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Emergency Medicine Flashcards

1
Q

What lab value is almost always seen with pediatric patients who have osteomyelitis

A

elevated ESR and CRP

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2
Q

Osteomyelitis

- two most common sx

A

fever

joint pain

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3
Q

PID

- outpatient treatment

A
  • ceftriaxone 250 mg IM

- doxy 100 mg PO BID x 14d

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4
Q

PID

- inpatient treatment

A
  • Cefotetan 2 gm q 12 hours

- doxy 100 mg PO/IV 1 12 hours

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5
Q

Spontaneous Pneumo

- tx if stable

A

100% oxygen, observation, repeat xray in 6 hours

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6
Q

Cholangitis

  • charcot triad
  • Reynolds pentad
A
  • fever, abd pain, jaundice

- above + confusion and hypotension

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7
Q

Cauda Equina

- Most sensitive sx

A
  • urinary retention
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8
Q

Lithium Toxicity

- acute

A
  • n/v
  • urinary concentrating defects
  • Neuro sx: weakness, twitching, drowsy, confusion, etc.
  • prolonged QT, ST/T wave changes
  • hypothyroid
  • leukocytosis
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9
Q

Lithium toxicity

- chronic

A
  • nephrogenic diabetes insipidus, interstitial nephritis, renal failure
  • Neuro sx: weakness, twitching, drowsy, confusion, etc.
  • myocarditis
  • aplastic anemia
  • dermatitis, ulcers, edema
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10
Q

Common cause of nephrogenic diabetes insipidus

A
  • lithium
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11
Q

Acute mesenteric ischemia

- MC artery

A

super mesenteric artery

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12
Q

Acute mesenteric ischemia

- RF

A
  • dysrhythmia (afib)
  • recent MI
  • CAD
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13
Q

Acute mesenteric ischemia

- lab findings

A

lactic acidosis

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14
Q

Acute mesenteric ischemia

- Dx

A
  • CTA

- angiography (gold standard)

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15
Q

Ranson’s Criteria

A 
Age >55
WBC > 16k
Glucose >200
LDH > 250
AST > 250
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16
Q

Postdural HA

- Clinical

A
  • bilateral
  • 48 hours after procedure
  • worse sitting/standing
  • resolve days to weeks
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17
Q

Postdural HA

- Prevention

A
  • small caliber needle (higher gauge)
  • blunt needle
  • stylet replacement before needle removal
  • direction of bevel parallel to dural fibers (parallel to spine)
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18
Q

Postdural HA

- management

A
  • hydration, NSAIDs
  • caffeine
  • epidural blood patch
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19
Q

DVT

- criteria to determine testing

A

Wells Criteria

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20
Q

DVT

- test of choice if low to moderate pretest probability

A

D-dimer

- can rule out DVT if negative

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21
Q

DVT

- low/mod risk with a positive d-dimer or high risk: test of choice

A

ultrasound

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22
Q

define grouped beats in second degree heart block type I

A

group of beats together and then dropped QRS

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23
Q

Acute angle closure glaucoma

- treatment

A
  • timolol topical
  • apraclonidine topical
  • pilocarpine topical
  • acetazolamide (systemic)
  • mannitol (systemic)
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24
Q

Normal intraocular pressure

A
  • 8-21
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25
Q

MC injury in children with blunt chest trauma

A

pulmonary contusion

- chest wall much more elastic than adults, less likely to have external signs including rib fractures

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26
Q

AAA

- signs

A
  • can be similar to renal colic
  • syncope
  • combo of back and abdominal pain
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27
Q

COPD exacerbation

- MC bugs

A
  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Moraxella catarrhalis
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28
Q

COPD exacerbation

- s/sx

A
  • tachypneic
  • tachycardic
  • AMS (dt CO2 retention)
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29
Q

COPD exacerbation

- management

A
  • beta-adrenergic agonist (albuterol)
  • Anticholinergic agents (ipatroprium)
  • oral steroids (prednisone)
  • Noninvastive positive pressure ventilation
  • Abx
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30
Q

Spinal epidural abscess

- RF

A
  • IV drug users
  • alcoholics
  • immunocompromised including DM
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31
Q

Spinal epidural abscess

- presentation

A
  • lower back pain
  • pain to palpation of spinal processes
  • elevated ESR and CRP
  • fever 50%
  • focal neurologic deficits 50%
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32
Q

Spinal epidural abscess

- imaging

A

MRI

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33
Q

Spinal epidural abscess

- management

A
  • neurosurgical consult for drainage and decompression

- broad spectrum abx

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34
Q

Giardia

- treatment

A
  • metronidazole
  • tinidazole
  • albendazole/mebendazole
  • nitazoxanide
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35
Q

PCP

  • describe
  • eye movements
  • clinical
A
  • dissociative anesthetic similar to ketamine
  • glutamate receptor (NMDA) antagonist
  • rotary nystagmus
  • behavior issues, anger, aggression, irritability, impaired judgement
  • HTN, tachycardia
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36
Q

Acute hypertensive heart failure

- initial management

A

nitroglycercine : pre and after load reduction

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37
Q

Knee effusions

- which bursa communicates with teh joint cavity

A

Suprapatellar bursa

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38
Q

Signs epistaxis is posterior not anterior

A
  • older patient
  • bleeding from both nares
  • bleeding in posterior pharynx
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39
Q

Posterior epistaxis complications

A
  • aspiration
  • hypoxia
  • hypercarbia
  • symptomatic bradycardia
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40
Q

What neuro complication are people with polycystic kidney disease at greater risk for?

A

berry aneurysms - SAH

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41
Q

SAH

- risk factors

A
  • Marfan
  • Polycystic kidney disease
  • Coarctation of the aorta
  • Fibromuscular dysplasia
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42
Q

Which traumatic event has the highest probability of resulting in post-traumatic stress disorder

A

rape

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43
Q

Vertigo

- signs is peripheral cause

A
  • rapid onset
  • increased intensity with head movement
  • intense spining
  • change in sensation of hearing
  • horizontal or rotary nystagmus
  • normal neuro exam
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44
Q

Vertigo

- signs is central cause

A
  • insidious onset
  • quality is ill-defined
  • head position does not affect
  • nystagmus can change direction
  • positive neuro findings
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45
Q

Nerve affected by falling asleep drunk at night on arm

A

radial nerve
(hand drop)
- numb over first dorsal interosseous muscles

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46
Q

SVT

- sx

A
  • abrupt onset tachycardia (120-200 bpm)

- narrow complex on EKG

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47
Q

SVT

- management

A
  • vagal maneuvers
  • adenosine 6 mg
  • adenosine 12 mg
  • cardioversion (if unstable)
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48
Q

TTP

- pentad

A
  • fever
  • anemia (microangiopathic, hemolytic)
  • thrombocytopenia
  • renal failure
  • neurologic findings
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49
Q

TTP

- management

A

plasmapheresis

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50
Q

One major differentiator between encephalitis and meningitis

A

presence of a distinct neurologic abnormality:

  • new psychiatric symptoms
  • cognitive deficits (aphasia, amnesia, acute confusional state)
  • seizures
  • movement disorders
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51
Q

Tension pneumothorax

- needle decompression locatoin

A
  • second intercostal space (above the rib)
  • midclavicular line
  • large bore needle (14 gauge or greater)
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52
Q

Endocarditis

- what type of pneumonia can tricuspid valve infections lead to

A
  • multifocal pneumonia

- vegetations on the right side of the heart and embolize to the lungs

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53
Q

Croup

- MC bug

A

parainfluenza virus

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54
Q

Croup

- treatment

A
  • antipyretics
  • hydration
  • nebulizer racemic epi
  • steroids
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55
Q

Aortic aneurysm

- sizes and assoc mgmt

A

> 5.5 or >0.5 cm expansion in 6 months: immediate surgical repair
4.5 cm: vascular surgeon referral
4-4.5 cm: monitor US Q6 months
3-4 cm: monitor US Q 1 year

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56
Q

What common medication can worsen the effects of heart failure?

A

NSAIDS

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57
Q

Low back pain

- indications for imaging

A
  • <18 or >50
  • night pain/weight loss
  • fever, chills, sweats
  • acute bony tenderness
  • Morning stiffness >30 min in young adult
  • urinary/bowel retention, saddle anesthesia
  • recent spinal instrumentation
  • immunodeficiency
  • coagulopathy
  • sx lasting >4-6 weeks
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58
Q

Croup

- MCC

A

parainfluenza virus

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59
Q

SAH

- medication to decrease vasospasm

A

nimodipine

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60
Q

What level does spinal cord terminate in adults

A

L1-L2

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61
Q

What is the most common cardiology finding in patients who have WPW (aside from WPW arrhythmia)

A

atrial fibrillation - seen in 25% with WPW

- will have a very rapid rate with wide-complex tachycardia

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62
Q

Which antiarrythmic medication is CI in setting of coronary artery disease or structural heart disease?

A

Flecainide

- increased risk of polymorphic v-tach

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63
Q

Tricuspid regurgitation

- causes

A
  • MC: elevated R heart pressure (COPD, pulmonary fibrosis, volume overload)
  • endocarditis: usu IVDU
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64
Q

Endocarditis

  • MC bug IVDU
  • MC native valve
  • MC bug men with GI/Gu procedure
A
  • staph aureus
  • strep viridans (esp person with dental disease)
  • enterococci
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65
Q

CHA2DS2-VASc

  • use
  • score
A 
estimate risk of stroke
- CHF
- HTN
- Age >75 (+2 points)
- DM
- Stroke hx (+2 points)
- Vascular disease
- Age 65-74
- Sex female 
0 points: low risk
1 point: low-mod risk, consider anticoag
2+ points: anticoagulation candidate
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66
Q

Rheumatic heart disease

- most common heart murmur

A 
mitral stenosis (diastolic low-pitched decrescendo at cardiac apex)
- best heart with bell in left lateral decubitus
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67
Q

Pericardial knock

- what heart condition

A

constrictive pericarditis

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68
Q

Two types of beat associated with ventricular tachycardia

A
  • fusion beats: when impulses from two locations activate the ventricle
  • capture beats: sinus beat is normally conducted and a single beat with sinus QRS occurs with wide complex tachycardia
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69
Q

V-tach

- define

A
  • > 3 consecutive ectopic ventricular beats
  • monomorphic, polymorphic
  • wide complex
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70
Q 
V-tach
treatment
- pulseless
- unstable
- stable
A
  • immediate defibrillation
  • synchronized cardioversion
  • procainamide, amiodarone, cardioversion if refractory
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71
Q

Hypertensive emergency

- define

A
  • severe elevation bp

- evidence of end-organ damage

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72
Q

Hypertensive emergency

- treatment

A
  • reduce MAP 10-20% first hour, graduate reduction during next 23 hours
  • goal: reduction 25% compared to baseline within 24 hours
  • IV labetalol
  • esmolol, nicardipine, hydralazine, nitroglycerine
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73
Q

BP Goals
>= 60 yo
< 60
>18 with CKD or DM

A

<150/90
<140/90
<140/90

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74
Q

What four drugs have shown decreased in mortality for pt with MI

A

ASA
BB
Statin
ACEi

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75
Q

Back pain red flags

- RF for what

A
  • fracture
  • malignancy
  • infection
  • cauda equina
  • -> get XR
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76
Q

Back pain red flags

- list

A
  • night pain, weight loss (tumor)
  • fever, chills, sweats (bone/disk infection)
  • acute bony tenderness (fx)
  • morning stiff >30 min in young adults
  • urinary/bowel retention, saddle anesthesia (caudal equina)
  • recent spinal instrumentation (abscess or hematoma)
  • immunodeficiency (bone/disk infection)
  • extremes of age
  • coagulopathy (spinal epidural hematoma)
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77
Q

Ankle fracture mgmt

  • stable
  • unstable, non displaced
  • unstable, displaced
A
  • 4-6 weeks weight bearing cast/brace
  • non-weight bearing cast
  • open/closed reduction
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78
Q

Spinal stenosis

  • dx
  • mgmt
A
  • MRI

- PT and surgery

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79
Q

MC fracture carpal bone

A

scaphoid

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80
Q

DTR

List

A 
C5/6 Biceps
C6 Brachioradialis
C7 Triceps
L4 Patellar
S1 Achilles
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81
Q

Name for test for hip dysplasia: lay on back and flex knees to compare femur length

A

Galeazzi test

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82
Q

Treatment for osteomyelitis due to cat bite

A

ampicilling-sulbactam

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83
Q

Name for fracture-dislocation of the tarsometatarsal joints

A

Lisfranc injury

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84
Q

Lisfranc

- mechanisms of injury

A
  • Severe plantar flexion of foot

- sports, MVCs, fall from height

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85
Q

Lisfranc

- clinical

A
  • pain at tarsal-metatarsal joints
  • ecchymosis, instability
  • forefoot rotation against a stabilized hind foot (calcaneus) = severe pain (but not in sprained ankle)
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86
Q

Rotator Cuff

- tests

A
  • Neer and Hawkins
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87
Q

Rotator Cuff

- common clinical findings

A
  • pain brushing hair or teeth
  • pain at night when rolling onto shoulder
  • baseball pitchers
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88
Q

What imaging is appropriate for suspected disk herniation

A

none :)

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89
Q

Osteomyelitis

  • XR findings
  • Dx modalities
A
  • periosteal elevation or bony erosion

- bone scan or MRI

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90
Q

Osteomyelitis

- MC orgs

A
  • s. aureus
  • sickle cell: salmonella
  • cat/dog bite: pasteurella multocida
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91
Q

Osteomyelitis

  • treatment
  • adult vs. children
A
  • long term abx
  • debridement if nail puncture wound
  • adults: contiguous spread
  • children: hematogenous spread
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92
Q

Mgmt of Salter Harris fx

A
  • splint with non-weight bearing as tolerated
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93
Q

Duodenal vs. gastric ulcer

- when eat food

A
  • duodenal: pain alleviated (DUDe give me food)

- gastric: exacerbated by food

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94
Q

MCC of upper GI bleed

A

peptic ulcer disease

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95
Q

Peptic ulcer disease

- how to diagnose

A

upper endoscopy

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96
Q

Esophageal stricture

- mgmt

A
  • dilation

- +/-PPI

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97
Q

Electrolyte and acid/base status in pyloric stenosis

A
  • metabolic alkalosis
  • hypochloremic
  • hypokalemic
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98
Q

PUD

- treatment for h. pylori

A
  • triple therapy: CAP (clarithromycin, amoxicillin, PPI)

- quad therapy (bismuth, metronidazole, tetracycline, PPI)

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99
Q

Esophageal rupture

- etiology

A
  • spontaneous: Boerhaave syndrome

- Iatrogenic (esophageal dilation, intubation, EGD)

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100
Q

Esophageal rupture

- clinical

A
  • chest/midepigastric pain
  • pleuritic pain worse with neck flexion and swallowing
  • mediastinal crunch
  • rapid development of sepsis
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101
Q

Esophageal rupture

  • dx
  • mgmt
A
  • chest xray shows mediastinal air and esophageal with water soluble solution
  • broad spectrum abx, surgical consult
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102
Q

Esophageal varices

- treatment

A
  • hemodynamic support
  • octreotide
  • prophylactic ceftriaxone
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103
Q

MCC liver disease in the US

A

Non alcoholic fatty liver disease

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104
Q

what vertebrae level is a swallowed foreign body most likely to get stuck?

A

C6: cricopharyngeus muscle (upper esophageal sphincter)

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105
Q

AP appearance of swallowed coin

  • in trachea
  • in esophagus
A
  • oval: side view

- circle: flat view

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106
Q

Traveler’s Diarrhea

  • MCC
  • sx
  • treatment
A
  • enterotoxigenic E. coli (ETEC)
  • diarrhea, abd cramps, nausea, bloating
  • fluid replacement, cipro, azithromycin (pregnant and children)
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107
Q

Acute diverticulitis

- clinical

A
  • abdominal pain
  • n/v
  • fever
  • change in bowel habits (constipation MC)
  • hematochezia (rare)
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108
Q

Acute diverticulitis

- dx

A
  • CT: localized bowel wall thickening, pericolonic fat stranding, colonic diverticula
  • US
  • MRI
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109
Q

Acute diverticulitis

- management

A
  • abx: cipro and flagyl

- surgical if complicated

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110
Q

Acute diverticulitis

- 3 MC complications

A
  • obstruction
  • perforation
  • abscess
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111
Q

Acute diverticulitis

- diet recommendations

A

low fiber diet until asx for 6 weeks.

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112
Q

Ranson’s Criteria

  • use
  • list
A

Assess severity and mortality of acute pancreatitis

  • Age >55
  • WBC > 16k
  • Glucose >200
  • LDH > 350
  • AST > 250
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113
Q

screening age for colon cancer

A

50 to 75

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114
Q

What electrolyte abnl is common post operative period? What can it cause?

A
  • hypokalemia

- ileus

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115
Q

Ischemic Colitis

- cause

A

global low flow state

  • HF
  • MI
  • Sepsis
  • Hemorrhage
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116
Q

Ischemic Colitis

- presentation

A
  • acute onset crampy abd pain, TTP over affected bowel
  • blood diarrhea
  • hx of atherosclerosis
  • *differs from acute mesenteric ischemia which has pain out of proportion to exam
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117
Q

Ischemic Colitis

- imaging

A

CT: bowel wall edema

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118
Q

Ischemic Colitis

- mgmt

A
  • signs of peritonitis, possible bowel infarction = immediate surgical intervention
  • Most resolve with supportive care: IVF and bowel rest
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119
Q

Pneumocystis jirovecii PNA

- clinical

A
  • immunocompromised: HIV or transplant pt
  • HIV CD4 <200
  • Sx progress over 2-3 weeks
  • fever, dry cough
  • O2 desaturation with ambulation
  • LDH often elevated
  • CXR: bilateral infiltrates (batwing pattern)
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120
Q

Pneumocystis jirovecii PNA

- treatment

A
  • steroids if PaO2 < 70

- Bactrim

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121
Q

Bronchiolitis

- clinical

A
  • Usu <2 yo
  • preceded by 1-3 day URI prodrome
  • fever, cough
  • polyphonic wheezing and rales
  • resp distress
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122
Q

Bronchiolitis

- complications

A
  • dehydration
  • apnea (premature or <2 mo)
  • aspiration PNA, resp failure
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123
Q

Bronchiolitis

- mgmt

A
  • Nasal suctioning, hydratoin

- ?bronchodilator, heated high flow nasal cannula, CPAP, intubation

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124
Q

TB

- active/reactive sx

A
  • fever
  • night sweats
  • weight loss
  • productive cough
  • hemoptysis
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125
Q

TB

- CXR

A
  • Ghon focus

- upper lobe, cavitary lesions

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126
Q

TB

- Dx

A
  • latent/primary: PPD

- active/reactivation: sputum smear for AFB, sputum culture of AFB (GS)

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127
Q

TB

- mgmt

A
  • Latent: INH x 9 months, rifampin for 4 months, INH/rifampin for 3 months
  • active/reactive: RIPE (rifampin, INH, pyrazinamide, ethambutol)
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128
Q

TB

- what is given with INH to prevent peripheral neuropathy?

A

B6

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129
Q

Bronchitis

  • sx
  • PE
  • CXR
  • mgmt
A
  • mucopurulent cough x 5 days +
  • wheezing and rhonchi
  • CXR: thickened bronchial walls in lower lobes
  • supportive: dextromethorphan, guaifenesin
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130
Q

PE

  • MC sx
  • MX sign
  • EKG
A
  • dyspnea
  • tachycardia
  • nonspecific ST and T wave changes, S1Q3T3
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131
Q

PE

- CXR

A
  • Hampton’s Hump

- Westermark’s sign

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132
Q

PE

- dx

A
  • CT pulmonary angiography

- low clinical suspicion: can rule out with negative d-dimer

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133
Q

PE

- mgmt

A
  • anticoagulation (heparin, LMWH)
  • supportive
  • thrombolytics if hemodynamically unstable
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134
Q

Hydrocarbon ingestion

  • sx
  • CXR
A
  • non-specific: grunting, gagging, chocking, tachypnea, fever, persistent cough
  • diffuse bilateral infiltrates
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135
Q

Carcinoid syndrome

- mgmt

A

octreotide

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136
Q

PNA

- CAP treatment for children

A

amoxicillin

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137
Q

CAP

- MCC

A

strep pneumoniae

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138
Q

“walking” PNA

- MCC

A

mycoplasma pneumonia

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139
Q

Egophony

  • explain
  • when found
A
  • pt says “eee” but sounds like “ahh” (abnl finding)
  • happens in PNA: sounds is transmitted through consolidated parenchyma
  • helps differentiate PNA from other lung conditions like bronchitis or emphysema
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140
Q

Foreign body aspiration

- exam tool

A
  • rigid bronchoscopy (flexible can dislodge the object and cause complete obstruction)
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141
Q

Nontraumatic intracerebral hemorrhage in adult

- MCC

A

hypertensive vasculopathy

- leads to degenerative changes and eventual rupture of penetrating arteries.

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142
Q

Cryptococcal neoformans in AIDS

- sx

A
  • indolent onset, 1-2 weeks
  • HA, fever
  • stiff neck, photophobia, vomiting
  • CD4 < 100
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143
Q

Cryptococcal neoformans in AIDS

- Dx

A
  • india ink stain on CSF (round yeast)

- Cryptococcal antigen - CSF or serum

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144
Q

Cryptococcal neoformans in AIDS

- Mgmt

A
  • Amphotericin B
  • Fluconazole
  • Flucytosine
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145
Q

Lidocaine toxicity

A
  • CNS and CV problems secondary to sodium channel blockade
  • dizzy, HA, tingling, tinnitus, sedation, tremor, seizure
  • bradycardia, heart block, dysrhythmia
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146
Q

Amide local anesthetics

A
  • Lidocaine
  • Bupivocaine

** Two Is

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147
Q

Ester local anesthetics

A
  • Tetracaine
  • benzocaine

** only one I

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148
Q

What affect does hyperbaric O2 therapy have on carbon monoxide poisoning

A

reduces risk of neurologic sequelae

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149
Q

Brain abscess

- bugs

A
  • strep
  • staph
  • anaerobes
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150
Q

Brain Abscess

- mgmt

A
  • third get cephalosporin
  • agent to cover anaerobes: metronidazole
  • neurosurgery consult
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151
Q

SAH

- MCC

A
  • ruptured aneurysm, often berry aneurysm in circle of willis
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152
Q

SAH

- Dx

A
  • Noncontrast CT

- if negative but high suspicion: LP

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153
Q

SAH

- mgmt

A
  • supportive

- Nimodipine (decreases cerebral vasospasm)

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154
Q

At what level does the spinal cord terminate in adults

A

L1-L2

** LP best L3/4 L4/5 or L5/S1

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155
Q

Treatment for active seizure

A 
IV benzo (midazolam)
Buccal, IM, and intranasal second line option for route
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156
Q

Status epilepticus

- define

A
  • continuous seizure activity >5-10 min OR

- >2 seizures without full recovery

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157
Q

Status epilepticus

- mgmt

A
  • finger stick glucose
  • consider B6 of INH toxicity
    1st line: benzo
    2nd line: phenytoin, l
    3rd line: pentobarbital, propofol
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158
Q

Thalamic hemorrhage

A
  • contralateral hemisensory loss**
  • hemiparesis and ocular sx
  • acute with rapid progression
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159
Q

SAH Hunt Hess Grading Scale

A

I: mild HA, normal mental status, no nerve deficits
II: severe HA, normal mental status, cranial nerve deficit
III: somnolent, confused, maybe cranial nerve or mild motor nerve deficit
IV: Stupor, mod-severe motor deficit, intermittent reflex posturing
V: coma, reflex posturing or flaccid

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160
Q

Brudzinski Sign

A

Perform neck flexion

Positive test: reflexive flexion of hips and knees

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161
Q

Kernig’s Sign

A

Flex hip and knees to 90 and then attempt to extend the knee

- positive test: significant pain

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162
Q

Bacterial Meningitis

- sx

A 
HA
neck stiff
photophobia
phonophobia
fever
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163
Q

Bacterial Meningitis

- MCC bug

A

strep pneunomiae

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164
Q

Bacterial Meningitis

- treatment

A
  • 18-50 yo: ceftriaxone + vanc

- >50: ceftriaxone, vanc, ampicillin (listeria)

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165
Q

Median nerve

  • motor
  • sensation
A
  • OK sign

- index finger

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166
Q

Ulnar nerve

  • motor
  • sensation
A
  • 5th finger abduction

- 5th finger

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167
Q

Radial Nerve

  • motor
  • sensation
A
  • wrist/finger extension

- dorsal thumb-index finger web space

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168
Q

Syringomyelia

A
  • CSF cavity in spinal cord
  • MC in c-spine
  • Arnold-Chiari malformation
  • Loss of pain and temp sensation, preserved proprioception and light touch in “cape-like” distribution
  • MRI
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169
Q

Medication(s) recommended for secondary stroke prevention for non-cardioembolic TIA and ischemic stroke

A

Aspirin OR clopidogrel OR dipyridamole

But combo is not more effective but has higher risk of bleed

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170
Q

Posterior epistaxis

A
  • less common than anteiror
  • older population
  • HTN/atherosclerotic disease
  • More severe
  • Admit pt with posterior packing to a monitored bed
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171
Q

Preseptal cellulitis

- overview

A

infection involving contents of orbit (adipose and muscle)

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172
Q

Preseptal cellulitis

- etiology

A

Children > adults

  • bacterial rhino sinusitis (MC)
  • orbital trauma w/ fx or foreign body
  • dacryocystitis
  • teeth, middle ear, face infection
  • infected mucocele
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173
Q

Preseptal cellulitis

- clinical

A
  • no pain with eye movement, proptosis, diplopia, visual impairment, all of which are seen with orbital cellulitis
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174
Q

Preseptal cellulitis

- mgmt

A
  • broad spectrum abs: vanc + piperacillin-tazobactam

- surgery

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175
Q

Sinusitis

  • mgmt uncomplicated
  • mgmt complicated
A
  • Amoxicillin

- Augmentin (daycare, <2 yo, abx in last 1-3 months)

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176
Q

Acute mastoiditis

- clinical

A
  • lethargy and malaise
  • abnl TM
  • post auricular erythema and tenderness
  • fever
  • otalgia, otorrhea
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177
Q

Acute mastoiditis

- mgmt

A
  • admission
  • IV abx
  • drainage
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178
Q

Acute mastoiditis

- MC bug

A

strep pneumonia

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179
Q

Retropharyngeal abscess

- clinical

A

MC 3-5 yo

  • sore throat
  • fever
  • neck stiffness
  • odynophagia
  • neck swelling
  • poor oral intake
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180
Q

Retropharyngeal abscess

- imaging

A

CT with contrast for dx

- XR will show widened retropharyngeal space

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181
Q

Dacrocystitis

- clinical

A
  • unilateral, painful
  • red, swollen, warm
  • tender lacrimal sac
  • ? purulent discharge
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182
Q

Dacrocystitis

- MC bug

A

staph aureus

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183
Q

Dacrocystitis

- mgmt

A
  • warm compress
  • gentle massage
  • mild: clinda
  • severe: vanc, 3rd gen cephalosporin
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184
Q

AOM

- abx choice

A
  • First line: amoxicillin
    Second line: 3/4th gen cephalosporin (Cefdinir)
  • Adults: consider augmentin d/t drug resistance
  • PCN allergy: Azithromycin or Bactrim
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185
Q

Optic neuritis

- sx

A
  • partial/complete loss of vision
  • painful vision loss, retro-orbital pain
  • altered color vision
  • Uhthoff’s phenomena: worsening of vision with increased body temp
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186
Q

Optic neuritis

- dx

A
  • slip lamp testing or direct ophthalmoscopy
  • ocular MRI
  • visual evoked potential testing
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187
Q

Optic neuritis

- mgmt

A
  • steroids
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188
Q

Optic neuritis

- MCC

A

MS

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189
Q

Perichondritis

- MC bugs

A
  • pseudomonas
  • staph aureus
  • strep pyogenes
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190
Q

Perichondritis

- mgmt

A
  • Possible I&D
  • FQ: cipro
  • IV abx possibly
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191
Q

Periapical abscess

A
  • hx of dental carries
  • pain on tooth percussion
  • PCN to treat + analgesia and dental f/u
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192
Q

Rhinosinusitis

- how to determine viral vs. bacterial

A

Bacterial if:

  • sx >10 days
  • worsen after 5-7 days
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193
Q

Rhinosinusitis

- mgmt

A
  • 98% will resolve spontaneously
  • analgesics mainstay of treatment: tylenol or NSAIDs
  • if bacterial: Augmentin
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194
Q

Conjunctivitis

- mgmt

A

abx

  • erythromycin
  • gentamycin
  • cipro
  • ofloxacin

*contacts: FQ

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195
Q

Angioedema

- mgmt

A
  • airway management!!
  • Hereditary or acquired: FFP to replace C1-esterase inhibitor
  • Drug induced: supportive care
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196
Q

Radial head fracture

  • MC pt
  • PE
  • Xray
A
  • adult with FOOSH
  • localized swelling, TTP, decreased motion
  • fat paid “sail sign”
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197
Q

What is the definitive exam to clear a cervical spine

A

c-spine MRI

* xray cannot visualize spinal cord and ligaments

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198
Q

Rabies

- MC animal

A

bats raccoons and skunks)

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199
Q

Rabies

- post-exposure prophylaxis

A
  • Human rabies immunoglobulin

- 4 doses of inactivated rabies vaccine over 14 days

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200
Q

Rabies

- sx

A
  • hydrophobia
  • agitation
  • spasms
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201
Q

EKG findings left main occlusion

A
  • ST segment elevation in AVR > 1mm or greater than elevation in V1
  • ST depression in I, II, V4-6
202
Q

Injury of which portion of the spine is most likely to be associated with cord injuries

A

thoracic spine

- more rigid = requires more force to create injury.

203
Q

MC injured portion of the spine

204
Q

Animal bites

  • what types require abx
  • abx
A
  • puncture, hands/feet, and high-risk patients

- Augmentin, Clinda + Bactrim in PCN allergic

205
Q

Animal bites

- primary closure vs. secondary

A

primary if on scalp, face, torso, extremities other than hands and feet

206
Q

CO poisoning

- clinical

A
  • HA
  • n/v
  • LOC
  • hypoxia, chest pain
  • cherry red skin
  • Labs: Carboxyhemoglobin
207
Q

CO poisoning

- mgmt

A
  • airway
  • High-flow O2
  • hyperbaric O2
208
Q

Brown-Sequard Syndrome

- mechanism

A

MC penetrating trauma

209
Q

Brown-Sequard Syndrome

- clinical

A
  • Ipsilateral: loss motor, vibratory sensation, proprioception
  • Contralateral: loss pain and temperature
210
Q

Anterior cord syndrome

- mechanism

A

Flexion or vascular

211
Q

Anterior cord syndrome

- clinical

A
  • complete loss motor, pain, temp below injury

- retains proprioception and vibratory sensation

212
Q

Central cord syndrome

- mechanism

A

forced hyperextension

213
Q

Central cord syndrome

- clinical

A

sensory and motor deficit

Upper>lower extremities

214
Q

what nasal injury is considered an emergency

A

septal hematoma: can lead to necrosis and a perforated septum.
- drain and pack the nose to keep perichondrium in contact with the septal cartilage

215
Q

EKG

- hypokalemia

A
  • flattened or inverted T waves

- U waves (upward deflection after the T wave)

216
Q

Hypercalcemia of malignancy

- treatment

217
Q

MC type of incontinence in elderly population

218
Q

BV

- cause

A
  • decrease in concentration of Lactobacillus sp which leads to an increase in vaginal pH and overgrowth of anaerobes including Gardnerella vaginalis
219
Q

What electrolyte disorder can Bactrim cause

A

Hyperkalemia

220
Q

What medications commonly cause hypokalemia

A
  • Loop diuretics (furosemide)
  • HCTZ
  • insulin
221
Q

what is a common cause of normal anion gap acidosis

222
Q

Impetigo

  • topical
  • systemic
A
  • mupirocin

- oral cephalexin

223
Q

Hypersensitivity Reaction Type I

  • mechanism
  • Examples
A
  • IgE mediated degranulation of mast cells with release of mediators
  • Anaphylaxis, urticaria, angioedema
224
Q

Hypersensitivity Reaction Type II

  • mechanism
  • Examples
A
  • IgG or IgM ab react with cell antigens = compliment activation
  • autoimmune hemolytic anemia, good pasture syndrome
225
Q

Hypersensitivity Reaction Type III

  • mechanism
  • Examples
A
  • IgG or IgM ab react with cell antigens = compliment activation
  • Serum sickness, SLE, RA
226
Q

Hypersensitivity Reaction Type IV

  • mechanism
  • Examples
A
  • Activated T cells vs. cell surface bound antigens

- contact dermatitis, TB skin test, transplant rejection

227
Q

Serum sickness

A
  • Type III hypersensitivity
  • Onset 7-21 days after exposure OR 12-36 hours after reexposure
  • flulike sx, rash
228
Q

Rocky Mountain Spotted Fever

- clinical

A
  • tick bite
  • abrupt onset sx
  • fever
  • HA
  • myalgias
  • maculopapular rash (palms and soles)
  • photophobia
  • v/d
229
Q

Rocky Mountain Spotted Fever

- mgmt

A

doxycycline

230
Q

Rocky Mountain Spotted Fever

- bacteria

A

rickettsia rickettsia

231
Q

Cellulitis Abx

  • non-purulent
  • purulent
A
  • cephalexin, dicloxacillin
    (PCN allergic: valinda or erythromycin)
  • bactrim, linezolid, vanc
232
Q

Herpes Simplex Virus

- gold standard diagnostic test

A
  • tissue culture with PCR
233
Q

DTR

- hypothyroid

A

delayed relaxation of DTR

234
Q

Hypothyroid

- labs

A
  • high TSH
  • low T4
  • antithyroid peroxidase
  • antithyroglobulin antibodies
235
Q

Thyroid Storm

- RF

A
  • infection (MC)
  • surgery
  • trauma
    • acute event
236
Q

Thyroid storm

- clinical

A
  • tachycardia >140
  • HF
  • hypotension
  • dysrhythmia (afib)
  • hyperpyrexia
  • agitation
  • psychosis, stupor
  • coma
237
Q

Thyroid storm

- Mgmt

A
  • BB (propranolol)
  • PTU or methimazole
  • Iodine
  • Steroids
  • Bile acid sequestrate
238
Q

What is graves disease also known as

A

toxic diffuse goiter

*toxic multi nodular goiter is the second MCC of hyperthyroidism in the US

239
Q

Which medication for hyperthyroidism is best in pregnancy

A

PTU

P for pregnant

240
Q

First line test for suspected acromegaly

A

insulin-like growth factor 1

241
Q

HELLP syndrome

A
  • hemolysis
  • elevated liver function test
  • low platelets
  • mg for eclamptic seizure and deliver the baby
242
Q

Vaginal pH

  • candidiasis
  • Trich
  • BV
A

< 4.5
> 5
> 4.5

243
Q

Greatest RF for ectopic pregnancy

A

previous ectopic pregnancy

* also PID

244
Q

Preterm Rupture of Membrane

- sx

A
  • vaginal pH >6.5, nitrazine paper turns blue

- ferning

245
Q

RF for suicide

A 
SADPERSONS
Sex: male
Age <19 or >45
Depression or hopeless
Prev attempts/psych care
Excessive etoh or drug use
Separated, divorced, widowed
Organized or serious attempt
No social support
Stated future intent
246
Q

Definition of substance abuse

A
  • failure to fulfill major life obligations
  • recurrent use in situations in which it is physically haszardous
  • recurrent related legal problems
  • Continued used despite persistent social or interpersonal problems
247
Q

Opioid Overdose

- mgmt

A
  • support the airway

- O2 then naloxone

248
Q

MC finding abusive head trauma in infants

A

retinal hemorrhage

249
Q

MC malignancy of the head and neck in children

A

Hodgkin’s lymphoma

250
Q

Megaloblastic anemia

A
  • often vegan or alcoholic
  • fatigue, weakness
  • PE: pallor, glossitis
  • MCV > 100, hypersegmented neutrophils
  • B12 and folate
    • only B12 deficiency = neuro sx
251
Q

Lab finding to differentiate between iron def anemia and thalassemia

252
Q

What type of hemoglobin does hydroxyurea increase?

253
Q

ALL

- clinical

A
  • bone pain
  • lymphadenopathy
  • hepatosplenomegaly
  • CNS involvement
254
Q

Winter formula to calculate concomitant respiratory alkalosis/acidosis

A

pCO2 = 1.5 (bicarb) + 8 +/- 2

255
Q

Erythema rashes (5)

A
  • Erythema multiform: target-like, infectious, medication, autoimmune
  • Erythema marginatum: macule with central clearing, spares the face, rheumatic fever
  • erythema nodosum: inflammatory nodules, infectious, autoimmune
  • Erythema migrant: bull’s eye, lyme disease
  • Erythema infectious: slapped cheek, circumoral pallor, parvovirus B19 (fifths disease)
256
Q

Galeazzi Fracture

A
  • Distal radius fracture

- distal radioulnar joint (DRUJ) dislocation

257
Q

Monteggia Fracture

A
  • Proximal to mid ulna fracture

- radial head dislocation

258
Q

Ottawa Ankle Rules

- ankle xray

A

Pain in malleolar region +

  • bone tenderness posterior edge of distal or tip of lateral malleolus
  • bone tenderness posterior edge of distal or tip of medial malleolus
  • inability to bear weight for min 4 steps immediately after injury AND at time of evaluation
259
Q

Ottawa Ankle Rules

- foot xray

A

Pain in the mid foot region +

  • bone tenderness of navicular bone
  • bone tenderness at base of fifth metatarsal
  • inability to bear weight for min 4 steps immediately after injury AND at time of evaluation
260
Q

Myocarditis

- dx

A
  • endomyocardial biopsy is GS
  • clinical
  • cardiovascular MRI
261
Q

Myocarditis

- clinical

A
  • fatigue, exercise intolerance
  • chest pain, pericarditis
  • unexplained sinus tachycardia
  • gallop
  • abnl EKG or echo
  • HF
  • dysrhythmia or heart block
  • elevated troponin
  • cariogenic shock
262
Q

Myocarditis

- mgmt

A
  • supportive
  • HF treatment
  • antidysrhythmics as needed
  • immunosuppressants
  • IVIG
263
Q

Light criteria

  • what for
  • criteria
A

Determine if fluid is transudative or exudative
Exudate if:
- Pleural:serum protein => 0.5
- Pleural:serum LDH => 0.6
- Pleural fluid LDH >2/3 upper limit normal

264
Q

Treatment for right ventricular infarct

A
  • IVF

- avoid nitrates

265
Q

Acute pyelonephritis treatment

A
  • FQ
  • Bactrim
  • pregnant: ampicillin/gentamicin or 3rd gen ceph
266
Q

Multifocal atrial tachycardia (MAT)

- clinical

A
  • min 3 diff P wave morphologies
  • rate 100-180
  • irregular rate
267
Q

Multifocal atrial tachycardia (MAT)

  • etiologies
  • mgmt
A
  • chronic lung dz like COPD, hypoxia, pulm HTN

- O2, treat underlying condition, rate control

268
Q

Anterior Cerebral artery

- sx

A
  • paralysis contralateral foot/leg
  • sensory loss toes, foot, leg
  • gait/stance impairment
  • Flat affect, slow, distracted
  • cognitive impairment
  • urinary incontinence **
269
Q

Pericardial tamponade

- PE

A
  • muffled heart sounds
  • JVD
  • hypotension
270
Q

Pericardial tamponade

- EKG

A
  • low voltage QRS

- electrical alterans

271
Q

Aortic dissection

- mgmt

A
  • reduce BP to lowest tolerable
  • HR < 60 bpm
  • IV bb: esmolol, labetalol, propranolol
  • nitroprusside one HR is controlled
  • Pain control
272
Q

Aortic dissection

- dx

273
Q

Name for severe hypothyroidism

A

myxedema coma

  • decompensated metabolic state
  • mental status change
274
Q

Croup

- sx

A
  • seal-like cough
  • inspiratory stridor
  • low grade fever
275
Q

Croup

- mgmt

A
  • mild: cool humidified air, hydration, dexamethasone
  • Moderate: dexamethasone +/- neb epi, observe for 3-4 hours
  • Severe: dexamethasone, epi, hospitalization
276
Q

MC sign of hemorrhoids

A

bleeding with defecation

277
Q

Middle cerebral artery

- stroke sx

A

contralateral paralysis
upper > lower
aphasia

278
Q

Schizoaffective disorder

A

sx of schizophrenia plus mood disorder (mania or major depression)

279
Q

Schizophreniform disorder

A

schizophrenic symptoms that last more than one month but less than 6 months

280
Q

What antipsychotic causes agranulocytosis?

281
Q

MCC compartment syndrome

A

tibia fracture

anterior compartment of lower leg

282
Q

Volvulus

- dx

A
  • plain film
  • abd CT
  • contrast enema
283
Q

Volvulus

- clinical

A
  • slowly progressive abd pain
  • abd distention
  • n/constipation
  • vomiting
284
Q

Volvulus

- mgmt

A
  • flexible sigmoidoscopy

- surgery to prevent recurrence

285
Q

Erysipelas

- MCC

A

strep progenies (GABS)

286
Q

Erysipelas

- mgmt

A
  • penicillin V
  • amoxicillin
  • azithromycin
  • clarithromycin
287
Q

Burn Rule of nines

A 
Head 9%
Each arm 9%
torso 18% front 18% back
Each leg 18%
perineum 1%
  • palm is about 1% of BSA
288
Q

Parkland formula

A

4 mL/kg % total BSA burned

50% given in first 8 hours, remainder over 16 hours

289
Q

Arteries in an inferior coronary infarct

A

RCA

left circumflex

290
Q

Arteries in lateral coronary infarct

A

Left circumflex

Diagonal of LAD

291
Q

What should alert you to potential for right ventricular infarction?

A

inferior MIs -> right-sided EKG

- if ST elevation in V4R-V6R = right ventricular infarction

292
Q

Medications to treat mastitis

A
  • cephalexin
  • dicloxacillin
  • Bactrim
  • Clinda if PCN allergic
293
Q

Treatment for gamekeepers thumb

A
  • thumb spica splint

- may need sx repair

294
Q

Second degree type I heart block

- mgmt

A

only if symptomatic:

atropine, epi +/- pacemaker

295
Q

What to co-morbidities is digoxin a good medication for?

A

a-fib with hypotension or congestive HF

296
Q

A fib

- when use dual antiplatelet

A

only if CI to anticoagulation

297
Q

PSVT

- two kinds

A
  1. AV nodal reentry tachycardia (AVNRT): two pathways within the AV node, one slow and one fast. MC
  2. AV reciprocating tachycardia (AVRT): one path in AV node, one path outside. Ex WPW and LGL
298
Q

PSVT

- two conduction patterns

A
  • Orthodromic (95%): down normal, returns via accessory. Narrow complex tachycardia
  • Antidromic (5%): down accessory and returns via normal pathway. Wide complex tachycardia
299
Q

PSVT

- mgmt

A
  • stable/narrow: vagal, adenosine, AV nodal blockers
  • stable/wide: amio, procainamide in WPW
  • unstable: cardioversion
300
Q

WPW

A

Bundle of Kent

  • slurred, wide QRS (AVRT)
  • delta wave, short PR interval
  • *avoid AV nodal blockers (Adenosine, BB, CCB, digoxin)
301
Q

Nitrates

- effects (2)

A
  • Increase supply by artery dilation

- Decrease demand and preload via venous dilation

302
Q

First line chronic agent to treat angina

A

BB

CCB 2nd line

303
Q

STEMI

- reperfusion goal time

A

12 hours

PCI best within 3 hours of onset (90 min best)

304
Q

How does alteplase work

A

activates tissue plasminogen => plasmin => dissolves clot

305
Q

What score is used to determine risk fo death and ischemic events in UA or NSTEMI to determine benefit of angiography?

306
Q

HF

  • MCC
  • MCC diastolic
307
Q

major ADR of ACEi

A

hyperkalemia

308
Q

What two BB are used for HF

A

carvedilol and metoprolol

309
Q

Diuretics

- ADR

A

hypokalemia
hyponatremia
hypocalcemia

hyperglycemia
hyperuricemia

310
Q

Digoxin effect

A
  • positive inotrope
  • negative chronotrope
  • slows speed of conduction
311
Q

Treatment of CHF

A

LMNOP

  • lasix
  • morphine
  • nitrates
  • O2
  • position upright
312
Q

Aortic regurgitation

  • MCCs
  • murmur
  • other findings
  • mgmt
A
  • rheumatic heart disease, endocarditis, aortic root disease/dilation
  • diastolic decrescendo, blowing murmur at LUSB
  • bounding pulse and wide pulse pressure
  • reduce after load: BB, nifedipine, hydralazine
313
Q

Mitral regurgitation

- murmur

A

blowing, holosystolic murmur at apex

- radiation into axilla

314
Q

Endocarditis

- blood culture

A

must get 3, 1 hour apart

315
Q

Endocarditis treatment

A
  • empiric
  • native valve: vanc +/- cefazolin
  • Ill with HF: gentamicin + cefepime + vanc
  • Valve replacement if refractory or abscess
316
Q

Endocarditis

  • criteria for dx name
  • criteria
A
  • Duke Criteria

- 2 major, 1 major and 3 minor, 5 minor

317
Q

Endocarditis

Major criteria

A
  • two + blood cultures with typical org

- echo with new valvular regurgitation

318
Q

Endocarditis

minor criteria

A
  • predisposing factor
  • Fever >100.4 (38)
  • vascular phenomena (embolic dz or pulmonary infarct)
  • Immunologic phenomena (glomerulonephritis, osler node, roth spot)
    • blood culture not meeting major criteria
319
Q

PAD

- mgmt

A
  • platelet inhibitor: cilostazol, ASA, clopidogrel
320
Q

AAA

- major RF

A
  • smoking

- atherosclerosis

321
Q

Aortic dissection

- RF

A

HTN

age 50-60

322
Q

Shoulder dislocation

- anterior vs. posterior

A

Anterior MC

Posterior: seizure, trauma, electric shock

323
Q

Rotator cuff injury

- types

A
  • Tendonitis MC <40

- Tear MC >40

324
Q

Rotator cuff injury

- clinical

A
  • anterior deltoid pain with decreased ROM during overhead activities
  • PE: passive ROM>active ROM
325
Q

AC joint dislocation

A

direct blow to adducted shoulder
pain, unable to lift shoulder
+/- AC joint deformity

326
Q

Proximal humerus or humeral head fracture

  • position at presentation
  • check what?
A
  • arm in adducted position

- deltoid sensation to r/o brachial plexus or axillary nerve injuries

327
Q

Humeral shaft fracture

- risk of waht nerve

A

radial nerve injury: wrist drop

328
Q

Supracondylar humerus fracture

  • MC population
  • presentation
  • nerves/arteries to worry about
A
  • 5-10 yo
  • swelling/tender elbow
  • posterior or anterior fat pad sign on xray
  • median nerve, radial nerve, and brachial artery
329
Q

Flexor tenosynovitis

- signs

A
  1. finger held in flexion
  2. TTP tendon sheath
  3. enlarged finger
  4. pain with passive extension
330
Q

Flexor tenosynovitis

- mgmt

A
  • IV abx

- I&D

331
Q

Flexor tenosynovitis

- describe

A

infection of flexor tendon synovial sheath in finger

332
Q

Olecranon fracture

- nerve at risk

A

ulnar nerve

333
Q

Colles fracture

- describe

A
  • dorsal or posterior angulation of fractured piece

- 60% also have ulnar styloid fracture

334
Q

Boutonniere deformity

A

hyperflexion at PIP
hyperextension at DIP
Splint PIP in extension for 4-6 weeks

335
Q

Boxer’s fracture

A

4th or 5th metatarsal neck fracture

- ulnar gutter splint

336
Q

Hip dislocation

  • mech of injury
  • complications
  • MC location
  • presentation
A
  • usu dt trauma
  • avascular necrosis, sciatic nerve injury
  • MC posterior
  • hip pain with shortened leg and internally rotated leg, adducted with slight knee/hip flexion
337
Q

ACL injury

A
  • pop and swelling –> hemarthrosis

- Lachman most sensitive

338
Q

Meniscal tear

A
  • locking, popping, giving way
  • effusion after use
  • McMurrays test
339
Q

Knee dislocation

- risk to what nerves/arteries

A
  • popliteal artery
  • peroneal nerve
  • tibial nerve
340
Q

Tibial plateau fracture risk of injury to waht nerve

A

peroneal nerve: foot drop, sensation in first web space

341
Q

Herniated disk

  • MC locatoin
  • testing
A
  • L5-S1: junction of mobile and nonmobile spine
  • sciatica is L5-L1 dermatome
  • straight leg test, crossover test
342
Q

L4-L6 nerves

- sensation

A

Sensation: ALP

  • L4: anterior thigh
  • L5: lateral thigh
  • L6: posterior leg/calf
343
Q

L4-L6 nerves

- motor

A
  • L4: ankle dorsiflexion
  • L5: big toe extension
  • L6: plantar flexion
344
Q

Spondylolysis

A

Pars intraairticular defect: failure to fuse or stress fracture
- MCC back pain in children/adolescents

345
Q

Spondylolithesis

A

One vertebrae slips forward from the next

- back pain and sciatica

346
Q

Osteomyelitis

- MC bug

A

staph aureus

347
Q

Osteomyelitis

- Dx tool

A

MRI most sensitive early
XR
bone aspiration: gold standard

348
Q

Septic arthritis

  • MC location
  • MC bugs
  • arthrocentesis findings
A
  • knee
  • staph aureus, often polymicrobial
  • WBC > 50k with PMNs
349
Q

Septic arthritis

- abx

A
  • nafcillin
  • MRSA: vanc
  • gram neg: ceftriaxone
350
Q

Esophagitis

- CMV vs. HSV

A
  • CMV: large, superficial shallow ulcers (gancyclovir)

- HSV: smal, deep ulcers (acyclovir)

351
Q

Boerhaave Syndrome

  • describe
  • s/sx
  • dx
  • mgmt
A
  • full thickness tear distal esophagus
  • vomiting, retrosternal pain, worse with deep inspiration and swallowing, pneumomediastinum
  • CT/CXR
  • Contrast esophagram with gastrogaffin
352
Q

Gastritis

- cause

A
  • increased aggressive factors

- decreased protective factors

353
Q

Gastritis

- dx

354
Q

Gastritis

- treatment if NOT h. pylori

A
  • acid suppression
  • PPI, H2 blocker
  • Sucralfate
355
Q

PUD

- duodenal vs. gastric

A
  • duodenal: better with food, younger patients, 4x MC, increased damaging factors
  • gastric: older patients, worse with food, loss of protective factors
356
Q

Toxic megacolon

  • describe
  • mgmt
A
  • colon dilated > 6 cm + signs of toxicity

- bowel decompression, rest, NG, broad spectrum abx

357
Q

IBD

- mgmt

A
  • Aminosalicylates: sulfasalazine and mesalamine
  • steroids: acute flairs only
  • immune modifying agents
    • 5-ASA most helpful in UC
358
Q

IBD

- aminosalicylates

A
  • Oral mesalamine: terminal small bowel and colon, best for maintenance
  • Topical mesalamine: rectal supp and enema: distal colon only
  • Sulfasalazine (oral and topical): mostly in colon
359
Q

Hernia

- incarcerated vs. strangulated

A
  • incarcerated: painful and irreducible

- strangulated: incarcerated + systemic toxicity

360
Q

Anti-diarrhea meds : list

A
  • Bismuth subsalicylate
  • Opioid agonists
  • anticholinergics
361
Q

Bismuth subsalicylate

  • effects
  • ADR
A
  • antimicrobial
  • anti-secretory
  • anti-inflammatory
  • Reye syndrome risk
362
Q

Opioid agnostics for anti-diarrhea

A
  • Loperamide (immodium)
  • Diphenoxylate/atropine (Lomotil)
  • Bind gut wall opioid receptors, inhibits peristalsis
  • loperamide also increases anal sphincter tone
  • avoid in acute dysentery and colitis
363
Q

Anticholinergics for anti-diarrhea

A
  • Hyoscyamine
  • Scopalamine
  • Atropine
  • Phenobarbital
  • inhibits acetylcholine-related GI motility, antispasmotic
364
Q

Anti-emetics

- two main kinds

A
  • ondansetron

- dopamine blockers

365
Q

Ondansetron

A
  • blocks serotonin receptors:

- ADR: sedation, prolonged QT, arrythmia

366
Q

Anti-emetics

- dopamine blockers (3 names)

A
  • prochlorperazine
  • promethazine
  • metochlopramide
367
Q

Anti-emetics

- dopamine blockers: MOA, ADR

A

block CNS dopamine receptors

- increased QT, anticholinergic, antihistamine, extrapyramidal sx

368
Q

Gastroenteritis

- MCC

A

norovirus

* rotavirus MCC diarrhea children

369
Q

Gastroenteritis

- staph aureus

A

dairy, mayo, meat, eggs

370
Q

Gastroenteritis

- Enterotoxigenic E coli

A

travelers diarrhea

  • fluids
  • FQ if severe
371
Q

Gastroenteritis

- vibrio cholera mgmt

A
  • fluid replacement

- tetracyclines

372
Q

Gastroenteritis

- Campylobacter

A

c. jejuni MC bacterial enteritis
- MC antecedent to Guillain-barre
- poultry, undercooked food
- mgmt: erythromycin

373
Q

Gastroenteritis

- Yersinia

A
  • can mimic appendicitis
  • mesenteric adentitis
  • mgmt: fluids
374
Q

Pleural effusion

- s/sx

A
  • dec tactile fremmitus
  • dec breath sounds
  • dullness to percussion
  • pleural friction rub
375
Q

PE

- triad sx

A
  • dyspnea
  • pleuritic chest pain
  • hemoptysis

+- cough

376
Q

PE

- PERC criteria

A 
<50 yo
Pulse <100
O2 sat >95%
No prior PE hx
- if all negative, low risk
377
Q

PNA

- MCC

A

strep pneumonia

H flu 2nd MCC (esp with underlying dz like COPD)

378
Q

PNA

- MCC atypical

A

mycoplasma pneumoniae

*bullous myringitis

379
Q

PNA

- MC bug CAP

A
  • strep pneumo

- mycoplasma

380
Q

PNA

- MC bug in HAP

A
  • psuedomonas

- MRSA

381
Q

PNA

- PE

A
  • dullness to percussion
  • increased fremitus
  • bronchial breath sounds
382
Q

PNA

- rusty sputum indicates what

A

strep pneumo

383
Q

PNA

- CAP outpatient abx

A

macrolide or doxy

- FQ if comorbidities or recent abx use

384
Q

PNA

- cap inpatient abx

A
  • beta-lactam + macrolide or doxy

- FQ

385
Q

PNA

- HAP abx

A
  • beta-lactam with antipseudomonal + FQ

- vanc/linezolid if MRSA

386
Q

PNA

- legionella abx

A

levo

azithromycin

387
Q

PNA

- aspiration abxx

A

Clinda
Metronidazole
Augmentin

388
Q

Rifampin

- ADR

A
  • thrombocytopenia
  • orange
  • hepatitis
389
Q

Isoniazid

- ADR

A
  • Hepatitis

- peripheral neuropathy (B6/pyridoxine)

390
Q

Pyrazinamide

- ADR

A
  • hyperuricemia
  • photosensitive derm rash
  • caution in gout and lever diease
391
Q

Ethambutol

- ADR

A
  • optic neuritis

- peripheral neuropathy

392
Q

Acute bronchitis

- MCC

A

adenovirus

393
Q

Epiglottitis

- treatment

A

ceftriaxone or cefotaxime

394
Q

ARDS

-d escribe

A
  • alveolar damage > increased permeability of alveolar-capillary barrier > pulmonary edema > reduced blood oxygenation
395
Q

ARDS

- Sx

A
  1. severe refractory hypoxemia
  2. bilateral pulmonary infiltrate on CXR
  3. no cariogenic pulm edema or CHF
396
Q

ARDS

- XR

A

diffuse, bilateral pulmonary infiltrates

“white out pattern”

397
Q

ARDS

- Mgmt

A
  • noninvasive or mech ventilation
  • CPAP
  • PEEP
    goal O2 >90%
398
Q

Pertussis abx

399
Q

Lung cancer

- MCC

A

Non Small Cell Carcinoma

  • adenocarcinoma MC, usu peripheral
  • squamous cell: bronchial, centrally located
  • large cell, very aggressive
400
Q

Lung cancer

- less common type

A

small cell, very aggressive with early mets

401
Q

Bells palsy

  • which CN
  • assoc with what
A
  • CN VII (facial)

- herpes simplex

402
Q

Tension HA

- mgmt

A
  • NSAIDs
  • ASA
  • Acetaminophen
  • TCA (amytriptyline)
  • BB
403
Q

Migraine HA

  • cause
  • mgmt
A
  • vasodilation of blood vessels innervated by trigeminal nerve
  • abortive: triptans and ergotamines
  • dopamine blockers: metoclopramide, promethazine, prochlorperazine with benadryl
  • mild: NSAID, tylenol
  • prophylactic: BB, CCB, TCA, anticonvulsants (valproate, topiramate), NSAIDS
404
Q

Cluster HA

- mgmt

A
  • 100% o2
  • antimigraine meds
  • prophylaxis: verapamil
405
Q

TIA

  • MCC
  • two types
A
  • embolus
  • Interal carotid: amaurosis fugal, weakness in contralateral hand
  • Vertebrobasilar: brainstem/cerebellar sx
406
Q

TIA

- mgmt

A
  • ASA +/- plavix

- reduce RF

407
Q

Ischemic stroke

- lacunar sx

A
  • pure motor MC
  • ataxic hemiparesis leg>arm
  • hx of HTN
408
Q

Spontaneous ICH

  • MCC
  • location
  • what not to do
  • mgmt
A
  • MCC HTN
  • basal ganglia
  • NO LP
  • head elevation, mannitol, hyperventilation
409
Q

Epidural hematoma

- sx

A
  • LOC > lucid > coma
410
Q

Which type of hematoma can cross suture lines?

411
Q

Meningitis

- LP findings

A
  • incr PMN
  • dec glucose
  • incr protein
  • incr CSF pressure
412
Q

Meningitis

- abx if 1 mo to 18 years

A

vanc and ceftriaxone

- mc N. meningitidis or strep pneumo

413
Q

Meningitis

- abx if 18-50 yo

A

vanc and ceftriaxone

- mc strep pneumo, could also be N. meningitidis

414
Q

Meningitis

- abx if >50

A

van, ceftriaxone AND ampicillin to cover for Listeria

415
Q

Viral meningitis

- LP findings

A
  • lymphocytosis

- normal glucose

416
Q

Viral meningitis

- MCC

A

enterovirus MCC

- also mumps, HSV

417
Q

Encephalitis

- MCC

418
Q

Simple partial vs. complex partial seizure

A
  • simple: maintain consciousness, focal defect

- complex: consciousness impaired, automatisms (lip smack, etc.)

419
Q

Valproic acid

  • MOA
  • ADR
A
  • inc GABA
  • dec glutamate/NMDA receptor excitiation
  • ADR: hepatitis, pacreatitis
420
Q

Lamotrigine

  • MOA
  • ADR
A
  • blocks Na and Ca channels > dec glutamate release

- ADR: SJS

421
Q

Phenytoin

  • MOA
  • ADR
A
  • stabilize neuronal membrane
  • rash, gingival hyperplasia
    • monitor drug levels
422
Q

Carbamezapine

  • MOA
  • ADR
A
  • NA channel blocker

- ADR: hyponatremia, SJS, blood dyscrasias

423
Q

Topiramate

  • MOA
  • ADR
A
  • NA channel blocker, inc GABA
  • glutamate antagonist
  • ADR: weight loss
424
Q

Benzo

  • MOA
  • ADR
A
  • inc GABA mediated CNS inhibition

- ADR: Sedation, ataxia

425
Q

Blepharirits

- CAuse of anterior vs. posterior

A

Anterior: seborrheic or infections
Posterior: Meibomian gland dysfunction

426
Q

Corneal abrasion

- mgmt

A
  • erythromycine
  • polymyxin/trimethoprim
  • Cipro
  • FQ if contacts
427
Q

PE difference in three types of conjunctivitis

A
  • Bacterial: mucopurulent discharge, red, not pruritic
  • Viral: watery discharge, red, pruritic
  • Allergic: rare discharge, cobblestoning, red, pruritic
428
Q

Orbital cellulitis

  • MCC
  • clinical
  • dx
  • mgmt
A
  • secondary to sinus infection
  • reduced vision, pain with ocular movement, proptosis
  • CT scan
  • IV abx: vanc, clinda, cefotaxine
429
Q

Papilledema

- mgmt

A
  • diuretics

- acetazolamide: reduces production of CSF and aqueous humor

430
Q

Optic neuritis

- PE pupil findings

A

Marcus-Gunn pupil

  • dilates when light on it (abnl)
  • constricts when contralateral eye has light (normal)
431
Q

Optic neuritis

- mgmt

A
  • methyprednisone
432
Q

Otitis externa

- mgmt

A
  • keep dry
  • Cipro/dextramethasone
  • Aminoglycoside ONLY if TM is visualized and not perforated
433
Q

Mastoiditis

- mgmt

A
  • IV abx
  • drainage
  • Abx: same used in AOM
434
Q

Vestibular neuritis

  • s/sx
  • mgmt
A
  • continuous vertigo
  • no hearing loss
  • steroids and symptomatic
435
Q

Labrynthitis

- s/sx

A
  • continuous vertigo

- continuous hearing loss

436
Q

Acute sinusitis

- mgmt

A
  • decongestants, antihistamines, mucollytics, nasal lavage
  • amoxicillin for 10-14 days if sx >10-14 days
  • second line: doxy, bactrim
  • FQ if recent abx or refractory
437
Q

Strep pharyngitis

- mgmt

A
  • Amoxicillin

- Macrolide if PCN allergic

438
Q

ATN

A

Cause of AKI

- acte destruction/necrosis of nephron renal tubules

439
Q

Nephrotoxic causes of AKI

A
  • aminoglycosides
  • dye
  • cyclosporin
  • gout
  • rhabdo
  • MM
440
Q

ATN

- UA findings

A
  • epithelial cell casts

- muddy brown casts

441
Q

AIN

- overview

A

Interstitum

MC due to drug hypersensitivity (PCN, sulfa, NSAIDs, infection)

442
Q

AIN

- lab findings

A
  • UA: WBC pathognomonic

- Inc serum IgE

443
Q

Epididymitis

- mgmt

A
  • bed rest, cool compress, NSAIDs
  • G/C: doxy and ceftriaxone
  • e. coli: FQ
    • chronic: 4-6 weeks abx
444
Q

Uncomplicated cystitis

- abx

A
  • nitrofurantoin
  • Cipro
  • bactrim
    3-5 D
445
Q

Complicated cystitis

- abx

A

FQ
amino glycoside
7-14 D

446
Q

Cystitis while pregnant

- abx

A
  • amoxicillin 7-14 d
447
Q

Pyelonephritis

- abx

A
  • IV or PO FQ
  • Aminoglycosides
  • 14 D
448
Q

Sx specific to prostatitis

A

perineal pain

449
Q

Nephrolithiasis

- <5 mm

A

fluids
analgesics
anti-emetics
tamulosin

450
Q

Nephrolithiasis

>7 mm

A

lithotripsy

uretoscopy with stent (obstructed or at risk kidney)

451
Q

Nephrolithiasis

- >10 mm or struvite

A

percutaneous nephrolithotomy

452
Q

Stress incontinence

- tx

A
  • alpha agonist
  • midodrine
  • psuedoephridine
453
Q

Urge incontinence

  • cause
  • tx
A
  • overactive detrusor muscle. Small volume voids and nocturia
  • bladder training
  • anticholinergics (oxybutynin, tolterodine, TCA, mirabegron)
454
Q

Overflow incontinence

  • cause
  • Tx
A
  • underactive detrusor muscle, or bladder outlet obstruction (BPH), increased post void residual
  • intermittent self cath, cholinergics
455
Q

Bullous pemphigoid

A
  • MC in elderly
  • Type II HSN IgG vs. epithelial basement membrane > subepidermal blistering
  • systemic steroids, antihistamines
456
Q

Decubitus ulcer

A

I: superficial, nonblanchable redness
II: into dermis, blister or abrasion
III: full thickness skin, may be in subcut layer
IV: beyond fascia into muscle, bone, tendon

457
Q

Roseola Infantum

  • aka
  • microbe
  • s/sx
A
  • Sixths dz
  • HHV 6/7
  • rose pink rash on trunk/back > face (Only one that starts on body and moves to face)
458
Q

Cocksackie

A
  • HFM: mild fever, URI sx, dec appetite > oral enanthem > exanthem
  • Herpangina: high fever, stomatitis 3-5D
459
Q

Mumps

  • microbe
  • s/sx
A
  • paramyxovirus
  • parotid gland pain and swlling
  • orchitis, pancreatitis
460
Q

Rubeola

  • aka
  • microbe
  • s/sx
A
  • Measles
  • paramyxovirus
  • cough, coryza, conjunctivitis
  • koplik spots
  • morbiliform maculopapular brick red rash on face then body X 7D
461
Q

Rubella

  • aka
  • microbe
  • s/sx
A
  • German Measles
  • togavirus
  • low grade fever, cough, anorexia, lymphadenopathy
  • light pink, spotted maculopapular rash on face then body
  • spreads more rapidly than rubeola
  • Teratogenic, esp first trimester
462
Q

Erythema infectiousum

  • aka
  • microbe
  • s/sx
A
  • Fifths disease
  • Parvovirus B19
  • coryza and fever > slapped cheeks with circumoral pallor and lacy reticular body rash. Spare palms and soles
463
Q

Classic signs of acute adrenal insufficiency

A
  • profound weakness
  • severe abd pain
  • peripheral vascular collapse
  • electrolyte abnl
  • shock
464
Q

Adrenal insufficiency

- labs

A

hyponatremia

  • hypoglycemia
  • hyperkalemia
465
Q

Adrenal insufficiency

- treatment

A
  • glucocorticoids
  • regulate NA and K
  • fludrocortisone (mineralocorticoid)
466
Q

Addisonian Crisis

  • cause
  • clinical
  • mgmt
A
  • stressful event > worse adrenal insufficiency
  • MCC abrupt withdrawal of steroids
  • shock: hypotension/hypovolemia
  • hypo N, K, glycemia
  • IVF, IV hydrocortisone, fludrocortisone, electrolyte issues
467
Q

Cushings:

- testing

A
  • low does dexamethasone suppression test: no suppression = cushings
  • 24 hour urinary free cortisol levels
    to differentiate cause:
  • high dose dexamethasone suppression test: no suppression = adrenal or ectopic ACTH-producing tuomr
468
Q

Biguadines

  • ex
  • MOA
  • ADR
A
  • Metformin
  • reduce hepatic glucose production and increase peripheral glucose use
  • Gi, lactic acidosis, microcytic anemia (B12)
469
Q

Sulfonyureas

  • MOA
  • adr
A
  • increase pancreatic insulin release

- hypoglycemia, weight gain, GI

470
Q

alpha-glucosidease inhibitors

  • exs
  • MOA
  • ADR
A
  • Acarbose, miglitol
  • delays intestingal glucose absorption
  • GI, hepatitis
471
Q

GLP-1 agonist

  • exa
  • MOA
  • ADR
A
  • liraglutide “-glutide” Byetta and Victosa
  • mimics incretin > increased insulin release. Deplays gastric emptying
  • pancreatitis, CI if hx of gastroparesis
472
Q

DPP-4 Inhibitor

  • exs
  • MOA
  • ADR
A
  • “-gliptins” Januvia and Tradjenta
  • inhibits degradation of GLP-1
  • pancreatitis, GI, renal failure
473
Q

SGLT-2 inhibitor

  • exs
  • MOA
A
  • “-flozins”

- increased urinary glucose excretion

474
Q

Diagnostic test for diabetes insipidus

A

free water deprivation

  • normal: concentrated urine
  • abnl: unconcentrated urine
475
Q

Diabetes insipidus

- mgmt

A
  • central: DDAVP or carbamezapine

- nephrogenic: na/protein restriction, hctz

476
Q

DUB

- management of severe bleed

A
  • IV estrogen
  • high dose OCP
  • D&C
477
Q

Ectopic pregnancy

- triad of sx

A
  • unilateral pelvic/abd pain
  • vaginal bleeding
  • amenorrhea
    +- dizzy, n/v, sycope, tachycardia, hypotension
478
Q

Spontaneous abortion

  • medications
  • procedures
A
  • up to 7 weeks: methotrexate and misoprostol
  • up to 9 weeks: mifepristone and misoprostol
  • D&C 4-12 weeks
  • D&E >12 weeks
479
Q

Schizophrenia

- criteria

A

1 must be hallucination, delusion, disorganized speech
2+ of other positive or negative symptoms
6+ months

480
Q

Schizophrenia

- mgmt

A
  • antipsychotics: dopamine receptor antagonists

- 2nd generation is first line: risperidone, olazapine, quetiapine, etc.

481
Q

ADR citalpram

482
Q

Bipolar I

- define

A

Manic episode +/- depressive episode (not required for diagnosis)

483
Q

Bipolar I

- mgmt

A
  • lithium
  • 2nd gen antipsychotic
  • bentos for psychosis and agitation
484
Q

Bipolar II

- define

A
  • Hypomania
  • Major depression
    NO mania
485
Q

DIC

- define

A

pathologic activation of coagulation system > widespread micro thrombi > severe thrombocytopenia

486
Q

DIC

- RF

A
  • gram neg sepsis MC
  • malignancy
  • OB
  • massive tissue injury
487
Q

DIC

- labs

A

increased PT, PTT, INR

increased d-dimer

488
Q

DIC

- mgmt

A

treat underlying issue

- FFP if severe bleeding

489
Q

ITP

- etiologies

A
  • child: MC s/p viral infection

- Adult: chronic

490
Q

ITP

- define

A

autoimmune ab vs. platelets with splenic platelet destruction

491
Q

ITP

- clinical

A
  • mucocutaneous bleeding
  • no splenomegaly
  • normal coags
492
Q

ITP

- treatment

A

Children: observe +/- IVIG
adults: steroids, IVIG, splenectomy

493
Q

Hemophilia

  • treatment of A vs. B
  • inheritance
  • labs
A

A: DDAVP and factor VIII
B: Factor IX (no DDAVP)

  • x-linked recessive
  • increased PTT, normal platelets
494
Q

Von Willebrand Dz

  • describe
  • inheritance
A
  • ineffective platelet adhesion

- autosomal dominant

495
Q

Von Willebrand Dz

- clinical

A
  • mucocut bleeding
  • increased bruising
  • petechiae
496
Q

Von Willebrand Dz

- mgmt

A
  • avoid ASA

- DDAVP

497
Q

Hodgkins Lymphoma

  • age
  • assoc with what
  • sx
  • lab finding
A
  • 20s and >50s
  • Epstein-Barr virus
  • MC male
  • painless lymphadenopathy
  • night sweat, weight loss, etc
  • Reed-Sternberg cells
  • mediastinal lymphadenopathy
498
Q

Non-Hodgkins Lymphoma

  • RF
  • clinical
A
  • age and immunosppression
  • painless lymphadenopathy
  • extra nodal sites common: GI, Skin, CNS
499
Q

ALL

A
  • MC childhood malignancy
  • RF downsyndrome
  • Pancytopenia, fever, bone pain
500
Q

AML

A

Auer rods, adults, pancytopenia, splenomegaly, gingival hyperplasia

501
Q

Polycythemia Vera

A
  • increased production all cells lines
  • MC men 50-60
  • JAK2 mutation
  • hyper viscosity/thrombis > pruritus (hot bath), HA, facial plethora
  • Dx: inc RBC mass (hct and hg), bone marrow bx
  • mgmt: phlebotomy, hydorxyurea
502
Q

Factor V Leiden

A

MC causes hypercoagulability

- incr risk PE and DVT

EORs (9 decks)

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