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High Yield Flashcards

1
Q

What is Pulmonary HTN

A

Increased pulmonary vascular resistant

Leads to RVH and eventual Right sided HF

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2
Q

What causes Pulmonary HTN

A

Idiopathic - Usually middle age or young women

Secondary is COPD, sleep apnea

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3
Q

Sx of Pulmonary HTN

A

Dyspnea, Chest Pain, Weakness, Fatigue, Cyanosis

Signs of Right sided HF

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4
Q

Dx of Pulmonary HTN

A

Right sided Cath is definitive: Pulmonary Artery PRessure >25 mmHg at rest or >35 mmHg during exercise)
CXR see enlarged pulmonary arteries
EKG shows Cor Pulmonale (RVH, RAE, RAD, RBB)

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5
Q

Tx of Pulmonary HTN

A 
Vasodilators
-CCB are 1st line
-Phosphodiesterase-5-Inhibitors (Sildenafil)
-Prostacyclins (Epoprostenol)
-Endothelin Receptor Antagonists
Oxygen
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6
Q

What is Systolic HF

A

Most common form of CVF

Decreased EF associated with S3 gallop

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7
Q

Sx of HF

A

Left Sided: Dyspnea, Pulmonary Congestion Rales, Rhonchi, HTN
Right Sided: Peripheral Edema, JVD, GI/Hepatic Congestion

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8
Q

Dx of HF

A

Echo is #1: See Decreased EF, thin ventricular walls, dilated LV chamber with Systolic HF
See Normal EF, thick ventricular walls, small LV chamber with Diastolic HF
CXR: Cephalization, Kerley B lines, Cardiomegaly, Pleural Effusions
BNP

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9
Q

Tx of HF

A

Ace-I are 1st line! They decrease Mortality, decrease preload/afterload
Beta-Blockers decreased mortality, Increased EF
Nitrates decrease mortality, decrease preload
Diuretics tx the symptoms (furosemide, spironolactone, HCTZ)
Digoxin tx the symtpoms

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10
Q

What is Thrombophlebitis

A

Inflammation of superficial vein and or thrombus

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11
Q

What causes Thrombophlebitis

A

Usually IV cath, trauma, pregnancy, varicose veins

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12
Q

Sx of Thrombophlebitis

A

Tenderness, Pain, Induration, Edema, Erythema along course of superficial vein, Palpable Cord

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13
Q

Dx of Thrombophlebitis

A

Venous Duplex Ultrasound: Noncompressible vein with clot

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14
Q

Tx of Thrombophlebitis

A

Supportive: Extremity elevation, warm compress, increase activity, NSAIDS, Compression Stockings
Phelbectomy if extensive varicose veins

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15
Q

What is Myocarditis

A

Inflammation of the heart muscle

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16
Q

What causes Myocarditis

A

Viral: Entervorisus like Coxsackie B, Echovirus

SLE, Rheumatic Fever

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17
Q

Sx of Myocarditis

A

Viral Prodrome (Fever, Myalgias, Malaise)
HF sx: Exercise Intolerance, Syncope, Tachypnea, Tachycardia, S3 gallop
Pericarditis

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18
Q

Dx of Myocarditis

A 
Endomycardial Biopsy is Gold Standard: Shows infiltrations of lypmhocytes with myocardial tissue necrosis
CXR shows Cardiomegaly
EKG: Sinus Tach
Cardiac Enzymes: CK-MB and Troponin
Echo shows ventricular dysfunction
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19
Q

Tx of Myocarditis

A

Supportive with diuretics, Ace-I, Dopamine

IVIG

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20
Q

What is Dilated Cardiomyopathy

A

Most common form of Cardiomyopathy

Systolic dysfunctions leads to ventricular dilation which leads to dilated weak heart

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21
Q

What causes Dilated Cardiomyopathy

A

Idiopathic
Viral: Enterovirus (Coxsackie, Echo), Parvovirus
Alcohol Abuse

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22
Q

Sx of Dilated Cardiomyopathy

A

Systolic HF sx (S3, Fatigue, Syncope, Dyspnea)

Arrhythmias, Chest Pain on Exertion

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23
Q

Dx of Dilated Cardiomyopathy

A

Echo: LV dilation, Low EF, LV Hyopkinesis
DXR: Cardiomegaly, Pulmonary Edema, Pleural Effusion
EKG: Sinus Tach

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24
Q

Tx of Dilated Cardiomyopathy

A 
Ace-I
Diuretics
Digoxin
Beta Blockers
Implantable Defibrillator if Ef <30-35%
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25
Q

What is Restricted Cardiomyopathy

A

Impaired Diastolic function with preserved contractility

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26
Q

What causes Restricted Cardiomyopathy

A

Infiltrative Disease: Amyloidosis, Sarcoidosis

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27
Q

Sx of Restrictive Cardiomyopathy

A

Right Sided HF: Increased JVD, Kussmaul’s sign,

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28
Q

Dx of Restrictive Cardiomypathy

A

Echo: Ventricles are non-dilated with normal wall thickness, Dilated atria

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29
Q

Tx of Restrictive Cardiomyopathy

A

Tx the sx: Diuresis, Vasodilators

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30
Q

What is Hypertrophic Cardiomyopathy

A

Inherited genetic disorder of inappropriate LV or RV Hypertrophy

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31
Q

What causes Hypertrophic Cardiomyopathy

A

Hypertrophied Septum with Systolic anterior motion

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32
Q

Sx of Hypertrophic Cardiomyopathy

A

Dyspnea, Fatigue, Angina, Syncope, Arrhythmias (AF, Palpitations), Sudden Cardiac Death

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33
Q

What Murmur do you hear with Hypertrophic Cardiomyopathy

What maneuvers increase/decrease the murmur

A

Harsh systolic crescendo-decrescendo best heard at LUSB
Increase Murmur: Valsalva and Standing
Decrease Murmur: Squatting, Laying Down

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34
Q

Dx of Hypertrophic Cardiomyopathy

A

Echo: Asymmetrical wall thickness, SYstolic anterior motion of mitral valve
EKG: LVH, Atrial Enlargement

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35
Q

Tx of Hypertrophic Cardiomyopathy

A

Beta Blockers are 1st line!
CCB
Myomectomy
Alcohol Septal Ablation

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36
Q

What is Atrial Fibrillation

A

No P-waves

Irregularly Irregular Rhythm

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37
Q

Tx of Atrial Fibrillation

A

Rate Control: Vagal Maneuvars, CCB, Beta-Blockers

Rhythm: DC Cardioversion (3-4 weeks after anticoagulation)

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38
Q

What are the criteria for CHADS to prevent stroke and what does it mean

A 
C: CHF 1 point
H: HTN 1 point
A: Age >75 years 1 point
D: DM 1 point
S: Stroke 2 points

Tx

  • 0-1: No tx or ASA
  • 1: Warfarin or ASA
    2: Warfarin for sure but INR between 2-3
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39
Q

What is Sick Sinus Syndrome

A

Combination of sinus arrest with bradycardia and tachycardia

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40
Q

What causes Sick Sinus Syndrome

A

SA node Disease or corrective cardiac surgery

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41
Q

Tx of Sick Sinus Syndrome

A

Permanent Pacemaker if symptomatic

If severe, permanent pacemaker with implantable cardioverter defibrillator

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42
Q

What is Sinus Bradycardia

A

Normal Sinus Rhythm with rate <60bpm

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43
Q

What causes Sinus Bradycardia and who is it seen in

A

Young athletes, Vasovagal Reaction, Increased Intracranial Pressure
BB, CCB, Digoxin, Carotid Massage

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44
Q

Tx of Sinus Bradycardia

A

Atropine is 1st line if symptomatic
Epinephrine Transcutaneous Pacing
Permanent Pacemaker is definitive

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45
Q

What is Paroxysmal Supraventricular Tachycardia

A

Sudden onset and termination of tachycardia

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46
Q

Tx of Paroxysmal Supraventricular Tachycardia

A

Vagal Maneuvers, Adenosine, BB or CCB, Cardioversion if unstable

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47
Q

What is Wolff-Parkinson White

A

An accessory pathway (Kent Bundle) that pre-excites the ventricle

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48
Q

What do you see on EKG for WPW

A

Delta Waves (Slurred QRS upstroke, wide QRS, and short PR interval)

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49
Q

Tx of WPW

A

Vagal Maneuvers
Antiarrhythmics like Procainamide, Amidoraone
Radiofrequency Ablation is definitive

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50
Q

What causes Aortic Stenosis

A

Degeneration
Congenital
Rheumatic Disease

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51
Q

Sx of Aortic Stenosis

A

Angina, Syncope, CHF

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52
Q

What type of murmur is heard with Aortic Stenosis

A

Systolic Ejection Crescendo-Decrescendo heard best at RUSB

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53
Q

Where does an Aortic Stenosis murmur radiate to

A

Carotid Arteries

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54
Q

What are features of Aortic Stenosis

A

Pulsus Parvus Et Tardus (weak, delayed pulse)

Narrow Pulse Pressure

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55
Q

What is Mitral Regurgitation

A

Backflow from LV into LA that leads to volume overload

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56
Q

What causes Mitral Regurgitation

A

Mitral Valve Prolapse
RHD, Endocarditis
Ischemia, Papillary Muscle Rupture, Chordae Tendinate after MI

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57
Q

Sx of Mitral Regurgitation

A

Pulmonary Edema, Dyspnea

A.Fib, CHF

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58
Q

What type of murmur is heard with Mitral Regurgitation

A

Blowing Holosystolic murmur heard best at the apex

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59
Q

Where does a Mitral Regurgitation murmur radiate to

A

Axilla

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60
Q

What is Aortic Regurgitation

A

Backflow from aorta to LV leads to LV volume overload

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61
Q

What causes Aortic Regurgitation

A

Rheumatic heart disease, HTN, Endocarditis, Marfans

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62
Q

Sx of Aortic Regurgitation

A

Right Sided HF

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63
Q

What type of murmur is heard with Aortic Regurgitation

A

Blowing, Diastolic Decrescendo heard best at LUSB

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64
Q

Where does an Aortic Regurgitation murmur radiate to

A

Left Sternal Border

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65
Q

What are other features of Aortic Regurgitation

A

Bounding Pulses
Wide Pulse Pressure
Pulse Bisferiens

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66
Q

What is Mitral Stenosis

A

Obstruction of flow from LA to LV leads to left atrial enlargement

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67
Q

What causes Mitral Stenosis

A

Rheumatic Heart Disease!!

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68
Q

Sx of Mitral Stenosis

A

Right sided HF
Pulmonary HTN
A.Fib

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69
Q

What type of murmur is heard with Mitral Stenosis

A

Diastolic Rumble hears best at apex

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70
Q

Where does Mitral Stenosis murmur radiate to

A

Nowhere

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71
Q

What are other features of Mitral Stenosis

A

Opening Snap

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72
Q

What is a 1st degree Heart Block

Tx

A

Constant Prolonged PR interval (>0.20)
Every P-Wave is followed by QRS
Tx: None

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73
Q

What is a 2nd degree Heart Block Type I (Mobitz I: Wenckebach)

A

Progressive lengthening of PR interval with eventual dropped QRS
Tx: If no sx, just observe. If sx, Atropine, Epineprhine

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74
Q

What is a 2nd degree Heart Block Type II (Mobtiz II)

A

Constant PR Interval, eventual dropped QRS

Tx: Permanent Pacemaker

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75
Q

What is a 3rd degree Heart Block

A

Complete AV dissociation: P-waves are not related to QRS
Results in decreased Cardiac Output
Tx: Permanent Pacemaker

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76
Q

What is HTN

A

Elevated BP reading on more than 2 occasions

Systolic >140, Diastolic >90

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77
Q

What is secondary HTN

A

Usually due to renal artery stenosis, primary hyperaldosteronism, pheochromocytoma

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78
Q

What are complications of HTN

A

CAD, HF, MI, LVH, Renal Stenosis and Sclerosis

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79
Q

Sx of HTN

A

Papilledema is advanced stage
Retinopathy: Arterial Narrowing, AV Nicking, Soft Exudates
Striae, Carotid Bruits, JVD

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80
Q

Tx of HTN

A 
Goal is to be <140/90
If DM: <130/80
Lifestyle Modification is 1st, DASH diet, stop smoking, Exercise, Stop Drinking
HCTZ is 1st line
Ace-I provides cardioprotection
CCB
Beta Blockers
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81
Q

What is Nursemaid’s Elbow

A

Due to lifting/swinging/pulling a child

The radial head wedges into stretched annular ligament

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82
Q

Sx of Nursemaid’s Elbow

A

Child presents with arm slightly flexed, refuses to arm

Tenderness to palpation

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83
Q

Tx of Nursemaid’s Elbow

A

Reduction (pressure on radial head with supination and flexion)

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84
Q

What is Carpal Tunnel Syndrome

A

When the median nerve is entrapped or compressed

Seen with DM

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85
Q

Sx of Carpal Tunnel Syndrome

A

Parasthesias and pain of palmar 1st 3 and digits, usually at night
Thenar Muscle Wasting, Weakness of Thumb
Worse pain at night
Shaking hands reduces pain

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86
Q

Dx of Carpal Tunnel Syundrome

A

PHalen’s Sign: Flex both wrists for 30-60 seconds to reproduce pain
Tinel’s Sign: Percuss median nerve reproduces pain

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87
Q

Tx of Carpal Tunnel Syndrome

A

Volar Splint
NSAIDS
Corticosteroids

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88
Q

What is Spinal Stenosis

A

Narrowing of the spinal canal with impingement of nerve roots

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89
Q

Sx of Spinal Stenosis

A

Back pain with parasthesias in one or both extremtiies
Worse with extension and prolonged standing/walking
Better with Flexion, sitting, and walkin uphill (flexion increases canal volume)

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90
Q

Tx of Spinal Stenosis

A

Lumbar epidural injection of steroids

Decompression laminectomy

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91
Q

What is Dequervain’s Tenosynovitis

A

Stenosing tenosynovitis of abductor pollicus longus and extensor pollicus brevus
Due to repetitive thumb movements like golfers, clerical workers

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92
Q

Sx of Dequervain’s Tenosynovitis

A

Pain along radial aspect of wrist that radiates to forearm

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93
Q

Dx of Dequervain’s Tenosynovitis

A

Finkelstein Test: Pain with ulnar deviation or thumb extension

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94
Q

Tx of Dequervain’s Tenosynovitis

A

Thumb Spica Splint for 3 weeks
NSAIDS
Steroid Injections

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95
Q

What is Osgood Schlatter Disease

A

Osteochondritis of the patellar tendon at the tibial tuberosity from overuse
Usually seen in adolescent males with growth spurts

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96
Q

Sx of Osgood Schlatter Disease

A

Activity related knee pain with swelling

Tenderness to anterior tibial tubercle

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97
Q

Dx of Osgood Schlatter Disease

A

Xray shows ossification at tibial tuberosity

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98
Q

Tx of Osgood Schlatter Disease

A

RICE
NSAIDS
Quadriceps Stretching

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99
Q

What is Osteoarthritis

A

Chronic disease due to articular cartilage damage and degeneration
Obesity is risk factor
Common in weight bearing joints
Narrowed joint space, sclerosis, and osteophyte formation

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100
Q

Sx of Osteoarthritis

A

Evening joint stiffness, decreases with rest, worsens as day progresses
Heberden’s Nodes (Palpable Osteophytes at DIP)
Bouchard’s Nodes (PIP osteophytes)

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101
Q

Dx of Osteoarthritis

A

Xray: Narrowed joint space, osteophyte formation, subchondral bone cysts/sclerosis

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102
Q

Tx of Osteoarthritis

A

Acetaminophen in elderly
NSAIDS in everybody else
Corticosteroid injections

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103
Q

What is Osteoporosis

A

Loss of bone density over time due to increased aborption of bone or decreased formation of new bone
Loss of both bone mineral and matrix

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104
Q

What are causes of Osteoporosis

A

Primary: Postmenopausal and Senile
Secondary: Following chronic disease or meds (corticosteroids)

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105
Q

Sx of Osteoporosis

A

Asymptoamtic
Pathologic Fractures
Spine Compression
Back Pain

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106
Q

Dx of Osteoporosis

A

Serum Calcium, Phosphate, PTH, ALP are usually normal

DEXA Scan: Osteoporosis T Score

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107
Q

Tx of Osteoporosis

A 
Bisphosphonates are 1st line
Vitamin D (Ergocalciferol)
Raloxifene (Selective Estrogen Receptor Modulator)
Estrogen in postmenopausal women
Calcitonin is last line
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108
Q

What is Rheumatoid Arthritis

A

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

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109
Q

Sx of RA

A

Small joint stiffness (MCP, wirst, PIP, Knee< MTP, shoulder, ankle)
Worse with rest, morning joint stiffness > 60 minutes
Gets better with movement throughout the day
Symmetric arthritis, boggy joints
Boutonniere defomirty (flexion at PIP)
Swan Neck Deformity (flexion at DIP)
Ulnar Deviation at MCP joint
Rhemuatoid NOdules

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110
Q

Dx of RA

A

Positive RF
Positive Anti-CCP MOST SPECIFIC!
Xray: Narrowed joint space, subluxation, ulnar deviation

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111
Q

Tx of RA

A

DMARDS: Methotrexate, Hydroxychloroquine

NSAIDS for pain, low does steroids

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112
Q

What is Gout

A

Uric Acid deposition in soft tissues, joints, and bone

Due to purine rich foods (meats, chocolate, alcohol, yeasts), Diuretics, Ace-I

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113
Q

Sx of Gout

A

Joint erythema, swelling, stiffness
Podagra (1st MTP), Knees, feet, ankles
Tophi deposition
Uric acid nephrolithiasis and nephropathy

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114
Q

Dx of Gout

A

Arthrocentesis: Negatively Birefringent Needle Shaped Urate Crystals
Xray: Mouse/Rat Bite punched out erosions

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115
Q

Tx of Gout

A

NSAIDS (Indomethacin)
Colchicine is 2nd line
Allopurinol for Chronic management (Colchicine for chronic too)

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116
Q

What is Pseudogout

A

Calcium Pyrophopshate deposition in joints and soft tissue
Acute arthritis seen in knee
Red, swollen, tender joint

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117
Q

Dx of Pseudogout

A

Positively birefringent, Rhomboid-shaped CPP cyrstals

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118
Q

Tx of Pseudogout

A

Corticosteroids
NSAIDS
Colchcine

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119
Q

What is Ankylosing Spondylitis

A

Chronic inflammatory arthropathy of the axial skeleton and sacroiliac joints with progressive stiffness

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120
Q

Sx of Ankylosing Spondylitis

A

Chronic low back pain, morning stiffness with decreased ROM
Peripheral Arthritis, may develop sacroilitis
Pulmonary fibrosis

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121
Q

Dx of Ankylosing Spondylitis

A

Increased ESR
Positive HLA-B27
Bamboo Spine on xray (squaring of vertebral bodies)

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122
Q

Tx of Ankylosing Spondylitis

A

NSAIDS
Rest, Physical Therapy 1st line
TNF-Alpha Inhibitors
Steroids

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123
Q

What is an MCL and LCL Tear

A

MCL: Valgus stress with rotation
LCL: Varus stress with rotation

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124
Q

Sx of MCL/LCL Tear

A

Localized pain, swelling, ecchymosis, stiffness

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125
Q

What is an ACL Tear

A

Most common knee injury due to noncontact pivoting injury

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126
Q

Sx of ACL tear

A

Heard a pop and it swelled
Hemarthrosis
Knee buckling

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127
Q

Dx of ACL Tear

A

Lachman’s Test

Anterior Drawer Test

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128
Q

Tx of ACL Tear

A

Therapy

NSAIDS

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129
Q

What is a Meniscal Tear

A

Degnerative squatting twisting compression with rotation and axial loading

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130
Q

Sx of Meniscal Tear

A

Locking, Popping, giving way, effusion after activities

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131
Q

Dx of Meniscal Tear

A

Mcmurray’s sign (pop or click while tibia is externally and interanlly rotated

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132
Q

Tx of Meniscal Tear

A

NSAIDS
Partial weight bearing
Arthroscopy

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133
Q

What is Morton’s Neuroma

A

Degeneration/Proliferation of plantar digital nerve producing painful mass near tarsal heads
Usually seen in women with tight shoes, high heels or flats

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134
Q

Sx of Morton’s Neuroma

A

Lancinating pain with ambulation usually at 3rd metatarsal head
Reproducible pain on palpation
Palpable Mass
MRI may be used

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135
Q

Tx of Morton’s Neuroma

A

Wide shoes
Steroid injections
Surgical resection

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136
Q

What is Septic Arthritis

A

Infection in the joint cavity
A medical emergency
Usually hematogenous spread, direct inoculation via trauma, or contiguous spread

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137
Q

What is the most common pathogen in Septic Arthritis

A

Staph Auerus

Neisseria Gonorrhea in sexually active young adults

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138
Q

Sx of Septic Arthritis

A

Single, swollen, warm, painful joint, tender to palpation

Fevers, chills, sweats, myalgias

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139
Q

Dx of Septic Arthritis

A

Arthrocentesis: Joint Fluid Aspirate with WBC >50k mainly PMNs
Gram stain and culture
Crystals

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140
Q

Tx of Septic Arthritis

A

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

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141
Q

What is Giant Cell Arteritis

A

A vasculitis
Associated with Polymalgia Rheumatica
Usually seen in women >50yrs
Autoimmune

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142
Q

Sx of Giant Cell Arteritis

A

Headache, new onset and localized usually temporal
Jaw Claudication
Acute Vision Disturbances (Amaurosis Fugax: Monocular blindness), Anterior ischemic optic neuritis
Fatigue, weight loss, anorexia, fevers, night sweats
Tender scalp, decreases pulses
Aortic Aneurysm!

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143
Q

Dx of Giant Cell Arteritis

A

Increased ESR
Increased CRP
Temporal Artery Biopsy is definitive: See mononuclear lymphocyte infiltration, multinucleated gian cells, lamina cell degradation

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144
Q

Tx of Giant Cell Arteritis

A

High Dose Corticosteroids

Methotrexate

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145
Q

What is Sarcoidosis

A

Chronic Multisystemic, Inflammatory granulomatous disorder of unknown etiology
Lung is most commonly affected
Lymph Nodes
African Americans, Nortern Europeans, Females
Exaggerated T-Cell REsponse leads to Granuloma Formation

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146
Q

Sx of Sarcoidosis

A

Dry nonproducitve cough, dyspnea, chest pain
Painless hilar nodes, lymphadenopathy
Erythema Nodosum (bilateral tender red nodules on anterior legs)
Lupus Pernio (Violaceous raised discoloration of nose, ear, cheeck) Looks like frostbite
Uveitis (inflammation of iris and ciliary body)
Conjunctivitis
Arrhythmia
Arthrlagias
Fever, Malaise, weight loss
CN 7 Palsies

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147
Q

Dx of Sarcoidosis

A

Tissue Biopsy: Noncaseating granulomas
CXR: Bilateral hilar lymphadenopathy, Interstitial lung disease
PFT: Restrictive (normal or increased FEV/FVC, Lung volumes are decreased)
CT Scan: Ground glass, Fibrosis
Eosinophilia, Hypercalciuria, Increased ACE

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148
Q

Tx of Sarcoidosis

A

Observation
Oral Corticosteroids
Methotrexate, Hydroxychloroquine
NSAIDS

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149
Q

What is Asthma

A

Reversible hyperirritability of tracheobronchial tree
Leads to bronchoconstriction and inflammation
ATOPY: Asthma, Nasal Polyps, ASA/NSAID allergy, Eczema

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150
Q

Sx of Asthma

A

Dyspnea, Wheezing, Cough (especially at night)

Prolonged expiration with wheezing, Hyperresonance

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151
Q

Dx of Asthma

A

PFT is Gold Standard: Reversible (increased RV, TLC, RV/TLC)
Peak Flow Rate >15% from initial attempt (responds to tx)
Metacholine challenge test (Positive if >20% reduction in FEV1)
Bronchdilator Challenge test (Positive if >12% increase in FEV1 or >200cc)

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152
Q

What is Intermittent Asthma

Tx

A

<2x/week
Night: <2x/month
Albuterol use <2x/day
Tx: SABA (Albuterol)

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153
Q

What is Mild Persistent Asthma

A

> 2x/week
Night: 3-4x/month
Albuterol use >2days/week
Tx: SABA + low dose ICS (Beclomethasone, Flunisolide, Triamcinolone)

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154
Q

What is Moderate Persistent Asthma

A

Daily sx
Night: >1x/week but not nightly
Albuterol use daily
Tx: SABA + Medium ICS or LABA (Salmetrol, Fluticasone/Salmeterol)

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155
Q

What is Severe Persistent Asthma

A

Sx many times a day
Night: Nightly
Albuterol use many times a day
Tx: SABA + High ICS + LABA, possibly add Omalizumab (anti-IgE drug)

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156
Q

What is COPD

A

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

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157
Q

What causes COPD

A

Smoking

Alpha-1-Antitrypsin Deficiency (Alpha-1-Antitrypsin normally protects elastin in lungs)

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158
Q

What is Emphysema

A

Smoking leads to chronic inflammation and decreases protective enzymes, leads to increasing damaging enzymes, alveolar wall dstruction and loss of elastic recoid

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159
Q

Sx of Emphysema

A

Accessory muscle use, tachypnea, prolonged expiration

Hyperinflation: Hyperresonance to percussion, decreased breath sounds, decreased fremitus, barrel chest, pursed lips

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160
Q

What is Chronic Bronchitis

A

Productive cough lasting more than 3 months for 2 consectuvei years
Inflammation leads to mucous hypersecrtion and airway narrowing which leads to increased airway resistanc eleadsing to airway obstruction and mucous plugging

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161
Q

Sx of Chronic Bronchitis

A

Productive cough

Crackles, Rhoonchi, Wheezing, Signs of peripheral edema, Cyanosis

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162
Q

Dx of COPD

A

PFT is Gold Standard: Fev1/FVC <70% is dx (obstructive)
Hyperinflation: Increased lung volumes, increased RV, TLC
CXR: Hyperinflation, flat diaphragam, decreased vascular markings

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163
Q

Tx of COPD

A

Oxygen is only therapy to decreased mortality
Bronchodilators
-Anticholinergics (Tiotropium, Ipratropium)
-Beta-2 Agonists (Albuterol, Terbutaline, Salmeterol)
-Theophylline
Corticosteroids
Smoking cessation
Vaccinations: Pneumococcal and Influanza

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164
Q

What is the most common pathogen with Community Acquired Pneumonia and what does it look like

A

Strep Pneumoniae

Gram positive cocci

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165
Q

What is the 2nd most common cause of Community Acquired Pneumonia and what does it look like

A

H. Influenza

Gram Negative Rods

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166
Q

What is the most common pathogen with Atypical (Walking) Pneumonia and what does it look like

A

Mycoplasma Pneumoniae

No Cell Wall - doesn’t respond to beta-lactams

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167
Q

What pneumonia pathogen is associated with outbreaks related to cooling towards, A/C vents, and contaminated water supplies and what does it look like

A

Legionella

Gram Negative Rods

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168
Q

What pneumonia pathogen is associated with Alcoholics and what does it look like

A

Klebsiella

Gram Negative Rods

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169
Q

Name some Community Acquired Pneumonia pathogens

A 
S. Pneumonia
Mcoplasma
Chlamydia
H.Influenza
M.Catarrhalis
Legionella
Klebsiella
S. Aureus
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170
Q

Name some Hospital Acquired Pneumonia pathogens

A

Gram Negative Rods like Pseudomonas, Klebsiella

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171
Q

What are pathogens associated with Typical Pneumona vs. Atypical Pneumonia

A

Typical: Strep Pneumo, H. Influenza, Klebsiella, S. Aureus
Atypical: Mycoplasma, Chlamydia, Legionella, Viruses

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172
Q

What do you see on CXR with Typical vs. Atypical Pneumonia

A

Typical: Lobular
Atypical: Diffuse, patchy infiltrates

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173
Q

What are sx with Typical vs. Atypical Pneumonia

A

Typical: Sudden onset of fever, productive cough with sputum, pleuritic chest pain, Rigors, Tachycardia, Tachypnea. Bronchial breath sounds, dull to percussion, increased fremitus, egophony
Atypical: Low grade fever, dry, non-productive cough, myalgias, malaise, sore throat

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174
Q 
What does the sputum tell you about the organism involved in pneumonia
Rusty
Currant Jelly
Green
Fout Smelling
A

Rusty: Strep Pneumonia
Currant Jelly: Klebsiella
Green: H.Flu, Pseudomonas
Foul Smelling: Anaerobes

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175
Q

What is the treatment for Community Acquired Pneumonia in outpatient setting

A

Macrolide like Clarithromycin, Azithromycin
or
Doxycycline

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176
Q

What is the treatment for Community Acquired Pneumonia in inpatient setting

A

Beta-Lacta + Macrolide
Beta Lactams: Ceftriaxone, Defotaxime, Ampicilin Sulbactam (Unasyn)
Marolides: Clarithromycin, Azithromycin
OR
Broad spectrum Fluoroquinolones: Levafloxin, Gatifloxacin, Moxifloaxacin, Gemifloxacin

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177
Q

What is the treatment for Community Acquired Pneumonia in IUC setting

A

Beta-Lactam + Macrolide
OR
Beta-Lactam + Fluoroquinolones

Beta-Lactams: Ceftriaxone, Cefotaxime, Unasyn
Macrolides: Clarithromycin, Azithromycin
FQ: Levafloxacin, Moxifloxacin, Gemifloxacin

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178
Q

What are vaccines that can be given to people to prevent pneumonia

A

PCV13: Childhood vaccine at 2, 4, 6 months and last dose after 4 yrs
PPV23: Polyvalent Pneumococcal Vaccine in adults
-If >65 yrs revaccinate very 5 years
-If age 2-64 with chronic disease (DM, Alcoholic, liver disease, cardiac, pulmonary, immunocompromised)

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179
Q

What is the treatment for Atypical Pneumonia

A

Same as CAP Outpatient: Macrolide or Doxy

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180
Q

What is the treatment for a person with HIV and Pneumonia

A

Bactrim (TMP-SMX)

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181
Q

What is TB

A

Caused by Mycobacterium Tuberculosis that leads to granuloma formation

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182
Q

What is Primary TB

A

Initial infection, usually self-limited

Very Contagious

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183
Q

What is Chronic/Latent TB

A

A controlled TB infection
PPD will test positive in about 2-4 weeks after infection
Not Contagious

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184
Q

What is Secondary TB

A

Reactivation of latent TB with waning immune defnse

Very Contagious

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185
Q

Sx of TB

A

Chronic, Productive Cough, Chest Pain
Hemoptysis
Constitutional Sx: Night sweats, fevers/cills, fatigue, anorexia, weight loss
Rales or Rhonchi, Dull to percussion

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186
Q

What is considered a positive TB skin test in a person of the general population, a person with high risk exposure like healthcare worker, and a person with a known risk exposure or HIV+/Immunocompromised

A

Regular Population: >15
Healthcare Workers: >10
Known exposure/HIV: >5

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187
Q

Dx of TB

A

Acid-Fast Smear and Sputum culture for 3 days is definitive

CXR: Used for screening in patients with known positive PPD

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188
Q

Tx of TB

A

If active TB: RIPE with RIPE for 2 months, then RI for 4 more months
If latent TB: Isoniazi
R: Rifampin: SE is Orange secretions, Thrombocytopenia
I: Isoniozide: SE is Hepatitis, Peripheral Neuropathy
P: Pyrazinamide: SE is Hepatitis and Hyperuricemia, Photosensitivity
E: Ethambutol: SE is Optic Neuritis, red/green vision changes

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189
Q

What are the types of lung cancers

A

Non-Small Cell (most common)

Small-Cell: Metastasize early

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190
Q

What are the subtypes of Non-Small Cell Lung CA

A

Adenocarcinoma: Peripheral, Most common in everyone (smokers and non-smokers)
Squamous: Central, Hypercalcemia and Pancoast Syndrome
Large Cell: Peripheral, Aggressive

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191
Q

Sx of Lung CA

A

Constitutional Sx
Small Cell: SVC Syndrome, SIADH/Hyponatremia, Cushings Syndrome
Squamous: Hypercalcemia, Pancoast Syndrome (Shoulder pain, Horner’s Syndrome, Atrophy of hand/arm muscles)

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192
Q

Dx of Lung CA

A

Screening with Helical CT in smokers
CXR and CT show abnormalities
Sputum samples provide definitive
Bronchoscopy with biopsy

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193
Q

Tx of Lung CA

A

Non-Small Cell: Surgery

Small Cell: Surgery + Chemo

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194
Q

What is a Pulmonary Noudle

A

If greater than 3cm it’s a mass

Nodule is usually a granuloma from TB, fungal or foreign body

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195
Q

Sx of Pulmonary Nodule

A

Usually non, usually incidental finding

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196
Q

Dx of Pulmonary Nodule

A

CT finds nodule
Biopsy is defintiive but only done if nodule changes size
Lesion not enlarged in more than 2 years is usually benign, usually infectious granulomas
Malignant lesions are usually greater than 2 cm in size and cause sx

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197
Q

Tx of Pulmonary Nodules

A

Observation with CT every 3 months for an entire year, if stable, repeat every 6 months for next 2 years
If malignant/rapid changes, resection, if slow changes then biopsy

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198
Q

What is a Carcinoid Tumor

A

Usually neuroendocrine tumor

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199
Q

Sx of Carcinoid Tumors

A

Asymptomatic but hemoptysis, cough focal wheezing

Carcinoid Syndrome: Flushing, diarrhea, wheezing, hypotension

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200
Q

Dx of Carcinoid Tumor

A

Bronchoscopy

CT

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201
Q

Tx of Carcinoid Tumors

A

Surgery

Octreotide for sx

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202
Q

What is the transmission of Hepatitis B

A

Blood, Sex, Drugs

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203
Q 
What do the following tests tell you about Hepatitis B and its course/infectivity
HBsAg
HBsAb
HBcAb (IgM, IgG)
HBeAg
HBeAb
A

HBsAg: Surface Antigen: First evidence of infection before sx occur
HBsAb: Resolved infection or vaccination hx
HBcAb (You only see this if they’ve had the infection, not been immunized)
-IgM: Acute Infection
-IgG: Chronic Infection
HBeAg: Increased viral replication and increased infectivity
HBeAb: Waning viral replication and infectivity

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204
Q

What do you see during the window period of a Hepatitis B infection

A

Positive HBcAb: IgM

Everything else is negative

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205
Q

What do you see during an Acute Hepatitis B infection

A

HBsAg: Positive
HbsAb: Negative
HBcAb: IgM
May or may not see HB envelope

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206
Q

What do you see in an immunized person against Hepatitis B

A

HBsAg: Negative
HBsAb: Positive
HBcAb: Negative
All HBenvelopes negative

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207
Q

What do you see in someone who is recovering from a Hepatitis B infection

A

HBsAg: Negative
HBsAb: Positive
HBcAb: IgG

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208
Q

Tx of Hepatitis B

A

Acute: Supportive
Chronic: Alpha-Interferon 2b, Lamivudine, Adefovir

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209
Q

What is a contraindication to Hepatitis B vaccine

A

Allergies to Bakers Yeast

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210
Q

What is an Anal Fissure

A

A painful linear tear/crack in the distal anal canal

It usually only involves epithelium

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211
Q

Where is the most common site for an Anal Fissure

A

Posterior midline

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212
Q

What causes Anal Fissures

A

Low Fiber diet
Passage of large hard stools
Anal Trauma

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213
Q

Sx of Anal Fissures

A 
Severe painful bowel movements
Patients may not want to have BM
Constipation
Bright red blood per rectum
Rectal Pain
Skin tags
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214
Q

Tx of Anal Fissures

A

Sitz bath, analgesics, stool softeners, high fiber diet, laxatives

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215
Q

What is Achalasia

A

Loss of Auerbach’s Pleuxus which leads to increased LES pressure
Failure of LES to relax which leads to obstruction and lack of peristalsis

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216
Q

Sx of Achalasia

A

Dysphagia to both liquids and solids

Malnutrition, weight loss, dehydration, regurgitation, cough

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217
Q

Dx of Achalasia

A

Esophageal Manometry is gold standard, shows increased LES pressure and decreased peristalsis
Contrast Esophagram shows bird’s beak (LES narrowing)

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218
Q

Tx of Achalasia

A

Decrease LES pressure via botulinum toxin injection, nitrates, CCB, dilation of LES, Esophagomyomectomy

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219
Q

What is the most common form of Esophageal Cancer

A

Squamous Cell

Usually associated with Smoking and Alcohol use

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220
Q

What area of the esophagus is Squamous Cell Esophageal CA found

A

Proximal 1/3

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221
Q

What is another form of Esophageal CA (not Squamous), where is it found, and what is it a complication of

A

Adenocarcinoma
Distal 2/3
Complication of GERD, Barrett’s

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222
Q

Sx of Esophageal CA

A

Dysphagia with solids, Odynophagia
Weight loss, chest pain, anorexia, cough
Hypercalcemia

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223
Q

Dx of Esophageal CA

A

Upper Endoscopy with biopsy

Double contrast barium esophogram

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224
Q

Tx of Esophageal CA

A

Resection

Chemo

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225
Q

Where do you get Giardia from

A

Contaminated water from remote streams/wells

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226
Q

Sx of Giardia

A

Frothy, Greasy, Foul Diarrhea
No Blood or Pus
Cramping

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227
Q

Dx of Giardia

A

Trophozites/Cysts in stool

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228
Q

Tx of Giardia

A

Metronidazole

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229
Q

What is Peptic Ulcer Disease

A

Usually due to decreased mucosal protective factors and increased damagin factors

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230
Q

What are the 2 types of PUD and how can you tell them apart

A

Gastric Ulcers: Pain right after you eat

Duodenal Ulcers: Pain a few hours after eating, More common

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231
Q

What are causes of PUD

A

H.Pylori
NSAID use
Zollinger Ellison Syndrome (gastrinoma)

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232
Q

Sx of PUD

A

Dyspepsia, Epigastric pain, burning, gnawing
Gastric Ulcer: Pain 1-2 hours after meals and weight loss
Duodenal Ulcer: Pain Pain 2-5 hours after a meal, nocutral sx, relief with food

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233
Q

Dx of PUD

A

Endoscopy is gold standard

Upper GI Series

234
Q

How do you test for H.Pylori

A

Rapid Urease Test (direct staining of biopsy) is gold standard
H.Pylori Stool Antigen
Serologic Antibodies

235
Q

What test is used to to see if H.Pylori has been eradicated

A

Urea Breath Test, H.Pylori Stool Antigen

236
Q

Tx of H.Pylori

A

Triple Therapy: Clarithromycin + Amoxicillin + PPI

If allergic to PCN, give Metronidazole

237
Q

Tx of PUD with negative H.Pylori

A

PPI, H2 blocker, Atnacids, Bismuth

238
Q

What is Hemochromocytosis

A

Excess iron deposition in parenchymal cells of heart, liver, pancreas, and endocrine organs
Usually genetic

239
Q

Sx of Hemochromocytosis

A

Liver dysfunction, Cirrhosis, fatigue, weakness
Cardiomyopathy, Arrhythmias
Metallic or Bronze Skin

240
Q

Dx of Hemochromocytosis

A

Liver biopsy is gold standard: Increased Hemosiderin (iron storage)
Increased serum iron
Increased serum transferrin
Increased Ferritin

241
Q

Tx of Hemochromocytosis

A

Phlebotomy

If unable to do phlebotomy then cheleation

242
Q

What are the categories of Inflammatory Bowel Disease

A

Ulcerative Colitis and Crohn’s Disease

243
Q

What are the features of Ulcerative Colitis for area affected, depth, sx, dx, and tx

A

Limited to colon, starts in rectum and moves up
Mucosa and Submucosa ONLY
LLQ pain, Bloody Diarrhea
Uniform Inflammation, Sandpaper Appearance, Pseudo Polyps
+ P-ANCA
Surgery is Curative

244
Q

What are the features of Crohn’s Disease for area affected, depth, sx, dx, and tx

A

Any segment of GI from mouth to anus can be affected
Transmural
RLQ pain, weight Loss, No blood
See Skip Lesions and Cobblestone Appearance
+ASCA
Surgery is not curative

245
Q

What tests do you use for Ulcerative Colitis and Crohn’s if there is an acute attack

A

UC: Flex Sigmoidoscopy

Crohn’s: Upper GI series with small bowel follow through

246
Q

Tx of Inflammatory Bowel Disease

A

5-Aminosalicylic Acids: Oral Mesalamine, Topical Mesalamine, Sulfasalazine
Corticosteroids (for acute flares only)
Immune Modifying Agents: 6-Mercaptopurine, Azathioprine, Methotrexate
Anti-TNF Agents (Adalimumab, Infliximab, Certolizumab)

247
Q

What are features of Bacterial Vaginosis

  • How do you get it
  • Sx
  • Microscope
  • Tx
A

Decrease in lactobacilli leads to overgrowth of normal vaginal flora
Sx: Thin, Homogenous watery grey-white “fish rotten” smell, Pruritis
pH >5 (normal is 3.8-4.2)
Positive Whiff Test: Fishy Odor
KOH Prep shows Clue Cells, Few WBC
Tx: Metronidazole for 7 days, safe in pregnancy, Clindamycin

248
Q

What are features of Candida Vulvovaginitis

  • How do you get it
  • Sx
  • Microscope
  • Tx
A

Candida Albicans overgrowth (part of normal flora), usually use of antibiotics causes this
Vaginal erythema, swelling, burning, itching
Thick Curd-like/Cottage Cheese Dischrage
Normal pH
See Budding Yeast, Hyphae on KOH prep
Tx: Fluconazole oral one dose, or Intravaginal antifungals (Nystatin, Miconazole)

249
Q

What are features of Trichomoniasis

  • How do you get it
  • Sx
  • Microscope
  • Tx
A

Trichomonas Vaginalis, sexually transmitted
Vulvar pruritis, erythema, dysuria
Frothy green-yellow dischrage, Strawberry Cervix
pH>5
See Mobile Protozoa on wet mount and WBC
Tx: Metronidazole 2g oral one dose or 500mg bid oral for 7 days
Must treat partner

250
Q

What are features of Chlamydia

  • How do you get it
  • Sx
  • Microscope
  • Tx
A

Chlamydia Trahcomatis, causes cervicitis, sexually transmitted
Sx: Mucopurulent cervicitis, increased frequency, dysuria, abdominal pain
Dx: LCR, Cultures, DNA prope
Tx: Azithromycin 1g oral one dose or Doxy 100mg id for 10 days
Treat for Gonorrhea too (Ceftriaxone)

251
Q

What are features of Gonorrhea

  • How do you get it
  • Sx
  • Microscope
  • Tx
A 
Neisseria Gonorrhea
Sx: Vaginal discharge, cervicitis, increased frequency, dysuria
Dx: Culture, DNA
Tx: Ceftriaxone IM or Cefixime
Treat for Chlamydia too (Azithromycin)
252
Q

What are features of Chancroid

  • How do you get it
  • Sx
  • Microscope
  • Tx
A

Haemophilus Ducreyi (gram-negative Bacillus)
Sx: Genital PAINFUL ulcer, Painful inguinal LAD
Dx: Clinical or cultures
Tx: Azithromycin is 1st line, Ceftriaxone IM

253
Q

What are features of HPV

  • How do you get it
  • Sx
  • Microscope
  • Tx
A

Genital warts are 6 and 11
Cancer causing are 16 and 18
Sx: Flat, Pauplar, pedunculated or flesh colored growths, cauliflower like lesion
Dx: Whitening with acetic acid
Tx: Trichloracetic acid, Podophyllin wash, Cryotherapy

254
Q

What is Syphilis

A

Caused by Treponema Pallidum

255
Q

Sx of Syphilis

-primary, secondary, tertiary

A

Primary: Chancre (painless genital ulcer) lasts 3-4 weeks
Secondary: Maculopapular Rash usually on palms and soles, Condyloma Lata (Wart-like genital lesion)
Tertiary: Gumma (noncancerous granulomas on skin and body), Neurosyphilis (headache, eningitis, dementia, vision/earing loss), Aortic Regurgitation, Aortitis

256
Q

Dx of Syphilis

A

Darkfield Microscopy, VDRL/RPR

257
Q

Tx of Syphilis

A

Penicillin G

Tetracyclines, macrolides, ceftriaxone if PCN allergy

258
Q

What is Macular Degeneration

A

Most common cause of permanent blindness and visual loss in the elderly
Macula is responsible for central vision (detail and color)

259
Q

What is Dry Macular Degeneration and Wet Macular Degeneration

A

Dry: Gradual breakdown of macula. See Dursen (small, round, yellow-white spots on outer retina)
Wet: Neovascular or exudative, new abnormal vessels grow under central retina which leak blood

260
Q

Dx of Wet macular degeneration

A

Fluorescein Angiography

261
Q

Sx of Macular Degeneration

A

Bilateral blurred vision or loss of central vision
Scotomas (blind spots, shadows)
Metamorphopsia
Micropsia

262
Q

Tx of Macular Degeneration

A

Dry: Amsler Grid
Wet: Anti-Angiogenics (bevacizumab)

263
Q

What is Diabetic Retinopathy

A

Most common cause of new permanent vision loss/blindness in 25-74 year olds

264
Q

Sx of Diabetic Retinopathy

A

Microaneurysms, blot and dot hemorrhages, cotton wool spots, hard exudates
Neovascularization (treat with VEGF like Bevacizumab)
Macular edema or exudates blurred vision, central vision loss

265
Q

What is Hypertensive Retinopathy

A

Damage to retinal blood vessles from longstanding high blood pressure

266
Q

Sx of HTN Retinopathy

A

Arterial narrowing, AV nicking, Flame shaped hemorrhages, Cotton Wool Spots, Papilledema (bad)

267
Q

What is Retinal Detachment

A

Retinal tear leads to detachment from choroid plexus

268
Q

Sx of Retinal Detachment

A

Photopsia (flashing lights)
Floaters, Progressive unilateral vision loss
Shadow/Curtain in peripheral with eventual central vision loss
No Pain, No Redness

269
Q

Tx of Retinal Detachment

A

Emergency, Lacer, Cryotherapy Ocular Surgery

270
Q

What is Acute Narrow-Angle Closure Glaucoma

A

Glaucoma is increased intraocular pressure that leads to optic nerve damage
Acute narrow is decreased drainiage of aqueous humor

271
Q

Sx of Acute Narrow-Angle Closure Glaucoma

A

Severe unilateral ocular pain
N/V, headache intermittent blurry vision
Halos around lights
Peripheral loss of vision (Tunnel Vision)
Steamy Cornea, Eye feels hard to palpation

272
Q

Dx of Acute Narrow-Angle Closure Glaucoma

A

Tonometry measures intraocular pressure

Cupping of optic nerve

273
Q

Tx of Acute Narrow-Angle Closure Glaucoma

A

Acetazolamide IV is 1st line which decreased IOP and decreases aqueous humor production
Topical Beta-Blocker (Timolol)
Miotics/Cholingerics

274
Q

What is Otitis Externa

A

Swimmers ear

Pseudomonas

275
Q

Sx of Otitis Externa

A

Ear pain, pruritis, Auricular dischrage

Pain on traction of ear canal/tragus

276
Q

Tx of Otitis Externa

A

Dry ear with isopropyl alcohol and aceitic acid
Cipro/dexamethasone (Ofloxacin)
Neomycin
Amphotericin B if fungal

277
Q

What is Acute Otitis Media

A

Infection of the middle ear, temporal bone and mastoid air cells
Usually preceeded by URI
Strep. Pneumo, H. Influenza, Moraxella Catarrhalis, Strep Pyogens (same organisms as Bronchitis and Sinusitis)

278
Q

Sx of Acute Otitis Media

A

Fevers, Otalgia, Ear tugging in infants

Bulging, Erythematous TM with effusion and decreased TM mobility

279
Q

Tx of Acute Otitis Media

A

Amoxicillin for 10-14 days

Erythromycin-Sulfisoxazole if PCN allergy

280
Q

What is Acute Sinusitis

A

Strep Pneumo, H. Influenza, GABHS, M. Catarrhalis

URI leads to edema which leads to fluid buildup and bacterial colonization

281
Q

Sx of Acute Sinusitis

A

Sinus pain/pressure, Headache, purulent sputum or nasal drainage
Maxialllary pressure
Sinus tenderness on palpation, opacification with trans illumination

282
Q

Dx of Acute Sinusitis

A

CT is test of choice

Xray: See Water’s View

283
Q

Tx of Acute Sinusitis

A

Amoxicillin 10-14 days
Doxycycline
Bactrim

284
Q

What are Cataracts

A

Lens Opacification due to protein preceipitation in the lens

Smoking and steroid use are risk factors

285
Q

Sx of Cataracts

A

Blurred/loss of vision over months
Halos around lights
Absent red reflex, Opaque lens

286
Q

Tx of Cataracts

A

Remove via surgery

287
Q

What is Labyrinthitis

A

Vestibular Neuritis (inflammation of CN 8) and hearing loss/tinnitus

288
Q

Sx of Labyrinthitis

A

Peripheral vertigo, dizziness, N/V, gain distrubances, hearing loss

289
Q

TX of Labyrinthitis

A

Corticosteroids

Antihistamines (meclizine)

290
Q

What is Meniere’s Disease

A

Idiopathic distention of endolympahatic compartment of inner ear by excess fluid

291
Q

Sx of Meniere’s Disease

A

Episodic peripheral vertigo lasting 1-8 hours with horizatonal nystagmus, N/V

292
Q

Dx of Meniere’s Diseae

A

Dix-Hallpike Positional Test

293
Q

Tx of Meniere’s Disease

A

Antiemetics (Meclizine)
Diuretics for prevention (HCTZ)
Avoid salt, caffeine, chocolate, and alcohol

294
Q

What is Cholesteatoma

A

Abnormal growth of squamous epithelium which leads to mastoid bony erosion
Over time it erodes ossicles and leads to CONDUCTIVE hearing loss

295
Q

Sx of Cholestetoma

A

Painless otorrhea (brown/yellow discharge with strong odor), peripheral vertigo, conductive hearing loss

296
Q

Dx of Cholesteatoma

A

Granulation tissue seen with otoscope

297
Q

Tx of Cholesteatoma

A

Surgical excision and reconstruction of ossicles

298
Q

What is the most common site for anterior vs. posterior nosebleed

A

Anterior: Kiesselbach’s Plexus (more common)
Posterior: Palatine Artery (usually associated with HTN or atherosclerosis)

299
Q

Tx of Epistaxis

A

Direct Pressure usually seated or leaning forward
Short acting topical decongestants (cocaine, phenylephrine, Afrin)
Cauterization if area of bleeding can be visualized or nasal packing if all else fails
Posterior bleeds are serious and need hsopitalization and specialization

300
Q

What is Chronic Sinusitis

A

Sinusitis for more than 8 weeks

Usually due to Staph. Aureus or Pseudomonas, Aspergillus, Wegner’s

301
Q

What is Guillain Barre Syndrome

A

Demyelinating disease with Ascending WEAKNESS

Usually preceeded by viral infection like Campylobacter or other GI bug, CMV, EBV

302
Q

Sx of Guillain Barre Syndrome

A

Weakness and Parasthesias, usually symmetric
Decreased DTR
Autonomic dysfunction: Tachycardia, Hypotension, Breathing issues

303
Q

Dx of Guillain Barre Syndrome

A

CSF: High protein with normal WBC

304
Q

TX of Guillan Barre Syndrome

A

Plasmapheresis to remove harmful circulating antibodies

IVIG to suppress inflammation

305
Q

What is Myasthenia Gravis

A

Autoimmune disorder of peripheral nerves
Common in young women
Progressive weakness with repeated muscle use and recovery with periods of rest

306
Q

Sx of Myasthenia Gravis

A

Ocular weakness: Extraocular muscle weakness leads to diplopia, Ptosis
Generalized muscle weakness

307
Q

Dx of Myasthenia Gravis

A

Tensilon Test Edrophonium: rapid response to short acting IV edrophonium
Positive Ach-Receptor Antibodies
Ice pack test (improves ptosis)

308
Q

Tx of Myasthenia Gravis

A

Ach-ase inhibitors: allows ach to stay in synapse longer by preventing the breakdown via enzyme ach-ase
Pyridostigmine, Neostigmine
Immunosuppression

309
Q

What is Multiple Sclerosis

A

Autoimmune inflammatory demyelinating disease of the CNS
Axon degeneration fo whtie matter of brain, otpic nerve, and spinal cord
Found in young adults and usually women

310
Q

Sx of MS

A

Optic Neuritis: Unilateral eye pain worse with eye movement, diplopia, scotoma/vision loss
Sensory deficits: Weakness, Parasthesias, Fatigue
-Lhermitte’s Sign: Neck flexion causes lightning shock pain radiating from spine down the leg
-Uhthoff’s Phenomenon: Worsening of sx with heat (exercise, fever, hot tubs)
Spinal Cord: Nystagmus, stacatto speech, and intentional tremor, Spacity and psotiive upward Babinski

311
Q

Dx of MS

A

MRI with Gadolinium shows white matter plaques

CSF: See increased IgG

312
Q

TX of MS

A

Acute: Steroids

Relapse-Remitting/Progressive: Beta-Interferon, Amantadine for fatigue

313
Q

What are features of Cluster Headaches

A

Unilateral periorbital/temporal pain
Sharp, Lancinating
Usually lasts less than 2 hours
Nasal congestion/rhinorrhea, conjunctivitis and lacrimation

314
Q

Tx of Cluster Headaches

A

Oxygen is 1st line
Anti-migraine meds (subq sumatriptan or dihydroergotamine)
Verapamil for prophylaxis, steroids, ergotamine

315
Q

What is a Migraine Headache Common vs. Classic

A

Common: Without Aura
Classic: With Aura
Lateralize pulsatile/throbbing headache associated with N/V, Phtophobia and Phonophobia for 4-72 hours

316
Q

Tx of Migraine Headaches

A

Abortive: Triptans, IV Dihydroergotamine (Triptans and Ergots). Dopamine Blockers for N/V (IV Phenothiazines, Metoclopramide)
Prophylactic: Beta Blockers, CCB, TCA’s

317
Q

What are freatures of a Tension Headache

A

Bilateral, tight band-like, vise-like constant daily headache worse with stress
No N/V or focal neurologic deficits

318
Q

Tx of Tension Headaches

A

Same as Migraines

NSAIDS, TCA, Beta Blockers

319
Q

What is Trigeminal Nueralgia

A

Compression of trigeminal nerve root

320
Q

Sx of Trigeminal Neuralgia

A

Brief, Episodic, Stabbing/Lancinating pain in the 2nd or 3rd division of CN V worse with touch, drafts of wind and movements
Pain starts near mouth and shoots to eye, ear, nostrile

321
Q

Tx of Trigeminal Neuroalgia

A

Carbamazepine is 1st line

Gapaentin

322
Q

What are features of an Ischemic Stroke

A

Due to Thrombotic or Embolic event
Most common is Middle Cerebral Artery
-Contralteral sensory/motor loss/hemiparesis greater in face/arms than legs/foot

323
Q

Sx of Middle Cerebral Artery Ischemic Stroke

A

Contralateral sensory/motor loss/hemiparesis greater in face/arms than leg/foot
Preferential gaze towards side of lesion
Left side Dominant: Aphasia, Wernicke, Math comprehension
Right side Dominant: Spatial deficits, Dysarthria, L side neglect

324
Q

Dx of Ischemic Stroke

A

CT without contrast to rule out Hemorrhage

325
Q

Tx of Ischemic Stroke

A

After you’ve ruled out hemorrhagic stroke

If within 3 hours of onset of sx then initiate rTPA (Alteplase)

326
Q

Sx of Posterior Circulation Ischemic Stroke

A

Visual Hallucinations, Contralteral homonymous hemianopsia
Cerebellar dysfunction, CN palsies
Vertigo, N/V, Nystagmus

327
Q

What are features of an Epidural Hematoma

A

Arterial bleed between skull and dura
Due to skull fracture
Middle Meningeal Artery affected
CT shows convex bleed (doesn’t cross sutures)

328
Q

What are features of a subdural Hematoma

A 
Venous bleed (tearing of bridging veins) between dura and arachnoid
Due to blunt trauma
CT shows concave (crescent shaped, does cross sutures)
329
Q

What are features of subarachnoid hemorrhage

A

Arterial bleed between arachnoid and pia
Due to berry aneurysm rupture, AVM
Sx: Thunderclap, sudden headache of my life, STiff neck, photophobia
CT scan is 1st line

330
Q

What is a TIA

A

Transient episode of neurological deficits caused by focal brain, spinal cord, or retinal ischemia without acute infarction
Lasts less than 24 hours

331
Q

Sx of TIA

A

Monocular vision loss, lamp shade down one eye, weakness contrlateral hand, HEadache, speech changes, confusion

332
Q

Dx of TIA

A

CT to rule out hemorrhage
Assess CVA risk (Age, BP, Clinical features, Duration of sx, DM)
Carotid Doppler to look for stenosis
CT Angiography

333
Q

Tx of TIA

A

ASA and Clopidogrel (Plavix)
NO Thrombolytics
Place supine

334
Q

What is Bell’s Palsy

A

Idiopathic unilateral facial Nerve (CN 7) palsy

Thought to be due to HSV reactivation or VZV or Lyme Disease

335
Q

Sx of Bell’s Palsy

A

Sudden onset of ipsilateral ear pain
Unilateral facial paralysis: unable to lift affected eyebrow, can’t wrinkle forehead, smile, corner of mouth troops, taste distrubance

336
Q

Dx of Bell’s Palsy

A

Diagnosis of exclusion

337
Q

Tx of Bell’s Palsy

A

Prednisone
Artificial Tears
Acyclovir in severe cases

338
Q

Name the Cranial Nerves and what they’re responsible for

A

CN 1: Olfactory
CN 2: Vision
CN 3: Motor to Upper eyelid, and SR, IR, IO, MR
CN 4: Motor to Superior Oblique Eye
CN 5: Trigeminal, motor to muscles of mastication
-V1: sensory to forehead
-V2: sensory to cheeks
-V3: sensory to jaw and taste
CN 6: Motor to Lateral Rectus Eye
CN 7: Motor to facial expression, Taste anterior 2/3
CN 8: Vestibular, balance and hearing
CN 9: Glossopharyngeal, Motor to swallowing and gag, Taste posterior 1/3
CN 10: Vagus, Motor to voice, soft palate, gag, Sensory to organs
CN 11: Spinal Accessory, Motor to shrug, turn head, SCM
CN 12: Hypoglossal, Motor to Tongue

339
Q

What are the most common types of pathogens by age group for Meningitis

  • Infant
  • 1 month to 18 years
  • Adults
  • Geriatrics
A

Infant: Group B Strep (Strep Streptococus Agalactiae), Listeria, E.Coli
1 month to 18 years: N. Meningitidis, Strep. Pneuo, H. Influenza
Adults: Strep. Pneumo, N. Meningitidis, H. INfluenza, Listeria
Geriatrics: Strep Pneumo, Listeria, Gram Negative Rods

340
Q

What is the most common pathogen in a kid

A

N. Meningitidis

341
Q

What is the most common pathogen in adults

A

Strep. Pneumoniae

342
Q

Sx of Bacterial Meningitis

A

Fevers, chills, headache/nuchal rigidity, photosensivity, N/V, Seizures
Kernig’s Sign, Brudzinski Sign

343
Q

Dx of Bacterial Meningitis

A

Lumbar Puncture is Definitive

  • Bacteria: High protein, Low Glucose, PMN’s
  • Viral: Normal protein, Normal Glucose, Lymphocytes
344
Q

Tx of Bacterial Meningitis

A

Infants: Ampicillin + Cefotraxime
Kids and Adults: Ceftriaxone + Vancomycin
Geriatrics: Ampicillin + Cefotraxime

345
Q

What is a Simple Partial Seizure

A

Confined to a small part of brain
Consciousness maintained
May have focal sensory, automonic, motor sx

346
Q

What is a Complex Partial Seizure

A

Confined to a small part of the brain
Consciousness Impaired
Auras associated

347
Q

What is an Absence Seizure

A

Diffuse brain involvement
Brief impairment of consciousness
Brief staring episodes, Eyelid twitching

348
Q

What is a Tonic Clonic (Grand Mal) Seizure

A

Diffuse brain involvement
Loss of consciousness with rigidity followed by repetitive rhythmic jerking then flaccid coma/sleep
Auras may occur

349
Q

What is a Myoclonus Seizure

A

Sudden brief sporadic involuntary twitching

No Loss of Consciousness

350
Q

What is an Atonic Seizure

A

Drop attacks

Sudden loss of postural tone

351
Q

Tx of Seizures

A

Absence: Ethosuximide
Grand Mal: Valproic Acid, Phenytoin, Carbamazepine
Status Epilepticus: Lorazepam
Myoclonus: Valproic Acid

352
Q

What is Graves Disease

A

Autoimmune: TSH autoantibodies circulate and cause thyroid to release T3/T4
Leads to Hyperthyroidism

353
Q

Sx of Graves Disease

A

Hyperthyroidism: Health Intolerance, Weight Loss, Goiter, Anxiety, Tremors, Tachycardia, Palpitations, Diarrhea, Hyperglycemia
Exophthalmos is unique to Graves: Lid lag and Proptosis

354
Q

Dx of Graves

A

Positive Thyroid Stimulating antibodies
Low TSH, High T3/T4
RAIU: Diffuse Uptake

355
Q

Tx of Graves

A

Radioactive Iodine
Methimazole or PropylThioUracil (PTU safe in pregnancy)
Beta Blockers
Thyroidectomy

356
Q

What is Toxic Multinodular Goiter

A

Autonomous functioning nodules

357
Q

Sx of Toxic Multinodular Goiter

A

Hyperthyroidism

Palpable nodule

358
Q

Dx of Toxic Multinodular Goiter

A

Low TSH, High T3/T4

RAIU: Patchy areas of uptake

359
Q

Tx of Toxic Multinodular Goiter

A

Radioactive Iodine
Methimazole/PTU
Beta Blockers

360
Q

What is Hashimotos

A

Autoimmune that leads to Hypothyroidism

Most common form of Hypothyroidism in US

361
Q

Sx of Hashimotos

A

Hypothyroidism: Cold Intolerance, Weight Gain, Goiter, Fatigue, Memory Loss, Depression, Constipation, Bradycardia, Decreased CO, Menorrhagia, Hypoglycemia

362
Q

Dx of Hashimotos

A

Positive Thyroid antibodies present

TFT’s

363
Q

Tx of Hashimotos

A

Levothyroxine

364
Q

What is De Quervain’s

A

Usually post-viral

Clinically looks like Hyperthyroidism but eventually leads to Hypothyroidism

365
Q

Sx of De Quervain’s

A

Painful neck/thyroid

366
Q

What is a Thyroid Storm

A

Rare potentially fatal complication of untreated thyrotoxicosis
Hypermetabolic State

367
Q

Sx of Thyroid Storm

A

Hypermetabolic State: Palpitations, A. Fib, Tachycardia, High fevers, N/V, Psychosis, Delirium, Tremors

368
Q

Dx of Thyroid Storm

A

Low TSH, High T3/T4

EKG shows sinus tachy, A.Fib, A. Flutter

369
Q

Tx of Thyroid Storm

A

Methimazole, PTU, Beta Blockers for sx
Supportive: IV Fluids
Glucocorticoids

370
Q

What is a Myxedema Crisis

A

Extreme form of hypothyroidism

Seen in elderly women with long standing hypothyroidism in cold weather

371
Q

Sx of Myxedema Crisis

A

Bradycardia, CNS depression, Respiratory depression, Hypothermia, Hypotension

372
Q

Dx of Myxedema Crisis

A

Increased TSH, Low T3/T4

373
Q

Tx of Myxedema Crisis

A

Levothyroxine, Supportive (ICU, fluids, Abx, Steroids)

Passive Warming

374
Q

What are the types of Thyroid Cancers

A

Papillary: Most Common, Least Aggressive
Follicular: More Aggressive
Medullary: Associated with MEN 2
Anaplastic: Least common, Most aggressive

375
Q

What does Parathyroid Hormone do

A

High PTH increases calcium

Low PTH decreases calcium

376
Q

What is Primary Hyperparathyroidism

A

Inappropriate PTH production

Parathyroid Adenoma is most common cause

377
Q

What is Secondary Hyperparathyroidism

A

Increased PTH in response to low calcium or Vitamin D deficiency

378
Q

Sx of Primary Hyperparathyroidism

A

Stones, Bones, Abdominal Groans, Psychic Moans

Decreased DTR

379
Q

Dx of Primary Hyperparathyroidism

A

Hypercalcemia, High PTH, Low Phosphate
24 hour urine calcium exretion
Osteopenia/bone scan

380
Q

Tx of Primary Hyperparathyroidism

A

Surgery, Parathyroidectomy

Secondary tx with Vitamin D and Calcium Supplement

381
Q

What is Hypoparathyroidism

A

Low PTH or Insensitive to its action

Usually due to damage to Parathyroid glands post-surgical or autoimmune

382
Q

Sx of Hypoparathyroidism

A

Hypocalcemia: Carpopedal Spasms, Trousseau and Chvostek Sign

Increased DTR

383
Q

Dx of Hypoparathyroidism

A

Hypocalcemia, Low PTH, High Phosphate

384
Q

Tx of Hypoparathyroidism

A

Calcium Supplement and Vitamin D: Ergocalciferol or Calcitriol

385
Q

What is Chronic Adrenocortical Insufficiency

A

Primary is Addisons: Adrenal gland destruction due to autoimmune or infection (TB)
Secondary is pituitary failure of ACTH secretion

386
Q

Sx of Primary Adrenocortical Insufficiency

A

Nothing in Adrenal Gland Works
No Aldosterone, No Sex Hormones
Increased ACTH production causes Hyperpigmentation
No Aldosterone leads to orthostatic hypotension, Hyponatremia, HYPERKALEMIA, Metabolic Acidosis

387
Q

Sx of Secondary Adrenocortical Insufficiency

A 
No Cortisol (no ACTH production)
Weakness, muscle ache, myalgias, fatigue, headache, sweating, abnormal menstruation, hypoglycemia
388
Q

Dx of Adrenocortical Insufficiency

A
  1. Get baseline ACTH, Cortisol, and Renin
  2. High does ACTH Stimulation Test
    - Normal response is rise in cortisol after ACTH given
    - If little or no increase, Adrenal Insufficiency
  3. CRH Stimulation Test
    - High ACTH but low cortisol is Addisons
    - Low ACTH and low cortisol is Secondary (pituitary)
389
Q

Tx of Adrenocortical Insufficieny

A

Addisons: Mineralocorticoid and Glucocorticoid
Secondary: Glucocorticoid Only
Mineralocorticoid: Fludrocortison
Glucocorticoid: Hydrocortison

390
Q

What is Adrenal (Addisonian) Crisis

A

Sudden worsening of adrenal insufficiency due to a stressful event like surgery, trauma
Caused by abrupt withdrawal of glucocorticoids, someone undiagnosed with Addisons

391
Q

Sx of Addisonian Crisis

A

Shock, decreased BP, Hypotension, Hypovolemia

392
Q

Dx of Addisonian Crisis

A

BMP: Hyponatremia, Hyperkalemia, Hypoglycemia

393
Q

Tx of Addisonian Crisis

A

IV Fluids: Normal saline to correct hypotension and hypovolemia
Glucocorticoids: Dexamethasone
Reverse electrolyte abnormalities
Fludrocortisone

394
Q

What is Cushing’s Syndrome

A

Hypercortisolism

395
Q

What is Cushing’s Disease

A

Cushing’s Syndrome (Hyerpcrotisolsim) caused by pitutairy increase in ACTH secretion

396
Q

Sx of Cushing’s

A

Central Trunk Obseity, Moon Facies, Buffalo Hump, Supraclavicular Fat Pads, Wasting of extremtiies, Striae, Skin Atrophy, Weight gain, osteoporosis, Hypokalemia, Acanthosis Nigricans, Depression, Mania, Psychosis

397
Q

Dx of Cushing’s

A
  1. Low does Dexamethasone Suppression Test
    - Normal response is cortical suppression
    - No suppression is Cushing’s Syndrome
  2. Increased 24 hour Urinary free cortisol
    - If elevated in urine is Cushing’s Syndrome
  3. Increased Salivary Cortisol Levels
    - Increased in Cushing’s
  4. High Dose Dexamethasone Suppression
    - If suppressed: Cushing’s Disease
    - If not suppressed: Adrenal or Ectopic ACTH producing tumor
  5. ACTH Levels
    - Decreased ACTH is Adrenal Tumor
    - NOrmal/Increased ACTH is Cushin’s disease or ACTH producing tumor
398
Q

Tx of Cushing’s

A

Cushing’s Disease: Pituitary Tumor, Transsphenoidal Surgery
Ectopic or Adrenal Tumors: Tumor Removal, Ketoconazole
Iatrogenic Steroid Therapy

399
Q

What is a Pheochromocytoma

A

Catecholamine-Secreting Adrenal Tumor

Secretes Norepinephrine and Epinephrine

400
Q

Sx of Pheochromocytoma

A

Hypertension, Palpitations, Headaches, Excessive Sweating

401
Q

Dx of Pheochromocytoma

A

Increased 24 hour urine catecholamines including Metanephrine and Vanillylmadelic Acid

402
Q

Tx of Pheochromocytoma

A

Complete Adrenalectomy

Prior to surgery needs to have Alpha-Blockade (Phenoxybenzamine or Phetolamine) followed by beta-blockers

403
Q

What is Diabetes Insipidus

A

Problem with ADH
Central DI: No ADH production
Nephrogenic: Problem with response to ADH by the kidneys

404
Q

Sx of Diabetes Insipidus

A

Polyuria, Polydipsia, Nocturia
Hypernatremia if severe
Low water intake

405
Q

Dx of Diabetes Insipidus

A

Fluid Deprivation Test
-Normal response is urine becomes concentrated
-DI: Continued dilute urine
Desmopressin Stimulation Test
-Normal response is like ADH, so will concentrate urine
-If Urine becomes concentrated then it’s an issue with the release of ADH from the pituitary, so Central
-If urine continues to be dilute, it’s a problem with the kidneys not responding to ADH/Desmopressin, so Nephrogenic

406
Q

Tx of Diabetes Insipidus

A

Centra: Desmopressin/DDAVP
Nephrogenic: Na/Protein restriction, Indomethacin
If sx: Hypotonic fluid (pure water orally is preferred, D5W, 1/2 normal saline)

407
Q

What is Diabetes Mellitus

A

Hyperglycemia due to inability produce insulin or insulin resistance or both

408
Q

What is DM I

A

Pancreatic beta cells are destroyed so no insulin production

409
Q

What is DM II

A

Insulin resistance and impariment to insulin secretion

410
Q

What are risk factors for DM

A

FAmily hx, Hispanic/AA, HTN, Hyperlipidemia

411
Q

Sx of DM

A

Polyuria, Polydipsia, Polyphagia, Weight Loss

DKA

412
Q

What are complications of DM

A

Neuropathy: Stocking glove pattern of decreased proprioception, decreased DTR, Orthostatic hypotension
Retinopathy: Microaneurysms, hard exudates, flame shaped hemorrhages, cotton wool spots, Neovascularization, central vision loss
Nephropathy: Microalbuminuria
Hypoglycemia: Sweating, tremors, palpitations

413
Q

Dx of DM

A

Fasting Plasma Glucose >126 on 2 occasions at least 8 hours apart (gold standard)
HgA1c >6.5%
2 hour plasma glucose >200
Plasma glucose >220

414
Q

Who gets screened for DM

A

Patients >45 yrs, BP>138/80, BMI >25, low HDL, family hx

415
Q

Tx of DM

A

Lifestyle changes first
DM I: Insulin
DMII
-Metformin first

416
Q

What is DKA

A

REsults from insulin deficiency and counter-regulatory hormonal excess in response to stressful triggers
Hyperglycemia, Dehydration, Ketonemia, Potassium Deficit

417
Q

Sx of DKA

A

Thirst, polyuria, polydipsia, weakness, fatigue, abdominal pain, Ketotic breath, Kussmaul’s Respiration (deep continuous respirations to blow off CO2 excess)

418
Q

Dx of DKA

A 
Glucose >250
Arterial pH <7.30
Serum Bicarbonate 15-18
Ketones: Positive
Serum Osmolarity: Variable
419
Q

Tx of DKA

A

ABC, Mental status, vital signs, volume status
IV Fluids are 1st!! Isotonic 0.9% NS then 0.45% NS
Insulin (Regular)
Potassium
Bicarbonate in severe acidosis

420
Q

What is Crytptococcosis

A

Cryptococcus Neoformans

Bird droppings

421
Q

Sx of Cryptococcosis

A

Headache, Meningeal Signs, Penumonia

422
Q

Dx of Cryptococcosis

A

Antigen in CSF (seen with india ink stain)

Positive blood ultures

423
Q

Tx of Cryptococcosis

A

Amphotericin B + Flucytosine for 2 weeks followed by Fluconazole

424
Q

What is Histoplasmosis

A

Yeast

Bird/Bat Droppings in Mississippi and Ohio River Valleys

425
Q

Sx of Histoplasmosis

A

Penumonia, Disseminated in immunocompromised (hepatosplenomegaly, fevers, ulcers, bloody diarrhea)

426
Q

Dx of Histoplasmosis

A

Increased ALP, Increased LDH

427
Q

Tx of Histoplasmosis

A

Itraconazole

Amphotericin B

428
Q

What is Aspergillosis

A

Fungus characterized by Large Septate Hypae

Found in garden and houseplant soil and compost

429
Q

Sx of Aspergillosis

A

Allergic Bronchopulmonary Aspergillosis
Hemoptysis, Fungal Ball on CXR
Invasive Chronic Sinusitis

430
Q

Dx of Aspergillosis

A

Dusky, Necrotic Tissue on biopsy and seen in tissues

431
Q

Tx of Aspergillosis

A

Allergic: Tapered Steroids, Itraconazole
Severe: Voriconazole
Aspergilloma: Surgical resetion if sx

432
Q

What is Coccidiomycosis

A

Grows in soil in Southwestern US and MExico

433
Q

Sx of Coccidiomycosis

A

Mild flu-like illness, fever, chills, nasopharyngitis, headache, cough
Valley Fever: Fever, Arthralgias, Erythema Nodosum or Erythema Multiforme

434
Q

Dx of Coccidiomycosis

A

Early: IgM

Cultures are definitive

435
Q

Tx of Coccidiomycosis

A

Most are asympomatic and self-limiting

Fluconazole for CNS disease

436
Q

What is Impetigo

A

Caused by Group A Beta Hemolytic Strep (Strep Pyogens)

437
Q

Sx of Impetigo

A

Honey colored yellow crusts on arms, legs, face

438
Q

TX of Impetigo

A

Topical Mupirocin

Oral Keflex, Erytrhomycin, Clindamycin

439
Q

What is Cellulutis

A

Caused by S. Auerus or GABHS

440
Q

Sx of Cellulitis

A

Red, swollen, tender, hot, fevers, chills

441
Q

Tx of Cellulitis

A

Cephalexin, Dicloxacillin, Clindamycin or Erythromcyin if PCN allergy
MRSA: Bactrim

442
Q

How do you treat a cat bite

A

Augment

Caused by Pateurella Multocida

443
Q

How do you treat a dog bite

444
Q

What is Osteomyleitis

A

Caused by S. Auerus or Group B Strep

445
Q

Sx of Osteomyelitis

A

Local signs of inflammation/infection, pain over bone

446
Q

Dx of Osteomyelitis

A

MRI
Xray: See periosteal reaction
Bone biopsy is gold standard

447
Q

Tx of Osteomyeltiis

A

Nafcillin or Oxacillin

448
Q

What is Tetanus

A

Clostridum Tetani, Grame Positive Rod

Creates neurotoxin that blocks neuron inhibition leads to severe muscle spasms

449
Q

Sx of Tetanus

A

Pain/Tingling and inoculation site
Local muscle spasms, neck/jaw stiffness, dysphagia
Trismus (Lock jaw), Drooling, Risus Sardonicus, Muscle Rigidity in descending fashion

450
Q

Tx of Tetanus

A

Metronidazole or PCN G + Tetanus Immune Globuin
Prophylaxis: Tdap, Td vaccine every 10 years
If never immunzed give Tetanus Immune Globulin with initation of tetanus toxoid vaccine

451
Q

What is Botulism

A

Clostridum Botulinum
Produces neurotoxin that inhibits acetylcholine release at neuromuscular junction
Found in canned/smoked/vacuum packed foods
Infants if ingest honey will get it
Sx occur 6-8 hours after ingestion

452
Q

Sx of Botulism

A

Diplopia, Dry Mouth, Dysphagia, Dysarthria, Dysphonia, Decreased muscle streght, Dilated fixed pupils, Paralysis
Floppy Baby Syndrome: Newborn Botulism after ingestion of honey containing spores

453
Q

Tx of Botulism

A

Antitoxins

Respiratory support like intubation if respiratory failure

454
Q

What is Pertussis (Whooping Cough)

A

Bordetella Pertussis

Highly contageous

455
Q

Sx of Pertussis

A

Catarrhal Phase: URI symptoms
Paroxysmal Phase: Severe paroxysmal coughing fits with post vomiting emesis
Convalescent Phase: Resolving sx, cough may last up to 2 months

456
Q

TX of Pertussis

A

Erythromycin, helps prevent spread, does nothing to treat the actual disease

457
Q

What is Lyme Disease

A

Borrelia Burgdorferi, a Gram Negative Spirochete

Spread via Ixodes (deer) tick in spring and summer in Northeast, Midwest, Mid-Atlantic

458
Q

Sx of Lyme Disease

A

Early: Erythema Migrans (expanding, warm annular erythematous rash with central bullseye) usually a month after bite
Disseminated: Rheumatologic arthrlagias, meningitis, weakness, CN 7 palsy, AV blocks
Late: Persistent synovitis, Arthritis

459
Q

Dx of Lyme Disease

A

Clinical

ELISA (Serologic)

460
Q

Tx of Lyme Disease

A

Doxycycline

If kids <8yrs, use Amoxicillin

461
Q

What is Rocky Mountain Spotted Fever

A

Tick Disease, Rickettsia Rickettsii

Spread by Ticks in South/South Atlantic States in spring and summer

462
Q

Sx of Rocky Mountain Spotted Fever

A

Fevers, chills, myalgias, Headache
Red maculopapular rash first on wrists and ankles and then spreads centrally (palms and soles are characteristic), Petechia

463
Q

Dx of Rocky Mountain Spotted Fever

A

Clinical

Immunofluorescent assay for antibodies

464
Q

Tx of Rocky Mountain Spotted Fever

A

Doxycycline even in young children

465
Q

What is Coxsackie Virus

A

Part of Enterovirus family
Most common in kids 5 years or younger
Spread via fecal-oral route

466
Q

What are illnesses caused by Coxsackie

A

Hand, Foot, Mouth: Mild fever, URI, vesicular lesions on a reddended base in oral cavity
Herpangina: sudden onset high fever, stomatitis
Pericarditis and Myocarditis

467
Q

Tx of Coxsackie

A

Supportive

468
Q

What is HIV

A

Retrovirus with Reverse Transcripate

Transmitted via sex and IV drug use

469
Q

Sx of HIV

A

Acute seroconversion: Flu-like illness, fever, malaise, generalized rash
AIDS: CD4 <200, recurrent severe and life threatening opportunistic infection, neurologic changes (encephalopathy or dementia, chronic diarrhea, weight loss)

470
Q

Dx of HIV

A

Antibody Testing: ELISA. If positive confirm with Western Blot. Rapid testing blood or saliva
Western Blot Confirms
HIV RNA Viral Load: Can be positive in window period, used to monitor infectivity and tx effectiveness

471
Q

TX for HIV

A

HAART used when CD4<350 OR Viral load >55,000 by RNA
NNRTI + 2 NRTI
PI + 2 NRTI
INSTI + 2 NRTI

NRTI: Zidovudine, Emtricitabine, ABacavir
NNRTI: Efavirenz, Delavirdine, Etravirine
Protease Inhibitors: Atazanavir, Darunavir, Indinavir
INTI: Raltegravir, Dolutegravir

472
Q

What is Toxoplasmosis

A

Protozoan transmitted by cats (including cat litter)

473
Q

Sx of Toxoplasmosis

A

Encephalitis and Chorioretinitis in immunocompromised patients
Blueberry muffin rash (TTP), Hepatosplenomegaly, hearing loss, mental retardation if congenital

474
Q

Dx of Toxoplasmosis

A

PCR

CT shows ring-enhancing lesions

475
Q

Tx of Toxoplasmosis

A

Sulfadiazene or Clindamycin + Pyrimethamine

Prophylaxis: Pyrimethamine, Sulfadiazene, Bactrim

476
Q

What is Atopic Dermatitis (Eczema)

A

Atopy: Allergic Rhinitis, Asthma, Hay Fever

Due to altered immune reaction and increased IgE production

477
Q

Sx of Atopic Dermatitis

A

Pruritis, itch-scratch cycle
Small erythematous edematous ill-defined blisters, usually flexor creases
Nummular Exzema is sharply defined coin shaped lesions

478
Q

Tx of Atopic Dermatitis

A

Topical Steroids and Antihistamine for itching

479
Q

What is Pityriasis Rosea

A

Herald Patch on trunk with general exanthem 1-2 weeks later, smaller round/oval salmon colored papules with white circular scaling along cleavage lines
Christmas Tree Pattern

480
Q

Tx of Pityriasis Rosea

A

None needed
Topical Steroids for itching
Oral Antihistamines

481
Q

What is Psoriasis

A

Chronic multisystemic inflammatory immune disorder

T-Cell activation and cytokine release

482
Q

Sx of Psoriasis

A

Plaque: Raised, dark-red plaques/papules with thick silver/white scales on extensor surfaces
Guttate: Small erythematous papules with fine scale
Psoriatic Arthritis: inflammatory arthritis associated with psoriasis, Sausage digits, Xray shows pencil in cup

483
Q

Tx of Psoriasis

A

Topical steroids

UVB light therapy

484
Q

What is Tinea Versicolor

A

Caused by a yeast, Malassezia Furfur

485
Q

Sx of Tinea Versicolor

A

Well demarcated round/oval macules with fine scaling

486
Q

Dx of Tinea Versicolor

A

KOH prep see hyphae and spores, Spaghetti and Meatballs

Woods lap see yellow-green fluorescence

487
Q

Tx of Tinea Versicolor

A

Selenium Sulfide, Sodium Sulfacetamide, Azole antifungals

488
Q

What is Seborrheic Dermatitis

A

Occurs in areas of high sebaceous glands over secretions like scalp, face, eyebrows, body folds

489
Q

Sx of Seborrheic Dermatitis

A

Cradle cap in infants

Erythematous plaques with fine white scales (dandruff)

490
Q

Tx of Seborrheic Dermatitis

A

Selenium sulfide, sodium sulfacetamide, Ketoconazole, STeroids

491
Q

What is Erythema Multiforme

A

Target lesions, usually due to drugs like sulfonamides, penicillins, Dilatin

492
Q

What is Urticaria/Angioedema

A 
Type I (IgE) Hypersensitivity reaction
Triggers are foods, meds, infection, insect bites
493
Q

Sx of Urticaria/Angioedema

A

Urticaria: Blanchable, edematous pink papules, wheals or plaques
Angioedema: painless, deeper form of urticaria affecting lips, tongue, eyelids, hands and feet

494
Q

Tx of Urticaria/Angioedema

A

Oral antihistamines
Eliminate precipitants
H2 blockers

495
Q

What is Erythema Multiforme

A

Type 4 Hypersensitivity reaction

Associated with Herepes, Mycoplasma and meds

496
Q

Sx of Erythema Multiforme

A

Target lesion, dusty-violet red purpruic macule

497
Q

Tx of Erythema Multiofrme

A

Sx, antihistamines, analgesics

498
Q

What is Basal Cell Carcinoma

A

Most common skin cancer
Fair-skinned with prolonged sun exposure
Slow growing

499
Q

Sx of Basal Cell Carcinoma

A

Flat firm area with small raised translucent/pearly/waxy papule with central ulceration
Telengiectatic

500
Q

Dx of BCC

A

Punch or shave biopsy

501
Q

Tx of BCC

A

Electric desiccation/curettage

502
Q

What is Squamous Cell Carcinoma

A

Often preceeded by Actinic Keratosis, HPV infection

503
Q

Sx of Squamous Cell Carcinoma

A

Red, Eelvated nodule with adherent white scaly or crusted bloody margins

504
Q

Dx of Squamous Cell Carcnioma

A

Biopsy: Epidermal and dermal cells with large, pleomorphic, hyperchromatic nuclei

505
Q

Tx of Squamous Cell Carcinoma

506
Q

What is Malignant Melanoma

A

UV radiation causes it

Aggressive and high METS

507
Q

Sx of Malignant Melanoma

A

ABCDE
Asymmetry, Borders are irregular, Colors are dark or variable, Diamater >6mm, Evoluation
Thickness is most important for prognosis

508
Q

Dx of Melanoma

A

Full thickness wide excisional biopsy with lymph node biopsy

509
Q

Tx of Melanoma

A

Excision with lymph node biopsy or dissection

510
Q

What is Molluscum Contagiosum

A

Benign viral infection by Poxviridae

511
Q

Sx of Molluscum Contagiosum

A

Single or multiple dome shaped, flesh colored pearly white, waxy papules with CENTRAL UMBILICATION

512
Q

Tx of Molluscum Contagiosum

A

Usually resolve on their own in 3-6 months
Cryosrugery
Imiquimod or Podophyllin`

513
Q

What is Lice

A

Pediculosis

514
Q

Sx of Lice

A

Intense itching, papular uritcaria near lice bites

See nits in hair

515
Q

Tx of Lice

A

Permetrhin

Bedding and clothes should be washed in hot water with detergent and dried in hot drier for 20 minutes

516
Q

What is Scabies

A

Sarcoptes Scabiei

Spread via feces

517
Q

Sx of Scabies

A

Intesnely pruritic lesions, linear burrows usually in web spaces between fingers/toes, scalp
Itching is worse at night when females lay eggs

518
Q

Dx of Scabies

A

Skin scraping shows mites or eggs

519
Q

Tx of Scabies

A

Permetrin, may need reapplication after 1 week

Bedding and clothes washed in hot water and dried in hot dryer

520
Q

What are Dermatophytes

A

Fungal skin infections

521
Q

Dx of Dermatophytes

A

KOH smear

Woods Lamp

522
Q

Tx of Dermatophytes

A

Tinea Pedis, Cruris, Corporis with topical antifungals
Tinea Capitus with Griseofulvin
Onychomycosis with Griseofulvin

523
Q

What is Epididymitis

A

Usually due to Chlamydia in men <35 yrs or N. Gonorrhea

E.Coli or Klebsiella >35yrs

524
Q

Sx of Epididymitis

A

Gradual onset of scrotal pain, erythema, and swelling
Usually unilateral
Positive Prehn’s Sign (Relief of pain with elevation of testicle)
Positive Cremasteric Reflex

525
Q

Dx of Epididymitis

A

Scrotal Ultrasound: Increased testicular blood flow

UA: Increased WBC

526
Q

Tx of Epididymitis

A

BEd rest, scrotal elevation, cool compress, NSAIDS
If Gonorrhea and Chlamydia: Azithromycin and Ceftriaxone
If E.Coli: Fluoroquinolones

527
Q

What is a spermatocele

A

Epididymal cystic scrotal mass containing sperm

528
Q

Sx of Spermatocele

A

Painless, cystic mass in head of epididymis

Transilluminates easily

529
Q

Tx of Spermatocele

530
Q

What is Testicular Torsion

A

Spermatic cord twists and cuts off testicular blood supply

531
Q

Sx of Testicular Torsion

A

Abrupt onset of scrotal, inguinal or lower abdominal pain
N/V
Swollen, tender, retracted testicle
Negative Prehn’s Sign (no relief of pain with elevation)
Negative Cremasteric Reflex
Blue dot sign at upper pole

532
Q

Dx of TEsticular Torsion

A

Doppler Ultrasound: Avascular testcile

Radionuclide Scan is Gold STandard

533
Q

Tx of Testicular Torsion

A

Detorsion and Orchiopexy within 6 hours

534
Q

What is a Hydrocele

A

Cystic collection of fluid in testicle

Most common cause of painless scrotal swelling

535
Q

Sx of Hydrocele

A

Painless scrotal swelling, dull ache, or heaviness

Transillumiation

536
Q

Dx of Hydrocele

A

None

Aspiration of fluid if compressive

537
Q

What is a Varicocele

A

Cystic testicular mass of varicose veins
Usually found on left side
Surgically correctable

538
Q

Sx of Varicocele

A

Bag of worms superior to testicle

Dull ache or heavy sensation

539
Q

Tx of Varicocele

A

Surgery

If sudden onset in older male may be renal cell carcinoma

540
Q

What is Cryptorchidism

A

Undescended testicle

Increased risk in premature infant and low birth weight

541
Q

Sx of Cryptorhchidism

A

Emtpy, small scrotum with inguinal fullness

Complications are testicular cancer or infertility

542
Q

Tx of Cryptorchidism

A

Orchiopexy: as early as 6 months of age and before 1 year
Observation if less than 6 months
HCG or gonadotropin releasing hormone

543
Q

Sx of TEsticular Cancer

A

Painless testicular nodule, solid mass or enlargement

Gyncecomastia may be present

544
Q

Dx of Testicular Cancer

A

Scrotal US and Serum STudies
Seminomous: Radiosensitive and NO tumor markers
Non-seminomas: Radioresistant, Increased alpha-fetoprotein and Beta-HCG

545
Q

TX of Testicular CA

A

Low grade nonseminoma: Orchiectomy with retroperitoneal lymph node dissection
Low grade Seminom: Orchiectomy followed by radiation
High grade Seminoma: Debulking chemo then orchiectomy and radiation

546
Q

What is the most common pathogen in Cystitis

547
Q

Sx of Acute Cystitis

A

Dysuria, Increased Frequency, Urgency, Hematuria, Suprapubic discomfort

548
Q

Sx of Pyelonephritis

A

Fever and Tachycardia
Back/flank pain
Positive CVA tenderness
N/V

549
Q

Dx of Acute Cystitis/Pyelonephritis

A

UA: Pyuria, Positive leukocyte esterase, Positive Nitrities, Hematuria
Dipstick: Positive leukocyte esterase, nitrities, hematuria
IF you see WBC casts in UA it’s Pyelonephritis
Definitive is Urine culture

550
Q

Tx of Uncomplicated Cystitis

A

Fluoroquinolones: Cipro
Bactrim
Nitrofurantoin (Macrobid)

551
Q

Tx of Complicated Cystitis

A

Oral Fluoroquinolone or IV
Aminoglycosides
If pregnant: Amoxicillin, Nitrofurantoin

552
Q

Tx of Pyelonephritis

A

Fluoroquinolone or Aminoglycoside

553
Q

What is Paraphimosis

A

Foreskin becomes trapped behind corona of gland forms tight band
Constricts penis

554
Q

Sx of Paraphimosis

A

Enlarged, painful glans with constricting band of foreskin behind glans

555
Q

Tx of Paraphimosis

A

Manual reduction

Injection of Hyaluronidase

556
Q

What is Benign Prostatic Hypertrophy

A

Prostate Hyperplasia that leads to bladder outlet obstruction

557
Q

Sx of BPH

A

Frequency, Urgency, nocturia, hestitancy, weak/intermittent stream force, incomplete emptying and incontinence

558
Q

Dx of BPH

A

DRE: Uniformly enlarged, firm, rubbery prostate
UA: Normal
Increased PSA

559
Q

Tx of BPH

A

Observation
5-Alpha Reductase Inhibitors (Finasteride and Dutasteride) (affects clinical course)
Alpha-1 Blockers: Tamsulosin, Alfuzosin, Doxazosin (provides sx relief)
TUPR: trans urethral resection of prostate

560
Q

What is Bladder Cancer

A

Most are Transitional Cell

RF are smoking, occupational exposures

561
Q

Sx of Bladder Cancer

A

Painless microscopic or gross hematuria

Dysuria, urgency, frequency

562
Q

Dx of Bladder Cancer

A

Cystoscopy with biopsy

563
Q

Tx of Bladder Cancer

A

Localized or superficial: Transurethral resection
Invasive (involving muscle layer): Cystectomy
Recurrent: BCG Immune Therapy

564
Q

What is Renal Cell Carcinoma

A

Tumor of proximal convulted renal tubule cell

Smoking, Dialysis, HTN, and obesity are RF

565
Q

Sx of Renal Cell Carcinoma

A

Hematuria, Flank/ABdominal pain, Palpable mass

Varicocele

566
Q

Dx of Renal Cell Carcinoma

567
Q

Tx of Renal Cell Carcinoma

A

Localized: Radical nephrectomy, Immune therapy

Bilateral invovlement or with one kidenY; Partial nephrectomy

568
Q

What is the most common type of Kidney Stone

A

Calcium (Calcium Oxolate)

569
Q

Sx of Kidney Stones

A

Sudden onset of constant upper/lateral back pain over costovertebral angle
Radiates to groin/anterior
N/V
Positive CVA tenderness

570
Q

Dx of Kidney Stone

A

Noncontrast CT is 1st choice
IV Pyelography is gold standard
UA: Microscopic hematuria

571
Q

Tx of Kidney Stone

A

If <5mm: Spontaenous passage, fluids, analgesics
If >7mm: Shock wave lithotripsy, Uretoscopy with stent
Percutaneous Nephrolithotomy if large stones

572
Q

What is Prostatitis

A

Prostate gland ifnlammation due to secondary infection

Usually due to E.Coli, Pseudomonas, Chlamydia/Gonorrhea

573
Q

Sx of Prostatitis

A

Fever, Chills
Frequency, urgency, dysuria
Hestiancy, poor or interrupted stream
Tender, normal or hot boggy prostate

574
Q

Dx of Prostatitis

A

UA or culture
Don’t do prostatic massage in acute
Prostatic massage ok in chronic for culture

575
Q

Tx of Prostatitis

A

Acute: Fluoroquinolones, Bactrim
Crhonic: FQ, Bactrim, TURP for refractory

576
Q

What is Salmonellosis

A

Caused by Salmonella Enterica transmitted via food and water

577
Q

Sx of Salmonellosis

A

3 types: Enteric (typhoid fever), gastroenteritis, bacteremia
Enteric: 5-14 day incubation, malaise, headache, cough, sore throat, splenomegaly, person looks ill, pea soup diarrhea
Gasteroenteritis: 848 hour incubation, fever, N/V, crampy abdominal pain, bloody diarrhea
Bacteremia: Prolonged recurrent fevers, local infection in bone, joints, pleura, pericardium

578
Q

Tx of Salmonellosis

A

Tyhpoid: Ampicillin, Bactrim, but if resistant Ceftriaxone or FQ
Gastroenteritis: Self limited, but Bactrim, Ampicilin, Cipro work
BActeremia: Same as typhoid

579
Q

What is Shigellosis

A

Caused by Shigella Sonnei, Flexneri, Dystenteriae

580
Q

Sx of Shigellosis

A

ABrupt diarrhea, lower abdominal cramps, tenesmus, fever, chills, anorexia, headaches, malaise
Loose stools with blood and mucus
Tender abdomen

581
Q

Dx of Shigellosis

A

Stool positive for leukocytes and RBC

Cultures

582
Q

Tx of Shigellosis

A

Fluid replacement

Bactrim is 1st line, but Cipro and FQ work

Family Medicine (1 decks)

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