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Emergency Medicine > High Yield > Flashcards

High Yield Flashcards

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1
Q

What is Prinzmetal’s Angina

A

Coronary vasospasms that lead to transient ST elevations

Usually without an MI

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2
Q

Sx of Prinzmetal’s Angina

A

Chest pain, usually at rest
Occurs in the mornings with hyperventilation
Emotional stress or cold exposure
Not usually due to exertion

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3
Q

Dx of Prinzmetal’s Angina

A

EKG: Transient ST elevations
Angiography: No fixed stenotic lesions

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4
Q

Tx of Prinzmetal’s Angina

A

CCB
Nitrates prn
If acute sx present: ASA and Heparin until atherosclerosis is ruled out

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5
Q

What is Atrial Fibrillation

A

Irregularly irregular rhythm

No P-waves seen, usually at a rate of 350-600 bpm

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6
Q

How can you control Atrial Fibrillation

A

Rate Control with Vagal Maneuvers or Beta-Blockers
Rhythm Control with Cardioversion
If you cardiovert, the person must be on anticoagulation for 3-4 weeks prior to cardioversion

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7
Q

What is given for stroke prevention in a person with A.Fib

A 
Warfarin or ASA
Decision based on CHADS2
CHF
HTN
Age >75
DM
Stroke, TIA, Thrombus (2 points)
High risk: >2 points = Warfarin with INR 2-3
Moderate Risk: 1 = Warfarin or ASA
Low Risk: 0 = Nothing or ASA
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8
Q

Sx of Atrial Fibrillation

A

Tachycardia, Palpitations, Fatigue

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9
Q

What is an Aortic Dissection

A

Tear in the innermost layer of the aorta (intima)

Usually due to cystic medial necrosis

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10
Q

What are risk factors for Aortic Dissection

A

HTN
Age 50-60yrs
Vasculitis, trauma, family hx
Collagen Disorders (Marfans, Ehlers-Danlos)

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11
Q

Sx of Aortic Dissection

A

Sudden onset of severe, tearing, ripping knife-like chest pain that radiates to the back
Decreased Peripheral Pulses
Variation in pulses between left and right side
HTN
Aortic Regurgitation

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12
Q

Dx of Aortic Dissection

A

MRI Angiography is gold standard
CT with contrast is becoming test of choice
CXR: Widening of mediastinum
Trans Esophageal Echo

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13
Q

Tx of Aortic Dissection

A

Surgery if in Ascending and with Sx

Medications with Non-Selective Beta Blockers (Labetalol) with Sodium Nitroprusside for Descending

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14
Q

What is Multifocal Atrial Tachycardia

A

Rhythm characterized by varying P-Wave morphologies with marked irregular PP intervals
Rate is 100-140 bpm
Seen with COPD

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15
Q

Sx of Multifocal Atrial Tachycardia

A

Palpitations

ASsociated with severe COPD

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16
Q

Tx of Multifocal Atrial Tachycardia

A

Treat underlying disease
Verapamil
May progress to A. Fib in some patients

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17
Q

What is Wolff-Parkinson-White

A

An accessory AV pathway via Kent bundles
They produce short PR intervals with delta waves (preexication) at the onset of a wide and slurred QRS complex which leads to early depolarization

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18
Q

Sx of Wolff-Parkinson-White

A

Palpitations, Syncope, Rapid, Regular Rhythm

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19
Q

Tx of Wolff-Parkinson-White

A

Vagal Maneuvers
Antiarrhythmics such as Procainamide, Amiodarone
Radiofrequency ablation is definitive

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20
Q

What is Mitral Stenosis

A

Obstruction of flow from the LA to LV

Leads to Pulmonary HTN

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21
Q

What causes Mitral Stenosis

A

Rheumatic heart disease

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22
Q

Sx of Mitral Stenosis

A 
Right sided HF
Pulmonary HTN, Hemoptysis
Atrial Fibrillation
Mitral Facies (flushed cheeks)
Fatigue, exertional dyspnea, orthopnea
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23
Q

What murmur is heard with Mitral Stenosis

A

Diastolic Rumble at the Apex

Opening snap

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24
Q

Tx of Mitral Stenosis

A

Valvotomy in young pts

Repair preferred over Replacement

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25
Q

Dx of Mitral Stenosis

A

Ultrasound

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26
Q

What is Orthostatic Hypotension

A

A decreased in systolic blood pressure of 20 mmHg or a decrease in diastolic blood pressure of 10 mmHg within three minutes of standing, when compared to sitting or supine position

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27
Q

What causes Orthostatic Hypotension

A

Dehydration
Blood Loss
Neuro, cardiovascular or endocrine issues

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28
Q

Sx of Orthostatic Hypotension

A

Dizziness, lightheadadness, blurred vision, weakness, fatigue, Nausea, Palpitations, Headache
Syncope, Dyspnea, Chest Pain, Neck and Shoulder pain

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29
Q

Dx of Orthostatic Hypotension

A

Head-Tilt Table Test if autonomic dysfunction suspected
Measure BP: Lay flat for 5 minutes, then 1 minute after standing, and 3 minutes after standing
Heart rate increases of 100 bpm or by >30 bpm may indicate hypovolemia

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30
Q

Tx of Orthostatic Hypotension

A

Increased sodium intake
Fludrocortisone (causes Na retention)
Midodrine, an alpha-agonist that causes arterial and venous constriction
Indomethacin (NSAID) inhibits vasodilation

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31
Q

What is considered Hypertension

A

140/90 on 2 different readings for 2 different visits

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32
Q

What are complications of HTN

A

CAD, HF, TIA, STroke, Encephalopathy, Renal Stenosis, Retinal Hemorrhages

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33
Q

Sx of HTN

A

Fundoscopic: Papilledema means advanced stage, Arterial narrowing, A-V nicking, Soft exudates
Striae, Bruits over renal arteries

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34
Q

Tx of HTN

A 
Goal is <140/90
If Diabetic or chronic renal disease: >130/80
Lifestyle Modification, Diet, Weight loss, Exercise, Limit Alcohol
HCTZ is 1st line
Furosemide
Ace-I
CCB
Beta-Blockers
Alpha-Blockers
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35
Q

What is Acute Bacterial Parotitis

A

Inflammation and infection of the partoid gland

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36
Q

What pathogen is most commonly associated with Parotitis

A

S. Aureus

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37
Q

Sx of Parotitis

A

Swelling of gland
Increased pain and swelling with meals
Tenderness and erythema of duct opening

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38
Q

What causes Acute Bacteria Parotitis

A

Usually due to dehydration or with chronic illness
Underlying Sjogren
Ductal obstruction usually by mucous plug

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39
Q

Tx of Parotitis

A

IV Abx: Nafcillin
Hydration, warm compresses, Lemon drops, massage of gland
Can take 2-3 weeks to heal
If Chronic: CT the person or Ultrasound

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40
Q

What is Cerumen Impaction

A

Wax buildup

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41
Q

What is recommended cleaning to avoid Cerumen Impaction

A

Usually self-cleansing

Clean external opening with washcloth over index finger without entering canal

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42
Q

Tx of Cerumen Impaction

A

Detergent ear drops (hydorgen peroxide and carbamide peroxide), mechanical removal, suction, or irrigation
Irrigation with warm water to avoid vestibular caloric response

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43
Q

Sx of Cerumen Impaction

A

Hearing loss (Conductive)

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44
Q

What is Papilledema

A

Optic disk swelling due to raised intracranial pressure

Usually bilateral

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45
Q

What causes Chronic Papilledema

A

Intracranial HTN and Cerebral Venous Sinus Occlusion
Space Occupying Lesion (Tumor) in brain, Abscess in brain
Increased CSF production
Cerebral edema

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46
Q

Sx of Papilledema

A

Headache, N/V

Vision usually well preserved

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47
Q

Dx of Papilledema

A

MRI or CT first to r/o mass effect
Lumbar puncture to check CSF pressure
Fundoscopic shows swollen optic disc with blurred margins

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48
Q

Tx of Papilledema

A

Diuretics (Acetazolamide) to decreased production of aqueous humor and CSF

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49
Q

What is an Orbital Floor “blowout” fracture

A

Fracture of the orbital floor (maxillary, zygomatic, palatine)

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50
Q

Sx of Blowout Fracture

A

Decreased visual acuity
Diplopia especially with upward gaze
Enophthalmos (sunken eye)
Orbital Emphysema (eyelid swelling with blowing the nose)
Epistaxis, Anesthesia to Anteriomedial Cheek

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51
Q

Dx of Blowout Fracture

A

CT scan

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52
Q

Tx of Blowout Fracture

A 
Nasal Decongestants to decrease pain
Avoid blowing nose
Prednisone to decrease edema
Abx (Unasyn or Clindamycin)
Surgical Repair
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53
Q 
What is a 2nd Degree Superficial Partial Thickness Burn
Depth
Appearance
Sensation
Capillary Refill
Prognosis
A

Depth: Epidermis + Superficial portion of dermis
Appearance: Erythematous, pink, moist, weeping, Blistering
Sensation: Most painful of all burns, Very tender to touch
Capillary Refill: Refill intact, blanches with pressure
Prognosis: Heals in 2-3 weeks, No scarring

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54
Q 
What is a 2nd Degree Deep Partial Thickness Burn
Depth
Appearance
Sensation
Capillary Refill
Prognosis
A

Depth: Epidermis into deep portion of dermis
Appearance: Red, yellow, pale white, dry, Blistering
Sensation: Not usually painful
Capillary Refill: Absent
Prognosis: 3 weeks-2 months, Scarring Common

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55
Q

What is Molluscum Contagiosum

A

Benign viral infection of the Poxviridae family

Highly Contagious

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56
Q

Sx of Molluscum Contagiosum

A

Single or multiple dome-shaped, flesh colored to pearly-white, waxy papules with central umbilication
Curd-like material expressed from center if squeezed

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57
Q

Tx of Molluscum Contagiosum

A 
Usually resolves in 3-6 months
Imiquimod or Podophyllin
Cryosurgery
Electrodessication
Topical Retinoids for severe cases in HIV
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58
Q

What is Thyroiditis

A

Hashimoto Thyroiditis due to Autoimmunity
Subacqute Thyroiditis
Infectious Thyroiditis

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59
Q

What is hashimotos Thyroiditis

A

Autoimmune, Most common thyroiditis in US

Elevated serum antithyroid antibodies attack thyroid gland

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60
Q

Sx of Hasimotos Thyroiditis

A

Hypothyroidism: Slow metabolism, fatigue, depression, weight gain

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61
Q

Dx of Hashimoto’s Thyroiditis

A

Positive thyroid antibodies

Thyroblobulin Antibodies present

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62
Q

Tx of Hashimotos Thyroiditis

A

Levothyroxine

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63
Q

What is Hepatic Encephalopathy

A

A state of disordered central nervous sytem function resulting from failure of the liver to detoxify noxious agents of the gut or hepatocellular dysfunction and portosystemic shunting
Cirrhosis is a cause

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64
Q

Sx of Hepatic Encephalopathy

A

Mild Confusion, Drowsiness, Stupor, Coma
High ammonia levels from protein breakdown
Asterixis (flapping tremor)

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65
Q

Dx of Cirrhosis

A

Ultrasound

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66
Q

Tx of Hepatic Encephalopathy

A

Lactulose: Converted to lactic acid which pulls ammonia into gut
Neomycin: Antibiotic that decreases ammonia-producing flora
Protein Restriction

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67
Q

What is IBD

A

Ulcerative Colitis and Crohn’s Disease

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68
Q

What is Ulcerative Colitis

A

Limited to Colon, begins in rectum and moves up

Mucosa and submucosa only

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69
Q

Sx of Ulcerative Colitis

A

LLQ colicky main
Tneesmus, Urgency
Bloody Diarrhea, Hematochezia

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70
Q

What do you see in a colonoscopy with Ulcerative Colitis

A

Uniform inflammation, ulcerations in rectum/colon, sandpaper appearance
Pseudo Polyps

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71
Q

What role does surgery have in Ulcerative Colitis

A

Curative

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72
Q

What is Crohn’s Disease

A

Affects any segment of GI from mouth to anus
Most common in terminal ileum
Transmural in nature

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73
Q

Sx of Crohn’s Disease

A

RLQ abdominal pain, weight loss

Diarrhea with no visible blood

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74
Q

What do you see in a colonoscopy with Crohn’s Disease

A

Skip Lesions, Cobblestone appearance

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75
Q

What role does surgery have in Crohn’s Disease

A

Non-Curative

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76
Q

Dx of IBD

A

Colonoscopy for both UC and Crohns
Upper GI series in acute flares with Crohns
Flex Sigmoidoscopy in acute flares with UC

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77
Q

Tx of IBD

A

Aminosalicylates (Oral Mesalamine, Topical Mesalamine, Sulfasalazine)
Corticosteroids
Immune Modifying Agents (6-mercaptopurine, Azathioprin, Methotrexate)
Anti-TNF Agents (Adalimumab, infliximab, certolizumab)

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78
Q

What is Acute Appendicitis

A

Obstruction of the appendix
Usually due to a fecalith
Inflammation, malignancy or foreign body

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79
Q

Sx of Acute Appendicitis

A

Anorexia, Periumbilica/epigastric pain that eventually is localized to RLQ
Nausea, Vomiting
Rebound tenderness, rigidity and gurading
Rovsing Sign: RLQ pain with LLQ palpation
Obturator Sign: RLQ pain with internal and external hip rotation with bent knee
Psoas Sign: RLQ pain with right hip flexion/extension (raise leg vs. resistance)
McBurney’s Point Tenderness: 1/3 distance from anterior superior iliac spine

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80
Q

Dx of Acute Appendicitis

A

CT Scan

Ultrasound, Leukocytosis

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81
Q

Tx of Acute Appendicitis

A

Appendectomy

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82
Q

What is Clostridum Difficile

A

Nosocomial/Iatrogenic
Organism overgrowht secondary to alteration of normal flora
Usually seen after abx use (Clindamycin) or Chemo

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83
Q

Sx of C. Diff

A

ABdominal cramps, diarrhea, fever, tenderess
Lymphocytosis
Pseudomembranous Colitis

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84
Q

Tx of C. Diff

A

Metronidazole

Vancomycin 2nd line

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85
Q

What is Primary Biliary Cirrhosis

A

Idiopathic autoimmune disorder of intrahepatic small bile ducts
Leads to decreased bile salt excretions, cirrhosis and End-Stage Liver Disease
Seen in middle-age women

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86
Q

Sx of Primary Biliary Cirrhosis

A

Asymptomatic, Usually incidental with high ALP

Fatigue, Pruritis, Jaundice, RUQ discomfort, Hepatomegaly

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87
Q

Dx of Primary Biliary Cirrhosis

A

Positive Anti-Mitochondrial Antibody
Increased ALP and Increased GGT
Increased ALT, AST, Bilirubin
Liver Biopsy

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88
Q

Tx of Primary Biliary Cirrhosis

A

Ursodeoxycholic Acid is 1st line: Reduces Progression
Cholestyramine and UV lights for Pruritis
-Cholestyramine binds bile acid in gut, reduces bile salts’ irritant effect on skin

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89
Q

What is a hemothorax

A

A type of Pleural Effusion
Gross blood in pleural space
Usually due to chest trauma

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90
Q

Sx of a Hemothorax

A 
Asymptomatic
Dyspnea
Pleuritic chest pain
Cough
Decreased fremitis, Decreased breath sounds, dullness to percussion
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91
Q

Dx of Hemothorax

A

CXR: Se menisci (blunting of costophrenic angles)

Lateral Decubitus films are best

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92
Q

Tx of Hemothorax

A

If small, can observe
If large, Thoracentesis
If Traumatic: Surgical Exploration if more than 1,000 mL of blood are removed immediately after tube thoracostomy, if there is continued bleeding from chest, or repeated blood transfusions are required to maintain dynamically stable

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93
Q

What is COPD

A

Progressive irreversible airflow obstruction
Due to loss of elastic recoil and increased airway resistance
Includes Emphysema and Chronic Bronchitis

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94
Q

What are risk factors for COPD

A

Smoking
Alpha-1-Antitrypsin Deficiency (Alpha-1-Antitrypsin is protective for elastin in lungs from damage by WBC)
Occupational, Environmental exposures

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95
Q

What is Emphysema

A

Abnormal permanent enlargement of terminal airspaces

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96
Q

What is Chronic Bronchitis

A

Productive cough for >3months for 2 consecutive years

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97
Q

Sx of Emphysema

A

Accessory muscle use, tachypnea, prolonged expiration, hyperinflation, decreased breath sounds, decreased fremitus, barrel chest, Cachectic with pursed lip breathing

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98
Q

Sx of Chronic Bronchitis

A

Productive cough, Prolonged Expiration, Rales, Crackles, Rhonchi, WSheezing, Obese and Cyanotic

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99
Q

Dx of COPD

A

Pulmonary Function Tests are Gold Standard: Shows obstruction with decreased FEV1, Decreased FVC, and Decreased FEV1/FVC Ration (<70%). Shows Hyperinflation with Increased lung volumes, Increased RV, Increased TLC
CXR: Hyperinflation, Flat Diaphragm, Decreased Vascular Markings
EKG: Cor Pulmonale (RVH, RAE, RAD)

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100
Q

Tx of COPD

A

Oxygen is the only thing that will decrease mortality
Anticholingerigs + Beta-2-Agonists shows to be more effective when used together
Bronchodilators
-Anticholinergics (Tiotropium, Ipratoprium)
-Beta-2 Agonists (Albuterol, Terbutaline, Salmeterol)
-Theophylline
Corticosteroids (not used alone)

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101
Q

What is Asthma

A

Reversible hyperirritability of the tracheobronchial Tree

Results in bronchoconstriction and inflammation

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102
Q

Sx of Asthma

A

Dyspnea, Wheezing, Cough, Prolonged expiration with wheezing, hyperresonance

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103
Q

Dx of Asthma

A

Peak Expiratory Flow Rate: PEFR >15% from initial attempt indicates response to treatment (confirmed Asthma)
PFT is gold standard: Increased RV, Increased TLC

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104
Q

Tx of Asthma

A 
SABA 1st
\+Low dose ICS
\+Low-dose ICS + LABA or Medium-dose ICS
\+Medium-dose ICS + LABA
\+High-Dose ICS + LABA
\+High-dose ICS + LABA + Oral systemic corticosteroid
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105
Q

What are examples of Short-Acting Beta Agonist (SABA)

A

Alubetrol
Terbutaline
Epinephrine

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106
Q

What are examples of Long-Acting Beta Agonists (LABA)

A

Salmeterol, Budenoside, Formoterol, Fluticasone/Salmeterol (Advair)

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107
Q

What are examples of Inhaled Corticosteroids

A

Beclomethasone, Flunisolide, Triamcinolone

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108
Q

What is considered intermittent Asthma and what is the treatment of choice

A

<2x/day or >2x/week
Night: <2x/month
SABA: Albuterol inhaler

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109
Q

What is considered mild persistent Asthma and what is the treatment of choice

A 
>2x/wk
Night: 3-4x/month
SABA + Low-Dose ICS
(Albuterol + Beclomethasone/Flunisolide/Triamcinolone)
FEV1 > 70%
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110
Q

What is considered moderate persistent Asthma and what is the treatment of choice

A 
Daily sx
Night: >1x/wk
SABA + Low-Dose ICS + LABA
(Albuterol + Beclomethasone + Salmeterol)
OR
SABA + Medium-Dose ICS
FEV1 40-70%
111
Q

What is considered severe persistent Asthma and what is the treatment of choice

A 
Sx all day every day
Night: Nightly
SABA + High-Dose ICS + LABA
Albuterol + Beclomethasone + Salmeterol)
FEV1 <40%
112
Q

What are the pathogens associated with Typical Pneumonia

A

S. Pneumo
H. Influenza
Kelbsiella
S. Aureus

113
Q

What do you see on Xray with Typical Pneumonia

A

Lobar Pneumonia

114
Q

Sx of Typical Pneumonia

A

Sudden onset of fever, productive cough with purulent sputum, pleuritic chest pain, Tachycardia, Tachypnea, Dullness to percussion, increased tactile fremitus, Egophony

115
Q

What are the pathogens associated with Atypical Pneumonia

A

Mycoplasma
Chlamydia
Legionella
Viruses

116
Q

What do you see on Xray with Atypical Pneumonia

A

Diffuse, Patchy Infiltrates

117
Q

Sx of Atypical Pneumonia

A

Low Grade Fever
Dry, non-productive cough
Myalgias, malaise, sore throat, headache, N/V/D
Crackles, Rhonchi

118
Q

Tx of Community Acquired Pneumonia (outpatient)

A

Macrolide or Doxycycline

119
Q

Tx of Community Acquired Pneumonia (inpatient)

A

Beta-Lactam + Macrolide
or
Broad spectrum Fluoroquinolones (Levofloxacin, moxifloxacin, gemifloxacin)

120
Q

Tx of Community Acquired Pneumonia (ICU)

A

Beta-Lactam + Macrolide
or
Beta-Lactam + Broad Spectrum Fluoroquinolone

121
Q

Tx for Hospital Acquired Pneumonia

A

Need to cover for Pseudomonas
Beta-Lactam + Aminoglycoside/Fluoroquinolone
If MRSA suspected: Vancomycin

122
Q

What is Acute Respiratory Failure

A

Respiratory dysfunction resulting in abnormalities of oxygenation or ventilation severe enough to threaten the function of vital organs

123
Q

Sx of Acute Respiratory Failure

A

Hypoxemia, Dyspnea, Cyanosis, Restlessness, Confusion, Anxiety, Delirium, Tachypnea, Bradycardia, Tachycardia, HTN, Tremor
Dyspnea, Headache

124
Q

Tx of Acute Respiratory Failure

A

Tx underlying disease
Maintenance of adequate gas exchange
Supportive Care
Oxygen, Positive Pressure Ventilation
Tracheal Intubation indicated if: Hypoxemia despite supplemental oxygen, upper airway obstruction, impaired airway protection, inability to clear secretions, respiratory acidosis, progressive fatigue, tachypnea, apnea
Mechanical Ventilation: Apnea, Acute Hypercapnia, Severe Hypoxemia, Progressive patient fatigue despite appropriate treatment

125
Q

What pathogen causes Pertussis

A

Bordetella Pertussis

Whooping Cough

126
Q

Sx of Pertussis

A

Catarrhal Stage: Insidious onset with lacrimation, sneezing, coryza, anorexia, malaise
Paroxysmal Stage: Bursts of rapid, consecutive coughs followed by deep, high ptiched inspiration (whoop)
Convalescent Stage: Beings 4 weeks after onset with decrease in frequency and severity of paroxysms of cough
WBC Elevated

127
Q

Dx of Pertussis

A

Clinical or Nasopharyngeal Culture

PCR

128
Q

Prevention of Pertussis

A

Vaccine (DTaP)
Adults tend to be reservoirs so Tdap vaccine for adolescents and adults
Pregnant women should receive a dose of Tdap for each pregnancy regardless of prior vaccination history

129
Q

Tx of Pertussis

A

Erythromycin, Azithromycin, Clarithromycin

130
Q

What is Acute Lymphocytic Leukemia

A

KIDS
Most common childhood malignancy
B-Cells, T-Cells
>20% BLASTS

131
Q

Sx of ALL

A

Pancytopenia, Fatigue, Lethargy, Bone Pain
CNS sx: Headache, stiff neck, visual changes, vomiting
Pallor, Fatigue, Petechiae, Bruising
Hepatosplenomegaly

132
Q

Dx of ALL

A

Bone marrow: Hypercellular with More than 20% blasts

133
Q

Tx of ALL

A 
Oral Chemo (Imatinib, Hydroxyurea)
90% remission
134
Q

What is Chronic Lymphocytic Leukemia

A

50yrs or older

Most common leukemia in adults

135
Q

Sx of CLL

A

Asymptomatic, usually noted on blood tests

Fatigue, Increased infections, Lymphadenopathy, splenomegaly, hepatomegaly

136
Q

Dx of CLL

A

Peripheral Smear: Well-differentiated lymphocytes with scattered SMUDGE CELLS

137
Q

Tx of CLL

A

Observation if indolent
Chronic: Oral Chemo
Acute Blastic Crisis: Oral chemo (combination is best)

138
Q

What is Acute Myeloid Leukemia

A

50yrs or older

>20% blasts

139
Q

Sx of AML

A

Anemia, Thrombocytopenia, Neutropenia
Splenomegaly, gingival hyperplasia
Leukostasis (WBC >100,000)
CNS sx: Headaches, confusion, TIA, CVA

140
Q

Dx of AML

A

Auer Rods

?2-% blasts in bone marrow

141
Q

Tx of AML

A

Combination Chemo

BMT

142
Q

What is Chronic Myeloid Leukemia

A

Overproduction of myeloid cells

143
Q

Sx of Chronic Myeloid Leukemia

A

Most Asymptomatic

Blastic Crisis causes sx (acute leukemia)

144
Q

Dx of Chronic Myeloid Leukemia

A

Philadelphia Chromosome
WBC > 100,000
Increased LDH
Splenomegaly

145
Q

Tx of CML

A

Oral Chemo

146
Q

What is G6PD Deficiency

A

A hereditary enzyme defect that causes episodic hemolytic anemia because of the decreased ability of red blood cells to deal with oxidative stress
Associated with Heinz bodies that cause RBC membrane damage and removal by spleen

147
Q

Sx of G6PD Deficiency

A

Hemolysis due to oxidative stress by infection or exposure to drugs (Sulfa, Bactrim, Quinolones)

148
Q

Dx of G6PD Deficiency

A

Hgb < 8 g/dL
Bite cells seen in peripheral blood smear
Blister Cells
Heinz Bodies

149
Q

Tx of G6PD Deficiency

A

None

Avoid things that cause oxidative stress like drugs and certain foods

150
Q

What is Disseminated Intravascular Coagulation

A

Results from uncontrolled local or systemic activation of coagulation which leads to depletion of coagulation factors and fibrinogen as well as thrombocytopenia as platelets are activated and consumed
Associated with sepsis, cancer, trauma, and burns

151
Q

Sx of Disseminated intravascular coagulation

A

Bleeding at multiple sites such as IV catheters or incisions

152
Q

Dx of Disseminated Intravascular Coagulation

A

Early: Platelet and fibrinogen are normal
Progressive thrombocytopenia, Prolonged PT time
Elevated D-Dimer
Schistocytes on blood smear
HELLP Syndrome (Hemolysis, Elevated Liver Enyzmes, Low Platelets)

153
Q

Tx of Disseminated Intravascular Coagulation

A

Tx underlying disorder (Antimicrobials, chemo, surgery, delivery if pregnant)
Blood products only if significant hemorrhage

154
Q

What vaccinations are indicated for a person who received a Splenectomy

A

Pneumococcal
Meningococcal C Vaccine
Hib vaccine
Usually given 2 weeks prior to splenectomy or 2 weeks post-splenectomy

155
Q

What is Bell Palsy

A

Idiopathic facial paresis of lower motor neuron type
Involves facial nerve
Thought to be due to reactivation of herpes simplex or varicella zoster virus

156
Q

Sx of Bell Palsy

A

Facial paresis
Pain in ear first, then weakness but only lasts for a few days
Ipsilateral restriction of eye closure, difficultly eating
Taste disturbance
Inability to wrinkle forehead, smile on affected side, loss of nasolabial fold, drooping of corner of mouth

157
Q

Tx of Bell Palsy

A

Spontaneous recovery without treatment
Steroids (Prednisolone) increases chances of full recovery if started early
Acyclovir or Valacyclovir only indicated when evidence of herpetic vesicles on external ear canal

158
Q

What is a Subarachnoid Hemorrhage

A

Sudden, Thunderclap headache
Worst headache of my life
Arterial bleed between the arachnoid and pia

159
Q

How does a Subarachnoid Hemorrhage occur

A

Usually a Berry aneurysm rupture, AVM

160
Q

Sx of Subarachnoid Hemorrhage

A

Thunderlap sudden headache, worst headache of my life, stiff neck, photophobia, delirium

161
Q

Dx of Subarachnoid Hemorrhage

A

CT

If Negative, do LP: Xanthochromia (RBC), Increased CSF pressure and no focal neurological sx

162
Q

Tx of Subarachnoid Hemorrhage

A

Supportive

Bed rest, stool softeners, anti-anxiety meds

163
Q

What is a Brain Abscess

A

Presents as an intracranial space-occupying lesions and arises as a sequela of disease of ear or nose

164
Q

Sx of Brain Abscess

A

Headache, Drowsiness, Inattention, Confusion, Seizures

Signs of increased intracranial pressure then focal neurologic deficits

165
Q

Dx of Brain Abscess

A

CT: shows area of contrast enhancement surrounding low-density core
MRI

166
Q

Tx of Brain Abscess

A

IV antibiotics and surgical drainage (aspiration or excision)
Ceftriaxone, Metronidazole, Vancomycin
Serial CT scans every 2 weeks to show abscess removal
Dexamtheasone to reduce edema or IV Mannitol

167
Q

What does C5 nerve control

A

Arms and hands

168
Q

Sx of C5 injury

A

Can raise arms and bend elbows
Some or total paralysis of wrists, hands, trunk and legs
Can speak using diaphragm, but breathing will be weakened
Will need assistance with most ADL

169
Q

What function does UMN have

A

Connects cortex to LMN (in spinal cord)

Neurotransmitter glutamate transmits nerve impulses from UM to LMN (via glutamate receptors on receiving LMN)

170
Q

What causes UMN lesions

A

Stroke (CVA)
MS
Cerebral Palsy
Brain or Spinal Cord Damage

171
Q

Sx of UMN Lesions

A

Spacity (Hypertonia) with Increased DTR due to removal of inhibitory influence of cortex
Weakness
No Fasciculations
Upward Babinksi reflex (extension of great toe and fanning outward of other toes)
Little or No Muscle Atrophy

172
Q

What is Nephrolithiasis

A

Stones in the urinary system

Most are Calcium, Uric Acid, Struvite Stones, or Cystine

173
Q

Sx of Nephrolithiasis

A

Renal Colic: Sudden onset of constant upper/lateral back pain over the CVA radiating to groin
Nausea/Vomiting
Inability to find comfortable position
Positive CVA tenderness

174
Q

Dx of Nephrolithiasis

A

Urinalysis: Microscopic hematuria
Noncontrast CT is 1st diagnostic test
Renal Ultrasound

175
Q

Tx of Nephrolithiasis

A

Stones <5mm spontaneous passage, give IV fluids, analgesics, and antiemetics
Stones >7mm Shock wave lithotripsy, Uretoscopy with stent, Percutaneous Nephrolithotomy (usually reserved for large stones >10mm or Struvite)

176
Q

What is Bipolar Disorder Type 1

A

More than 1 manic episode and occasional Major Depressive Epsidoes

177
Q

What is Mania

A

Abnormal and persistent elevated, expansive or irritable modd that lasts for at least 1 week with marked impairment of social/occupational functions

178
Q

Tx of Bipolar Disorder Type 1

A

Mood Stabilizers: 2nd or 1st generation antipsychotics
May add SSRI for depressive sx
Cognitive, Bheavioral, and Interpersonal therapy

179
Q

What is Bipolar Disorder Type 2

A

Hypomania + Major Depressive Disorder
Hypomania: Period of elevated expansive or irritable mood for at least 4 days, does not cause impairment of social/occupational functions

180
Q

Tx of Bipolar Disorder Type 2

A

Mania: Lithium, Valproate, 2nd generation antipsychotic
Depression: Lithium, Valproate, Carbamazepine, 2nd Generation antipsychotics
Mixed: Atypical antipsychotics, Valproate

181
Q

What are features of Bacterial Vaginosis

A

Due to decrease in lactobacilli, leads to overgrowth of normal flora
Vaginal odor, worse after sex, Pruritis
Thin, homogenous, watery grey-white fish rotten smell

182
Q

Dx of Bacterial Vaginosis

A

Clue Cells

Few WBC

183
Q

Tx of Bacterial Vaginosis

A

Metronidazole (Flagyl) x 7 days

No douching

184
Q

What are features of Trichomoniasis

A

Pear shaped flagellated protozoa
Sexually Transmitted
Vulvular pruritis, erythema, dysuria

185
Q

Sx of Trichomoniasis

A 
Copious malodorous discharge
Frothy yellow green discharge, worse with menses
Strawberry Cervix (Cervical Petechiae)
186
Q

Dx of Trichomoniasis

A

Mobile Protozoa on wet mount

187
Q

Tx of Trichomoniasis

A

Metronidazole (Flagyl) 2g oral 1x or 500mg bid PO x7days

188
Q

What are features of Candida Vulvovaginitis

A

Overgrowth of Candida Albicans

189
Q

Sx of Candida Vulvovaginitis

A

Vaginal and vulvar erythema, swelling, burning, pruritis
Burning when urine touches skin
Thick curd-like/cottage cheese discharge

190
Q

Dx of Trichomoniasis

A

Hyphae, Yeast on KOH prep

191
Q

Tx of Candida

A

Fluconazole PO 1x

Intravaginal antifungals like Nystatin, Miconazole

192
Q

What are features of Chlamydia

A

Chlamydia Trachomatis
Most common cause of cervicitis
May have mucopurulent cervicit, increased frequency, dysuria, abdominal pain, post coital bleeding

193
Q

Dx of Chlamydia

A

LCR, Cultures

194
Q

Tx of Chlamydia

A

Azithromycin 1g PO 1x or Doxycycline 100mg PO bid x10days

Treat for gonorrhea too

195
Q

What are features of Gonorrhea

A

Neisseria Gonorrheae

Vaginal dischrage, cervicitis, increased frequency, dysuria

196
Q

Dx of Gonorrhea

A

Culture, DNA

197
Q

Tx of Gonorrhea

A

Ceftriaxone 250mg IM 1x

Cefixime

198
Q

What are features of Chancroid

A

Haemophilus Ducreyi
Genital Ulcer: Soft, shallow, PAINFUL may have foul discharge
Painful inguinal lymphadenopathy

199
Q

Tx of Chancroid

A

Azithromycin

Ceftriaxone

200
Q

What are features of HPV

A

Oncogenic: 16 and 18
Genital Warts: 6, 11
Flat, papular, pedunculated or flesh colored growths, cauliflower like lesions

201
Q

Dx of HPV

A

Whitening with acetic acid on cervix

Colposcopy, biopsy to look for dysplasia or cancer

202
Q

Tx of HPV

A

Cryotherapy, surgical removal

203
Q

Discuss Pap Smear Management

A 
Every 2 years starting at 21-29
Every 3 years after 30
Stop after 65
If Positive HPV and greater than 25
-Cytology and HPV testing in 12 months or Genotype for HPV 16, 18
If ASCUS and greater than 25yrs
-HPV testing: If Negative repeat pap and HPV in 3 years, if Positive Colposcopy with biopsy
If ASC-H
-Colposcopy
If LSIL
-Colposcopoy with Biopsy
-If Negative HPV repeat cytology in 1 year
-If HPV Positive, Colposcoy with biopsy
204
Q

What is a Molar Pregnancy

A

Hydatidiform: Neoplasm due to abnormal p lacental development with trophoblastic tissue proliferation arising from gestational tissue
Complete: Egg with no DNA fertilized by 1 or 2 sperm (46xx)
Partial: Egg fertilzied by 2 sperm

205
Q

Sx of Molar Pregnancy

A

Painless vaginal bleeding
Uterine size/date discrepancies
Hyperemesis Gravidarum
Choriocarcinoma

206
Q

Dx of Molar Pregnancy

A

Beta-HcG is markedly elevated (>100,000), Low maternal serum alpha-fetoprotein
Ultrasound: snowstorm or cluster of grapes apperance, no products of conception seen in complete

207
Q

Tx of Molar Pregnancy

A

Uterine suction curettage ASAP

If METS: Chemo (Methotrexate) which destroys trophoblastic tissue

208
Q

What is Dysfunctional Uterine Bleeding

A

Abnormal frequency/intensity of menses due to nonorganic causes
-Amenorrhea, Cryptomenorrhea, Menorrhagia, Metrorrhagia, Menometrorrhagia, Oligomenorrhea

209
Q

Dx of Dysfunctional Uterine Bleeding

A

Diagnosis of Exclusion
Need to exclude organic cause (Reproductive, systemic iatrogenic causes)
Workup includes: Hormone levels, transvaginal ultrasound, endometrial biopsy

210
Q

Tx of Dysfunctional Uterine Bleeding

A

OCP, Progesterone, GnRH

Hysterectomy, Endometrial Ablation

211
Q

What is Gout

A

Uric Acid Deposition in soft tissues, joints, and bones
Usually caused by purine rich foods (alcohol, liver, oily fish, yeast) causing rapid change sin uric acid concentrations
Diuretics, ACE-I, Ethambutol, ASA, ARBs also cause it

212
Q

Sx of Gout

A

Monoarthropathy with joint erythema, swelling and stiffness
Podagra: 1st MTP joint involvement
Knees, Feet, and Ankles are common
Tophi Deposition
Uric acid neprholithiasis and nephropathy

213
Q

Dx of Gout

A

Arthrocentesis: Negatively birefringent needle-shaped urate crystals
Xrays: Rat Bite, punched out erosions

214
Q

Tx of Gout

A

Acute: NSAIDS (Indomethacin), Colchicine is 2nd line
Chronic: Allopurinol, Febuxostat, Uricosuric Drugs, Colchicine

215
Q

What is Rheumatoid Arthritis

A

Chronic inflammatory disease with persistent symmetric polyarthritis with bone erosion, cartilage destruction and joint structure loss
T-Cell Mediated

216
Q

Sx of Rheumatoid Arthritis

A

Fevers, Fatigue, Weight Loss, Anorexia
Small Joint Stiffness: MCP, Wrist, PIP, Knee
Worse in the morning, better as day goes on
Morning joint stiffness >60min
Swollen, tender, erythematous boggy joint, swan neck deformity, Ulnar deviation at MCP

217
Q

Dx of Rheumatoid Arthritis

A

Positive RF
Positive Anti-Citrullinated Peptide Antibodies (Anti-CCP)
Arthritis in more than 3 joints, morning stiffness, disease duration longer than 6 weeks
Xray: Narrow joint space, subluxation deformities, ulnar deviation of hand

218
Q

Tx of Rheumatoid Arthritis

A

DMARDS (Methotrexate, Hydroxychloroquine)
NSAIDS for pain control
Low-Dose Steroids

219
Q

What is Osteoarthritis

A

Chronic disease due to articular cartilage damage and degeneration
Obesity is a risk factor
Found on weight bearing joints, knees, hips, cervical/lumbar spine, hip

220
Q

Sx of Osteoarthritis

A

Evening joint stiffness, better with rest, worse as day progresses
Herberden’s Nodes, Bouchard’s Nodes

221
Q

Dx of Osteoarthritis

A

Joint space narrowing
Osteophytes
Subchondral cysts/sclerosis

222
Q

Tx of Osteoarthritis

A

NSAIDS
Acetaminophen in elderly due to bleeding risk with NSAIDS
Corticosteroid injections

223
Q

What is Reactive Arthritis

A 
Reiter's Syndrome
Autoimmune response to infection in another part of the body
Asymmetric inflammatory artrhtis
Conjunctivitis/Uveitis
Urethritis, Cervicitis
224
Q

What pathogen is associated with Reactive Arthritis in young people

A

Chlamydia

225
Q

Sx of Reactive Arthritis

A

Can’t see, can’t pee, can’t climb a tree

  • Conjunctivitis
  • Urethritis
  • Arthritis
226
Q

Dx of Reactive Arthritis

A

HLA-B27
Increased WBC, Increased ESR
Synovial Fluid: WBC <8,000, BActerial culture is negative (aseptic)

227
Q

Tx of Reactive Arthritis

A

NSAIDS
Abx to treat underlying systemic infection that triggered disease
If no response, methotrexate, steroids, anti-TNF agents

228
Q

What is Septic Arthritis

A

Infection in the joint cavity

This is an emergency

229
Q

What pathogens are seen in Septic Arthritis

A

S. Auerus is most common
N. Gonorrhea in sexually active young people
Streptococci

230
Q

Sx of Septic Arthritis

A

Single, swollen warm and painful joint that is tender to palpation
Fevers, chills, sweats, myalgias, malaise, pain

231
Q

Dx of Septic Arthritis

A

Arthrocentesis: WBC >50,000, primarily PMNs, gram stain and culture

232
Q

Tx of Septic Arthritis

  • Gram Positive Cocci
  • Gram Negative Cocci
  • Gram Negative Rods
A

Gram Positive Cocci: Nafcillin (Vancomycin if MRSA)
Gram Negative Cocci: Ceftriaxone (Cipro if PCN allergy)
Gram Negative Rods: Ceftriaxone + Gentamicin

233
Q

What is Carpal Tunnel Syndrome

A

Median Nerve entrapment/Compression

Usually seen with DM

234
Q

Sx of Carpal Tunnel Syndrome

A 
Parasthesias and Pain of palmar first 3 digits
Thenar muscle wasting
Weakness in thumb
Pain is worse at night
Pain is decreased with shaking hands
235
Q

Dx of Carpal Tunnel Syndrome

A

Tinel’s Sign: Percussion of median nerve produces sx

Phalen’s Sign: Flex wirsts for 30 seconds produces sx

236
Q

Tx of Carpal Tunnel Syndrome

A

Volar Splints
NSAIDS
Corticosteroids
Surgery in refractory cases

237
Q

What is Dequervain’s Tenosynovitis

A

Stenosing tenosynovitis of abductor pollicus longus and extensor pollicus brevus

238
Q

How does Dequervain’s Tenosynovitis occur

A

Excessive thumb use with repetitive action

Seen in golvers, clerical workers

239
Q

Sx of Dequervain’s Tenosynovitis

A

Pain along radial aspect of wrist radiating to forearm especially with thumb extension or gripping, radial styloid pain

240
Q

Dx of Dequervain’s Tenosynovitis

A

Positive Finkelstein Test: Pain with ulnar deviation or thumb extension

241
Q

Tx of Dequervain’s Tenosynovitis

A

Thumb spica split 3x/wk
NSAIDS for 2 weeks
Steroid Injections
PT

242
Q

What is Colles Fracture

A

Distal radial fracture with dorsal angulation

243
Q

What causes Colles Fracture

A

FOOSH with wrist extension

244
Q

Dx of Colles Fracture

A

Dinner Fork Deformity: Need Lateral view to distinguish from Smith Fracture

245
Q

What is a complication with Colles Fracture

A

Extensor pollicus longus tendon rupture

246
Q

Tx of Colles Fracture

A 
Sugar Tong Splint/Cast
If stable (<20 degree angulation) can do closed reduction
247
Q

How does a Posterior Shoulder Dislocation Occur

A

Forced Adduction, Internal Rotation

Associated with seizures, shocks, direct trauma

248
Q

Sx of Posterior Shoulder Dislocation

A

Adducted, internally rotated

Anterior shoulder is flat, Humeral head is prominent

249
Q

Tx of Posterior Shoulder Dislocation

A

Reduction

250
Q

How does a Radial Head Fracture Occur

A

FOOSH

251
Q

Sx of Radial Head Fracture

A

Lateral (radial) elbow pain, inability to fully extend elbow

252
Q

Dx of Radial Head Fracture

A

Fat Pad Sign: Posterior or increased Anterior

253
Q

Tx of Radial Head Fracture

A

If non-displaced: Sling, Long arm splint 90 degrees

If displaced: Open Reduction Internal Fixation

254
Q

What is an Anterior Dislocation of Radial Head

A

Usually occurs in men who sustain high-force injury
In kids: Subluxation is more common rather than dislocated
Usually occurs after MVA, significant falls, FOOSH injury

255
Q

Sx of Anterior Dislocation of Radial Head

A

Person holds elbow flexed at 90 degrees
Resists passive and active ROM at elbow
Elbow is swollen and tender especially at radial head

256
Q

Tx of Anterior Dislocation of Radial Head

A

Reduction

257
Q

What is an Ankle Sprain

A

Usually involves Anterior Talofibular or Calcaneofibular ligament

258
Q

Sx of Ankle Sprain

A

Hear a pop followed by swelling, pain, inability to bear weath

259
Q

Tx of Ankle Sprain

A

RICE
NSAIDS
Increase ROM and Conditioning

260
Q

What are the Ottawa Ankle Rules

A

Inability to walk more than 4 steps at the time of injury or in the ER AND
Ankle Films: Pain along Lateral Malleolus or Pain along Medial Malleolus
Foot Films: Midfoot Pain or 5th metatarsal or navicular pain

261
Q

What is Mallet Finger

A

Avulsion of extensor tendon with sudden blow to the tip of extended finger with forced flexion

262
Q

Sx of Mallet Finger

A

Unable to straighten distal finger
It looks flexed at DIP joint
Usually associated with avulsion fracture of distal phalanx
Finger is painful, swollen, and bruised

263
Q

Tx of Mallet Finger

A

Splint the DIP joint with uninterrupted extension for 6 weeks
Surgical Pinning

264
Q

What is Gamekeeper’s Thumb

A

Ulnar collateral ligamental injury of the thumb

Causes instability of CMP joint

265
Q

How does Gamekeeper’s Thumb occur

A

Forced abduction of thet humb

266
Q

Sx of Gamekeeper’s Thumb

A

Thumb far away from the other digits

MCP tenderness, weakness in pinch strength

267
Q

Tx of Gamekeeper’s Thumb

A

Thumb Spica

Referral to hand surgeon because it affects pincer function

268
Q

What is Boxer’s Fracture

A

Fracture at the neck of the 5th metacarpal

269
Q

How does a Boxer’s Fracture occur

A

Punch with clenched fist

270
Q

Tx of Boxer’s Fracture

A

Ulnar gutter splint with joints in at least 60 degree flexion

271
Q

How does a Meniscal Tear occur

A

Degenerative, usually with squatting, twisting, compression or trauma with rotation and axial loading

272
Q

Sx of Meniscal Tears

A

Locking, popping, giving way, effusion after activities

Positive Mcmurray’s Sign: Pop or click while tibia is externally and internally rotated

273
Q

Tx of Meniscal Tears

A

NSAIDS
Partial weight bearing until ortho follow up
Arthroscopy

Emergency Medicine (6 decks)

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