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1
Q

Dressler Syndrome - Dx

A

Post MI pericarditis + fecer + PLEURAL EFFUSION **
“pericardial friction rub” at the end on expiration at left lateral sternal border
*Avoid NSAIDs (use ASA or Colchicine)

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2
Q

Multifocal Atrial Tachycardia - Dx

A

Normal rhythm, but 3 DISTINCT P WAVES (rate >100)
* Associated with COPD
Hypoxia, electrolyte imbalances

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3
Q

Hyponatremia - SC

A

** Probably caused by Heart Failure **
Serum Sodium <135
Hypervolemic
URINE SODIUM <20
JVD, pulmonary edema

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4
Q

Hypertension - Tx

A

Lifestyle: wt loss, stop smoking, decrease sodium, DASH diet
ACE I/ARB
Thiazide Diuretic (HCTZ)
CCB (amlodipine, nifedipineine)
If HF, AFib, - BB

C/I:
no BB with bronchospasm or heart block
no ACE/ARB with pregnancy

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5
Q

VTach - Tx

A

Stable - IV Amiodarone then try Lidacaine then try Procainamide
Pulse BUT UNSTABLE - Cardioversion then IV amiodarone
PulseLESS - Defibrillate

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6
Q

Acute Coronary Syndrome - Dx

A

Unstable cardiac ischemia (Unstable angina, NSTEMI, STEMI)
-Levine Sign: fist chest and leaned forward
-angina, diaphoresis, radiating pain
-ST depression, + biomarkers

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7
Q

Mitral Stenosis - Dx
Mitral Stenosis - H/P

A

“Opening Snap and low-pitched diastolic murmur”
+ exertional dyspnea, decreased exercise tolerance
+ pink-purple patches on cheek - mitral facies

Left ventricle outflow obstruction (increases left atrium pressure)

MCC: Rheumatic Heart Ds

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8
Q

Aortic Stenosis - DxS

A

crescendo-decresendo radiating to the carotids
ECHO

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9
Q

CHF
- H/P
- SC
-Clinical interventions
- Dx

A

SOB, fatigue, orthopnea
Edema
displaced apical pulses (rEF), s3, narrow pulse pressure, peripheral vasoconstriction

pulsus alternans

ECHO
- Systolic = reduced EF <50
- Diastolic = preserved EF >/= 50
BNP>100
NT-proBNP
<50 = >450
50-75 = >900
>75 = >1800
CXR: cephalization, Kerley b lines,e cardiomegaly
-

BB + ACE/ARB + Spironolactone +/-SLGT2 Inhibitor
- Balloon pump, Cardiopulm assist. device, LVAD

LSHF: LV, mitral, aortic valve dysfunction
RSHF: Pulm. HTN, RV, pull, tricuspid

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10
Q

Coronary Vascular Disease - SC

A

Atherosclerosis (plaque build-up in the arteries) = narrowed arteries = ischemia
- High cholesterol
OXYGEN SUPPLY DOES NOT MEET OXYGEN DEMAND

Stress test

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11
Q

Deep Vein Thrombosis - Health Maintance

A

Stay active/moving
Do not stay in bed all day (immobility)
No OCPs

ANTI-COAGS –> DOACs (don’t use if CrCl >/= 30
IVC Filter if AC is not tolerable

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12
Q

Angina - Clinical Tx

A

Acute: SL Nitro
Tx risk factors: HTN, Obesity, Sedentary
Preventative Tx: BB, Nitro, Statin, Aspirin

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13
Q

PAD - Health Maintenance

A

ABI <0.9
1st Line = WALKING, exercise, stop smoking, control lipids
Cilostazol

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14
Q

SVT - Treatment

A

1st - Vagal Maneuvers
2nd - Adenosine
** CATH. ABLATION **
1. Vagal + Adenosone + BB/CCB + Cardioversion
CModkc = CCB, BB, digoxin (block AV node)

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15
Q

AFib
- Dx Studies
-Health Main

A

EKG : irregularly irregular + NO P WAVES
* RVR >100
* Holter Monitor
* ECHO –> Commonly seen with left atrial enlargement!!!

<48hrs = Cardiovert + anticoag
>48hr = anticoag for 4 weeks, then on anticoagulant then TTE

TX: Anticoag + Rhythm control (Amiodarone) + Rate control (BB/CCB)

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16
Q

Toxic Megacolon - Dx Study

A

1st) Abdominal XR = Colon > 6cm
Caused by UC
* Fever, abdominal pain, tachy, dehydration, etc.
CT abdomen
Barium: “Stove pipe” + loss of haustrae

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17
Q

Status Epilep - H/P

A

Single seizure >5min or 2 episodes within 5 mins
- structural abnormalities
-infections (meningitis, enceph)
-metabolic abnormality
-meds
-toxins

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18
Q

Cardiac Arrest - Clinical Intervention

A

Stabilize!!!
- Obtain ROSC
- Endotracheal Tube
- Keep SBP >90, MAP >65
- Resp: SpO2 92-98%

EKG
PCI

PVT = Shock
VF = Shock

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19
Q

Corneal Ulcer - Clinical Intervention

A

STOP contacts
Protective eyewear (not a patch)
ABX drops

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20
Q

Acute Glaucoma
- Tx
- H/P (Acute angle CLOSURE)

A

Narrowing of the anterior chamber and the aqueous humor cannot drain which leads to IOP and damages the optic nerve
** IOP >30mm **

Sudden, unilateral eye pain + “Tunnel Vision Loss”, halos N?V
** Red Conjunctiva + corneal edema, haziness, cloudiness, shadow anterior chamber, mid0dialted pupil that poorly reacts to light

**Episode triggered by sudden papillary dilation from darkness, sympathetic arousal, meds or cocaine **

Emergent Opthom. Referral in 1 hr
Keep patient SUPINE

If cant get referral in 1 hour –> IV Timolol then Apraclonidine then Pilocarpine then Acetazolemide

AFTER ATTACK = Laser Peripheral Iridotomy

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21
Q

Rocky Mnt Spotted Fever
-H/P
-Dx

A

Tick bite

Rash on Palms and Soles (starts on ankle/wrists and spreads to the trunk) + fever + myalgia

Blanching rash –> Petechal –> hemorrhafic

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22
Q

TB - Health Maintenance (skin test)

Primary TB = Clinical Intervention

A

5mm or more = HIV +, immunocompromised, close contact with + TB person, CXR with healed TB

10mm or more = children < 4, DM, CKD, IVDU, Immigrant, High-Risk settings

> 15mm = no risk factors

SO - TB is positive if these sizes meet these criteria (ex: If a health care worker has a TB PPD > 10mm = Positive) order CXR

Primary:
RIPE drugs

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23
Q

Salmonellosis
- Tx
- SC

A

GI Bug “pea-soup” - GRAM-NEGATIVE RODS
fecal-oral - poultry, eggs

Replace fluids and electrolytes - self-limited
If severe can use FQ (Cipro or Levo) = gram neg
– Kids = Azithromycin

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24
Q

Shigella - Tx

A

Fecal Leukocytes Test = +
Azithromycin, Ceftriaxone, FQ
Rehydrate

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25
Diverticulitis - DxS
CT Scan = bowel wall thickening + increased soft tissue density with fat stranding or colonic diverticula Elevated ESR CRP + Leuks Abdominal US = Hypoechoic peridiverticular inflammatory reaction MRI = colonic wall thickening + diverticula Colonoscopy can cause rupture
26
Pancreatitis - Tx
FLUIDS epigastric pain that radiates to the back + elevated lipase Check Systemic Inflammatory Response Syndrome (SIRS) -Temp, HR, RR, WBC >12k Pt should be treated for other complicatiosn too (alc withdrawal) and hyperglycemia - they are at risk of developing preDM or DM after first episode of pancreatitis
27
Esophageal Varices - Tx
Stabilize = IV Fluids, Blood/FFP or platelets if INR >2.0 or plt <50k -- Tx: Vasoconstrict = Octreotide --ABX: Rocephin or FQ --Emergency Endoscopy with banding if pts hemodynamic status stabilized within 2-12hrs -BB to prevent rebleeding
28
Gastritis - Tx
Cause = H.Pylori Tx - CAP: Clarithromycin + Amoxicillin + PPL Cause = NSAID: Omeprazole, Misoprostol, Sucralfate (antiacid)
29
UC -Dx -Tx
Bloody diarrhea +P-ANCA - Sigmoidoscopy - anus + mucosa = friable, edema, mucopus, erosions = continuous/UNIFORM lesions/ulcers Tx: mild -- Topical Mesalamine + PO 5-ASA (sulfasalazine, Mesalamine) --Steroids is no help in 2 weeks severe --anti-TNF: INFFLIXIMAB +/- IMMUNOMODULATOR (mercaptopurine) or any "Mabs" Sigmoidectomy ?
30
Appendicitis -Tx
IV Fluids + Zosyn Surgical consult --> Appendectomy
31
Peptic Ulcer - Ruptured -Dx St
CBC, CMP, the&screen, Coags, Rectal Exam EGD!!!!!!! CXR/CT = air under diaphragms
32
Hep B -Health Mnt
Supportive care -Chronic: antiviral -- jaundice, liver inflamm, Increased ALT or + HBenvolope antigen Vax: Yeast (bakers yeast = CI) - Infant: @ BIRTH, 1-2 months, 6-18mth -Adult: 3 doses @ 0, 1, 6 months
33
Colon CA: - CI
MCC of LBO SURGICAL RESECTION Colonoscopy: starting at 50 every 10 yrs or sigmoidoscopy every 5 + fecal occult blood every 3
34
C.Diff -Tx
Metronidazole or Vancomycin Fidaxomicin for relapse
35
Pernicious Anemia -Dx
B12 deficiency (Macrocytic) Glossitis + neuropathy + hematology DXS: Hypersegmented neutrophils, macro-ovalcytes, low retic -high LDH, Homocysteine, Methylmalonic Acid
36
SBO -H/P
MCC - adhesions from surg N/V, colicky abdominal pain, onstipation, peristalsis Proximal: emesis with undigested food, epigastric pain Distal: diffuse, crampy abdominal pain
37
Giardiasis -S/C
flagella protozaon parasite (colonizes in small intestine) Infx causing microvilli shortening which leads to malabsorption in intestines leading to hypersecretion causing diarrhea
38
Polymyalgia Rheumatica -H/P -Dx
Proximal joint stiffness + pain (worse in am) - shoulders, hips, neck, pelvic girdle - hurts to comb hair GAINT CELL ARTERITIS NORMAL STRENGTH on PE
39
Low back strain - Tx
Heat, massage NSAIDS (do not rest) servere pain: tramodol or opioids
40
SLE - Clinical Int
Photoprotection, stop smoking, immunization ** Hydroxychloroquine (can add prednisone) --- S/E: toxic retinopathy, QTC Prolongation
41
Rotator cuff tear -H/P
Repetitive, overhead activity -tear in the undersurface/articular portion of the SUPRASPINATOUS tendon -Pain/weakness over LATERAL DELTOID worse with OH and at night Empty can test Hawkins kennedy painful arc (active) drop arm test weakness in external rotation < 90 degrees
42
Spinal stenosis - CI
PT, Steroid injections, wt loss, bracing, NSAIDS if sus caudal equina = Surgical Decompression Labecetomy
43
Polymyositis
Proximal joint WEAKNESS Women 30-50 progressive muscle weakness (brushing hair) - low grade fever, arthralgias -Weak grip strength - HYPERKERATOSIS HANDS (cracked/MECHANIC hands) RASH
44
ankle sprain - H/P
Here a pop, rolled ankle = INVERSION MC = ANTERIOR TALOFIBULAR LIGAMENT (LATERAL) anterior drawer test taler test
45
Bicep tendonitis CI
Supportive PT, NSAIDS, Rest
46
Mallet Finger -HM
Splint DIP in uninterrupted extension 6-8 weeks Surgical Pinning
47
Subarachnoid Hemorrhage H/P
Worse HA of my life, N/V, meningeal signs RF: HTN, Smoking Caused by AV Malformation, Stroke, Trauma Ruptured berry aneurysm at the ACA (anterior communicating artery)
48
Depression CI
SSRI for 6 months
49
Hyperkalemia Tx
Calcium Gluconate (stabilizes the myocardium) Lower with Parental Insulin + glucose (weakness, fatigue, paralysis) Stop Furosemide or Dialysis
50
Bladder CA DxS
Cystoscopy
51
Nephritic Syndrome Dx
Glomerulonephritis RBC cast (some proteinuria) Decreased GFR Edema, HTN
52
Acute interstitial nephritis CTx
WBC Casts + Eosinophilia Rash + Arthralgias Tx: stop agent Steroids Dialysis
53
Acute Pyelonephritis DxS H/P
E.COLI HX: DM, UTI, Preg Fever, chills, flank pain, dysuria, uregency, frequency UA: PYURIA (>10WBC) + Leuks + Nitrites + Blood ** WBC Casts DEFINITIVE DX = Urine Culture
54
Complicated Cystitis H/P
Obstruction, Renal Stone DM, HIV, Steroids, Chemo Pregnancy Male pt Indwelling Cath
55
Sarcoidosis DxS Tx
CXR ? = Hilar Lymphadopathy Increased ach Intially = Predinsone Then Methotrexate Last Hydroxychloriquine and Anti - TNF
56
COPD -H/P
Smoking, Air Pollution, Dust --> Sus: S.Pneumo, H.Influ Cor Pulm, Pulm HTN (Increased AP diameter, vascular marking) Increased Hemoglobin, HCT Resp. Acidosis
57
Hypersensitivity Pneumonitis Tx
Prednisone SOB, cough, rales, flu-like symptoms
58
Acute Bronchitis Dx Tx
Cough 5 days - no fever --hemoptysis (common) Symptomatic: Fluids, Dextromethorphan, antipyretics, analgesics
59
Asbestos H/P Dx
Working in old houses, destruction, insulation Cough + BIBASILAR CRACKLES CXR: Pleural PLAQUES in lower lobes, shaggy heart
60
asthma DxS
PVFs/Spirometry Decreased FEV1/FVC ratio <0.7 Decreased FEV1 + Bronchodilator response Tx Review: ICS: Beclomethasone, Fluisolide, Triamcinolone SABA: Albuterol, Terbutaline LABA: Formoterol, Salmeterol Anticholinergic: Ipratropium
61
Histoplasmosis DxS
Soil of bird/bats in Mississippi or Ohio River Valley - AIDS DIMORPHIC OVAL YEAST (fungal) Dx: Increased Alk Phos. and LDH CXR: UNILATERAL pulm infiltrates, hilar/mediastinal lymph. Sputum PCR or Urine High Specific Cultures = most specific
62
Klebs. Pneumo HM
RASH + pneumo symptoms Cavitary Lesions on CXR Currant Jelly Sputupe CAP = Azithromycin or Doxy Inpatient: Ceftiazone + Azithro/Doxy HAP: Bactrium or Cefepime or Ceftazidime + Aminoglycoside or FQ or Augmentin
63
Atypical Pneumonia Tx
Mycoplasma Reticulonodular CXR PCR = Cold agglutinins Tx: Azithromycin or Doxy
64
Community-Acquired S/C
Strep Pneumo Gram Positive Diplococci
65
Pneumocysitis Pneumo Dx
HIV, CD4 <200 Progressive DoE, Fever, Non-Productive Coufh -- O2 desat with ambulation CXR: Diffuse Bilateral Intersitial Infiltrates Increased LDH Bronchoalveolar Lavage Specimen: Trophic and Cysts
66
Tobacco Use DO HM
Low dose CT age 50-80 if ever smoked or quit within the past 15 years
67
Acute laryngotracheobronchitis (croup) HP
Seal Like Cough + Stridor Nasal congestion, rhinorrhea, fever, course XR: Steeple Sign Parainfluenza
68
PE H/P Dx
Sudden onset of CP and SOB, hemoptysis Hx of DVT: Anticoag, travel, OCPs, CA Factor V Leiden PERC Criteria - DVT - D-Dimer: >50, HR>100, O2<92, unilateral leg swelling, hemoptysis, surgery, prior PE, OCP Wells >6 = CTPA EKG = Sinus Tachycardia #1 --S1Q3T3
69
Adenocarcinoma (Pulm) Dx
Smoker Peripheral Lesions Bronchial mucosal glands
70
Pneumothorax TX
Sudden SOB, unilateral absent breath sounds - SIZE: Small <3cm = Will go away on its on + O2 and Observe -- Repeat films in 4 hours >3cm = Needle Decompression (4th-5th intercostal) = Thoracostomy followed by chest tube thoracostomy Tension = EMERGENCY chest tube + hospitalization
71
Subacute Thyroiditis Dx
POST VIRAL INFX PAINFUL Neck/Thyroid -- Labs go from hyper to normal to hypo --Tender Thyroid --Increased ESR
72
Pheochromocytoma DxS
24 hr Urine Metanephrines and Vanillymandelic CT/MRI
73
DM2 HM
Weight loss, Low carb diet Yearly Microalbumin, Yearly Foot and Eye exam Statin If A1C>9 = insulin
74
Hypercalcemia HP
- Hyperparathyroid: stones, bones, groans, psych moans, abd. groans EKG: shortened qt intervals
75
Thyroid Storm Tx
Fever, Achy, delirium Tx: Prompt BB (Propranolol) + Hydrocortisone, Methy/PTU
76
Intracranial Hemorrhage Tx
HTN, AV Malformation - HA, N/V, Loss of Consciousness Tx: REDUCE BP --- If ICP increased = Mannitol
77
Peripheral Vertigo Tx
BPPV Unidirectional nystagmus (vertical nystag = central) No neurological findings Dx: Dix-Hallpike Maneuver if BPPV --> Tx: Epley Maneuver
78
Multiple Myloma DxS
SERUM Protein Electrophoresis: Monoclonal Protein Spikes (IgG) URINE protein electrophoresis: Bence-Jones Protein (kappa or lambda) CBC: Rouleaux Formation (RBC stack of coins) Skull XR: Punched out lesions
79
B12 def HM H/P
aka Cobalamin - From Animal Protein, eggs, dairy products - Pernicious Anemia: lack of intrinsic factor -----Meds: H2 Blockers, PPIs, Metformin -----chronic alcohol, chrons, Vegans Neuropathy, GLOSSITIS, fatigue, ataxia Increased Homocysteine and Methylmalonic acid
80
ITP DxS
Idiopathic Thrombocytopenia - Autoantibodies against platelets leading to splenic destruction of platelets DxS: ISOLATED THROMBOCYTOPENIA (low platelets) -- Normal coags, WBC, hematocrit
81
Sickle Cell Anemia DxS
INITIAL = Peripheral Smear - Target cells, sickled erythrocytes + HOWELL-JOLLY BODIES Hemoglobin Electrophoresis - HbS and HbF
82
Von Willie HM
Bleeding d/s Mucocutaneous bleeding, prolonged PTT, normal platelets Screening: Plasma VWF Antigen: Decreased VWF antigen Plasma VWF Activity: Ristocetin cofactor activity decrease Factor VIII (8) Activity = Decreased Type 1 = quantitative def = desmopressin ** Major procedures: VWF - Contacting products Type 2 = qualitative def = desmopression
83
Dysfunctional uterine bleeding DxS H/P
hCG to rule out pregnancy = 1st 1st line = Transvaginal US Look for trauma, lesions, infections, FB
84
Human Pap Virus HM
9-Valent HPV (Gardasil-9) --- 9-14 years: 2 doses ---->14: 3 doses
85
Metabolic Syndrome Dx
Increased BP, Hyperglycemia, Waist Body Fat, Hyperlipidemia
86
Anal Fissure Dx Chronic Anal Fissure Tx
BRBPR Acute: Sitz bath, Nitro/diltiazem Refractory or >8wks = Lateral Internal Sphincterotomy --- RF: Fecal incontience
87
G6PD Dx
AA Males - Oxidative stress - Pain, anemia, jaundice, splenomegaly Peripheral smear: Normocytic anemia with HEINZ BODIES & SCHISTOCYTES (bite cells)
88
Cluster HA Tx
100% O2 -ptosisi, miosis, anhidrosis Props: Verapamil
89
Parkinsons Disease - Neurocognitive H/P
Leiw Body dementia resting tremor, bradykinesia, muscle rigidity Memory loss (loss of dopaminergic neurons = failure of acetylcholine inhibition in basal ganglia
90
Raynaud Phenomenon Tx
Vasodilators CCB (diltiazem, Amlodipine, verapamil)
91
Sick Sinus Syndrome Dx
Mix of tachy brady
92
Stroke DxS
CT Non-Contrast Hemorrhage = can do LP after --yellow to pink, increased RBC/pressure/protein, xanthochromia
93
Hypoventilation Syndrome CI
Obesity = Weight loss, stop drinking --CPAP = mainstay therapy --Surgical = Tracheostomy = Definitve
94
Granuloma Dx
Berylliosis sob, cough, joint pain, fever Biopsy = noncaseating granuloma Chrons,
95
Immunizations / Pulm HM
PCV13 = kids <2, PCV15, 20 = Adults >65 (who have not had PCV) PPSV23 = adults >65 (who have not had PCV)
96
Cor Pulmonale SC
HTN from COPD or hypoxemia Hypertrophy, dilation of rt ventricle = JVD, peripheral edema, ascites
97
Cardiac Tamponade CI
Becks Triad: JVD, distant heart sounds, hypotension Pericardiocentesis
98
Anterior MI DxS
ST elevation in leads V1-V4 LAD
99
Upper GI bleed CI
EGD
100
Cholecystitis HP
RUQ pain + radiates to scapula + N/V + Murpheys Sign
101
Delirium Dx
Sudden AMS after hospitalization, meds, UTI
102
BPH Tx
-tamsulosin (alpha 1 blocker = relieves symptom) -finasteride (5-alpha reductase= shrinks prostate) Surgery = TURP (if >12-24 months)
103
HTN Crisis Tx
Urgency = Clonidine Emergency = Nitroprusside, Labetolol, Nicardipine, Hydralazine Reduce MAP 10-20% in 1st hour, then 5-15% IN 23 HOURS
104
Dilated Cardiomyopathy HP
Systolic = weak floppy ventricles = Men 20-60 - Viral: coxsackie, HIV, Lymph, Parvo, Alcohol, Cocaine, Thiamine S3 gallop Systolic HF
105
Inferior STEMI Dx
II, II, AVF RCA
106
2nd Degree AV Block Type 2
Mobitz II = Random dropped QRS
107
Hypoglycemia Tx
Carbs/Sugars Insulin Stop offending agent
108
Barrett Esophagus DxS
EGD with Biopsy -esophageal squamous epithelium replaced by precancerous. cells -leads to Esophageal Adenocarcinoma
109
Hyperbilirubinemia SC
Hepatitis (Acute Viral), increased ALT/AST, Hemolytic anemia G6PD Bili is produced with RBC break down - taken up by liver and secreted into bile Causes: bile obstruction, liver dysfunction, choleysistits
110
Hemolytic Anemia Tx
increased retics, indirect bili increased, decreased hap Stop agent Blood Transfusion Prednisone
111
TTP Tx
ADAMTS13 def SLE Low platelets, bleeding Hem Anemia: anemia, jaundice Neurologica: visual changes, HA, confusion, seixures Fever Tx: PLASMAPHERESIS
112
Iron Def Anemia DxS
Low hem Low ferritin / transferrin High TIBC microcytic hypochromic anemia with increased RDW
113
Tetanus SC
Anaerobic bacterial clostridium tetani ---Exotoxin produced when bacteria lyse --> travels and enters central nervous system Puncture wounds
114
Meningitis HM
Dexamethasone, IV ABX Tx household contacts with Rifampin, Cipro, etc Vax: Meningococcal Vax - 11-12 yo + BOOSTER @. 16-23
115
Morton Neuroma Dx
burning, painful foot with weight bearing high heels nodule between 3rd and 4th MCP Palpable mass and mulders sign (click with palpation
116
Giant Cell Arteritis DxS
Temporal Biopsy
117
Erectile Dysfunction Tx
PDE-5 inhibitors (Sildenafil) -- CI with CV --S/E: flushing, PRIAPISM Can use antidepressants: wellbutrin, murtazapine
118
Polycystic kidney disease Tx
flank pain, uti, HTN, palpable mass Simple cyst: Observe + HTN meds (ace) Multiple cyst: Increase Fluids Control BP and increase fllies
119
Papillary Thyroid Carcinoma SC
head/neck radiation Increased THYROGLOBULIN levels Psammona bodies on FNA
120
Bacterial Meningitis Dx
LP: Glucose LOW, High opening pressure, high protein, neutrophils MC = strep pneumo Kids = n. meaning
121
Complex Regional Pain Syndrome Dx
pain, redness, to extremity/area after an injury
122
Reactive Arthritis Dx
sexually active, knee pain + conjunctivitis + urethritis

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