Obj. 15 PART ONE a-e Flashcards
What’s the most fractured bone of the face?
nasal
Your pugilistic patient has diplopia, upward gaze, decreased eye movement, and periorbital ecchymosis. What is the problem?
orbital blowout fracture
A drunk Stu Price just pulled out his own tooth to prove he’s a good dentist - what are you going to do with the tooth until it can be reimplanted?
Put tooth in one of the following, in descending order of preference:
- balanced salt solution
- cold milk
- saliva
- saline
Abrupt onset of severe, unilateral eye pain with blurry vision and increased intraocular pressure - what do you suspect?
acute glaucoma
Name 3 possible causes of painless, unilateral vision loss and how you might differentiate between them.
- retinal detachment - “curtain” descending over vision, can visualize retina hanging down with fundoscopy
- central retinal vein occlusion - dilated & tortuous veins, diffuse hemorrhages
- central retinal artery occlusion - disc pallor, “boxcar” retinal veins, cherry-red fovea
What are the main drugs that cause erythematous skin reactions?
~SULFONAMIDES
~penicillin, allopurinol, NSAIDs, anticonvulsants
What is the difference between SJS and TEN?
SJS (Stevens-Johnson syndrome): < 10% body surface area skin loss
TEN (toxic epidermal necrolysis): > 30% body surface area skin loss
Your patient is a 4 yo child with a hx of impetigo who now has multiple bullae and a positive Nikolsky sign.
What is it?
How will you treat it?
~staphylococcal scalded skin syndrome
~IV nafcillin
Your patient is a 32 yo woman who has been feeling ill (vomiting, fever, myalgia) for a few days and now is hypotensive and has a diffuse, blanchable macular erythematous rash and strawberry tongue.
What is it?
What do you expect to happen over the next 2 weeks?
What do you expect to see on blood culture?
How will you treat it?
~Toxic shock syndrome
~the erythema will fade in 3 days, and about a week after that, she will experience desquamation of her hands and feet
~caused by S. aureus, but 85% of the time, blood cultures are negative
~ensure any tampons are removed; admit to ICU; start IV 1st gen ceph or vanco
What are two medications used for lice and scabies?
permethrin, lindane
What is the treatment for felon?
drain abscess, treat empirically with antistaphylococcal abx for 5 days
What is the primary cause of cellulitis and erysipelas?
group A beta-hemolytic streptococcus
could also be staph or other flora
Which has erythema with poorly defined borders and which has erythema with well-defined borders, and why?
(cellulitis or erysipelas)
~cellulitis: erythema with poorly defined borders, because it’s a deeper infection
~erysipelas: well-demarcated erythematous areas, because it’s a more superficial infection
How would you treat cellulitis/erysipelas?
empirically with IV abx to cover strep (penicillin) and staph (nafcillin)
Your patient is a 19 yo male who drives a delivery truck for a living complaining of extreme pain near his buttcrack that is making it hard to sit in his truck. Your inspection reveals a tender, swollen, fluctuant nodule in the superior gluteal fold.
What is it?
How will you treat it?
~pilonidal abscess
~incision and drainage; remove debris from cavity; pack with gauze and have patient return in 2-3 days. Abx NOT needed.
What 3 drugs might you give to a patient experiencing angioedema?
- 1:1000 epinephrine
- diphenhydramine (benadryl)
- methylprednisolone
This rapidly spreading infection may initially look like cellulitis but will have systemic toxicity and severe pain followed by anesthesia of the involved area as local nerves are destroyed…Surgical exploration is mandatory and extensive debridement is essential for survival.
What is it and what is the most common causative organism?
~necrotizing fasciitis
~group A strep
What are the risk factors for primary and secondary spontaneous pneumothorax?
~primary: men 20-40 who smoke
~secondary: hx of COPD, pneumonia, CF, asthma, TB
Your 25 yo male patient has pleuritic chest pain, acute-onset dyspnea, and decreased breath sounds on the left side. What is it?
primary spontaneous pneumothorax
How is pneumothorax diagnosed, and how is it treated?
~chest x-ray
~chest tube with water seal
What additional findings will be present in a tension pneumothorax?
~PMI displaced to opposite side
~tracheal deviation to opposite side
~JVD
What 2 signs are very indicative of pericarditis?
~pt feels worse supine and better sitting up and leaning forward
~PR depression on EKG
What are the Duke criteria used for?
To diagnose infective endocarditis
What are the 3 dead white guy signs that are associated with bacterial endocarditis?
- Janeway lesions
- Osler nodes
- Roth spots
What’s the earliest cardiac biomarker that you can test for in suspected MI?
myoglobin - rises within 1-4 hours, returns to normal in 24 hours
What cardiac biomarker can you test for retrospective diagnosis of acute MI?
troponin - persists for 7-10 days
Your patient has unequal SBP in the arms, unequal radial pulses, and a carotid bruit. What do you suspect?
subclavian steal syndrome
Your 24 yo female patient has a sudden onset of moderate unilateral lower abdominal pain that gets worse when she changes position. The pain radiates to her flank.
What 2 tests are you going to perform?
What is the diagnosis?
What is the treatment?
~pregnancy test (negative), Doppler U/S to detect decreased/absent blood flow to affected ovary
~ovarian torsion
~laparotomy
Your patient is a 24 yo female with sudden onset of severe, stabbing lower quadrant pain that does not radiate.
What do you suspect?
What tests might you perform?
What is the treatment?
~ectopic pregnancy
~pregnancy test (positive), transvaginal U/S to detect adnexal mass/no uterine pregnancy
~if early pregnancy & stable, methotrexate; otherwise surgery to remove tube
What antiemetics could be used for hyperemesis gravidarum?
ondansetron, promethazine
Your 19 yo female patient presents with lower abdominal pain, vaginal discharge, fever, cervical motion tenderness, and bilateral lower adnexal tenderness.
What do you suspect?
How will you treat it?
Pelvic inflammatory disease
ceftriaxone + doxycycline
If a septal hematoma is not drained, the pt is at increased risk of developing this.
Necrosis –> Saddle nose deformity
What might you consider as prophylaxis post-orbital blow-out fracture?
tetanus shot
Pt arrives to clinic with “target” lesions on her palms and in her mouth. What do you suspect may be the cause of this presentation? How do you treat it?
Herpes Simplex (Erythema multiforme MINOR) Oral Acyclovir
