excretes metabolic waste products
- Excretion of nitrogenous wastes
- Detoxifies and eliminates toxins
- Regulates red blood cell production
- BP regulation
- Keep the acid/base concentration of your blood constant
- Regulates fluid and electrolyte balance
Name the two parts to a nephron
Glomerulus
Tubules
What does Blood Urea Nitrogen(BUN) represent
Reflects excretory capacity of kidney.
It is the final breakdown product of protein
What is the normal value of BUN
10-20 mg/dl
What is creatinine
Product of skeletal muscle metabolism.
Freely filted by glomerulus, not reabsorbed; minimally secreted by tubules.
Name the 2things that effect Creatinine
Age
Muscle mass
T/F
Creatinine clearance gives an accurate estimation of GFR
False
Overestimation
what is the normal GFR for men and woment
Males: 130 ml/min
Women: 120 mL/min
define Prerenal ARF
Reduced renal perfusion due to volume depletion and/or decreased perfusion.
Biggest cause is dehydration
What is the biggest cause of Pre-renal ARF
TQ
Dehydration Others: volume loss(bleedg) heart failure shock liver disease
What is post-renal ARF
Any obstruction to urinary outflow from renal calyces and pelvis to urethral meatu.
OBSTRUCTION-THIS IS PAINFUL
THIS IS AN EMERGENCY
How many pts die from ARF
50%
What are the ocular findings in ARF
Uveitis Ocular Muscle paralysis Hollenhorst crystals Roth spots in endocarditis Lupus retinopathy
Lupus retinopathy and kidney?
U will see acute lupus nephritis.
Biggest cause of death in pts.
Name the two conditions that cause CKD
Diabetes
HTN
Define Chronic Kidney disease
Presence of markers of kidney damage for three months.
Name some ocular disorders in CKD
Band K
Calcium deposits in conj, hyperemia
HTN retinopathy
Cranial nerve involvement: nystagmus, miosis, pupillary, EOM palsy
Name the three trt options for renal disease
- Hemodialysis
- Periotneal Dialysis
- Kidney transplantation
Name the indications for dialysis
A E I O U A; intractable metabolic acidosis E: electolyte imbalance, esp hyperkalemia I: intoxications O: overhydration U: uremia
What is the most common renal tumor in childhood?
Wilms tumor
95% before age 10
What is
WAGR
Wilms Tumor
Aniridia
GU anomalies
Mental retardation
Name the 7 types of primary lesions
Macule Papule Plaque Hives Nodule Vesicle Bulla
Name the 9 secondary lesion
Crust Scale Erosion Ulcer Fissure Atrophy Scar Lichenification Excoriation
What is another name for actinic keratosis
Pre-cancer to squamous cell carcinoma
Where is actinic keratosis usually found
On skin exposed areas
Is actinic keratosis progressive
Not really.
It is slowly growing, can take yrs to develop unless immunocompromised.
Which skin condition may develop a horn like texture
Actinic keratosis
How to trt actinic keratosis
- Burning
- Curettage and electrodesiccation
- Excision
- Cryotherapy
- 5-FU and Imiquimod: creams
What happens to the skin during therapy for actinic keratosis with 5-FU
As abnormal cells are eradicated, skin becomes redder, crusts and peels.
Name the three types of skin cancers
Basal Cell Carcinoma
Squamous Cell Carcinoma
Malignant Melanoma
T/F Basal cell carcinoma spreads throughout the body
False
Are basal cell carincoma curable
Yes; high cure rate.
But, there is a 20-40% chance of developing another case.
Name the skin cancer that accounts for 80% of new skin cancer cases
BCC
Can squamous cell carincoma spread?
claro que si
How to treat BCC and SCC
Surgical excision
Mohs sx
5 FU, Imiquimod cream
Radiation therapy
What is the worst skin cancer
Malignant Melanoma
80% of skin cancer deaths
Is malignant melanoma curable?
Si
What are the ABCDE of Melanoma
Asymmetry Border Color Diameter >6mm Elevation
What is superficial spreading melanoma
It grows as small plaque for 6 to 24 months and then develops nodule.
It is highly invasive.
What are some lab studies to include when diagnosing a possible skin cancer
Liver function test Dermoscopy Wood's lamp CBC w/ diff Pet Scan
Prognosis of melanoma sizes
Less than 1mm have good prognosis
Lesion that are greater than 3mm have guarded prognosis
Managment of melanoma
Excision
Lymph node dissection
Examination and lab screening for metastasis
Trt for metastatic dz usually unsatisfactory
What is allergic contact dermatitis
A delayed hypersensitivity rxn caused by contact with an allergen
Management of eczematous dematitis in all stages
Topical steroids Immunomodulators IM seroids Antihistmaines Antibiotics Lubrication
What is eczema herpeticum
Disseminated HSV
Painful, umbilicated pustular vesicals
Fever, malaise, lymphadenopathy
Significant morbidity and mortality
What is molluscom contagiosum caused by
Pox virus.
Dome shaped papules with central plug and umbilication
What kinds of pts does molluscum occur in
Children
Young adults
Immunocompromised pts
Which pathogen causes impetigo
Staph aureus
Describe impetigo
Pustular vesicles with straw colored discharge
Trt of impetigo
Self limiting
Systemic antibiotic
Topical Bactroban ung - TID for ten days
What is Dermatomyositis
Acquired, idiopathic connective tissue disease.
Charact by proximal muscle weakness, rash on eyelids, scalp.
Pathognomonic features of dermatomyositis
Heliotrope rash
Gottron’s papules
What is the name of the sign that is on the tip of the nose in Zoster
Hutchingson’s sign.
Means there are ocular complications
Management of zoster
Antiviral agents: valtrex, famvir, acyclovir
Prednisone
Anti staphy Abs
Oc lubs
Can nevus of ota cause glaucoma
Si
Up to 10%
What is syringoma
Benign adnexal neopaslm
Formed by well diff ductal elements
What is a Hidrocystoma
Cystic lesion of either the apocrine or eccrine sweat glands
What is xanthoma
Lipid deposit in the skin and tendons
Xanthelasma -
yellowish plaques on the eyelids.
50% have normal cholesterol but higher LDLs
Rosacea-Derm findings
Facial erythema Telangiectasia Red papules Pustules Sebaceous gland hypertrophy Rhinophyma
Trt of Rosacea
Oral tetracyline, doxycycline Oral erythromycin Topical metronidazole Isotretinoin Lid hygient Ats Topical steroids
Rosacea - Complications
Corneal scarring
COrneal perforation
Bleph
COnjunctivitis
What is seborrehic dermatitis
Common, chronic, inflammatory dermatitis
Associated with overgrowth of yeast Pityosporum ovale
Face, scalp, presternal, upper back.
Trt of seborrheic dermatitis
Sodium sulfacetamide Metronidazole Ketoconazole shampoo Tar shampoo Topical steroids Immunomodulators (elidel and protopic)
Psoriasis
Lifelong and characterized by chornic, recurrent exacerbations and remissions that can be emotionally and physically debilitating `
Pesudoxanthoma elasticum in the eye?
Angioid straks
Define metabolic syndrome
Group of risk factors that occur together and increase the risk for coronary artery disease and stroke
Name some risks for AMD
Age Genetics Gender Smoking Sunlight exposure High levels of LDL and low levels of HDL High BMI
What percentage of AMD cases are linked to Dry AMD
90%
10% = Wet AMD
T/F
BMI of 30 or higher was associated with a twofold higher risk of AMD
True
T/F
Obese men were 2x more likely to have dry AMD
true
T/F
Genetics plus higher BMI increased risk of AMD almost sixfold
True
What was the Diabetes Prevention Program
Modest wt loss through dietary changes and increased physical activity could prevent or delay the onset of type II diabetes in study participants by 58%.
What did the ARIC and cardiovascular health study find?
Obese persons were found to have a nearly four-fold increased risk of retinal vein occlusion
