Random Subject Review Part I Flashcards
complication of LP in patient with elevated intracranial presure
uncal herniation
diagnosis: child presents to ER with altered mental status, hypoglycemia, and lesions suggestive of chickenpox
rye’s syndrome (hepatoencephalopathy)
symptoms of basilar artery stroke
cranial nerve deficits, altered mental status/coma, contralateral full body weakness and decreased sensation, vertigo
TCA overdose signs and management
anticholingeric symptoms, cardiac and CNS toxicity
treat cardiac with sodium bicarb, and CNS with benzos
treatment for lithium induced nephrogenic diabetes insipidus
HCTZ and amiloride (binds lithium stimulated sodium channels)
treatment of acute dystonia
anticholinergics (benadryl, benztropine)
treatment of tardive dyskinesia
discontinue typical antipsychotic, switch to atypical antipsychotic
EEG pattern seen in absence seizures
3 cycle/second spike and wave pattern
typical complaint of patient with retinal detachment
sudden painless onset of flashing lights, floaters, and shade coming down over vision unilaterally
treatment for benign paroxysmal positional vertigo
epply maneuver to reposition otoliths
todd’s paralysis
post-ictal hemiparesis < 24 hours
drugs combined with SSRIs known for causing serotonin syndrome
SSRIs, SNRIs, MAOIs, levadopa, mepiridine, lithium, amphetamines, cocaine, ecstasy, LSD, st. john’s wort
most common cause of sensorineural hearing loss
prebycusis (progressive symmetric high-frequency loss of the elderly)
most common cause of conductive hearing loss
otosclerosis
most common complication of recurrent otitis media
hearing loss
medications used in ADHD
stimulants, TCAs, buproprion, alpha-2 agonists (clonidine)
medications used in tourette’s
fluphenazine, pimizide, tetrabenazine
most worrisome side effect of ADHD drug atomoxetine
increased suicidal ideation, hepatotoxicity
diagnosis: patient presents with hearing loss and vertigo, grayish-white “pearly” TM lesion apparent on PE
cholesteatoma
symptoms of basilar skull fracture
raccoon eyes (orbital fracture)
battle sign (bruising over mastoid process)
blood behind tympanic membrane
CSF coming out of nose or ears
diagnosis and next step: chest trauma, hypotension, JVD, and distant heart sounds
cardiac tamponade
pericardiocentesis
diagnosis and next step: chest trauma, JVD, hypotension, and respiratory distress
tension pneumothorax
needle decompression and chest tube placement
how to evaluate neck trauma
neck zone 1: CT angiogram
neck zone 2: surgical exploration
neck zone 3: CT angiogram and triple endoscopy
how to manage elevated ICP
elevated head of bed lidocaine prior to intubation mannitol hyperventilation decompressive surgery
next step: pelvic fracture, DPL shows blood in pelvis
emergent laparotomy
next step: pelvic fracture, DPL shows urine in pelvis
urgent laparotomy (bladder injury)
next step: pelvic fracture, DPL shows nothing but there is hemodynamic instability
suspect retroperitoneal hematoma, angiography with possible embolization
next step: blunt abdominal trauma, unstable vital signs, FAST shows fluid in pelvis
emergent laparotomy (assume it is blood)
next step: blunt abdominal trauma, unstable vital signs, FAST shows no fluid in pelvis
retroperitoneal hematoma, angiogram with possible embolization
next step: blunt abdominal trauma, unstable vital signs, FAST inconclusive
perform DPL
empiric treatment for brain abscess
antibiotics, needle aspiration, corticosteroids
treatment for cluster headaches
100% oxygen
triptans and ergotamines
when are triptans contraindicated for headaches
pregnancy, CAD, prinzmetal’s angina
cause vasoconstriction
side effects of theophylline overdose
seizures, excessive muscle contraction, hyperthermia, hypotension, cardiac tachyarrhythmias
ST elevation in multiple arteries
acute pericarditis
diagnosis: cardiac cath shows equal pressure in all chambers
constrictive pericarditis
antidote for methanol
fomepazole
2nd line: alcohol
antiode for ethylene glycol
fomepazole
2nd line: alcohol
antiode for arsenic
dimercaperol, succimer, or penicillamine
burn patient fluid replacement
lactate ringers
4 mL/kg x % burn area + maintenance fluids
1/2 first 8 hours
1/2 next 16 hours
treatment for neuroleptic malignant syndrome
discontinue offending medication
IV fluids and dantrolene (stops muscle contraction)
2nd line: bromocriptine or amantidine
paget’s disease lab abnormalities
elevated alkaline phosphatase
osteomalacia/rickets lab abnormalities
vitamin D deficiency
decreased calcium
increased PTH
increased or normal alkaline phosphatase
osteoperosis lab abnormalities
all values normal
osteopetrosis lab abnormalities
all values normal
pseudohypoparathyroidism lab abnormalities
decreased calcium
increased phosphate
increased PTH
(defective receptors)
diagnosis: hypertension, depression, kidney stones
hyperparathyroidism
complications arising from using vasopressors in shock
ischemia and necrosis of distal extremities
mesenteric ischemia and renal failure
most effective intervention for reducing blood pressure
weight loss
preferred initial antihypertensive in a patient with no comorbidities
HCTZ or chlorthalidone
first-line hypertensive for diabetics
ACE-inhibitor
first-line hypertensive for CHF patients
ACE-inhibitor
beta-blocker and spironolactone
first-line hypertensive for BPH
alpha-blocker
first-line hypertensive for LVH
ACE-inhibitor
considered pre-CHF
first-line hypertensive for hyperthyroidism
non-selective beta-blocker
first-line hypertensive for osteoporosis
HCTZ
first-line hypertensive for benign essential tremor
beta-blocker
first-line hypertensive for post-menopausal female
HCTZ
first-line hypertensive for migraines
beta-blocker
most likely cause of secondary HTN with proteinuria
renal disease
most likely cause of secondary HTN with hypokalemia
hyperaldosteronism
most likely cause of secondary HTN with tachycardia, diarrhea, and heat intolerance
hyperthyroidism
most likely cause of secondary HTN with hyperkalemia
renal artery stenosis and renal failure
most likely cause of secondary HTN with episodic sweating, tachycardia
pheochromocytoma
antihypertensive side effect profile: first dose orthostatic hypotension
alpha-blocker
antihypertensive side effect profile: hypertrichosis
minoxidil
antihypertensive side effect profile: dry mouth, sedation, rebound HTN
clonidine
must be dosed every three hours
antihypertensive side effect profile: bradycardia, impotence, asthma exacerbation
non-selective beta-blocker
antihypertensive side effect profile: reflex tachycardia
vasodilators
antihypertensive side effect profile: cough
ACE-inhibitor
antihypertensive side effect profile: sulfa allergy
HCTZ, loop diuretics
antihypertensive side effect profile: angioedema
ACE-inhibitor or less likely ARB
antihypertensive side effect profile: drug-induced lupus
hydralazine
anti-histone antibodies
antihypertensive side effect profile: cyanide toxicity
nitroprusside
vasodilating effects of nitroglycerin and dihyropyridine calcium channel blockers
venodilators
vasodilating effects of nitroprusside
arteriodilators and venodilators
JONES criteria for rheumatic heart disease
J - joint polyarthritis O - pancarditis N - nodules E - erythema nodosum S - syndenham's chorea
major DUKE criteria for endocarditis
serial positive blood cultures
presence of vegetations or cardiac abscess on ECHO
new onset valvular regurgitation
blood culture positive for Coxiella
minor DUKE criteria for endocarditis
predisposing heat condition or IV drug use
fever > 38C
vascular phenomenon (septic emboli, infarc, mycotic aneruysm, intracranial hemorrhage, janeway lesions)
immunologic phenomenon (glomerulonephritis, osler’s nodes, roth spots, positive rheumatoid factor)
positive cultures not meeting requirements for major criteria or serologic evidence of infection without positive culture
most common nephritic syndrome
membranous glomerulonephritis
endocarditis prophylaxis for oral surgery
amoxicillin before and after the procedure
endocarditis prophylaxis for GI/GU surgery
amipicillin + gentamicin before and amoxicillin after the procedure
treatment for mild unconjugated hyperbilirubinemia
UV therapy
when is the greatest risk for post-op MIs
first 48 hours
pressor causes vasoconstriction with bradycardia
phenylephrine
high dose pressor that maximizes alpha-1 constriction
epinephrine
when to stop warfarin prior to surgery
3-4 days
when to stop aspirin prior to surgery
5-7 days
treatment for DIC
FFP and possibly platelets
preferred placement of swan-ganz catheter
right IJ or left subclavian
protective measures for kidney with IV contract
n-acetylcysteine
IV fluids
sodium bicarbonate
treatment for cluster headaches
100% oxygen
triptans, ergotamines
antihypertensive contraindicated in bilateral renal artery stenosis
ACE-inhibitors
unilateral okay
antihypertensive contraindicated in advanced renal failure
ACE-inhibitors if they have hyperkalemia, otherwise okay
no potassium-sparing diuretics