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EOR - Family Med > Urgent Care + Heme/Onc > Flashcards

Urgent Care + Heme/Onc Flashcards

1
Q

MCC of RUQ pain (biliary vs hepatic)

A

Biliary - Biliary colic, acute cholecystitis, acute cholangitis, sphincter of oddi dysfunction

Hepatic - Fitz hugh curtis, liver abscess, budd-chiari, portal vein thrombosis

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2
Q

MCC of epigastric pain

A

Acute MI, acute or chronic pancreatitis (pain radiating to back) , Peptic ulcer dz, GERD, gastritis, dyspepsia, gastroparesis

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3
Q

MCC of left upper quadrant pain

A

Splenomegaly, splenic infarct, splenic abscess, splenic rupture

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4
Q

MCC of lower abdominal pain

A

Apendicitis, diverticulitis, nephrolithiasis, pyelonephritis, acute urinary retention, cystitis, infectious colitis,

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5
Q

Brown recluse spider bite sx

A
  • 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
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6
Q

Tx for brown recluse bite

A

For brown spider bites, use wound care, local symptomatic measures, and sometimes delayed excision

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7
Q

Sx of black widow spider bite

A
  • Red hourglass on the abdomen
  • Neurologic manifestations - You may not see much at bite site: toxic reaction: nausea, vomiting, HA, fever, syncope, and convulsions
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8
Q

Tx of black widow bite

A

anti-venom available for elderly and kids

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9
Q

Burns - 1-4th degree, how are they described

A
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10
Q

Tx of major burns involves what total body %

A

Major: >25% TBSA adults, >20% TBSA young/old, >10% full-thickness burn, burns involving the face, hands, perineum, feet, cross major joints/circumferential

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11
Q

Tx of major burns

A

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)
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12
Q

3 specific beta blockers used in heart failure

A

Bisoprolol

Carvedilol

Metoprolol succinate

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13
Q

What heart sound is heard with systolic heart failure

A

S3 (Rapid ventricular filling during early diastole is the mechanism responsible for the S3)

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14
Q

Diastolic left heart failure, what is usually normal?

A
  • Ejection fraction is usually normal
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15
Q

Causes of altered levels of consciousness - AEIOU TIPS

A
  • 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
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16
Q

Decreased extraocular movement, pain with movement of the eye and proptosis, signs of infection

A

Orbital cellulitis

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17
Q

Dx of orbital cellulitis

A

CT scan

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18
Q

Tx of orbital cellulitis

A

Hospitalization and IV broad-spectrum antibiotics (vancomycin)

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19
Q

Absence of breath sounds and hyperresonance to percussion with tracheal deviation

A

Pneumothorax

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20
Q

2 types of pneumothorax

A
  • 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
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21
Q

Tx of pneumothorax

A

<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
22
Q

Virchows triad in PE

A
  • Virchow’s triad: hypercoagulable state, venous stasis, vascular injury
23
Q

Dx of PE

A
  • Spiral CT: Best initial test
  • Gold Standard is pulmonary arteriography
24
Q

Tx of PE

A

Heparin to Coumadin bridge. 3-6 mo treatment

25
Q

Etiology of acute resp distress

A

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
26
Q

Dx study for resp failure/distress

A
  • 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

27
Q

3rd trimester bleeding MCC

A

Placental abrution vs placenta previa(painless)

28
Q

Anemia of chronic dz labs show elevated

A

Normal or ↓ MCV, ↓ TIBC, ↑ Ferritin (high iron stores) ↓ serum erythropoietin

29
Q

Which cell lines are decreased in aplastic anemia

A

All

The only anemia where all three cell lines are decreased ↓ WBC ↓ RBC ↓ Platelets - will have normal MCV and ↓ Retic

30
Q

After infection or medication (oxidative stress) in an African American male (x-linked) + Heinz Bodies and Bite Cells on smear

A

G6PD def

31
Q

Diagnostic studies for G6PD

A
  • Diagnostic studies: Heinz Bodies and Bite Cells on smear
32
Q

Red blood cells are destroyed faster than they can be made. The destruction of red blood cells is called hemolysis.

A

Hemolytic anemia

33
Q

5 types of hemolytic anemia

A
  1. Autoimmune Hemolytic anemia (+ Direct Coombs Test) - ↑ Retic, ↑ LDH, ↓ Haptoglobin, and ↑ Bilirubin (indirect)
  2. Hereditary Spherocytosis (+) osmotic fragility test. ↑ Retic, ↑ LDH, ↓ Haptoglobin, and ↑ Bilirubin (indirect) and the presence of spherocytes
  3. 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)
  4. Sickle Cell Anemia (Very ↑ Retic count + Pain in African American male, Hemoglobin electrophoresis: Hemoglobin S, Blood smear: Sickled RBCs, Howell-Jolly bodies, target cells)
  5. Thalassemia Very ↓ MCV (microcytic and hypochromic) with a normal TIBC and Ferritin, elevated iron and family history of blood cell disorder
34
Q

African American, pain, family history of blood disorder, Hemoglobin electrophoresis: Hemoglobin S, Blood smear: Sickled RBCs, Howell-Jolly bodies, target cells

A

Sickle cell

35
Q

Tx of sickle cell

A

Hydroxyurea

36
Q

Family history of blood cell disorder, Microcytic hypochromic, Elevated iron

A

Thalassemia

37
Q

Hbg electophoresis for beta thal will show

A
  • Hemoglobin electrophoresis: Hemoglobin A2 and F
38
Q

2 types of hemophilia and the clotting factors they affect

A
  • The Hemophilias
    • Hemophilia A ↓ clotting factor VIII
    • Hemophilia B ↓ clotting factor IX
39
Q
  • Most common genetic bleeding disorder, autosomal dominant
A

Von wille

40
Q

Tx of von wille

A

DDVAP

41
Q

MC type of hemophilia

A
  • Hemophilia A, which accounts for about 80% of all cases, is a deficiency in clotting factor VIII (“Aight”)
42
Q

CHILD + Lymphadenopathy + bone pain + bleeding + fever in a CHILD, bone marrow > 20% blasts in bone marrow

A

Acute lymph leukemia

43
Q

Middle age patient, often asymptomatic (seen on blood tests), fatigue, lymphadenopathy, splenomegaly

A

Chronic lymph leukemia

44
Q

Strikingly Increased WBC count > 100,000 + hyperuricemia + Adult patient (usually > 50 years old)

A

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
45
Q

Aur rods

A

AML

46
Q

Reed-Sternberg Cells are pathognomonic - B cell proliferation with bilobed or multilobed nucleus “owl eye”

A

Hodgkins

47
Q

malignancy of the bone marrow that results in the overproduction of red blood cells (primarily) but also can affect platelets, and white blood cells

A

Polycythemia

48
Q

Sx of polycythemia

A

pruritus after hot baths, as well as swelling, burning pain, and rubor of the hands and feet (erythromelalgia)

49
Q

4 H’s of polycythemia

A

The 4 H’s: Hypervolemia (↑ RBC), Histaminemia (↑ histamine due to release from mast cells), Hyperviscosity (↑ hematocrit = ↑ viscosity), and Hyperuricemia (↑uric acid)

50
Q

Tx of polycythemia

A

Treatment consists of repeated phlebotomy to lower hematocrit to ≤ 42%

EOR - Family Med (5 decks)

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