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Week 1 Flashcards

1
Q

nephrotic syndrome surprisingly includes

A

hypercoag leading to risk of renal vein thrombus

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2
Q

drugs turning pee red

A

macrobid and rifampin

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3
Q

parasite causing hematuria

A

schistosomiasis - eggs laid in Gu cells - 15% of people is some areas of africa - 150,000 deaths, common cause of CKD

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4
Q

bleeding issues in CKD

A

platelet dysfunction from uremia, needs dAVP

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5
Q

Branham sign

A

occlude AV fistula, get drop in HR, indicates high output heart failure on a dialysis patient from the AV fistula

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6
Q

PD related peritonitis

A

100WBC and 50% neutrophils. this is lower than the 250 neutophil cutoff for sbp in cirrhosis

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7
Q

stagnorn stones

A

made of struvite, klebliessa making urea stones

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8
Q

radio-lucent stones

A

uric acid stones - gout, leukemia, high protein diets

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9
Q

prostatitis and epididymitis treatment

A

under 35 tx like PID - ceftriaxone IM and doxy for 10 days. over 35 tx with bactrim for 2-4 weeks for e coli

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10
Q

lymphogranuloma venereum -

A

chlamydia, painless ulcer then inguinal adenopathy with pus possible, tx with doxy.

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11
Q

prehn sign

A

relief of pain with elevation of testicle - suggests epididymitis and not torsion

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12
Q

erythema multiforme

A

most commonly caused by HSV - target lesions develop over 72 hours - palms, trunk, and mucosal lesions - similar but different from SJS and TEN - tx with steroids

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13
Q

SJS and TEN

A

SJ is less than 10% (TEN)
HIV is x1000 risk
burn unit, eye consult

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14
Q

SSSS

A

exotoxin, usually kids <6, pos nikolsky, painful, erythema that is like sandpaper, tx with abx and ICU admit

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15
Q

exfoliative dermatitis

A

increased cell turnover leading to erythema then scaling tight skin, water and heat loss or regulation leads to 30% mortality

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16
Q

impetigo

A

honey colored staph and GAS infection on face in kid under 6 or elderly pt. bullous form in toxin and makes bullae/vesicles up to 3cm

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17
Q

erysipselas

A

raised erythematous plaque acute onset from strep - very SHARP boarder - amoxicillin unless systemic symptoms

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18
Q

nec fasc

A

clinda stops the toxin formation so it is first line - LIRNEC score

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19
Q

kerion

A

boggy bald circle - immune response to tinea capitis - tx with antifungal AND steroids

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20
Q

tzanck smear

A

HSV smear - mostly replaced by culture and PCR

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21
Q

herpetic whitlow

A

dont confuse with paronychia - its full of dead epithelial cells instead of pus - dont want to spread herpes into deep tissues

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22
Q

scabies tx

A

5% permethrin on days 1 and 7 of full body. or ivermectin on day 1 and 14 (non preg/breast feeding)

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23
Q

erythema nodosum

A

cancer, lung infections, IBD, OCPs. mosly young women. NSAIDS and elevation is tx after work up

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24
Q

pemphigus vulgaris

A

autoimmune loss of keraton adhesion causing plastering and mucous membrane involvement, much like SJS. 40-60yo patients. nikolsky posistive (SJS, TEN, SSSS, PV), not to be confused with bullous pemphigOID that is older than 60 and better prognosis. both tx with steroids

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25
BCC
most common skin cancer waxy, nodular, wxy, shinny red resection or chemo
26
SCC
ulcerating cecnter - resection cures >90%
27
melanoma
most deadly skin cancer by far, the ABCDE mole of melanoma
28
animal bits and fight bite that are high risk of infection
leave them open and let antibiotics and washout help
29
hantavirus
aerosolized rodent feces - pulmonary and fever - can be fatal
30
rat bite fever
brain and myocardial involvement in febrile illness after a rat bite
31
black widow
antivenom only for severe symptoms. it comes from horses so risk of anaphylaxis or serum sickness. otherwise watch or benzos, is an Ach release neurotoxin leading to cramping and spasm
32
brown recluse
necrotic initially painless wound - no antidote - supportive care
33
what is serum sickness
immune response delayed by 1 week after antigen exposure
34
scorpions
antivenom only indicated for bark scorpion and only available in AZ
35
stinger fish (zebra and lion, urchin)
venom can be inactivated by hot water for 1.5 hours
36
jelly fish
immerse in vinegar, then remove stingers. box jellyfish has antivenom
37
tetrodotoxin
blocks Na channels - leads to paralysis
38
pit vipers
rattle, copperhead, water moccasin(cottonmouth) | cro-fab, elevate
39
coral snakes
Ach receptor binding - can lead to paralysis, anti-venom, intubation?
40
malignant hyperthermia - patho and tx
genetic Ca release from skeletal muscles after succ or inhaled anesthetics tx with dantrolene
41
heat stroke
hyperthermia and AMS usually >40C hepatic damage anti-pyretics don't work
42
Frostbite
warm water rapid rewarming | leave the blisters in place or needle aspirate
43
trentch foot
unlike frostbite - this is above freezing temps but for prolonged time, also called immersion foot - this is rewarmed dry
44
hypothermia cutoffs
30, 32 and 35 C | shivering decreases at every stage mild to severe
45
core temp during ACLS
needs 32C to be declared dead | only need to shock once until above 32C
46
lightning 3` facts
lichtenberg fern figures do CPR on pulseless during mass triage, they may just need time cataracts years later
47
retina htn
flames, papilledema, exudates
48
TG for pancreatitis
500+
49
VSD
most common heart defect not cyanotic presents with poor weight gain, large liver
50
post rosc cooling (who?)
post Vfib arrest
51
arterial gas embolism
diving injury where alveoli rupture and air ebmolism goes to circulation system
52
water hemlock
looks like parsnips, gaba blocker leading to status and can be lethal
53
foxglove and oleander, lily of the vally
digoxin - Na K atpase block
54
anti cholinergic plants and treatment
jimsonweed | physostigmine is reversal
55
roccuronium reversal
suggamadex
56
anemia MCV
low - dont make heme (chronic, iron, lead) normo - destruction or hemorrhage high - cant divide (b12, folate)
57
HUS
MAHA from Ecoli with renal dysfunction
58
TTP
MAHA from ADAMTS13 deficiency - FATRN w/ jaundice | tx with plasma exchange
59
DIC vs TTP vs autoimmune
DIC has higher fever autoimmune has pos coombs fibrinogen low in DIC
60
aplastic crisis
Hb drop of 2 without reticulocytosis | parvovirus
61
polycythemia vera
thrombosis and bleeding
62
methemoglobinemia
tx with metholine blue (not if g6pd) oxidized iron 86% pulse ox brown blood
63
CML
hardly see it. most rare, mostly adults, phili 9-22 switch. usually asymptomatic
64
AML
most common ACUTE leukemia in adults (65) blasts, variable white count bone marrow biopsy
65
CLL
MOST common adult leukemia lymphocytes >5000, with neutropenia, anemia, tpn dx with cytometry
66
ALL
childhood leukemia - ages 2-5 onset | blasts -> biopsy
67
hodgkin lymphoma
20s and 50s cervical painless lymphadenopathy with pain after drinking owl eye cells very treatable
68
non Hodgkin lymphoma
elderly people, a grab-bag of B and T cell malignancies
69
burkitt lymphoma
EBV infection leading to lymphoma common in africa
70
ITP
treat with IVIG or steroids in adults, most kids just avoid sports and climbing for 2 months.
71
transfusion graft vs host
80% fatal - immunocompromised patients should get irradiated blood
72
von willebrans
desmopressin for mild factor 8 for bleeding - acts like hemophilia A - von willebrand factor is carrier protein for factor 8 which is a cofactor for platelets
73
when to give platelets
50000 and bleeding | 10,000 prophylaxis
74
reactive arthritis
reider syndrome (or urethritis) post chlamydia or diarrheas illness tx with NSAIDS
75
lefort
1 - hard palate 2 - into orbits 3 - hear no evil - zygoma
76
who needs ct before LP
altered, seizure, neuro deficit, papilledema. give abx, you have 2 hours for LP without effect on csf
77
procainamide dosing
50 mg per min up to 17 mg/kg
78
dementia types frontal temporal lewy body prion
FT - behavioral, quick decline lewy - visual hallucinations prions - MSK - myoclonus and chorea
79
traveler's diarrhea
azithro 1000mg for SE asia | cipro 750 x1 from latin america
80
HCAP risk factors
snf, 2 day admission, iv abx at home, dialysis, chemo
81
pelvic fracture types
AP - open book, bleeding, binder | vertical shear - sacral fx and sacral nerve root injuries
82
when not to use succ
Neuromuscular disease, stimulants, malig hyperthermia hx. or crush burn sepsis stroke after 5 days.
83
START system of triage
first priority is RPM RR 30 Perfusion issue Mental status cant follow commands
84
what is charcoal good for
delayed absorption recent ingestions that do not act on local tissues
85
gout arthrocetesis cells
neg birefringent cells pseudo gout is pos (p and p) 20,000 WBC
86
burst vs chance fracture
burst is retropulsion from anterior compression chance is disruption in horizontal plane both with seatbelts
87
replacing factor
assume 0, get to 100 in in head injury, 1u/kg raises 2% | start factor before CT
88
gonorrhea artitis
multiple joints, swab other placed because joint fluid may be negative, IV ABX not surgical wash out, look for papules
89
tumor lysis syndrome abnormalitis
high - urate, K, phos | low - Ca (ca urate crystals build up in urine)
90
headache tx with o2
cluster - tearing,
91
dantrolene
treats NMS
92
benztropine
helps you move but not your bowels tx for parkinsons treats dystonia (along with benadryl) causes constipation
93
IIH
usually well appearing with insidious vision changes in obese female - tetracycline, ocp, vit A
94
pna in hiv
most common still strep pneumo | PCP pneumonia is CD4<200
95
platelet transfusion
goes up 30,000 dont need to match ABO dont give in itp/ttp/hit
96
FFP
is 1 L (4 doses of 250) needs ABO is fibrinogen and factors
97
Cryo
has 8,13,fibrinogen, and vWF | does NOT need ABO match
98
PCC
TRANSIENT FAST replacement of 2.7.9.10 | also give vitK
99
hyperCa - work up, tx, symptoms, ekg
often from Cancer give lots of fluids stone, bones, groans, psych overtones short QTc
100
type 1 and 4 reactions
1 is IgE with mast cell degranulation | 4 is T cells attacking antigens directly (contact dermatitis)
101
acute closure glaucoma treatment
timolol, then Diamox, then pilocarpine drops
102
dissection and stemi
15% of dissections show myocardial focal ischemia, consider dissecting off a coronary, be careful
103
cavernous sinus thrombosis
CN 3,4,5, fever, headache, post viral
104
PCI timing
under 2 hours of symptoms gets 1 hour to cath | >2 hours gets 2 hours to cath
105
iron antidote
deferoxamine
106
charcoal does not bind to what?
``` C-phails caustics pesticides hydrocarbons alcohols iron lithium solvents ```
107
RMSF tx and where it is endemic
Doxy for all ages | midwest and southeast - weird!
108
compartment pressures
delta and absolute of 30 are concerning lines
109
hard signs to go to OR in neck stab wound
expanding hematoma pulsatile bleeding neurologic injury
110
ear infections and tx AOM AOE malignant OE
amox (over 2 waits 2 days) abx/steroid drops oral cipro for malignant
111
reasons for hyperbarics
neuro, cardiac changes, 25% CO, or 15% CO and pregnancy
112
CF pneumonia
staph aureus is most common, pseudomonas colonizes 80% by adulthood
113
yersinia enterocolitica
looks like appy needs special stool culture or stool PCR undercooked pork
114
MCC of acute chest
mycoplasma and chlamydia (no longer strep pneumo with vaccines)

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