Rapid Review Flashcards
ECG pattern in A flutter
sawtooth
Unstable angina (definition)
New or worsening angina w/ no increase in troponins
Antihypertensive for a diabetic patient w proteinuria
ACEi or ARB
Beck triad for cardiac tamponade
Hypotension, distant heart sounds, JVD
Drugs that slow heart rate (4)
B-blockers, CCB, digoxin, amiodarone
Hypercholesterolemia treatment that causes flushing & pruritis
Niacin
Murmur - HOCM
Systolic ejection murmur along lateral sternal border, increases with decreased preload (Valsalva)
Murmur - aortic insufficiency
Diastolic decrescendo, low-pitched, blowing, loudest when sitting up; increases with increased after load (handgrip)
Murmur - aortic stenosis
Systolic crescendo/decrescendo murmur that radiates to neck; increases with increased preload (squatting)
Murmur - mitral regurg
Holosystolic murmur, radiates to axilla; increases with increased after load (handgrip)
Murmur - mitral stenosis
Diastolic, mid to late, low-pitched murmur; opening snap
Treatment for a fib & a flutter (stable, then unstable)
Stable: rate control w/ B-blocker or CCB
Unstable: cardiovert
Treatment for v-fib
Immediate defibrillation
Dressler syndrome
Autoimmune reaction with fever, pericarditis, elevated ESR 2-4 weeks post-MI
Treatment for: IVDU + JVD + holosystolic murmur at LSB
Treat existing heart failure, then replace tricuspid valve
Diagnostic test for HOCM
Echo (thickened LV wall & outflow obstruction)
Pulsus paradoxus, & associated dz
Decrease in SBP >10mmHg with inspiration. Cardiac tamponade
Classic ECG findings in pericarditis
Low voltage, diffuse ST segment elevation
Surgically correctible causes of HTN (8)
Renal artery stenosis, aortic coarct, pheo, Conn syndrome, Cushing syndrome, unilateral renal parenchymal disease, hyperthyroidism, hyperPTH
Evaluation mode for pulsatile abd mass + bruit
Abdominal US & CT
Indications for surgical correction of AAA
> 5.5 cm, rapidly expanding, symptomatic, ruptured
Treatment for Acute Coronary Syndrome
Morphine, Oxygen, Nitro, ASA, B-blockers, clopidogrel, heparin
Metabolic syndrome - definition
Abdominal obesity, high TG, low HDL, HTN, insulin resistance, prothrombotic or proinflammatory states
Signs of active ischemia during stress testing
Angina, ST segment changes, hypotension
ECG findings suggesting MI (3)
ST segment elevation, flattened T waves, Q waves
Coronary territories in MI
Anterior wall (LAD/diagonal), inferior (PDA), posterior (LCX/oblique, RCA/marginal), septal (LAD/diagonal)
Common sx of silent MI
CHF, shock, AMS, fatigue, heartburn, SOB, neck/jaw pain, indigestion
Diagnostic test for PE
CT pulmonary angio
Protamine is for…
Heparin reversal agent
Which coag measure does warfarin affect
Prothrombin time
Endocarditis prophylaxis regimes
Oral surgery - amoxicillin
GI/GU surgery - none
Virchow triad
Hypercoagulability, stasis, endothelial damage
Most common cause of hypertension in young women
OCPs
Most common cause of HTN in young men
EtOH
Figure 3 sign on CXR
Aortic coarctation
Water-bottle-shaped heart
Pericardial effusion - look for pulses paradoxus
Waxy, stuck-on skin lesion
SK
Red plaques with silvery-white scales and sharp margins
Psoriasis
Pearly-colored papule with translucent surface and telangiectasias
BCC - most common skin cancer
Honey crusted skin lesions
Impetigo (staph, strep)
Febrile pt w diabetes presents w red, swollen, painful leg & intact pulses
Cellulitis
+Nikolsky sign, flaccid blisters
Pemphigus vulgaris
-Nikolky sign, tense blisters
Bullous pemphigoid
What to check when you find acanthosis nigricans in obese patient
Blood glucose
Dermatomal distribution of painful vesicles
Varicella zoster
Flat-topped, itchy, violet papules
Lichen planus
Iris-like targetoid lesions
Erythema multiforme
Christmas tree pattern of rash + herald patch
Pityriasis rosea
Flat, hypopigmented lesions on chest & back; KOH shows “spaghetti and meatballs”
Tinea versicolor
Characteristics of melanoma
Asymmetry, Border irregularity, Color variation, Diameter (large), evolution
Premalignant lesion caused by sun exposure that leads to SCC
AK
Crusting vesicles in all stages of healing
Varicella
Cradle cap (real name)
Seborrheic dermatitis
Associated w propionibacterium acnes & changes in androgen levels. Treatment of last resort?
Acne vulgaris. Oral isotretinoin. Needs monthly blood tests and 2x contraception
Painful, recurrent vesicular eruption of mucocutaneous surfaces
Herpes simplex
Inflammation and epithelial thinning of anogenital area, predominantly in postmenopausal women
Lichen sclerosus
Exophytic nodules on skin with scaling or ulceration
Squamous Cell Carcinoma, 2nd most common skin cancer
Most common cause of hypothyroidism in USA
Hashimoto thyroiditis
Lab findings in Hashimoto thyroiditis
high TSH, low T4, +TPO
Exophthalmos, pretibial myxedema, low TSH
Graves dz
Most common cause of Cushing Syndrome
Iatrogenic corticosteroid administration (2nd most common is Cushing dz)
Post thyroidectomy pt with hypocalcemia
Iatrogenic hypoparathyroidism, low PTH, high phos
Stones, bones, groans, psychiatric overtones
Hypercalcemia
HTN, hypoK, metabolic alkalosis
Hyperaldosteronism (1˚, caused by Conn syndrome or bilateral adrenal hyperplasia)
Tachycardia, highly variable BP, HA, diaphoresis, AMS, panic sx
Pheochromocytoma
First step in treating pheo
A-blockers (phenoxybenzamine)
Lithium use + increased urination
Nephrogenic DI
Treatment of central DI
DDVAP
Posted patient in pain + hyponatremia + 130/85
SIADH
Antidiabetic agent associated w lactic acidosis
Metformin
Pt w weakness, nausea, vomiting, wt loss, skin pigmentation. Hyponatremia, hyperkalemia. treatment?
1˚ adrenal insufficiency. Tx: Exogenous corticosteroids & mineralocorticoids, IV fluids
Goal HbA1c in T2DM
<7.0
Treatment of DKA
Fluids, insulin, electrolyte repletion
Bone pain, hearing loss, increased alk phos
Paget’s
Increased IGF-1
Acromegaly
Galactorrhea, amenorrhea, bitemporal hemianopsia
Prolactinoma
Elevated serum 17-hydroxyprogesterone
CAH (21-hydroxylase deficiency)
Pancreas, pituitary, & parathyroid tumors
MEN1
Most common cancer in men, most deadly cancer in men
Prostate, lung
% of cases within 1 standard deviation? 2SD? 3SD?
68% 95.4% 99.7%
Most common cause of SBO in its with no history of abdominal surgery
Hernia
Most common bacteria - diarrhea
Campylobacter
Most common bacteria - recent abx
C diff
Most common bacteria - camping
Giardia
Most common bacteria - picnic/mayonaise
S aureus
Most common bacteria - travelers diarrhea
Enterotoxigenic Escherichia
Most common bacteria - uncooked burger
E coli O157:H7
Most common bacteria - fried rice
Bacillus cereus
Most common bacteria - poultry/eggs
Salmonella
Most common bacteria - seafood
Vibrio, HepA
Most common bacteria - diarrhea in AIDS pt (3)
Isospora, cryptosporidium, MAC
Most common bacteria - pseudoappendicitis (2)
Yersinia, campylobacter
Cancer screening in Ulcerative Colitis
Colonoscopy every 1-2 years starting 8 years after dx
Extrainestinal manifestations of IBD (5)
Uveitis, ankylosing spondylitis, pyoderma gangrenous, erythema nodosum, 1˚ sclerosing cholangitis
Medical treatment of IBD - acute & chronic
Chronic 5-ASA agents, acute add steroids
30yoM with UC, new jaundice, pruritus, fatigue
1˚ sclerosing cholangitis
Mallory-Weiss tear
Superficial tear in esophageal mucosa
Boerhaave Syndrome
Full-thickness esophageal rupture
Charcot triad
Fever, jaundice, RUQ pain/Murphy’s sign
Reynolds pentad
Fever, jaundice, RUQ pain/Murphy’s sign, shock, AMS
Hepatic encephalopathy tx (3)
Decrease protein intake, lactulose, rifaximin
Occupational exposure to HepB
IVIG + vaccine if non-immune
Classic causes of drug-induced hepatitis
TB meds (rifampin, isoniazid, pyrazinamide), APAP, tetracyclines
Hernia type most at risk for incarceration
femoral
Abdominal pain out of proportion to exam
Mesenteric ischemia
Watery diarrhea, dehydration, muscle weakness, flushing - dx & tx?
VIPoma. Replace fluids & electrolytes, octreotide, resection)
Causes of microcytic anemia (5)
Iron deficiency, lead poisoning, anemia of chronic disease, sideroblastic anemia, thalassemia
Precipitants of hemolytic crisis in G6PD Deficiency
Sulfa, fava beans, infections, nitrofurantoin, dapsone, isoniazid, antimalarials (quinines)
Most common inherited hypercoagulability dz
Factor V leiden
Most common inherited bleeding d/o
vWD
Diagnostic test for spherocytosis
Osmotic fragility
Pure RBC aplasia
Diamond-Blackfan anemia
Anemia + absent radii/thumbs, hyper pigmentation, cafe-au-lait spots, microcephaly, pancytopenia
Fanconi anemia
Meds (4) & viruses (4) that lead to aplastic anemia
Meds: Chloramphenicol, sulfa, radiation, chemo
Viruses: ParvoB19, EBV, HIV, Hepatitis
Polycythemia vera vs 2˚ polycythemia labs: Hct, RBC, O2 sat, Epo
Polycythemia vera: high hct & RBC, normal O2, low EPO
2˚ polycythemia: high hct, RBC, EPO, low O2 sat
TTP pentad
LMNOP - low platelets, MAHA, Neuro sx, “Obsolete” renal fxn, Pyrexia
HUS triad
Anemia (MAHA), thrombocytopenia, acute renal failure
Treatment for TTP
Large-volume plasmapheresis, corticosteroids, anti platelet drugs
NO platelet transfusion - they’ll just get shredded
Treatment for ITP in children
Observe. May need IVIG or corticosteroids
Labs in DIC: fibrin split products, d-dimer, fibrinogen, plt, hct
Split: elevated D-dimer: elevated Fibrinogen: low Plt: low Hct: low
Med for hemophilia A
Desmopressin
Med for von Willebrand disease
Desmopressin (or FFP, cryoprecipitate)
Urine finding in multiple myeloma
Bence-jones protein
Reed-sternberg cells
Hodgkin Lymphoma
Anterior mediastinal masses
Thymoma, thyroid cancer, teratoma, terrible lymphoma
Ferritin
Iron stores. High in anemia of chronic disease, low in iron deficiency
Tumor lysis syndrome electrolytes
Low Ca2+
High PO4, uric acid, K+
Bacterial causes of PNA in neonates (3)
GBS, listeria, e. coli
Bacterial causes of PNA in adults 40-65 (3)
S. pneumo, H. flu, Mycoplasma
Asplenic pts are particularly susceptible to (4)
Encapsulated organisms - pneumococcus, meningococcus, H. flu, klebsiella
Causes of ring-enhancing brain lesions (5)
Abscess, toxo, metastasis, lymphoma, AIDS, neurocysticercosis
Causes of meningitis in neonates (3). Treatment?
GBS, listeria, E. coli. [Amp + cefotaxime] or [amp + gent]
Causes of meningitis in infants (3). Treatment?
S. pneumo, H. flu, N. meningitidis. [vanc + ceftriaxone]
Sx of Lyme disease (6)
Erythema migrant, arthralgias, migratory polyarthropathies, facial nerve palsy, myocarditis, 3˚ heart block
SIRS criteria
Temp
Tachypnea
Tachycardia
WBC
Endocarditis exam findings (6)
Fever, murmur, Osler nodes, splinter hemorrhages, Janeway lesions, Roth spots
Bacteria in burn victim infections
Pseudomonas
Migraine prophylaxis (4)
Antihypertensives, antidepressants, anticonvulsants, dietary changes
Treatment of prolactinoma
Dopamine agonists (bromocriptine, cabergoline)
Crescentic brain bleed
Subdural hematoma; bridging veins
Lens-shaped brain bleed; lucid interval
Epidural hematoma; middle meningeal artery
Albumoniocytologic dissociation
Guillain-barre - elevated CSF protein without elevated WBC
First line med for status epilepticus
IV benzos
Confusion, ophthalmoplegia, ataxia
Wernicke encephalopathy, 2/2 thiamine deficiency
Treatment for ALS
Riluzole
Mainstay for Parkinson’s treatment
Carbidopa/levodopa
Hyperphagia, hyper sexuality, hyperorality, hyperdocility
Kluver-Bucy syndrome (amygdala)
Chromosomal pattern of complete molar pregnancy
46, XX
Teratogenic abx
Tetracycline, fluoroquinolones, aminoglycosides, sulfonamides
Medical treatment for postpartum hemorrhage (1)
Oxytocin
PCOS therapy (2)
Weight loss, OCPs
Medical treatment for endometriosis (3)
OCPs, danazol, GnRH agonists
Increased vaginal discharge with petechial patches in upper vagina & cervix - cause?
Trichomonal vaginitis
Tx for bacterial vaginosis
Oral metronidazole
Bloody nipple discharge
Intraductal papilloma
Nipple itching, burning & erosion
Paget’s disease of the breast - malignant
Urge incontinence treatment
Anticholinergics (oxybutynnin) or beta-adrenergic (metaproterenol)
Most common cause of female infertility
Endometriosis
ASCUS x 2 - now what?
Colposcopy & endocervical curettage
Breast cancer type that increases future risk of invasive carcinoma in BOTH breasts
Lobular carcinoma in situ
Kid with nontender abdominal mass, elevated VMA & HVA
Neuroblastoma - look for metastases
Most common type of tracheoesophageal fistula
Esophageal atresia with distal tracheoesophageal fistula - presents w inability to pass NGT
Contraindication to TDaP
Encephalopathy within 7 days of last TDaP - switch to just Td vaccines
Contraindication to rotavirus vax
Personal hx intususception
Meconium ileus causes (2)
CF, hirschprung disease
Bilious emesis after first feed
Duodenal atresia
2mo baby w nonbilious projectile emesis
Pyloric stenosis. Hydrate, replete lytes. Pyloromyotomy to fix problem
Infant w high fever, breaks, then rash. What is he at increased risk for?
Febrile seizure. Roseola (HHV6 & 7)
1-3mo kid with recurrent severe infections
Bruton’s agammaglobulinemia - occurs earlier than T-cell immunodeficiencies (where sx start around 6mo)
Reye syndrome
Microvesicular fatty liver infiltration & mitochondrial damage causes fulminant liver failure
Other cancer associated with retinoblastoma
Osteosarcoma
First line tx otitis media
Amoxicillin x 10 days (then augmentin if failed)
Muscle rigidity, autonomic instability, fever, confusion, elevated CPK
Neuroleptic malignant syndrome
Side effects of atypical antipsychotics (3)
Wt gain, T2DM, QT segment prolongation
IV haldol then eyes are stuck looking sideways - dx & tx
Acute dystonia; diphenhydramine or benztropine
Treatment of acute mania
Lithium + atypical antipsychotic
Exudative pleural effusion criteria
Pleural/serum protein > 0.5
Pleural/serum LDH > 2/3
Causes for exudative pleural effusion
Leaky capillaries 2/2 inflammation - malignancy, TB, bacterial or viral infection, PE with infarct, pancreatitis
Causes of transudative pleural effusion
Intact capillaries, increased hydrostatic pressure - heart failure, liver dz, kidney dz, protein-losing enteropathy
Dyspnea, hilar LAD, increased ACE, hyperCalcemia
Sarcoidosis, noncaseating granulomas
Honeycomb pattern on best imaging - dx & tx
Interstitial lung disease; supportive care
SVC syndrome treatment
Radiation & endovascular stenting
Acid-base derangement in Pulmonary Embolism
Respiratory alkalosis with hypoxia & low PaCO2
NSCLC associated with hypercalcemia
Squamous cell carcinoma (ectopic PTHrP)
Lung cancer associated with SIADH
Small cell lung cancer (ectopic ADH)
Lung cancer associated with Lambert Eaton
Small cell lung cancer
Lung cancers related to cigarettes (2)
SCLC, squamous cell carcinoma
Treatment for all (even small) spontaneous pneumothoraces
Supplemental O2
Hypoxemia & pulmonary edema with normal PCWP
ARDS
Sequelae of asbestos exposure (4)
Pulmonary fibrosis, pleural plaques, bronchogenic carcinoma (mass in lung field), mesothelioma (pleural mass)
Silicosis causes increased risk for what type of infection?
Mycobacterium tuberculosis
Causes of hypoxemia (4)
R>L shunt, hypoventilation, low FiO2, diffusion defect, V/Q mismatch
CXR: cardiomegaly, prominent pulmonary vessels, Kerley B lines, bats-wing appearance of hilarious shadows, perivascular & peribronchial cuffing
Pulmonary edema
Treatment of hypernatremia
NS if unstable vitals
D5W or 0.45%NS to replace free water loss
DDX hypotonic hypervolemic hyponatremia (5)
Cirrhosis, heart failure, nephrotic syndrome, AKI, CKD
Treatment of hyperK
Calcium glutinate, bicarb, insulin + glucose, kayexalate
First-line tx for severe hyperCalcemia
IV fluids
Muscle spasms from tapping face or inflating BP cuff
Hypocalcemia
Acid base disturbance in salicylate ingestion
Gap metabolic acidosis (late) ; early primary respiratory alkalosis
Acid base disturbance in pregnancy
Respiratory alkalosis
RTA with abnormal H+ secretion & nephrolithiasis
Type 1 RTA (1 H, type 1)
RTA with abnormal bicarb reabsorption & rickets
Type 2 RTA (bi-carb, bi = 2, type 2)
RTA with low Aldosterone
Type 4
AKI with BUN:Cr > 20:1
Prerenal AKI
Muddy brown casts
Acute tubular necrosis
Drowsiness, asterixis, nausea, pericardial friction rub
Uremic syndrome 2/2 renal failure
Hematuria, HTN, oliguria, RBC casts
Neprhitic syndrome
Glomerulonephritis + deafness
Alport Syndrome
Glomerulonephritis + hemoptysis (2)
Goodpasture Syndrome
Wegener’s GPA
Proteinuria, hypoalbuminemia, edema, hyperlipidemia, thrombosis
Nephrotic syndrome
Waxy urine casts & maltese crosses (lipiduria)
Nephrotic syndrome
Most common form of nephrotic syndrome in adults
FSGS
Best test for nephrolithiasis
Non-contrast CT
US shows bilateral enlarged kidneys with cysts. Dx? What else to look for?
ADPKD. Check for brain aneurisms
BPH treatment options
Terazosin, finasteride, TURP
Most common type of bladder cancer
Transitional cell carcinoma
Hematuria, flank pain, palpable flank mass
Renal cell carcinoma
Most common type of testicular cancer
Seminoma (germ cell tumor)
Testicular cancer associated w high beta-hCG
Choriocarcinoma
Side effects of corticosteroids (6)
Acute mania, immunosuppression, thin skin, easy bruising, osteoporosis, myopathies
APAP overdose treatment
N-acetylcysteine
Benzo overdose treatment
Flumazenil (monitor for seizures)
NMS & malignant hyperthermia treatment
Dantrolene
Malignant HTN treatment
Nitroprusside
A-fib stabilization
Rate control, rhythm conversion, anticoag
Treatment for SVT (stable & unstable)
Stable: rate control w carotid massage or vagal maneuver. 2nd line: adenosine
Unstable: cardiovert (synchronized)
Causes of drug-induced SLE
INH, penicillamine, hydrazine, procainamide, chlorpromazine, methyldopa, quinidine
Macrocytic, megaloblastic anemia with neuro sx
B12 deficiency
Burnt patient with flushed skin, oral SaO2, elevated carboxyhemoglobin. Tx?
100% O2 (consider hyperbaric O2 if severe or pregnant)
Blood in urethral meatus, high-riding prostate
Bladder rupture or urethral injury
Test to r/o urethral injury
Retrograde cystourethrogram
Fluid repletion in burn victims - calculation
24h fluids = 4 x kg x %BSA
Acceptable urine output in trauma pt vs stable pt
Trauma: 50 cc/hr
Stable: 30 cc/hr
Spinal injury + hypotension + bradycardia
Neurogenic shock
Cushing triad - elevated ICP
Hypertension, bradycardia, abnormal respirations
Shock: low CO, low PCWP, high PVR. Tx?
Hypovolemic shock. Fluid/blood repletion
Shock: low CO, high PCWP, high PVR. Tx?
Cardiogenic shock. Inotropes (dobutamine)
Shock: high CO, low PCWP, low PVR. Tx?
Distributive (septic or anaphylactic) shock.
Septic: fluids & abx
Anaphylactic: 1:1000 epi, diphenhydramine
Pt with chest trauma was stable, suddenly dies. Why?
Air embolism
Distended neck veins, hypotension, diminished heart sounds. Dx? What other telltale symptom?
Cardiac tamponade. Pulsus paradoxus
Blunt or penetrating abdominal trauma + hemodynamically unstable. What’s next?
Ex lap
Head trauma with immediate LOC, then Lucent period, then rapid deterioration
Epidural hematoma
Expanding neck mass after recent surgery - what’s next
Wound exploration, hematoma evacuation