Review with Michelle Flashcards
short term effects of lithium
LMN (loose stool, memory loss and nausea)
the most common cause of acute kidney failure?
dehydration
seizure med known for causing gingival hyperplasia?
Phenytoin (dilantin)
antibiotic most likely to cause c.dif?
Clindamycin
bug that causes whooping cough
bordatella
bilateral peripheral vestibular dysfunction
oscillopsia (blurring with head movement
two meds used to treat HTN with preclampsia
labetalol and methyldopa
uterine procidentia
uterus descends beyond vulva
Ethambutol an HIV drug can cause?
vision loss
stroke + fever =
endocarditis
how does the K+ level change in chronic renal failure?
increased serum potassium
cardiac nuclear scan looks for?
vessel patency
Romberg tests
proprioception of the posterior/dorsal column of the spinal cord
if patient is ataxic but romberg is negative what part of the brain is likely affected?
Cerebellum=soberity and balance
patient’s taking valproate (depakote) must have what labs drawn?
Liver enzymes
spontaneous pneumo is caused by
sub pleural apical bleb due to high negative pressure
test of choice for DVT
doppler and human’s sign….. it will be swollen
test of choice for arterial claudiation
arterial duplex scan
you say mesthelioma, I say…..
asbestos
Kleb pneumonia = what type of antibiotic
IV-cefoxamine
prognosis of lung CA with liver mets
horrible —-no resection
dull aching, heaviness, in LE brought on by standing
Venous thrombosis
pain in calf with ambulation
Claudication - Arterial
OSA can cause what heart problem
right sided heart failure
S1 references what heart valve?
mitral
bones, stones, and groins =
hypercalcemia
vitamin deficiency = smooth red tongue
B12 (also think neuropathy of hands and feet)
hemarthrosis means?
bleeding into joint space
glucose 6 phosphate deficiency
x linked genetic deficiency
primaquine is a anti malaria drug, it may trigger
hemolysis
Philly chromosome
CML ( philly sandwich: Cheese, Meat, or Long bread)
Hyperthyroid med
propylthiouracil (PTU)
most common cause of hyperthyroidism
graves
gentamicin is toxic to….
fetus and ears
brown recluse bite description
ring of pallor/bleb in middle
erythema nodosum
unknown cause, may be post viral.. located on shins, red spots/inflammation. linked to HLA-B27. may also appear with sarcoidosis.
McMurray tests what in the knee?
positive McMurray = torn medial/lateral meniscus
bladder infection but allergic to sulfa, best alternative antibiotic?
Ampicillin
define pulse pressure
difference between systolic and diastolic BP
RA-hand deformities
swan neck, button hook, boutonniere and ulnar deviation
uterine leiomyomas
common, benign, represent localized proliferation of smooth muscle cells surrounded by compressed muscle fibers
During inhalation _______valve abnormalities are heard?
Right side-tricuspid
During exhalation________valve abnormalities are heard?
Left sided- mitral valve
double bubble sign—GI imagining
Pylori stenosis
Seidel’s sign / Waterfall
Flurosein pouring out of ruptured globe
Cloudy cornea, mid-fixed pupil and firm
acute angle glaucoma
abnormal swing flashlight test
marcus-gunn
bloody diarrhea, occurs at night, and exacerbated at night
UC
how many fasting glucose tests to dx DM
2
Rheumatic fever causes what heart condition
mitral stenosis
type of murmur heard with cardiac rheumatic fever, mitral stenosis?
apical diastolic murmur
mono virus causes lymphadenopathy of what lymph chain
posterior chain
lab test to evaluate and dx hemochromatosis?
Ferritin and iron studies
I say Bence Jones, you say?
MM
Patient has known Aortic stenosis, can you do a treadmill stress echo?
No, do a drug stress echo
lung findings-Asbestosis
dyspnea, interstitial fibrosis of lower lobes, thickened pleura plaques
Asbestosis is a restrictive or congestive lung disease?
Restrictive
exposure to silica = lung findings
small rounded opacities throughout the lungs and calcified hilar lymph nodes
how do you dx nephrotic type of proteinuria
24 hour urine catch
I say polymyagia rheumatic, you say
giant cell arteritis
100% of dermatitis herpetiform have….
celiac dz
tx for chronic psoriasis
light treatment
dermatitis herpetiform is
papules on the extensor surface of elbow and knees
malignant otitis media
cellulitis with DM or other immunocompromised illnesses
most common genital tract malignancy in US
Endometrial carcinoma
most common cancer in the world
breast cancer
4 things to know w/ molar pregnancy
- painless bleeding 2. uterine size and date discrepancy 3. passage of tissue 4. exaggerated AM sickness
molimina
mild form of PMS-3 or 4 symptoms = fluid retention, fluctuation of mood, headache and food craving
why not use antihistamines for sinus infection?
impairs drainage
what CN may be effected with septic cavernous sinus thrombophlebitis?
3 (oculomotor), 4(trochlear), and 6(abducens)
how do you dx purulent otitis media?
needle aspiration
quinsy throat aka….
peritonsillar abscess. complication of of strep A
antibiotics for peritonsillar abscess
pen G with clindamycin or metronidazole
antibiotic for pneumonia bug h.flu and m.cat
levofloxacin
antibiotic for s.pneumo
erythromycin
antibiotic for m.pneuno
doxycycine
neuroleptic malignant syndrome (NMS)
abrupt withdrawal of antiparkinson drugs, many dopamine receptors go unfilled = muscular rigidity
psych med that reduces seizure threshold?
wellbutrin
uncommon psych disorder in which agitation progresses to muscle rigidity and hyperthermia
lethal catatonia
cat scratch fever
bartonella henslae, playing with cats
trench fever
bartonella quintana, human lice
carrion’s disease
bartonella bacilliformes , sand fly bites
symptoms of cat scratch fever
fever, lymph node enlargement, papule or pustule at inoculation site
beta lactam work by
inhibit transpeptidation of the cell wall
Macrolide (azithromycin) works by
50S ribosomal subunit
Sulfa drugs work by…
inhibit dihydropterate and folate reproduction
Tetracycline works by….
binds 30S ribosomal subunits
Quinolones work by….
inhibit DNA replication
“B” symptoms refer to what disease?
non-hodgkin lymphoma
Amiodarone side effect?
hypothyroidism
Tendons involved in DeQuervian’s tenosynovitis?
Extensor Pollcis brevis and abductor pollis tendon
Test performed to confirm DeQuerivian’s
Finkelstein
Test performed to confirm ruptured achilles tendon
Thompson, place pt is prone position legs off of table, squeeze calf and watch for planter flexion
Ligament involved in Game keepers thumb
ulnar collateral ligament
homen’s sign
make sure patient’s knee is flexed and then dorsiflex foot forcefully
1st line treatment for Abnormal uterine bleeding in a 40 year old?
Levonorgestrol IUD
Best imaging to dx a PE?
CT
What murmur can be heard best when pt is placed in left lateral decubitus position
mitral stenosis
isometric handgrip increases arterial & left ventricular pressure, this increases what type of murmur?
Aortic regurgitation
most common drug to cause pill induced esophagitis?
Ibuprofen
skin tags are associated with what syndrome?
metabolic syndrome
Lyme dz symptoms
fever, vomiting, meningeal sign, and photophobia
treatment for clostridium tetani?
Tetanus immuneglobin, tetanus toxoid, and metronidazole
Breathing pattern associated with DKA
Kussmaul
First line treatment for giant cell arteritis is high dose steroids, how many mg of prednisone? And what is the dx modality?
60mg, dx with biopsy
meconium ileus
cystic fibrous
when does pylori stenosis most often occur?
3 to 6 months old
most common cause of non traumatic subarachnoid hemorrhage
cerebral aneurysm
how long should a non-complicated shoulder dislocation be in a sling?
2 to 4 weeks
fall onto outstretched abducted arm =
shoulder dislocation, majority are anterior
Cullen’s sign
sign of retroperitoneal hemorrhage such as periumbicilical (Cullen’s sign)
Grey-Turner’s sign
flank ecchymosis, a sign of retroperitoneal hemorrhage
AAA larger than ____cm are at higher risk of rupturing
5cm
How is a AAA diagnosed?
US is unstable or CT is the gold standard if patient is stable.
Risk factors AAA?
Hypertension, congenital heart disease, pregnancy, Marfans or iatrogenic from cardiac cath
how dissections occur
Intima is damaged allowing blood to enter the media and dissect between the initial and adventitial layers, developing a false lumen.
Common sites of AAA?
ascending aorta and the region of the ligamentum arteriosum
Gold standard to dx AAA?
Angiography
ER care of AAA-control hypertension with…
B-Blockers
where are most of DVTs located?
80% are located in or proximal to the popliteal vein.
negative ELISA D-dimer tell you that….
97% sure there is no clot
Treatment for DVT?
low molecular weight heparins (LMWH)
Common low molecular weight heparins?
dalteparin, enoxaparin, and tinzaparin
what is phlegmasia cerulean dolens
is an uncommon severe form of dvt which results from extensive thrombotic occlusion of the major and the collateral veins of an extremity. It is characterized by sudden severe pain, swelling, cyanosis and edema of the affected limb.
common location for acute arterial occlusion?
femoropopliteal, tibial, aortoiliac, and brachiocephalic
treat acute arterial occlusion with?
unfractionated heparin, catheter embolectomy using Fogarty ballon. All patient’s should be admitted and placed on telemetry.
dilated myopathy causes what type of heart failure?
Systolic, due to dilatation of the ventricle
Aortic regurgitation causes what type of heart failure?
Systolic
Beriberi, anemia, thyrotoxicosis, and pheochromocytoma all cause what type of heart failure?
High output failure –high metabolic output
Where is BUN produced? When is it increased?
Produced in the liver as a byproduct of protein metabolism and secreted by kidneys. Increased in dehydration, GI bleeding, and if renal excretion of urea is decreased (renal failure)
BNP stands for? Level that suggests cardiac cause of dyspnea?
Brain natriuretic peptide >200 =coronary cause of dyspnea
BNP <100 and dyspnea = what type of etiology?
pulmonary
patient is 65 years old, anemic, has bone pain, proteinuria and renal failure, this is…..
Multiple myeloma
cushing’s syndrome is a disorder of ?
cortisol
true or false cushing’s syndrome can cause osteopenia?
true
needle shaped crystals?
gout
Aspiration of joint shows >50,000 cell count?
septic joint
you think a patient has a lower leg DVT, how is this dx?
LE Doppler US
what is more specific and sensitive a myocardial perfusion scan (MPI) or an exercise stress test?
myocardial perfusion scan, is a nuclear medicine procedure that illustrates the function of the heart muscle
Glucose level, CSF mononuclear, and total protein level in Viral meningitis will be increased or decreased?
Viral meningitis: Increase in mononuclear cells and total protein. Glucose may be normal
Is C-reactive protein elevated in viral or bacterial meningitis?
Bacterial, glucose will be low
patient is female with a hx of iritis and erythema nodosum, fever, malaise, and dyspnea. Think?
Sarcoidosis
Iritis is a hint for?
autoimmune disorders
most common congenital viral infection in US?
CMV
babies infected with CMV prior to birth will have:
hearing loss, visual impairment, mental retardation and enlargement of liver / spleen.
What is sarcoidosis
idiopathic disease, noncaseating granulomatous inflammation in affected organs. 90% have lung involvement.
Physiological changes during severe hypothermia
fixed pupils, ventricular fibrillation
palmar cord causing palmar flexion of 4th and 5th fingers
Dupuytren’s
Red reflex tests?
corneal clarity and retinal mass
test done for strabismus?
corneal light reflex and uncover/cover test
Corneal light reflex is used on PE to evaluate?
Strabismus
Patient has AIDS and interstitial infiltrates, what is the most common opportunistic infection in HIV?
Pneumocystis jiroveci (PCP pneumonia)
what can be used as prophylaxis for pneumocystis jiroveci in HIV patient when CD4 count is below 200?
Bactrim
Patient presents complaining of 12 plus weeks of laryngitis and a slight cough. She has a h/o mitral regurg. Indirect laryngoscopy performed in the office reveals vocal cords that do not move with phonation. what is the next step in her evaluation?
If the vocal cords do not move it is no longer an ENT problem, but a chest or left recurrent laryngeal nerve problem. It is possible that mitral regurg has caused increase of her marked enlargement of her atrium, putting tension on the nerve
What is the most common anomaly associated with coarctation?
Bicuspid aortic valve (congenital)
reduced HCO3 bicarbonate concentration on the ABG may be due to….
anytime there is a significant change in the HC03 you are looking at a metabolic problem. Loss of bicarb means a loss of a base, and would therefore cause a metabolic acidosis.
do changes in CO2 affect the metabolic or respiratory side of the equation?
respiratory
highest populations affected by sarcoidosis
north american blacks and northern europeans
Organs affected in sarcoidosis?
Lungs, lymph nodes, eyes, skin, liver, spleen, parotid glands, heart and nervous system
Symptoms of sarcoidosis?
fever, cough, chest discomfort, erythema nodosum, malasie
How do you dx sarcoidosis?
Transbronchial biopsy of the lung or fine needle node biopsy. It will show noncaseating granulomas
treatment for sarcoidosis?
steroids
What labs are elevated in sarcoidosis?
Eosinophilia, erythrocyte sedimentation rate, angiotensin-converting enzyme.
Frost bite 1st degree
freeze no blister
Frost bite 2nd degree
freeze + blister
3rd stage frost bite
freeze = dead skin
4th stage frost bite
full thickness including bone
treatment for high altitude sickness
descent, oxygen, dexamethasome, acetazolamide
antidote for acetaminophen
acetylcysteine
antidote for organophosphate
atropine
antidote for benzos
flumazenil
antidote for b-blockers
glucagon
antidote for CCB
calcium
Antidote for digoxin
digibind
antidote for heparin
protamine
antidote for narcotics
naloxone (narcan)
antidote for tricyclic antidepressants?
sodium bicaronate
antidote for warfarin?
vitamin K
what electrolyte abnormality causes paralytic ileus
hypokalemia
sudden painless complete vision loss eye with cherry red fovea. treatment?
this is central retinal artery occlusion
tx with ocular massage and acetazolamide ( same drug used for altitude sickness
what electrolyte abnormality goes with DKA
hyperkalemia and low bicarb
Type II DM, with infection, weakness, polydipsia, glucose >600 most likely has?
hyperosmolar hyperglycemic state
Hypoglycemia is BG <50, what is the treatment
IV glucose or IM glucagon, thiamine to alcoholics
Thyroid storm treatment
volume replacement. b-bloker, PTU, methimazole and steroids
EKG changes that occur with thyroid storm?
tachycardia, a fib or flutter and prolonged QRS
absent cremasteric reflex =
testicular torsion (this is a surgical fix)
what cardiac med is responsible for angioedema
ACE
do steroids help with steven johnson syndrome?
no, just stop the offending agent
treatment for staph scalded skin syndrome
tx nafacillin or oxacillin
pemphigus vulgaris
loss of cohesion between keratinocytes in the epidermis, classified as a type II hypersensitivity reaction (in which antibodies bind to antigens on the body’s own tissues). It is characterized by extensive flaccid blisters and mucocutaneous erosions. Tx is fluids and steroids
1 cause of hypercalcemia?
primary hyperparathyroidism
2 cause of hypercalcemia?
malignancies
cardiac symptoms of hypercalcemia
short QT, bradycardia, hypertension
band keratopathy in the eye are associated with what electrolyte abnormality?
hypercalcemia
a patient with vomiting, lower chest pain and subcutaneous emphysema most likely has?
Esophageal rupture (boerhaaves syndrome)
tx for esophageal rupture?
NPO, IV antibiotics and surgery
What drug do you give for any pulseless rhythm?
Epi 1mg
what drug do you give for SVT?
Adenosine 6-6-12mg
What drug do you give for bradycardia?
Atropine 0.5-1mg
what node does atropine excite?
AV node
Patient presents with torsades de points
give Mg 1-2grams
For VF and pulseless VT give?
vasopressin
Hypertensive emergency give?
IV labetalol and IV Nitroprusside
What type of aortic dissection is fixed surgically?
Type A (ascending aorta)
most likely cause of metabolic alkalosis
vomiting-volume depletion
what is the pH and bicarb level in metabolic alkalosis
pH is >7.45 and bicarb is >26
Treatment for metabolic alkalosis?
acetazolamide ( this is also given for altitude sickness and central retinal artery occlusion
Name two conditions that cause Carpopedal spasm (painful contractions with adduction of the thumb, flexion of MCP joint, extension of the IP joints and flexion of the wrist)
Hypocalcemia and Respiratory acidosis
what are level of Ca+ that are considered hypo and hyper?
hypo <11
most common cause of hypocalcemia?
Chronic kidney disease, others include: hypoalbuminemia, hypoparathyroidism, vitamin d deficiency and low Mg
Signs and symptoms of hypocalcemia?
Tetany, tingling paresthesias and carpopedal spasm
A patient with MM is found to have hypercalcemia, what is the first line treatment?
Glucocorticoid steroids
Name 3 treatments for hypercalcemia
- Hydration to diruesis 2. IV biphosphonates to inhibit osteoclasts 3. Calcitonin
asthmatic attack will show what on ABGs?
respiratory acidosis
how does BiPAP help asthmatics
lowers the CO2 level
treatment for hypocalcemia
calcium chord of calcium gluconate
chvostek’s sign, what electrolyte imbalance is it testing?
tap the cheek causes contraction, hypocalcemia
Trousseau’s sign
hypocalcemia, use BP cuff to induce carpel spasm
EKG findings with hypocalcemia?
QT is prolonged (quite tense and longing for ca+)
Respiratory acidosis pH level and CO2 level
pH 45
guillian barre and myasthenia gravis will have what type of acid/base disorder?
respiratory acidosis
pH >7.45 and pCO2 <35
respiratory alkalosis
A patient presents with symptoms of pituitary tumor, what is the next step in evaluating whether or not this tumor is causing bitemporal hemianopsia?
since the question is asking about vision the next step is to formally evaluate peripheral field testing. Adenomas that affect the optic chiasm may cause irreversible vision changes.
Peripheral blood cell count in AIDS are best characterized as?
Decreased helper T cells and Lymphopenia
name the splint for the scaphoid fracture
thumb spica splint, refer to ortho
kiddo swallows battery- next step?
esophagogastroduodenoscopy b/c battery can cause a caustic erosion of the esophagus
Explain S4?
S4 is the sound of blood ejected during atrial contraction and striking the stiff ventricular wall of hypertrophy or stunned myocardium
If S4 is the sound of blood hitting the stiff enlarged ventricle or stunned myocardium. What heart conditions will you hear S4
Left or right Ventricle hypertrophy (heart failure), post MI, and cor pulmonale
If thyroid gland and parathyroid is removed, why may a patient have a positive chvostek sign?
Likely to have hypocalcemia, b/c parathyroid is responsible for calcium regulation
what does the Glasgow coma scale measure
Best eye movement, verbal response, and motor response
One category of the GCS is eye response, name the 4 levels of eye movement
1pt. no eye opening
2pt. eyes open to pain
3pt. eyes open to verbal response
4pt. eyes open spontaneously
Name the 5 levels of motor response according to the GCS
1pt. no response
2pt. extension to pain
3pt. flexion to pain
4pt. withdrawal to pain
5pt. localizes to pain
6pt. obeys commend
Name the 5 levels of verbal response according to the GCS
1pt no verbal 2pt incomprehensible sounds 3pt inappropriate sound 4pt confused 5pt orientated
What class of drug is Verapamil
CCB
what are CCB avoided in CHF
significant negative inotropic effect and reduces the EF and CO
What CCB is sometimes used in CHF due to it’s semi positive effects on contractility?
Amlodipine
what tests are the most S&S for RA?
CCP (cyclic citrullinated peptide) is 96%
Cholesteatoma
destructive/expanding growth consisting of keratinizing squamous epithelium in the middle ear and/or mastoid process. Can still cause problems because of their erosive and expansile properties resulting in the destruction of the ossicles and spread through the base of the skull into the brain.
