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PANCE Review > Treatment > Flashcards

Treatment Flashcards

1
Q

Benign essential tremor

A

Beta blocker (propanalol)

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2
Q

Parkinson’s

A

Carbadopa and levodopa

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3
Q

Heart failure

A

ACE
BB
Diuretic
+/- hydralazine, nitro, dig

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4
Q

CHF in ED

A

LMNOP

Lasix 
Morphine 
Nitro 
Oxygen
Position
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5
Q

Dilated cardiomyopathy

A

Same as CHF

ACE, diuretic, +/- BB

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6
Q

Restrictive Cardiomyopathy

A

Tx cause

Amyloidosis (MC)
Sarcoidosis
Hemachromatosis

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7
Q

HOCM

A

BB
CCB
Disopyramide

EtOH ablation
AICD surgery
Avoid dehydration and extreme exertion

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8
Q

Infective endocarditis

A

Vancomycin and Gentamycin unless fungal (ampho)

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9
Q

Pericarditis

A

Med: NSAIDS, aspirin, colchicine

Steroids if refractory

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10
Q

Pericarcial effusion

A

Pericarcial centesis

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11
Q

Constructive pericarditis

A

Pericardectomy

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12
Q

Pulmonary Htn

A

CCB
Viagra
Prostocyclins

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13
Q

CMV

A

Neonates (neurological, hearing loss)
Aids (blindness)
Serololgy, PCR tissue bx (AIDS)

Supportive AIDS
Oral valgancyclovir for sereve

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14
Q

EBV

A

Fever, malaise, pharyngitis, rash, spenomegally

Post cervical nodes

Atypical lymph
Monospot (25% false neg in first week)
Positive IgM

Supportive
Avoid contact sports

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15
Q

Rheumatic fever

A 
Carditis
Polyarthritis
Sydenham chorea
Erythema marginatum
Subq nodules
Fever
Arthralgia
Previous RF
Elevated APRs
Prolonged pr

NSAIDS, antibiotics
Propholaxis: benzathine PNC monthly for 10 years

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16
Q

TB

A

Positive ppd
5mm if immunosupressed

10mm CKD, healthcare

15mm all others

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17
Q

Rabies

A

PEP:
No vaccine, give IG and vaccine
Previous vaccine, give vaccine

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18
Q

Munmps

A

Orchids
Parotid enlargement
MENINGITIS

Live virus vaccine

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19
Q

HIV

A

HIV 1,2 Ab and HIV p24 g
If positive NAT
If reactive confirm with western blot

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20
Q

Rheumatic fever

A

Group A beta strep
Mitral valve

Jones criteria: carditis, poly arthritis, nodules, Erythema marginatum

Fever, Arthralgia, previous infection, APRs elevated, prolonged or

NSAIDS, antibiotics
Ppx, benzathine pnc monthly 10 yr or are 40

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21
Q

TB drugs

A

Isoniazid, peripheral neuropathy (give b6)
Rifampin, orange secretions
Pryazinamide, GI/muscle joint pain
Ethambutol, optic neuritis (red-green loss)

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22
Q

MAC

A

AIDS pts
fever, wt. loss anorexia, diarrhea

Azithro, clarithro, rifabutin, Ethambutol

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23
Q

Leporacy

A

Rifampin, dapasone, clofazimine

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24
Q

Cholera

A

Still culture

Doxy, aggressive rehydration

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25
Q

G and C

A

NAAT of urine

250 mg ceftriaxone, 2 g azithro

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26
Q

Salmanella

A

Pea soup
Typhi causes constipation
Rose spots on trunk

Still culture

Fluids, K, cipro, ceftriaxone

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27
Q

Shigella

A

Daycare
Bloody diarrhea

Stool culture

Cipro

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28
Q

Botulism

A

Diplopia, dry mouth, dysphagia, dysphonia
Descending paralysis, fixed dilated pupils

Hypotonicity

Clinical

Anti toxin A, B, E (w,e,n)

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29
Q

Tetanus

A

IG and vaccine if bad wound and never or under vaccinated

Only vaccine if minor wound

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30
Q

Lyme

A

Summer

Bullseye

Flu like sx
Arthritis and muscle pain, Neuro sx bell’s pausey
Disseminated

Doxy
ceftriaxone or pnc g in Neuro disease

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31
Q

RMSF

A

Fever, myalgia
Petechial or purpuric palms and soles

Leukocytosis, proteinuria, hematuria, thrombocytopenia

Sero test (difa)

Doxy (even in kids)

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32
Q

Syphilis

A

Torch

Chancre

VLDR

Rash on plans and soles, condylomata lata, argyll-robertson pupils, tabes dorsalis

Late stage: aortitis, aneurysms, aortic regurg

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33
Q

Cryptococcosis

A

Cryptococcus neoformans

Immuno compromised

H/A, AMS, meningitis

India ink prep

Fluconozole or ampho for neuro

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34
Q

Histoplasmosis

A

Most patients asymptomatic

Ranges from flu-like symptoms to multi-organ disease mediastinitis, eye, CNS

RIA, DNA probes
Cxr: military pattern

Itraconazole
Ampho

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35
Q

Pneumocystis Jiroveci

A

Fever, dyspnea, non-productive cough

Bilateral Interstitial disease without Hilary adenopathy

Low O2, gallium uptake, tissue stains via bronch

Bactrim

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36
Q

Hookworms

A 
Southeast
Tunneling
GI bleed, blood tinged sputum
Guac positive
O and p

Pyrantel, albendazol

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37
Q

Round worms

A

Contaminated soil

GI distention

Albendazole

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38
Q

Whip worm

A

Prolapse

O and p

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39
Q

Pinworms

A

Scotch tape

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40
Q

Malaria

A

Recurring fever, chills, spenomegally

Parasites on red blood smear

Falciparum is continuous, cerebral, and Blackwater fever

Atovaquone
Doxy, ppx

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41
Q

Toxoplasmosis

A

Immuno supressed

Strep-like

Serololgy
Ct scan (ring enhancing lesions)

Pyrimethamine and sulfadiazine

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42
Q

Fibromyalgia

A

Tylenol, NSAIDS, exercise, ssri, sleep

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43
Q

Gout

A

Uric acid crystals
Negative birefrengence

Indomethacin, colchicine

Allopurinol for ppx
Probenacid if not tolerated

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44
Q

Pseudo gout

A

Cpp crystals
Positive birefrengence

Indomethacin, colchecine

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45
Q

PMR

A

Multiple joint stiffness, shoulder often first
Elevated ESR often >100

Must evaluate for temporal arthritis!
H/A, elevated ESR, temples ttp, pain in jaw, vision changes

Temporal artery bx
Tx both with steroids

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46
Q

Reactive arthritis

A

Joint pain following a respiratory or GI infection

Chlamydia, campylobacter, shigella, salmonella, and yersenia

Uveitis, urethritis, arthritis
Balantitis, keratoderma
Elevated ESR and CRP

Tx cause
NSAIDS 
Steroids
DMARDs
Optho referral
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47
Q

Rheumatoid arthritis

A

Methotrexate
Antimalarials
Biologics

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48
Q

SLE

A

Joint pain, swelling

Fever, wt. Loss, fatigue

Mylar rash, discord rash, mucosal ulcerations, Alopecia, officer is, raynauds, livedo reticularis, Raynauds

ANA non specific

Hydroxychloroquinine
Methotrexate
Steroids

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49
Q

Sjhogrens

A

Dry sx

Salivary gland bx

Manage sx

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50
Q

Tension H/A

A

Ibuprofen, NSAIDS, caffeine, Tylenol

Amitryptylene, ssri, anti convusant

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51
Q

Migraines

A

NSAIDS, tylenol, tryptans, antiemetics

BB, CCB, ace/arb, dhe, dexamethasone

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52
Q

Cluster H/A

A

Severe pain, unilateral, ocular as, trigeminal neuralgia

High flow O2
Triptans

Verapamil, low dose prednisone

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53
Q

TIA

A

Stroke workup

Carotid endartectomy

Anti-platelet for 90 days

Risk factor reduction

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54
Q

Ischemic stroke

A

Stroke workup
Tpa within 4.5 hr
Thrombectomy within 6 to 24 hrs

Carotid endartectomy

Anti-platelet for 90 days

Risk factor reduction

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55
Q

Sub arachnoid hemmorage

A

Manage bp, reverse anticoag, shunt, clip anneurism, nimodipine

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56
Q

Bacterial meningitis

A

Pathogen directed antibiotics

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57
Q

Acyclovir

A

Acyclovir if HSV encephalitis

Benign and self-limited

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58
Q

Huntington disese

A

No cure, tx movement with terabenzanine and other neuroleptics

Fatal in 15-20 yrs

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59
Q

Parkinsons

A

Levodopa/carbadopa

Amantafine, benzotropine, COMT inhibitors

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60
Q

Seizure

A

Valproate, carbamazapine (CI in pregnancy)

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61
Q

Focal neuropaty

A

Activity modification

Anti-inflamatories, steroids

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62
Q

Cerebral pausey

A

Supportive, may sulfate in preterm labor

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63
Q

Concussion

A

Remove from activity, full exam, monitor 24 h, tx sx, admit GCS <15, a normal CT, seizures

Remember 2nd impact syndrome

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64
Q

Dementia

A

All types acetylcholine esterase inhibitors

AD: N-methyl-D aspartic acid and vit E

Lewy Body: dopamine agonist

Vascular: controlled BP

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65
Q

Delerium

A

Tx conservatively

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66
Q

Altered level of Consciousnee

A

ABC, monitor, tx cause

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67
Q

GBS

A

Immune-mediated demylienation
Ascending paralysis
In pt.

Plasma pharesis, IV If, monitor

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68
Q

MS

A

Relapsing remiting: high dose steroids

Primary progressive
Secondary progressive
Disease mod agents: glatiramir, fingolimod, natilizumab (multifocal leukoencephalopathy)

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69
Q

Tourette

A

Pt. Ed
Dopamine agonist (fluphenazine, pimozidel
Botox

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70
Q

Syncope

A

Tx. Directed at cause

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71
Q

Presbycusis

A

Age related hearing loss
High frequency

Hearing aids

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72
Q

Noise induced SNHL

A

Notched audiogram

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73
Q

Acoustic neuroma

A

Slow growing benign tumor CN 8

Unilateral loss, balance, tinnitus

Surgery, radiation

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74
Q

Sudden SNHL

A

Occurs within 72 hrs
Dizziness, fullness, vertigo

Emergency
Labrinthitis
Autoimmune
Vascular

Prednisone

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75
Q

External auditory canal foreign body

A

Remove if possible to get on the first try

Consult ENT if perf or touching TM

Don’t remove batteries

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76
Q

Articular hematoma

A

ID

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77
Q

Otitis externa

A

Topical AB

ciprodex

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78
Q

OE fungal

A

Very itchy
Suspect if refractory to AB

Acetic acid drops
Clotrimazole dropsa

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79
Q

Malignant OE

A

ENT emergency

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80
Q

Austrian tube disfunction

A

Nasal steroids

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81
Q

OM with effusion

A

Nasal steroids

Tubes

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82
Q

AOM

A

Amoxicillin

Macrolide in PN allergic or Bactrim

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83
Q

Mastoiditis

A

Emergency

AB and surgery

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84
Q

Cholesteatoma

A

Retraction pocket of following perf

Surgical excision

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85
Q

TM perf

A

Non ototoxic ear drops (quinilones)

Keep dry
Check in 1-2 months

Tympanoplasty

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86
Q

Bullous myringitis

A

Mycoplasma, H flu, step pneumo

Macrolide clarithro

Maybe opiates

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87
Q

Otosclerosis

A

Shapes fuse to TM

Stapedectomy
Hearing aids

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88
Q

Tinnitus

A

Pt. Education
Background noise
Avoid caffeine/nicotine

89
Q

Meinerers disease

A

Increased endolymphatic pressure
SNL hearing loss

Diuretics, restrict Na, meclizine surgery

90
Q

Labyrinthitis

A

Vertigo lasting days, imbalance for weeks

Tx with meclizine or diazepam, if SNL steroids

91
Q

Nasal FB

A

Remove, tx infection if present

92
Q

Nasal vestibulitis

A

Infection of nasal hair follicles

Bactroban, keflex, found a, amox

93
Q

Nasal mucositis

A

Saline nasal spray and, TOPICAL AB

94
Q

Epistaxis

A

Ant. Kesselbachs
Posterior, woodruffs

Manual compression
Afrin
Cautery (anesthetized, decongest, TOPICAL AB)
Cocaine

95
Q

Allergic rhynitis

A

IgE mediated

Nasal steroids
Antihistamines
Leukotriene inhibitors

96
Q

Nasal polyposis

A

Surgical if obstructive
Samters triad: sinusitis, asthma, polyps
Avoid asprin

97
Q

Vasomotor rhynitis

A

Similar tx as allergic

98
Q

Rhinitis medicamentosa

A

Stop attending agent, switch to steroids

99
Q

Viral rhinitis

A

Supportive

100
Q

Chronic sinusitis

A

Consider structural abnormality

101
Q

Viral pharyngitis

A

Tx supportive with OTC meds

102
Q

Strep pharyngitis

A

Amoxicillin, pen VK, augmentin

Azithro, clinda

103
Q

Acute tonsilitis

A

If bacterial AB, if viral supportive

104
Q

Peritonsillar abcess

A

ID, amoxicillin or clinda

105
Q

Parotitis and siladenitis

A

Tx cause

Sialogoues and warm compresses

106
Q

Sialolithiasis

A

Sialogoues, tx with surgery if obstructive

107
Q

Oral candidiasis

A

Oral nystatin 5cc swish and swallow qid

Fluconazole

108
Q

Squamous papilloma

A

Caused by HPV
Can become squamous cell
Biopsy

109
Q

Leukoplakia

A

Precancerous
Bx
Monitor
Smoking cessation

110
Q

Aphthous ulcers

A

Benign and self limiting

111
Q

Oral herpes simplex

A

Tx antivirals within 72 hrs

112
Q

Acute laryngitis

A

Tx with voice rest and fluids, smoking cessation

113
Q

Essential Hypertension

A

Goal >150/90 for >60
Goal <140/90 all others <60 (CVD, diabetes)

Non black
Thiazide, ace or arb, CCB

Black
Thiazide, CCB

Renal (Ace or ARB)

114
Q

Hypertensive urgency

A

BP > 180/120 with no target organ damage

Reduce 25% over several hours with labetelol, clonidine, nitrates, hydralizine

115
Q

Hypertensive emergency

A

BP >180/120 with target organ damage

Papilledema, neuropathy, seizures, AMS

Gradual reduce 10% 1hr and 15% over 3-12 no less than 160/110 with IV nitropruaside, hydralazine, nitro, nicardipine

116
Q

Metabolic syndrome

A 
Waste circumfrence
Htn
FBG >110
HDL<40 in men and <50 in women
Tri >150

Need 3 or more

117
Q

Stable angina

A

Exertional
Normal ekg
Releived with nitro

118
Q

Unstable angina

A

At rest
Lasts longer than stable
Not as well controlled with nitro

Aspirin, BB, statin
Also use these meds with stable angina

119
Q

NSTEMI

A

cardiac enzymes not elevated
ST depression, T wave inversion, possible Q waves
Possible stent

Aspirin and plavix, BB, CCB, ace, statin, nitro

120
Q

STEMI

A

Elevated enzymes and ST elevation

PCI <3h from sx onset and 90 mins from door to balloon

Plavix, aspirin, statin, BB, CCB, ACE, Nitro

121
Q

Types of MI

A 
RCA: Inferior: II, III, AVF
LCA: Lat: I AVL, V5-V6
LAD: Ant: V2-V4
RCA: Post: VI-V2
LAD: Ant lat: V2-V6
122
Q

Prinzmetal Angina

A

CCB avoid BB

Possible stent

123
Q

AAA

A

Surgical repair if >5.5 or cm per yr, sx, or rupture

124
Q

TAA

A

Surgical repair if >5.5, cm / yr or 4.5-5 if ED or Marfans

125
Q

Aortic dissection

A 
DeBakey I: to aortic arch (<65 y/o)
DeBakey II: confined to ascending aorta
DeBakey III: descending (elderly)
Stanford A is ascending (surgery)
Stanford B is descending (meds)

Tx with surgery (tube graft)

126
Q

PAD

A

Asprin +- plavix, statin, BB, ace
ABI<0.9
Doplar
Angiography is gold standard

127
Q

Arterial exclusive disease

A

Pain, Palos, pulslessness, poikilothermia, paralysis

CTA, doplar, MRA

Thrombectomy, thrombolytic, stent

128
Q

Varicose veuns

A

Compression hose, tx ulcers, ablation, sclerotherapy, vein stripping

129
Q

Phlebitis

A

NSAIDS, warm compresses, extremity elevation

130
Q

DVT

A

Ultrasound

Anticoagulate for 3 months lovenox, warfarin, xarelto, elequis

131
Q

PE

A

Spiral CT
Pulm angiography GS
S1Q3T3 for for pulmonale

Anticoag >3 months lovenox, warfarin, xarelto, elequis
IVC filter if unable to tolerate

132
Q

Esophagitis

A

Candida, GERD, pill, radiation

EGD

Tx cause

133
Q

Achalasia

A

Loss of ganglion cells in Auerbach plexus

Dysphagia And regurg of non-digested, non-acidic food

Birds been on barium swallow

Dilation, botox, esophagotomy

134
Q

Esophageal Strictures

A 
Schatzkis ring
Zenkers diverticulum (proximal esophagus) aspiration
Esophageal web (Plummer Vincent syndrome) DIGS

All dx with egd and barium swallow

All tx with soft diet and dilation

135
Q

Esophageal cancer

A

Upper 2/3 of esophagus squamous cell
Smoking and EtOH

Lower 1/3
Adenocarcenoma

EGD and bx

Surgery, chemo, rad

136
Q

Barrett esophagus

A

Long standing GERD

40x increase in esophageal cancer

137
Q

Mallorie weis tear

A

Superficial esophageal tear

Painless hematemisis

Self limiting, aged w/thermal coag

138
Q

Boerhaaves Syndrome

A

Esophageal rupture from forceful vomiting or instrumentation

Emergency

Hammans crunch

Widening of the mediastinum with free air

Anti-emetics, abx, surgery

139
Q

Esophageal varacies

A

Dilated esophageal veins

30% bleed, 30% of those die

Bright red upper GI bleed, +/- melna, hypotension, instability

Emergent fluids, sleep therapy, banding

140
Q

GERD

A

Antacid
H2
PPI

141
Q

Gastritis

A

Stop offending agent

EGD with biopsy, h pylori testing

Antacid, H2, PPI

142
Q

Peptic ulcer disease

A

H pylori, NSAIDS, secretions issues

Duodenal 5× more likely

H pylori
Clarithro, amox, and ppi

143
Q

GI cancer

A

Adenocarcinoma

Virchow node (supraclavicular)

Sister Mary Joseph’s nodule (periumbilical)

EGD w/biopsy, ct, resection, rads chemo

144
Q

Pylori stenosis

A

Greater in males

3wk-5mo

Non-bilious vomiting

Palpable olive mass

U/S and surgery

145
Q

Gallbladder

A

Charcots triad: jaundice, fever, pain
Reynolds pentad: above plus hypotension and AMS (septic cholangitis)

Corvoisier sign painless jaundice and large palpable non-tender GB (cancer at head of pancreas)

Boas sign pain radiating to tip of right scapula

Tx Cholecystectomy, ERCP

146
Q

Pancreatitis

A

Acute: EtOH, gallstones
Chronic: EtOH

Cullens sign: periumbilicall echimosis

Grey-Turner’s sign: flank echimosis

Lipase>300

Bowl rest, fluids, pain met, NPO

Random criteria estimates mortality

147
Q

Pancreatic cancer

A

CT, u/s with fnb

Surgery whipple, chemo, rad

Bad prognosis 1 yr 20% 5 yr 7%

148
Q

Vit. A def

A

Elderly, alcoholics

Night-blindness, dry skin, poor wound healing

149
Q

Vitamin B1 (thiamine)

A

Alcoholics, poor

Wernickes encephalopathy
Korsakoff syndrome
Beriberi (wet-dry)

150
Q

Vitamin B3 (niacin) def

A

Pellagra

3Ds: diarrhea, dermatitis, and dementia

151
Q

Vitamin B12 (coblamin) def

A

Elderly, vegans, atrophied gastritis

152
Q

Vitamin C def

A

EtOH and elderly
Scurvy
Bleeding gums, Petechia, poor healing

153
Q

Vitamin D def

A

Elderly, women, renal, low sun light, and infants

Ricketts and osteomalacia

154
Q

Vit K def

A

Increased bleeding, increased prothrombin time PT

155
Q

Phenylketonuria

A

Screened at birth
Enzyme that metabolized protein

Tx by reducing protein

156
Q

A flutter

A

Stable: vagle, BB, CCB
Unstable: SCV
Definitive: ablation

157
Q

A fibb

A

Stable: BB, CCB, dig, anticoag
Unstable: SCV if new if not anti cost for 3 weeks before
Definitive ablation

158
Q

SVT

A

Stable: adenosine, BB, CCB
Wide complex: amioderone
Unstable: SCV
Def: ablation

159
Q

WPW

A 
Delta waves
This is wide complex: procanimide
AVOID! Adenosine, BB, CCB, and dig
Unstable: SCV
Definitive: ablation
160
Q

V tach

A

R on T
Hypokalemia, hypomag, antiarrhthmic, prolonged QT

Stable: this is wide complex, so amioderone
Unstable with pulse: SCV
Polymorphic (torsades): mag
Unstable no pulse: defib and CPR

161
Q

Vfib

A

Unsyncronized CV

162
Q

2nd degree AV block

A

Type 1 wenkebach
Going drop

Type 2
sustained prolonged PR with drop

Tx with atrophied if sx brady

163
Q

1st degree AV block

A

Prolonged PR>0.2 s

Atropine if sx brady

164
Q

Third degree AV block

A

Transcutaneous pacing

Perm pace for definitive

165
Q

LBBB

A

Broad R in v5, v6

Deep S in v1, v2

166
Q

RBBB

A

RSR in v1, v2

Deep S in v5, v6

167
Q

Ekg right vent hypertrophy

A

R>7mm or positive in v1

168
Q

Ekg LVH

A

Add S in v1 or 2 to R in v5 or v6

>35 men or 30 women dx

169
Q

Blephritis

A

Baby shampoo, TOPICAL ab

170
Q

Ectropion

A

Eyelids roll out

treatment is surgery

171
Q

Entropion

A

Eyelids roll inward

Treatment is surgery

172
Q

Chalazion

A

Blocked memobian gland

Warm compress, elective removal

173
Q

Hordoleum

A

Painful
Caused by staff infection
Ab, id

174
Q

Dacrocystitis

A

Infection of the lacrimal sac secondary to staph, strep, staph epidermidis, Candida

175
Q

Pterygium

A

No treatment unless blocking vision

176
Q

Pinguecula

A

Benign yellow Mass on the conjunctiva

177
Q

Allergic conjunctivitis

A

Topical antihistamine drops, oral antihistamines

178
Q

Viral conjunctivitis

A

Adenovirus

Warm compresses, artificial tears, topical antibiotics?

179
Q

Bacterial conjunctivitis

A

Topical antibiotics or oral antibiotics for G / C conjunctivitis

180
Q

HSV conjunctivitis

A

Dendritic ulcers on cornea
Most common cause of corneal blindness
Hutchinson’s sign is HSV on tip of nose
Topical or oral antivirals

181
Q

Iritis

A

Limbic flush: erythema goes to edge of iris

Treat with steroids and dilating drops

182
Q

Corneal abrasion

A

Treat with topical antibiotics to cover pseudomonas

Do not give tetracaine or topical anesthetic

183
Q

Corneal ulcer

A

Immediate referral to Ophthalmology

184
Q

Cataracts

A

Lens replacement surgery

185
Q

Closed angle glaucoma

A

Immediate referral to Ophthalmology

Topical beta blockers and IV acetazolamide

186
Q

Open-angle glaucoma

A

Progressive vision loss

Treat with prostaglandins, beta blockers, Alpha Agonist, Carbonic anhydrase inhibitors

187
Q

Hyphema

A

Leading into the anterior chamber

Treat by elevating head of bed, reducing IOP, reversing coagulation issues, possible surgery

188
Q

Macular degeneration

A

Most common cause of blindness in age over 50

No true eatment

189
Q

Papilledema

A

Evidence of increased intracranial pressure

Suspect CNS tumor, intracranial hypertension, ventricular system obstruction

190
Q

Retinal detachment

A

Acute painless vision changes
Increased floaters, flashes, curtain
Laser cryosurgery
Patient lies with head to the affected side

191
Q

Central retinal artery occlusion

A

Emergent referral to Ophthalmology

192
Q

Central retinal vein

A

Thrombotic event
Sudden painless unilateral vision loss
Blood and Thunder
Can recover with time

193
Q

Retinopathy

A

Hypertensive: AV nicking, cotton wool spots

Diabetic: hard exudates, edema, microaneurysms, venous dilation

Treat underlying disease

194
Q

Orbital blowout fracture

A

Diplopia and exophthalmos
Entrapment can lead to diminished EOM in downward gaze

Observation if non-displaced fracture with normal extraocular movements

Surgery

195
Q

Penetrating eye trauma

A

Seidel sign: leaking Fluorescein, open globe

Shield eye

Immediate referral to opthamology

196
Q

Orbital cellulitis

A

Broad-spectrum antibiotics

197
Q

Horizontal nystagmus

A

Vestibular disorder

198
Q

Vertical nystagmus

A

Central nervous system disorder

199
Q

Optic neuritis

A

Multiple sclerosis!
Pain with arm movements, color vision alteration
MRI with contrast is highly sensitive
IV steroids speed recovery

200
Q

Strabismus

A

Misalignment of the eyes
Evident with corneal light reflex
Treat with exercises or surgery

201
Q

Amblyopia

A

Ocular pathology interfering with normal cortical visual development

Visual Center in the brain won’t develop and will never learn to see what then I

Can be caused by strabismus most common

Treat with early corrective lenses and patching

Vision loss permanent if left untreated

202
Q

Amblyopia

A

Ocular pathology interfering with normal cortical visual development

Visual Center in the brain won’t develop and will never learn to see what then I

Can be caused by strabismus most common

Treat with early corrective lenses and patching

Vision loss permanent if left untreated

203
Q

Graves disease

A

Autoimmune hypertyroid

TSH low
T4 high
TSI positive

Radioactive iodine
Meds if pregnant (polythiouracil 1st trim) methimazole after

204
Q

Hashimotos

A

Autoimmune hypothyroidism most common

Elevated TSH
Postitive tpo

Levothyroxine

205
Q

Subacute thyroiditis (dequervians)

A

Painful goiter, transient hyperthyroidism, follows viral infection

Tx as with BB, NSAIDS, and levothyroxine

206
Q

Primary hyperparathyroidism

A

Elevated serum Ca
Elevated PTH
Decreased phos

Bones, stones, groans, moans, psych overtones
Osteoporosis, kidney stones, constipation, muscle spasms, depression and personality d/o

Parathyroidectomy

207
Q

Hypoparathyroidism

A

Surgical MC

Parasthesias, laryngeal spasm, prolonged QT

Low calcium, low pth, high phos

Calcium supplementation and vit D

208
Q

Addisons

A

Fatigue, wt. Loss, hypotension, dry skin

Decreased sodium
Increased K
Hypoglycemia
Hypochloremia

Increased skin pigment due to ACTH
21 hydroxylase ab most specific
With adrenal cortex ab almost 99%

24 urine cortisol first test to r/o
ACTH st in test GS

Tx w/steroids

209
Q

Cushings

A

Excessive ACTH producing pituitary awesome MC

Dexamethasone suppression test (ACTH and cortisol can be supressed)

Adrenal adenoma decreased ACTH, increased cortisol can’t be suppressed with dexamethasone

Ectopic ACTH both elevates and aren’t suppressed

24th urine cortisol, salivary test

Surgery to remove tumor

210
Q

Acromegally

A

Pre puperty: gigantism
Post puberty: acromegally

Headache MC secondary sx, Arthralgia and myalgias

GH producing pituitary tumor

IGF and GH elevated

OGTT is GS (if suppressed, no acromegally)

Dopamine agonist (cabergoline) or surgery

211
Q

Dwarfism

A

Decreased IGF and insulin like binding protein

Dx with GH st in test with arginine and clonidine

GH shots

212
Q

Prolactinoma

A

Most common neoplasm in MEN-1

Galactorhhea (women)
Gynochamastia (men), decreased libido

Cabergoline

213
Q

Ventral DI

A

Caused by trauma

Politics, polydipsia

Low urine osmolariy, high serum Na, high serum similarity, low urine SG

Desmopressin

214
Q

Cervical lesions

A

LSIL with neg pap repeat in 1 yr

LSIS with no or positive pap: culpo and bx

215
Q

PMDD

A

4 depression sx for pms

5 for PMDD

216
Q

Gonnorhhea cervicitis

A

Rocephin 250 mg IM

217
Q

Chlamidya

A

Azithomycin 1 g

218
Q

Trichamonas

A

Flagyl

219
Q

HSV cervicitis

A

Acyclovir

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