SmartyPance Q's Flashcards
treatment for acute prostatitis
FQ’s or TMP-SMX for 4-6 weeks
s/s of Rickettsia?
fever, chills, headache, rash
rash develops 2-4 days after fever begins
what disease is caused by Rickettsia rickettsii?
Rocky Mountain Spotted Fever
s/s of acute glacoma
acutely painful eye elevated intraocular pressure acute eye pain w/ unilateral headache n/v cloudy vision colored rings around lights
Acute glaucoma is an ocular emergency that presents as an acutely painful eye and elevated intraocular pressure. Patients typically complain of acute eye pain associated with unilateral headache, nausea/vomiting, cloudy vision, and colored rings around lights. On exam the pupil is fixed and mid dilated with prominent ciliary flush.
thin frothy/bubbly pale yellow-green to gray vaginal discharge,
may have petechiae on cervix,
amine odor may be present
pH 5-6.5
trichomonas vaginitis
A football player complains of burning pain, numbness, and tingling extending from the left shoulder down into the hand after he tackled a player. These symptoms resolved spontaneously in minutes. Following resolution of the symptoms, he has full strength and normal sensation in the left arm. What is the most likely etiology of his symptoms?
stretching of nerve roots and brachial plexus
Brachial plexus neurapraxia, commonly called “stinger” injuries, results from stretching of the cervical nerve roots and brachial plexus by a mechanism such as that described in this question.
best imaging for subarachnoid hemorrhage (pt presents with “worst headache of her life”)
CT scan
A 68 year-old male with history of COPD is brought to the emergency department following a motor vehicle collision. On physical examination there is evidence of head trauma. The left side of the chest wall appears to move inward with inspiration and outward with expiration. A chest x-ray reveals multiple rib fractures on the left. Which of the following is the most appropriate intervention?
endotracheal intubation and mechanical ventilation
Indications for early endotracheal intubation and mechanical ventilation in treatment of flail chest include patients that are over the age of 65, have comorbid lung disease and associated severe head trauma. Other indications include shock, three or more associated injuries and fracture of eight or more ribs.
In a patient with amaurosis fugax what is the most appropriate initial diagnostic study?
carotid ultrasound
amaurosis fugax usually = atherosclerotic plaque in carotid artery, i.d.’d with u/s
In the treatment of alcohol-related hypoglycemia, thiamine is administered before glucose to prevent which of the following?
Wernicke’s encephalopathy
Alcoholics are typically deficient in thiamine. If glucose alone is given to treat hypoglycemia, Wernicke’s encephalopathy can be precipitated since thiamine is not available for nutritional purposes when glucose is replaced. Therefore, thiamine is always given prior to glucose until a satisfactory diet can be given in order to prevent Wernicke’s encephalopathy.
A 3-year-old boy is seen in the office with a 5-day history of fever, erythema, edema of the hands and feet, a generalized rash over the body, bilateral conjunctival injections, fissuring and erythema of the lips, and cervical adenopathy. Antistreptolysin O (ASO) titer and throat culture are negative. The most serious systemic complication associated with this disorder is
cardiac
The patient most likely has Kawasaki syndrome. The major complication with this disorder is coronary artery aneurysms, which are reported in up to 20% of affected children. The etiology of this disorder is uncertain, although a bacterial toxin with super antigen properties may be involved.
pharyngitis pt with small grayish vesicles and punched-out ulcers probably has which virus?
coxsackievirus
Coxsackievirus presents with small grayish vesicles and punched-out ulcers in the posterior pharynx.
primary sign of Tetralogy of Fallot
cyanosis (progressing cyanosis)
Which of the following drugs is first-line therapy for schizophrenia?
chlorpromazine (thorazine)
clozapine (clozaril)
haloperidol (haldol)
olanzapine (Zyprexa)
Olanzapine (Zyprexa)
Initial pharmacologic therapy of schizophrenia should begin with one of the newer, “atypical” antipsychotic drugs, such as olanzapine, risperidone, quetiapine, and ziprasidone because their side effect profile is significantly better than the older drugs, and they may be more effective for negative psychotic symptoms.
a fracture of the proximal ulna with anterior dislocation of the radial head.
Monteggia fracture
A 20-year-old male presents with a mass in the groin. On examination with the patient standing, a mass is noted that extends into the scrotum. The patient denies any trauma. The most likely diagnosis is
a) an indirect inguinal hernia
b) direct inguinal hernia
c) obturator hernia
d) femoral hernia
indirect inguinal hernia
An indirect inguinal hernia is caused by a patent processus vaginalis and the hernial contents may be felt in the ipsilateral scrotum.
A 28-year-old female, who has experienced occasional painful migratory arthralgias, complains now of a tender, swollen, and hot left ankle. The joint was aspirated and the synovial fluid showed 55,000 WBCs, 75% polymorphonuclear leukocytes, low glucose level, and no crystals. Which of the following would be the most likely diagnosis?
a) RA
b) septic arthritis
c) gouty arthritis
d) osteoarthritis
septic arthritis
Septic arthritis presents with a large number of WBCs, predominantly polymorphonuclear, and with glucose levels much lower than serum levels.
use of systemic corticosteroids can cause what adverse effect in the eye?
glaucoma
Acute rebound hypertensive episodes have been reported to occur with the sudden withdrawal of
a) verapamil
b) lisinopril
c) clonidine
d) HCTZ
clonidine
Clonidine (Catapres) is a central alpha agonist and abrupt withdrawal may produce a rebound hypertensive crisis.
A 72-year-old female presents with vulvar pruritus for the last nine months, which has progressively worsened over the last two months. She states that she went through menopause at age 54 and has been on estrogen and progesterone therapy since that time. Physical examination reveals red lesions with white plaques on the vulva. What should the next course of management include?
refer to a gynecologist for biopsy
Vulvar squamous cell hyperplasia causes thickening and hyperkeratosis of the vulva. The lesions are red and moist and cause intense pruritus over time the area becomes thickened and a white plaque may develop. Biopsy must be done to evaluate for intraepithelial neoplasm or invasive tumor.
The most common causes of transudative pleural effusions in the United States
heart failure
and
cirrhosis
The finding of egophony is most consistent with
lobar pneumonia
Egophony occurs with consolidation caused by lobar pneumonia
A patient presents with edema, which is most noticeable in the hands and face. Laboratory findings include proteinuria, hypoalbuminemia, and hyperlipidemia. The most likely diagnosis is
nephrotic syndrome
Proteinuria, hyperlipidemia, and hypoalbuminemia are consistent with nephrotic syndrome.
Which of the following can be used to treat chronic bacterial prostatitis?
penicillin
cephalexin
nitrofurantoin
levofloxacin
levofloxacin
Chronic bacterial prostatitis (Type II prostatitis) can be difficult to treat and requires the use of fluoroquinolones or trimethoprim-sulfamethoxazole, both of which penetrate the prostate.
A 25-year-old male with a history of syncope presents for evaluation. The patient admits to intermittent episodes of rapid heart beating that resolve spontaneously. 12 Lead EKG shows delta waves and a short PR interval. Which of the following is the treatment of choice in this patient?
radiofrequency catheter ablation
Radiofrequency catheter ablation is the treatment of choice on patients with accessory pathways, such as Wolff-Parkinson-White Syndrome.
Gallstones usually result in biliary symptoms by causing inflammation or obstruction following migration into the common bile duct or
cystic duct
Obstruction of the cystic duct by gallstones causes the typical symptom of biliary colic. Once obstructed the gallbladder distends and becomes edematous and inflamed. Gallstones can also migrate into the common bile duct through the cystic duct leading to a condition known as choledocholithiasis.
An elderly patient with poorly-controlled Type 2 diabetes and renal disease develops a fever of 102°F orally, productive cough, and dyspnea. Physical examination demonstrates a respiratory rate of 32/min, labored breathing, and rales at the left base. Pulse oximetry is 90%. Which of the following is the next appropriate step in the management of this patient?
a) administer nebulized corticosteroids
b) admit to hospital
c) oral antimicrobial therapy
d) endotracheal intubation
ADMIT TO HOSPITAL
Community acquired pneumonia is the most deadly infectious disease in the U.S. Important risk factors for increased morbidity and mortality include advanced age, alcoholism, comorbid medical conditions, altered mental status, respiratory rate greater than 30 breaths/min, hypotension, and a BUN greater than 30.
An 80-year-old female presents with pain in her vertebral column. Radiography reveals compression fracture of T12 that is consistent with an osteoporotic compression fracture. Which treatment modality has the potential to cause analgesia of the fracture site with its use?
Calcitonin (Miacalcin) nasal spray
Calcitonin has the ability to cause analgesia when used for acute compression fracture of the vertebral body.
A 29-year-old patient with idiopathic thrombocytopenia purpura (ITP) is treated with prednisone therapy. Despite therapy, platelet counts remain consistently below 20,000/microliter over the course of 6 weeks. Which of the following is the most appropriate intervention for this patient?
splenectomy
Persistently low platelet counts (less than 20,000) require effective long-term treatment, and splenectomy is the treatment of choice.
A 57-year-old male was working on his farm when some manure was slung hitting his left eye. He presents several days after with a red, tearing, painful eye. Fluorescein stain reveals uptake over the cornea looking like a shallow crater. Which of the following interventions would be harmful?
a) ophthalmic antibiotics
b) pressure patch
c) exam for visual acuity
d) copious irrigation
b) pressure patch
Patching of the eye after abrasion associated with organic material contamination is contraindicated due to increased risk of fungal infection.
Which of the following physical examination findings would be consistent with a pleural effusion?
hyperresonance to percussion
increased tactile fremitus
unilateral lag on chest expansion
egophony
unilateral lag on chest expansion
A lag on chest expansion may be seen in the presence of a pleural effusion.
(The presence of egophony would be consistent with a consolidation.)
A 53-year-old male is seen in the emergency department following a motor vehicle collision in which his knee impacted against the dashboard. The patient has a posterior knee dislocation that is promptly reduced in the emergency department. The patient currently has a palpable pulse in the dorsalis pedis and posterior tibial areas. Which of the following studies is mandatory?
a) anterior plain film of knee
b) sunrise view of knee
c) measurement of compartment pressures
d) angiography
ANGIOGRAPHY
The popliteal artery is at risk for injury whenever a patient sustains a posterior dislocation of the knee and should be evaluated with an arteriogram despite the presence of pedal pulses.
A 70-year-old presents with headache and neck stiffness. On physical exam, the patient is febrile, Kernig’s sign is present, and no rash is noted. A spinal tap reveals a white count of 250/cm3 with 100% neutrophils, total protein 250 mg/dL, and glucose 35 mg/dL. Which of the following is the most appropriate treatment?
AMPICILLIN AND CEFTRIAXONE (ROCEPHIN)
Ampicillin and ceftriaxone is used to treat bacterial meningitis, secondary to Listeria monocytogenes , which is common in the elderly. Ceftriaxone will cover other common etiologic agents such as Streptococcal pneumonia.
A 62-year-old male presents with complaints of vague epigastric abdominal pain associated with jaundice and generalized pruritus. Physical examination reveals jaundice and a palpable non-tender gallbladder, but is otherwise unremarkable. Which of the following is the most likely diagnosis?
a) viral hepatitis
b) pancreatic cancer
c) acute cholecystitis
d) Gilbert’s syndrome
PANCREATIC CANCER
Pancreatic cancer is suggested by the vague epigastric pain with the jaundice resulting from biliary obstruction due to cancer involving the pancreatic head. The presence of a palpable non-tender gallbladder (Courvoisier’s sign) also indicates obstruction due to the cancer.
Which of the following rotator cuff tendons is most likely to sustain injury because of its repeated impingement (impingement syndrome) between the humeral head and the undersurface of the anterior third of the acromion and coracoacromial ligament?
a) supraspinatus
b) infraspinatus
c) teres minor
d) subscapularis
SUPRASPINATUS
A critical zone exists for the supraspinatus tendon due to its superior insertion site. It is susceptible for injury because it has a reduction in its blood supply that occurs with abduction of the arm. Impingement of the shoulder is most commonly seen with the supraspinatus tendon, the long head of the biceps tendon and/or the subacromial bursa.
A 75-year-old woman presents to the office with complaint of vision loss. Examination reveals a palpable cord in the temporal region. Which of the following is the most helpful initial test to order on this patient?
a) carotid u/s
b) chest xray
c) complete blood count
d) ESR
ESR
The patient is suspected of having temporal arteritis. This disease is most commonly noted in patients over age 50 and should be suspected in patients with sudden vision loss and a palpable cord in the temporal region. Erythrocyte sedimentation rate is almost always increased in this disease.
A 33-year-old male presents to your office with a complaint of right knee injury associated with pain and swelling. He states he was running after his loose dog and suddenly stopped, hyperextended his knee, heard a pop and noticed immediate swelling. On physical examination, the Lachman test and anterior drawer test demonstrates joint laxity. Which ligament is most likely injured?
ANTERIOR CRUCIATE LIGAMENT
Anterior cruciate ligament injuries occur with sudden deceleration injuries. Patients often hear a pop and the diagnosis is aided by assessing the anterior drawer test and Lachman test. The immediate swelling as well as laxity with anterior drawer test and Lachman test should raise suspicion of anterior cruciate ligament injury.
hematuria, cola-colored urine, oliguria, and edema of the face and eyes in the morning
glomerulonephritis
Glomerulonephritis presents with hematuria, cola-colored urine, oliguria, and edema of the face and eyes in the morning. Urinalysis reveals red blood cells, mild proteinuria and red blood cell casts. Glomerulonephritis can occur 1-3 weeks after a strep infection.
A 25-year-old male presents to the emergency department for evaluation of a wound on his hand. He cut his hand while tearing down a chicken coop. On examination of his right hand you note a dirty 3 cm jagged laceration. The patient is unaware of his tetanus immunization status. Besides cleaning and debriding the wound, what is the recommended clinical intervention in this patient?
ADMINISTER TETANUS-DIPTHERIA TOXOID (Td) AND TETANUS IMMUNE GLOBULIN (TIG)
Td or Tdap with TIG is recommended as tetanus prophylaxis in a patient with a contaminated wound and unknown tetanus vaccination status.
A 57-year-old male recently on a high protein diet presents with an exquisitely tender, erythematous, warm right great toe. What is the treatment of choice for this patient?
NSAIDs
Nonsteroidal antiinflammatory drugs (NSAIDs) are the drugs of first choice in most settings. There is no evidence that one NSAID is superior to another in the treatment of gout. Systemic corticosteroid therapy can be used for patients with acute polyarticular gout who have not responded to other therapies as well as for patients in whom other therapies are contraindicated. Intra articular injections of corticosteroid medication are usually effective in patients with acute monoarticular gout.
Which of the following is a cause of acute kidney failure due to prerenal azotemia?
excessive diuresis
urinary tract obstruction
radiologic contract media
aminoglycosides
EXCESSIVE DIURESIS
Prerenal azotemia is due to renal hypoperfusion which can occur with intravascular volume depletion such as excessive diuresis, hemorrhage, and gastrointestinal losses.
A 49-year-old female presents complaining of several episodes of chest pain recently. Initial ECG in the emergency department shows no acute changes. Two hours later, while the patient was having pain, repeat electrocardiogram revealed ST segment elevation in leads II, III, and AVF. Cardiac catheterization shows no significant obstruction of the coronary arteries. What is the treatment of choice in this patient?
NIFEDIPINE
This patient is most likely having coronary artery spasm. This can be treated prophylactically with calcium channel blockers such as nifedipine.
what is the gross rupture of membranes in the presence of cervical dilation?
inevitable abortion
characteristic of threatened abortion
bleeding in the first trimester without loss of fluid or tissue
describe incomplete abortion
Incomplete abortion is when the cervical os is open and allows passage of blood. The products of conception may remain in utero or may partially extrude through the open os.
A 50-year-old male with history of alcohol abuse presents with complaint of worsening dyspnea. Physical examination reveals bibasilar rales, elevated jugular venous pressure, an S3 and lower extremity edema. Chest x-ray reveals pulmonary congestion and cardiomegaly. Electrocardiogram shows frequent ventricular ectopy. Echocardiogram shows left ventricular dilatation and an ejection fraction of 30%. Which of the following is the most likely diagnosis in this patient?
hypertrophic cardiomyopathy
dilated cardiomyopathy
restrictive cardiomyopathy
Takotsubo cardiomyopathy
DILATED CARDIOMYOPATHY
Dilated cardiomyopathy is often caused by chronic alcohol use. It is characterized by signs and symptoms of left-sided heart failure, a dilated left ventricle and decreased ejection fraction.
What diarrhea-causing pathogen is linked to Guillain-Barre syndrome?
CAMPYLOBACTER JEJUNI
Campylobacter jejuni is a Gram-negative bacteria that has been linked to the subsequent development of Guillain-Barré syndrome (GBS). GBS usually develops two to three weeks after the initial illness.
treatment for respiratory tract carriage of Bordetella pertussis
AZITHROMYCIN
Azithromycin terminates respiratory tract carriage of Bordetella pertussis.
A 28-year-old female comes to the office with fever, flank pain, and dysuria for the past two days. Which of the following urinalysis results are suggestive of acute pyelonephritis?
WHITE CELL CASTS
White cell casts are indicative of renal infection or inflammation as seen in pyelonephritis or interstitial nephritis.
Which medication is considered the mainstay of therapy for mild to moderate inflammatory bowel disease?
ondansteron
sulfasalazine
metronidazole
azothioprine
SULFASALAZINE
Sulfasalazine and other 5-aminosalicylic acid drugs are the cornerstone of therapy in mild to moderate inflammatory bowel disease as they have both anti-inflammatory and antibacterial properties.
A 59-year-old male with history of hypertension and dyslipidemia presents with complaint of substernal chest pain for two hours. The pain woke him from sleep, does not radiate, and is associated with nausea and diaphoresis. Electrocardiogram reveals ST segment elevation in leads II, III, and AVF. Which of the following walls of the ventricle is most likely at risk?
a) anterior
b) inferior
c) lateral
d) posterior
INFERIOR
Inferior wall myocardial infarction is characterized by ST segment elevation in leads II, III and AVF.
A 47 year-old perimenopausal female with vasomotor symptoms complains of vulvar itching and copious vaginal discharge with a rancid odor. Physical examination reveals erythema of the vulva and petechiae on the cervix. The pH of the vaginal discharge is five. Which of the following is the recommended treatment for this patient?
a) topical metronidazole
b) oral fluconazole
c) topical estradiol
d) oral metronidazole
ORAL METRONIDAZOLE
This is a classic description of trichomonas vulvovaginitis. This condition must be treated with oral metronidazole or tinidazole.
A 70 year-old male with history of ischemic cardiomyopathy presents with a syncopal episode. He denies complaints of chest pain, palpitations, or dyspnea. ECG shows no acute ST-T wave changes. Echocardiogram reveals an ejection fraction of 25% with no valvular abnormalities. Which of the following is the most appropriate management for this patient?
a) dual chamber permanent pacemaker
b) diltiazem
c) implantable cardio defibrillator
d) midodrine
IMPLANTABLE CARDIO DEFIBRILLATOR
This patient has ischemic cardiomyopathy and syncope, which is most likely due to ventricular tachycardia. Instertion of a cardio defibrillator is the management of choice in this patient.
A 25 year-old female presents with a three day history of chest pain aggravated by coughing and relieved by sitting and leaning forward. She is febrile and a CBC with differential reveals leukocytosis. Which of the following physical examination signs is characteristic of her problem?
a) pulsus paradoxus
b) localized crackles
c) pericardial friction rub
d) wheezing
PERICARDIAL FRICTION RUB
Pericardial friction rub is characteristic of an inflammatory pericarditis.
A 3 year-old child playing in an abandoned shed is bitten by a black widow spider. The mother rushes the child to the emergency department within 20 minutes of the incident. Which of the following if the best initial intervention?
a) intramuscular steroids
b) administration of antivenin
c) immediate immersion in a cold bath
d) hospital admission for symptomatic care
HOSPITAL ADMISSION FOR SYMPTOMATIC CARE
Hospital admission for symptomatic care should be considered in children, pregnant women, and patients with preexisting cardiovascular disease.
A 22 month-old male infant presents with one day of barking cough preceded by three days of cold symptoms. On physical examination, his axillary temperature is 100.4°F and he has no stridor at rest. Inspiratory stridor is evident when he becomes agitated during the examination. There are no signs of respiratory distress or cyanosis. What is the most appropriate treatment for this patient?
ORAL DEXAMETHASONE
Corticosteroids are beneficial in the treatment of croup. Intramuscular administration has shown no benefit over oral administration.
A 58 year-old female presents with acute onset of 105 degrees F fever, chills, delirium and tachycardia. Laboratory analysis reveals a TSH of 0.08 mcU/L (0.4-6.0 mcU/L), total T3 of 400 ng/dL (95-190 ng/dL)and a total T4 of 180 mcg/dL (5-11 mcg/dL). What is the initial treatment of choice to normalize this condition?
PROPYLTHIOURACIL
Propylthiouracil is the preferred initial drug in patients with thyroid storm.
A 30-year-old female presents to the emergency room having passed out at home 30 minutes prior to arrival. Her last menstrual period was 6 weeks ago and pregnancy test was reported positive 5 days ago. She started having vaginal bleeding last night. Vital signs are BP 70/40 mmHg, P 140 bpm, R 22. She is pale and diaphoretic. The next step in the evaluation of this patient’s condition should be which of the following?
A) abdominal u/s
b) culdocentesis
c) laparotomy
d) MRI
LAPAROTOMY
Laparotomy is indicated with presumptive diagnosis of ectopic pregnancy in an unstable patient.
grainy salt-like crystals opposite the second molars
KOPLIK SPOTS
______ motor neuron lesions cross; findings on the left are due to lesions on the right.
UPPER
The upper face is controlled by pathways from both sides of the face. Upper motor neuron lesions cross, findings on the left are due to lesions on the right. Lower motor neuron lesions of the face are ipsilateral.
________ motor neuron lesions of the face are ipsilateral.
LOWER
The upper face is controlled by pathways from both sides of the face. Upper motor neuron lesions cross, findings on the left are due to lesions on the right. Lower motor neuron lesions of the face are ipsilateral.
what meds are contraindicated for tachycardia seen in patients with tox screens positive for cocaine?
BETA BLOCKERS
why are beta blockers contraindicated in pts with tachycardia and tox screen positive for cocaine?
PARADOXICAL HYPERTENSION
Pure Beta blockers, such as propranol, can cause a paradoxical hypertension because of unopposed alpha-adrenergic effects.
what do you do with metabolic acidosis due to ingestion of methanol?
ETHANOL
Ethanol, along with hemodialysis and supportive measures, is indicated for metabolic acidosis caused by methanol ingestion.
splint of choice for Colles’ fracture
VOLAR FOREARM SPLINT
The volar forearm splint is best for temporary immobilization of forearm, wrist and hand fractures and is the splint of choice for Colles’ fracture.
exudate vs transudate - explain the difference
EXUDATE:
Increased production of fluid due to inflammatory or malignant processes results in an exudative pleural effusion.
TRANSUDATE:
Transudates result from increased hydrostatic or decreased oncotic pressures across normal capillaries.
Treatment of acute renal failure due to rhabdomyolysis
IV SODIUM BICARBONATE
Treatment of acute renal failure due to rhabdomyolysis is best accomplished with IV fluids and forced alkaline diuresis.
What drugs are associated with increased risk of hyperuricemia and gout?
THIAZIDE DIURETICS
Thiazide diuretics, such as hydrochlorothiazide, are associated with increased risk of hyperuricemia and gout.
A 22 year-old male presents several hours after sustaining a hand injury when he punched a wall. X-rays of the hand demonstrate fracture of the fifth metacarpal neck with 65 degrees dorsal angulation and a claw hand. What is the most appropriate intervention?
OPEN REDUCTION AND ULNAR GUTTER SPLINT IMMOBILIZATION
Open reduction is indicated with angulation of greater than 40 degrees
A 12 month-old in the emergency department is diagnosed with possible viral meningitis. Which of the following cerebral spinal fluid (CSF) laboratory results is most consistent with this diagnosis?
INCREASED CSF MONONUCLEAR CELLS AND NORMAL GLUCOSE
In aseptic meningitis, CSF shows mainly mononuclear cells within 6-8 hours, glucose is normal and there is normal to lower protein.
what antibiotic is used for human bites?
AUGMENTIN (AMOXICILIN CLAVULANATE)
Augmentin is considered to be the antibiotic of choice for human bites that may be contaminated with Eikenella corrodens, strep viridans, and staph aureus.
Which of the following is the most appropriate therapeutic agent for acute influenza?
a) azithromycin
b) acyclovir
c) tetracycline
d) zanamivir
ZANAMIVIR
Zanamivir is an anti-viral agent that is active against the influenza virus
6 y/o male presents w/ hemarthrosis of the L knee. Coag studies: PT 12.5s (normal12-14 sec), INR 1.0, aPTT 58s (normal 18-28 sec), platelet 430,000/microliter (normal 150,000-450,000/microliter), & bleeding time 4m (normal 2-12m). Which is the best tx option for this pt?
a) desmopressin acetate
b) corticosteroids
c) Vit K
d) cryorecipitate
CRYOPRECIPITATE (or FACTOR VIII CONCENTRATE)
Hemophilia A presents with a prolonged aPTT and normal platelet count and function. Hemophilia A is treated with factor VIII concentrate or cryoprecipitate.
coronary vasospasm associated with variant or Printzmetal’s angina treatment is….
CALCIUM CHANNEL BLOCKERS
Calcium channel blockers are effective prophylactically to treat coronary vasospasm associated with variant or Prinzmetal’s angina.
What mechanism leads to a primary pneumothorax?
RUPTURE OF SUBPLEURAL APICAL BLEBS DUE TO HIGH NEGATIVE INTRAPLEURAL PRESSURES
A primary spontaneous pneumothorax is thought to result from a rupture of subpleural apical blebs secondary to high negative intrapleural pressures.
What physical findings is suggestive of atrial septal defect?
FIXED SPLIT S2
An atrial septal defect will cause a shunt of blood from the left to the right atrium. This will result in an equalization in the amount of blood entering both the left and right ventricles which effectively eliminates the normally wide splitting that inspiration typically causes in hearts without an atrial septal defect.
An immunocompromised patient presents with signs and symptoms consistent with Legionella pneumophila who has not responded to initial antibiotic therapy with a macrolide. What should be added?
RIFAMPIN
Rifampin should be used as an adjunct in patients with either a macrolide or quinolone antibiotic, who have failed therapy, are immunocompromised or have severe illness.
Which of the following dietary substances interact with monoamine oxidase-inhibitor antidepressant drugs?
a) lysine
b) glycine
c) tyramine
d) phenylalanine
TYRAMINE
Monoamine oxidase inhibitors are associated with serious food/drug and drug/drug interactions. Patient must restrict intake of foods having a high tyramine content to avoid serious reactions. Tyramine is a precursor to norepinephrine.
treatment of pyelonephritis in pregnant patient
IV cephalosporins are first line treatment of pyelonephritis in a pregnant patient, followed by oral step-down therapy.
A 40 year-old female complains of acute right upper quadrant pain radiating to the back and low grade fever. Laboratory evaluation indicates the presence of urinary bilirubin and an elevation of serum alkaline phosphatase. What is the most likely diagnosis?
CHOLECYSTITIS
The presence of urinary bilirubin indicating conjugated hyperbilirubinemia coupled with the elevation of serum alkaline phosphatase suggests biliary obstruction that may lead to cholecystitis.
what is the “gold standard” for diagnosing retropharyngeal abscess?
CT OF THE NECK
CT of the neck is considered the “gold standard” for the diagnosis of a retropharyngeal abscess
what is the treatment for acute pericarditis
Indomethacin, a nonsteroidal anti-inflammatory medication, is the treatment of choice in a patient with acute pericarditis
what is Beck’s triad of cardiac tamponade?
Beck’s triad:
Hypotension
muffled heart sounds
elevated neck veins (JVD)
PULSUS PARADOXUS is a classic finding for what condition that often presents to the ER?
cardiac tamponade
Pulsus paradoxus is a classic finding (drop 10 mmHg in systolic pressure on inspiration), narrow pulse pressure
how does cardiac tamponade present on CXR?
water bottle heart
treatment for cardiac tamponade
pericardiocentesis
list acute and slow onset causes of cardiac tamponade
Causes
Acute onset: trauma, myocardial infarction, aortic dissection, pericardial effusion
Slow onset: cancer, chronic inflammation, uremic pericarditis, hypothyroidism, connective tissue disease
most common septic arthritis pathogen
staph aureus (40-50%)
two other septic arthritis pathogens
N. gonorrhea in sexually active young adults
strep, pseudomonas in IV drug users
how to diagnose septic arthritis
arthrocentesis
joint fluid aspirate for definitive dx
WBC > 50,000 primarily PMNs
treatment for septic arthritis
2-4 week abx + arthrocentesis
staph aureus - vanc
gonorrhea - ceftriaxone
iv drug users - cipro/levaquin
what is the most common type of cardiomyopathy?
what are some causes of this type of cardiomyopathy?
DILATED CARDIOMYOPATHY
ischemia (CAD, MI, arrhythmia),
genetics,
excess alcohol,
postpartum, chemotherapy, endocrine disorders, viral infections, cocaine use, heavy metals
(Inherited in 1/3 of cases)
s/s of dilated cardiomyopathy
Dyspnea, S3 GALLOP, rales, cardiomegaly (displaced apical impulse), edema, jugular venous distention - systolic heart failure
diagnosis of cardiomyopathy is made with….
ECHOCARDIOGRAPHY
EKG will show nonspecific ST/T wave changes.
CXR often shows a balloon-like heart - will show cardiomegaly and pulmonary congestion
treatment of dilated cardiomyopathy:
βblocker + ACE + Loop Diuretic
Use the mnemonic AABCD
(anticoagulants, ACE-I, β-blockers, calcium channel blockers, and diuretics/ digoxin )
A 32-year-old male presents with an acute onset of pain and swelling in his left ankle. On physical exam, the ankle is warm, swollen and erythematous. Evaluation of the synovial fluid reveals only leukocytosis with a low glucose. What is the most likely diagnosis?
SEPTIC ARTHRITIS
Leukocytosis and a low synovial glucose are indicative of septic arthritis
A patient who demonstrates pain on the radial aspect of the wrist with abrupt ulnar movements while the thumb is flexed into the closed palm most likely has
TENOSYNOVITIS
Tenosynovitis is diagnosed using Finkelstein maneuver. The patient’s thumb is placed in the palm of the hand and the wrist is abruptly deviated to the ulnar aspect of the wrist, causing pain on the radial aspect.
A 53 year-old female massage therapist presents with new onset of sudden swelling involving the right elbow. She denies previous episodes similar to this. On physical examination, the patient is afebrile. There is a 4 cm fluid-filled mass that is tender to palpation overlying the tip of the elbow with no evidence of erythema or warmth. What is the most appropriate intervention?
REST AND NSAIDs
Rest and NSAID is the most appropriate initial intervention in a patient with olecranon bursitis.
(Aspiration of the bursa and corticosteroid injection are second-line therapy in a patient with olecranon bursitis who fails rest and NSAIDs.)
During the stages of fracture healing what s responsible for producing collagen?
FIBROBLASTS
Fibroblasts produce collagen during the inflammation stage of healing.
A 35 year-old female presents with a long standing complaint of dry, scratchy eyes and dry mouth. She also reports dyspareunia. Labs demonstrate a positive anti-nuclear antibody and Anti-La antibodies. The patient has a prolonged Schirmer test. Which of the following classes of medicines should be avoided in treating this condition?
a) antimalarials
b) NSAIDs
c) glucocorticoids
d) anticholinergics
ANTICHOLINERGICS
Anticholinergics should be avoided in a patient with Sjogrens syndrome. All the other medications may be used to treat the systemic symptoms of Sjogrens.
what do the lateral spinothalamic tracts affect?
PAIN AND TEMPERATURE
what do the ventral spinothalamic tracts affect?
PRESSURE AND TOUCH SENSATION
what do the posterior columns of the spinal cord affect?
PROPRIOCEPTION AND VIBRATION SENSE
Which of the following medications is the treatment of choice for patients with chronic gout to prevent recurrence of symptoms during its quiescent phase?
probenecid
allopurinol
colchicine
indomethacin
ALLOPURINOL
Allopurinol is the best drug to lower serum urate in overproducers, stone formers, and patients with advanced renal failure. It is a xanthine oxidase inhibitor that is used to prevent the formation of uric acid.
(Colchicine treatment is recommended only in patients who have tophaceous deposits in the skin and is used in the acute rather than the chronic setting of gout.)
(Hint: Indomethacin is used in the acute management of gout but is not effective in decreasing monosodium urate deposition in the joints.)
A 75 year-old female presents with medial knee pain that worsens with stair climbing. Physical examination reveals swelling and point tenderness inferior and medial to the patella and tenderness overlying the medial tibial plateau. What is the most likely diagnosis?
PES ANSERINE BURSITIS
The pes anserine bursa underlies the semimembranosus tendon and may become inflamed or painful owing to trauma, overuse, or inflammation. It is a common cause of knee pain and it is often misdiagnosed in adults.
cat/dog bite bacteria and tx:
pasteurella multocida
AUGMENTIN
cat SCRATCH disease comes from which pathogen?
Bartonella henselae
what is alpha-1 antitrypsin deficiency (AAT deficiency)
Alpha-1 antitrypsin deficiency (AAT deficiency) is an inherited condition that raises your risk for lung and liver disease
what is the treatment for MILD INTERMITTENT asthma?
SABA prn
what is the treatment for MILD PERSISTENT asthma?
low dose ICS daily
what is the treatment for MODERATE PERSISTENT asthma?
low dose ICS + LABA daily
or
medium dose ICS + LABA daily
what is the treatment for SEVERE PERSISTENT asthma?
high dose ICS + LABA daily
or
high dose ICS + LABA + oral steroids
what is the acute treatment for asthma?
oxygen,
nebulized SABA,
ipratropium bromide, and
oral steroids
barking cough and stridor
croup
virus that causes croup
parainfluenza virus
what sign do we see on PA CXR indicating croup?
STEEPLE SIGN
narrowing trachea in subglottic region
treatment for severe croup = ?
IV fluids
nebulized racemic epi
steroids
