The 3rd Semester "I'm Getting Desperate" Flashcards
Tullio phenomenon
Loud noises causing dizziness, needs work up with a CT to determine pathology
Mandibular fractures of the condyle typically occur from the chin…. while angle fractures require workup of….
…hitting the curb
…..wisdom teeth integrity
Kiesselbach’s plexus
Formed via anastamosis of internal and external carotids and is located in the anterior nasal septum and most common cause of anterior epistaxis (why we hold the lower portion of the nose not the bridge when trying to stop a bleed)
Dental occlusion classes (4)
normal I
overbite II
Underbite III
Open bite
Lefort fracture classifcation (3)
I palate alone
II includes nose
III complete craniofacial dislocation including zygomatic bone
Weber test
- Doesn’t lateralize is normal
- lateralizes to one ear indicates conductive hearing loss of said ear or sensorineural hearing loss of opposite ear
Rinne test
- test with air conduction greater than bone is normal or confirmatory of sensorineural loss of the contralateral ear from the side lateralized to on the weber test
- Test with bone conduction greater than air conduction is confirmatory of conductive loss of the ipsalateral ear of the side lateralized to on weber test
Torus palentine
Large bumps of overgrown palate, harmless unless overgrows then needs surgical removal
Exostosis
torus palentine but of the ear, benign multiple growths of external auditory canal in dinviduals repeatedly exposed to cold water (surfers ear), can be surgically removed if too large
Most common cause of conductive hearing loss in children and how is it treated?
- Otitis media
- oral antibiotics
Viral cochleitis definition
Sudden hearing loss, vertigo, facial paralysis or pain, most common sensorineurall cause of sudden hearing loss in adults, treated with oral steroids
Meniere disease
episodic vertigo and hearing loss that usually lasts for hours, fullness and tinnitus, hearing loss that is low frequency and progress but is usually unilateral, treated with diet/lifestyle changes, diuretics, or surgery
Acoustic neuroma
Most common benign tumor that originates int he vestibule of the 8th cranial nerve presenting with unilateral or asymetric hearing loss, tinnitus, dizziness, headaches
Tragus tenderness automatically makes you think of what pathology?
Otitis externa
Serous otitis media vs acute
Serous is sometimes seen at beginning and end of acute otitis media infection (where the tympanic membrane is bulging) as well as in cases of allergies and does not require antibiotics
Tympanogram interpretation
- if peaks negative indicates eustachian tube dyfunction
- if flattened (less compliant) classic otitis media
Otitis media treatment options (4)
- amoxicillin
- augmentin
- 2nd gen cephalosporin
- ciprodex if perforation or ostomy tubes
Neurofibromatosis
Genetic condition that causes tumors to form in brain, spinal cord, and nerves, type 1 causes skin changes (6+ cafe olait spots) and deformed bones typically in childhood sometimes even present at birth, type 2 causes hearing loss ringing in ears and often poor balance in teen years and has bilateral vestibular schwanomas
Herpes zoster oticus (ramsay hunt sydnrome)
Shingles of the facial nerve near one of the ears
Hemmotympanum
Common result from temporal bone fracture causing disruption of ossicular chain and subsequent middle ear hearing loss requiring urgent referral, also see battle sign bruising behind ear
Otitis externa treatment (3)
- ofoxacin otic
- cipro otic
- ciprodex
Sensens duct
Empties parotid salivary gland and enters buccal mucosa opposite 2nd molar, sees facial nerve passing thru gland
Uvula deviates ___ lesion on vagus or peritonsillar absess, tongue deviates ___ lesion on hypoglossal nerve
away, toward
How to differentiate CSF from mucus?
Glucose strip test
Wegener’s granulomatosis with polyangitis
Inflammatory disease of blood vessels that if left untreated can be fatal, caused by autoantibodies and often has sore eye, ear, stuffy nose and trhoat, cough, treated with immunosuppressants
Why is azithromycin preferred to doxy for chlamydia treatment?
Better compliance as only 1 g dose 1 time
Gonorrhea treatment
Azithro or doxy + ceftriaxone
Chlamydia treatment
Azithro or doxy
Diptheria presentation (3)
pseudomembrane
sore throat
bullneck
Diptheria treatment (2)
diptheria antitoxin or erythromycin
Red petechiae on soft palate….
…..strep pharyngitis
Strep pharyngitis treatment
Oral penV
Brachial cleft cyst
Congenital failure of obliteration of brachila cleft during fetal development seen in late childhood or early adulthood as lateral portion of neck large mass, surgically excised
Most comon agent of otitis externa
P aeruginosa
Opioid antitussives suppress cough by…
…acting on CNS respiratory centers in medulla raising threshold
Dextromorphan
OTC derivative of morphine with no analgesic or addictive properties so used OTC cough preps not safe for children still
Reye’s syndrome
Rare disorder following viral illness, occurs in children resulting in brain and liver damage result of giving ASA to children
Bacterial sinusitis vs viral signs (4)
- long time of infection +10 days
- tends to be worse in morning
- got better then got worse
- severe facial pain
Acute epiglottitis definition and how is it treated (3)?
Bacterial infection of epiglottis sees rapid progression of symptoms including sore throat, dysphagia, hot potato voice, tripoding, drooling, distress, thumb brint sign on x ray
-o2, dexamethasone, empiric antibiotics
Orbital cellulitis will see this key feature
pain with EOMs
Orbital blowout fracture
Entraps inferior rectus and medial rectus impinging upward and lateral gaze dysufnciton respectively, treated with surgical decompression and followup
Ludwig’s angina
Bacterial infection of floor of mouth under tongue that occurs soon after tooth abscess, can eventually block off airway and is managed with antibiotics
Oral thrush can be ___, vs leukoplakia which cannot
brushed off
Reinke’s edema
vocal fold mass cauinsg progressive deepening of voice often in smokers
Pterygum
Surfer’s eye, noncancerous growth of the conjuncitva in wedge shape that will eventually cover the pupil, common in people who spend time outdoors and requires surgical removal
Conjunctivitis vs uveitis
Conjunctivitis has preserved visual acutiy, usually infectious, while uveitis loses acuity and is often autoimmune
Glaucoma
2nd most common cause of blindness due to optic nerve damage from increased pressure in anterior chamber of eye, either open angle or closed (emergency with acute pai, blurred vision, nausea, halos, elevated iop), risk factors include age, diabetes, high blood pressure
Hordeolum
classic stye, affects eyelash which is part of memobian glands and becomes occulded and infected, 2ndary progression into a chalazion
Pingulum
accumulation of conjunctival tissue at the nasal or temporal junction of the sclera and cornea that dones’t cover the pupil unlike pterygum
Strabismus
eye malalignment
Ambylopia
Monocular blindness due to failure to develop visual plexus capable of vocusing eye
Binocular vision loss lasting hours indicates…
…vertebrobailar insufficiency
Radiation pneumonitis
Condition occuring 4-12 weeks after chest radiaiton that presents with cough, dyspnea, chest pain, low grade fever can be treated with steroids but can cause lung fibrosis
Preop radiation is called ___, post op is ___
neoadjuvant, adjuvant
BI-RADS scoring
score of risk of breast mass being cancer with 0 being inconclusive, 1 being normal, 5 being highly suspicious and 6 a proven malignanc
Pagets disease
Rare cancer that begins iwth changes of skin cells at nipple scaling eventually becoming a red lesion almost 100% being associated with ductal carcinoma in situ, symptoms include senitivtiy, burning, pain, bloody discharge
Inflammatory breast Cancer
Rare type of cancer that causes severe swelling and redness and edema often presenting as peau d’orange seen in young women and is much more aggressive form of cancer
prostate cancer presenting symptoms
- weak interupted urine flow
- burning sensation when peeing
- low back pain or hip or thigh pain
- difficulty with erections
AML
80% of all acute leukemias, most frequent in neonates, letahl without intesnive chemo, fever, fatigue, leukemia cutis, auer rods on labs, treated with 7+3
APL
Emergency form of AML, dumbell nuclei, worrisome for hemorrhage, <1 month survival if lef untreated, treated with 7+3 regimen and at risk of cytokine storm
CML
Presents with fatigue, malaise, absolute basophilia**, triphasic coursse beginning asymptomatic then accelerating to resemble AML before death, phillie chromosome, treated with transplant or gleevec
ALL/LBL
Most common childhood malignancy, can occur with phylie xsome, hypercvad regimen or TKI if xsome pos. is treatment
CLL/SLL
Not related to radition exposure but sees waxing and waning lymphadenopathy of waldeyers ring, sudge cells, diagnosed via absolute lymphcyte count
NHL
Insidious, can cause compression of diddferent organs if severe, treated with R CHOP
HL
Reed stinberg cells, asymtpmatoci lymphadenopathy, generalized pruritis, ruberry lymph nodes, treated with ABVD regimen plus radiaiton
MM
Plasma cell malignancy, diagnosed via bone marrow plasma cells and CRAB (hypercalcemia, renal insuficiency, anemia, bone lesions), bnees jones proteins presence, punched out lesions on radiograph
Lynch syndrome
hereditary nonpolyposis colon cancer, collection of cancers related to defective tumor suppresor gene causing colon cancer without polyps
Pancoast tumor
High riding lung tumo puts pressure on brachila plexus resulting in horner syndrome, treated with wedge resection
What type of withdrawals are fatal (2)?
Alcohol and benzos
Naltrexone
pure opiod antagonist prevents euphoria with alcohol and opioid abuse
Methadone
opioid narcotic for pain but also used to decrease cravings for other more serious narcotics in withdrawal during abuse
Tramadol
Non opiod central acting PO agent for moderate to severe pain
Diclofenac
Topical solution for treatment of osteoarthritis or musculoskeletal pain
MCV
Determiens presence of macro or microcytic anemia by measuring avg size of RBC, if presence of both might look normal but then look at RDW and see its high
Macrocytosis causess
folate or b12 deficiency
Microcytosis causes
chronic iron deficiency
blood loss
MCHC
measures hemoglobin in avg RBCcorresponding to degree of chromasia (redness of RBC)
Anisocytosis
Presence of RBC of varying sizes
Polkiocytosis
Presence of RBC of varying shapes
High reticulocytes indicates
Anemia because bone marrow is working to replensih supply
RDW
Red cell distribution width measures variation on rbc size with deficinecy anemias tending to have higher RDWs
Most sensitive test for iron deficiency
Serum ferratin
G6PD deficiency
can cause sudden hemolytic episodes despite normal health between, triggered by febrile illness, sulfonamides, or fava beans, sees Heinz bodies (small blue dots in RBC) and bite cells
Thalassemias
reduced or absent produciton of one or more chains of hemoglobin
sickle cell trait
Normal but can see sickling under strenuous conditions requiring accommodations (sickle cells are ischemic to tissue because shape cannot pass capillaries and those with sickle cell d;isease die by age 50)
Hydroxyurea
Reactivates fetal hemoglobin helping alleviate frequency of pain episodes from sickle cell disease
Pernicious anemia
Deficiency due to low b12 due to lack of IF
Polycythemia vera
Too many RBC, itching after hot shower, treat with phlebotomy
Hemochromatosis
Cirrhosis, diabetes, skin pigmentation in late dz
Factor v leidan
Most common herediatary hypercoaguable dz
Von willebrand
Most comon bleeding disorder, treat with tranexamic acid clotting promotr
SIADH
Causes retention of water
Diabetes incipdus
Cuases inappropritae secretion fo water
Prerenal causes of deizease
-lack of blood flow or perfusion (renal artery stenosis, dehydration)
Intrarenal causes of dizease
GLomerular or vascular damage
Postrenal causes of disease
Stone, tumor, bph, cancer
FeNa <1%
Means kidneys are holding onto sodium indicating hypovolemic state (prerenal cause of disease), unless on diuretics
FeNa >2%
Indicates acute tubular necrosis
Fibromuscular dysplasia
beading of medium arteries in body particularly to kidneys, most awlays in women and progressive
Takasu arteritis
Inflammatory arteritis of aorta, genetic, seen in female asians with uncontrolled hypertension
Kawasaki disease
5+ day fever without other explanation, polymorphous rash, lympahdenopathy, treat with aspirin
What kills from renal failure?
Hyperkalemia leading to heart arrhythmia
BUN
Produced in liver and decreased in liver failure and increased in certain states like fever, some is normaly reabsorbed but some should be filtered
Creatinine
Produced by muscle breakdown and is filtered and secreted
BUN to Cr ratio
<10:1 indicates rhabdo, cirrhosis, SIADH
10:1- 20:1 normal
>20:1 indicates prerenal azotemia or uremia
Normal GFR
Estimated from serum creatinine levels which are filtered in a healthy funcitoning kidney and should be between 85-115ml/min
most common kind of kidneys tones
calcium oxylate
kidney stones in women with uti
struvite, staghorn
gout patient kidney stones
uric acid
genetically predisposed patients kidney stones
cysteine
Gold standard diagnosis and one alternative for kidney stone
CT, ultrasound
Meckel diverticulum
2% of population, 2 ft form ileocecal valve, 2 inches in lenth, presents at 2 years o fage, surgical removal of ectopic gastric mucosa is treatment
what does heme breakdown into
bilirubin
Pain out of proportion of physical exam indicates
mesenteric infarct
Rosving sign
RLQ pain with palpation of LLQ for appendicitis
psoas sign
RLQ pain with flexion of right hip against resistance for appendicitis
Kernigs sign
Flexion of hip at 90 degrees then extension of knee pain indicating meningitis
Murphy’s sign
Pain on catch on breath by palpating RUQ, indciative of acute cholecystitis
Duodenal ucler pain is ___ by food intake, gastric is ___
relieved, brought on
Mallory weiss tear
Nonbloody emesis followed by bloody
ischemic bowel patients vs peritonitis
Cant get comfortable vs lie deathly still
True refleciton of decreased liver function
INR elevation
AST/ALT
slight elevations indicate low grade inflammation, huge elevations indicate acute liver necrosis/injury but normal do not exlcude pathology
Alk phose
Elevated in indication of bile duct inflammation by either obstruction, infection, etc
Bilirubin
> 4 sees jaundice
AST/ALT > alk phos
Hepatocellualr injury
Alk phos > AST/ALT
Obstruciton (liver or bile duct)
first sign of liver dz
thrombocytopenia
Hep B is RNA or DNA
DNA
Hep B vaccine antibodies
-only pos for he b surface antibodiy
immune from reocvery of diseease hep B antibodies
positive for hep b surface antibody and core antibody
infectious acute hep b antibodies
positive for hep b surface antibodies and core antibody and E antigen
Chronoic hepatitis b carrier antibodies
positive for hep b surface antibody and core antibody and e antibody***
Cullen and grey turner indicate
acute pancreatitis
IBS
Late 20’s onset, recurrent abd pain releaved with defecation, cahnge in stool frequency or appearane
Crohn’s
full thickness of bowel in patchy noncontinuous distribution can cause fistulas invooling mouth to anus
UC
primarily in mucosa uniform and continuous only in colon with bloody diarrhea being hallmark
Diverticulosis vs diverticulitis
presence of diverticula, when diverticula are inflamed with most common on sigmoid colon causing left lower quadrant pain
Goodnell sign
Softening of uterus indicating pregnancy
Human placentallactogen
Antagonizes cellular action of insulin decreasing glucose utilizinato and increasing risk of gestational diabetes
Schedule of preterm visits
Q 4 wks to week 28, Q 2 wks to 28-36, Q wk for wks 36 until delivery, 2x/wk for >42 weeks
AFP
Produced by fetal liver, measured in 2nd trimeseter, elevated in pregnanceis with neural tube defects and low in cases of down syndrome
Neagle rule
estimated date of delivery = 1st day of last menstrual period + 7 - 3 months + 1 year
Best mehtod to predict due date
1st semester ultrasound measuring crownrump length earlier the better
DOC for ectopic pregnancy if not surgical indicated
methotrexate
Criteria to determine labor commencement
4 contractions over 20 min or 8 over 60+ cervical changes
-cervical dilation and effacement
Shorter cervical diameter greater risk of…
…impending delivery
Short term variability in fetal heart rate
5-15bpm amplitude good autonomic interplay with <5 idicating cns depression or fetal sleep period
Long term variability in fetal heart rate
3-25bpm
Fetal ead compression
Predicitble event as uterus compressed head engaged causing vagal slowing causing early deceleration and ends at same time as contraciton not considered sign of distress
Uteroplacental insufficiency
Predictible event as uteus compressed engaged head causing vagal slowing causing late deceleartion of fetal herat rate comparison to uterine contraction, requires change in maternal position, stopping oxytocin, and providing o2 to manage
Cord compression
causes variable decelearation of fetal heart rate and if prolonged causes hpyoxia
Categories of fetal heart rat(3)
1 - normal, predictive of normal acid base status at delivery
2 - indeterminite, require eval and continued surveillance
3 - abnormal, associated with abnormal fetal acid base balance
Placental abruption
premaure separation of normally implanted placenta either complete or partial causing painful hemorrhage of maternal bloo
Placenta previa
Implatnation of uterus over internal os partial or complete causing painless hemorrhage of mostly fetal blood
uterine atony treatments (3)
oxytocin
prostaglandin
bakri balloon
Pre-eclampisa HELLP syndroem
hemolysis
elevated liver enzymes
low platelet count
Treatment of eclamspia seizure
magnesium sulfate
Perineal degrees of lacerateion (4)
- 1st degree just tears mucosa
- 2nd tears superficial muscle
- 3rd tears anal sphincter
- 4th enters directly into rectum
Cardinal movements of labor
engagement, descent, flexion, internal rotation, extension, external rotation
Jjauncide in the 1st 24 hours of life
pathologic, physiologic breast feeding jaundice is fine in days after that
APGAR scores
taken at 1 and 5 min, <7 concerning
Tantrums
normally apepar at end of 1st yea of life and peak in prevalence between 2-4. lasting more than 15 or regularly occuring 3 times a day may reflect underlying issue
breast feeding guidelines
exclusive up to 6 onths then continued 1 year with other additions, wait till after 4-6 months to introduce allergic foods and do so one at time
omphalmocele vs gastroschisis
herniation of intestinal contents thru abominal wall into peritoneum covered sac vs without sac covering
Fat and cholesterol guidelines
not restricted under age 2, 12-24 months consume whole cow milk then older than 2 fat free or low fat milk
iron suplmeent in baby
4 motnhs
vit d supplement in baby
first few days
fluoride supplement in baby
6 month
Rooting reflex
Turn head towards mouth towards finger stroking cheek laterally
sucking reflex
tendency to instinctively suck vigorously at anything touching the mouth and swallow it regardless if hungry or not
moro reflex
child is slowly lowered head down their upper limbs abduct (thrown up)
grasp reflex
Instinctively grasp any object placed in palm and cannot voluntarily let go until 1 year of age, same with toes
placing reflex
pick foot up if held in front of table edge and place it on table
asymmetrical tonic neck reflex/fencer reflex
when lying supine turn head 90 degrees they take on a fencing pose
walking reflex
when held above ground will place one foot in front of another
Tonic vs clonic
contraction of muscle vs jerking
juvenile myoclonic seizures
occur in morning and resolve by adulthood
most common causes of status epilepticus (seizure lasting longer than 30 min)
-prolonged febrile seizure
SALTR Harris classification
Same level of physis only Above (metaphysis) Lower (epiphysis) Through (metaphysis thru epiphysis) R-crush injury to the physis
Physis
Growth plate
Epiphysis
Cartilagenous end of bone that articulates
Metaphysis
The neck of bone near the physis
Diaphysis
the shaft of the long bone
Legg calve perthes
Presents as younger hcild limping and is avascular necrosis demonstrated on x ray
slipped capital head of femur
older hcildren tend to be overweight
paraphimosis is a medical…
….emergency, unlike phimosis which can be treated with steroids daily to loosen ring
march of dimes
no induction of labor before 39 weeks
caput succedanoeum
crosses suture lines on infant typically self resolving
cephalhematoma
does not cross suture lines on infant typically self resolving
Umbilical vein carries _____, umbilical vein carries ___
oxygenated nutrient rich blood from placenta to fetus, deoxygenated nutrient depleted blood from fetus to placenta
Bell clapper deformity predisposes one to what?
Testicular torsion
testicular torsion
lack of cremasteric reflex and neg prehns sign adn doppler ultrasound
epididymitis
preserved cremasteric reflex and positive prehns sign (relief elicited upon raising the affected testicle)
hydrocele
collection of fluid in tunica vaginalis of testes, many present at birth, painless and resolved by 18 months, translumination shows enlargement of scrotum, requires referral to surgery urology as it is associated with a hernia
blue dot sign
appendiceal testes torsion, subacute pain
orchitis
entire testes swollen, think mumps
does a varicocele need treatment?
generally drains on own
incarceration
not easily mannually reduced inguinal hernia
strangulation
surgical emergency from inguinal hernia
caloric restriction theory
well researched effective means of slowing the aging process
urge incontennce
overactive detrusor
stress incontinence
incompetent urethral sphincter
overflow incontinence
loss of detrusor sensation and bladder overflows
polymyalgia rheumatica
quick onset mostly over 65 muscle pain and morning stiffness, associated with temporal arteritis
MS
autoimmune llong lasting diz that can affect brain, spinal cord and the optic nerves in eyes can cause problems with vision, balance, muscle control and other basic body functions, treated with low dose corticosteroids and immunosuppressants
DJD vs inflammatory arthritis
pain with use vs pain and stiffness in morning better with use
sarcoidosis
noncaseaiting granulomas form
inflammatory RA spares the….
…DIPs and lumbar area
HLA27
seen in ank spondy
schobers maneuver
test for ank spondy
systemic sclerosis with limited scleroderma
CREST syndrome (calcinosis, raynauds, esophageal dysmotility, sclerodactyly, telangeectasia)
gout crystals
strongly negative bifringent on aspiration
pseudogout crystals
weakly positive bifringent crystals
normal blood ph
7.35-7.45, less acidotic, more alkalotic
normal blood pCO2
35-45, greater than 45 acidosis, less than 35 alkalosis
normal blood hco3
22-26, less than 22 acidosis, greater than 26 alkalosis
normal base excess
+/-2
If ph and co2 is increased/decreased in same direction, then
metabolic
If ph and co2 is increased/decreased in opposite directions, it is
respiratory
causes of increased anion gap
mudpiles methanol uremia dka paraldehydes iron lactic acid ethylene glycol salicylates
Most specific and sensitive test for TB
quantiferon TB
most toxic inhalant
silica
strain pattern on ekg for LVH
s1q3t3
obstructive dz examples
asthma
copd
bronchiectasis, bronchiolitis, upper airway obstruction, FEV1 decreases, scooped out appearance, FEV1/FVC <70% predicted
restrictive dz examples
parenchymal dz (interstitial lung dz), pleural lung dz, chest wall dz, neuromuscular dz, fvc decrease, witch’s hat apperance, fev1/fvc normal range
emphysema
alveolar duct/alveoli problem, long expiratory phase
chronic bronchitis
hyperplacia of bronchioles and excess mucus secretion
copd is obstructive or restrictive
obstructive
precentral gyrus is ___, postcentral is ___
motor, somatosensory
upper motor neuron injury
spasticity, increased tone, clonus babinski
lower motor neuron injury
atrophy, weakness, fasciculations
posterior column
crosses at medulla senses fine touch, vibration, proprioception
spinoathalamic column
crosses at spinal level senses crude touch, temp, pain
corticospinal tract
crosses at medulla provides motor innervation
most common site of stroke
middle cerebral artery
gcs score 3-15,
8
GCS
best eye opening 1) does not open 2) open to painful stimulus 3) opens to voice 4) opens spontaneously best verbal score 1) no sounds 2) incomprehensible 3) inappropriate 4) confused 5) oriented best motor score 1) none 2) extensor posturing 3) flexor posturing 4) withdraws to pain 5) localizes to pain 6) obeys commands
spondylosis
2ndary degenerative changes including disc degeneration, dessication, height loss, herniation, joint degradation, ligamentous thickening, age 40-60,
spondylitis
inflammation of the vertebrae
spondylolysis
fracture of pars interarticularis without vertebral transfer (scottie dog)
spondylothesis
fracture of pars interarticularis without vertebral transfer
frontotemporal dementia (picks disease)
change in behavior to inappropriate, lack of social tact, increased sex drive, impulsivity
ulnar gutter splint fixes
boxers fracture
thumb spica fixes
gamekeepers thumb, de quarvian tenosynovitis
cock up splint treats
carpal tunnel
femoral neck fracture 3 findings
positive leg role
positive heel strike
positive stinchfield sign
c5 motor function and reflex
deltoid/biceps, biceps
c6 motor funciton and reflex
biceps/wrist extension, brachioradialis
c7 motor function and reflex
triceps/wrist flexion, triceps
c8 motor function and reflex
finger flexion, none
t1 motor function and reflex
finger abduction, none
anterior wall mi leads
v1-4, lad
inferior wall mi leads
ii and iii and avf, rca
lateral wall mi leads
i, avl, circumflex artery
big 6 to rule out chest pain
mi aortic dissection boerhaave syndrome pe tension pneumothorax cardiac tamponade
s3 gallop
dilated ventricle, systolic dysfunction
s4 gallop
stiff ventricle, diastolic dysfunction
mid systolic ejection click
mitral valve prolapse
nonblack patients htn treatment
thiazide, ace or arb or b blocker or ca2+ channel blocker
black patients htn treatment
thiazide diuretic, nondihydropiridine ca2+ channel blocker
1st degree av block
> .2sec pr interval
2nd degree av block type 1
pr longer then it drops
2nd degree av block type 2
normal pr interval then p wave not followed by qrs complex periodically
3rd degree av block
no relationship between p and qrs
right BBB
bunny ears v1 and v2
lvh indication ekg
large s in v1 and large r in v5
von willebrand is __ disorder and factor v leidan is ___ disorder
bleeding, clotting
hyper vs hypokalemia ekg
peaked t waves vs flattened
pericarditis ekg
diffuse st segment elevation
qrs up in I and up in AVF means
normal axis
qrs up in I and down in avf means
left axis deviaiton
qrs down in I and up in avf means
right axis deviation
qrs down in i and down in avf means
extreme right axis deviaiont
most common murmur in children
stills murmur - cooing dove
difference between anticoholinergic and sympathomimetic
anticholinergic has no sweating
dka vs hhs gluocse levels
<600 vs >600
adult burn estimation
Face - 9%, neck - 1%, Front core - 18%,back core - 18%, arm - 9%, leg – 18%
4:2:1 rule
4ml for fisrst 10 kg, 2 for next 10, 1 for rest
central cord syndrome
Most common type of cord syndrome, due to injury of corticospinal tract causing loss of motor function, can occur with hyperextension injury with cervical stenosis, can see with falling forward onto face, typically caused by vascular compromise of the anterior spinal artery, lower extremity less effected than upper and tends to recover before upper but typically permanent hand disability at least
anterirrior cord syndrome
Injury to ventral 2/3 of spinal cord psaring posterior column, see paraplegia (loss of motor) and sensory loss of pain/temp (spinothalamic), posterior column is still intact, due to infarction of cord in anterior spinal artery territory, has poor prognosis
hesselbachs triangle
inguinal ligmaent, lateral borderr of inferior epigastric vessels, medial border of rectus abdominis sheath
treatment of malignant hypothermia
dantrolene and cooling
1st 24 hours after surgery at risk for ___, next 2 days ___, days 3-4 ___, day 4-5 ___ and after ____
atelectasis urinary tract infection wound infection dvt wonder drugs
If external opening of fissure lies anterior to midline and is <3 cm, then ____, if posterior, ___. if anterior and >3cm, then ___
opens straight line, loops curves, loops curves
Which of the following forceps would work best for gripping less delicate tissue such as skin or fascia and are commonly used to manipulate skin while suturing?
adson
