Things I've Gotten Wrong Flashcards by Jacqueline Hines

MC cause of acute pericarditis

Idiopathic

Viral (coxsackie and echovirus)

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High pitched 3rd heart sound, dyspnea, and signs of right sided heart failure should make you think of this…

Constructive pericarditis

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Describe a pericardial knock

High pitched 3rd heart sound that occurs due to sudden cessation of diastolic filling

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Tx for constructive pericarditis

Pericardectomy

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MC cause of myocarditis

Viral or postviral immune mediated damage

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What causes rheumatic fever?

Acute autoimmune reaction to group A beta-hemolytic strep

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Jones criteria for rheumatic fever

MAJOR
Migratory polyarthritis
Active carditis
Subcutaneous nodules
Sydenham’s chorea 
Erythema marginatum

MINOR
Fever
Joint pain
Increased phase reactants
Prolonged PR

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Tx for rheumatic fever

2-6wk Aspirin taper

Pen G

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MC cause of mitral stenosis

Rheumatic heart disease

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MC causative organism of infective endocarditis

Subacute course: strep virus and from oral flora

Acute course or IVDU: staph aureus

*consider enterococcus in men who had recent GI/GU procedure

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4 peripheral manifestations of infective endocarditis

Janeway lesions
Roth spots
Osler nodes
Splinter hemorrhages

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Tx of endocarditis

Acute native: nafcillin with gentamicin for 4-6wk

Suspect MRSA, pcn allergic, or IVDU: vancomycin with gentamicin

Prosthetic valve: vanco, genta, and rifampin

Fungal: ampho B

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Endocarditis prophylaxis indications and tx

Prosthetic valve
Prosthetic repairs
Hx of endocarditis
Congenital heart dz
Valvulopathy of transplanted heart

2g amoxicillin or if pcn allergic 600mg clinda

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DVT treatment duration

1st episode with recent surg, transient identifiable factor, or high bleed risk: 3mo

Idiopathic 1st episode: 6mo

Recurrent episode:1yr

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Left bundle branch block

wide QRS
Slurred R is V5-6
Deep S in V1
possible ST elevations in V1-3

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Where is the infarct: ischemic changes in V1-4?

anterior wall

LAD

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Where is the infarct: ischemic changes in V1-2?

Septal

Proximal LAD

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Where is the infarct: ischemic changes in I, aVL, and V5-6?

Lateral wall

Circumflex

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Where is the infarct: ischemic changes in I, aVL, and V4-6?

Anterolateral wall

Mid LAD or circumflex

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Where is the infarct: ischemic changes in II, III, and aVF?

Inferior wall

Right coronary artery

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Where is the infarct: ST DEPRESSION in V1-2?

Posterior wall

right coronary artery or circumflex

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1st line tx for WPW syndrome

Procainamide

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Antiarrhythmic classes

Class I-Na channel blockers/rhythm: procainamide, lidocaine, flecanude

Class II-beta blockers/rate: atenolol, metoprolol, esmolol, ect

Class III- K channel blockers/rhythm: amiodarone, dofetilide, sotalol

Class IV-Ca channel blockers/rate: verapamil, diltiazem

Class V-digoxin

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Asthma classification by FEV1

Intermittent: >80%

Mild persistent: >80%

Moderate persistent: 60-80%

Severe persistent: <60%

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PFTs in COPD

FEV1/FVC is <70% In emphysema also look for increased lung volumes and decreased DLCO

Tram track appearance on chest CT, with chronic cough, mucopurulent sputum and hemoptysis

Bronchiectasis

Tx of bronchiectasis

ABX

MC cause of bronchiectasis

Recurrent infections - H flu Pseudomonas in CF patients

Gram negative rod causing pneumonia with cavitary lesions in an alcoholic

Klebsiella

Gram negative rod causing CAP in pt with underlying lung dz

H flu

Gram positive cocci in pairs that is MC cause of CAP

Strep pneumo

Intracellular gram negative rod that causes atypical pneumonia with GI sx, hyponatremia, and elevated LFTs

Legionella

Gram positive cocci in clusters that often causes multilobular pneumonia after a viral illness

Strap aureus

MC viral cause of pneumonia

RSV & parainfluenza in infants and children Influenza in adults

Pneumonia associated with bird/bat droppings in Ohio/Mississippi river valley

Histoplasmosis

Causative agent of bullous myringitis

Mycoplasma

Pneumonia treatment

CAP outpt: clarithro, azithromycin, or doxy Inpt or ICU: add FQ or beta lactam Hospital acquired: consider pseudomonas coverage, vanco or linezolid if MRSA, and Levi or azithro if legionella

Restrictive lung dz PFTs

Decreased lung volumes with Normal or increased FEV1/FVC

Tx of active TB infection

4drug regiment for 2mo followed by 4mo of dual therapy Rifampin, isoniazid, pyrazinamide, and ethambutol (or streptomycin) RIPE or RIPS

Rifampin MOA and adverse effects

Inhibits RNA synthesis Thrombocytopenia and orange secretions

Isoniazid MOA and adverse effects

Inhibits mycolic acid synthesis Hepatitis, peripheral neuropathy (give B6 pyridoxine), rash

Pyrazinamide adverse effects and cautions

Hepatitis, hyperuricemia, and photosensitivity Caution in gout or liver dz

Ethambutol adverse effects

Optic neuritis Peripheral neuropathy

Latent TB infection tx

Isoniazid with B6 for 9-12mo

MC cause of acute bronchitis

Often follows viral URI

Tx of Whooping cough

Supportive tx Erythromycin or azithromycin can be considered or given to exposed contacts *bactrim if macrolide allergic

Who gets acute bronchiolitis and what is the MC cause?

Children 2mo to 2yr old After viral infection

RSV mainstay of tx

Humidified O2 *ribavirin only in severe cases

MC cause of croup(laryngotracheitis)

Parainfluenza

Compare Chet-Stokes with Biot’s breathing.

Cheyenne-Stokes have a regular cycle of decreased breathing leading to apnea BUT Biot’s breathing is iregular quick shallow breaths with irregular periods of apnea

Normal values for determining acid-base disorders

pH >7.45 alkalosis pH <7.35 Acidosis Pco2 35-45 HCO3 22-26

Delta waves should make you think of

WPW syndrome

U waves should make you think of

Hypokalemia Quinidine Procainamide

Flaccid bulla with positive Nikolsky sign

Pemphigus vulagris

High riding humeral head on AP radiography

Suggestive of rotator cuff athropathy

How do you assess the murmur from a ventricular septal defect?

The louder it is the smaller the defect so the better the prognosis

What hormone replacement therapy should you recommend for menopause?

Uterus intact: estrogen/progesterone Post hype rectory: estrogen only

Idiopathic diabetes insipidus etiology and treatment

Destruction of hypothalamus; genetic form is autosomal dominant DOC is desmopressin

How does hyperaldosteronism affect blood pressure and lytes?

Hypertension Hypokalemia

MC cause of hyperaldosteronism

90% are primary hyperaldosteronism due to aldosterone producing tumor or bilateral adrenal hyperplasia

How do you get toxoplasmosis?

Eating undercooked meat or changing kitty litter

TB treatment for pregnancy

Isoniazid, rifampin, and ethambutol Streptomycin C/I and risk of pyrazinamide unkn

What triggers preeclampsia?

Placental ischemia

MC long term complication of supracondylar fracture

Cubitis varus

How do you diagnose RVS?

Nasopharyngeal swab

Medications useful for anger in borderline personality disorder

Topirimate and lamotrigine

How do you differentiate night terrors from nightmares?

Night terrors: first 60-90 minutes of sleep and associated with mental illness Nightmares: occur during REM sleep early in the morning

DOC for TCA poisoning (ventricular arrhythmias and hypotension)

Sodium bicarbonate

How do amphetamines work?

Causing the release of dopamine and NE

Crescent sign on hip x-ray

Avascular necrosis of the hip *a common complication following traumatic hip dislocation

Morphology and staining of strep meningitidis

Gram negative diplococcus

When is HIV PCP prophylaxis indicates?

CD4 <200 Hx PCP infection Evidence of immunocompromise (candidiasis)

Primary treatment of tumor lysis syndrome

Aggressive rehydration

Harsh bark-like cough with wheezing since infancy should make you think of this

Tracheomalacia

Afebrile infant with staccato cough and eosinophilia should make you think of

Chlamydia trachomatis *patchy infiltrates on CXR

Blood test for presymptomatic MEN2 associated cancers

RET mutation

Aspergilloma can be a late complication of this disease

Brochilithiasis can be a late complication of this disease

Histoplasmosis

Kernig sign indicates

Meningeal irritation

Kussmauls sign indicates

Cardiac tamponade

Quick’s sign/pulse indicates

Aortic insufficiency

Newborn conjunctivitis based on time

2-5d Gono 5-14d chlamydia

First line treatment for endometritis

Clinda and genta

Post C-section fever, soft tender uterus, and foul lochia

Endometritis

10-20% pts with CLL develops this

A secondary malignancy

Urine casts

Waxy-chronic dz or vigorous exercise Fatty-nephrotic syndrome RBC-glomerulonephritis WBC- pyelo or acute interstitial nephritis Hyaline- diuretic use

Stages of Lyme disease

Early localized- rash malaise & myalgiaS Early disseminated-heart and nervous system involvement Late/persistent- neuropsych manifestations and joint pain

Inheritance pattern of hemophillia A and B

X linked recessive | Only boys will have it

This immunoglobulin is elevated in Waldenstrom’s macroglobinemia

IgM

This immunoglobulin is elevated in multiple myeloma

IgG

VAP associated bacteria

Pseudomonas Klebsiella Enterobacter Serratia Acinetobactor

Tx of Hodgkin lymphoma

Doxrubicine, bleomycin, vinbkastine, and dacarbazine With possible radiation

Tx of multiple myeloma

Lenalidomide and prednisone

Who do you consult for drainage of a retropharyngeal abscess?

Otolaryngologist

What is telogen effluvium?

Stress induced hair loss