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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
MC injury in children with blunt chest trauma
pulmonary contusion | - chest wall much more elastic than adults, less likely to have external signs including rib fractures
26
AAA | - signs
- can be similar to renal colic - syncope - combo of back and abdominal pain
27
COPD exacerbation | - MC bugs
- Streptococcus pneumoniae - Haemophilus influenzae - Moraxella catarrhalis
28
COPD exacerbation | - s/sx
- tachypneic - tachycardic - AMS (dt CO2 retention)
29
COPD exacerbation | - management
- beta-adrenergic agonist (albuterol) - Anticholinergic agents (ipatroprium) - oral steroids (prednisone) - Noninvastive positive pressure ventilation - Abx
30
Spinal epidural abscess | - RF
- IV drug users - alcoholics - immunocompromised including DM
31
Spinal epidural abscess | - presentation
- lower back pain - pain to palpation of spinal processes - elevated ESR and CRP - fever 50% - focal neurologic deficits 50%
32
Spinal epidural abscess | - imaging
MRI
33
Spinal epidural abscess | - management
- neurosurgical consult for drainage and decompression | - broad spectrum abx
34
Giardia | - treatment
- metronidazole - tinidazole - albendazole/mebendazole - nitazoxanide
35
PCP - describe - eye movements - clinical
- dissociative anesthetic similar to ketamine - glutamate receptor (NMDA) antagonist - rotary nystagmus - behavior issues, anger, aggression, irritability, impaired judgement - HTN, tachycardia
36
Acute hypertensive heart failure | - initial management
nitroglycercine : pre and after load reduction
37
Knee effusions | - which bursa communicates with teh joint cavity
Suprapatellar bursa
38
Signs epistaxis is posterior not anterior
- older patient - bleeding from both nares - bleeding in posterior pharynx
39
Posterior epistaxis complications
- aspiration - hypoxia - hypercarbia - symptomatic bradycardia
40
What neuro complication are people with polycystic kidney disease at greater risk for?
berry aneurysms - SAH
41
SAH | - risk factors
- Marfan - Polycystic kidney disease - Coarctation of the aorta - Fibromuscular dysplasia
42
Which traumatic event has the highest probability of resulting in post-traumatic stress disorder
rape
43
Vertigo | - signs is peripheral cause
- rapid onset - increased intensity with head movement - intense spining - change in sensation of hearing - horizontal or rotary nystagmus - normal neuro exam
44
Vertigo | - signs is central cause
- insidious onset - quality is ill-defined - head position does not affect - nystagmus can change direction - positive neuro findings
45
Nerve affected by falling asleep drunk at night on arm
radial nerve (hand drop) - numb over first dorsal interosseous muscles
46
SVT | - sx
- abrupt onset tachycardia (120-200 bpm) | - narrow complex on EKG
47
SVT | - management
- vagal maneuvers - adenosine 6 mg - adenosine 12 mg - cardioversion (if unstable)
48
TTP | - pentad
- fever - anemia (microangiopathic, hemolytic) - thrombocytopenia - renal failure - neurologic findings
49
TTP | - management
plasmapheresis
50
One major differentiator between encephalitis and meningitis
presence of a distinct neurologic abnormality: - new psychiatric symptoms - cognitive deficits (aphasia, amnesia, acute confusional state) - seizures - movement disorders
51
Tension pneumothorax | - needle decompression locatoin
- second intercostal space (above the rib) - midclavicular line - large bore needle (14 gauge or greater)
52
Endocarditis | - what type of pneumonia can tricuspid valve infections lead to
- multifocal pneumonia | - vegetations on the right side of the heart and embolize to the lungs
53
Croup | - MC bug
parainfluenza virus
54
Croup | - treatment
- antipyretics - hydration - nebulizer racemic epi - steroids
55
Aortic aneurysm | - sizes and assoc mgmt
>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
56
What common medication can worsen the effects of heart failure?
NSAIDS
57
Low back pain | - indications for imaging
- <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
58
Croup | - MCC
parainfluenza virus
59
SAH | - medication to decrease vasospasm
nimodipine
60
What level does spinal cord terminate in adults
L1-L2
61
What is the most common cardiology finding in patients who have WPW (aside from WPW arrhythmia)
atrial fibrillation - seen in 25% with WPW | - will have a very rapid rate with wide-complex tachycardia
62
Which antiarrythmic medication is CI in setting of coronary artery disease or structural heart disease?
Flecainide | - increased risk of polymorphic v-tach
63
Tricuspid regurgitation | - causes
- MC: elevated R heart pressure (COPD, pulmonary fibrosis, volume overload) - endocarditis: usu IVDU
64
Endocarditis - MC bug IVDU - MC native valve - MC bug men with GI/Gu procedure
- staph aureus - strep viridans (esp person with dental disease) - enterococci
65
CHA2DS2-VASc - use - score
``` 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 ```
66
Rheumatic heart disease | - most common heart murmur
``` mitral stenosis (diastolic low-pitched decrescendo at cardiac apex) - best heart with bell in left lateral decubitus ```
67
Pericardial knock | - what heart condition
constrictive pericarditis
68
Two types of beat associated with ventricular tachycardia
- 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
69
V-tach | - define
- >3 consecutive ectopic ventricular beats - monomorphic, polymorphic - wide complex
70
``` V-tach treatment - pulseless - unstable - stable ```
- immediate defibrillation - synchronized cardioversion - procainamide, amiodarone, cardioversion if refractory
71
Hypertensive emergency | - define
- severe elevation bp | - evidence of end-organ damage
72
Hypertensive emergency | - treatment
- 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
73
BP Goals >= 60 yo < 60 >18 with CKD or DM
<150/90 <140/90 <140/90
74
What four drugs have shown decreased in mortality for pt with MI
ASA BB Statin ACEi
75
Back pain red flags | - RF for what
- fracture - malignancy - infection - cauda equina - -> get XR
76
Back pain red flags | - list
- 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)
77
Ankle fracture mgmt - stable - unstable, non displaced - unstable, displaced
- 4-6 weeks weight bearing cast/brace - non-weight bearing cast - open/closed reduction
78
Spinal stenosis - dx - mgmt
- MRI | - PT and surgery
79
MC fracture carpal bone
scaphoid
80
DTR | List
``` C5/6 Biceps C6 Brachioradialis C7 Triceps L4 Patellar S1 Achilles ```
81
Name for test for hip dysplasia: lay on back and flex knees to compare femur length
Galeazzi test
82
Treatment for osteomyelitis due to cat bite
ampicilling-sulbactam
83
Name for fracture-dislocation of the tarsometatarsal joints
Lisfranc injury
84
Lisfranc | - mechanisms of injury
- Severe plantar flexion of foot | - sports, MVCs, fall from height
85
Lisfranc | - clinical
- pain at tarsal-metatarsal joints - ecchymosis, instability - forefoot rotation against a stabilized hind foot (calcaneus) = severe pain (but not in sprained ankle)
86
Rotator Cuff | - tests
- Neer and Hawkins
87
Rotator Cuff | - common clinical findings
- pain brushing hair or teeth - pain at night when rolling onto shoulder - baseball pitchers
88
What imaging is appropriate for suspected disk herniation
none :)
89
Osteomyelitis - XR findings - Dx modalities
- periosteal elevation or bony erosion | - bone scan or MRI
90
Osteomyelitis | - MC orgs
- s. aureus - sickle cell: salmonella - cat/dog bite: pasteurella multocida
91
Osteomyelitis - treatment - adult vs. children
- long term abx - debridement if nail puncture wound - adults: contiguous spread - children: hematogenous spread
92
Mgmt of Salter Harris fx
- splint with non-weight bearing as tolerated
93
Duodenal vs. gastric ulcer | - when eat food
- duodenal: pain alleviated (DUDe give me food) | - gastric: exacerbated by food
94
MCC of upper GI bleed
peptic ulcer disease
95
Peptic ulcer disease | - how to diagnose
upper endoscopy
96
Esophageal stricture | - mgmt
- dilation | - +/-PPI
97
Electrolyte and acid/base status in pyloric stenosis
- metabolic alkalosis - hypochloremic - hypokalemic
98
PUD | - treatment for h. pylori
- triple therapy: CAP (clarithromycin, amoxicillin, PPI) | - quad therapy (bismuth, metronidazole, tetracycline, PPI)
99
Esophageal rupture | - etiology
- spontaneous: Boerhaave syndrome | - Iatrogenic (esophageal dilation, intubation, EGD)
100
Esophageal rupture | - clinical
- chest/midepigastric pain - pleuritic pain worse with neck flexion and swallowing - mediastinal crunch - rapid development of sepsis
101
Esophageal rupture - dx - mgmt
- chest xray shows mediastinal air and esophageal with water soluble solution - broad spectrum abx, surgical consult
102
Esophageal varices | - treatment
- hemodynamic support - octreotide - prophylactic ceftriaxone
103
MCC liver disease in the US
Non alcoholic fatty liver disease
104
what vertebrae level is a swallowed foreign body most likely to get stuck?
C6: cricopharyngeus muscle (upper esophageal sphincter)
105
AP appearance of swallowed coin - in trachea - in esophagus
- oval: side view | - circle: flat view
106
Traveler's Diarrhea - MCC - sx - treatment
- enterotoxigenic E. coli (ETEC) - diarrhea, abd cramps, nausea, bloating - fluid replacement, cipro, azithromycin (pregnant and children)
107
Acute diverticulitis | - clinical
- abdominal pain - n/v - fever - change in bowel habits (constipation MC) - hematochezia (rare)
108
Acute diverticulitis | - dx
- CT: localized bowel wall thickening, pericolonic fat stranding, colonic diverticula - US - MRI
109
Acute diverticulitis | - management
- abx: cipro and flagyl | - surgical if complicated
110
Acute diverticulitis | - 3 MC complications
- obstruction - perforation - abscess
111
Acute diverticulitis | - diet recommendations
low fiber diet until asx for 6 weeks.
112
Ranson's Criteria - use - list
Assess severity and mortality of acute pancreatitis - Age >55 - WBC > 16k - Glucose >200 - LDH > 350 - AST > 250
113
screening age for colon cancer
50 to 75
114
What electrolyte abnl is common post operative period? What can it cause?
- hypokalemia | - ileus
115
Ischemic Colitis | - cause
global low flow state - HF - MI - Sepsis - Hemorrhage
116
Ischemic Colitis | - presentation
- 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
117
Ischemic Colitis | - imaging
CT: bowel wall edema
118
Ischemic Colitis | - mgmt
- signs of peritonitis, possible bowel infarction = immediate surgical intervention - Most resolve with supportive care: IVF and bowel rest
119
Pneumocystis jirovecii PNA | - clinical
- 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)
120
Pneumocystis jirovecii PNA | - treatment
- steroids if PaO2 < 70 | - Bactrim
121
Bronchiolitis | - clinical
- Usu <2 yo - preceded by 1-3 day URI prodrome - fever, cough - polyphonic wheezing and rales - resp distress
122
Bronchiolitis | - complications
- dehydration - apnea (premature or <2 mo) - aspiration PNA, resp failure
123
Bronchiolitis | - mgmt
- Nasal suctioning, hydratoin | - ?bronchodilator, heated high flow nasal cannula, CPAP, intubation
124
TB | - active/reactive sx
- fever - night sweats - weight loss - productive cough - hemoptysis
125
TB | - CXR
- Ghon focus | - upper lobe, cavitary lesions
126
TB | - Dx
- latent/primary: PPD | - active/reactivation: sputum smear for AFB, sputum culture of AFB (GS)
127
TB | - mgmt
- Latent: INH x 9 months, rifampin for 4 months, INH/rifampin for 3 months - active/reactive: RIPE (rifampin, INH, pyrazinamide, ethambutol)
128
TB | - what is given with INH to prevent peripheral neuropathy?
B6
129
Bronchitis - sx - PE - CXR - mgmt
- mucopurulent cough x 5 days + - wheezing and rhonchi - CXR: thickened bronchial walls in lower lobes - supportive: dextromethorphan, guaifenesin
130
PE - MC sx - MX sign - EKG
- dyspnea - tachycardia - nonspecific ST and T wave changes, S1Q3T3
131
PE | - CXR
- Hampton's Hump | - Westermark's sign
132
PE | - dx
- CT pulmonary angiography | - low clinical suspicion: can rule out with negative d-dimer
133
PE | - mgmt
- anticoagulation (heparin, LMWH) - supportive - thrombolytics if hemodynamically unstable
134
Hydrocarbon ingestion - sx - CXR
- non-specific: grunting, gagging, chocking, tachypnea, fever, persistent cough - diffuse bilateral infiltrates
135
Carcinoid syndrome | - mgmt
octreotide
136
PNA | - CAP treatment for children
amoxicillin
137
CAP | - MCC
strep pneumoniae
138
"walking" PNA | - MCC
mycoplasma pneumonia
139
Egophony - explain - when found
- 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
140
Foreign body aspiration | - exam tool
- rigid bronchoscopy (flexible can dislodge the object and cause complete obstruction)
141
Nontraumatic intracerebral hemorrhage in adult | - MCC
hypertensive vasculopathy | - leads to degenerative changes and eventual rupture of penetrating arteries.
142
Cryptococcal neoformans in AIDS | - sx
- indolent onset, 1-2 weeks - HA, fever - stiff neck, photophobia, vomiting - CD4 < 100
143
Cryptococcal neoformans in AIDS | - Dx
- india ink stain on CSF (round yeast) | - Cryptococcal antigen - CSF or serum
144
Cryptococcal neoformans in AIDS | - Mgmt
- Amphotericin B - Fluconazole - Flucytosine
145
Lidocaine toxicity
- CNS and CV problems secondary to sodium channel blockade - dizzy, HA, tingling, tinnitus, sedation, tremor, seizure - bradycardia, heart block, dysrhythmia
146
Amide local anesthetics
- Lidocaine - Bupivocaine ** Two Is
147
Ester local anesthetics
- Tetracaine - benzocaine ** only one I
148
What affect does hyperbaric O2 therapy have on carbon monoxide poisoning
reduces risk of neurologic sequelae
149
Brain abscess | - bugs
- strep - staph - anaerobes
150
Brain Abscess | - mgmt
- third get cephalosporin - agent to cover anaerobes: metronidazole - neurosurgery consult
151
SAH | - MCC
- ruptured aneurysm, often berry aneurysm in circle of willis
152
SAH | - Dx
- Noncontrast CT | - if negative but high suspicion: LP
153
SAH | - mgmt
- supportive | - Nimodipine (decreases cerebral vasospasm)
154
At what level does the spinal cord terminate in adults
L1-L2 ** LP best L3/4 L4/5 or L5/S1
155
Treatment for active seizure
``` IV benzo (midazolam) Buccal, IM, and intranasal second line option for route ```
156
Status epilepticus | - define
- continuous seizure activity >5-10 min OR | - >2 seizures without full recovery
157
Status epilepticus | - mgmt
- finger stick glucose - consider B6 of INH toxicity 1st line: benzo 2nd line: phenytoin, l 3rd line: pentobarbital, propofol
158
Thalamic hemorrhage
- contralateral hemisensory loss** - hemiparesis and ocular sx - acute with rapid progression
159
SAH Hunt Hess Grading Scale
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
160
Brudzinski Sign
Perform neck flexion | Positive test: reflexive flexion of hips and knees
161
Kernig's Sign
Flex hip and knees to 90 and then attempt to extend the knee | - positive test: significant pain
162
Bacterial Meningitis | - sx
``` HA neck stiff photophobia phonophobia fever ```
163
Bacterial Meningitis | - MCC bug
strep pneunomiae
164
Bacterial Meningitis | - treatment
- 18-50 yo: ceftriaxone + vanc | - >50: ceftriaxone, vanc, ampicillin (listeria)
165
Median nerve - motor - sensation
- OK sign | - index finger
166
Ulnar nerve - motor - sensation
- 5th finger abduction | - 5th finger
167
Radial Nerve - motor - sensation
- wrist/finger extension | - dorsal thumb-index finger web space
168
Syringomyelia
- 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
169
Medication(s) recommended for secondary stroke prevention for non-cardioembolic TIA and ischemic stroke
Aspirin OR clopidogrel OR dipyridamole But combo is not more effective but has higher risk of bleed
170
Posterior epistaxis
- less common than anteiror - older population - HTN/atherosclerotic disease - More severe - Admit pt with posterior packing to a monitored bed
171
Preseptal cellulitis | - overview
infection involving contents of orbit (adipose and muscle)
172
Preseptal cellulitis | - etiology
Children > adults - bacterial rhino sinusitis (MC) - orbital trauma w/ fx or foreign body - dacryocystitis - teeth, middle ear, face infection - infected mucocele
173
Preseptal cellulitis | - clinical
- no pain with eye movement, proptosis, diplopia, visual impairment, all of which are seen with orbital cellulitis
174
Preseptal cellulitis | - mgmt
- broad spectrum abs: vanc + piperacillin-tazobactam | - surgery
175
Sinusitis - mgmt uncomplicated - mgmt complicated
- Amoxicillin | - Augmentin (daycare, <2 yo, abx in last 1-3 months)
176
Acute mastoiditis | - clinical
- lethargy and malaise - abnl TM - post auricular erythema and tenderness - fever - otalgia, otorrhea
177
Acute mastoiditis | - mgmt
- admission - IV abx - drainage
178
Acute mastoiditis | - MC bug
strep pneumonia
179
Retropharyngeal abscess | - clinical
MC 3-5 yo - sore throat - fever - neck stiffness - odynophagia - neck swelling - poor oral intake
180
Retropharyngeal abscess | - imaging
CT with contrast for dx | - XR will show widened retropharyngeal space
181
Dacrocystitis | - clinical
- unilateral, painful - red, swollen, warm - tender lacrimal sac - ? purulent discharge
182
Dacrocystitis | - MC bug
staph aureus
183
Dacrocystitis | - mgmt
- warm compress - gentle massage - mild: clinda - severe: vanc, 3rd gen cephalosporin
184
AOM | - abx choice
- First line: amoxicillin Second line: 3/4th gen cephalosporin (Cefdinir) - Adults: consider augmentin d/t drug resistance - PCN allergy: Azithromycin or Bactrim
185
Optic neuritis | - sx
- partial/complete loss of vision - painful vision loss, retro-orbital pain - altered color vision - Uhthoff's phenomena: worsening of vision with increased body temp
186
Optic neuritis | - dx
- slip lamp testing or direct ophthalmoscopy - ocular MRI - visual evoked potential testing
187
Optic neuritis | - mgmt
- steroids
188
Optic neuritis | - MCC
MS
189
Perichondritis | - MC bugs
- pseudomonas - staph aureus - strep pyogenes
190
Perichondritis | - mgmt
- Possible I&D - FQ: cipro - IV abx possibly
191
Periapical abscess
- hx of dental carries - pain on tooth percussion - PCN to treat + analgesia and dental f/u
192
Rhinosinusitis | - how to determine viral vs. bacterial
Bacterial if: - sx >10 days - worsen after 5-7 days
193
Rhinosinusitis | - mgmt
- 98% will resolve spontaneously - analgesics mainstay of treatment: tylenol or NSAIDs - if bacterial: Augmentin
194
Conjunctivitis | - mgmt
abx - erythromycin - gentamycin - cipro - ofloxacin *contacts: FQ
195
Angioedema | - mgmt
- airway management!! - Hereditary or acquired: FFP to replace C1-esterase inhibitor - Drug induced: supportive care
196
Radial head fracture - MC pt - PE - Xray
- adult with FOOSH - localized swelling, TTP, decreased motion - fat paid "sail sign"
197
What is the definitive exam to clear a cervical spine
c-spine MRI | * xray cannot visualize spinal cord and ligaments
198
Rabies | - MC animal
bats raccoons and skunks)
199
Rabies | - post-exposure prophylaxis
- Human rabies immunoglobulin | - 4 doses of inactivated rabies vaccine over 14 days
200
Rabies | - sx
- hydrophobia - agitation - spasms
201
EKG findings left main occlusion
- ST segment elevation in AVR > 1mm or greater than elevation in V1 - ST depression in I, II, V4-6
202
Injury of which portion of the spine is most likely to be associated with cord injuries
thoracic spine | - more rigid = requires more force to create injury.
203
MC injured portion of the spine
c-spine
204
Animal bites - what types require abx - abx
- puncture, hands/feet, and high-risk patients | - Augmentin, Clinda + Bactrim in PCN allergic
205
Animal bites | - primary closure vs. secondary
primary if on scalp, face, torso, extremities other than hands and feet
206
CO poisoning | - clinical
- HA - n/v - LOC - hypoxia, chest pain - cherry red skin - Labs: Carboxyhemoglobin
207
CO poisoning | - mgmt
- airway - High-flow O2 - hyperbaric O2
208
Brown-Sequard Syndrome | - mechanism
MC penetrating trauma
209
Brown-Sequard Syndrome | - clinical
- Ipsilateral: loss motor, vibratory sensation, proprioception - Contralateral: loss pain and temperature
210
Anterior cord syndrome | - mechanism
Flexion or vascular
211
Anterior cord syndrome | - clinical
- complete loss motor, pain, temp below injury | - retains proprioception and vibratory sensation
212
Central cord syndrome | - mechanism
forced hyperextension
213
Central cord syndrome | - clinical
sensory and motor deficit | Upper>lower extremities
214
what nasal injury is considered an emergency
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
EKG | - hypokalemia
- flattened or inverted T waves | - U waves (upward deflection after the T wave)
216
Hypercalcemia of malignancy | - treatment
IV fluids
217
MC type of incontinence in elderly population
urge
218
BV | - cause
- decrease in concentration of Lactobacillus sp which leads to an increase in vaginal pH and overgrowth of anaerobes including Gardnerella vaginalis
219
What electrolyte disorder can Bactrim cause
Hyperkalemia
220
What medications commonly cause hypokalemia
- Loop diuretics (furosemide) - HCTZ - insulin
221
what is a common cause of normal anion gap acidosis
diarrhea
222
Impetigo - topical - systemic
- mupirocin | - oral cephalexin
223
Hypersensitivity Reaction Type I - mechanism - Examples
- IgE mediated degranulation of mast cells with release of mediators - Anaphylaxis, urticaria, angioedema
224
Hypersensitivity Reaction Type II - mechanism - Examples
- IgG or IgM ab react with cell antigens = compliment activation - autoimmune hemolytic anemia, good pasture syndrome
225
Hypersensitivity Reaction Type III - mechanism - Examples
- IgG or IgM ab react with cell antigens = compliment activation - Serum sickness, SLE, RA
226
Hypersensitivity Reaction Type IV - mechanism - Examples
- Activated T cells vs. cell surface bound antigens | - contact dermatitis, TB skin test, transplant rejection
227
Serum sickness
- Type III hypersensitivity - Onset 7-21 days after exposure OR 12-36 hours after reexposure - flulike sx, rash
228
Rocky Mountain Spotted Fever | - clinical
- tick bite - abrupt onset sx - fever - HA - myalgias - maculopapular rash (palms and soles) - photophobia - v/d
229
Rocky Mountain Spotted Fever | - mgmt
doxycycline
230
Rocky Mountain Spotted Fever | - bacteria
rickettsia rickettsia
231
Cellulitis Abx - non-purulent - purulent
- cephalexin, dicloxacillin (PCN allergic: valinda or erythromycin) - bactrim, linezolid, vanc
232
Herpes Simplex Virus | - gold standard diagnostic test
- tissue culture with PCR
233
DTR | - hypothyroid
delayed relaxation of DTR
234
Hypothyroid | - labs
- high TSH - low T4 - antithyroid peroxidase - antithyroglobulin antibodies
235
Thyroid Storm | - RF
- infection (MC) - surgery - trauma * * acute event
236
Thyroid storm | - clinical
- tachycardia >140 - HF - hypotension - dysrhythmia (afib) - hyperpyrexia - agitation - psychosis, stupor - coma
237
Thyroid storm | - Mgmt
- BB (propranolol) - PTU or methimazole - Iodine - Steroids - Bile acid sequestrate
238
What is graves disease also known as
toxic diffuse goiter | *toxic multi nodular goiter is the second MCC of hyperthyroidism in the US
239
Which medication for hyperthyroidism is best in pregnancy
PTU | P for pregnant
240
First line test for suspected acromegaly
insulin-like growth factor 1
241
HELLP syndrome
- hemolysis - elevated liver function test - low platelets - mg for eclamptic seizure and deliver the baby
242
Vaginal pH - candidiasis - Trich - BV
< 4.5 > 5 > 4.5
243
Greatest RF for ectopic pregnancy
previous ectopic pregnancy | * also PID
244
Preterm Rupture of Membrane | - sx
- vaginal pH >6.5, nitrazine paper turns blue | - ferning
245
RF for suicide
``` 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
Definition of substance abuse
- 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
Opioid Overdose | - mgmt
- support the airway | - O2 then naloxone
248
MC finding abusive head trauma in infants
retinal hemorrhage
249
MC malignancy of the head and neck in children
Hodgkin's lymphoma
250
Megaloblastic anemia
- often vegan or alcoholic - fatigue, weakness - PE: pallor, glossitis - MCV > 100, hypersegmented neutrophils - B12 and folate * * only B12 deficiency = neuro sx
251
Lab finding to differentiate between iron def anemia and thalassemia
RDW
252
What type of hemoglobin does hydroxyurea increase?
HbF
253
ALL | - clinical
- bone pain - lymphadenopathy - hepatosplenomegaly - CNS involvement
254
Winter formula to calculate concomitant respiratory alkalosis/acidosis
pCO2 = 1.5 (bicarb) + 8 +/- 2
255
Erythema rashes (5)
- 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
Galeazzi Fracture
- Distal radius fracture | - distal radioulnar joint (DRUJ) dislocation
257
Monteggia Fracture
- Proximal to mid ulna fracture | - radial head dislocation
258
Ottawa Ankle Rules | - ankle xray
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
Ottawa Ankle Rules | - foot xray
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
Myocarditis | - dx
- endomyocardial biopsy is GS - clinical - cardiovascular MRI
261
Myocarditis | - clinical
- fatigue, exercise intolerance - chest pain, pericarditis - unexplained sinus tachycardia - gallop - abnl EKG or echo - HF - dysrhythmia or heart block - elevated troponin - cariogenic shock
262
Myocarditis | - mgmt
- supportive - HF treatment - antidysrhythmics as needed - immunosuppressants - IVIG
263
Light criteria - what for - criteria
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
Treatment for right ventricular infarct
- IVF | - avoid nitrates
265
Acute pyelonephritis treatment
- FQ - Bactrim - pregnant: ampicillin/gentamicin or 3rd gen ceph
266
Multifocal atrial tachycardia (MAT) | - clinical
- min 3 diff P wave morphologies - rate 100-180 - irregular rate
267
Multifocal atrial tachycardia (MAT) - etiologies - mgmt
- chronic lung dz like COPD, hypoxia, pulm HTN | - O2, treat underlying condition, rate control
268
Anterior Cerebral artery | - sx
- paralysis contralateral foot/leg - sensory loss toes, foot, leg - gait/stance impairment - Flat affect, slow, distracted - cognitive impairment - urinary incontinence **
269
Pericardial tamponade | - PE
- muffled heart sounds - JVD - hypotension
270
Pericardial tamponade | - EKG
- low voltage QRS | - electrical alterans
271
Aortic dissection | - mgmt
- reduce BP to lowest tolerable - HR < 60 bpm - IV bb: esmolol, labetalol, propranolol - nitroprusside one HR is controlled - Pain control
272
Aortic dissection | - dx
CT or TEE
273
Name for severe hypothyroidism
myxedema coma - decompensated metabolic state - mental status change
274
Croup | - sx
- seal-like cough - inspiratory stridor - low grade fever
275
Croup | - mgmt
- mild: cool humidified air, hydration, dexamethasone - Moderate: dexamethasone +/- neb epi, observe for 3-4 hours - Severe: dexamethasone, epi, hospitalization
276
MC sign of hemorrhoids
bleeding with defecation
277
Middle cerebral artery | - stroke sx
contralateral paralysis upper > lower aphasia
278
Schizoaffective disorder
sx of schizophrenia plus mood disorder (mania or major depression)
279
Schizophreniform disorder
schizophrenic symptoms that last more than one month but less than 6 months
280
What antipsychotic causes agranulocytosis?
clozapine
281
MCC compartment syndrome
tibia fracture | anterior compartment of lower leg
282
Volvulus | - dx
- plain film - abd CT - contrast enema
283
Volvulus | - clinical
- slowly progressive abd pain - abd distention - n/constipation - vomiting
284
Volvulus | - mgmt
- flexible sigmoidoscopy | - surgery to prevent recurrence
285
Erysipelas | - MCC
strep progenies (GABS)
286
Erysipelas | - mgmt
- penicillin V - amoxicillin - azithromycin - clarithromycin
287
Burn Rule of nines
``` Head 9% Each arm 9% torso 18% front 18% back Each leg 18% perineum 1% ``` * palm is about 1% of BSA
288
Parkland formula
4 mL/kg % total BSA burned | 50% given in first 8 hours, remainder over 16 hours
289
Arteries in an inferior coronary infarct
RCA | left circumflex
290
Arteries in lateral coronary infarct
Left circumflex | Diagonal of LAD
291
What should alert you to potential for right ventricular infarction?
inferior MIs -> right-sided EKG | - if ST elevation in V4R-V6R = right ventricular infarction
292
Medications to treat mastitis
- cephalexin - dicloxacillin - Bactrim - Clinda if PCN allergic
293
Treatment for gamekeepers thumb
- thumb spica splint | - may need sx repair
294
Second degree type I heart block | - mgmt
only if symptomatic: | atropine, epi +/- pacemaker
295
What to co-morbidities is digoxin a good medication for?
a-fib with hypotension or congestive HF
296
A fib | - when use dual antiplatelet
only if CI to anticoagulation
297
PSVT | - two kinds
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
PSVT | - two conduction patterns
- Orthodromic (95%): down normal, returns via accessory. Narrow complex tachycardia - Antidromic (5%): down accessory and returns via normal pathway. Wide complex tachycardia
299
PSVT | - mgmt
- stable/narrow: vagal, adenosine, AV nodal blockers - stable/wide: amio, procainamide in WPW - unstable: cardioversion
300
WPW
Bundle of Kent - slurred, wide QRS (AVRT) - delta wave, short PR interval * *avoid AV nodal blockers (Adenosine, BB, CCB, digoxin)
301
Nitrates | - effects (2)
- Increase supply by artery dilation | - Decrease demand and preload via venous dilation
302
First line chronic agent to treat angina
BB | CCB 2nd line
303
STEMI | - reperfusion goal time
12 hours | PCI best within 3 hours of onset (90 min best)
304
How does alteplase work
activates tissue plasminogen => plasmin => dissolves clot
305
What score is used to determine risk fo death and ischemic events in UA or NSTEMI to determine benefit of angiography?
TIMI
306
HF - MCC - MCC diastolic
- CAD | - HTN
307
major ADR of ACEi
hyperkalemia
308
What two BB are used for HF
carvedilol and metoprolol
309
Diuretics | - ADR
hypokalemia hyponatremia hypocalcemia hyperglycemia hyperuricemia
310
Digoxin effect
- positive inotrope - negative chronotrope - slows speed of conduction
311
Treatment of CHF
LMNOP - lasix - morphine - nitrates - O2 - position upright
312
Aortic regurgitation - MCCs - murmur - other findings - mgmt
- 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
Mitral regurgitation | - murmur
blowing, holosystolic murmur at apex | - radiation into axilla
314
Endocarditis | - blood culture
must get 3, 1 hour apart
315
Endocarditis treatment
- empiric - native valve: vanc +/- cefazolin - Ill with HF: gentamicin + cefepime + vanc - Valve replacement if refractory or abscess
316
Endocarditis - criteria for dx name - criteria
- Duke Criteria | - 2 major, 1 major and 3 minor, 5 minor
317
Endocarditis | Major criteria
- two + blood cultures with typical org | - echo with new valvular regurgitation
318
Endocarditis | minor criteria
- 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
PAD | - mgmt
- platelet inhibitor: cilostazol, ASA, clopidogrel
320
AAA | - major RF
- smoking | - atherosclerosis
321
Aortic dissection | - RF
HTN | age 50-60
322
Shoulder dislocation | - anterior vs. posterior
Anterior MC | Posterior: seizure, trauma, electric shock
323
Rotator cuff injury | - types
- Tendonitis MC <40 | - Tear MC >40
324
Rotator cuff injury | - clinical
- anterior deltoid pain with decreased ROM during overhead activities - PE: passive ROM>active ROM
325
AC joint dislocation
direct blow to adducted shoulder pain, unable to lift shoulder +/- AC joint deformity
326
Proximal humerus or humeral head fracture - position at presentation - check what?
- arm in adducted position | - deltoid sensation to r/o brachial plexus or axillary nerve injuries
327
Humeral shaft fracture | - risk of waht nerve
radial nerve injury: wrist drop
328
Supracondylar humerus fracture - MC population - presentation - nerves/arteries to worry about
- 5-10 yo - swelling/tender elbow - posterior or anterior fat pad sign on xray - median nerve, radial nerve, and brachial artery
329
Flexor tenosynovitis | - signs
1. finger held in flexion 2. TTP tendon sheath 3. enlarged finger 4. pain with passive extension
330
Flexor tenosynovitis | - mgmt
- IV abx | - I&D
331
Flexor tenosynovitis | - describe
infection of flexor tendon synovial sheath in finger
332
Olecranon fracture | - nerve at risk
ulnar nerve
333
Colles fracture | - describe
- dorsal or posterior angulation of fractured piece | - 60% also have ulnar styloid fracture
334
Boutonniere deformity
hyperflexion at PIP hyperextension at DIP Splint PIP in extension for 4-6 weeks
335
Boxer's fracture
4th or 5th metatarsal neck fracture | - ulnar gutter splint
336
Hip dislocation - mech of injury - complications - MC location - presentation
- 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
ACL injury
- pop and swelling --> hemarthrosis | - Lachman most sensitive
338
Meniscal tear
- locking, popping, giving way - effusion after use - McMurrays test
339
Knee dislocation | - risk to what nerves/arteries
- popliteal artery - peroneal nerve - tibial nerve
340
Tibial plateau fracture risk of injury to waht nerve
peroneal nerve: foot drop, sensation in first web space
341
Herniated disk - MC locatoin - testing
- L5-S1: junction of mobile and nonmobile spine - sciatica is L5-L1 dermatome - straight leg test, crossover test
342
L4-L6 nerves | - sensation
Sensation: ALP - L4: anterior thigh - L5: lateral thigh - L6: posterior leg/calf
343
L4-L6 nerves | - motor
- L4: ankle dorsiflexion - L5: big toe extension - L6: plantar flexion
344
Spondylolysis
Pars intraairticular defect: failure to fuse or stress fracture - MCC back pain in children/adolescents
345
Spondylolithesis
One vertebrae slips forward from the next | - back pain and sciatica
346
Osteomyelitis | - MC bug
staph aureus
347
Osteomyelitis | - Dx tool
MRI most sensitive early XR bone aspiration: gold standard
348
Septic arthritis - MC location - MC bugs - arthrocentesis findings
- knee - staph aureus, often polymicrobial - WBC > 50k with PMNs
349
Septic arthritis | - abx
- nafcillin - MRSA: vanc - gram neg: ceftriaxone
350
Esophagitis | - CMV vs. HSV
- CMV: large, superficial shallow ulcers (gancyclovir) | - HSV: smal, deep ulcers (acyclovir)
351
Boerhaave Syndrome - describe - s/sx - dx - mgmt
- full thickness tear distal esophagus - vomiting, retrosternal pain, worse with deep inspiration and swallowing, pneumomediastinum - CT/CXR - Contrast esophagram with gastrogaffin
352
Gastritis | - cause
- increased aggressive factors | - decreased protective factors
353
Gastritis | - dx
endoscopy
354
Gastritis | - treatment if NOT h. pylori
- acid suppression - PPI, H2 blocker - Sucralfate
355
PUD | - duodenal vs. gastric
- duodenal: better with food, younger patients, 4x MC, increased damaging factors - gastric: older patients, worse with food, loss of protective factors
356
Toxic megacolon - describe - mgmt
- colon dilated > 6 cm + signs of toxicity | - bowel decompression, rest, NG, broad spectrum abx
357
IBD | - mgmt
- Aminosalicylates: sulfasalazine and mesalamine - steroids: acute flairs only - immune modifying agents * * 5-ASA most helpful in UC
358
IBD | - aminosalicylates
- 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
Hernia | - incarcerated vs. strangulated
- incarcerated: painful and irreducible | - strangulated: incarcerated + systemic toxicity
360
Anti-diarrhea meds : list
- Bismuth subsalicylate - Opioid agonists - anticholinergics
361
Bismuth subsalicylate - effects - ADR
- antimicrobial - anti-secretory - anti-inflammatory - Reye syndrome risk
362
Opioid agnostics for anti-diarrhea
- 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
Anticholinergics for anti-diarrhea
- Hyoscyamine - Scopalamine - Atropine - Phenobarbital - inhibits acetylcholine-related GI motility, antispasmotic
364
Anti-emetics | - two main kinds
- ondansetron | - dopamine blockers
365
Ondansetron
- blocks serotonin receptors: | - ADR: sedation, prolonged QT, arrythmia
366
Anti-emetics | - dopamine blockers (3 names)
- prochlorperazine - promethazine - metochlopramide
367
Anti-emetics | - dopamine blockers: MOA, ADR
block CNS dopamine receptors | - increased QT, anticholinergic, antihistamine, extrapyramidal sx
368
Gastroenteritis | - MCC
norovirus | * rotavirus MCC diarrhea children
369
Gastroenteritis | - staph aureus
dairy, mayo, meat, eggs
370
Gastroenteritis | - Enterotoxigenic E coli
travelers diarrhea - fluids - FQ if severe
371
Gastroenteritis | - vibrio cholera mgmt
- fluid replacement | - tetracyclines
372
Gastroenteritis | - Campylobacter
c. jejuni MC bacterial enteritis - MC antecedent to Guillain-barre - poultry, undercooked food - mgmt: erythromycin
373
Gastroenteritis | - Yersinia
- can mimic appendicitis - mesenteric adentitis - mgmt: fluids
374
Pleural effusion | - s/sx
- dec tactile fremmitus - dec breath sounds - dullness to percussion - pleural friction rub
375
PE | - triad sx
- dyspnea - pleuritic chest pain - hemoptysis +- cough
376
PE | - PERC criteria
``` <50 yo Pulse <100 O2 sat >95% No prior PE hx - if all negative, low risk ```
377
PNA | - MCC
strep pneumonia | H flu 2nd MCC (esp with underlying dz like COPD)
378
PNA | - MCC atypical
mycoplasma pneumoniae | *bullous myringitis
379
PNA | - MC bug CAP
- strep pneumo | - mycoplasma
380
PNA | - MC bug in HAP
- psuedomonas | - MRSA
381
PNA | - PE
- dullness to percussion - increased fremitus - bronchial breath sounds
382
PNA | - rusty sputum indicates what
strep pneumo
383
PNA | - CAP outpatient abx
macrolide or doxy | - FQ if comorbidities or recent abx use
384
PNA | - cap inpatient abx
- beta-lactam + macrolide or doxy | - FQ
385
PNA | - HAP abx
- beta-lactam with antipseudomonal + FQ | - vanc/linezolid if MRSA
386
PNA | - legionella abx
levo | azithromycin
387
PNA | - aspiration abxx
Clinda Metronidazole Augmentin
388
Rifampin | - ADR
- thrombocytopenia - orange - hepatitis
389
Isoniazid | - ADR
- Hepatitis | - peripheral neuropathy (B6/pyridoxine)
390
Pyrazinamide | - ADR
- hyperuricemia - photosensitive derm rash - caution in gout and lever diease
391
Ethambutol | - ADR
- optic neuritis | - peripheral neuropathy
392
Acute bronchitis | - MCC
adenovirus
393
Epiglottitis | - treatment
ceftriaxone or cefotaxime
394
ARDS | -d escribe
- alveolar damage > increased permeability of alveolar-capillary barrier > pulmonary edema > reduced blood oxygenation
395
ARDS | - Sx
1. severe refractory hypoxemia 2. bilateral pulmonary infiltrate on CXR 3. no cariogenic pulm edema or CHF
396
ARDS | - XR
diffuse, bilateral pulmonary infiltrates | "white out pattern"
397
ARDS | - Mgmt
- noninvasive or mech ventilation - CPAP - PEEP goal O2 >90%
398
Pertussis abx
Macrolide
399
Lung cancer | - MCC
Non Small Cell Carcinoma - adenocarcinoma MC, usu peripheral - squamous cell: bronchial, centrally located - large cell, very aggressive
400
Lung cancer | - less common type
small cell, very aggressive with early mets
401
Bells palsy - which CN - assoc with what
- CN VII (facial) | - herpes simplex
402
Tension HA | - mgmt
- NSAIDs - ASA - Acetaminophen - TCA (amytriptyline) - BB
403
Migraine HA - cause - mgmt
- 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
Cluster HA | - mgmt
- 100% o2 - antimigraine meds - prophylaxis: verapamil
405
TIA - MCC - two types
- embolus - Interal carotid: amaurosis fugal, weakness in contralateral hand - Vertebrobasilar: brainstem/cerebellar sx
406
TIA | - mgmt
- ASA +/- plavix | - reduce RF
407
Ischemic stroke | - lacunar sx
- pure motor MC - ataxic hemiparesis leg>arm - hx of HTN
408
Spontaneous ICH - MCC - location - what not to do - mgmt
- MCC HTN - basal ganglia - NO LP - head elevation, mannitol, hyperventilation
409
Epidural hematoma | - sx
- LOC > lucid > coma
410
Which type of hematoma can cross suture lines?
subdural
411
Meningitis | - LP findings
- incr PMN - dec glucose - incr protein - incr CSF pressure
412
Meningitis | - abx if 1 mo to 18 years
vanc and ceftriaxone | - mc N. meningitidis or strep pneumo
413
Meningitis | - abx if 18-50 yo
vanc and ceftriaxone | - mc strep pneumo, could also be N. meningitidis
414
Meningitis | - abx if >50
van, ceftriaxone AND ampicillin to cover for Listeria
415
Viral meningitis | - LP findings
- lymphocytosis | - normal glucose
416
Viral meningitis | - MCC
enterovirus MCC | - also mumps, HSV
417
Encephalitis | - MCC
HSV-1
418
Simple partial vs. complex partial seizure
- simple: maintain consciousness, focal defect | - complex: consciousness impaired, automatisms (lip smack, etc.)
419
Valproic acid - MOA - ADR
- inc GABA - dec glutamate/NMDA receptor excitiation - ADR: hepatitis, pacreatitis
420
Lamotrigine - MOA - ADR
- blocks Na and Ca channels > dec glutamate release | - ADR: SJS
421
Phenytoin - MOA - ADR
- stabilize neuronal membrane - rash, gingival hyperplasia * * monitor drug levels
422
Carbamezapine - MOA - ADR
- NA channel blocker | - ADR: hyponatremia, SJS, blood dyscrasias
423
Topiramate - MOA - ADR
- NA channel blocker, inc GABA - glutamate antagonist - ADR: weight loss
424
Benzo - MOA - ADR
- inc GABA mediated CNS inhibition | - ADR: Sedation, ataxia
425
Blepharirits | - CAuse of anterior vs. posterior
Anterior: seborrheic or infections Posterior: Meibomian gland dysfunction
426
Corneal abrasion | - mgmt
- erythromycine - polymyxin/trimethoprim - Cipro * FQ if contacts
427
PE difference in three types of conjunctivitis
- Bacterial: mucopurulent discharge, red, not pruritic - Viral: watery discharge, red, pruritic - Allergic: rare discharge, cobblestoning, red, pruritic
428
Orbital cellulitis - MCC - clinical - dx - mgmt
- secondary to sinus infection - reduced vision, pain with ocular movement, proptosis - CT scan - IV abx: vanc, clinda, cefotaxine
429
Papilledema | - mgmt
- diuretics | - acetazolamide: reduces production of CSF and aqueous humor
430
Optic neuritis | - PE pupil findings
Marcus-Gunn pupil - dilates when light on it (abnl) - constricts when contralateral eye has light (normal)
431
Optic neuritis | - mgmt
- methyprednisone
432
Otitis externa | - mgmt
- keep dry - Cipro/dextramethasone - Aminoglycoside ONLY if TM is visualized and not perforated
433
Mastoiditis | - mgmt
- IV abx - drainage - Abx: same used in AOM
434
Vestibular neuritis - s/sx - mgmt
- continuous vertigo - no hearing loss - steroids and symptomatic
435
Labrynthitis | - s/sx
- continuous vertigo | - continuous hearing loss
436
Acute sinusitis | - mgmt
- 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
Strep pharyngitis | - mgmt
- Amoxicillin | - Macrolide if PCN allergic
438
ATN
Cause of AKI | - acte destruction/necrosis of nephron renal tubules
439
Nephrotoxic causes of AKI
- aminoglycosides - dye - cyclosporin - gout - rhabdo - MM
440
ATN | - UA findings
- epithelial cell casts | - muddy brown casts
441
AIN | - overview
Interstitum | MC due to drug hypersensitivity (PCN, sulfa, NSAIDs, infection)
442
AIN | - lab findings
- UA: WBC pathognomonic | - Inc serum IgE
443
Epididymitis | - mgmt
- bed rest, cool compress, NSAIDs - G/C: doxy and ceftriaxone - e. coli: FQ * * chronic: 4-6 weeks abx
444
Uncomplicated cystitis | - abx
- nitrofurantoin - Cipro - bactrim 3-5 D
445
Complicated cystitis | - abx
FQ amino glycoside 7-14 D
446
Cystitis while pregnant | - abx
- amoxicillin 7-14 d
447
Pyelonephritis | - abx
- IV or PO FQ - Aminoglycosides - 14 D
448
Sx specific to prostatitis
perineal pain
449
Nephrolithiasis | - <5 mm
fluids analgesics anti-emetics tamulosin
450
Nephrolithiasis | >7 mm
lithotripsy | uretoscopy with stent (obstructed or at risk kidney)
451
Nephrolithiasis | - >10 mm or struvite
percutaneous nephrolithotomy
452
Stress incontinence | - tx
- alpha agonist - midodrine - psuedoephridine
453
Urge incontinence - cause - tx
- overactive detrusor muscle. Small volume voids and nocturia - bladder training - anticholinergics (oxybutynin, tolterodine, TCA, mirabegron)
454
Overflow incontinence - cause - Tx
- underactive detrusor muscle, or bladder outlet obstruction (BPH), increased post void residual - intermittent self cath, cholinergics
455
Bullous pemphigoid
- MC in elderly - Type II HSN IgG vs. epithelial basement membrane > subepidermal blistering - systemic steroids, antihistamines
456
Decubitus ulcer
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
Roseola Infantum - aka - microbe - s/sx
- Sixths dz - HHV 6/7 - rose pink rash on trunk/back > face (Only one that starts on body and moves to face)
458
Cocksackie
- HFM: mild fever, URI sx, dec appetite > oral enanthem > exanthem - Herpangina: high fever, stomatitis 3-5D
459
Mumps - microbe - s/sx
- paramyxovirus - parotid gland pain and swlling - orchitis, pancreatitis
460
Rubeola - aka - microbe - s/sx
- Measles - paramyxovirus - cough, coryza, conjunctivitis - koplik spots - morbiliform maculopapular brick red rash on face then body X 7D
461
Rubella - aka - microbe - s/sx
- 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
Erythema infectiousum - aka - microbe - s/sx
- Fifths disease - Parvovirus B19 - coryza and fever > slapped cheeks with circumoral pallor and lacy reticular body rash. Spare palms and soles
463
Classic signs of acute adrenal insufficiency
- profound weakness - severe abd pain - peripheral vascular collapse - electrolyte abnl - shock
464
Adrenal insufficiency | - labs
hyponatremia - hypoglycemia - hyperkalemia
465
Adrenal insufficiency | - treatment
- glucocorticoids - regulate NA and K - fludrocortisone (mineralocorticoid)
466
Addisonian Crisis - cause - clinical - mgmt
- stressful event > worse adrenal insufficiency - MCC abrupt withdrawal of steroids - shock: hypotension/hypovolemia - hypo N, K, glycemia - IVF, IV hydrocortisone, fludrocortisone, electrolyte issues
467
Cushings: | - testing
- 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
Biguadines - ex - MOA - ADR
- Metformin - reduce hepatic glucose production and increase peripheral glucose use - Gi, lactic acidosis, microcytic anemia (B12)
469
Sulfonyureas - MOA - adr
- increase pancreatic insulin release | - hypoglycemia, weight gain, GI
470
alpha-glucosidease inhibitors - exs - MOA - ADR
- Acarbose, miglitol - delays intestingal glucose absorption - GI, hepatitis
471
GLP-1 agonist - exa - MOA - ADR
- liraglutide "-glutide" Byetta and Victosa - mimics incretin > increased insulin release. Deplays gastric emptying - pancreatitis, CI if hx of gastroparesis
472
DPP-4 Inhibitor - exs - MOA - ADR
- "-gliptins" Januvia and Tradjenta - inhibits degradation of GLP-1 - pancreatitis, GI, renal failure
473
SGLT-2 inhibitor - exs - MOA
- "-flozins" | - increased urinary glucose excretion
474
Diagnostic test for diabetes insipidus
free water deprivation - normal: concentrated urine - abnl: unconcentrated urine
475
Diabetes insipidus | - mgmt
- central: DDAVP or carbamezapine | - nephrogenic: na/protein restriction, hctz
476
DUB | - management of severe bleed
- IV estrogen - high dose OCP - D&C
477
Ectopic pregnancy | - triad of sx
- unilateral pelvic/abd pain - vaginal bleeding - amenorrhea +- dizzy, n/v, sycope, tachycardia, hypotension
478
Spontaneous abortion - medications - procedures
- up to 7 weeks: methotrexate and misoprostol - up to 9 weeks: mifepristone and misoprostol - D&C 4-12 weeks - D&E >12 weeks
479
Schizophrenia | - criteria
1 must be hallucination, delusion, disorganized speech 2+ of other positive or negative symptoms 6+ months
480
Schizophrenia | - mgmt
- antipsychotics: dopamine receptor antagonists | - 2nd generation is first line: risperidone, olazapine, quetiapine, etc.
481
ADR citalpram
long QT
482
Bipolar I | - define
Manic episode +/- depressive episode (not required for diagnosis)
483
Bipolar I | - mgmt
- lithium - 2nd gen antipsychotic - bentos for psychosis and agitation
484
Bipolar II | - define
- Hypomania - Major depression NO mania
485
DIC | - define
pathologic activation of coagulation system > widespread micro thrombi > severe thrombocytopenia
486
DIC | - RF
- gram neg sepsis MC - malignancy - OB - massive tissue injury
487
DIC | - labs
increased PT, PTT, INR | increased d-dimer
488
DIC | - mgmt
treat underlying issue | - FFP if severe bleeding
489
ITP | - etiologies
- child: MC s/p viral infection | - Adult: chronic
490
ITP | - define
autoimmune ab vs. platelets with splenic platelet destruction
491
ITP | - clinical
- mucocutaneous bleeding - no splenomegaly - normal coags
492
ITP | - treatment
Children: observe +/- IVIG adults: steroids, IVIG, splenectomy
493
Hemophilia - treatment of A vs. B - inheritance - labs
A: DDAVP and factor VIII B: Factor IX (no DDAVP) - x-linked recessive - increased PTT, normal platelets
494
Von Willebrand Dz - describe - inheritance
- ineffective platelet adhesion | - autosomal dominant
495
Von Willebrand Dz | - clinical
- mucocut bleeding - increased bruising - petechiae
496
Von Willebrand Dz | - mgmt
- avoid ASA | - DDAVP
497
Hodgkins Lymphoma - age - assoc with what - sx - lab finding
- 20s and >50s - Epstein-Barr virus - MC male - painless lymphadenopathy - night sweat, weight loss, etc - Reed-Sternberg cells - mediastinal lymphadenopathy
498
Non-Hodgkins Lymphoma - RF - clinical
- age and immunosppression - painless lymphadenopathy - extra nodal sites common: GI, Skin, CNS
499
ALL
- MC childhood malignancy - RF downsyndrome - Pancytopenia, fever, bone pain
500
AML
Auer rods, adults, pancytopenia, splenomegaly, gingival hyperplasia
501
Polycythemia Vera
- 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
Factor V Leiden
MC causes hypercoagulability | - incr risk PE and DVT

EORs (9 decks)

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