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EORs > Family Med EOR > Flashcards

Family Med EOR Flashcards

1
Q

MC org endocarditis

A
  • Native value infection: strep viridian’s (staph aureus and enterococci)
  • IVDU: S. aureus (tricuspid valve)
  • Prosthetic valve: s. aureus
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2
Q

Endocarditis treatment

A
  • empiric
  • native valve: vanc +/- cefazolin
  • Ill with HF: gentamicin + cefepime + vanc
  • Valve replacement if refractory or abscess
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3
Q

Endocarditis prophylaxis

A
  • before invasive dental work
  • If have prosthetic valve or congenital heart defect with prosthetic material or device, hx of previous endocarditis, unprepared cyanotic congenital heart disease, cardiac transplant with valve regurg
  • amoxicillin (clarithromycin or azithromycin)
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4
Q

Endocarditis

  • criteria for dx name
  • criteria
A
  • Duke Criteria

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

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5
Q

Endocarditis

Major criteria

A
  • two + blood cultures with typical org

- echo with new valvular regurgitation

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6
Q

Endocarditis

minor criteria

A
  • predisposing factor
  • Fever >100.4 (38)
  • vascular phenomena (embolic dz or pulmonary infarct)
  • Immunologic phenomena (glomerulonephritis, osler node, roth spot)
    • blood culture not meeting major criteria
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7
Q

First line BB therapy for CVD

A

AM

Atenolol and metoprolol

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8
Q

Nitrates

  • special dx instructions
  • effect
A
  • must have 8-10 hour treatment free interval to avoid tachyphylaxis
  • reduces preload and afterload and myocardial O2 demand via dilation of coronary arteries and increased supply of blood
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9
Q

CCB in CVD

- effect

A
  • coronary vasodilation and after load reduction
  • reduces contractility
  • 2nd line to BB and NTG
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10
Q

FEV1/FVC

  • obstructive
  • restrictive
A
  • obstructive: reduced ratio dt reduced FEV1

- restrictive: normal ratio with reduced FEV1 and FVC

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11
Q

how should asthma spirometry respond to albulterol

A

FEV1 or FVC increase > 12%

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12
Q

What type of med should be avoided in asthmatics

A

beta blockers

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13
Q

Asthma

  • CXR
  • ABG
A
  • hyperinflation

- hypocarbia: have increased respiratory rate. If normal or high, may be sign of impending respiratory failure

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14
Q

Intermittent Asthma

  • daytime sx
  • nighttime sx
  • interference with activities
  • SABA use
  • FEV1
  • exacerbations c steroids
A
  • ≤ 2 days/week
  • ≤ 2 times a month
  • no interference
  • ≤ 2 times a week
  • FEV1 >80% predicted
  • 0-1 exacerbations
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15
Q

Mild persistent asthma

  • daytime sx
  • nighttime sx
  • interference with activities
  • SABA use
  • FEV1
  • exacerbations c steroids
A
  • > 2 days/week, not daily
  • 3-4 times a month
  • minor
  • many but not all days
  • FEV1 >80% predicted
  • > 2 times a year
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16
Q

moderate persistent asthma

  • daytime sx
  • nighttime sx
  • interference with activities
  • SABA use
  • FEV1
  • exacerbations c steroids
A
  • daily
  • > once a week, not nightly
  • Some interference
  • Daily
  • FEV1 60-80% predicted
  • multiple
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17
Q

severe persistent asthma

  • daytime sx
  • nighttime sx
  • interference with activities
  • SABA use
  • FEV1
  • exacerbations c steroids
A
  • multiple times daily
  • daily
  • extremely limited
  • several times a day
  • FEV1 < 60% predicted
  • multiple
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18
Q

Asthma therapy steps

A

Step 1: SABA

*steps 2-6 SABA plus…

Step 2: Low dose ICS

Step 3: medium dose ICS OR low dose ICS + LABA/montelukast/theophylline

Step 4: medium dose ICS + LABA/montelukast/theophylline

Step 5: high dose ICS + LABA +/- omelizumab

Step 6: high dose ICS + LABA + oral steroid =/- omelizumab

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19
Q

COPD

- MC cause of exacerbations

A
  • infection
  • noncompliance
  • cardiac disease
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20
Q

COPD

- overview of treatment meds

A
  • Beta agonist and anticholinergic
  • +/- ICS
  • theophylline for refractory disease (less effective and more ADR vs. inhaled bronchodilators)
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21
Q

Ipatroprium bromide

  • brand
  • type of med
A
  • atrovent

- anti-muscarinic inhaled: antagonists M1 and M3 to prevent bronchoconstriction

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22
Q

SABA example brand and generic

A
  • Albuterol / proventil HFA

- Levalbuterol / Xopenex HFA

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23
Q

How are LABAs used differently in asthma and COPD

A
  • Asthma ALWAYS used with a ICS, never used alone (step 3 and above)
  • COPD used with a SABA in all but the most mild cases
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24
Q

LABA example brand and generic

A
  • Salmeterol / Serevent diskus
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25
Q

SAMA example brand and generic

A

ipatroprium / atrovent

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26
Q

LAMA example brand and generic

A

tiotroprium / spiriva

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27
Q

ICS two examples brand/generic

A
  • Fluticasone / flovent

- budensonide / pulmicort

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28
Q

2 Combo ICS and LABA that are common

A
  • fluticasone + salmeterol (Advair)

- budensonide + formoterol (Symbicort)

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29
Q

biologic used in asthma

A

omalizumab (Xolair) vs. IgE

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30
Q

COPD pharm based on GOLD

A

I: SAMA and/or SABA PRN
II: SABA PRN + LAMA or LABA
III: SABA PRN + LABA/ICS or LAMA
IV: same as III?

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31
Q

Definition of CAP timing vs. HAP timing

A
  • CAP: Outside hospital OR within 48 hours of hospital admission (pt does not live in long term care facility)
  • HAP: occurs more than 48 hours after hospital or other health care facility admission
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32
Q

CAP S/Sx

A
  • fever
  • cough +/- sputum
  • SOB on exertion
  • sweats, chills, rigors, chest discomfort, pleurisy, myalgias, HA, abd pain
  • tachypnea and tachycardia
  • O2 desat
  • inspiratory crackles and bronchial breath sounds
  • dullness to percussion
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33
Q

CAP

- CXR findings

A
  • patchy airspace opacities to lobar consolidation with air bronchograms
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34
Q

Pneumonia vaccinations

A
  • Prevnar 13 and Pneumovax 23

≥ 65
- Prevnar 13 then pneumovax 23 in one year

  • Received pneumovax 23 before 65, wait one year and then give prevnar 13, then wait one year and give pneumovax 23 again
  • Received pneumovax 23 at or after 65, wait one year and then give prevnar 13

19-64 with underlying conditions:

  • smoker, chronic illness, long-term facility living : pneumovax 23
  • immunocompromised: prevnar 13, 8 weeks then pneumovax 23, 5 years then pneumovax 23
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35
Q

MC pathogen

  • CAP
  • HAP
  • VAP
A
  • CAP: s. pneumoniae
  • HAP: s. aureus (MSSA and MRSA), pseudomonas
  • VAP: acinetobacter, stenotrophomonas maltophilia
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36
Q

What is the most common opportunistic infection in HIV patients?

A

pneumocystis jirovecii (pneumonia)

  • fever, sob, cough
  • CXR: perihilar infiltrates, reticular interstitial pneumonia
  • sputum: wright-giemsa stain or DFA
  • CD4 < 200 if AIDS
  • Bactrim
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37
Q

CAP treatment

A

KNOW charts

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38
Q

when to admit CAP

A

CURB 65 score:

  • confusion
  • uremia
  • respiratory rate
  • blood pressure
  • > 65 yo

<1: no hosp
1-2: hosp
3+: ICU

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39
Q

TB

  • mc org
  • transmission
  • s/sx
  • CXR
A
  • mycobacterium tuberculosis (acid fast bacilli)
  • aerosolized droplets
  • fatigue, weight loss, fever, night sweats, productive cough
  • CXR: caseating granuloma formation, pulmonary opacities (MC apical)
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40
Q

PPD results

A

Positive:

  • induration >15 mm and no risk factors
  • induration >10 mm and high risk (high prevalence area, homeless, immigrant in 5 years, prisoner, health care, nursing home, contact, etoh, DM)
  • induration >5 mm and very high risk (HIV, steroid, organ transplant, TB contact, CXR with cavitation)
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41
Q

TB treatment

- latent

A

(negative CXR, sputum, or both)

9 months INH

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42
Q

TB Treatment

- active

A
  • droplet precautions until sputum negative AFB
  • 2 months 4 drug RIFE tx then 4 months INH and rifampin
  • if isolate is INH and rifampin sensitive, can use 2 drug regimen
  • treat 3 months past negative culture
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43
Q

Small cell lung cancer

- s/sx

A
  • recurrent pneumonia
  • anorexia, weight loss
  • weakness
  • cough
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44
Q

Small cell lung cnacer

- associated sx

A
  • superior vena cava syndrome - obstruction by mediastinal tumor
  • phrenic nerve palsy: hemidiaphragmatic paralysis
  • recurrent laryngeal nerve palsy: hoarse
  • Horner sx: anhidrosis, ptosis, mitosis
  • pleural effusion
  • Eaton-Lamber sx: similar to myasthenia gravis
  • digital clubbing
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45
Q

Small cell lung cancer

- dx

A
  • definitive treatment: tissue bx
  • CXR for dx (NOT for screening)
  • CT w/ contrast to stage
  • sputum cytology to dx central tumors
  • PET scan
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46
Q

Small cell lung cancer

- tx

A
  • limited: chemo and radiation

- extensive: chemo only, radiation of responsive to chemo

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47
Q

small cell lung caner

- prognosis

A
  • limited: 10-13% 5y

- extensive: 1-3% 5y

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48
Q

non-small cell lung cancer

- etiology

A

squamous cell carcinoma MC

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49
Q

non-small cell lung cancer

- s/sx

A
  • Airway: cough, hemoptysis, obstruction, wheezing

- Pancoast syndrome: superior sulcus tumor - shoulder pain, horner syndrome, pain and upper extremity weakness

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50
Q

non-small cell lung cancer

- associated sx

A
  • SIADH
  • ectopic ACTH
  • PTH-like secretion
  • hypertrophic pulmonary osteoarthropathy
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51
Q

non-small cell lung cancer

- dx

A

same as small cell lung cancer

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52
Q

non-small cell lung cancer

- tx

A
  • surgery (unless metastatic outside of chest)
  • radiation adjunct to sx
  • chemo- uncertain benefit
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53
Q

Lung cancer screening

A
  • low dose CT
  • 55-80 yo
  • 30 pack-year smoking hx
  • current smoker or quit within past 15 years
  • dc screening once 15 years since quit or health issue that substantially limits life expectancy
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54
Q

OSA

- diagnostics

A
  • polysomnography (definitive): 5+ episodes of apnea, hypogea, respiratory related arousals per hour
  • CBC: erythrocytosis
  • Thyroid: r/o hypothyroid
  • ABG: CO2 >45 mmHg
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55
Q

OSA

- treatment

A
  • weight loss
  • CPAP (curative)
  • BiPAP if O2 < 90%
  • tracheostomy is definitive tx
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56
Q

Tobacco dependence

- 4 meds

A
  • bupropion (zyban)
  • nicolette gum (nicolette)
  • nicotine patch
  • verenicline (chantix)
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57
Q

MOA

  • bupropion (zyban)
  • nicolette gum (nicolette)/nicotine patch
  • verenicline (chantix)
A
  • norepinephrine/dopamine reuptake inhibitor
  • nicotinic cholinergic receptor agonist
  • partial cholinergic receptor agonist
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58
Q

ALT vs. AST specific organs

A

ALT more specific for the Liver

AST found in several tissues

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59
Q

when is alk phos elevated

A

obstruction to bile flow in any part of the bile tree (cholestasis)

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60
Q

There is one cause of diarrhea that is associated with a random other disease, what is it?

A

C. jejuni is associated with guillaine-barre

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61
Q

what marker is used to track colon cancer

A

CEA

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62
Q

AST and alk phos lab results

- Acute hepatitis

A

AST >10-20

alk phos <3

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63
Q

AST and alk phos lab results

- chronic hepatitis, cirrosis, tumor

A

AST < 10

Alk phos <3

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64
Q

AST and alk phos lab results

- extra-hepatic obstruction

A

AST >4

Alk phos >4 (very high)

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65
Q

Bilirubin in hepatic dz vs. extrahepatic obstruction

A
  • extra-hepatic obstruction will increase serum bilirubin but the kidneys compensate by excreting excess bilirubin (bilirubinemia)
  • hepatic failure can’t conjugate bilirubin and secrete via kidneys so get HIGHER bilirubin levels vs. extra-hepatic obstruction
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66
Q

PT - clotting factors

A

II, VII, IX, X
(extrinsic pathway)
prolonged in advanced liver disease

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67
Q

LFTs in cirrhosis or metastatic liver dz

A

often nl or low bc there is a reduction in healthy functioning hepatocytes

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68
Q

Anal fissure

- MC site

A

posterior anal midline

below or distal to dentate line

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69
Q

Anal fissure

- s/sx

A
  • tearing pain with defecation
  • perianal pruritus and/or skin irritation
  • BRBPR
  • chronic: anal spasm, high anal pressure
  • external skin tags (sentinel pile) at distal end of fissure
  • hypertrophied anal papillae at proximal end
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70
Q

Anal fissure

- dx

A
  • endoscopy: bleeding + 2 mo of tx
  • sigmoidoscopy: pts <50 with no fam hx of colon cancer
  • colonoscopy if suspicion for crohns
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71
Q

Anal fissure

- tx

A

Acute

  • fiber, water
  • sitz bath
  • topical anesthetic, vasodilator (nifedipine and NTG)

Chronic

  • Botox
  • lateral sphincterotomy (Gold standard)
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72
Q

Anal fissure

- prevention

A
  • proper anal hygiene
  • high fiber diet, fluids, avoid straining
  • avoid anal trauma
  • prompt tx of diarrhea
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73
Q

Anorectal fistula

- MC location

A

interspincteric

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74
Q

Anorectal fistula

- MCC

A

anorectal abscess

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75
Q

Anorectal fistula

- s/sx

A
  • non healing abscess following drainage or chronic purulent drainage and pustule-like firm mass in perianal or buttock area
  • intermittent rectal pain (worse with defecation, activity, sitting)
  • malodorous perianal drainage
  • pruritus
  • excoriation/inflammation perianal skin
  • inflamed, tender, draining external opening
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76
Q

Anorectal fistula

- dx

A
  • Anoscopy to look for internal opening
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77
Q

Anorectal fistula

- tx

A

Simple:

  • fustolotomy
  • simple ligation of internal fistula tract
  • fistulectomy (larger wound, longer healing, more incontinence vs. fistulotomy)

Complex
- Seton

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78
Q

Hemorrhoid

- internal vs. external

A

Internal

  • superior rectal plexus (insensate area)
  • above dentate line

External

  • inferior rectal plexus
  • distal to dentate line
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79
Q

Hemorrhoids

- tx

A
  • conservative management first line
  • rubber band ligation: protrudes with defecation, enlarged, intermittent bleeding
  • closed hemorrhoidectomy: permanently prolapsed
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80
Q

Hemorrhoid grading

A

I: visualized on anoscopy, may bulge into lumen but no prolapse
II: prolapse from anal canal with defecation/straining, reduce spontaneously
III: same as II but require manual reduction
IV: irreducible, may strangulate

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81
Q

Colon cancer

- MC type

A

adenocarcinoma

villous > tubular

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82
Q

Colon cancer

- s/sx

A
  • abd pain
  • change in bowel habit
  • weight loss
  • hematochezia
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83
Q

Colon cancer

- tx

A
  • surgery is curative (CEA level prior to sx)
  • adjuvant: chemo and radiation
  • f/u: stool guaiac, annual CT abd/pelvis, colonoscopy 1 year, then 3 year, CEA q 3-6 mo
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84
Q

Familial adenomatous polyposis (FAP)

A
  • autosomal dominant
  • > 100 colorectal adenomas
  • iron deficient anemia
  • endoscopy 25-30 yo
  • prophylactic colectomy recommended
  • thyroid screening annually
    • CRC risk 100% by 30s-40s
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85
Q

Peutz-Jeghers

A
  • hamartomas in small bowel, colon, stomach
  • pigmented spots around lips, oral mucosa, face, genitalia, palmar surface
  • complications: GI bleed, intussusception
  • increased risk of other ca
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86
Q

colorectal screening

A
  • 50 to 75 yo
  • fecal occult blood test annually
  • start 10 years younger than age of dx of relative
  • Colonoscopy q 10 years or 5 years with fam hx (** colonoscopy is most sensitive and specific test)
  • flexible sigmoidoscopy: 1 5 y + FOBT every 3 years
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87
Q

how to use CEA with CRC

A

NOT for screening

- useful for baseline and recurrence surveillance

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88
Q

PUD

- 3 MCC

A
  • h. pylori
  • NSAIDs
  • zollinger-ellison syndrome
    (smoking, ETOH, coffee, emotional stress, dietary factors)
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89
Q

PUD

- dx

A
  • endoscopy: to dx ulcers, r/o malignancy
  • barium swallow
  • h. pylori testing
  • biopsy (gold standard)
  • serum gastrin measurement for zollinger-ellison
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90
Q

PUD

- tx

A 
Supportive
- no ASA/NSAIDs, etoh, smoking, dec coffee
- reduce stress
- avoid eating before bed
Acid suppression
- **PPI, H2, antacids
- H. pylori: 3-4 drug therapy (CAP - clarithromycin, amoxicillin, PPI - MC)
Cryoprotection
- sucralfate: ulcer healing
- Misoprostol: reduce risk ulcers with NSAIDs
Surgical intervention
- truncal vagotomy and antrectomy
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91
Q

PUD

- duodenal vs. gastric

A

Duodenal

  • increased offensive factors
  • RF: NSAIDs
  • low malignancy
  • younger pts
  • releived with eating
  • MC nocturnal pain

Gastric

  • decreased defensive factors
  • RF: smoking
  • high malignancy
  • older pts >40
  • eating makes pain worse
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92
Q

Gastritis

- etiology

A
  • NSAIDS **
  • ASA
  • h. pylori
  • etoh, cigs, caffeine
  • physiologic stress
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93
Q

Gastritis

- S/sx

A
  • epigastric pain
  • no relationship with eating
  • dyspepsia
  • abd pain
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94
Q

Gastritis

- dx

A
  • upper GI endoscopy with bx (1st line)

- h. pylori testing

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95
Q

Gastritis

- tx

A

Acute

  • stop NSAIDs
  • empiric tx with acid suppression: PPI for 4-8 weeks.
  • no response, test for h. pylori

Chronic
- triple therapy (CAP) X 2 weeks or quad therapy (CAP + pep) X 1 week

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96
Q

Acute viral gastroenteritis

A
  • MC norwalk virus (rotavirus, enterovirus)
  • fecal-oral
  • MC cause of acute diarrhea
  • n/v
  • supportive
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97
Q

Travelers diarrhea

A
  • ETEC (campylobacter, shigella, salmonella)
  • contaminated food/water
  • 3+ unformed stools in 24 hours + one of fever, n, v, abd cramp, tenesmus, bloody stool
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98
Q

travelers diarrhea

- tx

A
  • Cipro empiric
  • resistent, children, preg: azithromycin
  • Bismuth-subsalicylate: 60% effective
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99
Q

Salmonella

A
  • food/water (poultry and eggs), fecal-oral
  • inflammatory diarrhea (blood), n/v, fever
  • 24-48 hours after food
  • Pos fecal leukocytes
  • Supportive tx usually, avoid dehydration
  • Cipro for immunocompromised and enteric fever (s. typhi)
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100
Q

Shigella

A
  • fecal-oral
  • MC in developing countries, children <5 and their caregivers
  • abd pain, inflammatory diarrhea small volume, mucous/blood stool, tenesmus*, n/v
  • Pos fecal leukocytes
  • tx: bactrim in severe cases
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101
Q

Enterohemorrhagic E. coli (EHEC)

  • aka
  • overview
A
  • e. coli O157:H7, shiga-toxin producing e. coli
  • under-cooked ground beef
  • water, voluminous non bloody diarrhea with n/v turns to bloody diarrhea
  • no fecal leukocytes
  • abx not recommended
  • HUS complication
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102
Q

HUS

A
  • AKI
  • thrombocytopenia
  • hemolytic anemia
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103
Q

Enteroinvasive E. coli

A
  • food
  • cramping, watery diarrhea
  • positive fecal leukocytes
  • tx: hydration, peptol-bismol, imodium
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104
Q

Cholera

A
  • profound, rapidly progressive dehydration and death
  • enterotoxin by org as colonizes in SI
  • consumption of shellfish, contaminated water
  • “rice water stool” diarrhea
  • tx: Fluoroquinolone**, tetracycline, macrolide, rehydration
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105
Q

Amylase or lipase for pancreatitis?

A

both but Lipase is much more specific

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106
Q

what are the randon criteria

A 
glucose
calcium
hematocrit
BUN
ABG
LDH
AST
WBC
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107
Q

Pancreatitis

- most accurate testing

A

CT

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108
Q

Pancreatitis

- Tx for mild

A
  • NPO
  • IV fluids
  • electrolyte balance
  • pain control
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109
Q

Pancreatitis

- tx for severe

A
  • ICU

- Enteral nutrition via NJ tube X 72 hr

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110
Q

Chronic pancreatitis

A
  • Etoh
  • n/v, weight loss, steatorrhea
  • Gold standard dx: ERCP “chain of lakes”
  • CT scan (calcifications), KUB
  • Amylase and lipase not elevated
  • stool elastase for pancreatic insufficiency
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111
Q

Chronic pancreatitis

- tx

A
  • Pain control
  • NPO
  • Pancreatic enzymes, H2 blockers, insulin,
  • frequent, small-volume, low-fat meals
  • Pancreaticojejunostomy or whipple
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112
Q

Chronic pancreatitis

- cComplications

A
  • Narcotic addiction
  • DM
  • Malabsorption
  • pseudocyst
  • CBD obstruction
  • B12 malabsorption
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113
Q

Markers for

  • Ulcerative colitis
  • Crohns
A
  • UC: ANCA

- Crohns: ASCA

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114
Q

Ulcerative colitis

A
  • LLQ
  • Tenesmus, bloody or pus diarrhea
  • small but frequent bowel movement
  • fever, weight loss, anorexia
  • No skip lesions
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115
Q

Ulcerative colitis

- extra intestinal sx

A
  • scleritis and episcleritis
  • primary sclerosing cholangitis
  • erythema nodosum
  • pyoderma gangrosum
  • ankylosing spondylitis
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116
Q

What three conditions/diseases are fecal leukocytes positive?

A
  • ulcerative colitis
  • ischemic colitis
  • infectious diarrhea
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117
Q

When you avoid colonoscopy in UC

A

severe disease - to avoid risk of perforation or toxic megacolon

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118
Q

UC

- treatment

A
  • Sulfasalazine
  • steroids
  • immunosuppressants
  • proctocolectomy (curative)
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119
Q

Crohns

A
  • Mouth to anus
  • terminal ileum
  • flares and remissions
  • transmural inflammation
  • fistulas and bowel lumen narrowing
  • RLQ pain
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120
Q

Crohns

- extra intestinal manifestations

A
  • uveitis
  • arthritis
  • erythema nodosum
  • aphthous oral ulcers
  • cholelithiasis
  • nephrolithiasis
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121
Q

Crohns

- dx

A
  • Endoscopy/colonoscopy: cobblestone appearance, psuedopolyps, skip lesions, rectal sparing
  • Abd CT
  • Upper GI with small bowel follow through for ileum or fistulas
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122
Q

Crohns

- Tx

A
  • mesalamine/sulfasalazine
  • prednisone for acute exacerbations
  • Metronidazole
  • Immunosupression
  • bile acid sequestrates
  • sx: SBO
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123
Q

Ischemic colitis

- s/sx

A
  • acute onset
  • mild, crampy abd pain
  • blood in stool, minimal blood loss
  • urge to defecate
  • anorexia, n/v
  • tenderness over affected area
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124
Q

Ischemic colitis

- dx

A
  • Definitive: Colonoscopy: petechial hemorrhage (early), segmental erythema w or w/o ulcerations (late)
  • leukocytosis, metabolic acidosis, elevated lactate
  • Abd radiograph: bowel distention and air-filled bowel loops
  • Barium enema - thumbprint, longitudinal ulcers
  • CT w/contrast
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125
Q

Ischemic colitis

- tx

A
  • IV fluids
  • hemodynamic stabilization
  • bowel rest
  • no vasoconstrictive drugs
  • empiric abx
  • 20% require surgery (peritonitis) - bowel resection with colostomy
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126
Q

Appendicitis

- etiology

A
  • lumen obstructed by hyperplasia of lymphoid tissue MC

- obstruction > stasis > bacterial growth and inflammation

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127
Q

Appendicitis

- s/sx

A
  • epigastric > umbilicus > RLQ pain
  • anorexia (ALWAYS)
  • n/v
  • McBurney point tenderness
  • rebound tenderness, guarding, diminished bowel sounds
  • low-grade fever
  • Rovsing, Psoas, obturator sign
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128
Q

GI bleed

- upper vs. lower

A

Ligament of Treitz defines

  • upper: peptic ulceration, esophageal varices, gastritis, AVM, tumor, Mallory-Weiss tear
  • Lower: diverticulitis (MC), colitis, colon cancer, anorectal disorders, proctitis
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129
Q

Cholelithiasis/biliary colic

- overview

A
  • epigastric, RUQ pain
  • steady
  • often after eating
  • radiates to scapula
    (in the gallbladder)
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130
Q

Acute cholecystitis

- overview

A
  • severe epigastric, RUQ pain
  • radiates to scapula
  • Fever, nausea, vomiting
    • Murphy sign
      (gall bladder)
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131
Q

Ascending cholangitis

- overview

A
  • abd pain, jaundice, fever (Charcot triad)
  • Triad + confusion and hypotension (Reynolds pentad)
  • hepatomegaly
  • icterus
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132
Q

Gallstone pancreatitis

- overview

A
  • severe epigastric pain
  • pain radiates to back
  • n/v
  • elevated lipase
  • elevated ALT
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133
Q

Progression of gallbladder disease

A
  • biliary colic
  • acute cholecystitis
  • choledocholithiasis
  • ascending cholangitis
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134
Q

Cause of acute (ascending) cholangitis

A

stasis and infection of biliary tract

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135
Q

Treatment of cholangitis

A

broad spectrum abx (piperacillin-tazobacam)

- biliary drainage (ERCP)

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136
Q

Spontaneous peritonitis

  • past history of what
  • presenting sx
A
  • chronic liver disease, cirrhosis

- fever, chills, abd pain

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137
Q

Spontaneous peritonitis

  • PE
  • labs
  • diagnosis made via what
A
  • ascites, shifting dullness
  • PMNs >250, WBC >1,000, pH <7.34
  • analysis of ascites fluid
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138
Q

Spontaneous peritonitis

  • MCC org
  • tx
A
  • e. coli, strep spp

- IV abx (3rd gen cephalosporin), ? albumin

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139
Q

Vitamin A

  • source
  • functions
  • risk groups
A
  • liver, fish oil, fortified milk, eggs
  • vision, epithelial cell maturity, resistance to infection, antioxidant
  • elderly, etoh, liver dz
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140
Q

Vitamin A

  • deficiency sx
  • toxicity
A
  • night blindness, dry skin, dry eyes, impaired wound healing, squamous metaplasia, Bitot’s spots (white spots on conjunctiva)
  • skin disorder, hair loss, teratogenicity, ataxia
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141
Q

Vitamine C

  • source
  • function
  • risk group
A
  • citrus, strawberry, broccoli, greens
  • collagen synthesis, hormone function, neurotransmitter synthesis
  • etoh, elderly men
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142
Q

Vitamin C

  • deficiency sx
  • toxicity
A
  • scurvy (poor wound healing, petechiae, bleeding gums)

- diarrhea

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143
Q

Vitamin D

  • source
  • functions
  • at risk groups
A
  • fortified milk
  • calcium regulation, cell differentiation
  • elderly, shut-in, low sun exposure
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144
Q

Vitamin D

  • deficiency
  • toxicity
A
  • rickets, osteomalacia

- hypercalcemia (tetany), kidney stones, soft-tissue deposits

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145
Q

Vitamin D

- tx

A
  • ergocalciferol
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146
Q

Vitamin Bs

- list

A
  • B1 thiamin
  • B2 riboflavin
  • B3 niacin/nicotinic acid
  • B6 pyridoxine
  • B12 cobalamin
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147
Q

B1 Thiamin

  • source
  • fn
  • at risk group
A
  • pork, grain, beans
  • carb metabolism, nerve function
  • etoh**, poverty
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148
Q

B1 thiamin

- deficiency sx (3)

A
  1. Beriberi
  2. Wernicke’s encephalopathy
  3. Korsakoff’s dementia
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149
Q

Beriberi

  • what vitamin
  • sx
A
  • B1 (thiamin)
  • nervous tingling, poor coordination, edema, weakness, cardiac dysfunction
    Breakdown:
  • dry: nervous system changes
  • wet: high output heart failure, dilated cardiomyopathy
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150
Q

Wernicke’s encephalopathy

A
  • Ataxia
  • global confusion
  • ophthalmoplegia (paralysis or abnl of ocular muscles)
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151
Q

Korsakoff’s dementia

A
  • memory loss (esp short term)
  • confabulation
  • irreversible…
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152
Q

B2 riboflavin deficiency

  • source
  • function
  • at risk group
A
  • milk, spinach, liver, grain
  • energy
  • No risk group
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153
Q

B2 riboflavin deficiency

- deficiency sx

A
  • oral inflammation
  • eye disorders
  • oral-ocular-genital syndrome
    1. oral lesions, magenta colored tongue, angular cheilitis
    2. ocular: photophobia, corneal lesions
    3. genital: scrotal dermatitis
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154
Q

B3 niacin

  • sources
  • functions
  • at risk group
A
  • bran, fish, meat
  • energy, fat metabolism
  • poverty, etoh
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155
Q

B3 niacin

- deficiency

A

Pellagra (3 Ds)

  • dermatitis (photosensitive)
  • Diarrhea
  • dementia
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156
Q

B6 pyridoxine

  • source
  • function
  • at risk
A
  • animal protein, spinach, salmon
  • protein metab, hemoglobin, nt synthesis
  • adolescent, etoh
    • INH use
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157
Q

B 6 pyridoxine

- deficiency

A
  • HA, sideroblastic anemia, seizure, flaky skin, stomatitis and glossitis
  • peripheral neuropathy*
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158
Q

B12 cobalamin

  • source
  • physiology
  • function
  • at risk
A
  • animals
  • stomach releases B12 from food, binds to intrinsic factor, absorbed in terminal ileum
  • folate metab, nerve function
  • elderly, *vegans
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159
Q

B12 cobalamin

- deficiency

A
  • Neuro: paresthesias, gait abnl, memory loss, dementia
  • GI: anorexia, diarrhea, **glossitis
  • Macrocytic (megaloblastic) anemia: inc MCV + hypersegmented neutrophils
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160
Q

B12 cobalamin

- 4 etiologites

A
  1. pernicious anemia
  2. strict vegans
  3. malabsorption
  4. reduced intrinsic factor production
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161
Q

Pernicious anemia and B12 deficiency

A
  • autoimmune destruction or loss of gastric intrinsic cells
  • reduced/no intrinsic factor
  • dx: ab testing, Schilling test
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162
Q

Malabsorption and B12 deficiency

A
  • alcoholism

- disease affecting ileum (Crohn’s, celiac dz)

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163
Q

What can reduce the production of intrinsic factor?

A
  • drugs: PPIs and H2RA
  • gastric bypass sx
  • atrophic gastritis
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164
Q

Folate

  • source
  • fun
  • at risk group
A
  • green leafy veg, OJ, grain, organ meat
  • DNA synthesis
  • etoh, pregnancy
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165
Q

Folate

- deficiency sx

A
  • megaloblastic anemia
  • sore tongue
  • diarrhea
  • mental disorders
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166
Q

How to diagnose metabolic syndrome

A

3 of the 5:

  1. Abd obesity (waist >102 men, >88 women)
  2. Triglycerides >150 or on drug tx for triglycerides
  3. HDL <40 men <50 women
  4. BP >130/85 or drug tx for HTN
  5. glucose >100 or drug tx for hyperglycemia
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167
Q

Necrotizing (malignant) otitis externa

A
  • invasive infection on EAC and skull base
  • MC elderly pts with DM
  • pseudomonas aer.
    Clinical:
  • otalgia and otorrhea
  • not responsive to topical tx
  • pain worse at night
  • radiation to TMJ (pain with chewing)
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168
Q

PE difference in three types of conjunctivitis

A
  • Bacterial: mucopurulent discharge, red, not pruritic
  • Viral: watery discharge, red, pruritic
  • Allergic: rare discharge, cobblestoning, red, pruritic
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169
Q

nystagmus with water in ear

A

COWS

  • Cold Opposite
  • Warm Same
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170
Q

Bilateral discharge on day 3 of life in neonate

A
  • Gonococcal ophthalmia neonatorum

- topical 0.5% erythromycin applied after birth to prevent

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171
Q

Three types of neonatal conjunctivitis and time of presentation

A
  1. Chemical: first 24 hours, secondary to use of topical agents to prevent gonococcal conjunctivitis
  2. Gonococcal: 3-5 days after birth
  3. Chlamydia: 5-10 days after birth
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172
Q

Croup

  • peak age
  • clinical presentation
  • MCC
  • Xray
  • Toxic appearance?
  • Vaccine?
  • Management
A
  • 6 mo to 3 years
  • URI, barking seal cough, inspiratory stridor, low-grade fever
  • parainfluenza virus
  • steep sign PA view
  • NON-toxic
  • No vaccine
  • Steroids, aerosolized epi
How well did you know this?
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173
Q

Epiglottiis

  • peak age
  • clinical presentation
  • MCC
  • Xray
  • Toxic appearance?
  • Vaccine?
  • Management
A
  • 3 to 7 yo
  • rapid progression high fever, drooling, stridor
  • H. influenza, strep spp, S. aureus
  • Thumbprint on lateral view
  • toxic appearing
  • Vaccine for h. flu
  • Airway management and Abx
174
Q

Bacterial tracheitis

  • peak age
  • clinical presentation
  • MCC
  • Xray
  • Toxic appearance?
  • Vaccine?
  • Management
A
  • 3 to 8 years
  • URI prodrome like croup, intensifies to high fever, both inspiratory and expiratory stridor
  • s. aureus
  • subglottic narrowing, ragged edge of tracheal air column,
  • Toxic appearing
  • No vaccine
  • Airway and abx
175
Q

Epidural vs. subdural hematoma

A

Epidural

  • artery (middle meningeal): rapid expansion
  • skull fracture
  • dura pushed inward (convex)

Subdural

  • bridging veins: slow expansion
  • does not cross falx, tentorium bc dura attached to the skull
176
Q

Hodgkin Lymphoma

  • incidence
  • Assoc with what
A
  • Bimodal: 20s and >50s, MC males

- Epstein-Barre virus

177
Q

Hodgkin Lymphoma

- Clinical

A
  • Painless lymphadenopathy
  • alcohol may induce lymph node pain
  • Advanced: night sweats, weight loss, cyclical fever
178
Q

Hodgkin lymphoma

- Dx

A
  • Reed Sternberg cells (owl eyes) large cells with bilobed or multi lobar nucleus
  • mediastinal lymphadenopathy (PET/CT)

** highly curable compared to Non-hodgkins

179
Q

Non-Hodgkin lymphoma

  • Overview
  • Risk factors
A
  • lymphocyte neoplasm
  • MC >50 yo
  • ** peripheral lymph nodes
  • RF: age, immunosuppression (HIV)
180
Q

Non-Hodgkin lymphoma

  • clinical manifestations
  • subtype name and sx
A
  • Local painless lymphadenopathy (Gi, skin, CNS MC)

- Burkitt lymphoma: abd pain, jaw involvement, starry sky histology

181
Q

Non-Hodgkin lymphoma

- managment

A
  • unpredictable course

- rituximab

182
Q

Multiple Myeloma

- pathophys

A
  • proliferation of a single clone of a plasma cell
  • monoclonal ab (IgG and IgA MC)
  • ab accumulate in bone marrow, interrupt nl cell production
183
Q

Multiple Myeloma

- Risk Factors

A
  • > 65 yo
  • AA
  • Men
184
Q

Multiple Myeloma

- Clinical manifestations

A

BREAK

  • Bone pain (MC spine and ribs): osteolytic, destructive lesions
  • Recurrent infection dt leukopenia
  • Elevated calcium
  • Anemia
  • Kidney failure
185
Q

Multiple Myeloma

- Dx

A
  • Serum protein electrophoresis: monoclonal protein spike**
  • Urine protein electrophoresis: Bence-Jones proteins**
  • CBC: Rouleaux formation, increased ESR
  • Skull xray: punched out lesions
  • Bone marrow bx: plasmacytosis
186
Q

Multiple Myeloma

- Tx

A
  • autologous stem cell transplant
187
Q

Acute Lymphocytic Leukemia (ALL)

  • pathophys
  • distribution
  • RF
A
  • malignancy of lymphoid stem cells
  • MC childhood (3-7 yo)
  • RF down syndrome
188
Q

Acute Lymphocytic Leukemia (ALL)

- clinical

A
  • Pancytopenia –> Fever (MC)

- CNS: HA, stiff neck, vision

189
Q

Acute Lymphocytic Leukemia (ALL)

  • PE
  • DX
A
  • hepatosplenomegaly, lymphadenopathy

- Bone marrow: hyper cellular >20% blasts

190
Q

Acute Lymphocytic Leukemia (ALL)

- Tx

A
  • chemo
191
Q

Chronic Lymphocytic Leukemia (CLL)

  • pathophys
  • Clinical
A
  • B cell clonal malignancy

- Most asx, incidental finding on CBC, fatigue MC

192
Q

Chronic Lymphocytic Leukemia (CLL)

- Dx

A
  • well differentiated lymphocytes with “smudge cells”

- Pancytopenia

193
Q

Acute Myeloid leukemia (AML)

- common population

A
  • MC acute leukemia in adults (>50)
194
Q

Acute Myeloid leukemia (AML)

- Clinical

A
  • pancytopenia: anemia, splenomegaly, gingival hyperplasia

- Leukostasis: WBC>100,000

195
Q

Acute Myeloid leukemia (AML)

- Dx

A

Bone marrow bx:

  • Auer Rods
  • > 20% blasts
196
Q

Chronic Myelogenous Leukemia (CML)

  • pathophys
  • age
  • clinical
A
  • granulocyte proliferation
  • Usu >50 yo
  • most asx until blastic crisis, splenomegaly
197
Q

Chronic Myelogenous Leukemia (CML)

- Dx

A
  • Philadelphia chromosome (tx with imatinib)

- Very high WBC counts

198
Q

Abx vs. MRSA

A
  • Bactrim
  • Rifampin (rapid resistance when used alone)
  • Clindamycin (GI)
  • Tetracyclines
199
Q

Causes of erythema multiform

A
  • target-like lesions
  • herpes simplex (MC viral cause)
  • Mycoplasma
  • Sulfonamides
  • PCN
  • barbituates
  • Phenytoin
  • etc
200
Q

Erythema Multiform vs. SJS, vs. TEN

A 
EM
<10% TSBA
- Hands/forearms
- Target lesion
- 50% have oral lesions

SJS

  • <10% TSBA
  • MC in children
  • URI like prodrome
  • Drug rx MCC
  • > = 2 mucosal sites
  • Burn center

TEN

  • > 30% TBSA
  • Elderly MC
  • HIV increased risk
  • Abrupt onset
  • Nikolsky sign
  • burn center
201
Q

Rocky Mountain spotted fever

  • Org
  • clinical presentation
  • Tx
A
  • rickettsie rickettsii
  • Tick bite (dog or wood ticks)
  • abrupt onset sx
  • Fever, HA, myalgias, Rash (palms and soles to trunk)
    • Petechiae formation after blood pressure cuff inflation
  • Doxy
202
Q

Type 1 hypersensitivity

  • time frame
  • what antibodies
  • examples
  • explanation
A
  • Immediate
  • IgE mediated, degranulation of mast cells and release of mediators
  • Anaphylaxis, urticaria, angioedema
  • requires 2 separate exposures to antigen. First causes sensitization
  • Foods, Abx, hymenoptera stings
203
Q

Type II hypersensitivity

  • antibodies
  • examples
  • explanation
A

(cytotoxic)

  • IgG or IgM react with cell antigens with resultant complement activation
  • Autoimmune hemolytic anemia, Goodpasture syndrome, Erythroblastalis fetalis
  • requires 2 separate exposures to antigen. First causes sensitization
204
Q

Type III hypersensitivity

  • antibodies
  • examples
A

(immune complex)

  • IgG or IgM deposition and subsequent complement activation
  • serum sickness, SLE, RA
205
Q

Type IV hypersensitivity

  • Antibodies
  • examples
A

(cell mediated- delayed)

  • T cells activated vs. surface bound antigens
  • Contact dermatitis
  • TB skin test
  • Transplant rejection
206
Q

Burn classification

- list types

A
  • Superficial
  • Superficial partial
  • Deep partial
  • Full
207
Q

Superfiical burn

A
  • epidermis only

- pain, red, mild swelling

208
Q

Superficial partial burn

A
  • dermis: papillary region

- Pain, blisters, splotchy skin, severe swelling

209
Q

Deep partial burn

A
  • Dermis: reticular region

- white, leathery, relatively painless

210
Q

Full burn

A
  • Hypodermis (subcut tissue)

- charred, insensate, eschar formation

211
Q

Amide vs. Ester anesthetics

A

Amides (have two Is)
- lidocaine, mepivicaine, bupivicbine, prilocaine, ropivacaine)

Esters (have one I)
- Procaine, chloroprocaine

212
Q

Bullous Pemphigoid

- overview

A
  • elderly (>65 MC)
  • drug, injury, skin infection triggers
  • autoantibodies target *basement membrane. Separation of epidermis from dermis forms a sub epidermal blister
213
Q

Bullous Pemphigoid

- Clinical

A
  • prodrome: red, itchy, urticarial or papular eruption
  • *Tense bullae, rupture to form erosions
  • rare mucous membrane involvement (oral mainly)
  • negative Nikolsky
214
Q

Bullous Pemphigoid

- Dx

A
  • Immunoflourescence: ab fluorescente along BM

- H&E of skin: subepidural blister, eosinophils in superficial dermis, C3 deposition epidermal BM zone

215
Q

Pemphigus Vulgaris

  • epidemiology
  • etiology
A
  • 5th/6th decade (younger than bullous pemphigoid)
  • MC Jewish, mediterranean, middle eastern
  • IgG autoantibodies vs. desmosomes in epidermis which causes epidermal separation
216
Q

Pemphigus Vulgaris

- clinical

A
  • flaccid bullae
  • mucosal erosions (usu oral)
  • Nikolsky sign
217
Q

Pemphigus Vulgaris

- Dx

A
  • Immunoflourescence: chickenwire pattern (vs. basement membrane in BP)
  • Histology: intraepidermal blister formation
218
Q

Bullous Pemphigoid and pemphigus vulgarisms tx

A

steroids: topical and systemic

219
Q

Urge incontinence

  • Common causes
  • Sx
  • Tx
A
  • stroke, alzheimers, parkinsons, BPH
  • urgency, frequency, day or night
  • Anticholinergic drugs (WHAT)
220
Q

Stress incontinence

  • Common causes
  • Sx
  • Tx
A
  • urologic procedure, multiple childbirths
  • small volume urine loss coughing or laughing
  • topical estrogen
221
Q

Overflow incontinence

  • Common causes
  • Sx
  • Tx
A
  • BPH, fecal impaction
  • Poor stream, incomplete emptying
  • alpha-adrenergic blockers (WHAT)
222
Q

Atonic bladder

  • Common causes
  • Sx
  • Tx
A
  • DM neuropathy, stroke
  • loss of bladder control
  • Intermittent cath
223
Q

Acute Lymphocytic leukemia

- brief overview

A
  • MC childhood leukemia
  • 75% affects b-cell precursors, 20% T-cell
  • good prognosis
224
Q

Chronic lymphocytic leukemia

- brief overview

A
  • MC adult leukemia
  • smudge cells
  • worst prognosis
225
Q

Acute myelogenous leukemia

- brief overview

A
  • more common adults vs. children
  • Auer rods
  • Fair prognosis, worse than ALL
226
Q

Chronic myelogenous leukemia

- brief overview

A
  • Mostly adults
  • Philadelphia chromosome
  • Basophilia on smear
  • Good prognosis
227
Q

Flexor Tenosynoviits

- dx

A
  • Kanavel’s criteria:
  • flexor tendon tenderness
  • fusiform or symmetrical swelling of the finger (sausage finger)
  • pain with passive extension
  • finger held in flexion
228
Q

Deep tendon reflexes test what nerves?

A 
Triceps: C7
Biceps: C5/C6
Brachioradialis: C6
Patellar: L4
Achilles: S1
229
Q

What is the Galeazzi test?

A

ID for hip dysplasia (along with Barlow and Ortolani)

- person on back with feet on floor, inspect knee height: if not level, positive test

230
Q

Ortolani vs. Barlow

A

Barlow: dislocate hip
Ortolani: reduce hip
Both clunk :)

231
Q

Sign of colchicine toxicity

A

severe gastroenteritis

232
Q

What drug is commonly used to treat RA and lupus?

A

Hydroxychloroquine (also malaria)

233
Q

Hydroxychloroquine

- common ADR to screen for

A
  • Corneal and macular toxicity

- Annual ophthalmologic exam

234
Q

Polymyalgia rheumatica

  • associated with what
  • clinical
  • treatment
A
  • giant cell arteritis
  • Symmetrical aching and stiffness of shoulders, hip girdle, neck, torso
  • Worse in am
  • > 50 yo
  • Steroids
235
Q

Autoantibodies

- Lupus

A
  • ANA
  • Anti-dsDNA
  • Anti-Smith

(also Anti-SSA/Ro)

236
Q

Autoantibodies

- Sjogren

A
  • ANA
  • Anti-La/SS-B

(also Anti- SSA/Ro

237
Q

Autoantibody

- CREST

A

*ANA

Anti-centromere

238
Q

Autoantibody

- Inflammatory myopathy

A

*ANA

Anti-Jo1

239
Q

Autoantibody

- RA

A

Rheumatoid factor

240
Q

Autoantibody

- Primary biliary cholangitis

A

Anti-mitochondrial antibody

241
Q

Migraine

- Acute exacerbation

A
  • Triptans
  • Ergots
  • NSAIDs
  • Acetaminophen
  • Antiemetics
242
Q

Migraine

- prophylaxis

A
  • Propranolol
  • verapamil
  • Amytriptyline
  • Valproic acid, topiramate
  • Botox
243
Q

Tick paralysis

A
  • rocky int wood tick and american dog tick
  • Female tick feeds, sx 4-7 days later
  • Salivary toxin = pathologic effects
  • Ascending paralysis, ataxia
  • Remove tick, sx resolve in hours
244
Q

Cluster HA

A
  • Always unilateral (can switch sides)
  • Excruciating periorbital and temporal pain
  • Ptosis, mitosis, lacrimation, conjunctival injection, rhinorrhea, nasal congestions
  • 15-180 minutes, attacks in clusters
  • 100% O2 and sumatriptan
245
Q

5 types of dementia and risk factors

A
  • Alzheimers (MC, 2/3): age, fam hx
  • Vascular (1/4): HTN, dyslipidemia, DM, smoking, age
  • Lewy Body: cognitive fluctuations, visual hallucinations, Parkinsonism
  • Neurodegenerative: Huntingtons, metabolic abnl
246
Q

Croup

- Overview

A
  • laryngotraceobronchitis
  • URI-like sx, seal barking cough, stridor, worse at night
  • hypoxia is UNcommon
  • Tx: cool humidified air, racemic epinephrine, dexamethasone
247
Q

RSV

A
  • fever, tachypnea, wheezing, nasal flaring, retractions
  • CXR: diffuse infiltrates
  • bronchiolitis: mucus and inflamed bronchiole wall
248
Q

Pneumonia

5 common bacteria

A
  1. Strep pneumonia: MC CAP, often follows URI or influenza, acute onset
  2. H. influenza: often after URI, COPD
  3. Staph aureus: may follow influenza, cavitary, MRSA
  4. Klebsiella: etoh, DM, immunocompromised, LTAC, aspiration
  5. Pseudomonas: chronic lung dz, mechanical ventilation
249
Q

Legionella Pneumonia

A
  • epidemics possible
  • Water source and air travel
  • Pleuritic chest pain, bradycardia, GI sx, neuro sx, hyponatremia
  • CXR: alveolar infiltrates
250
Q

Postinfluenza pneumonia

A
  • MC staph aureus
  • necrotizing pneumonia
  • CXR: multiple cavitary lesions
251
Q

Pneumonia

- Atypical orgs (5)

A
  • mycoplasma pneumonia: young adults
  • Legionella: humidifier, hot tube, air conditioning, pleural effusion, GI/neuro, hyponatremia
  • Chlamydia
  • Coxiella burnetii
  • Chlamydia psittaci
252
Q

Miliary TB

A
  • hematogenous dissemination of mycobacterium tuberculosis
  • Clinical: failure to thrive, fever unknown origin, multi organ dysfunction, night sweats, rigors
  • Extrapulmonary: lymph, bones/joints, liver, CNS, adrenal glands
  • CXR: millet seed pattern
253
Q

Pertussis

- 3 stages

A
  • Catarrhal (7-10D): mild fever, cough, coryza, conjunctivitis *most contagious
  • Paroxysmal (7-28D): spasmodic cough -> inspiratory whoop
  • Convalescent (months): decreasing cough
254
Q

Pertussis

- tx

A

Macrolides (Azith, erythema)

*Bordetella pertussis

255
Q

Lung absecess

A
  • cough, fever, pleuritic chest pain, weight loss, night sweats
  • CXR: area of dense consolidation and air-fluid level inside thick-walled cavitary lesion
  • Usu dt aspiration pneumonia
  • Tx: ampicillin-sulbactam, carbapenems, clindamycin
256
Q

Fine crackles

  • characteristics
  • Clinical
A

Characteristics

  • discontinuous
  • fine, high pitched
  • end of inspiration
  • not cleared by cough

Clinical

  • pneumonia
  • HF
  • Chronic bronchitis
  • asthma
  • COPD
257
Q

Coarse Crackles

  • characteristics
  • Clinical
A

Characteristics

  • Discontinous
  • low pitched, bubbling/gurgling
  • Start in early inspiration, extend into expiration

Clinical

  • same as fine but usu more advanced dz
  • pulmonary edema
  • Pulmonary fibrosis
258
Q

Wheeze

  • characteristics
  • Clinical
A

Characteristics

  • continuous
  • high pitched, musical
  • MC in expiration
  • small airways

Clinical

  • asthma
  • COPD
  • HF
259
Q

Rhonchi

  • characteristics
  • Clinical
A

Characteristics

  • continuous
  • low-pitched and coarse, loud, snoring/moan
  • MC in expiration
  • coughing may clear

Clinical

  • Obstructed trachea
  • bronchitis
  • pneumonia
260
Q

Pleural friction rub

  • characteristics
  • Clinical
A

Characteristics

  • superficial, low-pitched, rubbing/grating
  • inspiration and expiration
  • loudest lower anterolateral surface
  • not cleared by cough

Clinical

  • pleurisy
  • pericarditis
  • pericardial effusion
261
Q

TB test results

A

> 5 mm

  • HIV
  • contact with TB pt
  • Nodular/fibrotic change on CXR
  • organ transplant

> 10

  • recent arrival from high-prevalence country
  • IVDU
  • resident/employee high risk setting
  • comorbid conditions
  • < 4 yo
  • young person exposed to high risk categories

> 15
- no risk factors

262
Q

Two main types of lung cancer

A

Small cell and non-small cell

263
Q

Small cell lung cancer high points

A
  • Central (“S” central)
  • Small cell
  • Squamous cell
264
Q

Non-small cell lung cancer 3 types

A
  • Adenocarcinoma (MC), peripherally located
  • Squamous cell: starts centrally, hypercalcemia
  • large cell carcinoma
265
Q

S3 vs. S4

A

S3

  • early diastole
  • during passive LV filling
  • may be normal (children, pregnant)
  • Requires compliant LV
  • systolic HF

S4

  • late diastole
  • active LV filling
  • Always abnl
  • requires non-compliant LV
  • diastolic HF
266
Q

Preseptal Cellulitis

  • eyelid swelling
  • eye pain
  • pain with eye movement
  • proptosis
  • ophthalmoplegia +/-diplopia
  • vision impairment
  • chemosis
  • leukocytosis
A
  • yes
  • may have pain
  • no
  • no
  • no
  • no
  • rare chemosis
  • maybe leukocytosis
267
Q

Preseptal Cellulitis

  • eyelid swelling
  • eye pain
  • pain with eye movement
  • proptosis
  • ophthalmoplegia +/-diplopia
  • vision impairment
  • chemosis
  • leukocytosis
A
  • yes
  • deep eye pain
  • yes
  • usually proptosis, may be subtle
  • yes
  • may have vision impairment
  • possible
  • possible
268
Q

Dry age-related macular degeneration

A

MC

  • drusen
  • gradual loss of vision
  • macular thinning
  • not total blindness
269
Q

Wet age-related macular degeneration

A
  • neovascularization
  • less common
  • sudden loss of vision
  • bleeding, leakage of fluid
  • more severe central vision loss vs. dry
270
Q

Duke criteria

- major criteria

A
  • two separate blood cultures pos for typical orgs

- positive echo

271
Q

Duke criteria

- minor criteria

A
  • heart condition
  • IVDU
  • temp >38
  • vascular phenomena
  • Immunological phenom
  • one positive culture but doesn’t meet major criteria
272
Q

What Duke criteria needed to dx endocarditis

A

2 major
1 major + 3 minor
5 minor

273
Q

what orgs are typical for endocarditis

A
  • strep viridan
  • strep bovis
  • HACEK
  • staph aureus
  • enterococci
274
Q

Vascular signs of endocarditis

A
  • major arterial emboli
  • septic pulmonary infarct
  • mycotic aneurysm
  • intracranial hemorrhage
  • conjunctival hemorrhage
  • Janeway lesion
275
Q

Immunological signs of endocarditis

A
  • glomerulonephritis
  • Osler nodes
  • Roth spots
  • rheumatoid factor
276
Q

USPSTF Lung cancer screening recommendations

A
  • age 55 to 80
  • low-dose CT
  • 30 pack-year hx currently or quit less than 15 years ago
  • discontinue once no smoking 15 years, not going to treat anyways
277
Q

Radial nerve palsy

A
  • Loss of extension of fingers, thumb, wrist
  • wrist drop
  • numbness over 1st dorsal interosseus muscles
  • saturday night palsy (etoh)
  • dt radial nerve compression in axilla
278
Q

Treatment for olecranon bursitis

A

Compression and NSAIDs

can also aspirate but second line

279
Q

Medication for acute low back pain

A

1st line: NSAIDs, acetaminophen
2nd Line: cyclobenzaprine, diazepam
3rd line: opioids, tramadol

Also:
antidepressants, steroids, anti-epileptics

280
Q

Straight leg raise test

A

Test for L5 or S1 radiculopathy, sciatica

  • passively raise sx leg with knee straight
  • Positive: pain in back radiating past knee when elevated 30 to 70 degrees
281
Q

What is Dupuytren’s contracture associated with?

A

DM

282
Q

Dupuytren’s contracture

A
  • fibrous fascia of palmar surface shorten and thickens
  • pitted nodules on palm -> contracture of fingers
  • Difficult to do tasks (wash face, comb hair, etc)
  • steroid injections, sx
  • RF: Dm, etoh, smoking
283
Q

Ankylosing spondylitis overview

A
  • low back/hip pain
  • limited ROM spine and tender SI joint
  • morning stiffness
  • bamboo spine
  • men > females
  • HLA-B27
  • NSAIDs and Infliximab
284
Q

Cauda Equina

  • imagining
  • injury of what
A
  • MRI lumbar spine

- lumbosacral nerve roots

285
Q

Low back pain red flags (4)

A
  1. night pain, weight loss (tumor)
  2. fevers, chills, sweats (bone/disk infection)
  3. acute bony tenderness (fracture)
  4. morning stiffness in young adult (ankylosing spondylitis)
286
Q

Mallet finger

A
  • forced flexion of DIP -> rupture of extensor tendon
  • splint in full extension or hyperextension
  • can lead to swan neck deformity
287
Q

Swan neck deformity

A
  • hyperextension of PIP

- flexion of DIP

288
Q

Boutonniere deformity

A
  • hyperextension of the DIP

- flexion of the PIP

289
Q

When to perform trephination of subungal hematoma?

A
  • > 50% nail bed surface or smaller if painful
  • electrocautery preferred method (heated paperclip, 18 gauge needle/syringe)
  • Keep dry and clean for two days
290
Q

Scoliosis

A
  • Cobb angle >= 10 degrees
  • RF: <12, onset prior to menarche, curves >20, female, double/thoracic curves
  • confirm dx via XR to obtain cobb angle
  • Treatment based on Cobb angle:
  • <10 reassurance
  • 10-19 observe with f/u q 6-9 months
  • 20-40 bracing
  • > 40 surgery
291
Q

MC shoulder and hip dislocation

A
  • Shoulder: anterior

- Hip: posterior

292
Q

How to image suspected spinal stenosis?

A

MRI of lumbar spine

293
Q

Ganglion cyst

  • location
  • tx
A
  • dorsum of wrist at scapholunate joint

- observation, needle aspiration of cyst, sx

294
Q

CHA2DS2-VASc

categories and points

A 
CHF
Hypertension
>75 yo (**2 points)
DM
Stroke (**2 points)
Vascular dz
Age 65-74
Sex female
295
Q

CHADS-VASc score interpretation

A

0 - anticoag not needed
1 - consider antiplatelet or anticoag
2+ anticoag candidate

296
Q

Pericarditis

  • MCC
  • Sx
A
  • viral infection MCC
    Also bacterial, TB, fungal, idiopathic, neoplasm, etc.
  • pleuritic chest pain
  • less pain sitting forward, worse in recumbency
  • effusion and tamponade
  • friction rub at L sternal border
297
Q

Pericarditis

- Tx

A
  • NSAIDS*
  • steroids
  • Colchicine
  • infectious: drainage and abx
298
Q

Pericarditis

- EKG

A
  • PR depressions

- diffuse ST elevations

299
Q

High output cardiac failure

- causes

A
  • hyperthyroidism or high metabolic rate
  • shunting of blood that increases myocardial O2 demand
  • beriberi
  • AV fistula
  • Pregnancy
  • Anemia
300
Q

Low output cardiac failure

A
  • usu dt depressed ejection fraction
  • dilated cardiomyopathy
  • chronic HTN
  • valvular heart disease
301
Q

High output cardiac failure sx

A

palpitations
dyspnea on exertion
decreased exercise tolerance

302
Q

constrictive pericarditis heart sound

A

pericardial knock

- accentuated heart sound just before the 3rd heart sound

303
Q

Restrictive cardiomyopathy

heart sound

A

S3 dt abrupt cessation of rapid ventricular filling

304
Q

constrictive pericarditis

- etiology

A

rare

  • impaired filling dt restraint of ventricular diastolic expansion because of a stiff pericardium
  • any cause of pericarditis can cause this
305
Q

Constrictive pericarditis

- sx

A
  • dyspnea, fatigue, peripheral edema
  • right sided heart failure: ascites, pedal edema, hepatojugular reflex, JVD
  • no pulmonary congestion
306
Q

MC cause of syncope in pt with non-specific hx

A

idiopathic

307
Q

Common causes of syncope

A
  • Reflex: vasovagal
  • Orthostatic
  • Cardiac
308
Q

Vasovagal sycope

A
  • orthostatic or emotional stress
309
Q

Orthostatic syncope

A
  • primary: purely autonomic like Parkinsons or Lewy body dementia
  • drug induced: vasodilators, diuretics, thiazines, antidepressants
310
Q

Cardiac syncope

A
  • bradydysrhythmias
  • tachydysrhythmias
  • structural heart disease
311
Q

Chronic HF treatment

A
  • lifestyle
  • diuretics: acute pulmonary edema, no mortality benefit
  • ACEi: decreased mortality
  • BB: decreased mortality in classes II-IV
  • Hydralazine with nitrate: dec mortality for AA
  • Spironolactone: dec mortality in class III and IV
  • digoxin: refractory systolic dysfunction, no mortality benefit
312
Q

NYHA classification for HF

A

I: no limitation
II: slight limitation, mild sx with ordinary activities
III: moderate limitation, sx noted with min activity
IV: severe limitation, sx at rest

313
Q

Hypertrophic cardiomyopathy

- murmur

A

usu delayed onset

  • 3-4/6 grade
  • crescendo-decrescendo
  • L lower sternal border
  • increases with less venous return: sitting to standing or valsalva
314
Q

Hypertrophic cardiomyopathy

- tx

A

avoid physical activity
BB
defibrillators and transplant
(no s)

315
Q

Aortic stenosis leads to what heart changes

A
  • increased LV after load
  • concentric LV hypertrophy and then remodeling
  • Leads to abnl diastolic function (bc less space)
  • leads to concentric hypertrophy to compensate
316
Q

Aortic stenosis

- sx

A

dyspnea
chest pain
syncope

317
Q

Aortic stenosis

- PE

A
  • crescendo-decrescendo systolic murmur
  • radiates to carotids
  • Paradoxically split S2
  • S4 gallop
  • murmur will decrease with valsalva
318
Q

Aortic stenosis

  • Age
  • RF
  • Tx
A
  • older
  • Dm and HTN
  • valve replacement
319
Q

Restrictive Cardiomyopathy

- s/sx

A
  • peripheral edema, dyspnea, fatigue (Right sided HF)
320
Q

Restrictive Cardiomyopathy

- Echo

A
  • Impaired diastolic filling

- preserved systolic function

321
Q

Restrictive Cardiomyopathy

- EKG

A

low voltage, non specific changes

322
Q

Restrictive Cardiomyopathy

- MC cause

A

amyloidosis

323
Q

Supraventricular arrhythmias (5)

A
  • sinus brady
  • supraventricular tachy
  • a fib
  • a flutter
  • junctional rhythm
324
Q

Drugs to increase heart rate (sx bradycardia)

A
  • Vagolytic: atropine

- positive chronotrope: epi or dopamine

325
Q

Overview of treatment of sx tachycardia

A
  • synchronized cardioversion

- antiarrhythmibc: amiodarone, bb, procainamide

326
Q

Paroxysmal supraventricular tachycardia

  • EKG
  • two main types
A
  • regular, narrow QRS
  • AV nodal reentry tachycardia (AVNRT)
  • AV reciprocating tachycardia (AVRT)
327
Q

AV nodal reentry tachycardia (AVNRT)

A

Type of PSVT

  • 2 pathways
  • Both WITHIN the Av node, one slow and one fast
  • MC type
328
Q

AV reciprocating tachycardia (AVRT)

A

Type of PSVT

  • 1 pathway in AV node
  • 1 pathway is accessory, outside AV node
  • WPW!!
  • Lown-Ganong-Levine syndrome
329
Q

Two conduction patterns in PSVT

A
  • Orthodromic (MC): impulse down normal AV node, returns via accessory. Narrow complex tachycardia
  • Antidromic: impulse down accessory and returns via normal pathway. WIDE complex tachycardia
330
Q

PSVT management

- Stable narrow complex

A
  • vagal maneuver
  • Adenosine
  • AV node blockers (BB, CCB)
331
Q

PSVT management

- Stable wide complex

A
  • anti-arrhythmics: amiodarone

* * procainamide if suspect WPW

332
Q

PSVT management

- unstable

A

synchronized cardioversion

*definitive: radiofrequency ablation

333
Q

A. fib

- types

A
  • paroxysmal: self terminating in 7 days +/- recurrent
  • Perisistent: >7 days, requires termination (med or electrical)
  • Permanent: persistent >1 year. Refractory to cardioversion or not tried
  • Lone: all of the types without evidence of heart dz
334
Q

A fib

- rate vs. rhythm control

A

Rate control usu preferred over rhythm control

- rhythm may be used in younger pts with lone a fib

335
Q

A. Fib

- Rate control management

A
  • BB (Metoprolol)
  • CCB (diltiazem*, verapamil)
  • Digoxin: preferred pts with hypotension or CHF
336
Q

A. fib

- rhythm control

A
  • synchronized cardioversion preferred
  • Pharm: ibutilide, flecainide, sotalol, amiodarone
  • Ablation
337
Q

When can A. fib be cardioverted?

A
  • AF present <48 hours

- 3-4 weeks of antiocoag AND TEE shows no atrial thrombi

338
Q

A. Fib

- Unstable tx

A

synchronized cardioversion

339
Q

A. Fib

- Anticoagulation

A

Based on CHADS-VASc score

  • NOACS: Dabigatran (direct thrombin inhibitor) and Factor Xa inhibitors (apixaban, edoxaban, rivaroxaban)
  • Warfarin (INR 2-3)
  • dual anti platelet therapy (ASA + clopidogrel) but inferior to above two
340
Q

A. flutter

  • stable management
  • unstable management
  • definitive management
A
  • vagal, BB, CCB
  • synchronized cardioversion
  • ablation

** same anticoag as a. fib

341
Q

What dysrhythmia has capture beats and fusion beats?

A

ventricular tachycardia

  • fusion: indicates 2 foci of pacemaker cells
  • capture: return of atrial control
342
Q

Torsades de pointes

- causes

A
  • drugs prolong QT
  • Class IA antidysrhythmics
  • Class IC antidysrhythmics
  • cyclic antidepressants
  • erythromycine
  • methadone
343
Q

Ventricular dysrhythmias

- overview

A
  • unpredictable, unstable, lethal dt compromised stroke volume and coronary flow
  • wide, bizarre QRS
344
Q

Ventricular tachycardia

A

> = 3 PVS and rate >100

- prolonged QT can cause

345
Q

Torsades de pointes

- MC cause

A

hypomagnesemia

346
Q

Ventricular tachycardia
management
- stable
- unstable

A
  • stable: antiarrhythmics (Amiodareon)
  • Unstable with pulse: synchronized cardioversion
  • Unstable no pulse: defibrillation and CPR
347
Q

Torsades de pointes

- management

A
  • IV mg

- correct electrolyte abnormalities

348
Q

Wolf Parkinson White

  • pathway
  • EKG
A
  • bundle of Kent
  • pre-excitation of ventricle
  • Slurred, wide QRS with delta wave, short PR
349
Q

Wolf Parkinson White

- management stable if wide complex

A
  • vagal maneuvers
  • antiarrhythmics: procainamide preferred
  • AVOID AV nodal blockers (ABCD: adenosine, BB, CCB, Digoxin) bc can cause preferential conduction through fast pathway = worsening tachy
350
Q

Wolf Parkinson White

- management unstable

A
  • synchronized cardioversion
351
Q

Wolf Parkinson White

- Definitive tx

A

ablation

352
Q

Medical management of Long QT syndrome

A
  • metoprolol if hemodynamically stable
353
Q

Long QT syndrome

- QT interval definition

A
  • > 480 ms w/ sycope

- >500 ms no sx

354
Q

Holiday Heart syndrome

A
  • A fib, a flutter, atrial tachycardia after etoh
  • present with palpitations
  • usu spont converts 24-48 hrs
  • Observe pt is first step
355
Q

Multifocal atrial tachycardia

A
  • > 3 P wave morphologies
  • Rate 100 to 180
  • Irregular rate
  • secondary to COPD, hypoxia, pulmonary HTN
  • Management: O2, tx underlying condition, rate control
356
Q

Hyperkalemia and EKG

A
  1. peaked T wave
  2. dropped P wave and widened QRS
  3. Sine wave
357
Q

Does Type 1 second degree heart block need treatment?

A

Not always, can be a normal variant (they 2 second degree is NEVER normal)

358
Q

What does obesity do to BNP?

A

decreases level

359
Q

BNP level

  • dx HF
  • definite rule out HF
A
  • HF if >500

- <100 eliminates HF

360
Q

Alternative therapy to ASA (allergy) during acute coronary syndrome

A

clopidogrel

361
Q

Special considerations in RV infarct

A
  • become preload dependent bc RV impaired and relies on passive flow to LV
  • hypotension = IV fluids to increase preload
  • Nitrates are CI
362
Q

First steps to care for acute MI

A
  • cardiac monitor (look for dysrhythmias)
  • peripheral IV
  • O2
  • ASA
  • NTG (as long as not RV or right heart)
363
Q

Meds given post MI

A
  • ASA
  • BB
  • Statin
  • ACEi
    (reduced mortality)
364
Q

What med is sometimes used during and surrounding coronary artery procedures

A

abciximab (GP IIb/IIIa inhibitor)

- prevents platelet adhesion and thrombus formation

365
Q

Antiplatelet meds

A
  • ASA
  • clopidogrel
  • ticagrelor
  • prasugrel
366
Q

MC cause of sudden cardiac arrest and death

A

Ischemic heart disease

367
Q

Common cardiac finding in heart failure with respiratory distress

A

third heart sound (S3 gallop)

- high likelihood ratio of CHF

368
Q

What common drug can worsen the sx of heart failure?

A

NSAIDs

369
Q

beta blockers to use in HF

A
  • bisoprolol
  • carvedilol
  • metoprolol
370
Q

STEMI ST elevation evolution

A
  • hyperacute T wave
  • J point elevation
  • ST segment elevation
  • Q wave formation, loss of R wave
  • T wave inversion
371
Q

Med overview for chronic stable angina

A
  • statin
  • Antihypertensive (BB first line)
  • antiplatelet (ASA)
  • NTG
372
Q

hypertriglicertidemia pancreatitis

A
  • xanthomas on extensor surfaces of arms, legs, buttocks, back
  • hepatosplenomegaly
  • DM, etoh, obese, pregnant, hx pancreatitis
373
Q

1st line med to tx:

  • LDL
  • triglycerides
  • HDL
A
  • statins
  • fibrates
  • niacin
374
Q

Niacin medication

  • main effect
  • ADR
A
  • vitamin B3
  • increase HDL
  • flushing, HA, warm sensation, itching
  • hyperuricemia (gout)
  • hyperglycemia
375
Q

Statins
- aka
- main effect
-

A
  • HMGcoA reductase inhibitors
  • inhibits rate-limiting step in hepatic cholesterol synthesis and increases LDL receptors so more LDL removed from blood
376
Q

Statin

  • ADR
  • when to give
A
  • myositis, myalgia, rhabdomyolysis
  • Hepatitis: LFTs first 3 mo
  • bedtime
377
Q

Fibrates

  • main effect
  • MOA
  • names
A
  • decrease triglycerides
  • inhibits peripheral lipolysis and reduces hepatic TGL production
  • gemfibrozil
  • fenofibrate
378
Q

Fibrates

- ADR

A
  • myositis, myalgias
  • esp with concomitant statin us
  • gallstones
379
Q

Bile acid sequestrants

  • main effect
  • MOA
  • names
A
  • bind bile acid, blocking reabsorption
  • reduce cholesterol pool, removes LDL from blood
  • most useful + statin or niacin
  • cholestyramine, colestipol, colesevelam
380
Q

Bile acid sequestrants

- ADR

A
  • GI
  • inc LFTs
  • inc triglycerides (dont’ use in pt with elevated TGL)
381
Q

Ezetimibe

A

zetia

  • inhibits cholesterol absorption in intestine
  • lowers LDL
  • increased LFTs, esp with statin use
382
Q

What is the only lipid lowering agent that is safe in pregnancy

A

bile acid sequestrates

383
Q

HTN

  • urgency
  • emergency
A
  • urgency: HTN w/o end organ damage
  • emergency: HTN + end organ damage

*damage: encephalopathy, cardiac ischemia, renal ischemia

384
Q

HTN emergency management

A

Reduce MAP 25% first hour, normalize bp next 8-24 hours

    • reduce >25% might result in end-organ ischemia
  • IV labetalol or nicardipine
385
Q

HTN goals

  • <60 yo
  • > = 60 yo
  • CKD
  • DM
A
  • <140/90
  • <150/90
  • <140/90
  • <140/90
386
Q

HTN initial meds

- non AA

A
  • thiazide
  • CCB
  • ACEi / ARB
387
Q

HTN initial meds

- AA

A
  • thiazides

- CCB

388
Q

HTN initial med

- CKD

A
  • ACEi or ARB
389
Q

Amiodarone ADR

  • MC
  • others
A
  • MC: hypotension
  • blue-gray discoloration
  • corneal microdeposits
  • hypo/hyperthryoid
  • interstitial lung dz
  • hepatitis
  • epididymitis
  • etc
390
Q

Amiodarone

- MoA

A
  • inhibits outward K channels

- prolongs the duration of the action potential

391
Q

Mitral stenosis

  • RF
  • sound
  • position
  • stethoscope
A
  • rheumatic heart dz
  • diastolic
  • low-pitched decrescendo at cardiac apex
  • may appear in pregnancy
  • best in left lateral decubitus
  • bell
392
Q

MCC tricuspid regurg

A

elevated R heart pressure

393
Q

Aortic regurgitation

A
  • diaphragm
  • left sternal border
  • accentuated when pt leans forward
  • diastolic
  • high pitched, blowing, decrescendo
394
Q

What condition must be avoided in aortic stenosis?

A

hypotension - pt is preload dependent

  • ensure hydrated
  • Avoid vasodilators and diuretics
395
Q

MCC tricuspid stenosis

A

Rheumatic heart disease

396
Q

Prinzmetal angina

  • daily prophylaxis meds
  • MC pt
  • MC time of onset
  • EKG
  • Two contributing factors
A
  • CCB or nitrates to prevent vasoconstriction
  • women <50
  • early morning
  • ST segment elevation
  • smoking and cocaine
397
Q

Best anticoagulation for pregnant woman

A

LMW heparin

DVT, etc.

398
Q

Chronic venous insufficiency

  • cause
  • sx
A
  • MC vascular diorder
  • incompetent venous valves
  • lower extremity pain or discomfort
  • worse when standing or seated with feet down
  • better with elevation and walking
399
Q

Chronic venous insufficiency

- s/s

A
  • abnl venous dilation
  • telangiectatsias
  • varicose veins
  • edema
  • inflammation
  • dermatitis
  • ulceration
400
Q

Chronic venous insufficiency

- RF

A
  • age
  • fam hx
  • inc body mass
  • smoking
  • lower leg trauma
  • venous thrombosis
  • pregnancy
401
Q

Tx and length of time to tx for DVT

A

dabigatran or warfarin X 12 months min

402
Q

Pneumonia

- h. influenza

A
  • 2nd mc cause CAP

- more common with underlying pulm dz like COPD, CF, etc

403
Q

Pneumonia

- mycoplasma pneumoniae

A
  • MC cause of atypical (walking) pneumonia
  • mc in school aged children, college, military
  • *bullous myringitis
404
Q

Pneumonia

- staph aureus

A
  • often after viral infection like flu
405
Q

Pneumonia

- anearobes

A
  • aspiration pneumonia

- MC R lower lobe

406
Q

Pneumonia

- mc route of infection

A

microaspiration of oropharyngeal secretions

407
Q

typical pneumonia

  • MC org
  • CXR
  • clinical manifestations
A
  • s. pneumoniae
  • lobar pneumonia
  • fever, cough c sputum, pleuritic chest pain, rigors, tachypnea and tachycardia
408
Q

Typical pneumonia

- PE

A
  • bronchial breath sounds
  • dullness to percussion
  • tactile fremetis
  • egophany
  • inspiratory rales
409
Q

CXR pneumonia

  • abscess formation
  • upper lobe with bulging fissure, cavitations
A
  • s. aureus

- klebsiella

410
Q

Sputum pneumonia

  • rusty
  • current jelly
A
  • strep pneumonia

- klebsiella

411
Q

Percussion results

  • pneumonia
  • pleural effusion
  • pneumothorax or obstructive lung disease
A
  • dullness
  • dullness
  • hyperresonanace
412
Q

fremitus

  • pneumonia
  • pleural effusion
  • pneumothorax or obstructive lung disease
A
  • increased
  • decreased
  • decreased
413
Q

Breath sounds

  • pneumonia
  • pleural effusion
  • pneumothorax or obstructive lung disease
A
  • Bronchial, egophony
  • decreased
  • decreased
414
Q

Pneumonia Treatment

- CAP outpatient

A
  • Macrolide or doxy

- fluoroquinolone if recent abx use

415
Q

Pneumonia Treatment

- CAP inpatient

A

beta lactam (ceftriaxone) & macrolide or FQ

416
Q

Pneumonia Treatment

- HAP

A
  • pseudomonas risk

- piperacillin/tazobactam or cefepime + amino glycoside OR levofloxacin or moxifloxacin

417
Q

HTN
Thiazide diuretics
- MoA and effect

A
  • increased Na and H2O excretion at distal convulsed tubule = reduced blood volume
  • tx of choice in uncomplicated HTN
418
Q

HTN

Thiazide diuretics ADR

A
  • hyponatremia
  • hypokalemia
  • hypercalcemia
  • hyperuricemia
  • hyperglycemia

*careful in gout, DM

419
Q

HTN
Loop diuretics
- MoA

A
  • inhibits water transport across loop of Henle
  • excretes water, Na, Cl, K
  • Strongest diuretic
420
Q

HTN
Loop diuretics
- ADR
- CI

A
  • volume depletion
  • hypokalemia
  • hyperglycemia
  • metabolic alkalosis
  • ototoxicity
  • CI: sulfa allergy
421
Q

HTN
K-sparing diuretics
- MoA

A
  • inhibits aldosterone-mediated Na/H2O absorption

- week diuretic, best used with loops to min K loss

422
Q

HTN
K-sparing diuretics
- ADR
- CI

A
  • hyperkalemia
  • gynecomastia w/ spironolactone
  • CI: renal failure, hyponatremia
423
Q

HTN
ACEi
-MoA

A
  • reduces synthesis of Angiotensin II and aldosterone
  • renoprotective
  • cardioprotective
424
Q

HTN
ACEi
- ADR

A
  • 1st dose hypotesion
  • Azotemia/renal insufficiency
  • hyperkalemia
  • cough
  • angioedema
  • hyperuricemia
425
Q

HTN
ACEi
- CI

A

pregnancy (ARBS too)

426
Q

HTN
CCB
two types

A
  1. dihydropyridines: potent vasodilation. (amlodipine, nifedipine)
  2. non-dihydropyridines: cardiac contractility and conduction, vasodilation
    (verapamil and diltiazem)
427
Q

HTN

with what comorbidity is non-dihydropyridine used?

A

HTN with A fib

428
Q

HTN
CCB
- ADR

A
  • HA
  • dizzy
  • lightheaded
  • flushing
  • peripheral edema
    Verapamil: constipation
429
Q

HTN
CCB
- CI

A

CHF and 2/3rd degree heart block

430
Q

Weber test

A
  • conductive: lateralizes to impaired ear

- neurosensory: lateralizes to the good ear

431
Q

Rinne test

A
  • conductive: bone conduction louder than air on impaired ear
  • neurosensory: air louder than bone conduction. Might not hear the bone conduction

EORs (9 decks)

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