Misc Flashcards
Most effective drug for allergic rhinitis
intranasal steroids
Tx for peritonsillar abscess
amp/sulbactam
dacroadenitis:
lacrimal gland (above)
dacrocystitis:
nasolacrimal gland (below)
RF for retinal detachment
myopia, cataracts
+ sign seen with retinal detachment
Shafer’s sign
Shafer’s sign
clumping of brown colored pigment cells in the anterior vitreous humor resembling tobacco dust
When can you patch a corneal abrasion?
if >5 mm, but not more than 24 hours and not in contact wearers
pH of eye?
7.0-7.3
Pre-septal cellulitus tx
amoxicillin
Orbital cellulitis tx
vanco
What drop is ok in a TM perforation?
ofloxacin
placenta over os
placenta previa
sudden painless bleeding in pregnancy
placenta previa
adherent placenta
placenta accreta
Premature separation of placenta
placental abruption
dark 3rd trimester bleeding; severe pain
placental abruption
MCC of placental abruption
maternal HTN
fetal vessels transverse the fetal membrane over cervical os
vasa previa
abortion: termination <
20 weeks
Abortion is MC in the ?
7th week
MCC of 1st trimester bleeding
threatened abortion
Cervical os closed; bloody vaginal d/c
threatened
cervical dilation > 3 cm; bleeding
inevitable abortion
some POC expelled, some retained; heavy bleeding/cramping/boggy uterus
incomplete abortion
all POC expelled; cervical OS closed
complete
fetal demise but remains in uterus >6 weeks
missed
Only potentially salvageable abortion?
threatened
Dysfunctional uterine bleeding in premenopausal women is likely d/t?
anovluation
Dysfunctional uterine bleeding in perimenopausal women is likely d/t ?
consider hyperplasia/carcinoma
Acute severe vaginal bleeding?
high dose IV estrogen or high dose OCPs; D&C if estrogen fails
Primary dysmenorrhea is due to increase in?
prostaglandins
MCC of secondary dysmenorrhea in young
endometriosis
MCC of secondary dysmenorrhea in older
adenomyosis
Tx of dysmneorrhea
NSAIDS; vitamin E
Herniated disc MC @
L5-S1
Sciatica:
back pain radiating to thigh/buttock –> lower leg (below knee)
Pain: L4
anterior thigh
Pain: L5
lateral thigh, hip/groin
Pain: S1
posterior leg/calf, gluteus
Sensory loss: L4
median ankle
Sensory loss: L5
dorsum foot (between 1-2 toes)
Sensory loss: S1
plantar foot
Weakness: L4
ankle dorsiflexion
Weakness: L5
big toe extension; walking on heels difficult
Weakness: S1
plantar flexion; walking on toes difficult
Reflex diminished: L4
knee jerk; weak knee extension
Reflex diminished: L5
normal
Reflex diminished: S1
loss of ankle jerk
Tx cauda equina:
neurosurgery and corticosteroids
Spinal stenosis is worse with?
extension (prolonged standing/walking)
Spinal stenosis is better wtih?
flexion (sitting/walking uphill)
Spinal stenosis tx:
lumbar epidural injection of corticosteroids
Gout is MC d/t
under excretion of uric acid
Which ARB does not cause gout?
Losartan
What HTN meds increase risk of gout?
ARB/diuretics/ACE
CXR gout:
mouse-bite or punched out erosions
only drug used in acute and chronic gout?
colchicine
MC site of pseudogout
knee
Tx of pseudogout
intraarticular steroids (1st), NSAIDs, colchicine (chronic: colchicine)
Tietze syndrome
localized palpable edema, heat, and erythema –> MC at 2nd and 3rd costochondral junctions
85% of ankle sprains involve?
collateral ligaments
MC ligament impacted by ankle sprain?
anterior talofibular
Main stabilizer during ankle inversion?
ATFL
injured with ankle eversion?
deltoid
Bell Palsy is a CN?
VII (7)/facial palsy
What virus has a strong association with Bell Palsy?
herpes simplex virus
Bell Palsy is MC on which side?
right
Bell palsy progression?
sudden onset of painless ear pain 24-48 hours –> unilateral facial paralysis (unable to wrinkle forehead), loss of nasolabial fold, decreased lacrimation
Bell phenomenon?
eye on affected side moves laterally and superiorly when eye closure attempted
Trigeminal neuralgia tx:
carbamazepine (tegretol)
cluster prophylaxis
verapamil
essential tremor inheritance
AD
What type of tremor is an essential tremor?
intentional
Essential tremor MC location?
UE and head
What tremor is relieved with alcohol?
essential tremor
Parkinson’s is d/t
dopamine depletion; failure to inhibit acetylcholine in basal ganglia
What type of tremor is assoc with Parkinson’s?
resting tremor (“pill rolling”); worse at rest
Gait associated with Parkinson’s?
shuffling gait; festination (increased speeding with walking)
Myerson’s sign
tapping bridge of nose repetitively causes sustained blink in Parkinson’s
Tx of Parkinson’s
Levodopa/carbidopa
Seizure assoc with bilateral symmetric 3 Hz spike
absence
Tx of absence seizures
1st line: ethosuximide
2nd line: valproic acid
Tonic =
rigid
clonic =
jerking
HIV conditions requiring abx, treat with?
bactrim
HCM treated with?
BB
“drop attack” seizures
atonic
Status epilepticus treatment
1) BZD (lorazepam, diazepam)
2) add AED if refractory to BZD (phenytoin)
3) Phenobarbitol
+ thiamine, followed by dextore if hypoglycemia
amaurosis fugax is associated with TIA of?
iCA
Initial test for TIA
CT
Scoring system for TIA?
ABCD2
ABCD2 for TIA
Age 60+ (+1)
BP >140/90 (+1)
Clinical features
Unilateral weakness (+2)
Speech disturbances w/o weakness (+1)
Other symptoms (0)
Duration
<10 minutes: 0
10-59 minutes: +1
60+: + 2
History of DM (+1)ABCD2 for TIA scoring
0-3: low risk
4-5: mod risk
6-7: high risk
Tx of TIA
ASA +/- dipyridamole or clopidogrel
Eczema treatment (alt to steroids)
calcineurin inhibitors (tacrolimus) is an alternative to steroids (no skin breakdown)
Tacrolimus assoc with
lymphoma/skin cancer
Hypersensitivity reaction: I
IgE mediated
Hypersensitivity reaction: II
cytotoxic, Ab-mediated
Hypersensitivity reaction: III
immune antibody-antigen complex
Hypersensitivity reaction: IV
delayed, cell mediated
Hypersensitivity reaction: urticaria
I
Hypersensitivity reaction: angioedema
I
Hypersensitivity reaction: bullous pemphigoid
II
Hypersensitivity reaction: drug mediated vasculitis
III
Hypersensitivity reaction: morbilliform
IV
Hypersensitivity reaction: EM
IV
MC drug reaction
morbilliform
EM is MC associated with
herpes simplex
Scabies TOC
permetherine from neck to soles for 8-14 hours before showering, repeat 1 week
Lindane SE
seizures, if after shower
Alt option for scabies tx for infants and pregnant women
sulfur in petroleum jelly
Spider bite associated with local burning/erythema/hemorrhagic bullae?
brown recluse
spider biter associated with muscle pains, spasms, rigidity?
black widow
Primary Adrenal insufficiency
Addison’s, adrenal gland destruction
MCC of primary adrenal insufficiency in industralized countries
AI
MCC of primary adrenal insufficiency worldwide
infection
Secondary Adrenal Insufficiency
primary failure of ACTH secretion
MCC of secondary adrenal insufficiency
stopping exogenous steroid use
Adrenal insufficiency pathway
Hypothalamus (CRH) –> anterior pituitary (ACTH) –> adrenal cortex (cortisol)
Tertiary adrenal insufficiency
hypopituitarisim
Labs associated with adrenal insufficiency
hyponatremia, hypotension, hypoglycemia
High dose acth stimulation test: addisons
little or no increase in cortisol (<20)
CRH stimulation test: primary
increased ACTH, but low cortisol
CRH stimulation test: secondary (pituitary)
low ACTH, low cortisol
CRH stimulation test: tertiary (hypothalamus)
exaggerated ACTH response
Tx for addrenal insufficiency:
Addisons: glucocorticoids (hydrocortisone) and mineralocorticoids (fludrocortisone)
Secondary: only glucocorticoids
First line depression tx:
psychotherapy
second line depression meds
1st: SSRI
2nd: bupropion, mirtazipine
Name some SSRIs:
citalopram, escitalopram, paroxetine, fluoxetine, sertraline, fluoxamine
What SSRI is avoided in long QT syndrome?
Citalopram
SSRIs inhibit?
CNS uptake of serotonin
Name some SNRIs:
venlafaxine, desvenlafaxine, duloxetine
SNRIs inhibit?
serotonin, norepinephrine, and dopamine uptake
AIDS: CD4 count
200
HIV testing:
ELISA + –> confirm with western blot
Which type of influenza is most likely to cause a pandemic?
Influenza A
Antivirals for flu within?
48 hours
Kernig’s:
inability to straighten knee with hip flexion
CSF for acute bacterial meningitis:
100-10,000 PMN
decreased glucose <45
Increased total protein
Increased CSF pressure
Post-exposure for meningitis
cipro 500 mg po x 1
1 mo -18 yo MC bacterial meningitiis
n. meningitidis
1 mo -18 yo bacterial meningitiis tx
ceftriaxone + vanco
18 yo- 50 ys MC bacterial meningitis
s. pneumo
18 yo -50 ys bacterial meningitis tx
ceftriaxone + vanco
> 50 bacterial meningitis tx
ampicillin + ceftriaxone +/- vanco
MC viral meningitis
enterovirus (echo, coxsackie)
MRI for viral meningitis
diffuse enhancement of the meningies
frontal or temporal enhancement with HSV-1
MC valvular disease
Aortic stenosis
MC congenital cause of aortic stenosis
bicuspid AoV
aortic stenosis becomes symptomatic when AoV
1 cm
MC symptom of aortic stenosis
Dyspnea
Aortic stenosis complications
Angina, syncope, CHF
Where does aortic stenosis radiate to?
carotids
definitive test for aortic stenosis?
cardiac cath
Tx for aortic stenosis?
replacement
Where does aortic regurgitation radiate to?
left sternal border
What murmur can be associated wtih AR?
Austin-Flint: mid-late diastolic rumble at apex secondary to retrograde regurgitant jet competing with antegrade flow from LA into ventricles
Wide pulse pressure signs seen in?
Chronic AR/AI
Sift upstroke and rapid fall of radial pulse accentuated with wrist elevation
water hammer
Like WHP but specific to cartoid
Corrigan’s
Popliteal artery systolic > brachial artery by 60 mmHg
Hill’s sign
Most sensitive sign for chronic AR/AI?
Hill’s sign
Gradual pressure over femoral –> systolic and diastolic bruits
Durozeiz sign
Double sound heard at femoral artery with compression of femoral
Traube’s sound
head bobbing with heart beat
De musset
Visible systolic pulsations of uvula
Muller’s
Visible fingerbed pulsations with light compression of nailbed
Quinckes
Double pulse carotid upstroke
Pulses bisferiens (combined AR, AS)
Mitral stenosis MC d/t
rheumatic heart disease
Mitral stenosis AKA
fish mouth valve
MC symptom of Mitral stenosis
dyspnea
Valve disorder associated with ruddy (flushed) cheeks with facial pallor
mitral stenosis
Opening snap with
mitral stenosis
Tx of mitral stenosis?
percuatenous valvuloplasty/valvotomy
MCC of mitral regurgitation?
MVP
MR radiates to?
axilla
Tx of MR?
repair preferred over replacement
MVP symptoms?
anxiety, atypical chest pain, panic attacks, palpitations, syncope, dizziness, fatigue
What valve disorder is closely related to CT disease and is AD?
MVP
Valvular disorder –> posterior bulging leaflets
MVP
MVP tx
reassurance, BB
Valvular disorders that’s almost always congenital and a disease of the young?
pulmonic stenosis
pulmonic stenosis radiates to?
neck or base of heart
Tx pulmonic stenosis
balloon valvuloplasty
Murmur associated with pulmonic regurg?
Graham Steel murmur: brief decrescendo early diastolic murmur at LUSB with full inspiration
MC primary cause of tricuspid regurg
infective endocarditis
MC secondary cause of tricuspid regurg
pulmonary HTN
Sign associated with tricuspid murmur
Carvallo’s sign: increased murmur intensity with inspiration
Murmur associated with pulsatile liver
tricuspid regurgitation
Nosocomial UTI treatment
cipro or levo 7 -14 d
MCC of urethritis
gonorrhea
MCC of scrotal pain
epididymitis
MCC of epididymitis if <35
chlamydia
MCC of epididymitis if >35
e.coli
If epididiymitis likley d/t G/C –>
ceftriaxone 250 mg IM x 1 + Azithromycin 1 gm x 1 (can sub doxy)
-If MSM, ceftriaxone 250 mg IM x 1 + levo 500 mg x 10 days
MC complication of mumps
orchitis
Orchitis viral or bacterial?
viral
MCC of balanitis in adults
DM
MCC of obstructive uroopathy in men?
BPH
Normal urine output
800 mL - 2 L/day
oliguria:
<400 mL
MCC of renal artery thrombosis
a. fib
What lab may be elevated in renal artery thrombosis?
LDH (increased in ischemia)
Test for renal artery thrombosis
non-con CT (renal US NOT useful)
tx renal artery thrombosis
anticoagulate
