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Medicine Flashcards

1
Q

Cor Pulmonale findings and Dx

A

GPE: loud P2, PSM, JVD, peripheral edema, hepatomegaly, ascitis

CXR: enlarged central pulmonary ateries and loss of retrosternal air space

ECG: right axis deviation, R BBB, RV hypertrophy, RA enlargement.

R heart catheterisation: elevated central venous pressure, RV end diastolic press and mean pulm artey press >=25mmHg

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2
Q

Pulmonary Thromboembolism treatment

A

Immediate anticoagulation unless contraindicated.

Normal pts- RIVAROXABAN(immediate action and hence no need of bridging with heparin) EXNOXAPARIN, FONDAPARINUX.

Pts with renal insufficiency- UNFRACTIONATED HEPARIN followed by WARFARIN

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3
Q

Pulmonary infarction S/S

A

Pleuritic chest pain

Hemoptysis

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4
Q

Bronchiectasis s/s, causes and Dx

A

Signs & symptoms:
Cough with daily mucopurulent sputum production
Rhinosinusitis, dyspnea, hemoptysis
Crackles, wheezing
Etiologies:
Airway obstruction (eg, cancer)
Rheumatic disease (eg, RA, Sjögren), toxic inhalation
Chronic or prior infection (eg, aspergillosis, mycobacteria)
Immunodeficiency (eg, hypogammaglobulinemia)
Congenital (eg, CF, alpha-1-antitrypsin deficiency)
Evaluation:
1. HRCT scan of the chest (needed for initial diagnosis)
2. Immunoglobulin quantification
3. CF testing, sputum culture (bacteria, fungi & mycobacteria)
4. Pulmonary function testing

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5
Q

Bronchiectasis due to CF findings

A
  • Pseudomonas aeruginosa in sputum(in almost all bronchiectasis)
  • Upper lung lobe involvement - bronchiectasis due to CF.
  • Mutation of CF transmembrane conductance regulator gene results in DEFECTIVE CHLORIDE AND SODIUM TRANSPORT.
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6
Q

Asbestos exposure is seen in..

A 
Plumbers
electricians
carpenters
pipefitters
Insultation workers
plastic/rubber manufacturing
Ship-building
Construction
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7
Q

Ischemic chest pain (CAD)- type of pain

A

Substernal squeezing pain

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8
Q

Progressive dyspnoea on exertion in the setting of morbid obsesity

A

Obesity Hypoventilation Syndrome (OHS)

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9
Q

Patho of OHS

A
  1. Hypoxia or hypercapnia leads to bicarbonate retention-> decreased chloride reabsorption-> COMPENSATORY METABOLIC ALKALOSIS
  2. Chronic hypoxia-> pulmonary hypertension-> cor pulmonale-> PERIPHERAL EDEMA
  3. Chronic hypoxia -> increased erythropoietin-> COMPENSATORY ERYTHROCYTOSIS
  4. Chronic hypoxia-> chronic hypoventilation-> INCREASED pCO2
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10
Q

Pleural fluid pH

A

Normal: 7.60

Transudate: 7.4-7.55
Exudates: 7.30-7.45

pH <7.30 : Empyema (increased acid production by cells or bacteria)
OR
Decreased H ion efflux from pleural space ( pleuritis, tumor, pleural fibrosis)

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11
Q

Auscultation finding in COPD and ILD

A

COPD- wheezing

ILD- crackles

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12
Q

ARDS diagnosis

A

New worsening respiratory distress within 1 week of insult

CXR- b/l lung opacities

Hypoxemia with PaO2/FiO2 ratio < 300mmHg

PAP increased
Pulmonary capillary wedge press (or left atrial press) normal

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13
Q

ARDS treatment

A

Mechanical ventilation ( low TV, high PEEP, high FiO2, permissive hypercapnia)

PaO2: 55-80mmHg (SpO2: >88-95%)

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14
Q

Central Respiratory Depression Dx & TX

A

ABG- primary respiratory acidosis( low pH and high PaCO2)

TX- increase minute ventilation ( mainly by increasing the respiratory rate)

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15
Q

Diagnostic tests for pulmonary embolism

A
  • CT angiography of chest
  • Ventilation- Perfusion scan (alternate to CTA)
  • transthoracic ECHO
  • D-diner assay
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16
Q

COPD Tx

A 
Smoking cessation 
Supplemental O2
Inhaled bronchodilators (Ipatropium and Tiotropium)
Anti-muscarinic agents + SABA(albuterol)
Inhaled steroids 
LABA
Lung reduction Surgery
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17
Q

Reactivation of latent TB finding

A

CXR- apical cavitatory lesion

Chronic low grade fever, nigh sweats, WY loss, cough with blood tinged sputum

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18
Q

Aspiration pneumonia findings

A

Fever, cough
Leukocytosis

CXR- lobar infiltrates

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19
Q

Difference between Chr Bronchitis and Emphysema

A

Bronchitis:
DLCO- normal
CXR- prominent bronchovascular markings and mildly flattened diaphragm

Emphysema:
DLCO- decreased
CXR- decreased vascular markings and hyperinflated lungs

Hypoxemia is more in bronchitis

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20
Q

Pneumothorax findings

A

Hyper resonance to percussion
Diminished breath sounds
Decreased tactile fremitis
Hypotension (decreased venous return)

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21
Q

Criteria for initiation of Long term supplemental oxygen therapy (LTOT)

A

Resting PaO2 55%

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22
Q

Histoplasma capsulatum findings

A

H/o exposure to bird/bats

CXR- mediastinal hilar lymphadenopathy with focal reticulonodular/miliary infiltrates

Dx- histoplasma antigen testing of urine or blood
Serology
Tissue diagnosis- granulomas with narrow based budding yeasts

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23
Q

Hypersensitivity pneumonitis (Bird Fanciers disease) h/o and Dx

A

CXR- ground glass opacities/ haziness of lower lung fields

H/o bird or mould exposure which usually resolves within 24 hours

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24
Q

Acute exacerbation of COPD findings and Dx

A

Change in >=1 of the following:

  • cough severity /frequency
  • sputum volume/ character
  • level of dyspnea

GPE- wheezing, tachypnea, prolonged expiration, use of accessory muscles, JVD(during expiration)

CXR- hyperinflation

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25
Q

How to differentiate between AE of COPD from Heart failure

A

B-type Natriuretic Peptide

Normal: <100pg/ml

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26
Q

Community acquired pneumonia s/s, Dx and Tx

A 
S/s- dyspnea
Productive cough 
Fever
Pleuritic chest pain
Tachypnea
Tachycardia

PE- focal increased breath sounds and crackles

CXR- lobar/ interstitial/ cavitatory infiltrates
Consolidator alveolar filling process

TX- Ceftriaxone + azithromycin (hospitalised pts)
Azithromycin (opd pts)

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27
Q

Hypovolemia S/S and Dx

A

S/s- diarrhoea, poor appetite, flat neck veins
Old pts- orthostatic hypotension
& orthostatic syncope

Increased hematocrit 
Decreased serum sodium and potassium
Decreased urine urea nitrogen levels
Urine osmolality increased
Decreased Brain natriuretic peptide
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28
Q

Idiopathic pulmonary fibrosis- s/s and Dx

A

S/s- slowly progressive dyspnea
Dry cough
Fine bibasilar crackles
Advanced- end inspiratory squeaks, digital clubbing, abnormal S2(loud P2, fixed, split S2)

CXR- non specific reticular infiltrates
CT chest- peripheral/bibasilar reticular infiltrates and honeycombing
VQ mismatch
Increased A-a gradient
Decreased TLC, Residual Volume and Functional Residual Capacity

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29
Q

ARDS TX

A

Mechanical ventilation- either increasing FiO2 (<60%/0.6) or increasing PEEP

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30
Q

Pulmonary Function Test interpretation

A

FEV1/FVC - <70%- obstructive
>70% -restrictive

FVC- N/reduced- obstructive
<80%- restrictive

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31
Q

Oropharyngeal cobblestoning and rhinorrhea seen in

A

Upper Airway cough syndrome

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32
Q

Mechanical Ventilation settings

A

TV should be ~6ml/kg of ideal body weight

I’m case of hyperventilation(^ pH & low pCO2 ) - RR has to be decreased.

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33
Q

Chest Physiotherapy is done for which diseases?

A

Pneumonia
Atelectasis
Bronchiectasis- long term

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34
Q

Interstitial lung disease- causes, s/s and Dx

A

Etiology:

  • Sarcoidosis, amyloidosis, alveolar proteinosis
  • vasculitis
  • Infections
  • occupational & environmental agents
  • connective tissue disease
  • IPF, interstitial pneumonia

S/S:

  • Progressive exertions dyspnea/ persistent dry cough
  • Findings from other underlying conditions
  • > 50% have smoking history
  • Fine crackles during mid-late inspiration, possible digital clubbing

Inv:
CXR- reticular/nodular opacities
HRCT- fibrosis, honeycombing or traction bronchiectasis
PFT- N or increased FEV1/FVC, decreased DLCO, decreased TLC, decreased Residual Volume
ABG- N or mild hypoxemia at rest and severe hypoxemia on exertion

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35
Q

CHF exacerbation findings and Dx

A

Bibasilar crackles
Decreased breath sounds at base (due to pleural effusion)
Occasional wheezing

ABG- hypoxia, hypocapnia, resp alkalosis
BNP- > 100
Pulm capillary wedge pressure

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36
Q

SIADH causes, s/s and Dx

A 
Causes:
CNS- stroke, hemorrhage
Meds- carbamazepine, ssri, nsaid 
Lung disease - pneumonia 
Ectopic ADH secretion- small cell lung cancer
Pain/ nausea

S/S-
Nausea, forgetfulness
Seizures, coma
Or euvolemia

Inv:
Hyponatremia 
Serum osmolality <275 mOsm/kg H2O 
Urine osmolality >100mOsm/kg H2O
Urine sodium >40 mEq/L
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37
Q

Serum osmolality calculation

A

(2 x serum Na + serum glucose /18) + ( serum BUN/2.8)

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38
Q

Factitious hyponatremia

A

Evidence of hypovolemia is seen :

Dry mucus membrane , decreased skin turgor, serum BUN/creat ratio >20

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39
Q

Pleural fluid showing moderate lymphocytosis,
very high protein and
increased LDH , it is …

A

Tubercular effusion

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40
Q

Chylothorax

  • increased triglycerides
  • milky white in colour
  • exudative
A

Disruption of thoracic duct

  • malignancy
  • trauma

Fever and chest pain uncommon

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41
Q

Catheterisation(heart) interpretation

A

Increased PA and RA pressure > pulmo hypertension

Increased PCWP and RA and PA pressure > left sided heart failure leading to right sided heart failure

Normal PCWP and increased PA pressure > intrinsic pulmonary process (eg: pulmonary embolism)

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42
Q

Theophylline toxicity s/s and drugs/conditions which increase toxicity

A

S/S:
CNS - insomnia, seizures, headache
GI disturbance- nausea, vomiting
Cardiac toxicity- arrhythmia

Drugs which reduces clearance - Ciprofloxacin, cimetidine, erythromycin, clarithromycin, verapamil

Concurrent illness which increases toxicity-
Cirrhosis, cholestasis, respiratory infections

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43
Q

Myasthenic crisis- causes and Tx

A 
Causes:
Infection/ surgery
Pregnancy/ childbirth
Drugs ( amino glycosides, fluoroquinolones, beta blockers, CCB, magnesium)
Tapering of immunosuppressants
Treatment: 
Elective intubation 
Plasmapheresis and IVIG
High dose corticosteroids 
Azatgioprine
Pyridostigmine (for mild to mod disease)
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44
Q

LTOT criteria

A
  1. Resting PaO2 55%
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45
Q

ICS adverse effects

A 
Oral thrush, 
cataract, 
adrenal suppression, 
decreased growth in children, 
interference with bone metabolism and 
purpura
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46
Q

Chronic pulmonary thromboembolism PFT

A

Normal Fev1, FVC, fev1/FVC ratio but decreased DLCO

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47
Q

Endocarditis

A

Valvular dysfunction
Left sided heart FAilure
Increased PCWP
Bibasilar crackles

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48
Q

Exercise induced bronchoconstriction s/s and Tx

A

Coughing, wheezing and breathlessness following exercise

Tx:
Beta agonists (Saba 10-20 mins prior to exercise)
Mast cell stabilisers
Antileukotriene agents ( if can not tolerate beta agonists)
Steroid inhalers for everyday athletes
Ipatropium inhalers + beta agonists for acute exacerbations

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49
Q

Granulomatosis with polyangiitis findings

A 
ANCA: PR3 ~70% and MPO ~20%
Biopsy:
Skin- leukocytoplastic vasculitis
Kidney- pauci-immune glomerulonephritis 
Lung- granulomatous vasculitis

Increased creatine

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50
Q

GPA treatment

A

High dose corticosteroids
Cyclophosphamide or
Rituximab

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51
Q

Pulmonary embolism findings

A

ECG- prominent S in lead I , Q in lead III and inverted T in lead III (S1Q3T3)

CXR- Hampton hump
Westermark sign

CT scan- wedge shaped, pleural based opacification

CECT- filling defect in the pulmonary artery

Atrial fibrillation and low o2 saturation is bad prognosis

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52
Q

Pneumonia common cause

A

CAP- streptococcus pneumoniae

Hospital acquired- Pseudomonas aeruginosa

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53
Q

Löfgren syndrome

A

Erythema nodosum
Hilar lymphadenopathy
Migratory polyarthralgia
Fever

Seen in sarcoidosis

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54
Q

Sarcoidosis

A 
S/S-
Fever
Dry cough 
Dyspnea 
Fatigue
Weight loss

CXR- hilar lymphadenopathy
Biopsy- non-caseating granulomas

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55
Q

Diamond classification for Acute coronary syndrome

A

For angina

  1. Substernal/left chest pain
  2. Worse on exertion
  3. Relieved by nitroglycerin

3/3- Typical angina
2/3- Atypical angina
0-1/3- not angina

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56
Q

Treatment for Acute Coronary Syndrome

A

MONA BASCH

Morphine
Oxygen
Nitrates
Aspirin 
Beta blockers 
ACE inhibitors 
Statins
Clopidogrel 
Heparin
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57
Q

Treatment of choice for heart failure

A

2D ECHO

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58
Q

Treatment for heart failure

A 
Base on NYHA classification: (goes on adding)
I- Beta blockers + ACE -inhibitors/ARB
II- Loop diuretics
III- ISDN-hydralazine, spironolactone
IV- Ionotropes(dobutamine, milrinone) 
LV assist device/ transplant

I-III: AICD if EF <35%

If ischemic - aspirin and statin

Limit fluid intake <2L/day
Limit salt intake <2G/day
Smoking cessation

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59
Q

Symptoms of GERD

A

Heartburn
Usually after lying down after eating food
Abdominal or chest pain

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60
Q

CHF treatment

A 
LMNOP
Lasix
Morphine
Nitrates
Oxygen
Position
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61
Q

Murmurs

A

Mitral stenosis- diastolic, with opening snap
aortic regurgitation- diastolic, rumbling
Aortic stenosis- Systolic, Harsh crescendo decrescendo
Mitral regurgitation- systolic, holosystolic, high pitched.

The above murmurs increase on squatting and leg lift.

HOCM- systolic
Mitral Valve prolapse- systolic
These decrease on squatting/leg lift

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62
Q

Pericarditis diagnosis

A

ECG- diffuse ST elevation and depressed PR segment(pathognomonic)
MRI- best test

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63
Q

pericarditis treatment

A

NSAIDs+ colchicine
NSAIDs
Colchicine
Steroids

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64
Q

Becks triad

A

Seen in pericardial tamponade:

  1. JVD
  2. Hypotension
  3. decreased heart sounds
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65
Q

Pericardial effusion treatment

A 
NSAIDs+ colchicine
Pericardial window (if fluid still present)
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66
Q

Pericardial tamponade immediate management

A

Pericardiocentesis

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67
Q

Pericardial effusion/ constrictive pericarditis diagnosis

A

ECHO

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68
Q

Vasovagal syncope Tx

A

Beta blockers

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69
Q

Orthostatic syncope Tx

A

IV fluids

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70
Q

criteria to start statins in pts with cholesterol

A
  1. Vascular disease
  2. LDL> 190
  3. LDL 70-189 + age(>40) + DM
  4. LDL 70-189 + age(>40) + calculated risk ( age, HTN,
    Obesity, smoking)

remember everyone gets statins except LDL <70 and no other disease

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71
Q

Statin side effects

A

Statin-induced myositis: elevated CK

Statin-induced hepatitis: elevated LDH

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72
Q

Drugs that can be used in cholesterol

A

Statins
Fribrates(second-line)

Not really used:
Ezetimibe
Bile acid resins
Niacin

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73
Q

Hypertension Tx

A

Heart failure, CAD- beta blockers(metoprolol, carvedilol,
labetolol), ACE-inhibitors
Stroke- ACE-inhibitors, HCTZ
Kidney disease- ACE-inhibitors (except stage IV)
Diabetes- ACE-i

Lifestyle modifications:
Diet- salt <2.4g/day, DASH diet, potassium
supplementation
Exercise- ~30min/day (2hr/week)
Weight loss- if overweight/obese (BMI >25)

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74
Q

Dilated cardiomyopathy S/S

A

S/S of systolic CHF-
orthopnea, OND, dyspnea on exertion:
Crackles, pulm edema

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75
Q

Dilated cardiomyopathy Tx

A

Tx of CHF-
Beta bockers, ACE-inhibitors, Loop diuretics

Transplant
Stop alcohol/chemotherapy if thats the cause

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76
Q

Cardiomyopathy Dx

A

ECHO:
dilated chambers- dilated cardiomyopathy
Asymmetric hypertrophy of ventricle- HOCM
Concentric hypertrophy- concentric cardiomyopathy
Restrictive pattern- restrictive cardiomyopathy

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77
Q

HOCM S/S and Tx

A

S/S- young athlete with syncope on exertion/shortness of breath

Tx-
avoid dehydration
Dont get the HR up > no exercise
beta blockers, CCB
remove obstruction:  alcohol ablation/ myomectomy
AICB 
Transplant
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78
Q

Restrictive cardiomyopathy S/S and Tx

A

signs of diastolic CHF

Rx-
Tx diastolic CHF
beta blovkers and CCb
Gentle diuresis
Transplant
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79
Q

general ECG changes in arrhythmia

A

Fast:
narrow QRS- SVT, A fib
wide QRS- Torsades, V Tachycardia

Slow:
Narrow qrs- Sinus bradycardia, 1 degree AV block, 2 degree I, 2 degree II AV block

Wide- 3 degree AV block, Idioventricular rhythm

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80
Q

SVT ECG changes

A

No P waves

HR >150, regular

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81
Q

A fib ECG changes

A 
No P waves
Irregularly irregular
HR <150
Chaotic background
Sawtooth
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82
Q

Torsades de pointes ECG changes

A

Changing amplitude

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83
Q

Ventricular tachycardia ECG changes

A

Monomorphic

Fast rhythm

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84
Q

AV block ECG changes

A

Prolonged PR interval

Dropped beats in 2 degree

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85
Q

ACLS- stable Tx

A

ECG:
fast, wide- Amiodarone
fast, narrow- adenosine
slow- atropine and then beta blockers and ccb

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86
Q

ACLS- unstable Tx

A

ECG:
fast- shock( synchronised cardioversion)
slow- pace

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87
Q

ACLS- no pulse Tx

A

2 mins of CPR> check pulse, rhythm> shock if indicated> repeat

ECG:
V tach/ V fib- shock, epinephrine, amiodarone
PEA, asystole- epinephrine

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88
Q

Cholelithiasis S/S

A

4Fs- Fat, Female, forty, Fertile

Colicky pin in the RUQ- radiates to shoulder ( worse with fatty food)

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89
Q

4Fs- Fat, Female, forty, Fertile

Colicky pin in the RUQ- radiates to shoulder ( worse with fatty food)

A

RUQ USG- gallstones

Rx:
Cholecystectomy( elective )
Ursodeoxycholic acid

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90
Q

Cholecystitis S/s

A

Constatnt RUQ pain
Murphy’s sign positive
Fever, leukocytosis

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91
Q

Cholecystitis Dx and Rx

A

Dx:
RUQ USG- inflammation
HIDA scan

Rx:
NPO
IV fluids
Antibiotics- cipro+MTZ
Cholecystectomy (urgent)
Cholecystostomy -in non surgical candidates)
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92
Q

Choledocolithiasis S/S

A

PAINFUL JAUNDICE
Murphy’s sign +
Fever, leukocytosis

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93
Q

Choledocolithiasis Dx and Rx

A

Dx:
RUQ USG- stones in CBD, obstruction, dialted ducts
MRCP

Rx:
NPO, IV fluids, IV Abx- cipro+MTZ
ERCP (urgent)
Cholecystectmy (electively)

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94
Q

Cholangitis S/s

A 
Charcot's triad/ reynold's pentad:
RUQ pain
Painful jaundice
Fever
Hypotension
Altered mental status
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95
Q

cholangitis management

A

IV fluids, IV abx(cipro+mtz), NPO
ERCP emergently- diagnostic+therapeutic
Cholecystectomy (urgently)

RUQ USG- obstruction

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96
Q

Infetious esophagitis management

A

Candida- fluconazole
HSV- acyclovir
CMV- gancyclovir
If HIV opportunistic inf- add HAART

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97
Q

esophagitis Dx

A

Endoscopy+biopsy

Bx: >15 eosinophils/hpf- eosinophilic esophagitis
In case of caustic esophagitis- to see severity

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98
Q

Achalasia s/s and Dx

A

Pt- knot/ball of food stuck mid-sternum

Dx:
MANOMETRY (contracted LES)
Barium swallow- bird beak appearance
EGD+ Bx- to r/o cancer

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99
Q

Achalasia Tx

A

MYOTOMY
Botulinum - done only in bad surgical candidates
Pneumatic dilatation

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100
Q

Scleroderma s/s

A 
C alcinosis
R eynolds 
E sophageal dysmotility
S clerodactyly
T elangiectasia

Systemic Sclerosis( involving kidnery, heart and lungs)

Relentless GERD

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101
Q

Scleroderma Dx and Tx(for GERD symptoms)

A 
Manometry- (no contractions at LES)
Barium swallow
EGD+ Bx
Serology- CREST- anti-centromere
                SS- anti-scl-70

Tx- PPIs

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102
Q

Diffuse esophageal spasm s/s

A

Symptoms of MI- crushing chest pain, retrosternal, gets better with nitrates and CCB.
(without swallowing)

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103
Q

Diffuse esophageal spasm Dx and Tx

A

Dx:
Manometry- random contractions
Barium swallow- corkscrew esophagus
EGD+Bx

Tx:
CCB -> Nitrates
PPIs

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104
Q

Schatzki’s ring s/s and Dx

A

“steakhouse dysphagia”
Dx:
Barium swallow- narrow lumen
EGD+Bx- to r/o cancer

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105
Q

Schatzki’s ring Tx

A

Lyse the ring during EGD- open it up

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106
Q

Esophageal webs s/s

A

female
Dysphagia
iron def anemia

Webs->cancer

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107
Q

Esophageal webs Dx and Tx

A

Dx:
Barium swallow- webs
EGD+Bx

Tx:
Iron
EGD+Bx- to screen for cancer

esophagectomy if cancer develops

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108
Q

Zenker’s diverticulum s/s

A

HALITOSIS
Older men
Regurgitation of undigested food
Coughs and gags on swallowing

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109
Q

Zenker’s diverticulum Dx and Tx

A

Dx:
Barium swallow- diverticulum
EGD+Bx

Tx:
Surgery

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110
Q

Esophageal stricture s/s

A

Long standing GERD
Progressive dysphagia
Wt loss

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111
Q

Esophageal stricture Dx and Tx

A

Dx:
Barium swallow- symmetric, circumferential narrowing of lumen
EGD+Bx- no cancer

Tx:
PPIs
Dilatation

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112
Q

Esophageal carcinoma s/s

A

Long standing GERD
Progressive dysphagia
Wt loss

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113
Q

Esophageal carcinoma Dx and Tx

A

Dx:
Barium- asymmetric narrowing of lumen
EGD+Bx- cancer

Tx:
Chemo/ radiation
Surgery

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114
Q

GERD s/s

A

Typical-
burning chest pain- worse on lying down/eating spicy food

Atypical-
Hoarseness
Coughing, stridor
NOCTURNAL ASTHMA

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115
Q

GERD Dx

A 
PPI+ lifetsyle mod  for 6 weeks
                    I
      if doesnt work
                    I
  24 hr pH monitoring
EGD+Bx- if alarming symptoms(wt loss) and also to check for Barett's esophagus
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116
Q

GERD Tx

A

PPIs > H2 blockers > liquid antacids
Metaplasia- higher dose of PPIs
Dysplasia- local ablative therapies(RFA, laser, cryo)+ surveillance EGDs

Surgical:
Nissen fundoplication

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117
Q

Peptic ulcer Disease common causes

A 
H. pylori
NSAIDs
Malignancy
Curling ulcers- in burn pts
Cushing ulcers- in raised ICP, steroids, ventilator
Gastrinoma
118
Q

Peptic ulcer Disease s/s

A

Asymptomatic- 70%
Gnawing epigastric pain
Food- worse: gastric ulcer
better: duodenal ulcer

119
Q

Peptic ulcer Disease Dx and Tx

A

EGD+Bx
Multiple, shallow- NSAIDs
Single- H. pylori
Necrotic, heaped margins- cancer

Tx:
Stop smoking, alcohol, NSAIDs
PPIs

120
Q

H. pylori Dx

A 
EGD+Bx-
1. rapid urease test
2. HISTOLOGY
3. Culture
Serology
Urea breath test
Stool antigen
121
Q

H. pylori Tx

A

TRIPLE THERAPY-
Clarithromycin
Amixicillin
PPis

If allergic to penicillin- Metronidazole instead of amoxicillin

122
Q

ZE Syndrome (Gastrinoma) s/s ,Dx and Tx

A

s/s- diarrhea
refractory

Dx:
Big virulent refractory ulcers
Gastrin level >1600- gastrinoma
                           250-1600- secretin stin test
SOMATOSTATIN RECEPTOR SCINTIGRAPHY (SRS)
CT abdomen

Tx- resection

123
Q

Gastroparesis s/s

A

abdominal discomfort
chr. nausea and vomiting
Bloating
Peripheral neuropathy if diabetic

124
Q

Gastroparesis Dx

A

Auscultation- splash heard while moving pt
EMPTYING STUDY
EGD+Bx- to r/o GOO, PUD, cancer

125
Q

Gastroparesis Tx

A 
Prokinetic agents:
 metaclopramide PO
 erythromycin IV -in acute flare
Low-fiber, small-vol diet
Avoid opiates
Blood glucose control
126
Q

Cyclic vomiting syndrome s/s and Tx

A

S/S:
Nausea and vomiting after many weeks of smoking weed
Dx: clinical

Tx: Stop THC
Metaclopramide
Erythromycin

127
Q

Gastric adenocarcinoma s/s

A

Early satiety
Wt loss
Obstructive symptoms

128
Q

Gastric adenocarcinoma Dx and Tx

A

Dx:
EDG+Bx- Signet ring cells
PET CT/ Pan CT

Tx:
resection+ chemo

129
Q

Acute diarrhea- organism/type based on history

A 
ENTEROTOXIC- watery diarrhea
C. diff- recent Abx use
ETEC- traveller's diarrhea
V. cholerae- no boiled water, 3rd world country
S. aureus- potato/eggs kept out for long
B. cereus- reheated rice
giardia- fresh water /camping
Cryptosporidium- a/w AIDS
INVASIVE- bloody diarrhea+fever+leukocytosis+ feca; leukocytes
Shigella- HUS
Salmonella- uncooked eggs/poultry
EHEC- HUS, uncooked meat
Campylobacer- MC
130
Q

C. diff / Abx associated diarrhea s/s

A

recent Abx use
watery diarrhea
smelly

severe:
fever+leukocytosis
megacolon
renal failure

131
Q

C. diff / Abx associated diarrhea Dx

A

Dx:
C. diff NAAT
C. diff toxin
Colonoscopy- pseudomembrane

132
Q

Dx:
C. diff NAAT
C. diff toxin
Colonoscopy- pseudomembrane

A

Only diarrhea:
oral vancomycin
3rd time- oral vanco or oral fidaxomycin
Refractory: fecal transplant

Severe: admit+ oral vanco

Fulminant (^ creat, ^WBC, VERY SICK):
admit+ higher dose oral vanco(PO/PR)+ IV metronidazole

133
Q

Hemolytic Uremic Syndrome s/s

A

^ in children
Bloody diarrhea ( after eating uncooked meat)
^ BUN / creat (renal failure)
Anemia

134
Q

Hemolytic Uremic Syndrome Dx and Tx

A

Dx:
Smear- MAHA+ schistocytes
Shiga-like toxin assay

Tx:
Supportive
Plasma exchange

135
Q

How to calculate Stool osmolar gap

A

Measured Osm (290) - calculated Osm [2*(Na+K)]

<50- secretory diarrhea
>100- osmotic diarrhea

136
Q

How differentiate b/w Secretory,osmotic and inflammatory diarrhea (i/c/o chronic diarrhea)

A

Secretory- No change with NPO, nocturnal symptoms present

Osmotic- ^ fecal osmotic gap, stops with NPO

Inflammatory- fecal RBC, WBC and mucus +

Malabsorptive- fecal fat present

137
Q

Secretory diarrhea + pancreatic mass =

A

VIPoma

138
Q

Secretory diarrhea + liver mass =

A

Carcinoid tumor/syndrome

139
Q

Carcinoid syndrome s/s

A

intermittent diarrhea
flushing
wheezing
Right heart problems

140
Q

Carcinoid syndrome Dx and Tx

A

Dx:
5- HIAA (hydroxyindoleacetic acid) urine test
CT scan- to stage

Tx:
resection

141
Q

Celiac sprue s/s

A 
Gluten allergy
diarrhea
wt loss
bloating
Skin- dermatits herpetiformis
Iron def anemia
Osteoporosis
142
Q

Celiac sprue Dx and Tx

A

Antibodies- ttG (tissue transglutaminase)- 1st test
anti-endomysial Ab
EGD+Bx- flatteing of villi

Tx: Avoid gluten

143
Q

Tropical sprue Dx and Tx

A

Same as celiac sprue but doesn’t get better with avoiding gluten

Tx: Antibiotics- ciprofloxacin followed by TMP/SMZ

144
Q

Whipple’s disease s/s

A 
Malabsorption
Arthitis
ocular findings
neurologic- dememtia, seizures
lymph nodes
145
Q

Whipple’s disease Dx and Tx

A

EGD+Bx-
PAS + macrophages (on light microscopy)
organism seen (on electrn microscopy)

Tx:
TMP-SMZ
Doxycycline

146
Q

Diverticulosis s/s

A 
> 50 yoa
low fiber diet
diet rich in red meat, fat
has constipation for a long time
Mostly asymptomatic

If pain- post-prandial pain in LLQ
relieved by bowel movement

147
Q

Diverticulosis Dx and Tx

A

Dx:
Usually incidental
Colonoscopy
CT scan

Tx:
None if asymptomatic
High fiber diet

148
Q

Diverticular hemorrage s/s and management

A

Painless hematochezia
>50yoa
Immediate Tx- IV fluids, PPI
(all immediate Tx for massice GI bled)

Dx:
Colonoscopy- if bleeding stops
Arteiogram- if bleeding persists -> emboloisation

Tx: Embolisation

149
Q

Constant LLQ pain + tenderness + fever/leukocytosis =

A

Diverticulitis

150
Q

Diverticulitis Dx

A

KUB (upright) to r/o perforation

CT (IV contrast)

151
Q

Diverticulitis Tx

A 
Mild- liquid diet, oral Abx
Severe- NPO, IV Abx
Abscess- NPO, IV Abx, dran
Perforation- NPO, IV Abx, surgery (ex lap)
Refractory (>/= 2 times)- hemicolectomy

Antibiotics:
Cipro + MTZ
Gentamycin/ampicillin + MTZ

152
Q

Colon cancer s/s

A

Asymptomatic screening -> polyp
Iron def anemia
change in caliber of stool / alternating bowel movts

>50 YOA
alcohol/smoking
obesity
processed red meats
IBD, PSC
family history
153
Q

Colon cancer Dx and screening

A

Dx:
Colonoscopy+ Bx
Barium enema = “apple core”- late stage

Screening:
Colonoscopy at age 50 -> every 10 yrs till age 75-85
Sigmoidoscopy + FOBT at 50 -> q5yrs
FOBT g1yr

1 family history- at age 40 -> q5yr
321(HNPCC)- at age 25 -> q1-2yr
FAP- sigmoidoscopy at age 12 - q1yr
previous polyp -> q3-5yr
previous colon cancer-> at 1yr  -> 3yr -> q5yr
154
Q

Familian Adenomatous polyposis s/s and Tx

A

young
Thousands of polyps - by age 20
cancer by 30yoa
death by 40 yoa

Tx:
Prophylactic colectomy

155
Q

Colorectal CA + endometrial CA + ovarian CA

3 family members + 2 generations + 1 premature

A

HNPCC(Hereditary Non-poluposis colorectal cancer) / Lynch synd

156
Q

Brain tumor + colon CA

A

Turcot syndrome

157
Q

colorectal CA + osteomas (or jaw tumor) + soft tissue tumors

A

Gardner syndrome

158
Q

melanotic spots on lips/ skin + small bowel CA

A

Peutz-Jeghers syndrome

  • ^ frequency of breast CA
  • ^ gonadal and pancreatic CA
159
Q

Causes for cirrhosis

A

VW HAPPENS

Viral hep
Wilson's disease
hemochromatosis
alpha 1 -antitrypsin def
PSC
PBC
Ethanol
NASH/NAFLD
Somethin else
160
Q

Hep A Dx

A

IgM for Hep A- infected

IgG- immune

161
Q

Hep B Dx and Tx

A 
HBsAg- infected
HBeAg- infectious
IgM-HBsAg- early infection
IgG- HBsAg- immune
IgG-HBcAg- immunity through eposure

Tx:
no specific Tx
always only ONE drug is given

162
Q

Hep C Dx

A

Hep C PCR RNA viral load

Ab + HCV RNA+ = infected
Ab - HCV RNA+ = acute
Ab+ HCV RNA- = treated

163
Q

Hep C Tx

A

Tx:

Protease inhibitors- Boceprevir, sofosbuvir, etc

164
Q

Wilsons disease s/s

A

Liver cirrhosis
hepatic insufficiency
CNS symptoms- chorea, psychosis, ataxia etc
Eyes- KF rings

165
Q

Wilsons disease Dx and Tx

A

S. ceruloplasmin
LIVER BIOPSY
Slit-lamp exam- KF rings
Urine copper following Pencillamine administration

Tx:
PENICILLAMINE
Zinc
Trientine
Transplant
166
Q

Hemochromatosis s/s

A 
Bronze diabetes (pigmented skin + diabetes)
Fatigue, joint pain
Erectile dysfunction
Amenorrhea 
Cardiomyopathy
167
Q

Hemochromatosis Dx

A 
S. FERRITIN  >1000
S. Iron
LIVER BIOPSY
Transferrin >50%
ECHO- dilated and restricted cardiomyopathy
168
Q

Hemochromatosis Tx

A

PHLEBOTOMY

Deferoxamine

169
Q

Young adult + COPD (emphysema) + cirrhosis

A

alpha 1- antitrypsin deficiency

170
Q

alpha 1- antitrypsin deficiency Dx and Tx

A

Dx:
Biopsy- PAS + macrophages
Family h/o COPD at early age

Tx:
Enzyme replacement
Liver transplant

171
Q

Male + pruritis + jaundice + 30-50yoa

+ IBD

A

Primary Sclerosing Cholangitis

172
Q

Female + pruritis + jaundice + 30-50yoa

A

Primary Biliary Cirrhosis

173
Q

Primary Sclerosing Cholangitis Dx and Tx

A

Dx:
Alk Phos, GGTP and bilirubin - elevated
MRCP- strictures/narrowing/beading of biliary system

Tx:
Ursodeoxycholic acid
Transplant

174
Q

Primary Biliary Cirrhosis Dx and Tx

A

Elevated alk phos but normal bilirubin
LIVER BIOPSY
Anti-mitochondrial Ab

Tx:
Ursodeoxycholic acid
Transplant

175
Q

LFT:

AST&raquo_space; ALT

A

Alcoholic Liver diasease

or any other drug related liver disease

176
Q

LFT:

ALT&raquo_space; AST

A

Viral hepatitis

177
Q

Non-alcoholic + Biopsy (microvesicular fatty deposits) + mildly abnormal LFT

A

NASH / NAFLD

178
Q

Liver disease + confused + altered mental status + asterexix

A

hepatic encephalopathy

179
Q

hepatic encephalopathy Dx and Tx

A

Dx: clinical
NOT ammonia level

Tx: Lactulose
Rifaximin
Zinc

180
Q

Varices s/s and management

A

s/s:
hematemesis or melena

Dx:
NG tube
Endoscopy -> banding

Tx:
banding 
Octreotide
Antibiotics
Propanolol/nadolol
TIPS
Balloon tamponade
181
Q

Ascitis Dx

A

Paracentesis -> SAAG and Biopsy

SAAG >1.1 : Portal HTN, cirrhosis, CHF, Hepatic vein thrombosis, Constrictive pericarditis

SAAG <1.1: Infection, cancer, nephrotic synd

182
Q

Ascitis Tx

A

Furosemide + spironolactone
limit salt & water intake
paracentesis

183
Q

Spontaneous Bacterial Peritonitis Dx

A

neutrophil count >250 -> immediate Tx

Culture (dont wait for report)

184
Q

Spontaneous Bacterial Peritonitis Tx

A

Ceftriaxone / cefotaxime

Prophylaxis- norfloxacin or TMP/SMZ

185
Q

HCC Dx and Tx

A

screen- RUQ USG
AFP
Triple phase CT (confirmatory)

Tx:
Resection -if small
Transplant -if big
Radiofrequency ablation - if multiple/ too big
Chemo embolization
186
Q

GI bleed immediate management

A 
Stabilize:
2 large bore IV
IV fluids
IV PPIs
Type+cross
Call GI

Octreotide + ceftriaxone - if cirrhotic

187
Q

hemetemesis following vomiting a lot all of a sudden

eg: weekend alcohol drinking

A

Mallory-Weiss tear

Tx: self limiting

188
Q

Hemetemesis in pt who vomits often (alcoholics/ bullemia)

A

Booerhav syndrome

189
Q

Booerhav syndrome Dx and Tx

A 
Pt: febrile, dyspnia
Auscultation- crunch in chest
Dx:
Gastrograffin swallow
CXR- air in mediastinum
EGD

Tx: Surgery

190
Q

Dieulafoy’s lesion

A

Pt: Brisk painless GI bleed

Dx: EGD

Tx: resect

191
Q

Hemorrhoids S/S

A

Internal: Bleeds, no pain
External: Pain, does not bleed

Blood will be on toilet paper

192
Q

Hemorrhoids dx and Tx

A

Dx: clinical

Tx: Sitz bath
Hemorrhoidectomy

193
Q

Mesenteric ischemia s/s

A

Pain out of proportion to physical exam
H/o pain while eating -> decreased eating -> wt loss
Might have Afib( embolisation)

194
Q

Mesenteric ischemia Dx and Tx

A

Dx:
Angiogram
Colonoscopy

Tx:
Resect
Revascularisation

195
Q

Ischemic colitis s/s

A

Hypotensive

Painfull hematochezia

196
Q

Ischemic colitis Dx and Tx

A

Dx:
Colonoscopy = dead tissue

Tx: Supportive

197
Q

Pancreatitis causes

A

I GET SMASHED

Idiopathic
Gallstones
Ethanol
Trauma
S
M
Autoimmune
Scorpion sting
Hypertriglyceridemia, hypercholesterolemia
ERCP
Drugs
198
Q

Pancreatitis s/s

A

Epigastric pain - radiates to back(positional)
nausea/vomiting
anorexia

O/E:
Tenderness +
Grey Turner sign- flank discoloration
Cullen sign- umbilical discoloration

199
Q

Pancreatitis dx

A

S. LIPASE >3xULN
S. Amylase (amylase-P)
CT SCAN

Prognosis- BUN

200
Q

Pancreatitis Tx

A 
NPO
IV fluids
Analgesics
Refeeding on demand
ERCP - if due to gallstones
201
Q

Pancreatitis complications

A 
Early:
ARDS
Hypocalcemia (means calciponification)
Pleural effusion
Ascites

Mid:
SIRS

late:
Abscess
Pseudocyst

202
Q

Ulcerative colitis s/s

A 
Bloody diarrhea (sudden onset)
20-30yoa

Extraintestinal- PSC, p-ANCA

203
Q

Ulcerative colitis Dx

A

EGD: continuous lesions from the rectum
(stays within the colon)

Bx: only superficial layer
crypt abscesses

204
Q

Ulcerative colitis Tx

A

Colectomy

screening for colon CA- at 8th year -> q1yr

205
Q

Crohn’s disease s/s

A

20-30yoa or 50-75yoa
Watery diarrhea (insidious)
Wt. loss

Extraintestinal- fistulas

206
Q

Crohn’s disease Dx and Tx

A

EGD- skip lesions
anywhere in GI tract

Bx- transmural
non-caseating granulomas

Tx: Sx only for complications

207
Q

IBD Tx

A

Mild: 5-ASA compounds- mesalamine

Mod: Immune modulators- azathioprine, 6-mercaptopurine, MTX

Severe: CD- TNF-inhibitors: infliximab
UC- Surgical resection

Flares- STEROIDS
Abx- Cipro / MTZ

If perianal disease- drain

208
Q

Prehepatic jaundice Dx and causes

A

^ Unconjugated (indirect) bilirubin (fat-soluble, crosses BBB)
Urine is not dark

causes:
hemolysis
hematoma

209
Q

Posthepatic jaundice Dx and causes

A

^ Conjugated (direct) bilirubin (does not cross BBB)
DARK URINE

Causes: OBSTRUCTION
Painfull- gallstones
Painless- Stricture, cancer, PSC, PBC.

210
Q

Intrahepatic jaundice Dx and causes

A

If ^unconjugated B= Criggler-Najjar synd, Bilberts synd.
If ^conjugated B= Dubin-Johnson synd, Rotors.

If mixed- Hepatits, Cirrhosis

211
Q

Types of stroke

A

Ichemic-
Thrombotic - brain distal to the vessel dies
Embolic
Hemorrhagic- intracerebral / subarachanoid h.

212
Q

Focal neurological deficits + Scenarios-

1. Vasculopathies (HTN, DM, smoking, etc)
2. Young girl with neck pain following trauma.
3. Afib/ prosthetic valve (not on anticoagulation)
    4. Thunderclap headache
A

Ichemic stroke

213
Q

Management of Ichemic stroke

A 
tPA
Non-contrast CT head
ECG - Afib/Aflutter- Warfarin, NOAC
ECHO- Thrombus -  Anticoagulation - 
             Warfarin, NOAC
Carotid duplex USG- Carotid artery stenosis
     >70%-CEA, stenting
214
Q

Ischemic stroke Tx

A

Supportive-> airway, O2, IV fluids.

Acute phase-
<3hrs (<4.5hrs if non diabetic)- tPA
ASA 325 mg
DM- controlled but not too low
Permissive HTN (220/120)
Chronic phase-
If on prophylaxis for DVT, etc - Heparin
If Afib/ prosthetic valve - anticoagluation
ASA 81 + dipyridamole  (or)
Clopidogrel
High potent statins
HbA1c <8% 
HTN- ACE-i, diuretics
215
Q

TIA s/s

A

Ipsilateral blindness (amaurosis fugax) - “shade pulled over one eye.”
Unilateral hemiplegia
Hemiparesis
weakness or clumsiness that lasts less than 5 minutes.

216
Q

TIA Dx and Tx

A

Carotid duplex scan -to look for carotid stenosis.

Tx:
Aspirin and antiplatelet medications.
Carotid endarterectomy- if the degree of carotid stenosis is 70% to 99%.

217
Q

Types of seizures

A
  • Simple partial
    • Complex partial
    • Tonic-clonic
    • Absent
    • Febrile
      • Secondary
218
Q

Causes of seizures

A

VITAMINS
Vascular
Infection (meningitis, encephalitis, toxoplasmosis, cysticercosis)
Trauma
Autoimmune
Metabolic (hypoglycemia, hypoxia, phenylketonuria, hyponatremia)
Ingestion/wIthdrawal (lead, cocaine, carbon monoxide poisoning)/ (alcohol, barbiturates, benzodiazepines, withdrawing anticonvulsants toorapidly)
Neoplasm
pSych/ Stroke

219
Q

seizures s/s

A

LOC
Jerking
Tongue biting
Post-ictal state

220
Q

Status epilepticus management

A 
ABCs (airway,breathing,circulation)
Roll the patient on his or her side to prevent aspiration.
Benzo (Lorazepam/ diazepam) IV
Fosphenytoin
Phenobarbital
Midazolam
Propofol
221
Q

Antiepileptic drugs:

A 
Valproate
Lamotrigine
Levetiracetam
Carbamazepine
Ethosuximide
222
Q

Atonic epilepsy Dx & Tx

A

no LOC, loss of tone +

Tx- Valproate

223
Q

Myoclonic epilepsy Dx & Tx

A

no LOC, uneccessary tone +

Tx- Valproate

224
Q

Absence epilepsy Dx & Tx

A

Brief (10–30 seconds in duration) generalizedseizures
Loss of consciousness, often with eye or muscle fluttering.
No postictal state

Tx- Ethosuximide

225
Q

Simple partial (also presents as trigeminal neuralgia) s/s

A

(local or focal)seizures-

  • may be motor (e.g., Jacksonian march) or sensory (e.g., hallucinations),
  • psychic (cognitive or affective symptoms).
  • Consciousness isnotimpaired.
226
Q

Simple partial Tx

A

Carbamazepine
lamotrigine
oxcarbazepine
levetiracetam

227
Q

Complex partial (psychomotor)seizures S/s

A

Any simple partial seizure followed by impairment of consciousness.

228
Q

Complex partial (psychomotor)seizures Tx

A

Valproate
lamotrigine
levetiracetam.

229
Q

Tonic-clonic (grand mal)seizuress/s

A
  • Associated with an aura.
  • Tonic muscle contraction is followed by clonic contractions.
  • Usually lasting 2–5 minutes.
  • Associated symptoms may include incontinence and tongue lacerations.
  • Postictal state
230
Q

Postictal state

A

Characterized by drowsiness, confusion, headache, and muscle soreness.

231
Q

Tonic-clonic (grand mal)seizures Tx

A

Valproate
lamotrigine
levetiracetam

232
Q

Febrile seizure s/s

A
  • Children between the ages of 6 months and 5 years may have a seizure caused by fever.
  • Always assume another cause outside this age range.
  • Usually of the tonic-clonic, generalized type.
233
Q

Febrile seizure Tx

A

No specific seizure treatment is required, but you should treat the underlying cause of the fever
Acetaminophen to reduce fever.

234
Q

Parkinsons disease S/s

A

Usually above age 60.
Classic tetrad.
1. Bradykinesia + mask like facies
(hypomimia)
2. Cog-wheel / Lead-pipe deformity
3. Abnormal gait- shuffling gait and festinant
4. Resting tremors ( pill-rolling tremors) which improves with movement

Micrographia
Postural instability due to orthostatic hypotension
May have dementia or depression also.

235
Q

Parkinsons disease Dx and Tx

A 
If >70 and loss of function -
LEVODOPA + CARBADOPA
MAO-B inhibitors : selegiline, rasagiline
COMT inhibitors: entacapone, tolcapone
Deep brain stimulation

If <70 yr and no loss of function -
Dopamine agonists: Ropinirole, Pramipexole - Anticholinergics - benztropine, trihexyphenidyl
- Amantadine

236
Q

parkinsonism + dementia

A

Lewy body dementia

237
Q

parkinsonism + orthostasis

A

Shy-Drager synd

238
Q

Essential tremors s/s

A

↑ in males.
40- 60 yoa
Family history present
Tremor not present at rest -> begins when tries to move

239
Q

Essential tremor Dx and Tx

A

Dx: clinical

Tx: Propanolol

240
Q

Intention tremors s/s

A

Pt:
No tremor at rest
Tremor increases in amplitude as he goes closer to the target.

241
Q

Intention tremors Dx and Tx

A

Dx: clinical
CT/MRI brain

Tx: None

242
Q

Huntington’s chorea s/s

A

Involuntary
Ballistic movements
Purposeless movts
Starts with fidgetiness or restlessness progressing to dystonic postural, rigidity and akinesia.

Psychiatric- psychosis, depression, dementia, etc
Most of them commit suicide.

243
Q

Huntington’s chorea Dx and Tx

A

Dx: Genetic analysis- CAG trinucleotide repeat sequences + the triad ( movement / memory / mood)

Tx: No specific tx.
Tetrabenazine - for dyskinesia
Haloperidol, quetiapine- for psychosis.

244
Q

Restless leg syndrome s/s

A

Uncomfortable sensation in the legs - “creepy and crawly “ at night.
Worsened by caffeine
Relieved by moving the legs.
Can even happen during sleep.

245
Q

Restless leg syndrome Dx and Tx

A

Dx: clinical

Tx: Dopamine agonists - pramipexole.

246
Q

Tourette disorder s/s

A

Vocal tics, grunts, coprolalia
Motor tics ( sniffing, blinking, frowning)
OCD

247
Q

Tourette disorder Tx

A 
Tx:  Fluphenazine
	Clonazepam
	Pimozide
	Methylphenidate
        ADHD tx.
248
Q

Causes for parkinsons disease

A
  • Repeated head trauma from boxing
  • use of antipsychotics (thorazine)
  • Encephalitis
  • Reserpine
  • metoclopramide
249
Q

Tension Headache

A

Pt:
Usually bilateral
Front radiating to the neck
Vice-like pain

Dx: clinical

Tx: NSAIDs

250
Q

Analgesic rebound

A

Path: Withdrawal of analgesics (opiates, tryptans, etc)

Pt: Takes analgesics >10 times/ month -> stops -> headache

Dx: clinical

Tx: Withdrawal

251
Q

Cluster headache s/s

A

Asymptomatic for a long time/ months
Suddenly develops headache which comes in clusters (8-10 times/ day or >3 times/ week)
severe, and tender
Unilateral eye pain, red eye.
A/w Horner’s synd - lacrimation, rhinorrhea, lip sagging, nasal congestion, etc

252
Q

Cluster headache Dx and Tx

A

Dx: Clinical

Tx: Supplemental oxygen
Triptans (Sumatriptan)
Prophylaxis- CCB- Verapamil, Prednisone, valproate.

253
Q

Migraine s/s

A

Ages of 10 and 30 years.
Unilateral pulsatile headache
Debilitating - photophobia, phonophobia, nausea/vomiting
Aura
Trigger (which they usually know and avoid it)
Lasts for 4-72 hrs
Sleep -> aborts -> hangover

254
Q

Migraine Dx and Tx

A

Dx: Clinical

Tx:   Mild- NSAIDs
	Mod- severe - Triptans
			     Ergotamine
			     Antiemetics
Prophylaxis- Propanolol , Valproate, Topiramate
255
Q

Idiopathic intracranial hypertension (IIH)/ Pseudotumor cerebri S/S

A

Young females, obese
Headaches frequently
Symptoms of raised ICP- Nausea/vomiting, papilloedema
FND
Worrisome sequela is vision loss, diplopia

256
Q

Idiopathic intracranial hypertension (IIH)/ Pseudotumor cerebri Dx

A

Dx:
CT brain - shows nothing
Lumbar puncture- Opening press. >25cm of H2O and relief

257
Q

Idiopathic intracranial hypertension (IIH)/ Pseudotumor cerebri Tx

A 
Acetazolamide
  Wt loss
  Repeated LP
  CSF shunt/ VP (ventriculoperitoneal) shunt
  Fenestration of optic nerve
258
Q

Giant cell (temporal) arteritis s/s

A

Tenderness of the temporal area
Unilateral vision loss/ disturbance
Systemic symptoms- fatigue, muscle pain and weakness.
Jaw claudication

259
Q

Giant cell (temporal) arteritis Dx and Tx

A

Dx: Biopsy
ESR- markedly elevated

Tx: Steroids- prednisone

260
Q

Postherpetic neuralgia Tx

A
  • TCA, gabapentin, pregabalin, carbamazepine or phenytoin.
  • Acyclovir, famicyclovir, or valgancyclovir may reduce its incidence.

Prevention of Herpes zoster- Zoster vaccine to all people >60yoA.

261
Q

Extracranial causes of headache

A

• Eye pain (optic neuritis, eyestrain from refractive errors, iritis, glaucoma)
• Middle ear pain (otitis media, mastoiditis)
• Sinus pain (sinusitis)
• Oral cavity pain (toothache)
• Herpes zoster infection with cranial nerve involvement
Nonspecific headache (e.g., malaise from any illness)

262
Q

Disc Herniation s/s

A

older men
Heavy lifting
Sciatica
SLR test +

263
Q

Disc Herniation Dx and Tx

A

Dx: X-ray
MRI

Tx: Sx > conservative management if < 6 months
Sx = conservative management >1yr.

264
Q

Osteophytes s/s

A

older man
No heavy lifting
Sciatica +
SLR test +

265
Q

Osteophytes Dx and Tx

A

Dx: X-ray
MRI

Tx: Surgery

266
Q

Compression fracture spine s/s

A

older women
h/o fall on coccyx
Pin-point tenderness +
Vertebral step-off +

267
Q

Compression fracture spine Dx and Tx

A

Dx: x-ray / MRI
Dexa scan

Tx: Surgery
Tx for osteoporosis

268
Q

Spinal stenosis s/s, Dx and Tx

A

Pt: >50yoa
Pseudoclaudication - positional (present only while straight and walking)- In butt and thighs

Dx: x-ray
MRI

Tx: Laminectomy

269
Q

Delirium

A

Acute, dramatic

Reversible

Global memory impairment

Causes: illness(sepsis), intoxication, etc

Attention- poor

Arousal- fluctuates

270
Q

Dementia

A

Chronic, insidious

Usually irreversible

Remote memory impairment

Causes: Alzheimer’s, multi-infarct stroke

Attention- unaffected

Arousal-normal

271
Q

Reversible causes for dementia and Dx

A 
TSH, T4 - hypothyroidism
										Creat , BUN- kidney
										LFTs - cirrhosis
										Vit B12 deficiency- B12 level , methylmalonic acid level.
										RPR / VDRL- neurosyphilis

Depression screening (pseudodementia)

272
Q

Alzheimer’s disease Path and s/s

A

Path: Plaques + tangles
Chromosome 21 association

Pt: memory impairment (recent)
Social distancing
Might be a downs synd pt.
Personality changes later

273
Q

Alzheimer’s disease Dx and Tx

A

Dx: clinical
CT - diffuse atrophy

Tx:    Supportive
	Family education
	Mild- Ach-E inhibitors - donepezil, 
rivastigmine, galantamine, tacrine
        Severe-  memantine
274
Q

Pich’s disease ( Frontotemporal degeneration ) s/s

A 
Personality changes (emotional and social appropriateness lost)
Memory retains ( but later deteriorates)
Loss of filter
275
Q

Pich’s disease ( Frontotemporal degeneration ) Dx and Tx

A

Dx: clinical
CT - Frontotemporal degeneration

Tx: Supportive
  Ach meds.
276
Q

Lewy-Body dementia s/s

A

Parkinsonian symptoms

VISUAL HALLUSINATIONS

277
Q

Lewy-Body dementia Dx and Tx

A

Dx: clinical
MRI- loss in substantia nigra

Tx: supportive
Levodopa/carbidopa

278
Q

Vascular dementia

A

Pt: Stepwise decline with each stroke

Dx: CT- multiple infarcts
Clinical

Tx: supportive

279
Q

Creutzfeldt-Jakob Disease (CJD) s/s

A 
Undercooked meat
Sporadic mutation
Young (30-40)
Rapidly progressive dementia
MYOCLONUS
280
Q

Creutzfeldt-Jakob Disease (CJD) Dx and Tx

A

Dx: MRI/CT - normal
CSF protein : 14-3-3
Biopsy

Tx: supportive

281
Q

NPH ( normal press hydrocephalus) s/s

A

Wet - urinary incontinence
Wobbly - gait ataxia
Weird- dementia

282
Q

NPH ( normal press hydrocephalus) Dx and Rx

A

Dx: CT- hydrocephalus
Lumbar puncture - improvement

Tx: VP shunt

283
Q

Posterior fossa insults causes

A

MS, tumor, stroke
Abscess
Seizures
Migraines

284
Q

Posterior fossa insults s/s and Dx

A

FND- cerebellar signs
Vertigo
No ear s/s

Dx: MRI

285
Q

BPPV ( Benign paroxysmal positional vertigo)

s/s

A

Recurrent
Reproducible
Lasts for <1min

286
Q

BPPV ( Benign paroxysmal positional vertigo) Dx and Tx

A

Dx: Dix-Hallpike manoeuvre - nystagmus

Tx: Epley manoeuvre

287
Q

Vastibular Neuritis s/s

A

h/o URI 4 weeks back
Vertigo lasting 1-10mins
Hearing loss +/-
Nausea / vomiting +

288
Q

Vastibular Neuritis Dx and Tx

A

Dx: clinical

Tx: Steroids (acutely)
Meclizine (long-term)

289
Q

Meniere’s disease s/s

A

Triad - Vertigo
Tinnitus
Hearing loss
Lasts for >30 mins but < 1hr

290
Q

Meniere’s disease Dx and Tx

A

Dx: clinical

Tx: Salt restriction
Thiazide diuretics
Anti-vertigo meds (Meclizine)

291
Q

Most common causes of syncope

A
  • Vasovagalsyncope(most common)- classically seen after stress or fear.
  • Arrhythmias
  • Orthostatic hypotension
  • Hypoglycemia

Step 2 CK (1 decks)

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