UWorld wrong questions part 1 (1st 200 qs) Flashcards
What vitamin deficiency accompanies carcinoid syndrome?
niacin (b/c 5-HT is made from tryptophan which also makes niacin)
4 diagnostic things to do with carcinoid syndrome
24 hr urine with 5-HIAA, CT/MRI abd/pel, metastasis scan, echo
proximal muscle weakness + weight loss, anxiety, tremor with movement, tachy = think…
hyperthyroidism
Causes of proximal muscle weakness
poly/dermatomyositis, hypo/hyperthyroidism, Cushing’s, Lambert-Eaton, myasthenia gravis, steroids
suspect MEN syndrome: what do you do to screen and treat?
screen: genetic testing
treat: total thyroidectomy
what drug decreases frequency of acute relapse in MS?(for relapsing-remitting)
IFN-beta
what drug should be given DURING acute flare of MS?
high dose steroids
what drugs treat progressive form of MS?(one with no remissions)
immunosuppressants: cyclosporine, methotrexate, mitoxantrone
1st step in diagnosing/managing MS? 2nd step?
MRI of brain w/ w/o gadolinium, showing demyelinated plaques (SECOND step = IgG on CSF)
Extrapyramidal side effect of restlessness = ? treat with?
Akathisia. Benzo
Extrapyramidal side effect of tremor, rigidity, slow movements = ? treat with?
Parkinsonism. no Tx.
Sudden sustained contraction of neck, mouth, tongue, eyes = ? Treat with?
Acute dystonia. Benztropine or diphendydramine
adrenal insufficiency signs + hyperpigmentation, increased K, decreased Na, decreased BP = ?
primary insufficiency (so decreased cortisol, increased ACTH, decreased aldosterone)
best preventative measure to do to reduce chances of peripheral neuropathy with diabetes?
blood pressure control
diff between VIPoma and carcinoid syndrome?
VIPoma tumor in pancreas, carcinoid tumor in SI. also decreased H, Cl, and K in VIPoma
increased T3, T4 and normal TSH = ?
resistance to thyroid hormones. have hypothyroidism signs
loss of pain/temp over ipsi face & C/L body, ipsi dysphasia/hoarseness(CN IX/X), vertigo, nystagmus, Horner’s = what disease, localized where in brain? Tx?
Wallenberg syndrome (lateral medullary infarct). Tx: t-PA
Weakness of jaw, decreased sensation on face = what neuro area infarct?
Lateral pons infarct = more sensory issues. / medial pons = more motor issues
C/L arm/leg paralysis, tongue deviation toward lesion = what neuro area infarct?
Medial medullar infarct
Patient with Parkinsonism experiences: orthostatic hypotension + autonomic dysfunction (i.e. bladder probs, ED, cholinergic signs) + neuro signs? Tx?
Shy Drager syndrome (Multiple System Atrophy). / Tx: fludrocortisone, salt, alpha-adrenergic agonists, constrictive garments
child with autonomic dysfunction and orthostatic hypotension, think what aut dom disease?
Riley Day Syndrome (Ashkenazis_
brain death = what is still functioning?
spinal cord, so DTRs present. NO brainstem fxn (no HR, no breathing, etc)
intention tremor found with what disease?
alcoholism –> cerebellar degeneration
lab values in secondary hyperparathyroidism? (PTH?Ca?PO4?D?)
increased PTH, decreased Ca, increased phosphate, decreased vit D
increased Ca+2 labs; next 2 steps?
Repeat Ca, THEN measure PTH
if hypercalcemia + increased PTH, consider what?
primary and tertiary hyperpara, familial hypercalcemic hypocalcuria, lithium
if hypercalcemia + decreased PTH, consider what?
malignancy, vit D tox, gramulomas, HCTZ/theophylline, thyroxic, vit A tox, immobilization
3 steps to take in management when suspecting acromegaly?
IGF-1 –> oral glucose suppression —> MRI of brain (pituitary?)
where can median nerve entrapment occur?
wrist (loss of motor and sensory) > mid-forearm > elbow (sensory spared)
lacunar infarct will cause what Sx?
U/L motor impairment (b/c posterior limn of internal capsule); no sensory deficits
lesion of optic radiation causes
contralateral hononymous hemianopia
oculomotor nerve lesion causes
ptosis and eye looking down and out (unopposed IV and VI)
trochlear nerve lesion causes
vertical diploplia and extorsion of eye
lesion on medial lemniscus causes
decreased touch and vibration sensation
what withdrawal symptoms happen from abrupt discontinuation of benzos?
seizures
what is first line treatment for OCD?
SSRIs + clomipramine (TCA)
what med to treat anorexia with if no response to CBT?
olanzapine
Cushingoid Sx - steps in management?(4)
1st get 24 hr cortisol / low dose dexa sup test. 2nd get ACTH level. 3rd get imaging based on where it is(adrenal/head MRI?). 4th get IPSS/full body imaging/high dose dexa for ectopic source
Addison Sx - how to diagnose?
after cortissol levels, do Consyntropin stimulation test (analog of ACTH) - if no increase in cortisol it’s primary
Parkland burn formula - how much IVF to give?
4 mL x kg x %BSA, then give first 1/2 first 8 hrs, 2nd half next 16 hrs
When to admit burn patient inpatient and do IVF, escharotomy?
2nd degree with >10% BSA, 3rd degree with >2% BSA, or involving face/hands/genitalia/skin flexure areas
glucose suppression test used for what?
confirmatory diagnosis of acromegaly (after iGF-1, which is 1st step in management)
differences in Ca and PO4 with primary vs secondary hyperparathyroidism?
primary: increased Ca, decreased PO4. secondary: decreased Ca, increased PO4.
feel palpable thyroid nodule, what are next steps in management?
1st get TSH, T4, U/S. 2nd: if hypo or euthyroid, get FNA. If hyperthyroid, do radionucleotide iodine uptake scan. If hot treat hyper. If cold, FNA.
For diabetics, when to do a) physical exam w/ glucose, b) urine microalbumin, U/A, CMP c) lipid panel, d) ophtho visit e) what vaccines
a) 3-6 months dep on HbA1C, b) yearly, c) yearly d) yearly e) flu and pneumo
if you see microalbuminuria in DM patient, what next?
24 hour urine protein to look for nephrotic syndrome
what is neovascularization on fundo exam and how is it treated?
Proliferative DM retinopathy: treat with laser photocoag
J waves on EKG = ?
hypothermia (bump after QRS)
How to treat scorpion sting?
atropine (antichol), antivenin, phenobarbitol
How to treat brown recluse spider bite?
debridement, dapsone. if infection, oral erythromycin.
If dirty/punctured/crush wound, do what tetanus stuff?
Td if > 5 years since last dose and equal to or more than 3 prior immunizations, Td + tetanus Ig if less than 3 prior immunizations
Do not do exercise stress test if…
L BBB, LVH (do nuclear & pharm)
gold standard for CAD?
coronary angio (after 1st step: stress test shows ischemia, angina, or greater than 1 mm ST depression)
chlorpromazine, prochlorperazine, or metoclopramide are hat kinds of drugs, and can be used with NSAIDs or triptans for what?
antiemetics, for migraines
migraine PPx drug?
beta blocker
what antipschotic is associated with QT prolongation and thus you should do ECG?
ziprasidone
what second gen antipsychotic comes with hyperprolactinemia?
risperidone
antipsychotics with highest risk of weight gain/llipid/glucose increase?
olanzapine, clozapine
how to tell malignant hyperthermia from thyroid storm?
malig hyperthermia: muscle rigidity, hyperkalemia. thyroid storm: lid lag, arrythmmias, tremor, goiter. BOTH can occur after surgery.
How to treat thyroid storm?
PTU, iodine, beta blocker for Sx, glucocorticoids for creasing T4 to T3 conversion
B/L LE weakness, UMN signs, think
spinal cord compression (UMN = CNS), B/L = spinal cord and not brain
what is trihexyphenidyl?
anticholinergic, often used for Parkinson’s
essential tremor is what? how to treat?
worsens with activity (OPPOSITE of Parinsonian kind) Primidone + beta blocker. (2nd line = benzos, clozapine)
painless curtain over eye, CAD = what?
amaurosis fugax = loss of vision from emboli, shows stroke is coming. Do Duplex U/S of neck – most common site.
levodopa + carbidopa: s.e.
somnolence, confusion, hallucinations in order patients
amantadine: s.e.
ankle edema, livedo reticularis
apomorphine, bromocriptine, pramipexole, ropinirole: s.e. (Parkinsonian drugs)
somnolence, confusion, hypotension, hallucinations in older patients (these are dopamine agonists)
entacapone/tolcapone: type, s.e. (Parkinsonian drugs)
COMT inhibitor. Dyskinesia, hallucinations, confusion, N, hypotension
selegiline: type, s.e.
MAO-B inhibitor. insomnia, confusion
treatment for prolactinoma: 1st, then 2nd
capergoline>bromocriptine, then Sx if it fails
what is diagnostic of MS?
MRI brain (not LP- IgG bands, b/c this only exists in 90% of pts)
treatment for Paget’s disease?
bisphosphonates if symptomatic
Patient with HTN & hypokalemia, suspect hyperaldosteronism. 1st step in management? 2nd? 3rd?
1) aldosterone/renin ratio. (primary vs secondary)
2) if increased, do adrenal suppression tests (if +, then adrenal imaging)
Type of gait in Parkinsonism?
hypokinetic (slow, shuffling, narrow, immobile arms)
waddling gait is in what?
muscular dystrophy (weak gluteals)
spastic gait is in what?
UMN lesions or cerebral palsy
wide-based, high stepping gait is in what?
sensory ataxia (because loss of proprioception) – Romberg +. Wide is also in MSA, multiinfarct.
how to tell apart lacunar infarct vs MCA vs ACA?
lacunar: U/L motor impairment. MCA: C/L sensory & motor face, arm, leg, homonymous hemianopia, eye deviation twd infarct, aphasia/hemineglect. ACA: same as above but in LE only.
1st and final diagnosis of prinzmetal angina?
1st: stress test (ST elev during pain sx only). Final diagnosis: coronary arteriography showing NO stenosis
1st line treatment of prinzmetal angina?
CCB (NOT beta blocker)
when to do CABG?
> 50% stenosis in LAD, 3 vessel disease, or CAD + DM
when to do fibrinolysis?
STEMI, NOT unstable angina
what to give in a propanolol OD?
glucagon, Ca, insulin + dextrose
what is a diagnostic glucose level for DM?
random >200 + DM symptoms OR fasting >126 on two occasions
narrow QRS, HR >100, healthy young patient
paroxysmal SVT. This includes WPW & AV nodal reentry. [v. tachy = wide QRS!)
treatment for SVT
1st: carotid massage, valsalva. 2nd: IV amiodarone. 3rd: CCBs, BB. 4th: CV.
hyperthyroidism can cause what heart problem?
a fib (no P, narrow QRS)
How to treat a fib?
if 48 hrs, anticoag & TEE to check for thrombus. Then rate control (bb) or rhythm control (sotalol or amiodarone, aka K+ antiarrythmics)
wide QRS, no p waves
PVCs. No Tx.
slightly decreased T3, normal T4, normal TSH with person with acute illness = what?
sick euthyroid syndrome
Myasthenia gravis: what is screening test, what is used to diagnose, and what is 3rd test?
Screening: Edrophonium. Diagnose: EMG & ACh-R Ab test. 3rd: CT scan of chest (to look for thymoma)
What DM drug is best for weight loss?
GLP-1-R agonist, i.e exenatide
loss of motor and sensory function in LE + loss of rectal tone/urinary retention, sensation at umbilicus intact= ?
acute spinal cord compression (do emergent MRI + surgery, IV glucocorticoids). [not cauda equina b/c this would have saddle anesthesia // not conus medullaris lesion b/c this wouldn’t have motor/sensory loss]
how to tell apart ruptured aneurysm -> subarachnoid hemorrhage vs. a intracerebral hemorrhage?
subarachnoid wouldn’t have specific FNDs like hemiparesis; just headache and N/V.
What symptoms compose Wernicke’s encephalopathy?
triad: encephalopathy, oculomotor dysfunction, and gait ataxia.
What constitutes progression of Wernicke’s into Korsakoff’s syndrom?
once neuro Sx include amnesia, confabulation, and apathy
when should you do parathyroidectomy for asymptomatic hypercalcemia?
Ca >1mg above, age
burst fracture of the vertebrae + loss of motor fxn I/L with loss of pain/temp B/L
anterior cord synfrome
I/L motor and proprioception loss, C/L pain loss
Brown Sequard Syndrome
Positive straight leg raising test means…
acute disk prolapse
burning pain and paralysis in UE, sparing of LE, from hyperextension of neck in elderly
central cord syndrome
a) enlargement of cerebral ventricles in what psych disease? b) total brain volume increased where? c) decreased hippocampus where? d) decreased amygdala where?
a) schizophrenia b) autism c) PTSD d) panic disorder
what drugs reduce mortality in CHF?
beta blockers, ACE inhibitors, and aldosterone antagonists (ie eplenerone)
VSD murmur?
systolic
murmur buzzwords – a) opening snap? b)bounding pulses/head bobbing?
a) MS b) AR
late systolic murmur at apex?
MVP (MR would be holosystolic)
valsalva maneuver makes what murmurs louder?
HCM, MVP (because it decreased preload?
DCM vs HCM - what heart sounds?
DCM: S3. HCM: S4
confirmatory diagnosis of RCM?
with biopsy
Kussmaul sign vs pulsus paradoxus?
Kussmaul: JVD w/ inspiration, constrictive pericarditis. Pulsus paradoxus: decreased SBP w/ inspiration. with cardiac tamponade
Screening and gold standard test for renal artery stenosis?
Screen: MRA. Gold: renal arteriogram
1st line drug for HTN?(nonblacks)
thiazide diuretics (also CCB, ACE, or ARB)
Diuretics - which increase K? decrease K? increase Ca? decrease Ca?
increase K: aldo-I, ACE-I. / Decrease K: loop, thiazides. / increase Ca: thiazides. / decrease Ca: loops.
beta-1 selective BBs
atenolol, metoprolol (first half of alphabet)
beta-1/alpha-1 BBs
labetalol, carvedilol (don’t end in Olol)
beta blocker s.e.s
bronchoconstriction (so, contra. in asthma/COPD - esp propanolol b/c nonselective), decrease HDL, increase Tgs, mask hypoglycemia
nifedipine, amlodipine, diltiazem, verapamil - diffs?
1st 2: dihydro (-DIPINE) CCBs. work at vasculature. HTN, prinzmetal angina, migraines, esoph. spasm.
2nd 2: nondihydro CCBs: work at heart. rate control for A. fib.
hydralazine, minoxidil, nitroprusside - type? s.e.?
vasodilators. (only this nitrate = vaso AND venodilator), s.e.: reflex tachy, so use with BB
Treatment BP goals for HTN
> 60 yrs with no CKD/DM:
Black population w/o CKD - what HTN drugs to use?
thiazide diuretics or CCB
what HTN drug is contraindicated in CHF?
nondihydro CCBs (diltiazem, verapamil); BBs during acute exacerbation
best HTN drug for person with osteoporosis/post-menopausal?
thiazide (because increased Ca is effect)
Drugs for HTN in pregnancy?
Hydralazine, Methyl-dopa, Labetalol, Nifedipine (HTNive mothers love nifedipine)
diuretics: contraindicated in = ?
gout
what treats both migraines and essential tremor?
BBs
treatment for cardiogenic shock?
dobutamine (beta-1 effect) or dopamine, PTCA (MI), intraaortic balloon pump
if decreased BP, how can you tell that this is shock and not someone’s baseline low BP?
urine output & mental status (end organ damage)
treatment for septic shock:
Abx, IVF, norepinephrine (because causes vasocontriction without effecting heart)
treatment for anaphylactic shock
Epi, diphenhyhdramine, maintain airway, IVF
treatment for neurogenic
IVF, vasopressors, atropine if bradycardia
PCWP of Swann-Ganz cath measures…? when is it high/low?
left atrial P. high in cardiogenic. low in everything else.
In what kinds of shock is SVR low?
neurogenic, septic, anaphylactic
what is best pressor for a) cardiogenic shock? b) septic shock? c) anaphylactic shock?
a) dobutamine b)NE or phenylephrine; vasopressin if resistant c) Epi
causes of decreased iodine uptake:
subacute thyroiditis, levothyroxine OD, iodine-induced thyrotoxicosis, struma ovarii
How to treat metastases?
one: surgical resection then stereotactic radiosurgery/whole brain radiation. multiple: straight to whole brain radiation. [[chemo best for small cell, lymphoma, choriocarc]]
Treatment of restless leg synfrome?
pramipexole (dopamine agonist); 2nd line = gabapentin
ulnar nerve compression most common at the…
elbow
How to treat myasthenia CRISIS?
intubate, then steroids + plasmapheresis > IVIG
When to use haloperidol vs benzos for agitation?
benzos for younger patients (ontraindicated in older), haloperidol for older
Pseudotumor cerebri/benign intracranial HTN is treated with what? What is complication?
weight reduction and Acetazolamide (b/c it is a problem with impaired absorption of CSF by arachnoid villi). Blindness.
what is true vertigo?
spinning sensation looking at things (as opposed to dizziness from lightheadedness, syncope)
vertigo and nystagmus on lying back into supine position with head rotated = ? Indicates what? Cause?
Dix-Hallpike maneuver. Indicated benign paroxysmal positional vertigo (caused by semicircular canal dysfunction)
a) Pronator drift indicated what? b) Romberg indicates what? c) rapid alternating movements test what?
a) UMN damage of UEs. b) proprioception loss (posterior column sensory). c) cerebellar dysfunction
facial pain leading to headache, FNDs, ring enhancing lesion = ?
ethmoid sinusitis ==> brain abscess, usually with S viridians or anaerobes
Cauda equina syndrome (spinal nerve roots) vs. conus medullaris syndrome (spinal cord termination) – differences?
Cauda equina: saddle anesthesia, U/L motor weakness, hyporeflexia.
Conus medullaris: perianal anesthesia, B/L motor weakness, hyperreflexia.
decreased Ca, decreased PO4, increased PTH with IBD/Gi thing or after surgery – what is cause?
osteomalacia/vit D deficiency (b/c malabsorption). Will have bone pain and increased alk phos as well.
“suicide attempt” in person with CAD and wheezing, hypotension, bradycardia, hypoglycemia, seizures, =?
beta blocker OD. give glucagon
a tachy with AV block, think…
digitalis toxicity
HTN in young adult patient, consider =? treat=?
aortic coarctation, so do B/L arm/leg BP measurements. treat with baloon angioplasty
Mixed venous-oxygen saturation for types of shock= ?
will have opposite trend of SVR, so just remember that.
What drugs cause widening of QRS with increased heart rate (“use dependence”)?
antiarhythmics
murmur with Marfan syndrome? what does it sound like?
aortic dissection that leads to aortic regurgitation. Early diastolic murmur. [also, MVP!]
pulsus parvus et tardus = ?
arterial pulse with decreased amplitude and delayed peak seen in aortic stenosis
Renal artery stenosis: how to treat in young patient, and in old patient?
Young: angioplasty with stent. Old: ACE inhibitor
Heart failure after chemo, think…
constrictive pericarditis (if with JVP/kussmaul’s, low voltage QRS on ECG, +HJ reflux, knock (mid-diastolic sound)
difference between chronic and acute MR?
acute: usually from papillary muscle displacement after acute MI, leading to volume overload –> increased LAP, LVP. chronic: increased atrial SIZE
How to diagnose and treat AAA?
DIag: abd U/S. Treat: BB; surgery if Stanford A type.OR diameter >5.5 in men, >5 in women, or increase >0.5 in 6 months
How to treat PVD aka PAD?
cilostazol to decrease claudiation (if no HF), ASA, clopidogrel, statin. If fails, angioplasty or bypass graft.
When do you do a Ankle-Brachial Index (ABI)?
To diagnose PVD AND to r/o PVD when checking varicose veins
If you see BP 170/94, HR 52, RR 9 think…
increased intracranial P (this is Cushing’s triad). Look for papilledema and pupil asymmetry too
What to do to Dx/Tx stab wound in zone I of neck? zone II? zone III?
zone I (below cricoid): EGD + full imaging. Zone II: surgical exploration. zone III (above mandible): 4 vessel CT angio.
How to manage blunt abdominal trauma in patient with stable vitals?
ABCs, 2 large bore IVs, NG/Foley, and CT abdomen and pelvis
How to manage blunt abd trauma and unstable vitals?
FAST (Focused Assessment with sonography for trauma). If (+) for blood in pelvis: emergent lap.
If (-) for blood: angiography + embolization –> if this is normal, CT abd.
. If FAST inconclusive: DPL (diagnostic peritoneal lavage).
How to treat patient with pelvic fracture?
IVF +/- blood, FAST. If (+) blood, emergent lap. If no fluid but unstable, DPL. If no blood on DPL and unstable,, angio + embolization. (may be retroperitoneal hemorrhage).
Pelvic fracture + DPL shows blood in pelvis. Next step?
emergent lap
Pelvic fracture + DPL shows urine in pelvis. Next step?
urgent lap
Pelvic fracture + DPL shows nothing + unstable. Next step?
angiography + embolization
Blunt abd trauma + unstable vitals + FAST shows fluid in pelvis. Next step?
emergent lap
Blunt abd trauma + unstable vitals + FAST shows no fluid in pelvis. Next step?
angiography + embolization
Blunt abd trauma + unstable vitals + FAST inconclusive. Next step?
DPL
Patient has a. fib with RVR, has chronic a fib. What is next step?
TEE (look for clots ) – BEFORE CV
What to do for stable fracture? For unstable fracture?
Stable: immobilization. Unstable: int/ext fixation
neurovascular injury + fracture = Tx?
fasciotomy (risk of compartment syndrome)
When to perform C-section with trauma in pregnant patient?
fetuses > 24 weeks in distress, or mom with CV compromise.
When can you D/C a pregnant patient who had trauma?
- contractions >10 min, no vag bleeding (and if ANY bleeding, check Rh and give RHoGAM if Rh-), no abdominal pain, and normal fetal heart
Smokers - what to test pre-op?
make sure they stopped smoking >2 months; PFTs if with myasthenia.
Can give what for renal patients pre-op?
N-acetyl cysteine
High pitched bowel sounds and air fluid levels on abd CT means what?
bowel obstruction (HANG IV: Hernias, Adhesions, Neoplasms, Gallstone ileus, Intussuseption, Volvulus)
How to treat diverticulitis?
metronidazole + fluoroquinolone
how to treat hemorrhage from GI perforation?
angio + embolization
sudden onset intense abdominal pain in CAD patient, bloody diarrhea, but not much on physical exa; CT with bowel wall thickening + air within bowel wall (pneumatosis)= ? Tx?
Acute Mesenteric Ischemia (“GI MI”). Tx: NPO, broad Abx, NG decomp, angiogram, heparin. If embolus/thrombus caused it, do -ectomy/resection of necrotic bowel + revascularization and 2nd look lap 1-2 days later for stuff you missed.
dull post-prandial epigastric pain in CAD patient, weight loss, abdominal bruit =? Tx?
Chronic Mesenteric Ischemia (“GI angina”). Tx: ypass, endartectomy, angioplasty + stenting
anti donor T cell Abs are present in what type of transplant rejection?
Acute (6 days - 1 yr)
s.e. of cyclosporine and tacrolimus (immunosupp)?
nephrotoxicity (tacro used for eczema)
s.e. of azathioprine, muromonab, and mycophenolate (immunosupp)?
bone marrow supp, decreased WBCs
do not use azathioprine with which drug?
allopurinol (both inhibit xanthine oxidase)
s.e. of rapamycin(immunosupp)?
decreased platelets, increased lipids
what drug for lupus caused decreased WBCs, lymphoma, and is a teratogen?
mycophenolate
Hydroxycholorquine - what is it used for and what s.e. does it have?
lupus and RA (immunosuppressant). s.e. = visual disturbances.
if someone has a pure motor stroke but CT head does not show anything, where is the stroke probably located?
deep lacunar infarct from the internal capsule
difference between CMV and HSV/VZV retinitis?
CMV = painLESS & no conjunctivitis + fluffy/grandular/hemorrhagic lesions.
HSV: painFUL, conjunctivitis, keratitis, pale lesions + central necrosis of retina.
MI + hypotension, ncreased JVP, and clear lung fields, think…
right ventricular infarct (inferior wall)
migrating skin rash + DM + GI symptoms (inc diarrhea), think what tumor?
glucagonoma (skin rash = necrolytic migratory erythema)
cold leg vs warm leg, what to think/do?
cold = acute limb ischemia from arterial occlusion, often from emoblus/thrombus. Do echo to look for thrombus, anticoag + surg. warm = DVT = Do doppler.
main differentiating factor between seizures and syncope?
post-ictal state in seizures
s.e. of antithyroid drugs (thoinamides) a) methimazole b) PTU
a) agranulocytosis
b) hepatic failture
how to tell apart aortic dissection and esophageal perforation?
esophageal perf will have high amylase & low pH, and think of it more with alcoholic (Boerhaave)
How to diagnose and treat Mallory-Weiss; Boerhaave?
Mallory dx: EGD. tx: wait.
Booerhave dx: CT/contrast w/ Gastrografin. tx: Sx for thoracic perf, Abx for cercical perf.
diabetic neuropathy causes what GU problems?
hypogonadism, neurogenic bladder with overflow incontinance (dribbling + high RV) – SEPARATE from diabetic NEPHROpathy
lidocaine – type, use, risk?
class IB antiarrythmic. decreases v. fib chances. Increases risk of asystole.
what is keratitis?
irritation of the cornea; often from contact lens, and if infected can cause redness and ulceration (acute glaucoma does not cause ulceration, just opacification). emergenc, needs broad spec Abx
what is episcleritis?
inflammation/redness at corners of sclerae only (as name suggests!) - associated with autoimmune i.e. RA
proteinuria, heart failure sx, hepatomegaly, neuropathy, bruising/bleeding, echo = thickened ventricle and normal size, ECG = low voltage, think =? Dx?
Amyloidosis. Dx: tissue biopsy i.e. from abd fat pad, bone marrow, etc
how is central retinal artery occlusion treated?
**remember it presents with amaurosis fugax, painLESS loss of vision *** Tx: ocular massage to dislodge embolus, and high flow O2
difference between closed and open angle glaucoma?
closed: acute, painful, red eye with fixed dilated pupil.
open: chronic, decreasing peripheral vision.
MAIN s.e. to remember with CCBs like amlodipine? how to fix?
peripheral edema. Add ACE inhibitor or ARB.
at what stenosis level should you do carotid endarterectomy?
70%+ in women, 50%+ in symptomatic men, 60%+ in asymptomatic men
CHF Sx in young patient, think…
DCM, and if sick then secondary to viral myocarditis.(often Coxsackie B)
young woman with acute pain on eye movement, color perception problems, sluggish pupillary response, central scotoma =?
optic neuritis. common with M.S.
What is presbyopia? How to treat?
loss of elasticity in lens from old age; cannot focus on near object as well anymore. Get reading glasses.
unstable vital signs
retroperitoneal hematoma. Dx: noncontrast CT abd and pelvis.
Tx: ICU, bed rest, IVF/blood (supportive)
diff between viral and allergic conjunctivitis?
allergic: always B/L, shorter duration, itchy.
Viral: gritty/sandy, U/L or B/L, longe duration with URI sx.
How to treat acute glaucoma?
mannitol, acetazolamide, timolol, or pilocarpine to decrease IOP. [do NOT use atropine, it can make it worse]
How to treat A. fib in patients with WPW? What NOT to do?
Procainamide for rhythm control for stable patients; CV for unstable. DO NOT use beta blockers, CCBs(esp verapamil), digoxin, or adenosine because theyblock AV node, increasing conduction thru accessory pathway.
