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Emergency Medicine > Exam 2 Reverse > Flashcards

Exam 2 Reverse Flashcards

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1
Q

Serum level dec. but total body sodium normalSevere1. Hyperglycemia2. Hyperproteinemia3. Hyperlipidemia

A

What is psuedohyponatermia & causes?

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2
Q

<113 - seizures & coma High mortality w/ CNS findings

A

S/S Hyponatremia

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3
Q

True hyponatremia - osmolality decFactitious hyponatremia - osmolality normal or inc.

A

Dx hyponatermia

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4
Q

Osmotic pressure >295MCC hyperglycemiaEach 100mg/dL inc. in glc dec. serum sodium by 1.7 due to water moving into ECF

A

Hypertonic hyponatermia

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5
Q

Osmotic pressure 275-295High proteins & lipids cause a lab to report a falsely lowered sodium than what the serum actually contains

A

Isotonic hyponatremia

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6
Q

Osmotic pressure >275 Hypovolemic - loss of Na & waterEuvolemic - normal volume statusHypervolemic - excess total body water

A

Hypotonic hyponatremia

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7
Q

Hypovolemic hyponatremiaUrinary sodium >201. Diuretics2. Renal tubular acidosis, chronic renal failure, nephritis3. Osmotic diuresis4. Addison’s

A

Causes of renal losses of sodium

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8
Q

Hypovolemic hyponatremiaUrinary sodium <201. Vol replacement w/ hypotonic fluids2. GI loss (V/D, tube suction)3. 3rd space loss (burns, peritonitis, pancreatitis)4. Sweating (CF)

A

Causes of extrarenal losses of sodium

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9
Q

Urinary sodium >201. SIADH - tumors, CNS disease, pulm disease, meds, idiopathic2. Hypothyroid3. Pain, stress, psychosis - stimulates ADH4. Drugs - carbamazepine, phenothiazines, TCAs5. Water intoxication6. Glucocorticoid deficiency

A

Euvolemic hyponatremia

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10
Q

Volume overload Urinary sodium >20 - renal failureUrinary sodium <20 - CHF, cirrhosis, nephrotic syndrome

A

Hypervolemic hyponatremia

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11
Q

Hypervolemic or euvolemic hyponatremia - fluid restriction SIADH - demeclocycline or furosemideHypovolemic hyponatremia - isotonic saline

A

Tx hyponatremia

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12
Q

Central pontine myelinolysis brain injury

A

What can happen if you correct hyponatremia too rapidly?

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13
Q

Give 3% hypertonic saline at 25-60 mL/hrDo not raise Na >2mEq/L/hrStop when sodium reaches 120 or when Pt improves

A

Acute Hyponatremia <120 w/ CNS Sx - how do you treat?

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14
Q

Correction of Na no more than 0.5 mEq/L/hr

A

Tx chronic hyponatremia

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15
Q
  1. Na <1252. Require IV3. Significant comorbidities
A

When do you admit hyponatremia Pts?

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16
Q

Na >1501. Reduced water intake2. Inc. water loss - hypervent., DI, osmotic diuresis, thyrotoxicosis, severe burns3. Inc. sodium intake/renal salt retention - hypertonic saline ingestion, sodium bicarb, hyperaldosteronism, Cushing’s

A

Hypernatremia causes

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17
Q

Usually at Na>158 - rate of change important1. Confusion, weakness, irritable, restless, tremulous, seizures, coma2. Hypocalcemia may be present causing CNS Sx3. Flat neck veins, orthostatic HOTN, tachycardia, poor skin turgor, dry mucous membranes

A

Sx hypernatremia

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18
Q

Severe dehydration - NS or LR Then 0.45% saline Sodium reduction should not exceed 15mEq/L/day Reach normal serum sodium in 48-72hrs

A

Tx hypernatremia

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19
Q

5-Mar

A

You lose 1L of water, how much does your serum sodium increase?

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20
Q

Hypokalemia - <3.5

A

What is the MC electrolyte abnormality?

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21
Q
  1. Extrarenal - inadequate intake, V/D, inc. insulin, alkalosis2. Renal - diuretics, aldosteronism, renal tubular acidosis3. Lithium, heavy exercise, heat stroke, fever
A

Causes of hypokalemia

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22
Q
  1. Weakness, paresthesias, polyuria, orthostatic HOTN, areflexia, ileus, arrhythmias 2. EKG - T wave flattening/inversion, U waves, ST depression, PVC’s, wide QRS, tachyarrhythmias Want to get CK, Mg, UA, BMP
A

S/S hypokalemia

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23
Q

K>2.5 w/o EKG findings - oral replacement daily until normalK<2.5

A

Tx hypokalemia

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24
Q

K >5.5 1. Factitious - release of intracellular K by hemolysis during phlebotomy2. Extrarenal causes - insulin deficiency, acidosis, hyperosmolality, beta-blockers, supplements, massive transfusion, crush injuries, burns, mesenteric or muscle infarction 3. Renal causes - chronic renal insufficiency, acute renal failure, hypoaldosteronism, drugs (NSAIDs, ACEi, K-sparing diuretics)

A

Hyperkalemia causes

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25
Q

Weakness, paresthesias, confusion, paralysis, areflexia, V/D, ileus, arrhythmias (VF, heart block, asystole)EKG changes6.5-7.5 - Prolonged PR, tall peaked T waves, short QT7.5-8 - Flattening of P wave, QRS widening10-12 - QRS complex degradation into a sinusoidal pattern

A

S/S hyperkalemia

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26
Q
  1. Albuterol 2. CaCl or gluconate 3. Sodium bicarb4. Insulin & glc5. Furosemide6. Dialysis 7. Kayexalate
A

Tx hyperkalemia

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27
Q

Ionized Ca

A

Causes of hypocalcemia

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28
Q
  1. Circumoral & distal extremity paresthesis2. Irritability, weakness, fatigue, muscle cramps3. Seizures 4. Hyperreflexia 5. Carpopedal spasm, tetany, laryngospasm6. Trousseau’s sign7. Chvostek’s sign 8. Prolonged QT9. Sinus bradycardia10. Heart block11. VT/VF
A

S/S hypocalcemia

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29
Q

Asymptomatic - oral therapyTx hypomagnesemia <1.3 or Sx - IV Cagluconate over 10 min then maintenance infusion-careful w/ Digoxin

A

Tx hypocalecemia

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30
Q

Total Ca > 10.5Ionized Ca >2.7 1. CA/hyperparathyroidism**2. Endocrine - hyperthyroidism, pheochromocytoma, adrenal insufficiency3. Granulomatous disorders - sarcoid, TB, histoplasmosis, coccidiomycosis4. Immobilization, Paget’s disease, dehydration, excess Ca ingestion, milk alkali syndrome

A

Hypercalcemia Causes

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31
Q
  1. Weakness, depression, confusion, lethargy, personality changes, N/V, anorexia, constipation, HA, abd pain2. Dehydation, dec. motor strength3. Dec. mental status4. Ataxia, hyporeflexia5. Fx6. HTN, wt loss, renal insufficiency, cardiac arrest7. Short QT, widened T waves, bradyarrhythmias, BBB, AV blocksStones, bones, moans & groans
A

S/S hypercalcemia

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32
Q

Any Sx Pt or total Ca >14 1. Vol replacement2. Furosemide3. Mithramycin 4. Pamidronate5. Calcitonin6. Hydrocortisone7. DialysisWatch hypokalemia & hypomagnesemia

A

Tx hypercalcemia

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33
Q

<11. Alcoholism2. Malnutrition3. Cirrhosis4. Pancreatitis5. Excessive GI fluid losses (Diarrhea)

A

Causes of hypomagnesemia

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34
Q
  1. Malaise2. Muscle weakness3. Anorexia, N/V4. Seizures 5. Chvostek & Trousseau’s6. Tremors, twitching, clonus, dec. DTR, carpopedal spasm, tetany, delirium, dysarthria 7. Tachyarrhythmias, Torsades, prolonged PR & QT
A

S/S hypomagnesemia

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35
Q

Mild - Mg(OH)2Severe - neuro findings & arrythmias - MgSO4 Admit if <1 & SxWatch hypokalemia, hypocalcemia, hypophosphatemia

A

Tx hypomagnesemia

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36
Q

> 2.5 - Rare - usually w/ renal failure/iatrogenic cause1. Rhabdo2. Tumor lysis3. Burns4. Trauma5. DKA6. Hypothyroid7. Antacids8. Laxative abuse9;. Eclampsia Tx

A

Hypermagnesemia Causes

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37
Q

Nonspecific1. N/V2. Lethargy, confusion3. Coma4. If >4 - Dec. DTR’s, muscle weakness, bulbar paralysis, resp. insufficiency

A

S/S hypermagnesemia

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38
Q
  1. Cagluconate/chloride2. Furosemide3. DialysisWatch hyperkalemia/hypercalcemia
A

Tx hypermagnesemia

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39
Q
  1. CNS lesions2. Sedative therapy & overdose3. Neuromuscular disorders4. Pleural disease5. COPD
A

Causes of resp. acidosis

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40
Q
  1. Anxiety - MCC2. Hypoxia3. Pulm. disorders4. Salicylate toxicity5. CNS disorders6. Pregnancy7. Early sepsis
A

Causes of resp. alkalosis

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41
Q

> 7.73

A

At what pH is there dec. cardiac function?

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42
Q

AlcoholMethanolUremiaDKAParaldehydeIron, IsoniaziedLactic acidosisEthylene glycolCarbon monoxideAspirinToluene

A

Causes of anion gap metabolic acidosis

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43
Q

Lactic acidosis - due to dec. oxygen to tissues, sepsis, shock

A

What is the MCC of anion gap met. acidosis?

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44
Q
  1. Conditions that cause renal loss of bicarb - renal tubular acidosis, acetazolamide therapy 2. Conditions that lead to GI loss of bicarb - diarrhea, pancreatic fistula, ureterosigmoidostomy3. HCl, ammonium chloride, oral CaCl2
A

Causes of nonanion gap metabolic acidosis

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45
Q

pH s respiration - rapid regular deep resp. rate

A

S/S met. acidosis

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46
Q

Na - (HCO3 - Cl)Normal is 10-12>12 - met. acidosis

A

Anion gap formula

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47
Q
  1. Tetany2. Seizures3. Loss of Ca, K & Mg
A

S/S met. alkalosis

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48
Q

Insulin

A

MCC hypoglycemia?

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49
Q
  1. Inadequate food intake2. Insulin/meds3. Drug interaction4. Infection5. Renal/hepatic failure6. ACS7. Stress
A

Causes of hypoglycemia

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50
Q
  1. Glucose D50W2. Glucagon 3. Octreotide - suppresses insulin secretionIf alcoholic - give thiamin to prevent Wernicke-Korsakoff’s syndrome
A

Tx hypoglycemia

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51
Q

Octreotide

A

Tx hypoglycemia cause by sulfonylurea?

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52
Q
  1. Not taking insulin2. Infection3. Pregnancy4. Hyperthyroidism5. Substance abuse (Cocaine)6. Meds - steroids, thiazides, antipsychotics, sympathomimetics 7. Heat-related illness8. CVA9. GI hemorrhage10. MI11. PE12. Pancreatitis13. Major trauma/surgery
A

Causes of DKA

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53
Q
  1. N/V, abd pain2. Polyuria, polydipsia3. AMS4. Kussmaul’s breathing5. Fruity breath6. Dehydration - HOTN, tachycardia, dry skin, dry mucous membranes
A

S/S DKA & HHS

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54
Q
  1. Glc >2502. Anion gap >103. Bicarb <7.35. Ketonemia
A

Labs DKA

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55
Q
  1. NS 2. Follow K+3. Insulin - 0.1/kg/hr
A

Tx DKA

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56
Q

Diabetics1. Stressor - infection, CVA, GI bleed, MI, pancreatitis2. Meds - thiazide diuretics, corticosteroids, lithium, beta-blockers, Ca-channel blockers, phenytoinNondiabetics 1. Severe dehydration/excess glucose load - burns, heat stroke, dialysis, diet, hyperalimentation

A

Causes of hyperosmolar hyperglycemia state

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57
Q
  1. Glc >6002. Osmolality >3153. Bicarb >154. pH >7. 3
A

Dx HHS

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58
Q
  1. IVF - correct 1/2 w/in 1st 12h then rest over next 24h 2. Once HOTN, tachycardia & urine output improve - switch to 0.45% NS 3. Potassium 4. Insulin
A

HHS Tx

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59
Q

Alcoholics who abruptly stop drinking after a binge or 1st time drinkers

A

Who gets alcoholic ketoacidosis?

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60
Q

Binge drinking then1. Abd pain - pancreatitis, gastritis, hepatitis2. N/V3. Alcohol withdrawal/DTs4. Dehydration - HOTN, tachycardia5. Kussmaul’s respiration6. +/- fever7. NL MS/coma8. Abd tenderness9. Heme + stool10. Hepatomegaly

A

S/S alcoholic ketoacidosis

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61
Q
  1. Low/NL/slightly inc. glc2. Wide anion gap met. acidosis3. +serum ketones
A

Dx alcoholic ketoacidosis

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62
Q
  1. Saline w/ glucose & thiamin 2. Insulin if DM3. Consider Mg & multivitamin 4. Bicarb if pH<7.1
A

Tx alcoholic ketoacidosis

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63
Q

Shortened bowel sundrome caused by bacterial fermentation

A

Type D lactic acidosis

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64
Q

Caused by tissue hypoxiaHas a high mortalityRelated to hemorrhagic, hypovolemic, cardiogenic & septic shock

A

Type A lactic acidosis

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65
Q

No tissue hypoxia - may be abrupt in onset or over a few hours Seen w/ DM, liver disease, seizures, renal disease, genetic disorders of metabolism, drugs (ethanol, metformin, salicylate ingestion)

A

Type B lactic acidosis

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66
Q

Produces anion gap acidosisAbrupt onset - ill Pt1. Hypoventilation or Kussmaul’s breathing2. Lethargy, coma3. Vomiting, abd pain

A

S/S lactic acidosis

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67
Q
  1. Ventilation & volume replacement2. Diuresis 3. Bicarb if pH<7.2 Admit to ICU
A

Tx lactic acidosis

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68
Q
  1. Infection - MCC2. Trauma, surgery, hyperosmolar coma3. DKA4. Withdrawal of thyroid med, iodine or contrast administration, thyroid gland palpation, ingestion of thyroid hormone, amiodarone, large doses of povidone-iodine w/ skin breakdown5. MI, CVA, PE6. Parturition (childbirth), eclampsia
A

Causes of thyroid storm

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69
Q
  1. Exopthalmos2. Widened pulse pressure3. +/- Palpable goiter4. Heat intolerance5. Fever6. Tachycardia out of proportion to fever7. Profuse sweating8. Dehydration9. Hair loss 10. Inc. SBP11. Inc. pulse pressure12. Systolic flow murmur13. Sinus tachycardia14. AFib, CHF, pulm. edema 15. Agitation, restlessness, psychosis, confusion, obtundation, coma, proximal muscle weakness, hyperreflexia16. Wt loss, N/V/D, anorexia, abd pain
A

S/S thyroid storm

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70
Q
  1. Inc. FT42. Suppressed unmeasureable TSH 3. Sinus tach/AFib
A

Dx thyroid storm

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71
Q
  1. IVF w/ dextrose 2. Oxygen3. Acetaminophen 4. Cooling blankets5. Cholestyramine6. Propylthiouracil/Methimazole7. Iodine, KI, NaI, Li8. Propranolol9. Hydrocortisone
A

Tx thyroid storm

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72
Q

Infection, cold, trauma, MI, CHF, CVA, GI bleed, surgery, burns Meds - beta-blockers, sedatives, narcotics, amiodarone MC in winter months in old ladies

A

Causes of myxedema coma

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73
Q
  1. Hypothermia2. Resp distress w/ hypoventilation, hypercapnia, hypoxia3. Cardiomegaly, vent arrhythmias, HOTN, bradycardia4. Seizures, ataxia, tremors, slow mentation, delusions, psychosis5. Megacolon, urinary retention, abd distention
A

S/S myxedema coma

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74
Q
  1. High TSH2. Low T43. Dec. Na & Cl 4. Hypoxia & hypercapnea
A

Dx myxedema coma

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75
Q

Tx before labs confirm Thyroid replacement therapySupportive care

A

Tx myxedema coma

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76
Q
  1. HOTN refractory to fluids & pressors2. Dehydation3. Weakness, lethargy4. Shock 5. Delirium6. Abd pain w/ N/V7. +/- sepsis
A

S/S adrenal crisis

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77
Q
  1. Hyponatremia2. Hypoglycemia3. Hypercalcemia4. Inc. BUN5. Mild met. acidosis 6. Flattened T waves, Prolonged QT & PR, low voltage, ST depression, signs of hypo/hyperkalemia
A

Dx adrenal crisis

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78
Q
  1. IVF2. Hydrocortisone3. Vasopressors
A

Tx adrenal crisis

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79
Q

Alcoholic w/ poor nutrition from thiamin deficiency PPTd by giving glucose to alcoholic w/ inadequate thiamin

A

Cause of Wernicke-Korsakoff’s syndrome

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80
Q

Triad1. AMS2. Opthalmoplegia3. Gait ataxia Also1. Hypothermia2. HOTN3. Coma4. Circulatory collapse

A

S/S Wernicke-Korsakoff

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81
Q

Usually made clinicallyTx immediately

A

Dx Wernicke-Korsakoff

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82
Q
  1. Thiamin2. Mg
A

Tx Wernicke-Korsakoffs

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83
Q

Ecchymosis of umbilicusFrom retroparitoneal hemorrhage from pancreatitis or trauma

A

What is Cullen’s sign & when is it seen?

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84
Q

Flank ecchymosisFrom retroperitoneal hemorrhage from pancreatitis or trauma

A

What is Turner’s sign & when is it seen?

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85
Q

Dilated veins around umbilicusSeen in liver disease

A

What is caput medusae & when is it seen?

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86
Q

Dilated bowel loops

A

Tympanic abdomen percussion means??

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87
Q

Could be cardiac or esophageal…needs more testing

A

Pt comes in w/ CP, given NTG & gets better. What was wrong?

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88
Q
  1. Carbonation - EZ gas2. IV glucagon - smooth muscle relaxer3. Acute endoscopy
A

Tx esophageal food bolus

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89
Q

Iatrogenic

A

MCC esophageal perforation?

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90
Q

Heard on heart ascultationDue to mediastinal emphysema

A

What is Hamman crunch & when is it seen?

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91
Q
  1. Pain acute, severe, diffuse, located in chest, neck, abd w/ radiation to back/shoulders2. Pain worse w/ swallowing3. HOTN4. Fever5. Abd rigidity6. Tachycardia, tachypnea CXR - mediastinal air, SQ emphysema, wide mediastinum, effusion
A

S/S esophageal perforation

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92
Q
  1. Chest CT/endoscopyTx 1. Shock resuscitation2. IV abx3. Surg. consult
A

Dx & Tx esophageal perforation

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93
Q
  1. Refusal to eat2. Inc. salivation3. Odynophagia4. Vomiting5. Choking6. Resp. Sx - stridor, cough, wheeze7. Neck or throat pain
A

S/S swallowed FB in kiddos

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94
Q

Distal to pylorus - d/c & wait to pass Obstruction? Emergent ednoscopy -button batters, perf, coin at cricopharyngeus muscle, >24h

A

Tx FB swallow

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95
Q

Can cause corrosion & perf…get XrayIf above pylorus - endoscopyIf passed - watch & f/u in 24h, repeat films in 48h

A

Swallowed button battery…what do you do??

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96
Q

Observe or whole bowel irrigationEndoscopy contraindicated - can rupture!

A

Tx body packers

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97
Q
  1. CXR - free air in 75%2. +/- CTTx 1. Labs - type & cross2. 2 large bore IVs3. O24. NG tube5. Broad spectrum abx6. Surg. consult
A

PUD Dx & Tx

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98
Q

PUD

A

MCC Upper GI bleed?

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99
Q
  1. PUD - epigastric pain, melena/hematemesis, stool +2. Variceal bleeding - painless, massive hematemesis, signs of chronic liver disease3. Mallory-weiss tear - Hx of forceful vomiting
A

Causes of upper GI bleeds

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100
Q
  1. 2 large bore IVs2. Transfusion of PRBCs3. PUD? IV PPI/H2 blocker4. +/- vasopressin 5. Mallory weiss tear? d/c after bleeding stops
A

Tx upper GI bleed

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101
Q

Viral gastroenteritis

A

MCC N/V?

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102
Q

Contains blood, mucus & pus

A

What is dysentery diarrhea?

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103
Q

Acute intestinal inflammation causing diarrhea w/ N/V

A

What is gastroenteritis?

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104
Q
  1. Salmonella2. Shigella3. Campylobacter4. Toxin producing E. coli
A

What should you suspect if you see systemic illness, fever & bloody stools?

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105
Q

BananasRiceApple sauceToastdiarrhea Pts

A

What is a BRAT diet & who should use it?

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106
Q

ex. LoperamideDon’t use w/ toxigenic gastroenteritis 1. Toxin producing E. coli2. Staph aureus3. Bacillus cereus4. C. diff

A

When should you avoid antidiarrheals?

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107
Q

No cramps, fever or fecal leukocytes Diarrhea goes away after meds stopped

A

S/S diarrhea caused by abx or other meds

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108
Q

VirusNorovirus

A

MCC infectious diarrhea

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109
Q

Clindamycinalso cephalosporings, PCN & fluoroquinolone

A

Which abx is most often assoc. w/ C. diff?

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110
Q

C. diff toxin in stoolColonoscopy? Yellowish plaques in lumenMild - monitorModerate - Flagyl for 10-14 daysSevere - hospitalize, Vanco PO x 10days

A

Dx & Tx C. diff

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111
Q

Feeling like you have to poop but your bowels are empty

A

What is tenesmus?

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112
Q

CT 1. Restore fluids & electrolytes2. NPO3. NG suction for obstruction, ileus, toxic megacolon4. Narcotics5. Abx

A

Dx & Tx Crohn’s & ulcerative colitis

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113
Q
  1. Antidiarrheals2. Hypokalemia3. Narcotics4. Cathartics 5. Pregnancy6. Enemas7. Recent colonoscopy Ulcerative colitis & Crohn’s at inc. risk
A

Causes of toxic megacolon

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114
Q

Adhesions from abdominal surgery2nd MCC? Incarceration of groin hernia

A

MCC small bowel obstruction??

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115
Q

CA2nd MCC? Diverticulitis

A

MCC large bowel obstruction?

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116
Q

Abd CT w/ contrast Xray - air fluid levels WBC >20k - gangrene, intra-abd abscess, peritonitisWBC >40k - mesenteric vasc. occlusion Inc. Hct, BUN & Cr - vol. depletion & dehydrationInc. urine spef. gravity, ketonuria, elevated lactate & met. acidosis - severe disease

A

Dx bowel obstruction

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117
Q
  1. Surg. consult2. NG tube if severe distention & vomiting 3. IVF
A

Tx bowel obstruction

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118
Q
  1. Closed-loop obstruction2. Bowel necrosis3. Cecal volvulus
A

Which types of bowel obstructions are surgical emergencies?

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119
Q
  1. IVF2. Observation
A

Tx adynamic ileus

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120
Q

aka Ogilvie syndrome Distention of colon but no obstruction Xray - dilated bowel w/o air fluid levels Risk factors - age, anticholinergics/TCAs, recent surg. Avoid barium studies Tx - colonoscopy or neostigmine infusion

A

What is pseudo-obstruction?

121
Q

Abd CT - inc. soft tissue density w/ pericolic fat, bowel wal lthickening 1. Supportive - bowel rest & IVF2. Cipro & Flagyl 3. Surgery if perforation, obstruction or abscess

A

Dx & Tx diverticulitis

122
Q
  1. LLQ pain 2. Fever3. N/V4. Anorexia5. Dysuria
A

S/S diverticulitis

123
Q

2 or +1. Straining at defecation at least 25% of time2. Hard stools at least 25% of time3. Incomplete evacuation at least 25% of time4.

A

Rome Criteria for Dx of constipation

124
Q

Acetaminophen overdose

A

MCC acute hepatitis?

125
Q

Spontaneous bacterial peritonitis leading to renal failure w/ hepatic failure1. More serious. Progressive oliguria & doubling serum Cr in 2wks 2. Gradual impairment of renal function that may or may not advance

A

Types of hepatorenal syndrome

126
Q

Accumulation of nitrogenous waste products cuz liver sucks1. General apathy2. Lethargy, drowsiness, variable orientation, asterixis3. Stuper w/ hyperreflexia, extensor plantar reflexes4. Coma

A

Stages of hepatic encephalopathy

127
Q

Hepatic encephalopathy & coagulopathyHOTN, hypoglycemia, adrenal insufficiency

A

Hallmarks of liver failure

128
Q

Lactulose

A

Tx hepatic encephalopathy

129
Q
  1. Intubation2. IVF3. Blood products4. Vasopressors PRN5. Mannitol if cerebral edema
A

Tx liver failure

130
Q

AST:ALT >2

A

Alcoholic LFT

131
Q

Hemolysis - elevated LFT - low plateletsOccurs w/ preeclampsia-eclampsia in late 3rd trimester or postpartum periodTx >34 - immediate delivery

A

HELLP syndrome

132
Q
  1. Cholelithiasis2. AlcoholOthers - trauma, infection, meds, hyperparathyroidism, hyperlipidemia
A

Causes of pancreatitis

133
Q
  1. N/V2. Epigastric pain radiates to back may be relieved by leaning forward3. Epigastric tenderness4. Diminished bowel sounds5. Fever6. Jaundice 7. Cullens/Turners sign if retroperitoneal hemorrhage
A

S/S pancreatitis

134
Q

Use Ranson’s criteria >31. Amylase2. Lipase** 3. Xray - ‘cutoff’ sign 4. US5. CT - best test, but not needed if no complications

A

Dx pancreatitis

135
Q
  1. NG suction2. Antiemetics3. IVF4. Foley cath to monitor fluids5. Analgesics6. +/- abx
A

Tx pancreatitis

136
Q

Forty FatFemaleFertileFlatulentFair

A

Risk factors for gall stones

137
Q
  1. RUQ pain radiate to scapula2. Post-prandial pain after eating fatty foods3. Murphy’s sign 4. +/- fever5. Jaundice
A

S/S cholecystitis

138
Q

Labs elevatedUS**1. NG suction2. Bowel rest3. IVF4. Surg. consult

A

Dx & Tx cholecytitis

139
Q
  1. RUQ pain2. Fever3. Chills & jaundiceSeen w/ ascending cholangitis Infection of biliary system from stone in bile duct Tx - same as cholecystitis but add abx
A

What is Charcot’s triad & when is it seen?

140
Q
  1. RUQ pain2. Fever & chills3. Jaundice4. AMS5. HOTN Tx - same as cholecystits but add abx
A

What is Reynold’s pentad & when is it seen?

141
Q

Fecalith

A

MCC appendicitis?

142
Q
  1. Gen. umbilical pain then localized to RLQ2. Anorexia3. N/V4. McBurney’s point5. Involuntary guarding & rebound tenderness 6. Rovsing’s sign 7. Psoas sign8. Obturator sign
A

S/S appendicitis

143
Q

All the dumb signs LabsCT w/ contrast1. NPO2. IVF3. Antiemetics + narcotics4. Abx5. Surgery

A

Dx & Tx appendicitis

144
Q

Appendicitis

A

MC surgical emergency in pregnant ladies?

145
Q

AlcoholEndocrine & EnvironmentalInsulin & impaired glucose utilization***Ox deprivation & opiate ODUremiaTraumaInfectionPsychiatric causes & porphyriaSpace occupying lesions - inc. pressure on RAS

A

Causes of AMS & Coma

146
Q

Temporal lobe herniation on same side or if alert - could be from drops or compression of CN III

A

Causes of fixed dilated pupil

147
Q

COPSClonidineCholinergicsOpiatesOrganophosphatesPhenothiazinesPontine hemorrhageSedative hypnoticsSleep

A

Causes of miosis

148
Q
  1. Anticholinergics2. Sympathomimetics
A

Causes of mydriasis

149
Q

Crescendo-decrescendo pattern1. Bilat hemisphere dysfunction, intact brain stem2. Metabolic disorder2. Transtentorial herniation

A

Causes of Cheyne-Stokes respirations

150
Q

Prolonged pause after inspiration -pontine infarct

A

Causes of apneustic breathing

151
Q
  1. Met. acidosis2. Salicylate OD3. Hypoxia4. Hypercarbia
A

Causes of hyperventilation

152
Q
  1. Lack of focal exam findings2. Pupillary response usually preserved
A

S/S toxic-metabolic coma

153
Q
  1. Progressive hemiparesis2. Asymmetric strength & reflexes Ex. Uncal herniation Also see w/ inc. ICP - HTN & bradycardia = Cushing’s triad
A

S/S supratentorial lesion coma

154
Q

Cerebellar hemorrhage or infarction may cause coma1. Abnormal extensor posturing2. Loss of pupillary reflexes3. Loss of EOMEx. pontine hemorrhage - pinpoint pupils

A

S/S infratentorial lesions - posterior fossa coma

155
Q

Pupillary responses, EOM, muscle tone & reflexes normal

A

S/S pseudocoma

156
Q

Hx - look for reversible causes If on meds that can check levels - check it!CTTx - ABCs

A

Dx & Tx coma

157
Q

Occipitonuchal

A

MC location of SAH HA?

158
Q

Temporal arteritis

A

Jaw claudication w/ HA?

159
Q

Sinusitis

A

Facial painw/ HA?

160
Q

Glaucoma

A

Vision change & eye pain w/ HA?

161
Q

PulsatileDuration of 4-72hUnilatN/VDisabling intensityif 4/5 - most likely migraine

A

POUNDing approach to HA

162
Q
  1. Meningitis2. Sinusitis3. SAH
A

HA w/ fever?

163
Q
  1. Toxoplasmosis2. CNS lymphoma>3days? Higher risk of AMS & new seizure
A

Causes of HA w/ HIV?

164
Q

SAHCT w/o contrast or CT angioLP if no Dx1. LOC2. Seizure3. Diplopia4. Other neuro signsExercise, intercourse or defecation sets it offMCC ruptured aneurysm

A

Thunderclap HA?

165
Q
  1. Control BP, pain & nausea2. Prevent vasospasm w/ Nimodipine3. Refer to surg.
A

Tx SAH

166
Q

Remote trauma w/ HA1. Anticoagulants2. Chronic alcohol abuse3. Old peopleGet noncontrast CT

A

Risk factors of subdural hematoma

167
Q
  1. HA2. Vomiting3. SeizuresCommon w/ hypercoagulable state, OCs, postpartum/postopNeed magnetic resonance venogram
A

S/S Cerebral venous thrombosis

168
Q
  1. HA - severe & throbbing over frontotemporal area2. Jaw claudication3. Hx of polymyalgia rheumatica4. +/- loss of vision 5. High ESR Tx - prednisone
A

S/S & Tx temporal arteritis

169
Q
  1. Young Pt w/ chronic Has2. N/V3. Visual problems4. Papilledema5. Normal CT6. Elevated CSF pressureTx - Acetazolamide
A

S/S & Tx pseudotumor cerebri

170
Q
  1. Unilat neck pain or HA usually by eye/frontal areaDx - angiography
A

S/S internal carotid dissection & Dx

171
Q

Occipital or posterior neck pain Dx - angiography

A

S/S & Dx vertebral artery dissection

172
Q
  1. DHE - don’t use in pregnancy, uncontrolled HTN, CAD, causes N/V2. Triptans3. Metoclopramide, prochlorperazine - dystonic rxns4. Ketorolac5. Narcotics6. Dexamethasone
A

Tx migraine

173
Q
  1. Bilat, nonpulsating2. Not worsened by exertion3. No N/VSevere HAs may cause N/VTx - NSAIDs/analgesics
A

S/S & Tx tension HA

174
Q
  1. Rare, short lived, MC men >202. Severe unilat orbital, supraorbital or temporal pain lasting 15-180mins3. Pacing & restless4. Conjunctival injection, lacrimation, nasal congestion, rhinorrhea, facial swelling, miosis, ptosisTx1. Oxygen2. DHE3. Triptans4. Analgesics
A

S/S & Tx cluster HAs

175
Q

CarbamazepineMC in women

A

Tx Trigeminal neuralgia

176
Q

CVA

A

MCC disability?

177
Q
  1. Thrombotic2. Embolic3. Hypoperfusion
A

Types of ischemic stroke

178
Q

Watershed areas - periphery of major vessels

A

Main areas affected by hypoperfusion ischemic stroke?

179
Q

Chronic HTNMC in Asians & Blacks

A

MCC intracerebral hemorrhagic stroke?

180
Q

MC type1. Contralat hemiparesis2. Facial plegia3. Sensory loss4. Homonymous hemianopsia & gaze preference toward side of infarct5. Face & upper extremities affected more than lower

A

S/S middle cerebral artery stroke

181
Q
  1. Contralat sensory & motor Sx in lower extremity, sparing hands & face2. +/- aphasia neglect3. +/- incontinence
A

S/S anterior cerebral artery stroke

182
Q
  1. Unilat HA2. Contralat homonymous hemianopsia 3. Unilat cortical blindness
A

S/S Posterior cerebral artery stroke

183
Q
  1. Vertigo - w/ cerebellar or brainstem signs2. HA3. Nausea4. Visual disturbances5. Oculomotor palsies6. Ataxia7. Sensory disturbance8. Bilat limb weakness
A

S/S Vertebrobasilar stroke

184
Q
  1. Vertigo2. Gait instability3. Ataxia4. Dysarthria5. N/V6. Cranial nerve abnormalities
A

S/S cerebellar stroke

185
Q

Assoc. w/ HTNInvolve basal ganglia, internal capsule, thalamus & brainstem1. Pure motor deficit of face, arm & leg2. May be subclinicalBetter prognosis

A

S/S lacunar stroke

186
Q

CT w/o contrast May get other tests to see where emboli came from1. If no thrombolytics & has HTN - lower if >220/1202. If getting thrombolytics - lower to

A

Dx & Tx ischemic stroke

187
Q
  1. Aspirin +/- Clopidogrel
A

Tx TIA

188
Q

MRI/MRA & CT/CTATx - heparin then Coumadin

A

Dx & Tx cervical artery dissection

189
Q

Systemic1. Intoxication - ethanol, sedative hypnotics, phenytoin, carbamazepine, valproic acid2. HyponatremiaNervous system3. Cerebellum - hemorrhage, infarct4. Cortex - tumor, hemorrhage, trauma, hydrocephalus5. Subcortical - infarct, Parkinson’s6. Spinal cord - cervical spondylosis7. Peripheral nervous system - neuropathy

A

Causes of ataxia

190
Q

Sensory ataxia w/ problem in posterior column, vestibular dysfunction or peripheral neuropathyAtaxia w/ - Rhomberg?Motor ataxia w/ problem in cerebellum

A

NAME?

191
Q

Loss of proprioceptionAbrupt mvmt of legs & slapping of feel w/ each step

A

S/S Sensory ataxia

192
Q

Lost ability to initiate walkingSeen w/ nondominant hemispheric lesions

A

Apraxic gait?

193
Q

Narrow based shuffling stepsSeen w/ Parkinson’s

A

Festinating gait?

194
Q

Perception of mvmt when none exists

A

What is vertigo?

195
Q
  1. Vestibular neuritis2. Labyrinthitis3. Meniere’s disease4. Benign paroxysmal positional vertigo5. Drug induced vertigo
A

Causes of peripheral vertigo

196
Q
  1. Acoustic schwannoma or meningioma2. Cerebellar pontine angle tumors3. Cerebellar infarct4. Cerebellar hemorrhage5. Vertebrobasilar insufficiency
A

Causes of central vertigo

197
Q

Benign paroxysmal positional vertigo Do Dix-Hallpike Maneuver - Nystagmus toward affected ear for 10-40 secs

A

MCC vertigo in old people?

198
Q

Peripheral1. Hydration2. Antihistamines3. Anticholinergics4. Antiemetics5. Benzos6. ReassuranceCentralRefer to neuro!

A

Tx vertigo

199
Q

IV magnesiumDefinitive Tx - deliveryPregnant >20wks, HTN, edema & proteinuria

A

Tx seizures in pregnant eclampsia Pt?

200
Q

Neuro!

A

Tx peripheral neuropathies

201
Q

Sx w/in 48h of ingestion of tainted food/wound infections/IVDU1. N/V/D2. Abd cramps3. Descending symmetric paralysis - CN & bulbar muscles affected first 4. Diplopia, dysarthria, dysphagia5. Pupils dilated & nonreactive

A

S/S botulism

202
Q
  1. Constipation2. Poor feeding3. Lethargy4. Weak cry5. “Floppy infant”
A

S/S botulism in baby

203
Q
  1. Supportive2. Botulinum antitoxin
A

Tx botulism

204
Q

Sx 2-6 days after tickAtaxia of LE then UE then resp. failureTx - remove tick

A

Tick paralysis S/S & Tx

205
Q

Peripheral nerve myelin sheath destructionSubacute ascending symmetric weakness or paralysis & loss of DTRs, watch resp. functionTx - IVIG & plasmapharesis

A

Giullan-barre syndrome

206
Q

Skeletal muscle injury causing release of cell contents into plasmaInc. PCKUrine dipstick +blood - microscopic myoglobinTx - Tx cause1. Hydration2. Alkalinization of urine >6

A

Rhabdomyolysis

207
Q

Extreme weakness w/ resp. failure May be triggered by infection, surgery or tapering meds Give Neostigmine

A

Myasthenia crisis

208
Q

Side effect of too much meds Worsens w/ Edrophonium May need intubation & mgmt of secretions & bronchospasmTx - Atropine

A

Cholingergic crisis

209
Q

Hyperthermia, rigidity, AMS, fever 1. Dopamine antagonistsProlixin, Haldol, Regla, Clozapine 2. W/D dopamine agonistL-dopa, Bromocriptine, Amantadine3. Dopamine depletionXenazine Elevated CK, leukocytosisTx 1. Cooling2. Fluids & alkaline diuresis to Tx rhabdo3. Dantrolene, Bromocriptine, Nondepolarizing NMB, Nipride

A

Causes of neuroleptic malignant syndrome

210
Q

Hemorrhoids

A

MCC rectal bleeding?

211
Q
  1. Manual reduction if nonthrombosed, sitz-baths 2. Topical analgesics & steroids 3. Bulk laxatives/stool softeners, high fiber diet, fluidsThrombosed internal - surgeryThrombosed external - cut it out
A

Tx hemorrhoids

212
Q

Posterior or anterior midlineAny other area suggestive of Crohn’s, ulcerative colitis, carcinoma, infection Usually due to passage of large hard stool or frequent diarrhea, consider child abuse

A

Location of anal fissures

213
Q
  1. Constant throbbing pain, worse w/ BMs2. Purulent d/c3. Polymicrobial Tx1. I&D 2. +/- abx
A

S/S & Tx anorectal abscesses

214
Q
  1. Rectal mucosa only2. All layers3. Intussusception of upper rectum through the lower Tx1. Reduce w/ analgesia & sedation2. Can’t do it? Surg.
A

Types of rectal prolapse & Tx

215
Q
  1. Diverticular disease2. Colitis3. Polyps4. CA
A

MCC lower GI bleeds

216
Q

Ischemic colitis

A

MCC intestinal ischemia?

217
Q

Indirect inguinal hernia Get US

A

MC type of hernia?

218
Q

Acute onset of periumbilical pain out of proportion to physical findingsDx - CT angioTx - IVF, surg consult

A

S/S, Dx & Tx mesenteric ischemia

219
Q

Eye trauma

A

MCC blindness in kids?

220
Q

From blunt force trauma 1. Diplopia2. Periorbital ecchymosis & edema3. Anesthesia of maxillary teeth & upper lip4. Step off deformity over infraorbital ridge5. Orbital crepitus6. Xray - teardrop sogm Dx - CTTx - Surgery

A

S/S, Dx & Tx blowout Fx

221
Q

GonococcalTx 1. Lavage mucus2. Ceftriaxone or Azithromycin

A

Severe conjunctivitis in 12-24h?

222
Q

Chlamydia conjuncitivitsTx1. Tetracycline, doxy, erythromycin, azithrymycin2. +/- topical abx

A

Tarsal/bulbar conjunctival inclusion follicles?

223
Q

Viral conjunctivitisTx1. Artificial tears2. Cool compressesHerpes? Use acyclovir

A

Subconjunctival hemorrhages w/ itchy, tearing eyes?

224
Q

Broad spectrum abxSulfonamides, tetracycline, erythromycin

A

Tx bacterial conjunctivitis

225
Q
  1. Topical antihistamines2. Short course of topical steroids
A

Tx allergic conjunctivitis

226
Q
  1. Fluorescein eye drops 2. Slit lamp for intraocular FBTx1. Cotton tip2. 25 guage needle3. Topical abx - Tobramycin, polymyxin-bacitracin ointment, erythromycin ointmentContacts? Need Cipro4. NSAID Diclofenac or Mydriacyl5. Anesthetic eye drop
A

Dx & Tx corneal abrasion

227
Q

All normal eye complaints +1. Cells in flare in anterior chamber2. Ciliary flush3. Keratic precipitates 4. Unilat/bilat5. Adhesions to the iris (posterior synchiae)6. Brow ache/HA

A

S/S iritis

228
Q
  1. Cycloplegics - homoatropine or atropine drops2. Prednisilone acetate3. Refer to ophthamologist
A

Tx iritis

229
Q
  1. Fluorescein eye drops2. Culture - bacterial & viralIf non infectious? Look at rheumatoid arthritisTx1. Gentamicin or CefazolinContacts? Cipro2. Cycloplegic eye drops3. Refer
A

Dx & Tx corneal ulcer

230
Q

Pseudomonas Staph is also common

A

Corneal ulcer w/ contacts - what’s the bacteria?

231
Q
  1. Sulfa drugs2. OTC decongestants3. Motion sickness meds4. Adrenergic agents5. Antipsychs6. Antidepressants7. Anticholinergics
A

Causes of angle closure glaucoma

232
Q

All other eye complaints:1. Halos around lights2. Pain ppt by dark conditions*3. Elevated IOP - maybe >60 4. Steamy cornal edema5. Mid dilated fixed pupil6. Shallow anterior chamber

A

S/S Angle closure glaucoma

233
Q

Reduce IOP & break angle closure 1. Beta-adrenergic drops2. Topical steroid drops3. Alpha-adrenergic agonists4. Carbonic anhydrase inhibitor acetazolamide5. Hyperosmotic agents if IOP very high 6. Laser peripheral iridotomy to relieve pressureEMERGENCY!

A

Tx angle closure glaucoma

234
Q

From Topiramate/sulfa use1. D/c med2. Cycloplegia - atropine3. IV hyperosmotic agents4. IV steroids 5. Refer

A

Tx secondary angle closure glaucoma

235
Q

Anterior aspect of the ciliary body

A

MC site of bleeding for hyphema?

236
Q

Hx of trauma1. Blood/clot in anterior chamber2. R/o ruptured globe3. Measure IOPTx1. Acetaminophen2. Bed rest/limited activity3. Elevate head 4. Eye shield 5. Atropine6. Refer

A

Dx & Tx hyphema

237
Q
  1. Hx sinus infection/surgery/insect bid/stye chalazion/infection2. CT w/ contrast Tx1. Nasal decongestants & vasoconstrictors to drain sinuses2. Augmentin/Ceftriaxone3. I&D of abscessImmunosuppressed? Antifungal - Amphotericin-B
A

Dx & Tx orbital cellulitis

238
Q
  1. CT scan/MRITx 1. Antihistamines2. Cool compresses - insect bite3. Amoxicillin
A

Dx & Tx preseptal cellulitis

239
Q

22-Oct

A

What is normal eye pressure?

240
Q
  1. Painless, acute vision loss (over seconds)2. Cherry red fovea3. Causes irreversible cell injury in 100min 4. HA, wt loss, jaw claudication, scalp tenderness, fever, proximal joint pain5. Hx Afib, endocarditis, coagulopathies, atherosclerotic disease6. Fell asleep on eye
A

S/S retinal artery occlusion

241
Q
  1. Whitening of retina on posterior pole2. Cherry red spot macula3. + APD4. Narrowed retinal arterioles5. Boxcarring/segmentation of blood columns in arterioles 6. Find out where emboli came from
A

Dx retinal artery occlusion

242
Q
  1. Ocular massage w/ firm pressure 2. Anterior chamber paracentesis3. IOP reduction - Acetazolamide/topical beta-blockers4. Hypervent. to induce resp. acidosis & vasodilationMust be done 90-120min after eventREFER
A

Tx retinal artery occlusion

243
Q

Retinal artery occlusion

A

Cherry red macula?

244
Q
  1. Topical anesthesia2. Irrigation - check pH3. Artificial tears4. Bandage contact lens5. Amniotic membrane transplant 6. Topical steroids7. Abx eye drops8. IOP>30 needs Tx9. Cycloplegics for pain
A

Tx chemical burns

245
Q

Inflammation of the cornea Infection/dry eyes/contacts/injury/Vit A deficiency

A

What is keratitis?

246
Q
  1. Unlat2. Mild conjunctival injection3. Epithelial dendrites4. Stromal scarring & vascularization w/ advanced diseaseTx - 1. Cycloplegic2. Trifluridine3. Acyclovir
A

S/S & Tx herpes simplex keratitis

247
Q
  1. Vesicular rash of CN 52. Hutchinson’s sign - lesion on tip of nose3. Conjunctivitis4. Uveitis5. Glaucoma6. ScleritisTx1. Acyclovir2. Tears
A

S/S & Tx herpes zoster ophthalmicus

248
Q
  1. Conjunctival injection2. Epithelial defect3. Stromal infiltration4. Gray-white color & rough corneal surface5. Irregular feathery edge infiltrates6. White ring on corneaMay develop ulcerDx - corneal scrapings, gram & giemsa stain Tx1. Natamycin or Amphotericin B2. Cycloplegics
A

S/S & Dx & Tx Fusarium fungal keratitis

249
Q
  1. Conjunctival hyperemia2. Folds in Descemet’s membrane3. Upper eyelid edema4. Posterior synchiae5. Focal/diffuse corneal edema6. Mucopurulent exudateDx - corneal scraping on chocolate, blood & Sabouraud agarSmears for gram, giemsa & AF stain Tx 1. Tobramycin alternateing w/ Cefazolin
A

S/S & Dx & Tx bacterial keratitis

250
Q
  1. Conjunctival hyperemia2. Corneal ulcer3. Lid edema4. Corneal ring stromal infiltrate5. Inc. IOP6. Hypoyn7. CataractDx - Corneal scraping on non-nutrient agar Smears for gram, giemsa & calcofluor white stain (+cysts)Tx 1. Polyhexamethyl biguanide2. Propamidine isethionate3. Itraconazole4. D/c contacts 5. Cycloplegics
A

S/S & Dx & Tx Acanthameoba keratitis

251
Q
  1. Hyperemia2. Mucus3. High tear lakes from reflex tearing4. Low tear lakes5. EpiphoriaDx - measure tear breakup timemeasure tear production - Schirmer tear test Tx 1. Artificial tears2. Lubricating ointment at bedtime3. Restasis4. Punctal plugs
A

S/S & Dx & Tx Keratitis sicca

252
Q
  1. +APD2. Visual field loss3. Pale swollen disc +/- flame hemorrhages4. Tender palpable temporal artery5. Central retinal artery occlusion6. Cranial nerve palsy7. Scalp necrosis
A

S/S temporal arteritis

253
Q

BxTx - 1. Prednisone

A

Dx & Tx temporal arteritis

254
Q

Superior temporal

A

Which quadrant of the retina is the MC site of retinal detachment?

255
Q

IgE dependentAnaphylactoid - does not require sensitizing exposureTypical rxn & HOTN1. ABCs2. Epi3. IVF4. Steroids IV, antihistamines, albuterol, glucagon

A

Anaphylaxis

256
Q
  1. Antihistamines (H1 +/- H2)2. +/- steroids If severe - epi
A

Tx urticaria

257
Q
  1. Stop ACEiNot great but use:Epi, antihistamines & steroidsHereditary? C1 esterase inhibitor or FFP
A

Tx angioedema

258
Q

May not respond to epi so give glucagon

A

What to give in anaphylaxis on beta-blockers?

259
Q

Usually >50 Only 1/3 w/ known CA Hx1. Unremitting pain2. Night pain3. Wt loss

A

S/S back pain due to cancer

260
Q

NAME?

A

Straight leg raise

261
Q
  1. Pain2. Neuro deficits - urinary incontinence, perianal sensory loss 3. Sciatica4. Urinary retention5. Weak/stiff lower extremities6. Paresthesias7. Abnl straight leg raise Give Dexamethasone before MRI
A

S/S cauda equina

262
Q

Sx >3mo1. Fever2. TTP3. Inc. ESR, NL WBCXray NL until bone demineralizes Consult surg before abx

A

S/S Vertebral osteomyelitis

263
Q
  1. Constant back pain, awaken at night - not relieved by rest/meds2. +/- fever3. +/- neuro deficits4. ESR inc. +/- inc. WBC
A

S/S discitis

264
Q
  1. Pain, fever, neuro deficits2. Localized pain then radicular then neuro deficits then paralysis 3. Xrays NL GET MRI - emergent Surg.
A

S/S spinal epidural abscess

265
Q

Salmonella - vanco + cipro

A

Sickle cell Pt w/ septic arthritis..what’s the bacteria & Tx?

266
Q

3rd gen cephalosporinTx if suspected before cultures come back

A

Tx gonococcal septic arthritis

267
Q

Vanco + CeftriaxoneRefer

A

Tx nongonoccocal septic arthritis

268
Q

uric acid - gout

A

Negative birefrigence crystals on joint aspiration?

269
Q

calcium pyrophosphate - pseudogout

A

Positive birefrigence crystals on joint aspiration?

270
Q
  1. NSAIDs2. Colchicien3. Prednisone if not workingRenal failure? narcotics
A

Tx gout & pseudogout

271
Q

Mono/oligoarticular Larger joints more - may be migratoryDoxy, Pen G, amoxicillin, Ceftriaxone

A

Lyme septic arthritis?

272
Q

Prepatellar or olecranon bursa

A

MC locations of bursitis

273
Q

PasturellaAugmentin or moxiflocin

A

Tx dog/cat bite

274
Q

Kanavel 4 cardinal signs1. Percussion tenderness over flexor tendon sheath2. Uniform swelling3. Intense pain w/ passive extension4. Flexion posture Surgical emergency - staph MC Tx 1. Augmentin2. Immobilize & elevate

A

Flexor tenosynovitis

275
Q

No mammary glandsGive acyclovir - immobilize & elevate

A

Do you drain herpetic whitlows?

276
Q

DeQuervian tenosynovitis extensor pollicis brevis & abductor pollicis tendons Immobilize, ROM exercises, NSAIDs

A

FInkelstein?

277
Q

NSAIDs

A

Tx ganglion cysts

278
Q
  1. URI2. Fever3. HA4. Hematuria5. Diarrhea6. Arthralgias7. Rash - bullae on skin & mucus membranes, ulcers on cornea & stoma, vesicles that ruptureTx the cause, +/- steroids
A

S/S SJS

279
Q

1-2 wk prodome1. Fever2. Malaise3. Arthralgias4. URI5. Skin tenderness, tingling/burning6. Erythema intially on face & genitals becoming generalized & tender & confluent rapidly then bullae7. Nikolsky sign Tx1. Hospitalize in ICU/burn unit2. ABCs3. Elecrolyte & fluid replacement4. Debridement & dressing

A

S/S & Tx Toxic epidermal necrolysis

280
Q

Common in kids <6 1. Painful erythema & blistering of skin w/ fever2. NO mucus membrane involvement3. + Nikolsky sign Skin Bx, cultures on skin, throat & bloodTx - IVF & abx

A

S/S Dx & Tx Staphylococcal scalded skin syndrome

281
Q

Herpes Zoster of CN VII - vesicles in ear canal/pinnaHearing loss, facial paralysis, loss of taste

A

What is Ramsey Hunt syndrome?

282
Q

Poison ivy, oak, sumac1. Antihistamines2. Oatmeal baths3. Topical steroids 4. Prednisone

A

Tx Rhus Dermatitis

283
Q
  1. Pharyngitis, meningitis, bacteremia2. HA, fever, AMS, N/V, myalgias, stiff neck 3. Rash - petechiae, hemorrhagic vesicles Pt in shock & can develop DICTx - abx ASAP - Ceftriaxone
A

S/S & Tx meningococcemia

284
Q

Old people - usually from steroids, infection, dehydration/thromboembolismVesicles or bullae that vary in size, blisters clear & tense then become flaccid & burst+ NikoslkyTx1. Admit2. IVF & electrolytes3. Steroids4. Immunosuppressants - Azathioprine5. Plasmapheresis6. IVIG

A

Pemphigus vulgaris & Tx

285
Q

Only give abx if contaminated 1. Polymyxin B2. Ciprodex3. Floxin

A

TM rupture

286
Q

Abscess of submaxillary, sulingual & submental spaces w/ tongue elevation, usually due to lower 2nd & 3rd molars1. Jaw swelling2. Stiff tongue3. Trismus4. Fever, chills5. Difficulty swallowingDx - CTTx - ABCs, IV abx (PCN + Flagyl), OR for drainage

A

Ludwig’s angina

287
Q

2-3 days post extraction - Severe pain d/t clot displacement of dissolvingLocal/topical anesthesia, irrigate, suction fluid, pack Abx - dental referral

A

Dry socket

288
Q

Sepsis & cardiopulm failure

A

MCC death assoc. w/ ARF?

289
Q

Labs + Renal USAvoid contrast dyes

A

Dx ARF

290
Q

Color doppler USAspiration of dark intracevernosal blood from copusTx - Terbutaline SQ in deltoid Corporal aspiration followed by irrigationSurgery

A

Dx & Tx Priapism

291
Q

PCP

A

MC opportunistic infection in AIDS?

292
Q

Strep pneumoniae

A

MCC PNA AIDS Pts?

293
Q

<500

A

Pt is on AZT, what should you suspect their CD4 count to be?

294
Q

Hips & knees flex when you flex neckSign of meningitis

A

What is Brudzinski sign?

295
Q

Hamstrings contract when knee extended w/ hip flexedSign of meningitis

A

What is Kernig sign?

296
Q

Strep pneumoalso N. meningitidis & Listeria Tx - Ceftriaxone/Cefotaxime

A

MC bacterial cause of meningitis?

297
Q
  1. Arbovirus2. HSV3. HZV4. CMV
A

Causes of encephalitis?

298
Q

Brain abscess

A

Ring of enhancement on CT?

299
Q

Brain BxTx - Rabies IVIG & vaccine

A

Dx rabies

Emergency Medicine (5 decks)

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