Last Minute Flashcards
6 possible exogenous causes of hyponatremia?
Oxytocin Surgery Narcotics Inappropriate IV fluid administration Diuretics Antiepileptics
ECG findings in electrolyte disturbances?
HyperK - tall, tented T waves
HypoK - loss of T waves/T-wave flattening and U waves
HyperCa - QT shortening
HypoCa - QT prolongation
Mainstays of therapy for CHF?
Sodium restriction
Diuretics (furosemide, spironolactone, metolazone)
ACEIs (first line)
Beta-blockers (if stable)
Digoxin (ONLY moderate-to-severe CHF with low EF or systolic dysfunction)
Vasodilators
Most common type of esophageal cancer and cause? Second most common and causes?
Most common - adenocarcinoma 2/2 long-standing reflux and Barrett esophagus
2nd most common - SqCC - smoking and alcohol
Screen for hereditary hemochromatosis?
Transferrin saturation test (serum iron/TIBC) and ferritin
Cause of bronchiolitis vs. croup?
B - RSV, parainfluenza, influenza
C - parainfluenza, influenza
Rx bronchiolitis vs. croup?
B - humidified O2, bronchodilators (?), ribavirin if severe
C - dexamethasone, nebulized epinephrine, humidified O2
3 sequelae of strep infection? Which are prevented by treatment?
Rheumatic fever*
Scarlet fever*
PSGN
Odds Ratio =?
AD/BC
RR = ?
(A/A+B)/(C/C+D)
Attributable Risk?
A/A+B - C/C+D
The P-value reflects the likelihood of making a ___ error.
Type 1
Causes of low maternal serum AFP?
Down syndrome
Inaccurate dates (most common)
Fetal demise
Causes of high maternal AFP?
Neural tube defects
Ventral wall defects
Inaccurate dates
Multiple gestation
Always perform ___ before ___ in the setting of third trimester bleeding in case placenta previa is present.
U/S; pelvic exam
Humeral fracture may present with what motor/sensory dysfunction? Nerve involved?
Wrist drop
Back of forearm and hand (first 3 digits)
Radial
Elbow dislocation may present with what motor/sensory dysfunction? Nerve involved?
Claw hand
Front and back of last 2 digits
Ulnar nerve
Carpal tunnel syndrome and humeral fracture may present with what motor/sensory dysfunction? Nerve involved?
Impaired pronation, thumb opposition
Palmar surface of hand (first 3 digits)
Median nerve
Upper humeral dislocation or fracture may present with what motor/sensory dysfunction? Nerve involved?
Impaired abduction, lateral rotation
Lateral shoulder
Axillary nerve
Knee dislocation may present with what motor/sensory dysfunction? Nerve involved?
Impaired dorsiflexion/eversion, possible foot drop
Dorsal foot, lateral leg
Peroneal nerve
Compare the presentation, symptoms/signs, and treatment of LCPD vs. SCFE.
LCPD: 4-10 y/o, short male with delayed bone age; Rx with orthoses
SCFE: 9-13 y/o, overweight M adolescent; Rx with surgical pinning
BOTH have knee, thigh, groin pain, limp
Pulsatile abdominal mass + hypotension = ruptured AAA until proven otherwise. Immediate next step?
Immediate laparotomy
BPH can present as acute renal failure. Patients have what exam findings? Management?
Distended bladder and bilateral hydronephrosis on U/S without “medical” renal disease
Drain the bladder first (cath), then TURP
Metabolic derangements caused by thiazide diuretics?
Hyper: Ca, glycemia, uricemia, lipidemia
Hypo: Na, K (metabolic alkalosis), volemia
Watch out for sulfa allergy
Metabolic derangements of loop diuretics?
Hypokalemic metabolic alkalosis
Hypovolemia
Ototoxicity
Hypocalcemia
Watch out for sulfa allergy
Metabolic deranagemnets of carbonic anhydrase inhibitors?
Metabolic acidosis
What are the potassium-sparing diuretics?
Spironolactone
Benzodiazepine OD - antidote?
Flumazenil
Beta blocker OD - antidote?
Glucagon
Cholinesterase inhibitor OD - antidote?
Atropine, pralidoxime (anticholinergics)
Copper or gold OD - antidote?
Penicillamine
Lead OD - antidote?
Edetate (EDTA); succimer in children
Methanol or ethylene glycol OD - antidote?
Fomepiazole, ethanol
Muscarinic blockers - antidote?
Physostigmine
Quinidine or TCA OD - antidote?
Sodium bicarbonate (cardioproective)
Aspirin OD can be fatal and classically leads to what metabolic derangements
Both metabolic acidosis and respiratory alkalosis
[Look for coexisting tinnitus, hypoglcyemia, vomiting, history of swallowing pills
Alkalosis and acidosis can cause symptoms of K and/or Ca derangement. What should be done in these settings and what derangements are caused?
Alkalosis - hypoK, hypoCa
Acidosis - hyperK, hyperCa
Rx the acid-base disturbance, not the levels
What can make hypoCa and hypoK unresponsive to replacement therapy?
Hypomag
Hemolysis can falsely elevate what lab?
K
Hypoalbuminemia can falsely decrease what lab?
Ca
Hyperglycemia can falsely decrease what lab?
Na
“Bitot spots”
Vitamin A deficiency
Cherry-red spot on the macula WITHOUT HSM
Tay-Sachs
Cherry-rod spot on the macula WITH HSM
Niemann-Pick disease
Cafe-au-lait spots with normal IQ
NF
Cafe-au-lait spots with intellectual disability
McCune-Albright or Tuberous sclerosis
Postpartum fever unresponsive to broad-spectrum ABX?
Septic pelvic thromboplehbitis
Low grade fever in the first 24 hours after surgery?
Atelectasis
Claudication and atrophy of the buttocks with impotence?
Aortoiliac occlusive disease (aka Leriche syndrome)
True or false - the body does not compensate beyond a normal pH.
True
Should you give bicarbonate to a patient with acidosis?
For boards, almost never. First try IV fluids and correction of the underlying disorder. If all other measures fail and pH remains less than 7.0, then give bicarbonate.
Signs and symptoms of hyponatremia?
Lethargy Seizures Mental status changes or confusion Cramps Anorexia Coma
Rx SIADH if water restriction fails?
Demeclocycline (induces nephrogenic DI)
Rate of correction in chronic, severe symptomatic hyponatremia?
Should not exceed 0.5 to 1.0 mEq/L/hr
Once glucose is >200, sodium decreases by ___ for each rise of ___ in glucose.
1.6 mEq/L; 100 mg/dL
Signs and symptoms of hypernatremia?
AMS
Seizures
Hyperreflexia
Coma
Rx hypernatremia?
Water replacement (usually severely dehydrated) -> NS, then switch to 1/2 NS when hemodynamiccaly stable
NEVER D5W
Signs and symptoms of hypokalemia?
Muscle weakness (paralysis, ventilatory failure, ileus, hypotension) EKG - T wave loss/flattening, U waves, PVCs, PACs, tachyarrhythmias
Potassium levels should be monitored carefully in all patients taking ___.
Digoxin
Signs and symptoms of hyperkalemia?
Weakness and paralysis
EKG - tall peaked T waves, QRS widening, PR prolongation, loss of P waves, sine wave
First consideration in an asymptomatic patient with a normal EKG and hyperkalemia?
Hemolysis of lab specimen -> repeat the test
Rx hyperkalemia
In general, decrease K intake and given Kayexalate (resin)
If >6.5 or cardiac toxicity is apparent ->
1. Calcium gluconate (cardioprotective)
2. Sodium bicarbonate (alkalosis -> shifts K inside cells)
3. Glucose with insulin (ditto)
Beta2 agonists are an option
Dialysis if failure or renal failure
Signs and symptoms of hypocalcemia?
Tetany (Chvostek, Trousseau)
Convulsions/seizures
EKG - QT prolongation
Signs and symptoms of hypercalcemia?
Often asymptomatic Osteopenia Kidney stones/polyuria Abdominal pain, N/V, constipation, anorexia Depression, psychosis, AMS EKG - QT shortening
Rx hypercalcemia
- IV fluids
- Once well-hydrated, give furosemide (calcium diuresis)
+/- phosphorus administration, calcitonin, bisphosphonates, plicamycin, prednisone, etc.
In what clinical scenario is hypomagnesemia usually seen?
Alcoholism
Signs and symptoms of hypomagnesemia?
Similar to hypocalcemia (prolonged QT, tetany)
Signs and symptoms of hypermagnesemia?
Decreased DTRs, hypotension, respiratory failure
Rx of preeclampsia, renal failure
Maintenance fluid of choice for patients who are not eating?
Half normal saline with 5% dextrose (adults)
Add KCl to prevent hypokalemia
What may happen if you give glucose WITHOUT thiamine?
Precipitate Wernicke (give thiamine BEFORE glucose)
Rx bleeding esophageal varices?
- ABCs
- IV fluids and blood if needed.
- Correct clotting factor deficiencies with FFP, fresh blood, and vitamin K, if needed.
- Upper endoscopy -> sclerotherapy (cauterization, banding, or vasopressin)
Rx varices with no history of bleeding?
Non-selective beta blockers (propranolol, nadolol, timolol) to relieve portal HTN (so long as there is no contraindication)
If a question asks you to calculate the RR from retrospective data, what is the answer?
None of the above or cannot be calculated
Positive skew is an asymmetric distribution with an excess of ___ values; the tail of the curve is on the ___. Relationship between mean, median, and mode?
High; right; mean > median > mode
The incidence of a disease is equal to the absolute or total risk of developing a condition (as distinguished from relative or attributable risk).
Cool beans.
What test compares percentages or proportions (non-numeric or nominal data)?
Chi-squared test
What is a type II error?
Null hypothesis is accepted when in fact it is false (null should be rejected but isn’t)
Rx MI.
- Early reperfusion (fibrinolysis, PCI, etc.)
- EKG monitoring (if VTach -> amiodarone)
- O2 (>90%)
- Morphine
- Aspirin
- Nitroglycerin
- Beta blockers (unless contraindicated)
- Clopidogrel
- Unfractionated or LMWH (unstable angina, cardiac thrombus, CHF on echo, unless contraindicated)
- ACEI or ARB within 24 hours
- Statin
Presentation of variant (Prinzmetal) angina? Rx?
Pain at rest (unrelated to exertion) + ST-segment elevation with NORMAL cardiac enzymes
Responds to nitroglycerin, Rx long term with CCBs
Late diastolic blowing murmur best heard at the apex
+/- opening snap, loud S1, AF, LA enlargement, pulmonary hypertension
Mitral stenosis
Early diastolic decrescendmo murmur best heard at apex
+/- widened pulse pressure, LVH, LV dilation, S3
Aortic regurgitation
Harsh systolic ejection murmur, best heard at aortic area, radiates to carotids
+/- slow pulse upstroke, S3/S4, ejection click, LVH, cardiomegaly, syncope, angina, heart failure
Aortic stenosis
Midsystolic click, late systolic murmur
+/- panic disorder
Mitral prolapse
Holosystolic murmur that radiates to the axila
+/- soft S1, LAE, PH, LVH
Mitral regurgitation
Rx mitral stenosis
Balloon valvotomy or surgery if severe
Medical management (diuretics, digoxin, beta blockers) is ONLY adjunctive.
Rx mitral regurgitation?
Corrective surgery if indicated (flail leaflet, severe regurgitation)
Vasodilators (nitroprusside, hyralazine) if symptomatic
AFIb is common
Rx aortic stenosis
Aortic valve replacement if symptomatic (essentially all patients)
Rx aortic regurgitation?
Replacement or repair if symptomatic, or asymptomatic with certain indications (progressive LV enlargement)
Vasodilators to reduce hemodynamic burden
Rx superficial thrombophlebitis (erythema, tenderness, edema, palpable clot in superficial vein)
NSAIDs and warm compress
How are heparin, warfarin, and aspirin monitored?
Heparin -> PTT
Warfarin -> PT/INR
Aspirin -> Bleeding time (platelet function)
Note - LMWH doe snot affect any of these
Reverse heparin/LMWH?
Protamine
Reverse warfarin?
FFP (immediate) and/or vitamin K (several days)
Reverse aspirin?
Platelet transfusions
Rx acute CHF?
Inpatient
O2, diuretics, positive inotropes
Digoxin if stable
IV sympathomimetics (dobutamine, dopamine, amrinone) if severe
Rx 1st degree heart block
None; avoid BBs, CCBs (slow conduction)
Rx 2nd degree heart block
Mobitz type I - pacemaker or atropine only if symptomatic
Mobitz type II - pacemaker in all patients
Rx 3rd degree heart block
Pacemaker
Rx WPW syndrome
Procainamide or quinidine
NO digoxin or verapamil
Rx VTach
Pulseless - immediate defibrillation followed by epi, vasopressin, amiodarone, or lidocaine
Pulse - amiodarone and synchronizde cardioversion
Rx VFib
Immediate defibrillation followed by epi, vasopressin, amiodarone, or lidocaine
Rx PVCs
Usually not treated; if severe and symptomatic, BBs or amiodarone
Major risk factors for CHD?
Age (M 45+, F 55+ or with premature menpause)
Family history of premature heart attacks (MI or sudden death in F/first degree M relative <55, mother/first degree F relative <65)
Cigarette smoking
HTN
DM
Low HDL (<40)
LDL = ?
Total cholesterol - HDL - (TG/5)
Macule and patch?
Flat spot (<1 cm and >1 cm)
Papule and plaque?
Solid, elevated (<1 cm, >1 cm)
Dry, well-circumscribed, silverly, scaling papules and plaques that are NOT pruritic
Psoriasis
Rx pityriasis rosea?
Reassurance
Causes of erythema multiforme?
Sulfa drugs, penicillins
Herpes
SJS if severe
Squamous cell cancer often develops in areas with pre-existing ___ or burn scars.
Actinic keratoses (hard, sharp, red, often scaly lesions in sun-exposed areas)
Best prognostic factor of malignant melanoma?
Thickness of tumor
Potential concern of giving beta-blockers to hypoglycemic diabetic patients?
May mask hypoglycemia symptoms (caused by catecholamine release)
