Urgent Care + Heme/Onc Flashcards
MCC of RUQ pain (biliary vs hepatic)
Biliary - Biliary colic, acute cholecystitis, acute cholangitis, sphincter of oddi dysfunction
Hepatic - Fitz hugh curtis, liver abscess, budd-chiari, portal vein thrombosis
MCC of epigastric pain
Acute MI, acute or chronic pancreatitis (pain radiating to back) , Peptic ulcer dz, GERD, gastritis, dyspepsia, gastroparesis
MCC of left upper quadrant pain
Splenomegaly, splenic infarct, splenic abscess, splenic rupture
MCC of lower abdominal pain
Apendicitis, diverticulitis, nephrolithiasis, pyelonephritis, acute urinary retention, cystitis, infectious colitis,
Brown recluse spider bite sx
- Brown violin on the abdomen
- Necrotic wound - Local tissue reaction causes local burning at the site for 3-4 hours → blanched area (due to vasoconstriction) → central necrosis erythematous margin around an ischemic center “red halo” → 24-7 hours after hemorrhagic bullae that undergoes Eschar formation → necrosis
Tx for brown recluse bite
For brown spider bites, use wound care, local symptomatic measures, and sometimes delayed excision
Sx of black widow spider bite
- Red hourglass on the abdomen
- Neurologic manifestations - You may not see much at bite site: toxic reaction: nausea, vomiting, HA, fever, syncope, and convulsions
Tx of black widow bite
anti-venom available for elderly and kids
Burns - 1-4th degree, how are they described
- 1st degree (sunburn): Erythema of involved tissue, skin blanches with pressure, the skin may be tender
- 2nd degree (partial thickness): Skin is red and blistered, the skin is very tender
- 3rd degree (full thickness): Burned skin is tough and leathery, skin non-tender
- 4th degree: Into the bone and muscle
Tx of major burns involves what total body %
Major: >25% TBSA adults, >20% TBSA young/old, >10% full-thickness burn, burns involving the face, hands, perineum, feet, cross major joints/circumferential
Tx of major burns
Treatment: monitor ABCs, fluid repletion, topical antibiotic
- Cleans with mild soap and water, don’t apply ice directly; irrigate chemical burns with running water x 20 min, topical antibiotic cream to superficial burns, fingers and toes wrapped individually to prevent maceration and gauze placed between them
- Children with > 10% total body surface area and adults with > 15% need fluid resuscitation ⇒ LR IV x 24 hrs (1/2 in first 8 hrs; ½ in remaining 16)
3 specific beta blockers used in heart failure
Bisoprolol
Carvedilol
Metoprolol succinate
What heart sound is heard with systolic heart failure
S3 (Rapid ventricular filling during early diastole is the mechanism responsible for the S3)
Diastolic left heart failure, what is usually normal?
- Ejection fraction is usually normal
Causes of altered levels of consciousness - AEIOU TIPS
- Alcohol or AAA
- Electrolytes, endocrine
- Insulin
- Opiates
- Uremia
- Trauma, temperature or toxemia
- Infections – sepsis, meningitis
- Psychogenic or pulmonary embolus
- Space occupying lesions, strokes, shock, seizure
Decreased extraocular movement, pain with movement of the eye and proptosis, signs of infection
Orbital cellulitis
Dx of orbital cellulitis
CT scan
Tx of orbital cellulitis
Hospitalization and IV broad-spectrum antibiotics (vancomycin)
Absence of breath sounds and hyperresonance to percussion with tracheal deviation
Pneumothorax
2 types of pneumothorax
-
Primary spontaneous pneumothorax occurs in the absence of underlying disease - tall, thin males between 10 and 30 years of age are at the greatest risk of primary pneumothorax
- Secondary spontaneous pneumothorax occurs in the presence of underlying disease - asthma, COPD, cystic fibrosis, interstitial lung disease
Tx of pneumothorax
<15% of the diameter of the hemithorax will resolve spontaneously without the need for chest tube placement
- For large, > 15% of the diameter of hemithorax, and symptomatic pneumothoraces, chest tube placement is performed
- Patients should be followed with serial CXR every 24 hours until resolved
Virchows triad in PE
- Virchow’s triad: hypercoagulable state, venous stasis, vascular injury
Dx of PE
- Spiral CT: Best initial test
- Gold Standard is pulmonary arteriography
Tx of PE
Heparin to Coumadin bridge. 3-6 mo treatment
Etiology of acute resp distress
Etiology: Sepsis, severe trauma, aspiration of gastric contents, near-drowning
- Rapid onset of profound dyspnea occurring 12-24 hours after the precipitating event.
- Tachypnea, pink frothy sputum, crackles
Dx study for resp failure/distress
- Chest radiograph: air bronchograms and bilaterally fluffy infiltrate
- Normal BNP, pulmonary wedge pressure, left ventricle function and echocardiogram
Treatment: Underlying cause and intubation positive pressure oxygen
3rd trimester bleeding MCC
Placental abrution vs placenta previa(painless)
Anemia of chronic dz labs show elevated
Normal or ↓ MCV, ↓ TIBC, ↑ Ferritin (high iron stores) ↓ serum erythropoietin
Which cell lines are decreased in aplastic anemia
All
The only anemia where all three cell lines are decreased ↓ WBC ↓ RBC ↓ Platelets - will have normal MCV and ↓ Retic
After infection or medication (oxidative stress) in an African American male (x-linked) + Heinz Bodies and Bite Cells on smear
G6PD def
Diagnostic studies for G6PD
- Diagnostic studies: Heinz Bodies and Bite Cells on smear
Red blood cells are destroyed faster than they can be made. The destruction of red blood cells is called hemolysis.
Hemolytic anemia
5 types of hemolytic anemia
- Autoimmune Hemolytic anemia (+ Direct Coombs Test) - ↑ Retic, ↑ LDH, ↓ Haptoglobin, and ↑ Bilirubin (indirect)
- Hereditary Spherocytosis (+) osmotic fragility test. ↑ Retic, ↑ LDH, ↓ Haptoglobin, and ↑ Bilirubin (indirect) and the presence of spherocytes
- G6PD deficiency after infection or medication (oxidative stress) in an African American male (x-linked) + Heinz Bodies and Bite Cells on a smear (damaged hemoglobin - G6PD protects RBC membrane)
- Sickle Cell Anemia (Very ↑ Retic count + Pain in African American male, Hemoglobin electrophoresis: Hemoglobin S, Blood smear: Sickled RBCs, Howell-Jolly bodies, target cells)
- Thalassemia Very ↓ MCV (microcytic and hypochromic) with a normal TIBC and Ferritin, elevated iron and family history of blood cell disorder
African American, pain, family history of blood disorder, Hemoglobin electrophoresis: Hemoglobin S, Blood smear: Sickled RBCs, Howell-Jolly bodies, target cells
Sickle cell
Tx of sickle cell
Hydroxyurea
Family history of blood cell disorder, Microcytic hypochromic, Elevated iron
Thalassemia
Hbg electophoresis for beta thal will show
- Hemoglobin electrophoresis: Hemoglobin A2 and F
2 types of hemophilia and the clotting factors they affect
-
The Hemophilias
- Hemophilia A ↓ clotting factor VIII
- Hemophilia B ↓ clotting factor IX
- Most common genetic bleeding disorder, autosomal dominant
Von wille
Tx of von wille
DDVAP
MC type of hemophilia
- Hemophilia A, which accounts for about 80% of all cases, is a deficiency in clotting factor VIII (“Aight”)
CHILD + Lymphadenopathy + bone pain + bleeding + fever in a CHILD, bone marrow > 20% blasts in bone marrow
Acute lymph leukemia
Middle age patient, often asymptomatic (seen on blood tests), fatigue, lymphadenopathy, splenomegaly
Chronic lymph leukemia
Strikingly Increased WBC count > 100,000 + hyperuricemia + Adult patient (usually > 50 years old)
Chronic myeloid
- 70% asymptomatic until the patient has a blastic crisis (acute leukemia)
- Diagnostic studies: Philadelphia chromosome (translocation of chromosome 9 and 22) - “Philadelphia CreaM cheese”, splenomegaly
Aur rods
AML
Reed-Sternberg Cells are pathognomonic - B cell proliferation with bilobed or multilobed nucleus “owl eye”
Hodgkins
malignancy of the bone marrow that results in the overproduction of red blood cells (primarily) but also can affect platelets, and white blood cells
Polycythemia
Sx of polycythemia
pruritus after hot baths, as well as swelling, burning pain, and rubor of the hands and feet (erythromelalgia)
4 H’s of polycythemia
The 4 H’s: Hypervolemia (↑ RBC), Histaminemia (↑ histamine due to release from mast cells), Hyperviscosity (↑ hematocrit = ↑ viscosity), and Hyperuricemia (↑uric acid)
Tx of polycythemia
Treatment consists of repeated phlebotomy to lower hematocrit to ≤ 42%
