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REMEDIATION Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Achilles Rupture

A

CAUSE: FLUOROQUINOLONES, exercise

Presentation: “pop” and painful
Weakness in calf and heel + difficulty walking
Palpable gap + increased resting DORSIFLEXION in prone position

Dx: MRI
US
Ortho Test: THOMPSON TEST → Absent PLANTAR flex

Tx: Keep in plantar flexion + Posterior splint for 4 weeks

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2
Q

Pneumocystis Pneumonia

A

Patho: PMH of HIV
CD4 <200

Presentation: fever, cough, sob
LOW O2 even after tx

Dx: CXR (diffuse interstitial or bilateral perihilar infiltrates
PCR Bronchoalveolar Lavage
Methenamine Silver Stain

Tx: BACTRIM
If allergic: PENTAMIDINE
(if PaO2 → <70 = Prednisone)

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3
Q

Giardia

A

Patho: parasite in poor sanitation/unsafe water
- Loss of intestinal epithelial barrier

Presentation: camper’s diarrhea
Bloody diarrhea
Watery, foul smelling diarrhea

Tx: Metronidazole

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4
Q

Sickle Cell Anemia

A

Sickle Cell Anemia: (dx)
Patho: Autosomal Recessive hemolytic anemia → Defect in Beta Chain
African American = MC

Presentation: anemia, conjunctival pallor, weakness, expressive aphasia, fever

Dx: hemoglobin electrophoresis → Sickled Cells and Hemoglobin S
HbSS = Ds
HbAS = Trait
HbAA = normal
HIGH retic count
-Howell Jolly + Target Cells
Normochromic, normocytic

Tx: Crisis → oxygen, hydration

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5
Q

Von Willebrand Disease

A

Patho: missing protein for platelet function → platelets cannot stick to vessel walls at injury site → bleeding does not stop as quickly
Auto-dominant

Presentation: Decreased vW + Decreased Factor VIII

Dx: VWF antigen/factor will be decreased (possibly Factor VIII)

Tx: DESMOPRESSIN
Excessive → Transfusion of clotting factors

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6
Q

BPPV

A

Patho: Vertigo with positional changes

Presentation: positional vertigo NO HL, Tinnitus, or Ataxia

Dx: Dik-Hallpike

Tx: Epley Maneuver
Meclizine or BENZOS (DIAZEPAM)

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7
Q

Placenta Abruption

A

Patho: Placenta detaches after 35 weeks

Presentation: PAINFUL 3rd trimester bleeding
Pelvic & back pain
(placenta previa is painless)
Can lead to shock, DIC, fetal demise

Dx: Clinical
US determines if it is minor/stable

Tx: Emergency C-sectionDelivery
Blood type + cross + large bore IV

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8
Q

Posterior Shoulder DL

A

Patho:
SEIZURES

Presentation: Arm in INTERNAL rotation + ADDUCTED

Dx: Light-bulb sign on XR (AP or scapular Y)

Tx: Closed reduction + post reduction films

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9
Q

DVT

A

Patho: Atherosclerosis
Stasis + Hypecoag state + Trauma
Cancer, immoble, smoking, OCP, surgery

Presentation: Painful, swollen, red CALF

Dx: + Homan’s Sign
Duplex US
D-Dimer (in low risk)
Venography (GOLD)

Tx: IV Heparin → Warfarin
Recurrent = lifelong

**Women >35 who smoke = at risk → avoid OCPs
Progestin-Only is best

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10
Q

Priapism

A

Patho: MC in 30s, Sickle Cell pts
Trazodone, cocaine, Spider bite, scorpion bite

Presentation: prolonged erection (>4hr)

Dx: Clinical

Tx: PHENYLEPHRINE INJX

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11
Q

Vasovagal Syncope

A

Patho: Lack of O2 to the brain causing a brief LOC with loss of postural tone
- HAS A TRIGGER, warning sign → drop in BP and HR
Presentation: “Patient gives blood and passes out”

Dx: ECC, Pulse Ox, etc
Tilt table test

Tx: Avoidance
If needed → FLUDROCORTISONE ACETATE
SSRI possibly

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12
Q

AAA

A

Patho: blood filled area in the aorta

Presentation: Back + flank pain + pulsatile mass and HYPOTENSION
Dissection → tearing chest pain radiating to the back
Possible palpable pulsatile mass

Dx: US = Initial study of choice
CT (thoracic)
ANGIOGRAPHY = GOLD

Tx: Ascending → Surgery
Descending → Beta Blockers

**Screening → US > 65 + smoker
**Surgery → >5.5
**Monitor >3 1 xyr - >4 2 xyr

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12
Q

Dressler Syndrome

A

Patho: Pericarditis post MI
MI causes inflammation of the pericardium

Presentation: Retrosternal chest pain + “friction rub”

Dx: EKG → ST elevation in V1-V6
CXR → water bottle sign

Tx: NSAIDS

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13
Q

CHF

A

Patho: heart fails to pump correctly

Presentation:
Rt Sided: Lower extremity edema, JVD, Hepatomegaly
Lungs clear to ausc.

Lf Sided: Pulmonary Edema, cough, dyspnea, worse laying down
Lungs fluid filled

Systolic → S3, Reduced EF
Diastolic → S4, Preserved EF

Dx: ECHO
Ejection Fraction
Reduced EF (systolic) → <40%
Preserved EF (diastolic) → >50%

CXR → Kerley B + cardiomegaly

Tx:
Reduced EF (Systolic): BB, Furosemide, ACE
“Lol”, “pril”, Spironolactone
Bisoprolol, Carvedilol, Metoprolol, Entresto (alt of ACE)

Preserved EF (diastolic): Ace + BB/CCB

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14
Q

Corneal Ulcer

A

Patho: sore on eye from infx, injury, dry eyes, CONTACTS

Presentation: white spot on cornea → round ulceration

Dx: Fluorescein stain → Round/Ulcerative

Tx: OPHTHALMOLOGY REFERRAL + Ophthalmic ABX → CIPROFLOXACIN, Ofloxacin, gentamycin, erythromycin, Polymyxin B, tobramycin

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15
Q

Peptic Ulcers (included RUPTURED)

A

Patho: Irritation/wear down of gastric lining
Smoking increases risk
H. Pylori

Presentation: throwing up blood/hematemesis (if ruptured) or Melena
Epigastric pain

Duodenum (anterior) → decreased pain with food
Gastric (lesser curve) → gets worse with food

Dx: “FREE AIR ON XRAY” + Amylase → RUPTURED
Endoscopy
Urea Breath Test

Tx: PPI (Omeprazole) for 4-8 weeks
HPy → CAP
Clarithromycin + Amoxicillin + PPI
Or quad tx (PPI + Bismuth sub + Metro + Tetra)
RUPTURED → IMMEDIATE SURGERY

** STOP NSAIDS

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16
Q

what levels do you check with new onset afib?

A

TSH

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17
Q

Post MI –> what reduces mortality

A

ASA

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18
Q

+ straight leg raise –> tx?

A

NSAIDS

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19
Q

Shoulder ligament (bicep tendonitis pain) –> tx?

A

NSAIDS

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20
Q

Elevated Lipase (>140/160) –>

A

Pancreatitis

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21
Q

What are the components of a tetanus vaccine?

A

Tetani, Pertussis, Diphtheria

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22
Q

Patient bleeding + isolated thrombocytopenia (low platelets)

A

Idiopathic thrombocytopenia purpura

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23
Q

Pt with anemia + increased LDH + schistocytes

A

Autoimmune Hemolytic Anemia

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24
Q

If woman is excessively bleeding what test needs to be ordered?

A

Pregnancy Test

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25
Q

Anechoic US –>

A

Hydatidiform Mole (molar preg)

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26
Q

HTN Emergency tx –>

A

Nicardipine

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27
Q

UVEITIS, URETHRITIS, CONJUNCTIVITIS
+ joint pain

A

Reactive Arthritis

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28
Q

Lachman’s Test

A

ACL

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29
Q

Pt drinks lots of alcohol + vomits, now bleeding –>

A

Mallory Weiss

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30
Q

Initial tx for epiglottitis

A

Intubate (airway)

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31
Q

Pt’s O2 is ~ 90% –> 1st step

A

airway

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32
Q

MC cause of Guillain Barre

A

Campylobacter

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33
Q

Hep B

A

Patho: needles, sex, maternal → inflammation of liver

Presentation: jaundice + flu-like symptoms

Dx:
HepB Surface Antibody (Anti- HBs) = Immunity (post infx or vax)
HepB Surface Antigen (sAg) = CURRENT INFX
IgM = Acute
IgG = Chronic

Tx: Supportive

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34
Q

Essential Tremor

A

Patho: Autosomal Dominant
Presentation: Bilateral + shaking hand/head during PURPOSEFUL, VOLUNTARY movements (not at rest)

Dx: Clinical

Tx: IF SYMPTOMS EFFECT ADLs → PROPRANOLOL
Or Primidone, Alprazolam, Gabapentin, Topiramate or Nimofipine

Alcohol helps stop tremor

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35
Q

HPV (Quadrivalent Vaccine)

A

Patho: Human Papillomavirus

Presentation: Causes Warts (Condyloma Acuminatum - genital warts)
Leads to cervical cancer

Dx: Shave/Punch Biopsy → Koilocytic Squamous Epithelial cells in clumps → Pap Smear

Tx: Removal
Podophyllin or TCA (trichloroacetic acid)

**VAX: Quadrivalent (covers genital and cervical cancer) → aka Gardasil → HPV 6, 11 (genital warts) + 16, 18 (cervical cancer)

9-Valent Vax (Gardasil 9) → 6,11, 16, 18 + 31, 33, 45, 52, and 58
ONLY ONE AVAILABLE IN US
11-12 yr (CAN BE GIVEN AT 9)
<15 = 2 doses
>15 + IC = 3 doses

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36
Q

Worst sign of injury regarding the spinal cord?

A

Loss of rectal tone

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37
Q

Pt comes in with a back injury and cannot pee –> order ? –> concerned for ?

A

MRI –> Cauda Equina

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38
Q

Pt gets diarrhea after every meal

A

Celiac Ds

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39
Q

Kid who is always wheezing

A

Asthma

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40
Q

Definitive test for an asthmatic patient?

A

Pulmonary Fnx Test

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41
Q

Pt swallows a battery, stuck where?

A

Right Main Bronchus

42
Q

Cause of Orchitis

A

Not getting MMR vax

43
Q

Manic Symptom

A

Irritability

44
Q

Mallot Finger

A

Patho: flexion deformity of the fingertip (DIP JOINT) caused by avulsion/rupture of the extensor tendon
Sudden blow to finger tip

Presentation: Unable to straightenin DIP

Dx: XR → Bony avulsion of DIP

Tx: Splint in extension 6-8 weeks

45
Q

What happens if you don’t splint mallet finger?

A

Swan Neck Deformity

46
Q

Finkelstein

A

DeQuerves Tendosynovitis

47
Q

Tx for Bradycardia

A

Atropine

48
Q

Distant heart sounds, JVD, Hypotension =

A

Beck’s triad –> Cardiac Tamponade

49
Q

Patient rollover golf cart wreck, pulseless, paresthesia in limbs → Check for ?

A

Compartment Syndrome

50
Q

LP Glucose <30 =
Tx?

A

Bacterial Meningitis
-Ceftriaxone + Vancomycin

51
Q

List 4 MC NSAIDS

A

Ibuprofen
Naproxen
Diclofenac
Celecoxib

52
Q

Cherry Red Fovea indicates

A

Central Retinal Artery Occlusion

53
Q

HYPERPIGMENTATION, CONSTIPATION, FATIGUE

A

Adrenal Insufficiency –> Addisons

54
Q

TX for depression

A

SSRI

55
Q

Bacterial Pneumonia

A

Patho: fluid build up in the lung aveloi

Strep Pneumonia (rust colored + splenectomy)

Staph Aureus (post Flu + salmon colored)

Mycoplasma (walking pneumonia)

Klebsiella (alcohol + current jelly)

Legionella (air conditioning)
Pseudomonas (ventilators, CF)

Pneumocystis (HIV)

Apical → TB
Lobar → Community Acquired

Presentation: Cough, fever, crackles on auscultation, SOB, Tachycardia/tachypnea
+ egophony, tactile fremitus, dullness to percussion

Dx: CXR
Cultures x2

Tx: Azithromycin or Amoxicillin or Doxy (if no morbidities)

IF pt has comorbidities (CHF, Disease, DM, Alcohol use, Cancer, Immunosuppression, no spleen) → Levofloxacin or Augmentin

** Empyema = pus in pleural space → complication of pneumonia**

56
Q

Pneumothorax

A

Patho: Collapsed lung → air in pleural space

Spontaneous: tall, thin male
Tension: trauma (penetration/blunt)
Mediastinal shift to other side

Presentation: Sudden SOB, absent lung sounds unilateral, unilateral chest pain
(-) tactile fremitus, deviated trachea, hyperresonance

Dx: Stable → CXR
Unstable → US

Tx: <15% → spontaneous resolve + O2 if symptomatic

> 15% CHEST TUBE

TENSION → MEDICAL EMERGENCY
LARGE BORE NEEDLE IN CHEST + CHEST TUBE`

57
Q

Cardiac Tamponade

A

Patho: Fluid build up around the heart
Decreased CO, perfusion
MI, trauma, AD, Pericardial effusion, cancer, etc.

Presentation: Beck’s Triad → DISTANT HEART SOUNDS, JVD, HYPOTENSION

Dx: Clinical Dx
ECHO = Gold (diastolic collapse of rt ventricle)
PULSUS PARADOXUS (narrow pulse pressure)
EKG →ELECTRICAL ALTERNANS + low volt QRS
CXR → water bottle sign

Tx: IV fluids + Pericardiocentesis
Decompression → Balloon Pericardiotomy and pericardial windows

58
Q

Compartment Syndrome

A

Patho: Pressure build up within the compartments
MC in Tibia
TRAUMA, snake bite

Presentation: PAIN, PARALYSIS, PARESTHESIA, PALLOR, PULSENESS, Poikilothermia (can’t regulate temp)

Dx: Measure pressure of compartment
>30-45 (normal = 0-8)
Delta Pressure = DBP - compartment pressure
Increase CK + myoglobin (muscle breakdown)

Tx: Emergency Faciotomy >30mm

59
Q

Bacterial Meningitis

A

Patho: Inflammation of the meninges due to bacteria
MC = Strep Pneumonia, Listeria Monocytogenes or N. Meningitidis (if pt has rash)

Presentation: FEVER + nuchal rigidity + HA
Photophobia

** ENCEPHALITIS = AMS + Petechiae)

Dx: LP
GLUCOSE <30
Increased Protein + increased OP
** (Bacteria love to eat the glucose) **

+ Kernig → knee extension = neck pain
+ Brudzinski → bend neck and leg raises

Tx: CEFTRIAXONE & VANCOMYCIN
>50: VANC + ROCEPHIN + AMPICILLIN

Household → Rifampin or Ciprofloxacin or Rocephin

Vax: Meningococcal Vax at 11-12 yrs + booster at 16 yo

** Viral → enterovirus or coxsackie → normal pressure and increased lymphocytes)

** Guillain Barre → Increased protein + normal glucose

60
Q

Cauda Equina

A

Patho: inflammation of the nerves at the end of the spinal cord
Ruptured disk in the lumbar spine

Presentation: “saddle anesthesia” + Urinary retention + fecal continuous + decrease/loss of sensation of lower extremities

Dx: MRI

Tx: Surgery → Lumbar Laminectomy + admission after

61
Q

Celiac Disease

A

Patho: Gluten Intolerance → inflammation of small bowel secondary to gluten
Autoimmune
Wheat, Rye, Barley = malabsorption

Presentation: Diarrhea, steatorrhea, gas, wt loss

Dx: IgA endomysial antibody (EMA) and Anti-Transglutaminase (anti-tTG) antibodies

IF (+) → Upper Endoscopy with Small Bowel Biopsy

Tx: Avoid Gluten + iron, B12, folate, calcium, Vit D supplements if needed

62
Q

Pericarditis

A

Patho: Inflammation of the pericardium

Presentation: Friction rub, Pleuritic chest pain worse lying down, better sitting up and leaning forward

Dx: CXR

EKG → Diffuse ST elevation
Tx: NSAIDS

63
Q

Intracranial hemorrhages

A

Patho: brain bleed → blood vessels rupture and causes a hematoma within the brain

Extra-axial: outside brain tissue
-Epidural Hematoma
Transient LOC then lucid
Middle Men
Lens shaped “E-E”

-Subdural Hematoma
Elderly falls
Crescent moon

-SAH
Worst HA oml

Intra-axial: inside brain tissue
- Intracerebral hemorrhage
HTN !!!
- Stroke like symptoms
Intraventricular hemorrhage
Presentation: headache possible nuchal rigidity or loc

Dx: CT head if normal LP

Tx: Surgery

64
Q

Central Rental Arterial Occlusion

A

Patho: Occluded flow through the CRA from embolism

Presentation: Sudde, PAINLESS, unilateral severe vision loss + CHERRY RED FOVEA

Dx: Fundoscopic exam

Tx: Emergent Ophthalmic Consult
Reduces IOP (Timolol or Acetazolamide)
Digital massage

65
Q

Acute otitis media + pneumonia symptoms tx?

A

Amoxicillin??

66
Q

DKA

A

Patho: increased acidity in blood Elevated blood sugar and
MC in DM1

5 I’s: infx, intoxication, infarction, illness, inap. Withdrawal of insulin

Presentation: N/V, Polydipsia, Polyuria, Wt. Loss + fruity breath
Kussmaul Breathing

Dx: Glucose >250, PH <7.3, + ketones in the bloodstream/urine →

BICARB <18 (bicarb is basic and DKA is acidic)

Tx: Fluids, Insulin

67
Q

Orchitis: (MCC?)

A

Patho: inflammation of testes due to bacteria from urinary tract

DIDN’T GET MMR VAX = MCC

Commonly present with epididymitis

Presentation: unilateral scrotal swelling, painful, tender swelling

Dx: UA with cultures → polyuria and bacteriuria

Tx: <35: Ceftriaxone + Doxy
>35: Levofloxacin

68
Q

Ramsey Hunt

A

Patho: Chickenpox or Shingles
Ramsey Hunt = shingles of facial nerve → facial palsy auditory symptoms

Presentation: ULCERATION OF EAR → ZOSTER OTICUS

Dx: Clinical or Tzanck SMear and multinucleated giant cells

Tx: Oral Acyclovir and Steroids

69
Q

Adrenal Insufficiency

A

Patho: Decreased Cortisol and Aldosterone, increased ACTH
Addison’s = AI disease
Secondary = Steroid use

Presentation: HYPERPIGMENTATION, CONSTIPATION, FATIGUE
HYPERkalemia and Hyponatremia

Dx: 8am cortisol + ACTH
Low Na = Aldosterone causes sodium reabsorption and potassium excretion = low aldosterone = low NA and high K)
Low glucose (bc cortisol stimulates gluconeogenesis)
CRH Stim. Test

Tx: Hydrocortisone + Fludrocortisone

70
Q

Depression

A

Patho: Decrease in Serotonin, Dopamine, and Norepinephrine

Presentation: sad, feeling down, worthless for > 2 weeks
“SIGECAPS”

Dx: Criteria

Tx: SSRI → increase dose every 3-4 weeks until symptoms are gone

SSRI’s:
Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Paroxetine (Paxil, Pexeva)
Sertraline (Zoloft)

71
Q

Bipolar 1

A

Presentation: MANIC EPISODES +/- depressive episodes

Dx: Criteria

Tx: Lithium (1st line), Valproate, SGAS (olanzapine, aripiprazole), carbamazepine

Maintence- SGAs, Gabapentin, Lamotrigine

72
Q

Psychosis Tx

A

Haloperidol, Risperidone, or Benzos

73
Q

Atrial Fibrillation

A

Presentation: palpations, syncope, dyspnea

Dx: EKG
No p wave
Irregularly Irregular

Tx: Diltiazem, Verapamil or Metoprolol

If <48 = cardiovert, amiodarone
>48 = anticoag for 21 days prior to cardiovert

Unstable Pt = synchronized cardiovert

what levels do you check with new onset afib? → TSH

74
Q

Atypical Pneumonia tx

A

Low risk → Amoxi or Azithro or Doxy

High risk → Augmentin or Levofloxacin

75
Q

Myasthenia Gravis

A

Patho: Decreased ACH → muscle weakness, Autoimmune,
Presentation: drooping eye (ptosis), worsening weakness throughout the day, fatigue, weak chewing

Dx: PLASMAPHERESIS
AchR antibodies, Muscle-specific serum kinase, LRP4 antibody
Single fiber electromyography

Tx: Acetylcholinesterase Inhibitor
Pyridostigmine/neostigmine
(Stops ACH breakdown)
Prednisone
Thymectomy <60 = curative

76
Q

Unstable Bradycardia

A

Transcutaneous Pacing

77
Q

Colles Fracture

A

Patho: distal radial fracture
Dinner Fork → posterior angulation

Presentation: FOOSH
Dx: XR → “Dorsally (upward) angulated”

Tx: Volar Splint or Sugar Tong at 15-30 degree extension

** Median Nerve can be injuried → index finger tingles **

78
Q

Pancreatitis

A

Patho: Inflammation of the pancreas → gallstones, trauma, alcohol, etc.

Presentation: epigastric pain radiates to back + bruising of flank + umbilical bruising

Dx: CT ab + Lipase
Xr → Sentinel Loops + Diminished bowel sounds

Tx: Acute → Supportive = IV Fluids, Pain control
Antibiotics, ERCP (if gallstones)

Pancreatic Pseudocyst (collection of fluid rich in pancreatic enzymes, blood, necrotic tissue)

**IF LIPASE IS MENTION → Pancreatitis

79
Q

MC Murmur with Endocarditis

A

Aortic Regurgitation

80
Q

MC organism from IVDU

A

Staph Aureus

81
Q

MC pt with endocarditis

A

IVDU

82
Q

If a person hates public speaking they have

A

Social Phobia

83
Q

TX for endocarditis:
- IVDU?
- Non-IVDU?
- Prosthetic Valve?

A
  • IVDU –> IV Nafcillin
  • Non-IVDU –> IV ampicillin + nafcillin + gentamicin
  • Pros.–> IV vancomycin + gentamicin + rifampin
84
Q

SJS

A

Patho: Sulfa/Anticonvulsants → Epidermal Necrosis

Presentation: “SLOUGHING OF THE SKIN” (+ Nikolsky)
<10%

Dx: Skin Biopsy
Serum Granulysin

Tx: Fluids + IVIG + Burn Unit

85
Q

PEMPHIGUS VULGARIS

A

Patho: Autoimmune Blistering ds → PAINFUL mucocutaneous lesions
Mediterranean/Jew

Presentation: Pain blisters/ulcer all over skin
Mouth, back, chest, cheeks, scalp

Dx: + NIKOLSKY
Immunofluorescence of serum
Biopsy → Acantholysis
IgG against DESMOSOMES → separates epidermis

Tx: ORAL PREDNISONE + Immunosuppressive agent, Azathioprine, Methotrexate

Refractory → Dapsone, Gold, Cyclophosphamide

86
Q

ITP

A

Patho: decrease platelets
Autoimmune → Splenic platelet destruction AFTER INFECTION

Presentation: Bleeding with low platelets
Petechia, Purpura, Mucosal Bleeding, easy bruising

Dx: CBC → platelets < 100,000

Tx: >30,000 = observe
<30,000 = Steroids
IVIG if can’t take steroids
Refractory = Splenectomy

87
Q

Autoimmune Hemolytic Anemia

A

Patho: AI → Following Viral infx

Presentation: Bruising + Petechiae on lower extremities

Dx: Schistocytes
(+ COOMBS TEST)
Elevated LDH
Elevated Indirect Hemoglobin

Tx: STEROIDS
Kids = No tx
Adult = IVIG
Splenectomy

88
Q

HTN Urgency vs Emergency

A

Patho: >180/120
Urgency = no end organ damage
Emergency = end organ damage

Presentation: HA, BLURRED VISION
EOD = Papilledema, retinal hemorrhages, ACI, encephalopathy, pulmonary edema, angina, hemorrhage

Tx:
Urgency → DO NOT TX IMMEDIATELY
Clonidine
Emergency → Must reduced within 1 hour
NITROPRUSSIDE + ICU
(or Nicardipine)
10-20% to prevent EOD
Target 1st hr → <180/120
Next 23 hrs → <160/110

89
Q

Glaucoma

A

Patho: Impaired aqueous flow

Presentation: PERIPHERAL VISION LOSS + cloudy cornea + red conjunctiva + fixed dilated pupil

Acute angle closure = SUDDEN pain + halos

Open angle = HTN/DM

Dx: Tonometry → Increased IOP
Cupping of optic nerve
Gonioscopy = Gold standard

Tx:
Acute Narrow-Angle Closure Glaucoma → IV Acetazolamide
BB → TIMOLOL

Chronic Open-Angle → Prostaglandin analogs (Latanoprost = increased outflow of humor)
BB

** All Pts screened at 40 yo **

90
Q

Aortic Stenosis

A

Patho: narrowing of aortic valve = reduces blood flow = makes heart work harder
Rheumatic Fever

Presentation: syncope, angina, dyspnea, “CRESCENDO-DECRESCENDO” RADIATES TO CAROTIDS
Radiates to neck + apex
Better leaning forward
Worse - valsalva + standing
Split S2

Dx: ECHO
EKG → LVH
CXR → Cardiomegaly, calcified valve, prom ascending aorta
BNP > 550
Helmet Cells (fragment RBC from AS)

Tx: surgery

91
Q

Reactive Arthritis

A

Patho: Reiters Syndrome → AI response from chlamydia/gonorrhea or GI infx

Presentation: UVEITIS, URETHRITIS, CONJUNCTIVITIS
Arthritis 2 or more joints

Dx: Clinical → joint pain + infx
HLA-B27
Synovial fluid = aseptic

Tx: NSAIDS +/- ABX

92
Q

ACL

A

Patho: rotational injury
Quick plant and twist

Presentation: “pop” + swelling + knee giving out

Dx: LACHMAN, Anterior Drawer, Lateral Pivot-Shift
MRI

Tx: Can do PT or Lifestyle in some patients
Surgery

93
Q

Mallory Weiss

A

Patho: throwing up → tear in esophagus at the gastroesophageal junction→ bleeding
Hx of alcohol
Presentation: PT DRINKS LOTS OF ALCOHOL → VOMITS
Dx: Upper Endoscopy
Tx: Self-Limiting
1st Line → UPPER GI ENDOSCOPY (both dx and tx)
Clipping (with adrenaline)
High Dose PPI (don’t give before endoscopy)
2nd line → Surgical Repair

94
Q

Epiglottis

A

Patho: H.influenza → inflammation of the Glottis
Emergency

Presentation: drooling, tripod position, respiratory distress, fever

Dx: Lateral Neck XR → Thumbprint
Elevated Lymphocytes

Definitive Dx → Laryngoscopy
Cherry Red epiglottis

Tx: Airway + IV Ceftriaxone or Vancomycin
Immunization!!

95
Q

Guillain Barre

A

Patho: COMMON AFTER CAMPYLOBACTER or immunization

Presentation: ascending paralysis that spreads upward after a recent infx

Dx: LP = elevated protein, normal WBC

Tx: Plasma exchange
IVIG

96
Q

Cluster HA

A

Patho: Alcohol can trigger

Presentation: UNILATERAL, SHARP< excruciating pain
Teary eyed, worse at night, repeat occurrences
Started in the eye
Awakes them from sleep

Dx: Clinical → Periorbital/Temporal pain

Tx: 100% OXYGEN + Sumatriptan
“Triptans” → relief
Verapamil = prophylaxis
Lithium(2nd)

97
Q

Hyphema

A

Patho: trauma → blunt/penetrating trauma → baseball, assault → tears the vessel of the ciliary body or iris

Presentation: Blood in anterior chamber of eye

Dx: Clinical Dx
CT if suspicious of globe fx
Ophthalmologist eval

Tx: RAISE HEAD OF BED + Eyeshield
Optho eval

** NO NSAIDS = Worsens **

98
Q

Papilledema

A

Patho: swelling of optic disc due to increased intracranial pressure
Malignant hypertension, thrombosis

Presentation: LOSS OF OPTIC DISC

Dx: LOOK for cause
MRI/CT → tumor, bleed, cerebral edema, CSF outflow obstruction
LP → Increased opening pressure

Tx: Treat underlying cause

99
Q

Allergic Rhinitis

A

Patho: inflammation and swelling of mucous of nose
Immunoglobulin E (IgE) mediated reactivity

Presentation: NASAL CREASE, BAGS UNDER THE EYES

Dx: History → skin tests or IgE can be done

Tx: H2 Blockers → Famotidine, Cimetidine, “dine”

Do not use nasal decongestants > 5 days → rebound
** Rhinitis Medicamentosa

100
Q

Testicular Torsion

A

Patho: Twist of the spermatic cord

Presentation: Severe lower abd. Pain that radiates to the thigh + vomiting

Hx of cryptorchidism
Elevated tested

Dx: testicular doppler US
(-) Prehn Sign
Loss of cremaster reflex
Blue Dot Sign

Tx: CALL UROLOGY → Orchiopexy → “Open-Book” technique to de-torse

101
Q

Prostatitis

A

Patho: E.COLI >35
<35 = Chlamydia/Gonarrhea
Inflammation of prostate

Presentation:
Fever, chills, urinary symptoms
Perineal/Low back pain
Warm, tender, enlarged prostate

Dx: (+) prehn sign
UA → Increased WBC
Cultures, US/CT, Blood Tests

Tx: <35: Ceftriaxone + Doxycycline
>35 → Bactrim or Azithromycin 4-6 weeks

102
Q

Thyroid Storm

A

Patho: Acute hyperthyroidism from untreated/inadequate treatment of hyperthyroidism
Graves Disease or Toxic Multinodular Goiter → infx, trauma, surgery, DKA, preeclampsia

Presentation: Fever, weakness, restlessness, confusion, psychosis, coma, nausea, vomiting, diarrhea, hepatomegaly, jaundice

Dx: Increased T3/T4, Decreased TSH

Tx: PROPYLTHIOURACIL

103
Q

Diabetes Insipidus

A

Patho: Decreased ADH
Central = Not being made
Nephrogenic = Kidneys not responding (Lithium)

Presentation: POLYURIA, POLYDIPSIA

Dx: Water Deprivation Test
SERUM OSMOL: HIGH
URINE OSMOL: LOW
Desmopression Stim Test →
Central = will decreased urine output
Nephrogenic = will not change

Tx: Central = Desmopressin
Nephrogenic = Na/Protein restriction
Hydrochlorothiazide, Indomethacin

ER ROTATION (4 decks)

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