REMEDIATION Flashcards
Achilles Rupture
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
Pneumocystis Pneumonia
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)
Giardia
Patho: parasite in poor sanitation/unsafe water
- Loss of intestinal epithelial barrier
Presentation: camper’s diarrhea
Bloody diarrhea
Watery, foul smelling diarrhea
Tx: Metronidazole
Sickle Cell Anemia
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
Von Willebrand Disease
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
BPPV
Patho: Vertigo with positional changes
Presentation: positional vertigo NO HL, Tinnitus, or Ataxia
Dx: Dik-Hallpike
Tx: Epley Maneuver
Meclizine or BENZOS (DIAZEPAM)
Placenta Abruption
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
Posterior Shoulder DL
Patho:
SEIZURES
Presentation: Arm in INTERNAL rotation + ADDUCTED
Dx: Light-bulb sign on XR (AP or scapular Y)
Tx: Closed reduction + post reduction films
DVT
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
Priapism
Patho: MC in 30s, Sickle Cell pts
Trazodone, cocaine, Spider bite, scorpion bite
Presentation: prolonged erection (>4hr)
Dx: Clinical
Tx: PHENYLEPHRINE INJX
Vasovagal Syncope
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
AAA
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
Dressler Syndrome
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
CHF
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
Corneal Ulcer
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
Peptic Ulcers (included RUPTURED)
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
what levels do you check with new onset afib?
TSH
Post MI –> what reduces mortality
ASA
+ straight leg raise –> tx?
NSAIDS
Shoulder ligament (bicep tendonitis pain) –> tx?
NSAIDS
Elevated Lipase (>140/160) –>
Pancreatitis
What are the components of a tetanus vaccine?
Tetani, Pertussis, Diphtheria
Patient bleeding + isolated thrombocytopenia (low platelets)
Idiopathic thrombocytopenia purpura
Pt with anemia + increased LDH + schistocytes
Autoimmune Hemolytic Anemia
If woman is excessively bleeding what test needs to be ordered?
Pregnancy Test
Anechoic US –>
Hydatidiform Mole (molar preg)
HTN Emergency tx –>
Nicardipine
UVEITIS, URETHRITIS, CONJUNCTIVITIS
+ joint pain
Reactive Arthritis
Lachman’s Test
ACL
Pt drinks lots of alcohol + vomits, now bleeding –>
Mallory Weiss
Initial tx for epiglottitis
Intubate (airway)
Pt’s O2 is ~ 90% –> 1st step
airway
MC cause of Guillain Barre
Campylobacter
Hep B
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
Essential Tremor
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
HPV (Quadrivalent Vaccine)
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
Worst sign of injury regarding the spinal cord?
Loss of rectal tone
Pt comes in with a back injury and cannot pee –> order ? –> concerned for ?
MRI –> Cauda Equina
Pt gets diarrhea after every meal
Celiac Ds
Kid who is always wheezing
Asthma
Definitive test for an asthmatic patient?
Pulmonary Fnx Test
Pt swallows a battery, stuck where?
Right Main Bronchus
Cause of Orchitis
Not getting MMR vax
Manic Symptom
Irritability
Mallot Finger
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
What happens if you don’t splint mallet finger?
Swan Neck Deformity
Finkelstein
DeQuerves Tendosynovitis
Tx for Bradycardia
Atropine
Distant heart sounds, JVD, Hypotension =
Beck’s triad –> Cardiac Tamponade
Patient rollover golf cart wreck, pulseless, paresthesia in limbs → Check for ?
Compartment Syndrome
LP Glucose <30 =
Tx?
Bacterial Meningitis
-Ceftriaxone + Vancomycin
List 4 MC NSAIDS
Ibuprofen
Naproxen
Diclofenac
Celecoxib
Cherry Red Fovea indicates
Central Retinal Artery Occlusion
HYPERPIGMENTATION, CONSTIPATION, FATIGUE
Adrenal Insufficiency –> Addisons
TX for depression
SSRI
Bacterial Pneumonia
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**
Pneumothorax
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`
Cardiac Tamponade
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
Compartment Syndrome
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
Bacterial Meningitis
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
Cauda Equina
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
Celiac Disease
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
Pericarditis
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
Intracranial hemorrhages
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
Central Rental Arterial Occlusion
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
Acute otitis media + pneumonia symptoms tx?
Amoxicillin??
DKA
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
Orchitis: (MCC?)
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
Ramsey Hunt
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
Adrenal Insufficiency
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
Depression
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)
Bipolar 1
Presentation: MANIC EPISODES +/- depressive episodes
Dx: Criteria
Tx: Lithium (1st line), Valproate, SGAS (olanzapine, aripiprazole), carbamazepine
Maintence- SGAs, Gabapentin, Lamotrigine
Psychosis Tx
Haloperidol, Risperidone, or Benzos
Atrial Fibrillation
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
Atypical Pneumonia tx
Low risk → Amoxi or Azithro or Doxy
High risk → Augmentin or Levofloxacin
Myasthenia Gravis
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
Unstable Bradycardia
Transcutaneous Pacing
Colles Fracture
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 **
Pancreatitis
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
MC Murmur with Endocarditis
Aortic Regurgitation
MC organism from IVDU
Staph Aureus
MC pt with endocarditis
IVDU
If a person hates public speaking they have
Social Phobia
TX for endocarditis:
- IVDU?
- Non-IVDU?
- Prosthetic Valve?
- IVDU –> IV Nafcillin
- Non-IVDU –> IV ampicillin + nafcillin + gentamicin
- Pros.–> IV vancomycin + gentamicin + rifampin
SJS
Patho: Sulfa/Anticonvulsants → Epidermal Necrosis
Presentation: “SLOUGHING OF THE SKIN” (+ Nikolsky)
<10%
Dx: Skin Biopsy
Serum Granulysin
Tx: Fluids + IVIG + Burn Unit
PEMPHIGUS VULGARIS
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
ITP
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
Autoimmune Hemolytic Anemia
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
HTN Urgency vs Emergency
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
Glaucoma
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 **
Aortic Stenosis
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
Reactive Arthritis
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
ACL
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
Mallory Weiss
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
Epiglottis
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!!
Guillain Barre
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
Cluster HA
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)
Hyphema
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 **
Papilledema
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
Allergic Rhinitis
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
Testicular Torsion
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
Prostatitis
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
Thyroid Storm
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
Diabetes Insipidus
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
