Medicine Flashcards
Cytochemical features of hairy cell leukemia?
Tartrate-resistant acid phosphotase (TRAP)
When should you give an meningococcus vaccine?
Travels to Asia
What type of cyst is found in echinococcus granulosus?
Hydatid cyst (eggshell calcifications
When should you be tested for HIV is a low-risk population?
One time between 15-65 using p24 antigen and antibody testing
What is imipramine?
Tricyclic antidepressent
Exertional dyspnea, pounding heart sensation, widened pulse pressure?
Aortic regurgitation
What cancer contains reed sternberg cells?
Hodgkin’s lymphoma
What treatments help pass kidney stones?
Hydration, analgesics, alpha blockers
How to evaluate uric acid stones?
Ct of the abdomen or intravenous pyelography
How to you manage a patient who does not smoke ad had a small (less than 4mm) nodule on CT?
No follow-up imaging
Patient with a sick contact, fever, cough, right lower lobe crackles, and absence of upper respiratory symptoms?
Community acquired pneumonia, diagnose with CXR
Signs of non-glomerular hematuria?
Blood but no protein
Dietary recommendations for patients with renal calculi are:
Increased fluid intake, decreased sodium intake, normal dietary calcium intake
PE rule-out in a hemodynamically unstable individual who cannot undergo CT angio?
TTE
empyema
collection of pus in a cavity, especially pleural
Urine sodium > 20mEq/L with low serum osmolarity > 300 mOsm/kg
SIADH
How does prevalence affect positive predictive value?
A population with a high prevalence means a positive test is more likely to be positive, increasing the positive predictive value
Greater the prevalence, the greater the PPB
Order of likelihood for brain mets
Lung>breast > unknown primary > melanoma > colon
In RA refractory to Methotrexate, what is next?
Add monoclonal antibody, etanercept
Salvage therapy?
treatment for a disease when standard treatment fails
Monoclonal gammopathy of unknown significance
Presence of serum monoclonal protein of less than3g/L without evidence of anemia, kidney failure, bone disease, or other myeloma-related and end-organ damage
Treatments for uncomplicated cystitis?
Nitrofurantoin, trimethoprim/sulfamethoxazole, fosfomycin, fluoroquinolones, urine culture (only if initial treatment fails)
Treatment for urinary urge incontinence?
Pelvic floor exercises -> antimuscarinic therapy if refractory (oxybutynin)
How to manage a patient with a blood smear showing platelet clumping?
Repeat platelet count
First line treatment in COPD patient?
bronchodilators (ipratropium or tiotropium) that are anti-cholinergic
Effect of malabsorption on calcium levels
Inhibits absorption of Vit. D -> low calcium, low phosphate
Treatment for Ulcerative Colitis?
Mesalamine (left-sided only), sulfasalazine, balsalazine, olsalazaine
When a patient presents with immediately-threatened limb ischemia, what should be the first step?
Heparinize the patient
ulnar nerve syndrome?
decreased sensation of 4th and 5th fingers, weak grip due to involvement of interosseous muscles
Most common site is the elbow (medial epicondylar)
dullnes to precussion with increased breath sounds?
Consolidated pneumonia
Lab findings in multiple myeloma?
Hypercalcemia and anemia, excessive production of a single monocloncal protein
painless, sudden vision loss (or haze)
centralretinal vein occlusion
Signs of thyroid storm?
Palpitations, weight loss, irregular menses, impaired glycemic control, confusion, agitation, n/v
Inheritance pattern of Hemophilia?
X-linked recessive
How do you treat cancer-related anorexia/cachexia syndrome?
Progesterone analogs *megestrol acetate)
What is the most common complication of HIT?
Additional venous thrombosis
What is the most common trigger for bronchoconstriction in patients with asthma?
Aspirin
Risk factors for cholesterol emboli?
Comorbid conditions (HLD, HTN, DM type II) Cardiac catheterization
How do nitrates relieve chest pain in angina?
Systemic vasodilation and decreased in cardiac preload -> reduction in left ventricular systolic wall stress -> decrease in o2 demands
Side-effect of radioiodine ablation?
Worsening of opthalmopahty
Presentation of OA of the hand?
Squaring of the first carpometacarpal joint (base of thumb) and DIP and PIP
What can cause decreased serum potassium?
Increased beta-adrengergic activity -> stimulates the sodium potassium ATPase pump and the sodium-potassium-2 chloride co-transporter
Signs of autoimmune hemolytic anemia?
Spherocytes and positive direct antiglobulin test
Why should metformin and NSAIDs be discontinued in treatment for volume depleted sepsis?
Nephrotoxins, worsen kidney function Metformin, specifically causes lactic acidosis in AKI and sepsis
What is an s4 heart sound associated with?
Long-standing hypertension, comes from a stiff left ventricle (diastolic heart failure)
Cardiac manifestations of TB
Pericarditis (fatigue, dyspnea, pericardial knock (early heart sounds after s2)), pericardial calcifications, sharp x, y decents
A person who is treated for Hodgkins lymphoma is at increased risk for?
Secondary malignancy
Parallel-group studies
One-treatrment to one group
Different treatment to a second
Severe symptoms of hyponatremia (seizures, inability to communicate and/or coma)
Bolus of hypertonic saline until symptoms improve, +/- vasopressin receptor antagonists (conivaptan)
Shingles infection (herpes zoster)
Yeast with papular, crusting lesion?
Histoplasmosis
Treatment for actinomyces?
Penicillin, surgery (if severe)
How to manage blood products in a patient who has experiences prior anaphylatic reactions?
Wash samples
How to treat an immunosuppressed patient with positive TB skin test?
9 months of isoniazid
How to diagnose cushing’s disease?
24-hour urine cortisol measurments
“culture-negative” urethritis Diagnosis?
Chlamydia trachomatis NAAT on first-catch urine
When should CAD testing not be performed?
When they can exercise and have a normal ECG
What test is the most sensitive for diagnosing heart failure?
Elevated brain natruretic peptide levels
Prophylactic therapy for a patient with HIV?
Trimethoprim-sulfamethoxazole
How are methemoglobinemia formed?
Exposure to oxidation agents (Fe2+-> 3+
Dapsone, nitrates, topical/local anesthetics
Signs of laxative abuse?
Hypokalemia with metabolic acidosis (decreased bucarb, which is lost in the GI tract
Treatment for RA?
Methotrexate
stevens-Johnson syndrome vs TENS?
SJS: <10% of body surface area
TEN >30% of total body surface area
Colloid solutions?
Albumin
Most common drugs assoicated with dyspepsia? Alternative tx?
NSAIDS, Initiate PPI is unable to stop NSAIDS
Management for epidural spinal cord compression?
Emergent MRI, Intravenous glucocorticoids, radiation-oncology and neurosurgy consultation
Confounding errors?
If the groups are stratified, there will not longer be any significant difference.
Features of glucogonoma?
Necrolytic migratory erythema- face, perineum, extremitiesDMGI- diarrhea, anorexiaWeight loss
What is the treatment for inadequately controlled asthma?
Long acting beta agonist
Hypertensive encephalopathy?
Severe hypertension with cerebral edema and non-locatizing neurologic symptoms and signs
Where is prophylaxis with with mefloquine, appropriate for malaria?
Sub-Saharan Africa, Amazon basic, Souther and Southeast Asia
Initial treatment for the management of severe hypercalcemia?
Normal saline infusion to restore intravascular volume immediately, bisphosphonates for long-term management
Bite cells with normal G6PD?
Glucose-6-phosphate dehydrogenase deficiency
oligomenorrhea, hirutism, elevated testosterone levels?Tx?
Polycystic ovarian syndromeTx: Weight loss and oral estrogen/progestin contraceptives
What is the next step after osteomyelitis is demonstrated?
Obtain blood cultures
If a person that HBsAB-positive need treatment after exposure to a hepatitis B patient?
No, they are immune
Most common trigger of COPD exacerbation?
Upper respiratory infection
Hearing loss with abnormal Rinne test?
Otosclerosis
Signs of allergic rhinitis?
nasal congestion, clear rhinorrhea, pale, edematous nasal mucosa, nasal creases, pharyngeal cobblestoning
What is the SPIKES protocol for family meetings?
Set up situation (privacy, etc)
Assess family perception (“What do you think is going on?”)
Obtain family’s invitation (“How much would you like to know?”)
Give knowledge and information
Use empathic statements
Strategy and summary
Curb-65 croteroa?
Confusion, urea >20mg/dL
Respiratory rate >/= 30
Blood pressure (systolic <90, diastolic <60)
Age >/= 65
Treatment for diabetic neuropathy in young patients?Older?
Young- amitriptylineOld: Pregabalin
What test should be used to evaluate the presence of a DVT in a low risk patient?
D-dimer (Wells criteria)
In patients with a likely PE, when should anticoagulants be given?
Unlikely?
Likely- anticoagulation prior to diagnostic testing
Unlikely- diagnostic testing before anticoagulation
Enlarged kidneys, hepatomegaly, and history of rheumatoid arthritis with nephrotic syndrome?
Amyloidosis -> glomerular deposits visualized with specialized Congo red staining
What is the effect of high anti diuretic hormone levels?
increase dilute urine excretion and loss of sodium
Orthostatic proteinuria
Proteinuria is greater standing than lying down Most common in children or young adults Associated with the “nutcracker syndrome”, compression of the left renal vein between the aorta and the SMA
What is the purpose of a negative predictive value?
Let’s us know how often a negative result will mean the patient does not have the disease
What differentiated malignant hypertension?
Severe hypertension with retinal hemorrhages, exudates, or papilledema
Long-standing smoking, chronic productive cough, recent hemoptysis?
Chronic bronchitis
Factitious fever
Young woman with irregular fever patterns, track with fever diary
Auer Rods Cancer?
Acute Myeloid Leukemia
Signs of infective endocarditis?
low-grade fever, generalized weakness, holosystolic murmur, osler nodes
Treatment for restless leg syndrome?
1st line: Dopamine
Alternative: alpha-2-delta calcium channel ligands (gabapentin enacarbil)
Drop in platelets in 5-10 days puts a patient at risk for?
Arterial thrombosis
Leukomoid reaction
high fever, infectious diarrhea, with increased metamyelocytes (late neutrophil precursors and high leukocyte alkaline phosphatase
Common pathogens of brain abscesses?
Viridans, s. aureus, gram negative organisms
How to calculate expected compensation in metabolic acidosis?
1.5 times bicarb + 8 (+/-2)
Enveloped-shaped calcium oxalate crystals are classically observed in patients with
ethylene glycol poisoning, from antifreeze
What medications can cause hyperkalemia?
non-selective beta androgenic blockers, potassium=sparing diuretics (triamterene, amiloride), ACT-I, ARBs, NSAIDS
Clinical features of cholesterol emboli?
Renal injury, CNS stroke, ocular involvement, livedo reticularis, ulcers, gangrene, blue toe syndome
What is a significant side affect of dihydropyridine ca-channel antagonists like amlodipine?
Edema
Tubulointerstitial nephritis
Analgessic nephopathy, drug-induced chronic renal failure Presentation: polyuria and sterile pyuria, mild proteinuria Caused by Aspirin and naproxen, and other analgesics
Actinic Keratosis
What type of kidney disease in most common in hodgkin’s lymphoma?
Minimal change disease
How to you calculate positive predictive value?
Across the row (TP)/(TP+FN)
Most common cause of abnormal hemostasis in patients with CRF?
Platelet dysfunction, treated with desmopressin
Facial plethora with normal oxygen saturations and low EPO?
Polycythemia Vera
How does long-standing hypertension affect the kidneys?
Intimal thickening, and intimal narrowing of renal arterioles with evidence of sclerosis
Direct contact with bone in a diabetic foot ulcer should require what management?
Bone biopsy
Signs of hypercalcemia?
Weakness, fastrointestinal distress, neuropsychiatric symptoms
When to suspect cardiac sarcoidosis?
Young patient (<55) with unexaplained second- or third-degree heart block or when ECG changes occur in a patient with known or suspected systemic sarcoidosis
Treatment for hypertrophic cardiomyopathy?
Avoidance of volume depletion, BBs/CCB, surgery, if persistent symptoms
Signs of cerebellar degeneration?
Progressive gait dysfunction, truncal ataxia, nystagmus, intention tremor or dysmetria (limb-kinetic tremor when touching a target)
Myositis, fever, subungual splinter hemorrhages, periorbital edema, eosinophilia
Trichinellosis
How to do treat BPH?
5-alpha reductase inhibitor
What is the appropriate treatment for a needle stick on an HIV patietn?
Three drug regimen and serology (for baseline) 2 nucleotide/nucleoside RTI plus integrase strand transfer inhibitor
Biological role of vitamin B12?
Formation of thmidylate and purine molecules for DNA
funduscopy with dilated and tortous veins leading to scattered and diffuse hemorrhages
central vein embolus
What agents should be used to rapidly lower potassium?
Insulin with glucose, beta-2-adrengergic agonists, sodium bicarbonate
Vocal cord dysfunction
Commonly mistakes for asthma, however, negative methylcholine challenge Signs: difficulty breathing, wheezing, coughing Diagnosis: Laryngoscopy
Side effect of phenytoin?Treatment?
Mild megaloblastic anemia caused by reduction in folic acid levelsTx- folic acid supplementation
Neoadjuvant therapy?
Treatment given before the standard therapy
How do ACE inhibitors cause chronic nonproductive cough?
metabolism of kinins and substance P inhibition -> kinin causes bronchial irritation
Mild to sever glomerular nephritis with low complement levels and nephritic urinary sediment?
Post infectious GN, lupud nephritis, MPGN, mixed cryoglobulinemia associated with hepatitis C
Signs of glucogonoma?
Hyperflycemia with elevated glucagon > 500pg/mL
Signs of mixed essential cryoglobulinemia?
Palpable purpura, proteinuria, hematuria
If a patient is taking steroids and gets sick, what should happen?
Increase dose of hydrocortisone during the intercurrent illnesses to avoid adrenal crisis
Causes of macrocytic anemia?
Folate deficiencyB12 deficiencyMyelodysplastic syndromeAcute myeloid leukemiasDrug induced (chemotherapy agents)Liver DxAlcohol abuseHypothyroidism
What is the greatest predisposing factor for stent thrombosis after intracoronary drug-eluting stent placement?
Premature discontinuation of antiplatelet therapy
How to treat A fib with RVR?
Synchronized cardioversion
Where does selective survival occur?
Case-control studies
Babesiosis?
Diagnosis?
Tx?
Protozoal illness endemic to northeastern united states,
Often asymptomatic, but shows up in immunocompromised patients or splenectomy patients.
Signs: Anemia and intravascular hemolysisBlood smear (maltese cross)
Tx: atovaquone plus azithromycin or quinine plus clindamycin (severe)
Flank pain, poor urine output and intermittent episodes of high-volume output?
Urinary outflow obstruction
Meningitis - CSF findings
elevated WBC, protein levels, decrease glucose
Target for treatment o
Galactorrhea and signs of secondary amenorrhea, next step?
Obain prolactin levels
Laboratory signs of diabetes insipidus?
Severe polyuria and mild hypernatremia
Reversal agent for heparin?
Protamine sulfate
MS stenosis presentation
gradual and progressively worsening dyspnea and orthopnea, hoarseness, left atrial enlargement -> elevation of left mainstem bronchus
Ebteroclysis
used to diagnose small bowel tumors and other pathology, which can cause intestinal obstruction
Clinical features of malaria?
Periodic febrile paroxysms, non specific malaise, headache, nausea, abdominal pain, diarrhea, myalgia, pallor, jaundice, petechiae, hepatosplenomegaly
In a young patient with suspected DM, what should be the first step in management?
Check for pancreatic autoantibodies to rule in/out DM type 1
Effects of hypopituitarism?
glucocorticoid deficiency, hypogonadism, hypothyroidism
Carcinoid tumors put you at risk for deficiency of what?
Niacin (diarrhea, dermatitis, dementia)
Physicial manifestations of Hemophilia A & B?
delayed/prolonged bleeding after mild traumaHemarthrosis, hemophilic arthropathyIntramuscular hematomasGastrointestinal or genitourinary tract bleeding
Role of large and small fibers in DM?
Large- numbness, proprioception, vibrationSmal- pain, paresthesias, allodynia
How does hypertensive intracerebral hemorrhage present?
Evolves over minutes to hours
Initially presents with focal neurological symptoms -> vomiting, headache, bradycardia (increased intracranial pressure) ->
Bacteria that can cause infective endocarditis?
Enterococci, Fungi, S. bovis, coagulase-negative Staph, Strep viridans, S. aureus
How does multiple myeloma cause infections? Most common types?
Impairs normal lymphocyte populations -> ineffective antibody production and hypogammaglobulinemia Respiratory (streptococcal pneumonia) and UTI
In a younger patient presenting with osteoporosis, what should be the first step in workup?
Find an underlying cause.
Treatment for fibromyalgia with or without depression?
Serotonin-norepinephrine reuptake inhibtors (duloxetine, milnacipran
Without a clear provoking factors, what procedures should be conducted?
Age-appropriate cancer screening and CXR
Osmolarity formula?
2 x [Na] + glucose/18 + BUN/2.8
How does the body respond to decompensated heart failure?
Activates the Renin-angiotensin-aldosterone system -> constriction of efferent renal arterioles -> increased intraglomerular pressure to maintain GFR rate
High-output heart failure
Cardiac output is higher than normal -> circulatory overload -> pulmonay edema (secondary to elevated diastolic pressure in left ventricle
What is uremic pericarditis?
retrosternal chest pain that is relieved by leaning forward, pericardial friction rub and renal failure. BUN is normally greater than 60
When is a cystoscopy useful?
When hematuria is present in urinalysis
When should you given dental procedure prophylaxis antibiotics?
- Prosthetic cardiac valves 2. History of prior infective endocarditis 3. Unrepaired congenital heart disease for 6 months following repair 4. Repaired congenital heart disease with residual defects or abnormalities 5. Cardiac transplantation recipients with cardiac valvulopathy
What defines a complicated pleural effusion?
- pH less than 7.2 2. pleural effusion glucose less than 60 3. lactate dehydrogenase > 1000 4. positive fluid gram stain
How to treat acute cholecystitis?
ERCP
Bird fancier’s lung
hypersensitivity pneumonitis causes by repeated inhalation of antigen -> leads to alveolar irritation Classic sign: haziness over the lower lung fields
Foul-smelling diarrhea, weight loss, fatigue
Steatorrhea and malabsorption
Calcium pyrophosphate dihydrate disease?
Presents like OA, but with atypical joints (hands)
How does trimethyprim cause hyperkalemia?
Blocks sodium channels in the epithelial sodium channel in the collecting tubule
How does primary polydipsia present osmolarity?
serum osmolarity less than 290, urine osmolarity less than 100
Malaria phases:
Cold- chills shivering, hot- fever, sweating
Which type of arrhythmia is most specific for digoxin toxicity?
Atrial tachycardia with AV block
How does pregnancy affect thyroid levels?
Causes a 30% increase in the first trimester
Normal DLCO and FEV1/FVC less than 70?
Chronic bronchitis, asthma
Signs of dominent frontal lobe ischemia?
Able to follow commands, but unable to veralize or write properly.
Affect brain pathways to mouth and larynx
Young adult who has a murmur that increases in intensity with the Valsalva?
Hypertrophic cardiomyopathy
What treatment should be used in severe chronic obstructive pulmonary disease?
Inhaled corticosteroids
How does heat stroke (105F+) cause rhabdomyolysis and organ system damage?
Body looses its ability to dissipate heat and leads to destruction of cells
most like cause of a respiratory alkalosis and metabolic acidosis?
Aspirin toxicity -> stimulates respiratory center to cause tachypnea and respiratory alkalosis and causes metabolic acidosis by increasing the production of lactic acid
How do you treat hypercalcemia due to sarcoidosis?
Corticosteroids, which decreases vitamin D3 production
How do you treat antiphospholipid syndrome?
Indefinately continue warfarin
Signs of cyanide toxicity?
altered mental status, lactis acidosis, seizures, coma
Charcot Triad
Pain, fever, jaundice
What is leukocyte alkaline phosphatase?
An active enzyme found within mature blood cells
Microscopic colitis?
chonic watery diarrhea without bleeding
How should suspected BPH be managed?
Order kidney ultrasound to rule out obstruction
What drugs should not be used in cocaine abusers?
Beta-blockers
What factor contributes to Warfarin necrosis?
Protein C (primary) and S deficiency
Prerenal azotemia BUN/Cr
>20:1
Sudden painless loss of vision?
Tx?
Central retinal artery occlusion d/t occlusion
Tx: Ocular massage and high flow O2
What actions are still present in a patient that is “brain dead”?
Deep tendon reflexes
Osteolytic lesions, fractures, hypercalcemia, anemia
Multiple myeloma
Aortic dissection that leads to pulmonary congestion?
Retrograde extension leads to aortic valve involvement and aortic regurgitation
thrombocytopenia and microangiopathic hemolyutic anemia
Thrombotic microangiopathy
What vaccinations should be taken prior to a trip to Ehypt?
Hepatitis A, B, typhoid vaccines, polio booster
Where do vagal maneuvers affect the heart?
AV node conduction
Selective survival bias
case-control studies when cases are selected from the entire disease population instead of just those who are newly diagnosed
How many days after last drink to alcohol withdrawal symptoms peak?
12-48 hours
What viruses can cause keratitis in an AIDs patient?
Varizella Zoster and herpes simplex
What is the most common cause of medical errors?
Communication failures between providers
MoA of HIT?
IgG autoantibody that coats the surface of platelets and forms complexes with platelet factor 4 (PF4)
JVD on expiration, wheezing, tachypnea, use of accessory muscles?
COPD
Acral lentiginous melanoma
Unevenly darkly pigmented patch mostly arises on the palmar, plantar, or subungual surfaces
What type of kidney stones are individuals with Chron’s disease predisposed to developing?
Oxalate, due to lack of binding in the gut by calcium
How to treat narrow-QRS complex tachycardia? MoA?
Adenosine slows sinus rate, increased AV nodal conduction delay, or transient block in AV node conduction
What are exam findings in aortic stenosis?
- Delayed rising and diminished carotid pulse (pulsus parvus and tardus) 2.Single and soft second heart sound 3. Mid- to late-peaking systolic murmur
Hawthorne effect?
Tendency of a study population to affect the outcome because theey are aware they are being studied
How does cardiogenic shock affect acid/base status?
Cells shift to anaerobic metabolism -> accumulation of lactic acid -> metabolic acidosis
Latency period
Delay between initial exposure and clinically apparent effects)
anasarca?
Extreme, whole body swelling
Human papillomarvirus infection
What predisposes an individual to the risk of developing minimal change disease?
NSAIDs, lymphoma
Best study for determining the incidence of a disease?
Cohort
Painless thyroiditis
acute thryotoxicosis with mild thyroid gland enlargement and suppressed TSH
How does renal hypoperfusion cause edema?
Activate renin-angiotensin system and causes retention of sodium and water, expanding intervascular volume
How do you manage hypobolemia hypernatremia?
Normal 0.9% saline, once resuscitated, switch to D5 (preferred) or 0.45% saline
What can happen is a penetrating injury to an eye?
Discovery of “hidden” antigens that the immune system can now recognize and attack, which leads to blindness
How do you treat a complicated pleural effusion?
Chest tube to drain
How do you treat single nodule colorectal mets?
Regional hepatectomy
How long can it take a person with inadequate dietary intake, intestinal malabsorption, or hepatocellular disease to become vitamin K deficient?
7-10 days
Hypotension, tachycardia, distended jugular veins, respiratory variation in systolic blood pressure?
Cardiac temponade
When is it appropriate to accept a gift from an external source?
Accepting nonmonetary gifts from parties only if the gifts directly benefit patient care and are or small monetary value
(educational materials, drug samples)
Where is blasto located?
Midwest, upper midwest, extending to southern Mississippi
How to diagnose idiopathic intracranial hypertension?
MRI +/- MRV, lumber puncture (CSF pressure >250mm H20 with normal analysis)
When is enterococci likely to cause endocarditis?
nosocomial UTI
How often should a PAP smear be done in a woman who had a hysterectomy for non-malignant reasons?
Discontinue pap smears
When should an HIV infected person stop receiving line attenuated vaccines?
CD4+ counts less than 200
Expansile and eccentrically places lytic area in the epiphysis of the distal femur?
Giant cell tumor, “Soap bubble” appearance
How to treat chemotherapy-induced nausea and vomiting?
Serotonin receptor antagonist (5HT)
What affect does COPD have on vital capacity?
Decreases it
How to treat a patient with stage III colon cancer s/p hemicolectomy?
Adhyvant chemotherapy
How can you confirm proper randomization?
Analysis of the patient characteristics
Signs of acute HIV infection?
Fever, lymphadenopathy, sore throat, arthralgiaas, GI symptoms
Painful mucocutaneous ulcerations
What is a common exam finding with aortic regurgitation?
Bounding pulses
What vaccines should patients with chronic liver disease receive?
Tdap/Td: Tdap once, Td booster every 10 years
Influenza: Annually
Pneumococcal PPSV23 once and PVC13 and PPSC23 at age 65
Hep A: 2 doses 6 months apart (with initial seronegative)
Hep B: 3 doses at 0 months, 1 months, at least 4 months (with initial seronegative)
How to treat a patient with ventricular tachycardia?
Placement of an ICD
Three most common causes of chronic dry cough?
GERD, postnasal drip, asthma
transient vision loss “a curtain falling down”
Retinal embolus from ipsilateral carotid
What STD testing should be conducted on all sexually active woman?
HIV, gonorrhea, Chlamydia
Back pain in an individual with Chron’s disease?
Enteropathic arthritis
Signs on glomerular hematuria?
Blood and protein
What is the first step in evaluating a patient for suspected BHP?
Urine analysis, check for PSA
Cardiac manifestations of Trypanosoma cruzi infection?
Cardiomegaly, causes systolic and diastolic heart failure
What is the role of heptoglobin?
Binds free hemoglobin and promotes its excretion by the reticuloendothelial system
Treatment for narrow complex tachycardia?
Supraventricular tachycardia -> immediate synchronized direct cardioversion
What cancer has retinoic acid receptor present?
Acute promyelocytic leukemia, presents with pancytopenia
How to treat a patient with SLE and suspected lupus nephritis?
High-dose steroids
Long-term pharmacological management of atrial fib?
Metoprolol and warfarin
At what CD4+ count should HIV patients shop receiving inactivated vaccines?
They should always receive them
pain along the anteromedial proximal tibia distal to the joint like that worsens walking up stairs and at night
Pes anserine bursitis
Signs of lupus
Gradual symptom onset, malar or discoid rash, joint, renal, serosal, and neurological involvment Ex: photosensitive skin, thrombocytopenia, glomerulonephritis, RBC casts low c3/c4
How to treat an individual with an intermittent asthma?
short-acting bronchodilator
Cordlike thickening breast and bilateral prementstrual tenderness
Fibrocystic changes
Low DLCO and FEV1/FVC less than 70%?
Emphysema
Diabetic patient with elevated serum creatinine and proteinuria
Chronic kidney disease from diabetic hlomerulosclerosis
rapidly progressing bilateral necrotizing retinitis
HSV
How do you evaluate a patient with suspected vertebral osteomyelitis?
MRI
Hemodynamically stable person with high risk of suspected DVT, next step?
CT angiogram
papules with indented centers, infection? Where are they not found?
Molluscum contagiosum (pox virus),
Not found of palms and soles
How do you manage a patient with ventricular fibrillation arrest in the setting of acute myocardial infarction?
Continued medical management for MI. 1 year risk is no greater than normal is this acute setting
CHF development in a young person andpleural effusions, and third heart sound?
Coxsackie B virus
Calcium oxalate crystals in the kidney suggests?
Ethylene glycol poisoning
Dermatitis herpetiformis
Signs of adrenal insufficiency?
hyperkalemia, hypoglycemia, eosinophilia
How does aortic stenosis present?
Decreased exercise tolerance, exertional dyspnea, angina, or syncope
What is a factoral study design?
2 or more experimental interventions with 2 or more variables that are studies independently
Elderly male with agitation, tachycardia, and lower abdominal tenderness 2 days following surgery?
Acute urinary retention
How to identify drug-induced lung toxicity?
Chronic, high eosinophils, fatigue, low-grade fever, cough
Vaginal pessary use?
Symptomatic pelvic organ prolapse and stress incontinence when surgery fails/in not an option
Best empiric antibiotic treatment for a native valve in suspected endocarditis?
Vancomycin
Sudden onset excruciating left-sided chest pain, tachycardia, dilated pupils, with necrotic nasal mucosa?
Tx?
cocaine toxicity
Tx: intravenous diazepam
How should a tick be removed from the skin?
Remove the tick with tweezers
When is a CT contraindicated in PE workup?
With kidney failure (high creatinine), use ventilation/perfusion scan instead
What drugs have been shown to improve survival rate in patients with heart failure?
Beta-blockers, ACE/ARBs, hydralazine and nitrates and spirolactone, and eplerenone
Management of a patient with a new onset breast nodule that was negative on mammorgram?
Aspiration or Biospsy
How to treat pituitary apoplexy?
Neurosurgery consult and glucocorticosteroids
Blood transfusion reaction that occurs between 1 and 6 hours?How to prevent?
Febrile non-hemolytic transfusionLeukoreduction
Symptoms of histoplasmosis infection?
fever, chills, malaise, weight loss and cachexia, cough, dyspnea, papules, nodules, reticuloendothelial
Signs of polycythemia vera?
Increased hemoglobin, increase leukocytes, increased platelets
G6PD deficiency laboratory signs?
Low hemoglobin, increased indirect hemoglobin, increased indirect bilirubin, increased lactate dehydrogenase, decreased haptoglobin
Electrolyte abnormality with constipation, increased thirst, anorexia, and easy fallibility?
Hypercalcemia
Dyspnea, wheezing, cough with positive bronchodilation response
Asthma
cells iwth convoluted nuclei and highly vacuolated cytoplasm?
infectious Mononucleosis (EBV)
Lung cancer associated with hypercalcemia?
Squamous cell carcinoma, PTHrP secretion
Tracheal narrowing with ulceration
characteristic of Granulomatosis with polyangiitis
Best tests to diagnose obstructive ureterolithiasis?
US or spiral CT without contrast
Hyperkalemia with a normal ECG, next best step?
Check for pharmacological causes of hyperkalemia
What is the first step in managing iron deficiency?
Determining the cause (Fecal occult blood)
How to calculate anion gap acidosis?
Serum sodium - (serum chloride and bicarb) = 14
How do you treat an esophogeal rupture?
surgically repair it
Characteristic signs of systemic Blastomycosis infections?
ulcerated skin lesion and lytic bone lesions
What pharmacologic treatments should be given to prevent acute arterial occlusion?
Apixaban, dabigatran, rivaroxaban, edoxaban
Elderly patient with severe lumphocytosis (>40000) lymphadenopathy, and bicytopenia suggests?
Chronic lymphocytic leukemia
When should you consider pulmonary rehabilitation?
COPD and remains symptomatic, or has decreased functional status
Waldenstrom macroglobulinemia
production of monoclonal IgM antibodieshymphadenopathy and hepatosplenomegaly may be present
Acute treatment for PE or DVT with subtheraputic INR on warfarin?
Rivaroxaban
Signs of cerebellar hemisphere infarct?
occipital headache, neck stiffness, ipsilateral hemiataxia
How to manage a patient with a PAP result of atypical squamous cells of undetermined significance?
Refer to colposcopy
How do you control for confounding errors in analysis?
Design state: Matching, restriction, randomization
Analysis stage: Stratified analysis, statistical modeling
What can improve survival in a severely septic patients at high risk of death?
Activated protein C
How are leukomoid reactions caused by severe infections?
Mobilization of mature and immature leukocytes from bone marrow
What is cryptogenic organizing pneumonia?
nonsmoker without any normal exposure history has acute to subacute development of nonspecific systemic and respiratory symptoms with a dominant alveolar process on CXR
Alternatives to mefloquine prophylaxis?
Atovaquone-proguanil and doxycycline
What medications can cause idiopathic intracranial hypertension?
tetracyclines, hypervitaminosis A,
Also associated with overweight woman of childbearing age
How to treat diffuse large B-cell NHL?
Abbreviated course of chemotherapy followed by radiation
Malaria: Lab findings, clinical diagnosis
Anemia, thrombocytopenia Diagnosis: blood smears
What types of vaccines are safe for people taking TNF-alpha inhibitors?
non-live attenuated
What does changing the cut off for a test change?
Sensitivity and specitivity
Effect modiciation?
external variable positively or negatively impacts the effect of a risk factor on the disease of interest
butterfly appearance with central necrosis on CT/MRI?
Glioblastoma multiforme
fatigue, weight gain, erectile dysfunction and hyponatremia suggest?
panhypopituitarism
Hard unilateral head and neck lymph nodes in an older patient with smoking history?
Squamous cell carcinoma
What DM medications are weight neutral?
DDP-4 inhibitors (sitagliptin)
What does a hazard ratio mean?
Less than 1 = treatment group had a significantly lower event rate
Greater than 1 = significant higher event rate
Solitary brain met in a patient with good performance status. Treatment?
Surgical excision
Signs of elevated pulmonary artery pressure?
- Loud P2, fixed S2 2. Pulmonic flow murmur 3. tricuspid regurgitation
Patient with malignant throid mass, elevated serum calcitonin, and family hx of thyroid malignancy likely has an inherited form of?
MEN2a or 2bRet mutation
Monorrhagia is common in which bleeding disorder?
Willebrand disease
Subclinical hypothyroidism
Mildly elevated serum TSH and normal T3 and T4Do not have clinical signs
Renal findings in multiple myeloma?
Bland with granular casts; nephritic disease
Signs of post-streptococcal glomerulonephritis?
Periorbital swelling, hematuria, and oliguria, hypertensive, serum c3 complements are low
What DM medications cause weight loos?
GLP-1 agonists (exenatide)
What drug is used to treat hairy cell leukemia? Side effects?
Cladribine; neurological and kidney damage
How do you treat lung abscess following aspiration?
Ampicillin-sulbactram
Antibiotic of choice for Oitis media?
Amoxicillin, alternatives: Amoxicillin-clavulanate, cefuroxime, ceftriaxone
Most common cause of acute bronchitis?
Viral infection
dullness to percussion with decreased breath sounds?
Pleural effusion
Signs of drug-induced interstitial nephritis?
Fever, rash, arthralgia, peripheral eosinophilia, hematuria, sterile pyuria and eosinophilurea and WBC casts
Acute radiation proctitis-cause, diagnostic method
Patient who receive pelvic radiation exposure and develop diarrhea.Diagnosis is done via flexible sigmoidoscopyLook for mucosal telangiectasia and submucosal fibrosis and arteriole endarteritis
Early diastolic murmur?
Aortic regurgitation
Signs of renal cell carcinoma?
Flank pain, hematuria, palpable abdominal mass scrotal varicoceles paraneoplastic syndrome
Most common cause of death in dialysis patients?
Cardiovascular disease
Concern when a patient with endocarditis develops a new conduction abnormality?
Perivalvular abscess
1-day history of swlling aliong the margen of the upper eyelid?
Stye, external hordeolum
Staphococcal infection of the eyelid, responds to the application of warm compresses
Gastric Bezoar
foreign body resulting from the accumulation of injested material,
How to diagnose CLL?
Flow cytometry of peripheral blood
Hemoptysis-definition
expectoration of blood originating from the lower respiratory tract
Syndrome with high proteinuria and evidence of edema
Nephrotic
Greater than 10 mm Hg drop in systolic blood pressure with inspiration?
Cardiac temponade
What type of acinar pattern exists with alpha-1-antitripsin?
Panacinar?
Uveitis
blurred vision, moderate pain, conjunctival injection and constricted pupils
Symptoms of Anklyosing spondylitis?
Low back pain (<40)
Hip and buttocks pain
limited chest expansion and spinal mobility
Enthesitis (inflammation at site of tendon insertion to bone)
systemic symptoms (fever, chills,)
acute anterior uveitis (unilateral pain, photophobia, blurry vision)
What is persistent asthma?
Asthma occurring 2 or more times per week or 2 or two or more times a month
Severe headaches at night for weeks/months over time? Treatment
Cluster headaches, treat with 100% oxygen
Friable papules and subcutaneous plaques?
Bartonella angiomatosis
Cardiac manfestations of sarcoidosis?
complete AC block, restrictive cardiomyopathy (early) and dilated cardiomyopathy (late)
Sings: Uveitis
Mediastinal widening, pericardial effusion, neck pain, syncope, HTN history, chest pain
Acute aortic dissection
Decrescendo early diastolic murmur when patient is sitting up, leaning forward, and holding the breath at maximum expiration
Aortic regurgitation
Common types of selection biases?
Ascertainment (sampling): study population differs rom target population
Nonresponse vias: High non-response to surveys/questionnaires
Berkson bias: Disease studies using onl hospital-based patients
Prevalence bias (neyman): exposure that happens long before disease assesment may cause study to miss diseased patients
Attrition bias: significant loss of study participants lost of follow-up
Side effects of thiazide siuretics?
Glucose intolerance by impairing insulin release from the pancreas and glucose utilization in the peripheral tissues
How do you calculate the number needed to treat?
1/absolute risk reduction
Acute hypophosphatemia signs?
Confusion, rhabomyolysis, hemolytic anemia, severe muscle weakness, most commonly seen in alcoholics after glucose administration, which causes uptake of phosphate into cells
Pain, itching, red streaks on an arm that presented in a different location preciously?Next step?
Migratory superficial thrombophlebitis (Trousseau’s syndrome)CT of the abdomen due to association with pancreatic cancer
Episodes of extraocular changes, dysarthria, dysphagia, any symmetrical proximal weakness involving the neck
Myasthenia gravis, cause by acetylcholine receptor antibodies at the motor end plate
Signs of TCA oversode?
drowsiness, delirium, seizures, prolonged QRS, dry mouth
Where is histoplasmosis found?
Mississippi and Ohio river valleys
Ruby-colored papules on lips that blanch partially with pressure?
Arteriovenous shunting (Osler-Weber-Syndrome)
Treatment of choice for serious gram-negative, multidrug resistant infections?
Aminoglycosides
signs of major depression? Treatment?
anhedonia, poor appetite, insomnia, fatigue, difficulties with focus accompanies by memory impairment
Tx: SSRI
What is the most important prognostic factor in breast cancer?
TNM staging, followed by ER/PR status, then Her-2/neu oncogene expression
Signs of theophylline toxiity?
central nervous system stimulation (headache, insomnia, seizures), GI disturbances (nausea, vomiting), cardiac toxicity (arrhythmia)
Sudden onset of shortness of breast, suspect?
Upper airway obstruction, laryngeal edema
hepatic cysts with daughter cysts within?
Echinococcosis (dogs and sheep)
Chronic cough that worsens overnight and does not improve with antihistamines?
Asthma
Obstructive lung disease FEV1, FVC, FEV1/FVC
Fev1-
How do you treat Pneumocystis jirovecii pneumonia?
Trimethoprim-sulfamethoxazole plus corticosteroids
postoperative endophthalmitis?
Within six weeks of surgery Presents with pain and decreased visual acuity, with swollen eyelids, conjunctiva, hypoyon, corneal edema, infection Mostly affects the vitreous
Dengue fever: signs
4-7 days post exposure muscle and joint pain, retroorbital pain, rash, leukopenia
What should all patients diagnosed with ITP be tested for?
HIV
What type of valve defect in seen with hypertrophic cardiomyopathy?
Systolic anterior motion of the mitral valve
Why is the general population not screening for Syphilis?
High rate of false-positives
When is the best time to initiate evaluation of thrombophilia?
2-4 weeks following completion of wargarin therapyStops false positives and false negatives
Cholesterol emboli, laboratory findings?
Eosinophilia, eosinophilerua, hypocomplementemia
Suspected autoimmune disorder, but treatment with corticosteroids causes rapid deterioration?
Think underlying infection
signs on meningococcemia
petechial rash that progresses to ecchymosis, bullae, vesicles, and gangrenous necrosis
Pain exacerbated by bladder filling and relieved by voiding
Interstitial cystitis
What is the first renal abnormality in diabetes?
Glomerular hyper-filtration
Signs of porphyria cutanea tarda?
Blisters, bullae, scarring, hypopigmentation/hyperpigmentation in sun-exposed skin
Signs of hypercortisolism?
Weight gain, psychiatric symptoms, HTN, hyperglycemia
How are p-values and confidence intervals related?
p-value of 0.05 is equal to a confidence interval of 95%
hypernatremia with hypokalemia with htn? Diagnostic test?
Hyperaldosteronism, aldosterone to plasma renin
After confirming a normal TSH, what is the next step in working up suspected Cushings?
24 hour free urine cortisol, salicary cortisol, or low-dose decamethasone suppression 2 must be abnormal
What drugs can increase bleeding risk for a patient on Warfarin?
Acetaminophen, NSAIDS, antibiotics, amiodarone,
What vitamin deficiency is associated with pernicious anemia?
B12, megaloblastic anemia
How do you reverse warfarin?
Vitamine K (slow) and prothrombin complex concentrate (rapid)
Needle-shaped urinary crystals
Uric acid
Transfusion-related acute lung injury
Fever, dyspnea, diffuse pulmonary infiltrates and hypocia
Swlliung on the eyelid which has appeared off an on for the past several years
Initially starts as a painful lesion, which regresses with hot compressions, but eventually reappears
Treatment?
Chalazion
Tx- Histopathological examination
Physical sign of acute cholecystitis?
Pain in the right upper abdominal area, positive Murphey’s sign
Signs of vitamin D toxicity?
vomiting, confusion, polyuria, polydipsia
Laboratory findings for lead poisoning
microcytic anemia,, basophilic stippling, high lead levels
Where can aspiration pneumonia form when supine?
posterior segments of upper lobes and superior segments of lower loabs
Restrictive lung disease FEV1, FVC, Fev1/FVC
FEV1- 70% FVC
EKG signs for supraventricular tachycardia?
No regular P waves. buried within the QRS complex
When do you see Auer rods? How does it present?
Acute myeloid leukemiaPresents with pancytopenia (bleeding or infection) and myeloblasts would be expected
Multiple miscarraiges and DVTs with SLE?
Antiphospholipid syndrome
Treatment for post nasal drip?
Chlorpheniramine (1st generation antihistamine)
Intermittent fever, fatigue, new holosystolic murmur and positive blood cultures?
Infective endocarditis
Complication of infectious mononucleosis?
Autoimmune hemolytic anemia and thrombocytopenia
How are ACEI/ARBS renal protective in diabetic patients?
reduces intraglomerular hypertension
Recent URI, dyspnea, elevated JVP, clear lung fields, increased cardiac silhouette on CXR?
Cardiac tamponade due to large pericardial effusion
Most common cause of mitral regurgitation in the developed world?
Mitral valve prolapse
Chronic myeloid leukemia laboratory findings?
leukocyte alkaline phosphotase = lowhigh number of myelocytes to melamyelocytesPresence of absolute basophilia
How do you treat severe, community acquired pneumonia?
cefotaxime, levofloxacin, and vancomycin
How do you treat diabetic neuropathy?
ACE inhibitors and ARBs, however, do not combine an ACE and an ARB
Treatment of a patient that has been exposed to smoke inhalation?
100% oxygen with facemask
What does an ANOVA test compare?
Means of three of more variables
Electrical alternans with sinus tachycardia is suggestive of? Treatment?
Pericardial effusion Pericardiocentesis
How to you treat prostate cancer?
Androgen deprivation therapy
Mutations that causes primary polycythemia vera?
Jak2 mutation
Cough-variant asthma
cough and chest-tightness
How to prevent malaria?
Chemoprophylaxis
Thrombocytopenia with thrombus progression 3 days into heparin therapy?
Type 2 herarin-induced thrombocytopenia
Chalazion
How does cyanide affect tissues?
reduces oxygen utilization by tissues by inhibiting cytochrome oxygase a3 in the electron transport chain
edematous external auditory canal with purulent discharge and granulation tissue on the floor? Tx?
Maligname (necrotizing) otitis externa (Pneudomonas aeruginosa) treat with intravenous ciprofloxacin
Does aspergillosis affect immunocompetent individuals?
Not likely
skin fradility, echymosis, normal laboratory studies
Senile purpura - Cause n pericascular connective tissue atrophy
Facial Rash and symmetric oligoarthritis are highly suggestive of?
Systemic Lupus Erythematosus
When should you receive your meningococcal vaccinations?
Age 11-12, 19-21 (if not previously vaccinated
Asporin exacerbated respiratory disease?
Asthma, chronic rhinosinusitis with nasal polyposis and broncospasm or nasal congestion following ingestion of aspirin or NSAID
What happens to incidence and prevalence when survival time increases?
Incidence remains the same, prevalence increases (more people living with the disease
Lentigo Maligna?
Slow growing melanoma seen on the sun-exposed areas of the face
Infection control protocol for N. meningitides?
Droplet precautions (face-mask)
Definition of diabetic neuropathy?
Hypertension, proteinuria, decline in GFR
IBS - Symptoms and Treatment
Recurrent abdominal pain or discomfort; marked change in bowel habit for at least 6 months, with syumptoms experience at least 3 days a month for 3 months.Must have 2 of the following:1. Pain relived by a bowel movement2. Onset of pain in related to a change in frequency of stool3. Onser ot pain is related to a change in the appearance of stool Tx- reassurance and high-fiber diet
Milk-alkali syndrome
Overconsumption of calcium and absorbable alkali -> hypercalcemia -> renal vasoconstriction and decreased GFR
When should you consider electric cardioversion?
Any patient who is unstable with an arrhythmia, other than sinus tachycardia
When do sideroblasts form?
When iron is available, but is unable to be incorporated into hemoglobin
When is cystoscopy recommended?
Unexplained gross hematuria or with microscopic hematuria with no evidence of glomerular disease or infection
What paraneoplastic syndrome is caused by small cell lung cancer?
SIADH, decreased sodium
chest pain, dyspnea, asymmetric leg edema, elevated central venous pressure, tachypnea, tachycardia, suspect?
Pulmonary Embolism, diagnose with CT angiography
SIADH osmolarity
Less than 290 serum, greater than 25mEq/L sodium with greater than 100 mOsm/kg urine
In a low risk patient, what is the size of a “positive” TB test?
For healthcare workers?
Immunocompromised patients?
15mm,
10mm,
5mm
How to you manage an adrenal incidentoma?
Overnight dexamethasone suppression test, 24-hour urine collection for metanephrines, measurement of plasma renin activity and serum aldosterone levels
How do you pharmacologically treat a patient with heart failure?
Beta-blocker and ACE inhibitor
Characteristic microscopic finding for membranoproliferative glomerulonephritis type 2?
dense intramembranous deposits that stain for C3
Anasarca, pulmonary and facial edema, hypertension, abnormal urinalysis with proteinuria?
acute nephritic syndrome
Side effects of rifampin?
Red-orange discoloration of body fluids
Leukoreduction
reducing the number of transgused leukocytes through filtering or other methods (washing). Reduces changes of HLA allommunization and transmission of CMV
What can be used for DVT prophylaxis?
unfractionated heparin, low molecular weight heparin, fondaparinux
Side effects of HCTZ?
hypercalcemia, photosensitivity, orthostatic hypotension
Scaly papules or plaques of fair skinned individuals that have high sun exposure?
Actinic keratosis
First step in the evaluation of a thyroid nodule > 1cm?
TSH levels and U/S
Cause of abnormal hemostasis in CRF?
Uremic coagulopathy`
How do you treat polycythemia vera?
Aspirin and phlebotomy
Alternative treatment for syphilis?
Doxycycline X 14 days (primary and secondary) Doxycycline x 28 days (latent) Ceftriaxone x 14 days (tertiary)
What infections should patients positive for gonorrhoeae also be tested for?
HIV, syphilis, Chlamydia, hep B
What is the treatment for toxoplasmosis?
zTrimethoprim-sulfamethoxazole, especially when cd count is less than 100,
low-grade fever and periorbital edema, several days after headache with vomiting and papilledema?
Cavernous sinus thrombosis
Still disease
daily (quotidian fever) evanescent salmon-colored rash, arthritis, multisystem involvement, markedly elevated ferritin
Absolute indications for dialysis?
Uncontrollable hyperkalemia, uncontrollable hypervolemia, altered mental status, increased somnolence, pericarditis, bleeding due to uremia platelet dysfunction
What does a Chi-square test measure?
proportions of categorized outcome. High/Low 2x2 table
Intermittent asthma definition?
daytime symptoms less than 2 times per week, nighttime less than/equal to 2 times per month, baseline FEV1 and FEV1/FVC are normal
How to treat complete heart block?
Cardiac pacing (pacemaker)
Causes of crystal-induced acute kidney injury?
Acyclovir, sulfonamides, methotrexae, ethylene glycol, protease inhibitors
What is required to discontinue life support for a patient that has legally been declared brain dead?
Nothing,
You suspect a patient is being abuse after noticing bruising, what is the first step?
Ask about the bruises
Treatment for TCA overdose with QRS > 100ms?
Sodium bicarbonate therapy
Allows the sodium load to alleviate depressant action on myrcardial sodium channels
How to treat infective endocarditis?
IV antibiotics for 4 weeks
First step in screening for thalassemia anemia?
Complete blood count
How to manage HIT?
Stop heparin and start non-heparin anticoagulation (fondaparinux or argatroban)
Henoch-schonlein purpura
purpuric rash predominately affecting distal lower extremities, artritis, abdominal pain, hematuriaskin biopsies reveal leukocytoclastic vasculitis
Nonsmoker with recent URI and persistent cough productive of yellow, blood-tinged sputum?
Acute bronchitis
Large amount of blood in the urine, but only 0-1 RBCs? Think?
Rhabdomyolysis
Thrombolytic therapy drug name?
Alteplase (tissue plasminogen activator
Signs of a first degree heart block?
PR interval greater than 0.2
Moderate symptoms of hyponatremia (confusion, lethargy) treatment?
Hypertonic saline first 3-4 hours
Brownish skin pigment? Disease?
Bronze diabetes, hereditary hemochromatosis
What are the exposures associated with smoke inhalation?
Carbon monoxide and hydrogen cyanide
Crystalloids
saline solutions
Young person with sudden onset of fever, stiff neck, headache, nausea, and myalgias
bacterial meningitis, can develop within several hours of the initial meningitis
Bleeding episodes and severe isolated thrombocytopenia with normal hematocrit and leukocyte count with normal fibrinogen and PT?
Immune thrombocytopenia (idiopathic thrombocytopenic purpura
Signs of lead poisoning?
Abdominal pain, constipation, fatique, irritability insomnia, neuropathies, neuropsychiatric disturbances and nephropathy, HTN
Isolated thrombocytopenia without anemia or leukopenia?
Idiopathic thrombocytopenia purpura
How do you treat chronic stable angina with worsening symptoms?
Increase dosage of beta-blocker
How do you prevent ventilatory associated pneumonia?
Keep the bed in a semi-erect position
What is the treatment for norcardia?
trimethoprim-suldamethoxazole (add carbapenems when the brain in affected for better control
BRBPR and pain with defectation?
Anal Fissure
Type of edema caused by hypoalbuminemia?
Peripheral
Displaced apical impulse, holosystolic murmur, third heard sound?
Mitral regurgitation
How to manage pain in terminal cancer patients?
- Try non-narcotics first (short-acting morphine is first)2. Do not be afraid to give narcotics3. Prescribe adequate amounts of medication
Crescendo-decrescendo systolic murmur without radiation to the carotids?
Interventricular septal hypertrophy
Prerenal Azotemia
autoregulation of kidney flow can no longer maintain GFR Look for nausea, vomiting, anorexia accompanied by relatively low pressure int eh absence of edema
What causes urinary retention in first generation antihistamines?
Failure of detrusor muscle contraction, and to a lesser extent impaired bladder sphincter relaxation
What is doxazosin?
alpha blocker
Gilbert Syndrome
Indirect hyperbilirubinemia, with normal hemoglobin and otherwise normal liver tests in an asymptomatic patient
Signs of an epidural spinal cord compression?
lower extremity motor weakness, hyperreflexia, and bladder dysfunction
Workup for hypocalcemia?
Recheck-> drug-> PTH-> 25-hydrocy vitamin D levels
Yeast with low grade fever and violaceous skin lesion?
Blastomycosis
Treatment for alcohol withdrawals?
Benzodiazepines (Chlordiazepoxide)
What anticoagulant can lead to low levels of Protein C and S?
Warfarin
Hemophilia laboratory findings?
Prolonged aPPT, decreased or absent Factor VIII or IX activity
How to distinguish neuromuscular restrictive disorder from obstructive disorders?
FEV1/TLC is larger, low maximal respiratory pressure
Facial plethora and high hemoglobin?Tx?
Polycythemia VeraPhlebotomy, may add hydroxyuria in cases with high risk of thrombosis
Late complications of STEMI?
Cardiogenic shock, ventricular septal defect, mitral regurgitation, free wall rupture, left ventricular thrombus
Signs of generalized resistance to thyroid hormones?
Normal TSH and high T3 and T4 with signs of hypothyroidism
Nephrotic syndrome complex
Proteinuria, hypoalbuminemia, edema, hyperlipidemia, lipiduria
What is the appropriate duration of heparin when using a bridge
Minimum 5 days with two IRN measurements >/= 2, 24 hours apart
What should you screen for in patients with hepatitis B?
Hepatocellular carcinoma
Heredity hemochromoctoma- risk factors?
Hepatocellular carcinoma
What drugs can cause ototoxicity?
Aminoglycosides, chemotherapy agents, aspirine, loop diuretics
Associated conditions with Porphyria Cutanea Tarda?
Hep C, HIV, EtOH abuse, estrogen use, smoking
a-thalassemia trait characteristics
mild anemia, microcytosis, hypochromia, target cells, and normal hemoglobin electrophoresis in adults
Acute radiation proctitis-cause, diagnostic method
Patient who receive pelvic radiation exposure and develop diarrhea.
Diagnosis is done via flexible sigmoidoscopy
Look for mucosal telangiectasia and submucosal fibrosis and arteriole endarteritis
IBS - Symptoms and Treatment
Recurrent abdominal pain or discomfort; marked change in bowel habit for at least 6 months, with syumptoms experience at least 3 days a month for 3 months.
Must have 2 of the following:
- Pain relived by a bowel movement
- Onset of pain in related to a change in frequency of stool
- Onser ot pain is related to a change in the appearance of stool
Tx- reassurance and high-fiber diet
Gilbert Syndrome
Indirect hyperbilirubinemia, with normal hemoglobin and otherwise normal liver tests in an asymptomatic patient
Physical sign of acute cholecystitis?
Pain in the right upper abdominal area, positive Murphey’s sign
Charcot Triad
Pain, fever, jaundice
How to treat acute cholecystitis?
ERCP
Most common drugs assoicated with dyspepsia? Alternative tx?
NSAIDS, Initiate PPI is unable to stop NSAIDS
BRBPR and pain with defectation?
Anal Fissure
What should you screen for in patients with hepatitis B?
Hepatocellular carcinoma
Treatment for Ulcerative Colitis?
Mesalamine (left-sided only), sulfasalazine, balsalazine, olsalazaine
Microscopic colitis?
chonic watery diarrhea without bleeding
Signs of an epidural spinal cord compression?
lower extremity motor weakness, hyperreflexia, and bladder dysfunction
Management for epidural spinal cord compression?
Emergent MRI, Intravenous glucocorticoids, radiation-oncology and neurosurgy consultation
Facial plethora and high hemoglobin?
Tx?
Polycythemia Vera
Phlebotomy, may add hydroxyuria in cases with high risk of thrombosis
Facial plethora with normal oxygen saturations and low EPO?
Polycythemia Vera
Mutations that causes primary polycythemia vera?
Jak2 mutation
How do you treat cancer-related anorexia/cachexia syndrome?
Progesterone analogs *megestrol acetate)
Lab findings in multiple myeloma?
Hypercalcemia and anemia, excessive production of a single monocloncal protein
Renal findings in multiple myeloma?
Bland with granular casts; nephritic disease
Signs of vitamin D toxicity?
vomiting, confusion, polyuria, polydipsia
Leukomoid reaction
high fever, infectious diarrhea, with increased metamyelocytes (late neutrophil precursors and high leukocyte alkaline phosphatase
How are leukomoid reactions caused by severe infections?
Mobilization of mature and immature leukocytes from bone marrow
Chronic myeloid leukemia laboratory findings?
leukocyte alkaline phosphotase = low
high number of myelocytes to melamyelocytes
Presence of absolute basophilia
What is leukocyte alkaline phosphatase?
An active enzyme found within mature blood cells
Without a clear provoking factors, what procedures should be conducted?
Age-appropriate cancer screening and CXR
When do you see Auer rods? How does it present?
Acute myeloid leukemia
Presents with pancytopenia (bleeding or infection) and myeloblasts would be expected
cells iwth convoluted nuclei and highly vacuolated cytoplasm?
infectious Mononucleosis (EBV)
Signs of lead poisoning?
Abdominal pain, constipation, fatique, irritability insomnia, neuropathies, neuropsychiatric disturbances and nephropathy, HTN
Laboratory findings for lead poisoning
microcytic anemia,, basophilic stippling, high lead levels
Physicial manifestations of Hemophilia A & B?
delayed/prolonged bleeding after mild trauma
Hemarthrosis, hemophilic arthropathy
Intramuscular hematomas
Gastrointestinal or genitourinary tract bleeding
Monorrhagia is common in which bleeding disorder?
Willebrand disease
Inheritance pattern of Hemophilia?
X-linked recessive
Hemophilia laboratory findings?
Prolonged aPPT, decreased or absent Factor VIII or IX activity
How long can it take a person with inadequate dietary intake, intestinal malabsorption, or hepatocellular disease to become vitamin K deficient?
7-10 days
What is the role of heptoglobin?
Binds free hemoglobin and promotes its excretion by the reticuloendothelial system
What is the first step in managing iron deficiency?
Determining the cause (Fecal occult blood)
What drug is used to treat hairy cell leukemia? Side effects?
Cladribine; neurological and kidney damage
Cytochemical features of hairy cell leukemia?
Tartrate-resistant acid phosphotase (TRAP)
Facial Rash and symmetric oligoarthritis are highly suggestive of?
Systemic Lupus Erythematosus
Multiple miscarraiges and DVTs with SLE?
Antiphospholipid syndrome
Brownish skin pigment? Disease?
Bronze diabetes, hereditary hemochromatosis
Heredity hemochromoctoma- risk factors?
Hepatocellular carcinoma
Elderly patient with severe lumphocytosis (>40000) lymphadenopathy, and bicytopenia suggests?
Chronic lymphocytic leukemia
How to diagnose CLL?
Flow cytometry of peripheral blood
What vitamin deficiency is associated with pernicious anemia?
B12, megaloblastic anemia
Osteolytic lesions, fractures, hypercalcemia, anemia
Multiple myeloma
How does multiple myeloma cause infections? Most common types?
Impairs normal lymphocyte populations -> ineffective antibody production and hypogammaglobulinemia
Respiratory (streptococcal pneumonia) and UTI
Isolated thrombocytopenia without anemia or leukopenia?
Idiopathic thrombocytopenia purpura
What should all patients diagnosed with ITP be tested for?
HIV
Bleeding episodes and severe isolated thrombocytopenia with normal hematocrit and leukocyte count with normal fibrinogen and PT?
Immune thrombocytopenia (idiopathic thrombocytopenic purpura
thrombocytopenia and microangiopathic hemolyutic anemia
Thrombotic microangiopathy
How to treat chemotherapy-induced nausea and vomiting?
Serotonin receptor antagonist (5HT)
Pain, itching, red streaks on an arm that presented in a different location preciously?
Next step?
Migratory superficial thrombophlebitis (Trousseau’s syndrome)
CT of the abdomen due to association with pancreatic cancer
Blood transfusion reaction that occurs between 1 and 6 hours?
How to prevent?
Febrile non-hemolytic transfusion
Leukoreduction
Leukoreduction
reducing the number of transgused leukocytes through filtering or other methods (washing). Reduces changes of HLA allommunization and transmission of CMV
Side effect of phenytoin?
Treatment?
Mild megaloblastic anemia caused by reduction in folic acid levels
Tx- folic acid supplementation
Salvage therapy?
treatment for a disease when standard treatment fails
Neoadjuvant therapy?
Treatment given before the standard therapy
Bite cells with normal G6PD?
Glucose-6-phosphate dehydrogenase deficiency
G6PD deficiency laboratory signs?
Low hemoglobin, increased indirect hemoglobin, increased indirect bilirubin, increased lactate dehydrogenase, decreased haptoglobin
Ruby-colored papules on lips that blanch partially with pressure?
Arteriovenous shunting (Osler-Weber-Syndrome)
How to manage pain in terminal cancer patients?
- Try non-narcotics first (short-acting morphine is first)
- Do not be afraid to give narcotics
- Prescribe adequate amounts of medication
First step in screening for thalassemia anemia?
Complete blood count
What anticoagulant can lead to low levels of Protein C and S?
Warfarin
How to manage HIT?
Stop heparin and start non-heparin anticoagulation (fondaparinux or argatroban)
Drop in platelets in 5-10 days puts a patient at risk for?
Arterial thrombosis
Thrombocytopenia with thrombus progression 3 days into heparin therapy?
Type 2 herarin-induced thrombocytopenia
MoA of HIT?
IgG autoantibody that coats the surface of platelets and forms complexes with platelet factor 4 (PF4)
Biological role of vitamin B12?
Formation of thmidylate and purine molecules for DNA
Expansile and eccentrically places lytic area in the epiphysis of the distal femur?
Giant cell tumor, “Soap bubble” appearance
Target for treatment o
What cancer has retinoic acid receptor present?
Acute promyelocytic leukemia, presents with pancytopenia
What factor contributes to Warfarin necrosis?
Protein C (primary) and S deficiency
Acute treatment for PE or DVT with subtheraputic INR on warfarin?
Rivaroxaban
Causes of macrocytic anemia?
Folate deficiency
B12 deficiency
Myelodysplastic syndrome
Acute myeloid leukemias
Drug induced (chemotherapy agents)
Liver Dx
Alcohol abuse
Hypothyroidism
Hard unilateral head and neck lymph nodes in an older patient with smoking history?
Squamous cell carcinoma
When is the best time to initiate evaluation of thrombophilia?
2-4 weeks following completion of wargarin therapy
Stops false positives and false negatives
How often should a PAP smear be done in a woman who had a hysterectomy for non-malignant reasons?
Discontinue pap smears
Waldenstrom macroglobulinemia
production of monoclonal IgM antibodies
hymphadenopathy and hepatosplenomegaly may be present
Monoclonal gammopathy of unknown significance
Presence of serum monoclonal protein of less than3g/L without evidence of anemia, kidney failure, bone disease, or other myeloma-related and end-organ damage
a-thalassemia trait characteristics
mild anemia, microcytosis, hypochromia, target cells, and normal hemoglobin electrophoresis in adults
When do sideroblasts form?
When iron is available, but is unable to be incorporated into hemoglobin
How do you treat single nodule colorectal mets?
Regional hepatectomy
How to treat a patient with stage III colon cancer s/p hemicolectomy?
Adhyvant chemotherapy
What is the most common complication of HIT?
Additional venous thrombosis
How to manage a patient with a PAP result of atypical squamous cells of undetermined significance?
Refer to colposcopy
Management of a patient with a new onset breast nodule that was negative on mammorgram?
Aspiration or Biospsy
How to you manage a patient who does not smoke ad had a small (less than 4mm) nodule on CT?
No follow-up imaging
How to you treat prostate cancer?
Androgen deprivation therapy
How to do treat BPH?
5-alpha reductase inhibitor
How do you treat polycythemia vera?
Aspirin and phlebotomy
Signs of polycythemia vera?
Increased hemoglobin, increase leukocytes, increased platelets
What cancer contains reed sternberg cells?
Hodgkin’s lymphoma
How to manage a patient with a blood smear showing platelet clumping?
Repeat platelet count
Auer Rods Cancer?
Acute Myeloid Leukemia
Transfusion-related acute lung injury
Fever, dyspnea, diffuse pulmonary infiltrates and hypocia
How to manage blood products in a patient who has experiences prior anaphylatic reactions?
Wash samples
Acral lentiginous melanoma
Unevenly darkly pigmented patch mostly arises on the palmar, plantar, or subungual surfaces
How to treat diffuse large B-cell NHL?
Abbreviated course of chemotherapy followed by radiation
Signs of autoimmune hemolytic anemia?
Spherocytes and positive direct antiglobulin test
How do you treat antiphospholipid syndrome?
Indefinately continue warfarin
Lentigo Maligna?
Slow growing melanoma seen on the sun-exposed areas of the face
Foul-smelling diarrhea, weight loss, fatigue
Steatorrhea and malabsorption
Effect of malabsorption on calcium levels
Inhibits absorption of Vit. D -> low calcium, low phosphate
First step in the evaluation of a thyroid nodule > 1cm?
TSH levels and U/S
Effects of hypopituitarism?
glucocorticoid deficiency, hypogonadism, hypothyroidism
Features of glucogonoma?
Necrolytic migratory erythema- face, perineum, extremities
DM
GI- diarrhea, anorexia
Weight loss
Signs of glucogonoma?
Hyperflycemia with elevated glucagon > 500pg/mL
Painless thyroiditis
acute thryotoxicosis with mild thyroid gland enlargement and suppressed TSH
What DM medications cause weight loos?
GLP-1 agonists (exenatide)
What DM medications are weight neutral?
DDP-4 inhibitors (sitagliptin)
Treatment for diabetic neuropathy in young patients?
Older?
Young- amitriptyline
Old: Pregabalin
Signs of thyroid storm?
Palpitations, weight loss, irregular menses, impaired glycemic control, confusion, agitation, n/v
After confirming a normal TSH, what is the next step in working up suspected Cushings?
24 hour free urine cortisol, salicary cortisol, or low-dose decamethasone suppression
2 must be abnormal
Carcinoid tumors put you at risk for deficiency of what?
Niacin (diarrhea, dermatitis, dementia)
Patient with malignant throid mass, elevated serum calcitonin, and family hx of thyroid malignancy likely has an inherited form of?
MEN2a or 2b
Ret mutation
Milk-alkali syndrome
Overconsumption of calcium and absorbable alkali -> hypercalcemia -> renal vasoconstriction and decreased GFR
Workup for hypocalcemia?
Recheck-> drug-> PTH-> 25-hydrocy vitamin D levels
Signs of generalized resistance to thyroid hormones?
Normal TSH and high T3 and T4 with signs of hypothyroidism
Subclinical hypothyroidism
Mildly elevated serum TSH and normal T3 and T4
Do not have clinical signs
Signs of hypercortisolism?
Weight gain, psychiatric symptoms, HTN, hyperglycemia
oligomenorrhea, hirutism, elevated testosterone levels?
Tx?
Polycystic ovarian syndrome
Tx: Weight loss and oral estrogen/progestin contraceptives
Side-effect of radioiodine ablation?
Worsening of opthalmopahty
Role of large and small fibers in DM?
Large- numbness, proprioception, vibration
Smal- pain, paresthesias, allodynia
How does pregnancy affect thyroid levels?
Causes a 30% increase in the first trimester
How to you manage an adrenal incidentoma?
Overnight dexamethasone suppression test, 24-hour urine collection for metanephrines, measurement of plasma renin activity and serum aldosterone levels
Galactorrhea and signs of secondary amenorrhea, next step?
Obain prolactin levels
In a young patient with suspected DM, what should be the first step in management?
Check for pancreatic autoantibodies to rule in/out DM type 1
In a younger patient presenting with osteoporosis, what should be the first step in workup?
Find an underlying cause.
fatigue, weight gain, erectile dysfunction and hyponatremia suggest?
panhypopituitarism
How to treat pituitary apoplexy?
Neurosurgery consult and glucocorticosteroids
hypernatremia with hypokalemia with htn? Diagnostic test?
Hyperaldosteronism, aldosterone to plasma renin
How to diagnose cushing’s disease?
24-hour urine cortisol measurments
If a patient is taking steroids and gets sick, what should happen?
Increase dose of hydrocortisone during the intercurrent illnesses to avoid adrenal crisis
Calcium pyrophosphate dihydrate disease?
Presents like OA, but with atypical joints (hands)
Treatment for fibromyalgia with or without depression?
Serotonin-norepinephrine reuptake inhibtors (duloxetine, milnacipran
Presentation of OA of the hand?
Squaring of the first carpometacarpal joint (base of thumb) and DIP and PIP
How to treat a patient with SLE and suspected lupus nephritis?
High-dose steroids
Back pain in an individual with Chron’s disease?
Enteropathic arthritis
Henoch-schonlein purpura
purpuric rash predominately affecting distal lower extremities, artritis, abdominal pain, hematuria
skin biopsies reveal leukocytoclastic vasculitis
pain along the anteromedial proximal tibia distal to the joint like that worsens walking up stairs and at night
Pes anserine bursitis
Still disease
daily (quotidian fever) evanescent salmon-colored rash, arthritis, multisystem involvement, markedly elevated ferritin
Treatment for RA?
Methotrexate
In RA refractory to Methotrexate, what is next?
Add monoclonal antibody, etanercept
Inelastic pericardium - AKA? Signs? Risk?
AKA- restrictive pericarditis
Signs-increased JVP, peripheral edema, ascites, hepatic congestion with hepatomegaly
Risk- late complication of radiation therapy
dyspnea, third heart sound, bibasilar crackles, low ejection fraction?
decompensated congestive heart failure due to LV systolic dysfunction
Alcoholic cardiomyopathy
Dilated cardiomyopathy in an alcoholic, when everything else has been rules out
Reversible risk factors for premature atrial contracitons?
Alcohol and tobacco, caffeine, stress
Premature atrial contractions-treatment?
Cessation of alcohol, tobacco, caffeine, stress, initiation of beta-blockers (if symptomatic)
Ludwig angina
Rapidly progresive cellulitis of the submandibular and sublingual spaces
Ceftriaxome with azithromycin- treatment?
Community acquired pneumonia
vanomycin with piperacillin-tazobactam-treatment?
Hospital-acquired pneumonia
Low-pitched, early diastolic heart sound, think?
Heart failure (third heart sound)
dypnea, hypoxemia, diffuse pulmonary crackles with third heart sound?
decompensated heart failure
Treatment for severe heart failure associated with severe left ventricular systolic dysfunction and cardiogenic shock? MoA?
Dobutamine, beta-1 receptor
MoA- increased myocardial contractilit -> greater colume of forward blood efection -> decreased left ventricular end-systolic volume
holosystolic murmur that increases with inspiration?
Tricuspid involvement
Systemic murmur that increases when the patient stands up?
hypertrophic cardiomyopathy
Mechanical complications post MI?
RC failure- acute
Papillary muscle rupture- Acute, 3-5 days
Interventricular septum rupture/defect- Acute, 3-5 days
Free wall rupture- 5 days to 2 weeks
How to calculate attributed risk percent?
ARP= (RR-1)/RR
Signs of cardiogenic shock?
Hypotension, reduced urine outpout, cool extremities
Classic finding: Beck triad-hypotension, elevated jugular venous pressure, distant heart sounds
hypoxia vasoconstriction in the lung
vessels shrink and divert blood to maintain V and Q matching
Intrapulmonary shunting
shunting of blood away from blocked alveolar consolidation and shunts it to other areas -> can cause V and Q mismatch
Continuous murmur throughout thorax with high blood pressure and headaches? Imaging?
Coarctation of the aorta
X-ray findings- inferior notching of the third to eighth rib, “3” sign due to aortic indentation
ECG: Left ventricular hypertrophy
Echo: diagnostic confirmation
Upturning of the cardiac apex- AKA, cause?
boot-shaped heart, caused by Tetralogy of Fallot, d/t pulmonic stenosis
Commonly associated SLE rashes
Malar rash, discoid plaques, ulcers
What causes drug induced acne? What do they look like? Management?
Glucocorticoids, androgens, azathioprine, EGFR inhibitors, anticonvulsants, antituberculosis
Description, monomorphic papules or pustules, no comedones, cysts, nodules
Management: D/C offending medication, standard acne therapy unlikely to be effective
What populations have a 5mm PPD/TST induration limit?
HIV-positive, recent contacts of known TB, nodular fibrotic changes of CXR consistent with previously healed tb, organ transplant recipients, and other immunosuppressed patients
Treatment for latent tb?
Isoniaxid and pyriodoxine
Drug-resistent HTN, and a midabdominal bruit?
Rebal artery stenosis
Highly specific finding in renal artery stenosis?
syustolic-diastolic abdominal bruit
What drugs can lithium interact with to cause toxicity?
ibuprofen, NSAIDS, thiazide diuretics, ACE-I, tetracyclines, metronidazole -> decrease renal clearance of lithium
Back pain with increased ESR/CRP, but normal X-rays, next step?
MRI, bone scanning using gallium (if MRI contraindicated)
MoA of beta blockers?
reducing cardiac oxygen deman through a decrease in heart rate and myocardial contractility
Treatment regimine for stable angina?
Beta blockers, aspirin, sublingual nitroglycerine
Signs of Alcoholic cerebellar degeneration?
Trucal coordination impairment (tandem gait), wide-based gait, postural instability, with intact limb coordination (finger-nose test)
Signs of hypokalemia?
Muscle weakness, arrhythmias, EKG changes
Chikungunya fever? Vector?
High fevers, polyarthralgias, maculopapular rash, lymphop[enia, thrombocytopenia
Vector: Ades mosquito
Cyclosporine side effects:
Nephrotoxicity- hyperkalemia, hypophosphatemia, hypomagnesemia
HTN: renal vasoconstriction and sodium retension
Neurotoxicity: headache, visual disturbances, seizures
Glucose intolerace
Dermatofibroma
benign fibroblast proliferation
firm, hyperpgmented nodule, most often on lower extremties
epidermal inclusion cyst? Diagnosis?
Discrete benign nodule lined with dquamous epithelium, that containes semisolid core of keratin and lipid.
Diagnosis: clinical with a firm, freely movable, dome-shaped cyst iwth central punctum
Cor pulmonale? X-ray findings? Diagnosis?
exertion symptoms over time, loud P2, tricuspid regurgitation, elevated JVP, hepatomegaly
X-Ray- enlarged central pulmonary arteries, right ventricular hypertrophy, right atrial enlargement
Diagnosis- fold standard is right heart catheterization
Priapism
persistent, painful ereation that develops without sexual stimulation and has a long duration
Post-void residual volume in UTI?
Low, due to frequent urination
b-HCG and AFP producing tumors in young males?
Nonseminomatous germ cell tumors
Seminoma vs nonseminomatous germ cell tumors
Nonseminomatous germ cell tumors - product AFP and b-HCG
Seminoma produce b-HCG
Site of nonseminomatous germ cell tumors in young males
mediastinal mass, testicular
pityriasis rosea?
numerous oval, scaly plaques that follow the cleavage lines fo the trunk, often presents with an inital, larger lesion, a herald patch
TInea corporis
pruritic rahs with scaly, erythematous border and central clearing
Ichthyosis vularis? Treatment
Chronic inherited skin disorder with diffuse dermal scaling, caused by mutation in filaggrin gene
Treatment -emollients, severe cases male require keratolytics (coal tar, salicylic acid, and topical retinoids
How to calculate sensitivity? Specificity?
Sensitivity- TP/(TP+FN)
Specificity = TN/(TN+TP)
Untreated AIDS, progressive neurological symptoms, nonenhancing white matter lesions suggest? Diagnosis?
Progressive multifocal leukoencephalopathy, caused by JC virus
Diagnosis: LP with PCR for JC
HIV-associated dementia?
deep gray matter structures affected, causing subacute connitive, behavioral, and motor deficits
Subacute sclerosing panencephalitis
progressive, fetal disease caused years after measles infections
Signs of peripheral nerve compression
Transient, unilateral foot drop, impaired anbkle dorsiflecion, preseved plantar flexion
How to rule out primary psychiatric disorders in physical manifestations?
Symptoms are explained by distribution along a single nerve
Arteriovenous fistula signs?
widenedd pulse presure, brish carotid upstroke, systolic flow murmur, tachycardia, flushed extremities, left ventricular hypertrophy
Hypertrophic cardiomyopathy vs AVF murmur
HCM- crescendo-decrescendo, increasing with valsava
AVF- systolic murmur, no increase with valsava
Treatment for torsades de pointes?
IV magnesium sulfate
What drugs should be withheld 48 hours prior to cardiac stress tests?
Beta-blockers, calcium channel blockers, nitrates
Signs of secondary syphillis?
Diffuse rash (begins on the trunk, extends to the extremities, involsing palms and soles), widespread lymphadenopathy, grey mucosal patches, raised grey genital lesions (condylomata lata), epitrochlear lymphadenopathy (pathognomonic)
Disseminated gonococcus signs
tenosynovitis, polyarthralgia, skin rash consting of a few pustules
What causes cardiac tamponade?
Decreased left ventricular preload
Signs of restrictive pericarditis?
Progressive peripheral edema, ascities, elevated JVP, pericaridal knowck, pericardial calcifications
How often are mammograms performed?
Every 2 years.
Disseminated mycobacterium avium complex infection signs?
fever, cough, diarrhea, splenomegaly, elevated alkaline phosphatase
Most common cause of community acquired vacterial meningitis?
Strep pneumoniae
Drugs that can cause angioedema?
Ace inhibitors -> increased bradykinin
Organs affected in Goodpasteur’s syndrome?
Renal and pulmonary
How to improve quality of care when transitioning between facilities?
Pharmacist-directed interventions
Drugs with photosensitivity reactions
Tetracyclines, chlorpromazine, prochlorperazine, hurosemide, hydrochlorothiazide, amiodarone, promethazine, piroxicam
Side effects of Erythromycin?
GI upset, cholestatic jaundice (estolate base)
Cause of ARDS in pancreatitis?
Phosphilipase A2 crosses pulmonary capillaries and increases inflammatory response
What is the negative predictive value?
Probability of being free of disease, if the test is negative
Positive predictive value, meaning?
Likelihood that a positive test means you have the disease.
Tinea versicolor causal organism? Trreatment?
Malassezia species
Tx: selenium sulfide, ketoconazole
Signs of atrial fibrillation?
palpitations, weakness, dizziness, presyncope, dyspnea, and/or chest pain
Conditions associated with atrial fibrillation?
CHF, Hypertrophic cardiomyothy, hypertensive heart disease (most common), obstructive sleep apnea, obesity, endocrine
Valvular involvement in infective endocarditis?
Mitral-damaged heart valces
Tricuspid- intravenous drug abuse
Signs of CMV in an AIDS patient? CD4+ count? Diagnostic test? Treatment?
Frequent, small volume diarrhea; hematochezia’ abdominal pain
CD4+ < 50
Diagnostic test: colonoscopy with biopsy (eosinophilic intranuclear and basophilic intracytoplasmic inclusion
Treatment: ganciclovir
Epinephrine vs antihistamines
Antihistamines treat uticaria, pruritus in anaphalaxis, however, they do not relieve upper airway edema or hypotension
Streptococcus gallolyticus
Streptococcus bovis (biotype 1) highest risk of colon cancer
Vibrio vulnificus? Treatment? Manifestations?
Gram-negative, free-living in marine environments
Increased risk in those with liver disease
Manifestations: rapidly progressive, septicemia, cellulitis (hemorrhagic bullae, necrotizing fascitis)
Treatment: IV ceftriaxone, doxycycline
What does A sengstaken-Blakemore tube do?
Balloon tamponade of variceal bleeding if endoscopy is unavailable
In patients with variceal bleeding, what should be the main goal?
Fluid resuscitation
In a patient with weakness and decreased pain in both legs, what type of injury is suspected? Action?
Lower spinal cord injury, insert urinary catheter to assess for urinary retention and prevent bladder injury
Signs of cardiac temponade?
hypotension (unresponsive to IV fluids), tachycardia, and elevated jugular venous pressure after blunt thoracic trauma
How is duodenal hematoma treated?
NG suction and parenteral nutrition
What is the first step in management of damage to the urethral meatus?
retrograde urethrogram
Use of NSAIDS with episodic postprandial epigastric pain?
Perforated peptic ulcer
How to treat perforated peptic ulcers?
NG suction, bowel rest, intravenous fluids, broad-spectrum antibiotics, IV PPI
Signs of acute adrenal insufficiency?
Severe and often refractory hypotension, vomiting, abdominal pain and fever
Signs of primary adrenal insufficiency?
hyponatremia and hyperkalemia
Best management of acute appendicitis?
Laparoscopic appendectomy
Epigastric pain/tenderness, weight loss in the setting of nonspecific systemic symptoms and significant smoking history?
Cancer of the upper GI or associated organs…think gallbladder, liver, pancreas
Classic description of pain in pancreatic cancer?
Abdominal pain that is insidious, gnawing, and worse at night
Varicocele-signs? Diagnostic method?
soft mass that worsens with standing and Valsalva maneuvers, but decreases when supine, does not transilluminated Diagnostic- US
Varicocele treatment?
NSAIDS or surgical correction
How do you manage small pneumothorax? Large?
Small- supplemental O2 Large- Needle thoracostomy/chest tube
Young male (20s) without trauma has pneumothorax?
Primary spontaneous pneumothorax
Differential for anterior mediastinal mass?
- Thymoma 2. teratoma 3. thyroid neoplasm 4. Lymphoma
Mediastinal mass with elevated AFP and b-HCG?
mixed cell germ tumor
Elevated serum b-HCG with normal AFP?
seminoma
Mediastinal mass with nomral b-HCG and AFP?
Thymomas
Initial management of non-displaced scaphoid bone fracture?
Wrist immobilization for 6-10weeks, with x-rays in7-10 days
Signs of elevated intracranial pressure?
HTN, bradycardia, respiratory depression (Cushing’s reflex)
Effects of uncal herniation?
- Ipsilateral hemiparesis 2. parasympathetic loss (mydriasis (early) ptosis, 3. Contralateral homonymous hemianopdia 4. altered level of consciousness
Patient response to atelectasis?
Hyperventilation -> respo. alkalosis, decreased pCO2
Leriche syndrome
bilateral hip, thigh, buttock claudication impotence symmetric atrophy of the bilateral extremities due to ischemia
Syndrome associated with arterial occlusion at the bifurcation of the aorta?
Leriche Syndrome
How do you counteract a decrease in blood pressure after administration of propofol?
Administer dopamine
How does pneumonia that is developing into septic shock present? Treatment?
acidosis, low urine output, hypotension, tachypnea, fever Tx- IV normal saline
Tetanus prophylaxis in a clean or minor wound?
Tetanus toxoid-containing vaccine only if
Tetanus prophylaxis in a dirty or severe wound?
Tetanus toxoid-containing vaccine only if booster > 5 years ago If unsure, tetanus toxoid-containing vaccine plus tetanus immune globulin
When do you give tetanus immune globulin?
severe or dirty wound with unsure vaccination history
How does venous insufficiency present?
worsens throughout the day and resolves overnight when the patient is recumbent
What are the signs of arterial occlusion?
Pain, pallor, paresthesias, pulselessness, and coolness to the touch
How do you store an amputated limb?
Place in saline moistened gauze and then in a plastic bag on ice…bring it wherever the patient goes.
Signs of retroperitoneal abscesses?
fever, child, and deep abdominal pain may initially be missed by a CT scan
How to treat a pancreatic abscess
Immediate placement of a percutaneous drainage catheter, culture of the drained fluid and surgical debridement
Hemoptysis with upper lung lobe involvment? Initial step?
TB, Isolation
Initial management of coughing with large amounts of blood (>600mL or 100mL/hour)?
Secure airway
When should you suspect diaphragmatic rupture?
History of blunt trauma/MVA, abnormal CXR, left lower lung opacity, elevated hemidiaphragm, and mediastinal deviation
How do patients with duodenal hematomas present? Etiology?
epigastric pain and vomiting d/t blood collection between the submucosal and muscular layers of the duodenum
Signs of urethral injury?
blood at the urethral meatus, inability to void, high-riding prostate on DRE
How to diagnose bladder trauam?
Retrograde cystogram with post-void films
NSAID use with several-day history of epigastric pain followed by acute-onset sevfere constant pain?
perforated peptic ulcer
Initial management for perforated peptic ulcer
NG suction, bowel rest, intravenous fluids, broad spectrum Abx ad intravenous PPI
periumbilical pain out of proportion to examination and hematochezia?
acute mesenteric ischemia Gold standard diagnosis is mesenteric angiography
Signs of adrenal insufficiency?
hypoension/shock weakness nausea, vomiting, abdominal pain, fever
Etiology of adrenal insufficiency?
adrenal hemorrhage/infarction acute illness/injury/surgery in patient with chronic adrenal insufficiency or long-term glucocorticoid use
migratory RLQ pain, nausea, vomiting, fever, leukocytosis
acute appendicitis
When are US and CT used in acute appendicitis?
when classic presentation/signs are not present
epigastroc pain/tenderness and weight loss with nonspecific systemic symptoms with significant smoking history
pancreatic adenocarcinoma
type of pain experiences with pancreatic cancer?
epigastric abdominal pain that is insidious. gnawing, and worse at night
Classic association with pancreatic cancer? Name?
migratory thrombophlebitis Trousseau sign
soft mass that worsens with standing and Valsalva maneuvers, but decreases when supine; does not transilluminate
varicocele
cardiac catheterization, anticoagulation, sudden hypotension, tachycardia, flat neck veins, back pain
retroperitoneal hematoma
Complications from cardiac catheterization
pseudoaneurysm, arteriovenous fistular formation, arterial dissection, acute thrombosis
pneumomediastinum and pleural effusions-cause?
esophageal rupture
pneumothorax despite chest tube, pneumomediastinum subcutaneous emphysema
tracheobronchial perforation (right bronchus is most common
Gallbladder distension and wall thickening, presence of pericholecystic fluid, without gallstones
acalculous cholecystitis
How to treat acalculous cholecystitis acutely? Definitively?
Acutely- percutaneous cholecystostomy and antibiotics Definitively- cholecystectomy with drainage of associated abscessess
How does mesenteric ischemia present?
sudden periumbilical abdominal pain out of proportion to examination findings
Signs of compartment syndrome?
- Pain out of proportion to injury 2. Pain increasing on passive stretch 3. rapidly increasing & tense swelling 4. paresthesia (early)
Signs of deep vein thrombosis?
alf tenderness with pain worsened by passive stretching of the calf.
Postoperative cholestasis-signs?
hypotension, blood loss into tissues, massive blood load (transfusion), decrease liver functionalty, decreased renal bilirubin excretion with normal ALT/AST
Preferred anticoagulant in end-stage renal failure patients?
Warfarin
What is required when starting Warfarin?
Heparin bridge- warfarin activates proteins C and S causing a transient prothrombotic state
When do patients show signs of pulmonary contusions?
Approx. 4 hours post-injury when hypoxia, respiratory distress, pulmonary edema set in
Physical signs of pulmonary contusions?
tachycardia, hypoxia, tachypenea
Pulmonary contusion-CXR results
patchy irregular alveolar infiltrate
Physical signs of a meniscal tear?
joint line tenderness, pain or catching in the provocative tests (Thessaly, McMurray
how to diagnose meniscal tears?
MRI
When should conservative management be used for menscal tear? Examples?
Short-term pain, elderly Example: rest, NSAIDs
Hoe do you treat anal fissures?
topical anesthetics, vasodilators (nifedipine) Sitz baths stool softeners high-fiber diet & adequate fluid intake
When should you considerd surgical interventions for anal fissures?
When medical management has failed
acute abdominal pain followed by lower GI bleeding after an episode of hypotension?
Ischemic colitis
Sites for ischemic colitis? Imaging signs? How to confirm?
Splenic flexure, rectosigmoid junction CT scan may show thickened bowel wall Confirm with colonoscopy
What is the postoperative cause of fever 0-2 hours after surgery?
Prior trauma/infection, blood products, malignant hyperthermia
What is the postoperative cause of fever 1-7 days after surgery?
Nosocomial infections, Group A streptcoccus, or C. perfringens
What is the postoperative cause of fever 1-4 weeks post surgery?
Other organisms (nor GAS, C. perfringens), C difficile, drug fever, PE/DVT
What is the cause of postoperative fever more than 1 months post-surgery
Viral infections, indolent organisms
Signs of fat embolism?
severe respiratory distress, petechial rash, subconjuctival hemorrhage, tachycardia, tachypnea, and fever
Organism most likely responsible for infection from intravascular devices?
Coagulase negative s. epi
How does an anterior should dislocation occur?
forceful abduction and external rotation a the glenohumeral joint; risks damage to the axillary nerve
Torus palatinus? Tx?
benign, bony growth located on the mid-line suture of the hard palate No treatment necessary unless systemic effects develop or it interferes with speech
Signs of rotator cuff impingement
pain with abduction, external rotation subacromial tenderness normal range of motion with positive impingement tests (Neer, Hawkins)
How does cervical impingement present?
pain and paresthesias of the neck and arm along with upper extremity weakness
Clinical signs of acute mesenteric ischemia?
Rapid onset of periumbilical pain Pain out of proportion to examination findings hematochezia
Risk factors for acute mesenteric ischemia?
Atherosclerosis Embolic source hypercoagulable disorders
What is the drop arm test?
Detects a tear in the supraspinatus; arm is abducted passively above head and they are instructed to lower it slowly
Signs of abdominal aortic aneurysm rupture?
severe back pain, syncope, profound hypotension
Signs of SBO strangulation?
peritoneal signs (rigidity, rebound) signs of shock (fever, tachycardia, leukocytosis)
Trochanteric bursitis- definition? Signs?
definition- inglammation of the curse surrounding the insertion of the gluteus medius onto the femur’s trochanter signs- hip pain when pressure is applied and with external or resisted abduction
Femoral nerve innervation
hip joint and skin of the anterior and medial thigh and leg
Complications associated with supracondylar fracture of the humerus
Brachial artery injury Median nerve injury Cubitus varus deformity Compartment syndrome/Volkman ischemic contracture
Signs of sepsis
worsening hyperglycemia, leukocytosis, thrombocytopenia, milk hypothermia, tachypnea, tachycardia
Signs of gallstone ileus
stuttering episodes of nausea and vomiting, pneumobilia, hyperactive bowel sounds, dilated loops of bowels
Important steps in the preoperative management of a patient taking Warfarin?
Check INR, reverse with fresh, frozen plasma
blunt abdominal trauma, hypotension, right chest/abdominal wall injury, and free intraperitoneal fluid
Hepatic laceration
Signs of meniscal tears?
pain, clicking, or catching
post-operative thoracic surgery, fever, tachycardia, chest pain, leukocytosis, and sternal wound drainage or purulent discharge?
Acute mediastinitis, TX- surgical debridement and antibiotic therapy
Signs of septal perforation?
whistling noise during respiration, caused by post-operative septal hematoma
blunt thoracic trauma, respiratory distress despite bilateral chest tubes
Flail chest, demonstrate tachypnea, shallow breaths
Symptoms in arterial embolism?
sudden and severe, with diminished pulses in the affected limb, but normal in the unaffected
Signs of arterial thrombosis
Slow, progressive narrowing of the vascular lumen Pulses are diminished bilaterally (normally)
Signs of pyloric strictures
postprandial pain, vomiting with early satiety, succussion splash on the epigastrium
Signs of esophageal stricture?
Dysphagia, no abdominal succussion splash
Signs of diaphragmatic hernia?
blunt abdominal trauma with mild respiratory distress and abnormal xray **smaller hernias present with nausea/vomiting and are delayed
Cause of infertility from varicocele?
Increased scrotal temperature
Cause of pretibial edema?I
Increased pulmonary vascular resistance
Holosystolic murmur heart of the left sternal border?
Pulmonary regurgitation
5 days after pancreatoduodenectomy , what type of feeding should be used?
Enteral tube feedings
What is erythema nodosum?
Acute, nodular, erythematous eruption on the extensor aspects of the lower legs. Associated with hypersensitivity reactions
What someone falls from a height, what X-rays should be ordered?
C-spine
What should be the first step in the treatment of a woman with breast cancer?
Resect the mass, then treat with chemo/rad
How can heart failure develop from an aneurysm?
Lead to the development of a fistula
What can cause narrowing of the biliary ducts?
cancer (specifically pancreatic), strictures (trauma)
Most common organism causing lymphangitis?
Strep pyo (group A)
How can you minimize the risk of infection from a PICC?
Remove it as soon as treatment/use is complete
Osgood-Schkatter disease
Painful lump below the kneecap in children during puberty, can cause a limp
Legg-Calve-Perthes disease
Blood flow is interrupted to the femoral head in children, can cause necrosis
How do you manage sigmoid volvulus?
Sigmoidoscopy-guided placement of a rectal tube
What should be the first step in management of an unknown mass on an HIV patient?
Biopsy
What is a pneumatocele?
cavity in the lung parenchyma filled with air that may result from pulmonary trauma during mechanical ventilation
Written description of C- Diff infection?
Patchy, white mucosa on colonoscopy
Diffusely enlarged thyroid gland with neck swelling and no symptoms of decreased thyroid?
Chronic lymphocytic thyroiditis (Hashimoto disease)
Long-term growth (> 6 months) on glans penis with negative VDRL test?
Penis cancer
How do you counteract the effects of propofol?
Dopamine
borborygmi
a rumbling or gurgling noise made by the movement of fluid and gas in the intestines
What is a major complication risk from AAA repair?
MI
diaphoretic
Sweating heavily
C8 radiculopathy
causes pain from the neck to the hand. Patients may experience weakness in hand grip, and pain and numbness can radiate along the inner side of the arm, ring, and little fingers.
C7 radiculopathy
(the most common) causes pain and/or weakness from the neck to the hand and can include the triceps (the muscles on the back of the upper arms) and the middle finge
C6 radiculopathy
(one of the most common), causes pain and/or weakness along the length of the arm, including the biceps (the muscles in front of the upper arms), wrists, and the thumb and index finger.
C5 radiculopathy
can cause pain and/or weakness in the shoulders and upper arms. Especially may cause discomfort around the shoulder blades. It rarely causes numbness or tingling.
Child with current-jelly stools?
Intussusception
How to treat intussusception?
Control enema
Cause of subcutaneous emphysema?
Tension pneumothorax
When giving large amounts of packed RBC’s, what must be added?
Platelets
Should volume support or patient transport during traumas come first?
Urban areas with close trauma center - transport All other areas- resuscitate
How to treat rib fractures in the elderly?
Local nerve block and epidural catheter
What should be done with all gunshot wounds to the abdomen?
Exploratory Laparotomy
What treatments should be provided for a through-and-through extremity gunshot wound?
Tetanus prophylaxis
When can early excision and grafting be used?
Small (
What degree of angulation is unacceptable in children (compared to adults)
Larger amounts
How are intertrochaneric fractures treated?
ORIF with anticoagulation
“tip of the finger remains flexed when the rest of the fingers are extended
Malley
Common cause of coma in a cirrhotic patient with bleeding varices?
Ammonium toxicities
Liters of drainage from an upper GI wound?
fluid replacement, nutritional support, protection of the abdominal wall
Old man with blood on the outside of his stool?
Hemorrhoids
Sources of inflammation in the left lower quadrant of women?
Diverticulitis, tube, ovary Diagnose with CT
Acute edematous pancreatitis
Alcoholics of gallstones Pain after large meal or EtOH _> constant, radiates to back-> nausea, vomiting, retching
Vascular rings
stridor, “crowing”, baby assumes hyperextended neck Bronchoscopy shows segmental compression of the trachea Tx- surgical division
What type of catheter is used for embolectomy of an atrial clot from a. fib?
Fogarty
Small, raised, waxy lesion
Basal cell carcinoma
non-healing ulcer?
Basal cell carcinoma
Where are squamous cell carcinoma found?
Lower lip and below on face
Where do you biopsy a basal cell carcinoma?
Edge of the lesion
Amblyopia
vision impairment resulting from interference with the processing of images by the brain during the firs t6-7 years of life
How to treat trigeminal neuralgia?
Anti-convulsants (carbamazapine)
Sudden testicular pain, pyuria, fever
acute epididymitis
acute epididymitis- treatment
Abx and sonogram to rule out torsion
Uropelvic junction obstruction signs
Intense pain when large diuresis occurs (beer drinking)
How do you treat testicular cancer?
platinum-based therapies
Treatment for impotence-first line?
Sildenafil, tadalafil, vardenafil
What is mandatory for all abdominal bullet wounds?
Ex Lap
Abdominal mass that moves up and down in a baby
Malignant tumor of the liver ie-hepatoblastoma or hepatocellular carcinoma
Child class factors to deny surgery
albumin below 2, INR 2 x normal, ascites
bilateral pulmonary infiltrates with low PO2
ARDS, PEEP
How do you obtain samples from a breast?
US guided imaging
Back pain in woman who recently has breast cancer?
Metastatic spread, diagnose with MRI
Signs of Zollinger-Ellison disease
Refractory to other treatments, multiple ulcers
Double bubble with normal gas
Malrotation
Square root sign
Chronic constrictive pericarditis
Workup for squamous cell carcinoma of the mucosa?
Panendoscopy
1 week post- otitis media infection: projectile vomiting, seizures, blurred vision, severe headache
Brain abscess
Why a newborn does not urinate during the first day after birth?
posterior urethral valves
Intervention for UPJ stones larger than 7mm
extraperitoneal shock-wave lithotripsy
Standard bolus for burns
1000mL/hr 30-120mL/hr
How do you test an animal for rabies?
Kill the animal and scan its brain
Chubby 13 year old boy limping, complaining of knee pain, sole of affected foot points towards the other one
slipped capital femoral epiphysis
arm held close to the body
Posterior shoulder dislocation, axillary/scapula xrays needed for diagnosis
In an ejection, what should always be imaged?
C-spine (CT scan)
How to treat lumbar disk herniation?
MRI of L4-S1, pain control with nerve blocks
Morton neuroma
inflammation of the common digital nerve in the third space
Signs of PE?
pleuritic (sudden onset), sob, diaphoretic, tachycardic, distended veins in neck and face
Cause of blood in rectum from child?
Merkel’s diverticulum, workup with technetium scan
First step in the workup for pancreatic cancer?
CT of the abdomen
First step in workup for a palpable breast mass?
US guided core biopsy
What are burns near the eyes covered with?
Triple abx ointment
Trashing around with sudden pain?
Stone stuck in ureter
If a patient is stable, which test is most sensitive for blood?
CT
How to treat acute rejection?
Tacrolimus or Mycophenolate mofetil with/without steroids
Patient passing stone suddenly spikes a fever
ER immediately, nephrostomy tube placement
How to workup claudication?
Doppler studies
Knee to chest position in children?
Ependymoma
Stumbling around and truncal ataxia in children?
Medulloblastoma
Contraindication to organ donation?
Positive HIV status
What does A sengstaken-Blakemore tube do?
Balloon tamponade of variceal bleeding if endoscopy is unavailable
In patients with variceal bleeding, what should be the main goal?
Fluid resuscitation
What does A sengstaken-Blakemore tube do?
Balloon tamponade of variceal bleeding if endoscopy is unavailable
In patients with variceal bleeding, what should be the main goal?
Fluid resuscitation
In a patient with weakness and decreased pain in both legs, what type of injury is suspected? Action?
Lower spinal cord injury, insert urinary catheter to assess for urinary retention and prevent bladder injury
Signs of cardiac temponade?
hypotension (unresponsive to IV fluids), tachycardia, and elevated jugular venous pressure after blunt thoracic trauma
How is duodenal hematoma treated?
NG suction and parenteral nutrition
What is the first step in management of damage to the urethral meatus?
retrograde urethrogram
Use of NSAIDS with episodic postprandial epigastric pain?
Perforated peptic ulcer
How to treat perforated peptic ulcers?
NG suction, bowel rest, intravenous fluids, broad-spectrum antibiotics, IV PPI
Signs of acute adrenal insufficiency?
Severe and often refractory hypotension, vomiting, abdominal pain and fever
Signs of primary adrenal insufficiency?
hyponatremia and hyperkalemia
Best management of acute appendicitis?
Laparoscopic appendectomy
Epigastric pain/tenderness, weight loss in the setting of nonspecific systemic symptoms and significant smoking history?
Cancer of the upper GI or associated organs…think gallbladder, liver, pancreas
Classic description of pain in pancreatic cancer?
Abdominal pain that is insidious, gnawing, and worse at night
Varicocele-signs? Diagnostic method?
soft mass that worsens with standing and Valsalva maneuvers, but decreases when supine, does not transilluminated Diagnostic- US
Varicocele treatment?
NSAIDS or surgical correction
How do you manage small pneumothorax? Large?
Small- supplemental O2 Large- Needle thoracostomy/chest tube
Young male (20s) without trauma has pneumothorax?
Primary spontaneous pneumothorax
Differential for anterior mediastinal mass?
- Thymoma 2. teratoma 3. thyroid neoplasm 4. Lymphoma
Mediastinal mass with elevated AFP and b-HCG?
mixed cell germ tumor
Elevated serum b-HCG with normal AFP?
seminoma
Mediastinal mass with nomral b-HCG and AFP?
Thymomas
Initial management of non-displaced scaphoid bone fracture?
Wrist immobilization for 6-10weeks, with x-rays in7-10 days
Signs of elevated intracranial pressure?
HTN, bradycardia, respiratory depression (Cushing’s reflex)
Effects of uncal herniation?
- Ipsilateral hemiparesis 2. parasympathetic loss (mydriasis (early) ptosis, 3. Contralateral homonymous hemianopdia 4. altered level of consciousness
Patient response to atelectasis?
Hyperventilation -> respo. alkalosis, decreased pCO2
Leriche syndrome
bilateral hip, thigh, buttock claudication impotence symmetric atrophy of the bilateral extremities due to ischemia
Syndrome associated with arterial occlusion at the bifurcation of the aorta?
Leriche Syndrome
How do you counteract a decrease in blood pressure after administration of propofol?
Administer dopamine
How does pneumonia that is developing into septic shock present? Treatment?
acidosis, low urine output, hypotension, tachypnea, fever Tx- IV normal saline
Tetanus prophylaxis in a clean or minor wound?
Tetanus toxoid-containing vaccine only if
Tetanus prophylaxis in a dirty or severe wound?
Tetanus toxoid-containing vaccine only if booster > 5 years ago If unsure, tetanus toxoid-containing vaccine plus tetanus immune globulin
When do you give tetanus immune globulin?
severe or dirty wound with unsure vaccination history
How does venous insufficiency present?
worsens throughout the day and resolves overnight when the patient is recumbent
What are the signs of arterial occlusion?
Pain, pallor, paresthesias, pulselessness, and coolness to the touch
How do you store an amputated limb?
Place in saline moistened gauze and then in a plastic bag on ice…bring it wherever the patient goes.
Signs of retroperitoneal abscesses?
fever, child, and deep abdominal pain may initially be missed by a CT scan
How to treat a pancreatic abscess
Immediate placement of a percutaneous drainage catheter, culture of the drained fluid and surgical debridement
Hemoptysis with upper lung lobe involvment? Initial step?
TB, Isolation
Initial management of coughing with large amounts of blood (>600mL or 100mL/hour)?
Secure airway
When should you suspect diaphragmatic rupture?
History of blunt trauma/MVA, abnormal CXR, left lower lung opacity, elevated hemidiaphragm, and mediastinal deviation
How do patients with duodenal hematomas present? Etiology?
epigastric pain and vomiting d/t blood collection between the submucosal and muscular layers of the duodenum
Signs of urethral injury?
blood at the urethral meatus, inability to void, high-riding prostate on DRE
How to diagnose bladder trauam?
Retrograde cystogram with post-void films
NSAID use with several-day history of epigastric pain followed by acute-onset sevfere constant pain?
perforated peptic ulcer
Initial management for perforated peptic ulcer
NG suction, bowel rest, intravenous fluids, broad spectrum Abx ad intravenous PPI
periumbilical pain out of proportion to examination and hematochezia?
acute mesenteric ischemia Gold standard diagnosis is mesenteric angiography
Signs of adrenal insufficiency?
hypoension/shock weakness nausea, vomiting, abdominal pain, fever
Etiology of adrenal insufficiency?
adrenal hemorrhage/infarction acute illness/injury/surgery in patient with chronic adrenal insufficiency or long-term glucocorticoid use
migratory RLQ pain, nausea, vomiting, fever, leukocytosis
acute appendicitis
When are US and CT used in acute appendicitis?
when classic presentation/signs are not present
epigastroc pain/tenderness and weight loss with nonspecific systemic symptoms with significant smoking history
pancreatic adenocarcinoma
type of pain experiences with pancreatic cancer?
epigastric abdominal pain that is insidious. gnawing, and worse at night
Classic association with pancreatic cancer? Name?
migratory thrombophlebitis Trousseau sign
soft mass that worsens with standing and Valsalva maneuvers, but decreases when supine; does not transilluminate
varicocele
cardiac catheterization, anticoagulation, sudden hypotension, tachycardia, flat neck veins, back pain
retroperitoneal hematoma
Complications from cardiac catheterization
pseudoaneurysm, arteriovenous fistular formation, arterial dissection, acute thrombosis
pneumomediastinum and pleural effusions-cause?
esophageal rupture
pneumothorax despite chest tube, pneumomediastinum subcutaneous emphysema
tracheobronchial perforation (right bronchus is most common
Gallbladder distension and wall thickening, presence of pericholecystic fluid, without gallstones
acalculous cholecystitis
How to treat acalculous cholecystitis acutely? Definitively?
Acutely- percutaneous cholecystostomy and antibiotics Definitively- cholecystectomy with drainage of associated abscessess
How does mesenteric ischemia present?
sudden periumbilical abdominal pain out of proportion to examination findings
Signs of compartment syndrome?
- Pain out of proportion to injury 2. Pain increasing on passive stretch 3. rapidly increasing & tense swelling 4. paresthesia (early)
Signs of deep vein thrombosis?
alf tenderness with pain worsened by passive stretching of the calf.
Postoperative cholestasis-signs?
hypotension, blood loss into tissues, massive blood load (transfusion), decrease liver functionalty, decreased renal bilirubin excretion with normal ALT/AST
Preferred anticoagulant in end-stage renal failure patients?
Warfarin
What is required when starting Warfarin?
Heparin bridge- warfarin activates proteins C and S causing a transient prothrombotic state
When do patients show signs of pulmonary contusions?
Approx. 4 hours post-injury when hypoxia, respiratory distress, pulmonary edema set in
Physical signs of pulmonary contusions?
tachycardia, hypoxia, tachypenea
Pulmonary contusion-CXR results
patchy irregular alveolar infiltrate
Physical signs of a meniscal tear?
joint line tenderness, pain or catching in the provocative tests (Thessaly, McMurray
how to diagnose meniscal tears?
MRI
When should conservative management be used for menscal tear? Examples?
Short-term pain, elderly Example: rest, NSAIDs
Hoe do you treat anal fissures?
topical anesthetics, vasodilators (nifedipine) Sitz baths stool softeners high-fiber diet & adequate fluid intake
When should you considerd surgical interventions for anal fissures?
When medical management has failed
acute abdominal pain followed by lower GI bleeding after an episode of hypotension?
Ischemic colitis
Sites for ischemic colitis? Imaging signs? How to confirm?
Splenic flexure, rectosigmoid junction CT scan may show thickened bowel wall Confirm with colonoscopy
What is the postoperative cause of fever 0-2 hours after surgery?
Prior trauma/infection, blood products, malignant hyperthermia
What is the postoperative cause of fever 1-7 days after surgery?
Nosocomial infections, Group A streptcoccus, or C. perfringens
What is the postoperative cause of fever 1-4 weeks post surgery?
Other organisms (nor GAS, C. perfringens), C difficile, drug fever, PE/DVT
What is the cause of postoperative fever more than 1 months post-surgery
Viral infections, indolent organisms
Signs of fat embolism?
severe respiratory distress, petechial rash, subconjuctival hemorrhage, tachycardia, tachypnea, and fever
Organism most likely responsible for infection from intravascular devices?
Coagulase negative s. epi
How does an anterior should dislocation occur?
forceful abduction and external rotation a the glenohumeral joint; risks damage to the axillary nerve
Torus palatinus? Tx?
benign, bony growth located on the mid-line suture of the hard palate No treatment necessary unless systemic effects develop or it interferes with speech
Signs of rotator cuff impingement
pain with abduction, external rotation subacromial tenderness normal range of motion with positive impingement tests (Neer, Hawkins)
How does cervical impingement present?
pain and paresthesias of the neck and arm along with upper extremity weakness
Clinical signs of acute mesenteric ischemia?
Rapid onset of periumbilical pain Pain out of proportion to examination findings hematochezia
Risk factors for acute mesenteric ischemia?
Atherosclerosis Embolic source hypercoagulable disorders
What is the drop arm test?
Detects a tear in the supraspinatus; arm is abducted passively above head and they are instructed to lower it slowly
Signs of abdominal aortic aneurysm rupture?
severe back pain, syncope, profound hypotension
Signs of SBO strangulation?
peritoneal signs (rigidity, rebound) signs of shock (fever, tachycardia, leukocytosis)
Trochanteric bursitis- definition? Signs?
definition- inglammation of the curse surrounding the insertion of the gluteus medius onto the femur’s trochanter signs- hip pain when pressure is applied and with external or resisted abduction
Femoral nerve innervation
hip joint and skin of the anterior and medial thigh and leg
Complications associated with supracondylar fracture of the humerus
Brachial artery injury Median nerve injury Cubitus varus deformity Compartment syndrome/Volkman ischemic contracture
Signs of sepsis
worsening hyperglycemia, leukocytosis, thrombocytopenia, milk hypothermia, tachypnea, tachycardia
Signs of gallstone ileus
stuttering episodes of nausea and vomiting, pneumobilia, hyperactive bowel sounds, dilated loops of bowels
Important steps in the preoperative management of a patient taking Warfarin?
Check INR, reverse with fresh, frozen plasma
blunt abdominal trauma, hypotension, right chest/abdominal wall injury, and free intraperitoneal fluid
Hepatic laceration
Signs of meniscal tears?
pain, clicking, or catching
post-operative thoracic surgery, fever, tachycardia, chest pain, leukocytosis, and sternal wound drainage or purulent discharge?
Acute mediastinitis, TX- surgical debridement and antibiotic therapy
Signs of septal perforation?
whistling noise during respiration, caused by post-operative septal hematoma
blunt thoracic trauma, respiratory distress despite bilateral chest tubes
Flail chest, demonstrate tachypnea, shallow breaths
Symptoms in arterial embolism?
sudden and severe, with diminished pulses in the affected limb, but normal in the unaffected
Signs of arterial thrombosis
Slow, progressive narrowing of the vascular lumen Pulses are diminished bilaterally (normally)
Signs of pyloric strictures
postprandial pain, vomiting with early satiety, succussion splash on the epigastrium
Signs of esophageal stricture?
Dysphagia, no abdominal succussion splash
Signs of diaphragmatic hernia?
blunt abdominal trauma with mild respiratory distress and abnormal xray **smaller hernias present with nausea/vomiting and are delayed
Cause of infertility from varicocele?
Increased scrotal temperature
Cause of pretibial edema?I
Increased pulmonary vascular resistance
Holosystolic murmur heart of the left sternal border?
Pulmonary regurgitation
5 days after pancreatoduodenectomy , what type of feeding should be used?
Enteral tube feedings
What is erythema nodosum?
Acute, nodular, erythematous eruption on the extensor aspects of the lower legs. Associated with hypersensitivity reactions
What someone falls from a height, what X-rays should be ordered?
C-spine
What should be the first step in the treatment of a woman with breast cancer?
Resect the mass, then treat with chemo/rad
How can heart failure develop from an aneurysm?
Lead to the development of a fistula
What can cause narrowing of the biliary ducts?
cancer (specifically pancreatic), strictures (trauma)
Most common organism causing lymphangitis?
Strep pyo (group A)
How can you minimize the risk of infection from a PICC?
Remove it as soon as treatment/use is complete
Osgood-Schkatter disease
Painful lump below the kneecap in children during puberty, can cause a limp
Legg-Calve-Perthes disease
Blood flow is interrupted to the femoral head in children, can cause necrosis
How do you manage sigmoid volvulus?
Sigmoidoscopy-guided placement of a rectal tube
What should be the first step in management of an unknown mass on an HIV patient?
Biopsy
What is a pneumatocele?
cavity in the lung parenchyma filled with air that may result from pulmonary trauma during mechanical ventilation
Written description of C- Diff infection?
Patchy, white mucosa on colonoscopy
Diffusely enlarged thyroid gland with neck swelling and no symptoms of decreased thyroid?
Chronic lymphocytic thyroiditis (Hashimoto disease)
Long-term growth (> 6 months) on glans penis with negative VDRL test?
Penis cancer
How do you counteract the effects of propofol?
Dopamine
borborygmi
a rumbling or gurgling noise made by the movement of fluid and gas in the intestines
What is a major complication risk from AAA repair?
MI
diaphoretic
Sweating heavily
C8 radiculopathy
causes pain from the neck to the hand. Patients may experience weakness in hand grip, and pain and numbness can radiate along the inner side of the arm, ring, and little fingers.
C7 radiculopathy
(the most common) causes pain and/or weakness from the neck to the hand and can include the triceps (the muscles on the back of the upper arms) and the middle finge
C6 radiculopathy
(one of the most common), causes pain and/or weakness along the length of the arm, including the biceps (the muscles in front of the upper arms), wrists, and the thumb and index finger.
C5 radiculopathy
can cause pain and/or weakness in the shoulders and upper arms. Especially may cause discomfort around the shoulder blades. It rarely causes numbness or tingling.
Child with current-jelly stools?
Intussusception
How to treat intussusception?
Control enema
Cause of subcutaneous emphysema?
Tension pneumothorax
When giving large amounts of packed RBC’s, what must be added?
Platelets
Should volume support or patient transport during traumas come first?
Urban areas with close trauma center - transport All other areas- resuscitate
How to treat rib fractures in the elderly?
Local nerve block and epidural catheter
What should be done with all gunshot wounds to the abdomen?
Exploratory Laparotomy
What treatments should be provided for a through-and-through extremity gunshot wound?
Tetanus prophylaxis
When can early excision and grafting be used?
Small (
What degree of angulation is unacceptable in children (compared to adults)
Larger amounts
How are intertrochaneric fractures treated?
ORIF with anticoagulation
“tip of the finger remains flexed when the rest of the fingers are extended
Malley
Common cause of coma in a cirrhotic patient with bleeding varices?
Ammonium toxicities
Liters of drainage from an upper GI wound?
fluid replacement, nutritional support, protection of the abdominal wall
Old man with blood on the outside of his stool?
Hemorrhoids
Sources of inflammation in the left lower quadrant of women?
Diverticulitis, tube, ovary Diagnose with CT
Acute edematous pancreatitis
Alcoholics of gallstones Pain after large meal or EtOH _> constant, radiates to back-> nausea, vomiting, retching
Vascular rings
stridor, “crowing”, baby assumes hyperextended neck Bronchoscopy shows segmental compression of the trachea Tx- surgical division
What type of catheter is used for embolectomy of an atrial clot from a. fib?
Fogarty
Small, raised, waxy lesion
Basal cell carcinoma
non-healing ulcer?
Basal cell carcinoma
Where are squamous cell carcinoma found?
Lower lip and below on face
Where do you biopsy a basal cell carcinoma?
Edge of the lesion
Amblyopia
vision impairment resulting from interference with the processing of images by the brain during the firs t6-7 years of life
How to treat trigeminal neuralgia?
Anti-convulsants (carbamazapine)
Sudden testicular pain, pyuria, fever
acute epididymitis
acute epididymitis- treatment
Abx and sonogram to rule out torsion
Uropelvic junction obstruction signs
Intense pain when large diuresis occurs (beer drinking)
How do you treat testicular cancer?
platinum-based therapies
Treatment for impotence-first line?
Sildenafil, tadalafil, vardenafil
What is mandatory for all abdominal bullet wounds?
Ex Lap
Abdominal mass that moves up and down in a baby
Malignant tumor of the liver ie-hepatoblastoma or hepatocellular carcinoma
Child class factors to deny surgery
albumin below 2, INR 2 x normal, ascites
bilateral pulmonary infiltrates with low PO2
ARDS, PEEP
How do you obtain samples from a breast?
US guided imaging
Back pain in woman who recently has breast cancer?
Metastatic spread, diagnose with MRI
Signs of Zollinger-Ellison disease
Refractory to other treatments, multiple ulcers
Double bubble with normal gas
Malrotation
Square root sign
Chronic constrictive pericarditis
Workup for squamous cell carcinoma of the mucosa?
Panendoscopy
1 week post- otitis media infection: projectile vomiting, seizures, blurred vision, severe headache
Brain abscess
Why a newborn does not urinate during the first day after birth?
posterior urethral valves
Intervention for UPJ stones larger than 7mm
extraperitoneal shock-wave lithotripsy
Standard bolus for burns
1000mL/hr 30-120mL/hr
How do you test an animal for rabies?
Kill the animal and scan its brain
Chubby 13 year old boy limping, complaining of knee pain, sole of affected foot points towards the other one
slipped capital femoral epiphysis
arm held close to the body
Posterior shoulder dislocation, axillary/scapula xrays needed for diagnosis
In an ejection, what should always be imaged?
C-spine (CT scan)
How to treat lumbar disk herniation?
MRI of L4-S1, pain control with nerve blocks
Morton neuroma
inflammation of the common digital nerve in the third space
Signs of PE?
pleuritic (sudden onset), sob, diaphoretic, tachycardic, distended veins in neck and face
Cause of blood in rectum from child?
Merkel’s diverticulum, workup with technetium scan
First step in the workup for pancreatic cancer?
CT of the abdomen
First step in workup for a palpable breast mass?
US guided core biopsy
What are burns near the eyes covered with?
Triple abx ointment
Trashing around with sudden pain?
Stone stuck in ureter
If a patient is stable, which test is most sensitive for blood?
CT
How to treat acute rejection?
Tacrolimus or Mycophenolate mofetil with/without steroids
Patient passing stone suddenly spikes a fever
ER immediately, nephrostomy tube placement
How to workup claudication?
Doppler studies
Knee to chest position in children?
Ependymoma
Stumbling around and truncal ataxia in children?
Medulloblastoma
Contraindication to organ donation?
Positive HIV status
In a patient with weakness and decreased pain in both legs, what type of injury is suspected? Action?
Lower spinal cord injury, insert urinary catheter to assess for urinary retention and prevent bladder injury
Signs of cardiac temponade?
hypotension (unresponsive to IV fluids), tachycardia, and elevated jugular venous pressure after blunt thoracic trauma
How is duodenal hematoma treated?
NG suction and parenteral nutrition
What is the first step in management of damage to the urethral meatus?
retrograde urethrogram
Use of NSAIDS with episodic postprandial epigastric pain?
Perforated peptic ulcer
How to treat perforated peptic ulcers?
NG suction, bowel rest, intravenous fluids, broad-spectrum antibiotics, IV PPI
Signs of acute adrenal insufficiency?
Severe and often refractory hypotension, vomiting, abdominal pain and fever
Signs of primary adrenal insufficiency?
hyponatremia and hyperkalemia
Best management of acute appendicitis?
Laparoscopic appendectomy
Epigastric pain/tenderness, weight loss in the setting of nonspecific systemic symptoms and significant smoking history?
Cancer of the upper GI or associated organs…think gallbladder, liver, pancreas
Classic description of pain in pancreatic cancer?
Abdominal pain that is insidious, gnawing, and worse at night
Varicocele-signs? Diagnostic method?
soft mass that worsens with standing and Valsalva maneuvers, but decreases when supine, does not transilluminated Diagnostic- US
Varicocele treatment?
NSAIDS or surgical correction
How do you manage small pneumothorax? Large?
Small- supplemental O2 Large- Needle thoracostomy/chest tube
Young male (20s) without trauma has pneumothorax?
Primary spontaneous pneumothorax
Differential for anterior mediastinal mass?
- Thymoma 2. teratoma 3. thyroid neoplasm 4. Lymphoma
Mediastinal mass with elevated AFP and b-HCG?
mixed cell germ tumor
Femoral nerve innervation
hip joint and skin of the anterior and medial thigh and leg
Child with current-jelly stools?
Intussusception
What is mandatory for all abdominal bullet wounds?
Ex Lap
Contraindication to organ donation?
Positive HIV status
Stumbling around and truncal ataxia in children?
Medulloblastoma
Knee to chest position in children?
Ependymoma
How to workup claudication?
Doppler studies
Patient passing stone suddenly spikes a fever
ER immediately, nephrostomy tube placement
How to treat acute rejection?
Tacrolimus or Mycophenolate mofetil with/without steroids
If a patient is stable, which test is most sensitive for blood?
CT
Trashing around with sudden pain?
Stone stuck in ureter
What are burns near the eyes covered with?
Triple abx ointment
First step in workup for a palpable breast mass?
US guided core biopsy
First step in the workup for pancreatic cancer?
CT of the abdomen
Cause of blood in rectum from child?
Merkel’s diverticulum, workup with technetium scan
Signs of PE?
pleuritic (sudden onset), sob, diaphoretic, tachycardic, distended veins in neck and face
Morton neuroma
inflammation of the common digital nerve in the third space
How to treat lumbar disk herniation?
MRI of L4-S1, pain control with nerve blocks
In an ejection, what should always be imaged?
C-spine (CT scan)
arm held close to the body
Posterior shoulder dislocation, axillary/scapula xrays needed for diagnosis
Chubby 13 year old boy limping, complaining of knee pain, sole of affected foot points towards the other one
slipped capital femoral epiphysis
How do you test an animal for rabies?
Kill the animal and scan its brain
Standard bolus for burns
1000mL/hr 30-120mL/hr
Intervention for UPJ stones larger than 7mm
extraperitoneal shock-wave lithotripsy
Why a newborn does not urinate during the first day after birth?
posterior urethral valves
1 week post- otitis media infection: projectile vomiting, seizures, blurred vision, severe headache
Brain abscess
Workup for squamous cell carcinoma of the mucosa?
Panendoscopy
Square root sign
Chronic constrictive pericarditis
Double bubble with normal gas
Malrotation
Signs of Zollinger-Ellison disease
Refractory to other treatments, multiple ulcers
Back pain in woman who recently has breast cancer?
Metastatic spread, diagnose with MRI
How do you obtain samples from a breast?
US guided imaging
bilateral pulmonary infiltrates with low PO2
ARDS, PEEP
Child class factors to deny surgery
albumin below 2, INR 2 x normal, ascites
Abdominal mass that moves up and down in a baby
Malignant tumor of the liver ie-hepatoblastoma or hepatocellular carcinoma
Treatment for impotence-first line?
Sildenafil, tadalafil, vardenafil
How do you treat testicular cancer?
platinum-based therapies
Uropelvic junction obstruction signs
Intense pain when large diuresis occurs (beer drinking)
acute epididymitis- treatment
Abx and sonogram to rule out torsion
Sudden testicular pain, pyuria, fever
acute epididymitis
How to treat trigeminal neuralgia?
Anti-convulsants (carbamazapine)
Amblyopia
vision impairment resulting from interference with the processing of images by the brain during the firs t6-7 years of life
Where do you biopsy a basal cell carcinoma?
Edge of the lesion
Where are squamous cell carcinoma found?
Lower lip and below on face
non-healing ulcer?
Basal cell carcinoma
Small, raised, waxy lesion
Basal cell carcinoma
What type of catheter is used for embolectomy of an atrial clot from a. fib?
Fogarty
Vascular rings
stridor, “crowing”, baby assumes hyperextended neck Bronchoscopy shows segmental compression of the trachea Tx- surgical division
Acute edematous pancreatitis
Alcoholics of gallstones Pain after large meal or EtOH _> constant, radiates to back-> nausea, vomiting, retching
Sources of inflammation in the left lower quadrant of women?
Diverticulitis, tube, ovary Diagnose with CT
Old man with blood on the outside of his stool?
Hemorrhoids
Liters of drainage from an upper GI wound?
fluid replacement, nutritional support, protection of the abdominal wall
Common cause of coma in a cirrhotic patient with bleeding varices?
Ammonium toxicities
“tip of the finger remains flexed when the rest of the fingers are extended
Malley
How are intertrochaneric fractures treated?
ORIF with anticoagulation
What degree of angulation is unacceptable in children (compared to adults)
Larger amounts
When can early excision and grafting be used?
Small (
What treatments should be provided for a through-and-through extremity gunshot wound?
Tetanus prophylaxis
What should be done with all gunshot wounds to the abdomen?
Exploratory Laparotomy
How to treat rib fractures in the elderly?
Local nerve block and epidural catheter
Should volume support or patient transport during traumas come first?
Urban areas with close trauma center - transport All other areas- resuscitate
When giving large amounts of packed RBC’s, what must be added?
Platelets
Cause of subcutaneous emphysema?
Tension pneumothorax
How to treat intussusception?
Control enema
C5 radiculopathy
can cause pain and/or weakness in the shoulders and upper arms. Especially may cause discomfort around the shoulder blades. It rarely causes numbness or tingling.
C6 radiculopathy
(one of the most common), causes pain and/or weakness along the length of the arm, including the biceps (the muscles in front of the upper arms), wrists, and the thumb and index finger.
C7 radiculopathy
(the most common) causes pain and/or weakness from the neck to the hand and can include the triceps (the muscles on the back of the upper arms) and the middle finge
C8 radiculopathy
causes pain from the neck to the hand. Patients may experience weakness in hand grip, and pain and numbness can radiate along the inner side of the arm, ring, and little fingers.
diaphoretic
Sweating heavily
What is a major complication risk from AAA repair?
MI
borborygmi
a rumbling or gurgling noise made by the movement of fluid and gas in the intestines
How do you counteract the effects of propofol?
Dopamine
Long-term growth (> 6 months) on glans penis with negative VDRL test?
Penis cancer
Diffusely enlarged thyroid gland with neck swelling and no symptoms of decreased thyroid?
Chronic lymphocytic thyroiditis (Hashimoto disease)
Written description of C- Diff infection?
Patchy, white mucosa on colonoscopy
What is a pneumatocele?
cavity in the lung parenchyma filled with air that may result from pulmonary trauma during mechanical ventilation
What should be the first step in management of an unknown mass on an HIV patient?
Biopsy
How do you manage sigmoid volvulus?
Sigmoidoscopy-guided placement of a rectal tube
Legg-Calve-Perthes disease
Blood flow is interrupted to the femoral head in children, can cause necrosis
Osgood-Schkatter disease
Painful lump below the kneecap in children during puberty, can cause a limp
How can you minimize the risk of infection from a PICC?
Remove it as soon as treatment/use is complete
Most common organism causing lymphangitis?
Strep pyo (group A)
What can cause narrowing of the biliary ducts?
cancer (specifically pancreatic), strictures (trauma)
How can heart failure develop from an aneurysm?
Lead to the development of a fistula
What should be the first step in the treatment of a woman with breast cancer?
Resect the mass, then treat with chemo/rad
What someone falls from a height, what X-rays should be ordered?
C-spine
What is erythema nodosum?
Acute, nodular, erythematous eruption on the extensor aspects of the lower legs. Associated with hypersensitivity reactions
5 days after pancreatoduodenectomy , what type of feeding should be used?
Enteral tube feedings
Holosystolic murmur heart of the left sternal border?
Pulmonary regurgitation
Cause of pretibial edema?I
Increased pulmonary vascular resistance
Cause of infertility from varicocele?
Increased scrotal temperature
Signs of diaphragmatic hernia?
blunt abdominal trauma with mild respiratory distress and abnormal xray **smaller hernias present with nausea/vomiting and are delayed
Signs of esophageal stricture?
Dysphagia, no abdominal succussion splash
Signs of pyloric strictures
postprandial pain, vomiting with early satiety, succussion splash on the epigastrium
Signs of arterial thrombosis
Slow, progressive narrowing of the vascular lumen Pulses are diminished bilaterally (normally)
Symptoms in arterial embolism?
sudden and severe, with diminished pulses in the affected limb, but normal in the unaffected
blunt thoracic trauma, respiratory distress despite bilateral chest tubes
Flail chest, demonstrate tachypnea, shallow breaths
Signs of septal perforation?
whistling noise during respiration, caused by post-operative septal hematoma
post-operative thoracic surgery, fever, tachycardia, chest pain, leukocytosis, and sternal wound drainage or purulent discharge?
Acute mediastinitis, TX- surgical debridement and antibiotic therapy
Signs of meniscal tears?
pain, clicking, or catching
blunt abdominal trauma, hypotension, right chest/abdominal wall injury, and free intraperitoneal fluid
Hepatic laceration
Important steps in the preoperative management of a patient taking Warfarin?
Check INR, reverse with fresh, frozen plasma
Signs of gallstone ileus
stuttering episodes of nausea and vomiting, pneumobilia, hyperactive bowel sounds, dilated loops of bowels
Signs of sepsis
worsening hyperglycemia, leukocytosis, thrombocytopenia, milk hypothermia, tachypnea, tachycardia
Complications associated with supracondylar fracture of the humerus
Brachial artery injury Median nerve injury Cubitus varus deformity Compartment syndrome/Volkman ischemic contracture
Trochanteric bursitis- definition? Signs?
definition- inglammation of the curse surrounding the insertion of the gluteus medius onto the femur’s trochanter signs- hip pain when pressure is applied and with external or resisted abduction
Signs of SBO strangulation?
peritoneal signs (rigidity, rebound) signs of shock (fever, tachycardia, leukocytosis)
Signs of abdominal aortic aneurysm rupture?
severe back pain, syncope, profound hypotension
What is the drop arm test?
Detects a tear in the supraspinatus; arm is abducted passively above head and they are instructed to lower it slowly
Risk factors for acute mesenteric ischemia?
Atherosclerosis Embolic source hypercoagulable disorders
Clinical signs of acute mesenteric ischemia?
Rapid onset of periumbilical pain Pain out of proportion to examination findings hematochezia
How does cervical impingement present?
pain and paresthesias of the neck and arm along with upper extremity weakness
Signs of rotator cuff impingement
pain with abduction, external rotation subacromial tenderness normal range of motion with positive impingement tests (Neer, Hawkins)
Torus palatinus? Tx?
benign, bony growth located on the mid-line suture of the hard palate No treatment necessary unless systemic effects develop or it interferes with speech
How does an anterior should dislocation occur?
forceful abduction and external rotation a the glenohumeral joint; risks damage to the axillary nerve
Organism most likely responsible for infection from intravascular devices?
Coagulase negative s. epi
Signs of fat embolism?
severe respiratory distress, petechial rash, subconjuctival hemorrhage, tachycardia, tachypnea, and fever
What is the cause of postoperative fever more than 1 months post-surgery
Viral infections, indolent organisms
What is the postoperative cause of fever 1-4 weeks post surgery?
Other organisms (nor GAS, C. perfringens), C difficile, drug fever, PE/DVT
What is the postoperative cause of fever 1-7 days after surgery?
Nosocomial infections, Group A streptcoccus, or C. perfringens
What is the postoperative cause of fever 0-2 hours after surgery?
Prior trauma/infection, blood products, malignant hyperthermia
Sites for ischemic colitis? Imaging signs? How to confirm?
Splenic flexure, rectosigmoid junction CT scan may show thickened bowel wall Confirm with colonoscopy
acute abdominal pain followed by lower GI bleeding after an episode of hypotension?
Ischemic colitis
When should you considerd surgical interventions for anal fissures?
When medical management has failed
Hoe do you treat anal fissures?
topical anesthetics, vasodilators (nifedipine) Sitz baths stool softeners high-fiber diet & adequate fluid intake
When should conservative management be used for menscal tear? Examples?
Short-term pain, elderly Example: rest, NSAIDs
how to diagnose meniscal tears?
MRI
Physical signs of a meniscal tear?
joint line tenderness, pain or catching in the provocative tests (Thessaly, McMurray
Pulmonary contusion-CXR results
patchy irregular alveolar infiltrate
Physical signs of pulmonary contusions?
tachycardia, hypoxia, tachypenea
When do patients show signs of pulmonary contusions?
Approx. 4 hours post-injury when hypoxia, respiratory distress, pulmonary edema set in
What is required when starting Warfarin?
Heparin bridge- warfarin activates proteins C and S causing a transient prothrombotic state
Preferred anticoagulant in end-stage renal failure patients?
Warfarin
Postoperative cholestasis-signs?
hypotension, blood loss into tissues, massive blood load (transfusion), decrease liver functionalty, decreased renal bilirubin excretion with normal ALT/AST
Signs of deep vein thrombosis?
alf tenderness with pain worsened by passive stretching of the calf.
Signs of compartment syndrome?
- Pain out of proportion to injury 2. Pain increasing on passive stretch 3. rapidly increasing & tense swelling 4. paresthesia (early)
How does mesenteric ischemia present?
sudden periumbilical abdominal pain out of proportion to examination findings
How to treat acalculous cholecystitis acutely? Definitively?
Acutely- percutaneous cholecystostomy and antibiotics Definitively- cholecystectomy with drainage of associated abscessess
Gallbladder distension and wall thickening, presence of pericholecystic fluid, without gallstones
acalculous cholecystitis
pneumothorax despite chest tube, pneumomediastinum subcutaneous emphysema
tracheobronchial perforation (right bronchus is most common
pneumomediastinum and pleural effusions-cause?
esophageal rupture
Complications from cardiac catheterization
pseudoaneurysm, arteriovenous fistular formation, arterial dissection, acute thrombosis
cardiac catheterization, anticoagulation, sudden hypotension, tachycardia, flat neck veins, back pain
retroperitoneal hematoma
soft mass that worsens with standing and Valsalva maneuvers, but decreases when supine; does not transilluminate
varicocele
Classic association with pancreatic cancer? Name?
migratory thrombophlebitis Trousseau sign
type of pain experiences with pancreatic cancer?
epigastric abdominal pain that is insidious. gnawing, and worse at night
epigastroc pain/tenderness and weight loss with nonspecific systemic symptoms with significant smoking history
pancreatic adenocarcinoma
When are US and CT used in acute appendicitis?
when classic presentation/signs are not present
migratory RLQ pain, nausea, vomiting, fever, leukocytosis
acute appendicitis
Etiology of adrenal insufficiency?
adrenal hemorrhage/infarction acute illness/injury/surgery in patient with chronic adrenal insufficiency or long-term glucocorticoid use
Signs of adrenal insufficiency?
hypoension/shock weakness nausea, vomiting, abdominal pain, fever
periumbilical pain out of proportion to examination and hematochezia?
acute mesenteric ischemia Gold standard diagnosis is mesenteric angiography
Initial management for perforated peptic ulcer
NG suction, bowel rest, intravenous fluids, broad spectrum Abx ad intravenous PPI
NSAID use with several-day history of epigastric pain followed by acute-onset sevfere constant pain?
perforated peptic ulcer
How to diagnose bladder trauam?
Retrograde cystogram with post-void films
Signs of urethral injury?
blood at the urethral meatus, inability to void, high-riding prostate on DRE
How do patients with duodenal hematomas present? Etiology?
epigastric pain and vomiting d/t blood collection between the submucosal and muscular layers of the duodenum
When should you suspect diaphragmatic rupture?
History of blunt trauma/MVA, abnormal CXR, left lower lung opacity, elevated hemidiaphragm, and mediastinal deviation
Initial management of coughing with large amounts of blood (>600mL or 100mL/hour)?
Secure airway
Hemoptysis with upper lung lobe involvment? Initial step?
TB, Isolation
How to treat a pancreatic abscess
Immediate placement of a percutaneous drainage catheter, culture of the drained fluid and surgical debridement
Signs of retroperitoneal abscesses?
fever, child, and deep abdominal pain may initially be missed by a CT scan
How do you store an amputated limb?
Place in saline moistened gauze and then in a plastic bag on ice…bring it wherever the patient goes.
What are the signs of arterial occlusion?
Pain, pallor, paresthesias, pulselessness, and coolness to the touch
How does venous insufficiency present?
worsens throughout the day and resolves overnight when the patient is recumbent
When do you give tetanus immune globulin?
severe or dirty wound with unsure vaccination history
Tetanus prophylaxis in a dirty or severe wound?
Tetanus toxoid-containing vaccine only if booster > 5 years ago If unsure, tetanus toxoid-containing vaccine plus tetanus immune globulin
Tetanus prophylaxis in a clean or minor wound?
Tetanus toxoid-containing vaccine only if
How does pneumonia that is developing into septic shock present? Treatment?
acidosis, low urine output, hypotension, tachypnea, fever Tx- IV normal saline
How do you counteract a decrease in blood pressure after administration of propofol?
Administer dopamine
Syndrome associated with arterial occlusion at the bifurcation of the aorta?
Leriche Syndrome
Leriche syndrome
bilateral hip, thigh, buttock claudication impotence symmetric atrophy of the bilateral extremities due to ischemia
Patient response to atelectasis?
Hyperventilation -> respo. alkalosis, decreased pCO2
Effects of uncal herniation?
- Ipsilateral hemiparesis 2. parasympathetic loss (mydriasis (early) ptosis, 3. Contralateral homonymous hemianopdia 4. altered level of consciousness
Signs of elevated intracranial pressure?
HTN, bradycardia, respiratory depression (Cushing’s reflex)
Initial management of non-displaced scaphoid bone fracture?
Wrist immobilization for 6-10weeks, with x-rays in7-10 days
Mediastinal mass with nomral b-HCG and AFP?
Thymomas
Elevated serum b-HCG with normal AFP?
seminoma
