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505 Cards in this Set

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Dx:
Absent bowel sounds with gaseous distention of small and large bowel after abdominal surgery or in a retroperitoneal hemorrhage assoc with vertebral fracture
Paralytic Ileus
Med Tx:

Paralytic Ileus
Bethenachol
Dx:
Fever of 104 - 105 after anesthesia
Malignant Hyperthermia
First Step:

Hemothorax
Chest Tube placement
Next step:

Chest tube from Hemothorax yields > 600ml
Thoracotomy
First step:

Broken ribs that are impairing breathing due to pain
Local Nerve block
First step:

Post-op disorientation and coma
Blood Gases
Dx test:

to monitor lung function if Contusion of Lung is suspected
Blood Gases
Dx:

Male with pelvic fracture and blood at penile meatus
Urethral Injury
First test:

Urethral injury
Retrograde Urethrogram
Next step:

Blood in penile meatus with pelvic fracture and negative retrograde urethrogram
Cystogram
First step:

Trauma and unsure if patient is bleeding in abdomen
Peritoneal Lavage
Next step:

Unstable trauma patient with Abdominal trauma and pelvic fracture has a negative Peritoneal Lavage
Angiography of Pelvis
Next step:

Patient with abdominal trauma is stable and bleeding or if patient is unconscious and bleeding with status unknown
CT with contrast
Dx:

Abdominal X-ray shows "stepladder" appearance or many air-fluid levels
Small Bowel Obstruction
First Dx Test:

Small Bowel Obstruction
Abdominal X-ray

(shows "stepladder" appearance or many air-fluid levels)
First Tx:

Small Bowel Obstruction
Conservative:
NPO, NG Tube, IV Fluids, Observation
Tx:

In Small Bowel Obstruction if no improvement in 24 hours with conservative measures or fever and leukocytosis develops
Laparotomy
Dx:

Bowel sounds with high-pitched tinkles and peristaltic rushes
Small Bowel Obstruction
Tx:

Sigmoid Volvulus
Barium Enema
Tx:

Diverticulitis
Antibiotics and conservative management
(NPO, NG tube placement)
Next step:

Diverticulitis that has perforated
Surgical resection and temporary colostomy
Tx:

Fracture of Femoral shaft
Closed Intermedullary Fixation
Next step:

Patient is Vomiting blood
Endoscopy
First step:

DRE shows Blood in stool
NG tube
Next step:

GI bleed with blood in NG tube
Upper Endoscopy
Next step:

GI bleed with no Blood in NG tube
Lower Endoscopy
Next step:

GI bleed with no source found on upper and lower endoscopy; less then 0.5cc per minute
Radionucleotide / Tagged Red Cell Study
Next step:

GI bleed with no source found on upper and lower endoscopy; greater then 2cc per minute
Angiogram
MCC:

UGI bleed
Gastritis
Dx:

LGI bleed and Colonoscopy reveals "cherry red spots" on bowel
Angiodysplasia
Dx test:

Angiodysplasia
Labeled Erythrocyte Scintigraphy
Colon CA presentation:

Blood coating stool and change in bowel habits
Left-sided Colon CA
Colon CA presentation:

Anemia
Right-sided Colon CA
Dx:

"Apple core" presentation on Barium enema
Left-sided Colon CA
Next step:

Determine the degree of invasion of Rectal Cancer
Endorectal Ultrasound
Next test:

Blood results confirmed Acute Pancreatitis
CT scan
First test:

Gallstone Hx or ETOH abuse with epigastric pain radiation to back
Serum Amylase/Lipase
Dx:

AXR shows "sentinel loop" or "colon cutoff" sign
Acute pancreatitis
Tx:

Acute Pancreatitis
Conservative measures
(NPO, NG tube, IV fluids, Pain meds)
Dx:

Pancreatic calcifications and mild ileus on AXR
Chronic Pancreatitis
Dx:

"Chain of Lakes" on Abdominal CT with persistent epigastric pain
Chronic Pancreatitis
Tx:

Patient w/ EBV infection has blunt trauma causing blood to collect in abdomen
Splenectomy
Dx:

AXR shows air under diaphragm
Bleeding ulcer / PUD
Dx:

Jaundice, RUQ pain, fever, shock, altered mental status
acute Suppurative Cholangitis
Tx:

acute Suppurative Cholangitis
Emergent Bile Duct Drainage
(ECRP or Percutaneous Transhepatic drain)
Dx:

Leukocytosis, Inc bilirubin, Inc Alk-phos, RUQ pain, Jaundice, Fever
Acute Cholangitis
Dx:

40-yo female with RUQ pain, N/V, fever, + Murphy's sign
Acute Cholecystitis
Tx:

Acute Cholecystitis
Cholesystectomy
Dx:

older patient with sudden ipsilateral blindness and TIA Hx
Carotid Stenosis
Tx:

Carotid Stenosis > 70%
Carotid Endarterectomy
Tx:

Carotid stenosis < 70%
daily Aspirin
Next step:

suspect Acute Cholecystitis with a non-diagnostic ultrasound
HIDA scan

(not for critically ill patients)
First test:

Carotid stenosis
Ultrasound
First step:

Pulsatile mass in the abdomen
Ultrasound
Next step:

AAA > 5.5cm
Surgery
Next step:

AAA that is tender on palpation
Surgery
Next step:

AAA < 5cm
Recheck in 2 years
Dx:

Pain in lower legs brought on with exercise and relieved with rest
Claudication
First step:

Claudication
Doppler
Dx test:

Claudication with pressure gradient
Arteriogram
Tx:

Claudication
Quit Smoking
Tx:

Claudication that interferes with work or lifestyle
Revascularization
Dx:

Localized leg pain with superficial cord-like structure and varicose veins
Superficial Thrombophlebitis
Tx:

Superficial Thrombophlebitis
NSAIDs
Dx:

Ulcer on Lateral aspect of leg that is well circumscribed
Peripheral Vascular Disease

(Arterial Insufficiency)
Dx:

Leg is leathery with serous drainage plus whole leg is swollen
Obstructed Lymphatics
Dx:

Hernia that goes into scrotum
Indirect Hernia

(MC hernia)
Dx:

Hernia Medial to epigastric vessels
Direct Hernia
Dx:

Hernia type due to congenital patent processus vaginalis
Indirect Inguinal Hernia
Dx:

Hernia type due to defect in the Transversalis fascia
Direct Hernia
Next step:

GSW to zone 1 of neck
Aortography
Next step:

GSW to zone 2 of neck
2-D Doppler (and selective exploration)
Next step:

GSW to zone 3 of neck
Aortography and Triple Endoscopy
Dx test:

Intracranial bleed of any kind
CT scan without contrast
First step:

Increased Intracranial Pressure
Intubate, Hyperventilate, Head elevation (reverse Trendelenberg)
Dx:

HA, N/V, papilledema, bilateral fixed and dilated pupils
Increased Intracranial Pressure
Dx:

CSF from nose or ears, postauricular and/or periorbital ecchymosis
Basilar Skull fracture
Dx:

Head trauma followed by lucid interval and then loss of consciousness
Epidural Hematoma
First Tx:

Subdural hematoma w/o midline shift
Conservative
(hyperventilation, head elevation, mannitol)
Next step:

Suspect Berry aneurysm, but CT scan is negative
Lumbar Puncture

(RBCs, Inc protein, yellowish CSF breakdown)
Next step:

After confirmation of Subarachnoid aneurysm
Four-vessel Angiography
Maintenance Tx:

Subarachnoid hemorrhage
Anticonvulsants and close observation
Definitive Tx:

Subarachnoid hemorrhage
Surgical Clipping
Definitive Tx:

Subarachnoid hemorrhage for those who cannot undergo surgery
Endovascular Coiling
MC place:

Cranial bleed assoc with HTN
Basal Ganglia
Dx:

Central cavitation of spinal cord causing bilateral loss of pain and temp below lesion in "cape distribution"
Syringomyelia
Dx Test:

Syringomyelia
MRI
Tx:

Syringomyelia
Shunt via surgery
Dx:

loss of pain, temp, and motor below lesion with preservation of vibratory and position sense; caused by "burst" fracture of vertebral bodies
Anterior Cord Syndrome
First step:

Spinal cord injury (any type)
Steroids (high dose)
Dx:

burning pain and paralysis to upper extremities (not lower) caused by forced hyperextension of the neck via rear-end collision
Central Cord Syndrome
MCC of a pathologic fracture
Osteoporosis
Fracture with the highest mortality
Pelvic
Dx:

Pain in the anatomic snuffbox
Scaphoid fracture
Dx test:

Lumbar disc herniation
MRI
Tx:

Lumbar disc herniation
NSAIDs, bed rest
Tx:

Cauda Equina syndrome
Surgery
Best test:

ACL tear
Lachman test
Dx test:

all Knee ligament injuries
MRI
Dx:

Knee dashbord injury with MVA
PCL tear
Dx:

Twisting of the knee w/ foot in fixed position; popping sound with pain and limited ROM; audible snap while extending leg at knee
Medial Meniscus tear
Dx:

Positive Valgus stress test
Medial Collateral Ligament tear
Dx:

Positive Varus stress test
Lateral Collateral Ligament tear
Dx:

Toddler with febrile illness followed by pain at specific point on bone and refusal to move it
Acute Hematogenous Osteomyelitis
Dx test:

Acute Hematogenous Osteomyelitis
Bone scan

(not x-ray)
Tx:

Acute Hematogenous Osteomyelitis
Antibiotics

(inpatient versus outpatient depending on severity)
Dx:

Non-acute increase in intraocular pressure and visual field loss
Open-angle Glaucoma

(MCC of glaucoma)
Tx:

Open-angle Glaucoma
Beta-blockers, Acetozolamide, Pilocarpine
Initial Tx:

Closed-angle Glaucoma
Pilocarpine, Acetozolamide
Dx:

Acute sudden loss of vision with fixed mid-dilated pupils and increased IOP
Closed-angle Glaucoma
Dx:

Optic Disc changes to an increased cup to disc ratio
Open-angle Glaucoma
Dx:

Sudden, painless unilateral blindness with cherry-red spot on fovea
Central Retinal Artery Occlusion
Tx:

Central Retinal Artery Occlusion

(2 together)
Thrombolytics + Oxygen
Tx:

Central Retinal Vein Occlusion
(seen in elderly)
Laser Photocoagulation
Dx:

Decreased visual acuity and changes in color perception with blurred disc margins; commonly assoc with multiple sclerosis and ethambutol
Optic Neuritis
Dx:

White/yellow deposits below retinal pigment epithelium
Drusen of Macular Degeneration

(MCC of sudden blindness >55-yo)
Dx:

Absent red reflex in elderly with slow vision loss
Cataracts
Dx:

Alcoholic bum with sudden bilateral vision loss
Methanol poisoning
Dx:

vitreous dot-blot hemorrhage with neovascularization
DM eye changes
Tx:

DM eye changes
Laser photocoagulation
Dx:

Cotton wool spots, copper wiring and a/v nicking in eye
HTN eye changes
Dx:

Decrease in visual acuity caused by normal aging
Presbyopia
Dx:

Light enters eye and falls in front of retina
Myopia

(nearsighted)
Lens Tx:

Myopia
Convex lens
Dx:

Light enters eye falling behind retina
Hyperopia

(Farsighted)
Lens Tx:

Hyperopia
Concave lens
Dx:

Painful lump near eyelid margin, caused by Staph aureus
Hordoleum
Tx:

Hordoleum and Chalizion
Warm compresses
Tx:

Herpes virus Keratitis
Topical antivirals
Drugs causing Hearing loss
(3)
Aspirin
Loop duiretics
Aminoglycosides
Dx:

Tumor causing hearing loss
Neurofibromatosis type 2
MCC of acquired hearing loss in children
Meningitis
Dx:

High-frequency hearing loss bilaterally w/ difficulty in speech descrimination in older patients
Presbyacusis (sensorineural)

(MCC is aging)
Dx:

progressive conductive hearing loss with loss of stapedial reflex
Otosclerosis
Dx:

Hearing loss on one side, vertigo, N/V and tinnitus
Meniere's Dz
Curative Tx:

Closed-angle glaucoma
Laser Iridotomy
Tx:

Meniere's Dz
Diuretics and Antihistamines

(thought to be secondary to excess water retention)
Dx:

Nystagmus and vertigo without hearing loss in certain head positions
Benign Positional Paroxysmal Vertigo
Dx:

Vesicles on tympanic membrane, fever
Infectious Myringitis
Dx:

recurrent nose bleed in teenage male non-nose picker
Nasopharyngeal Angiofibroma
Dx:

HA followed by periorbital edema, fever and ophthalmoplegia
Cavernous Sinus Thrombosis
Bug Dx:

Cavernous Sinus Thrombosis
Staph Aureus
MC presentation of Nasopharyngeal CA
Painless neck mass
First step:

Unconscious patient from a trauma
Airway with OROTRACHEAL intubation

(oxygen facemask is not enough)
Dx:

"Mushy" neck mass at the base of the neck
Cystic Hygroma
Dx:

Neck mass located at the edge of the SCM muscle
Brachial Cleft cyst
Dx:

20-yo with immobile fleshy mass on hard palate
Torus Palatinus
Dx:

young man with swollen testes; elevation of testes pain is same or worse
Testicular torsion
Dx:

man with swollen testes; elevation of testes causes pain to decrease
Epididymitis
Tx:

Moderate to advanced BPH
TURP
Tx:

Mild BPH
(2 together)
Terazosin and Finasteride
Next step:

on DRE felt a hard lesion or induration on prostate
US-guided Transrectal Bx
Greatest risk factor of Bladder CA
Smoking
Tx:

Midshaft closed Humeral fracture
Closed reduction followed by Hanging cast
Next step:

After a patient has an endoscopy he is in recovery and there is evidence of an esophageal perforation
Contrast study of esophagus

(follow-up endoscopy could increase bleed when air in infused into esophagus; must be treated surgically w/i 6 hours to prevent mediastinitis)
Dx test:

Traumatic rupture of the diaphragm following a trauma
Barium swallow or CT w/ oral contrast
Tetanous Tx:

Dirty wound and Hx of less then 3 doses of tetnaous toxoid
Tetanous toxoid and Tetanous IG

(only time you use Tetanous IG for wound)
Tetanous Tx:

Dirty wound and Hx of more then 2 doses of tetnaous toxoid, the last dose being greater then 5 years ago
Tetanous Toxoid
Next step:

Patient shows no chang in BP or pulse after giving 2 liters of crystalloids
Blood transfusion
Tx:

Best DVT prophylaxis for High-risk post-surgical patients
(2 possible)
LMWH

or

ORAL Warfarin
Dx:

Fever, Dysphagia, Drooling, mouth swollen
Ludwig's Angina
Next step:

Veins have collapsed and you cannot obtain IV access in adult
(2 possible)
Saphenous vein cutdown

Percutaneous Femoral vein catheter

(Interosseous is for children)
Dx test:

Meckel's Diverticulum
Technetium pertechnetium Scintigraphy
Tx:

Elderly patient with displaced Femoral Neck fracture
Primary Arthroplasty
First test:

in any multiple trauma after ABCs, even if there is evidence of a skull fracture
X-ray of the Spine
Next step:

Clavical fracture with normal CXR
Angiogram
Tx:

Scoliosis </= 20 degrees
Observation
Tx:

Scoliosis >/= 30 degrees
Bracing
Tx:

Scoliosis >/= 40 degrees
Surgery
Tx:

burn involving epidermis and some dermis, with open blisters
Silver Sulfadazine ointment

(Second degree burn Tx)
Tx:

burn involving all layers of skin and nerve endings
Skin Grafting

(and possible escharotomy)

(Third degree burn Tx)
Dx:

volume problem caused by TPN
Osmotic diuresis and water loss

(TPN leads to inc glucose which leads to osmotic diuresis)
First step:

6-yo with mushy, round mass occupying the left supraclavicular area
CT scan of neck and chest

(Cystic Hygroma can grow deep into chest; need to see extent before surgery)
Curative Tx:

Ulcerative Colitis
Total Proctocolectomy
Dx:

AXR shows dilated loops of bowel and air in the biliary tree
Gallstone Ileus
First Dx test:

Dysphagia
Barium swallow
Dx:

53-yo man playing golf falls to the ground only to get up and continue without a problem. Then 45 minutes later he is found in the clubhouse unconscious with a blown right pupil
Right Epidural hematoma
Dx:

CT scan shows Semilunar hematoma
Subdural hematoma
Dx:

CT scan shows Biconvex hematoma
Epidural hematoma
MCC of bleeding in a Hemothorax
Intercostal vessels
Next step:

Raccoon bites little girl and runs away
Rabies Ig + Rabies Vaccine

(if animal was caught, autopsy could be done to check rabies in brain first)
Dx:

Oliguria and sodium urine concentration of 40mEq/L
Acute Renal Failure
Underlying cause:

Perineal injury resulting in Impotence
Vascular arterial injury

(in pelvic surgery it is injury to Erectile Nerve Plexus)
Tx:

Seminoma testicular cancer
Radiation and Orchiectomy
Tx:

Non-seminoma testicular cancer
(2 together)
Platinum-based Chemotherapy + Orchiectomy
Dx:

Testicular mass with Inc B-hCG
Choriocarcinoma

(also elevated in 10% of Seminomas)
Dx:

testicular mass with Inc AFP
Endodermal Sinus (Yolk sac) tumor

(often elevated in nonseminomatous germ cell tumors)
Dx:

Breast mass with bloody nipple discharge
Intraductal Papilloma
Dx:

Increased EPO with out hypoxia; flank pain
Renal Cell CA
Tx:

Prostate CA in prostate only
(no mets)
Radical Prostatectomy
Tx:

Prostate CA that has spead to bone
Hormonal Therapy

(Leuproline, Flutamide)
Tx:

Prostate CA that has spread to bone and the hormone therapy is not controlling bone pain
Radiation
Greatest risk factor leading to Pancreatic CA
Smoking
Definitive Dx test:

Renal stone
Non-contrast Spiral CT scan
Next step:

Patient with claudication and skin changes
Ankle-Brachial Index
Tx:

Man with A-fib suddenly has pale, pulseless, painful lower extremity
Balloon Catheter

(remove clot)
Tx:

Torus Palatinus
Reassurance
Next step:

less then 35-yo woman with palpable breast mass
Ultrasound
Next step:

greater then 35-yo woman with palpable breast mass
Mammography
Dx:

male presents with Hx of RLQ mass that resolved 10 days ago. Now he is in the ER with abdominal pain, fever and tender pelvic mass on rectal exam
Pelvic Abscess from ruptured appendix

(MC pelvic abscess in males)
First surgery:

Mitral stenosis
Mitral Commissurotomy
First step:

Epididymitis
Ultrasound

(to rule-out torsion)
Next step:

progressive jaundice, 20-lb weight loss, Inc total bilirubin and Alk-phos. US shows dilated ducts and very distended, thin-walled GB
CT scan of abdomen

(for Pancreatic CA; not ERCP)
Dx:

"double bubble" sign with a little gas beyond
Malrotation
First step:

Pulmonary Embolism possibility
Blood gas
Next step:

suspecting PE and already ordered blood gas
V/Q scan
Next step:

suspecting PE and already ordered blood gas and V/Q scan
Spiral CT scan of chest
Next step:

suspecting PE and already ordered blood gas, V/Q scan and spiral CT of chest, but cannot identify lesion
Pulmonary Angiography

(definitive Dx test)
Next step:

patient has possible PE with Hx of atelectasis and pneumonia. Blood gas was drawn.
Sprial CT scan

(cannot do V/Q scan with atelectasis or pneumonia)
Next step:

child in MVA has duodenal hematoma from blunt trauma
NG suction and TPN

(resolves spontaneously)
Next step:

Intestinal obstruction with metabolic acidosis
Laparotomy

(met acidosis suggests bowel necrosis)
First step:

SVT
Carotid massage

(or valsalva)
Next step:

SVT with no change after carotid massage
IV Adenosine

(or IV Verapamil)
Dx:

another cause for a ring-enhancing lesion of an HIV patient aside from Toxoplasmosis
Primary Brain Lymphoma
First Tx:

PE
Heparin
Most important AE of Amiodarone
Pulmonary Fibrosis
CSF:

Inc Protein + Oligoclonal bands of IgG
Multiple Sclerosis
CSF:

Inc Protein with normal cell count
Guillain-Barre
CSF:

Inc Protein + marked Lymphocytosis + normal glucose
Viral infection
CSF:

Inc Protein + marked Lymphocytosis + decreased glucose
Mycoplasma infection
Dx:

Anti-RNA antibodies
Mixed Connective Tissue Dz
Dx:

Nodules along superficial arteries in legs with neutrophil infiltration; assoc with Hep-B
Polyarteritis Nodosa
Tx:

Hypertensive Emergency
Nitroprusside
First Tx:

Acute Gout attack
Indomethacin

(NSAIDs)
First step:

patient <45-yo with epigastric pain unrelated to meals and no other Sx
H. pylori Breath test
Best test:

Carpal Tunnel
Nerve Conduction Study
MC joint dislocation with Tonic-Clonic seizure or Electrocution
POSTERIOR dislocation of glenohumeral joint

(Post shoulder dislocation)
Dx:

Arm is adducted and internally rotated while shoulder is flat
POSTERIOR dislocation of glenohumeral joint

(Post shoulder dislocation)
Dx:

Arm is held slightly abducted and externally rotated
ANTERIOR shoulder dislocation

[Ant = aBducted]
[Post = aDducted]
alphabetical
Dx:

Transient unilateral weakness after Tonic-Clonic seizure
Todd's paralysis
Dx:

patient presents with periodic breathing difficulty and wheezing and recent persistent nasal drainage. Hx of unstable angina 5 months ago for which he takes ASA, diltiazem and a statin.
Aspirin Sensitivity Syndrome
anesthetic agent not to be used in crush or burn vicitm due to it causing HyperKalemia
Succinylcholine
Next step:

parents refuse Tx for child in a non-emergent, but possible fatal condition
get Court Order
Next step:

parents refuse Tx to child and delay of obtaining consent could be life-threatening
Provide emergency Tx

(physician is legally authorized to provide emergency treatment)
Tx:

Limb-threatening infection in DM patient
Admit and IV Cefotetan

(or IV Ampicillin/sulbactam or IV Clindamycin and FQ)
Tx:

NON-Limb-threatening infection in DM patient
Oral Cephalosporin

(or oral Clindamycin, Amox/clavu or FQ)
DM drug not to be given during renal failure, hepatic failure or sepsis
Metformin

(worsens patients possible lactic acidosis)
Dx:

young, obsese female with HA and increased CSF pressure while on OCP
Pseudotumor cerebri
what can patient develop if a Pseudotumor cerebri is untreated?
Blindness

(Tx: weight reduction and acetazolamide)
Dx:

postpartum patient with dull pain in lower leg for 3 days; there is erythemia, induration and tenderness along vein
Superficial Thrombophlebitis

(Tx: NSAIDs)
Dx:

postpartum patient with dull pain in lower leg for 3 days; there is erythemia, induration and tenderness along vein with high fever, chills and rigors
Septic Throbophlebitis
Dx:

postpartum patient with dull pain in lower leg for 3 days; there is erythemia, induration and tenderness along vein with edema and calf tenderness
DVT
what is the reason for non-alcoholic fatty liver disease in DM patient?
Insulin resistance
Dx:

Decreased total and free T3 with normal T4 and TSH in patient with a new severe disease
Sick Euthyroid syndrome
Next step:

Hyperthyroid patient on meds has a fever and sore throat
Stop PTU

(and test for Agranulocytosis)
Dx:

name of scaly patches over dorsum of proximal phalanges in dermatomyositis
Gottron's sign
Dx:

Periorbital edema, scaly patches over dorsum of proximal phalanges, proximal muscle weakness
Dermatomyositis
Dx:

HA, fatigue, weight loss and shoulder stiffness in morning with high ESR
Giant Cell arteritis
MC major complication of Giant Cell Arteritis
Aortic aneurysm
Bone sign:

Increased Osteoid deposition
Vitamin D deficiency
Bone sign:

bone demineralization besides osteoporosis
Hypothyroidism
Bone sign:

abundant mineralization of periosteum
Hypervitaminosis A
Dx:

Viral infection of eye and respiratory tract
Acute Keratoconjunctivitis
Bone sign:

Increased Osteoclastic activity
Hyperthyroidism
Dx:

Hypocalcemia and Hypophosphatemia in homeless
Malabsorption

(Vit-D deficiency)
Single most important factor for Breast CA
AGE
Renal:

Broad, waxy casts
Chronic Renal Failure
Renal:

Fatty casts
Nephrotic syndrome
Renal:

Muddy Brown casts
Acute Tubular Necrosis
Next step:

Midsystolic murmur on young adult
Reassurance
Next step:

Mid-diastolic murmur on young adult
Echocardiogram

(possibly an organic cause)
what occurs if you give a Pheochromocytoma patient a beta-blocker?
Increases BP

(must give alpha-blocker first before beta-blocker)
First step:

Epiglottitis
Fiberoptic Laryngoscopy in OR

(before x-ray, b/c it is an emergency)
Tx:

patient with suspected Influenza that presents within 2 day of onset of Sx
Oseltamivir (A and B)

(or Amantadin for A only)
Tx:

patient with suspected Influenza that presents after 2 days of onset of Sx
Bed rest and Acetaminophen
Dx:

Fluctuating cognitive impairment, parkinsonism, visual hallucinations
Lewey Body Dz
Dx:

Personality change, compulsive behaviors, impaired memory
Pick's Dz
Vessel:

Contralateral motor/sensory deficit in LOWER limb
ANTERIOR Cerebral
Vessel:

Contralateral motor/sensory deficit in UPPER limb
MIDDLE Cerebral
Bug:

Cutaneous and visceral angioma-like blood vessel growths in immunocompromised patient
Bartonella
Cause of Pancytopenia in SLE
Peripheral Destruction

(of All types of blood cells)
Dx:

Heart finding in Marfans syndrome or someone with an aortic dissection
Early Diastolic murmur
Next step:

Found metastasis of SCC in LN of neck
Triple Endoscopy
Next step:

Premature Atrial beats
Observation

(usually benign)
MC site of CA:

patient with diarrhea, flushing, pruritis and 5-HIAA in urine
Small bowel

(MC site of tumor for Carcinoid SYNDORME presentation; MC site for Carcinoid tumor-might not present w/ syndrome-Appendix)
Tx:

Cryptococcus Meningitis
IV Amphotericin

(and Flucytosine)
MC pathognomonic feature of Crohn's Dz
NON-CASEATING GRANULOMAS
Dx:

Lung and intestinal problems in patient with Bone Marrow transplant
CMV
Common cause of Secondary HTN in premenopausal women
OCPs
Tx:

Drug allergy causing urticaria and pruritis
Antihistamines
Dx:

Focal pain over vertebrae, fever and chills in IV drug user, HIV patient or Sickle cell patient
Vertebral OSTEOMYELITIS

(also presents with very high ESR)
Dx:

Elderly patient with bone pain, renal failure and hypercalcemia
MULTIPLE MYELOMA

(until proven otherwise; also anemia is seen)
Dx:

50-yo in ER due to acute respiratory difficulty and periorbital, circumoral and facial edema. He just began many new drugs for recent MI
ACE inhibitor toxicity

(causes: Isolated Angioedema)
Dx:

major cause of morbidity and mortality in a Subarachnoid hemorrhage
Vasospasm

(Tx: Ca-channel blockers to prevent)
Drug Tx:

confirmed Subarachnoid hemorrhage
Calcium channel blockers

(to prevent vasospasm)
Tx:

A-fib without any other medical problems
Aspirin
Dx:

Urethritis, arthritis and conjunctivitis
Reiter's Dz
Dx:

Anemia and splenomegaly w/ fever and chills from Africa
Malaria
First step:

possible Steatorrhea
72-hour Fecal Fat Collection
Underlying cause of Pica
Iron deficiency

(patient possibly has chronic bleeding from somewhere)
Dx:

patient with pain on eye movements, decreased visual acuity, sluggish pupil response and change in color perception
Optic Neuritis
MC eye Sx seen in Multiple Sclerosis
Optic Neuritis*
Dx:

lung problem that often presents initially with Erythema Nodosum (tender pink/red nodules on extensor surfaces of lower legs)
Sarcoidosis
Dx:

Mononucleosis-like Sx, atypical lymphocytes, no LN enlargement, no sore throat, negative Heterophile test
CMV
Renal:

GBM stains for C3
Membranoproliferative GN
Dx:

Epicondylitis of Extensors of forearm
Tennis Elbow

[tEnnis = Extensors; golF = Flexors]
Dx:

Epicondylitis of Flexors of forearm
Golfers Elbow

[tEnnis = Extensors; golF = Flexors]
Causes of "foot drop"
(2)
Common Peroneal nerve damage

L5-Radiculopathy
Best test:

possible Adrenal Insufficiency
COSYNTROPIN stimulation test
Screening:

Prostate CA
Annual DRE starting at age 50

(earlier if Hx of CA in first-degree relative)
Tx:

CIS or superficial Bladder CA
Intravesicular Chemotherapy
Tx:

Bladder CA with distant METS
Chemotherapy only
Tx:

Invasive Bladder CA without METS
Surgery

(with or without radiation)
Bug:

predisposes to Bladder CA
Schistosomiasis
Tx:

If renal stone < 3cm has not passed after Tx of hydration
Lithotripsy
Tx:

UTI
TMP-SMX
Tx:

Wegener's Granulomatous Dz
Steroids

(and Cyclophosphamide)
Renal:

GBM splitting
Alport's Dz

(also deafness and eye disorders)
MC renal problem presenting in adolescent male with respiratory or GI infection
IgA (Berger's) nephropathy
Renal:

"spike and dome" appearance to grandular deposits
Membranous nephropathy
Dx:

Nephrotic syndrome most common in HIV patients and IV drug users
Focal Segmental glomerulosclerosis
Renal:

Subendothelial deposits and decreased C3
Membranoproliferative

(type 1)
Tx:

Myoglobinuria or Rhabdomyolysis

(2 together)
Hydration + Urine Alkalinization
Renal:

Eosinophils and WBC
Acute Interstitial Nephritis
Another name for Stroke Volume
(for this test)
Pulse Pressure
Equation:

Ejection Fraction
EF = SV/EDV x 100%
Dx:

Increased PR interval followed by a dropped beat
Wenckebach

(Mobitz I)
Dx:

Dropped beat but no change in PR interval
Mobitz II
Dx:

No P followed by wide QRS
Premature Ventricular Contraction
Tx:

PRN for Premature Ventricular Contraction
Lidocaine
Surgical Tx:

Wolff-Parkinson-White
Radiofrequency catheter ablation
Best predictor of survival post AMI
Ejection Fraction
MCC of death post AMI
Arrhythmia
Dx test:

suspect Restrictive cardiomyopathy
Cardiac Biopsy

(abnormal)

[In Constrictive it will be a Normal Bx]
Difference on exam b/t Constrictive and Restrictive CM
"Knock" heard w/ Constrictive


[Knock = Konstrictive]
Tx:

Constrictive CM
Remove Pericardium
NY CHF class:

Comfort at rest and mild exertion
Class 2
NY CHF class:

Comfort ONLY at rest
Class 3
Dx:

previously healthy 20 - 40-yo with cor pulmonale
Primary Pulmonary HTN
Screening:

HTN
Every 2 years starting at age 3;

3 measurements on 3 separate occasions >140/90, separated by 2 weeks
Next BP check appt:

Stage I: 140-159/90-99
confirm in 2 months
Next BP check appt:

Stage II: 160-179/100-119
check within 1 month
Next BP check appt:

Stage III: 180-209/110-119
check within 1 week
Next BP check appt:

Stage IV: >210/120
Immediate care (Nitroprusside)
Equation:

LDL
LDL = Total cholesterol - HDL - (TG/5)
Dx:

Salmon plaques with white scales on head, knees and elbows
Psoriasis

(T-cell mediated)
Dx test:

Psoriasis
Skin Bx
Tx:

Psoriasis

(2 together)
Phototherapy + Steroids
Dx:

Neutrophils at dermal-epidermal junction
Bullous Pemphigoid
Dx:

large itchy bullae in patients > 60-yo; dermal-epidermal junction involvement; no lateral extension to blisters or mucous membrane involvement
Bullous Pemphigoid
Dx:

blisters on skin and mucous membranes in patients >60-yo; lateral blister extension; mucous membrane involvement; intradermal involvement
Pemphigus Vulgaris
Dx:

Intradermal bullae immunoflorescense IgG and C3
Pemphigus Vulgaris
MCC of Cellulitis
Group A Strep

(Staph is second)
Dx:

Oral mucosal lesions plus Purple polygonal-shaped lesions; associated with Hep-C
Lichen Planus

[Purple = Planus]
Bug:

Impetigo with furuncle
Staph
Bug:

Impetigo without furuncle
Strep
Dx:

Red papules of the face that are sometimes confused with acne; exacerbated by heat, sun and alcohol
Rosacea
Dx:

50-yo with big nose and symmetric red, flushed face
Rosacea
Tx:

Rosacea
Tetracycline

(severe/refractory = Isotretinoin)
Dx:

Target lesions, even on palms and soles
Erythema Multiforme
Dx:

Erythema Multiforme (target lesions) that also affect lips, mouth and conjunctiva; fever; epidermis become necrotic
Stevens-Johnson syndrome
Dx:

Acute erruption of a seborrheic keratosis (large mole with wartlike layer on top)
Gastric CA
Tx:

Varicella Zoster
Acyclovir
Dx:

skin depigmentation
Vitilgo
Tx:

Lice, crabs and Scabies
Premethrin cream
Dx:

"Ringworm"
Tinea Corporis
Dx:

"Jock itch"
Tinea Cruris
Tx:

All Tinea types
Azoles

(Fluconazole)
Dx:

Skin problem following bone marrow transplant
Toxic Epidermal Necrolysis

(similar to SSSS)
Dx:

Painful erythematous nodules on patients lower legs and slowly spread turning brown and gray; fever and joint pain
Erythema Nodosum
Dx:

tiny, waxy papules with central umbilication
Molluscum Contagiosum
Dx test:

Molluscum Contagiosum
Giemsa or Wright stain
Dx:

"warts"
Verrucae
Dx test:

Warts (Verrucae)
Acetowhitening
Tx:

Pityriasis Versicolor
(Tinea Furfur)
Selenium sulfide (shampoo or cream)
Dx:

infection with HHV-7 and starts as an erythematous patch with peripheral scale that turns to fine papules with "cigarette paper" scale and "christmas tree" pattern
Pityriasis Rosea
Dx:

Brown papules on older person that look like they can be scraped off their back
Seborrheic Keratosis
Tx:

Seborrheic Keratosis
Cryotherapy
Dx:

Nodular, pearly papule with telangiectasias, scales around lesion and central ulceration
Basal Cell CA
Dx:

Vesicles on anterior thigh in Celiac Sprue
Dermatitis herpetiformis
Dx:

Cutaneous T-cell lymphoma
Mycosis Fungoides
Microcytic Anemia:

Increased Ferritin; Decreased TIBC
Anemia of Chronic Dz
Microcytic Anemia:

Decreased Ferritin; Increased TIBC
Iron Deficiency
Smear cell:

Howell-Jolly Bodies
Asplenia

(Nuclear remnant that should have been removed by spleen)
Blood Smear cell:

Target cell
Thalassemia; Asplenia
Blood Smear cell:

Teardrop cell
Myelofibrosis

(squeezed out of bone marrow)
Blood Smear cell:

Schistocytes
Intravascular Hemolysis

(or Artificial Heart valve)
Hemophilia inheritance
X-linked Recessive
Tx:

Bleeding episode in Hemophilia patient
Cryoprecipitate
(or Transfuse clotting factors)
Blood Smear cell:

Burr cells
ARF / Uremia
Blood Smear cell:

Acanthocytes / Spur cells
Abetalipoproteinemia
G6PD inheritance
X-linked Recessive
Anemia type:

Increased MCHC
Spherocytosis
Dx:

Hematocrit > 50; Oxygen sat is normal; decreased EPO; hypercellularity in BM Bx
Polycythemia Vera
Dx test:

Paroxysmal Hemoglobinuria
Hamm's test / Sugar Water test
Tx:

Polycythemia Vera
serial Phlebotomy
Tx:

Life threatening HUS
Plasmapheresis
Tx:

DIC
Cryoprecipitate and platelets
Tx:

Mild Von Willebrand's dz
Desmopressin
MC hereditary cause of a hypercoaguable state; decreases the activation of Protein C
Factor V Leiden
Dx test:

Von Willebrand's Dz
Ristocetin assay
Transfusion:

IgA deficiency
Washed RBC
AML type:

Auer rods; pro-myelocytes; DIC
M3
AML type:

Gingival Hyperplasia; pro-monocytes
M5
AML lab test
Sudan Black stain
Tx:

AML type M3
Retinoic Acid
Dx:

WBC > 50,000; massive splenomegaly, fever, weight loss, night sweats
CML
Drug Tx:

chronic CML
(2 together)
Alpha-interferon and Hydroxyurea
Dx:

CD5+; smudge cells; diffuse lymphadenopathy; lymphocytosis
CLL
Non-Hodgkins Lymphoma type:

Most common / best prognosis
Small Follicular
Non-Hodgkins Lymphoma type:

Worst prognosis
Large Diffuse
Non-Hodgkins Lymphoma type:

assoc with EBV; affects abdomen in USA and jaw in Africa
Burkitt's lymphoma
First step:

Lymphoma
LN Bx
Dx:

precursor to Waldenstroms Dz and MM
MGUS
Dx:

hyperviscosity with Raynauds plus cold insensitivity; IgM spike and Cold agglutinins
Waldenstrom's Dz
Dx test:

Waldenstrom's Dz
Bone Marrow Bx

(IgM spike with abnormal plasma cells)
Dx:

bleeding and thrombosis with platelet count > 1,000,000
Primary Thrombocytopenia
Dx:

Reed-Sternberg cells
Hodgkins lymphoma
Dx:

cervical andenopathy, possible mediastinal mass, pruritis HSM, fever and Alcohol-induced pain
Hodgkin's lymphoma
Dx:

EKG change with Hypercalcemia
QT interval shortening
Dx:

EKG change with Hypocalcemia
QT interval prolongation
Confirmatory Test:

Acromegaly
MRI

(reveals sellar lesion)
Dx:

unexplained increased CK and myopathy, tired, constipated
Hypothyroidism
Dx:

Anti-peroxidase Ab and Lymphocyte infiltration in thyroid
Hashimoto's
Tx:

Hashimoto's thyroiditis
Levothyroxine
Tx:

Myxedema coma
IV Levothyroxine + IV Hydrocortisone
Dx:

Hypothermia, hypothyroidism, hypoglycemia, shock and hypoventilation
Myxedema coma
Dx:

Entire thyroid gland takes up radioactive iodine
Graves Disease
Next step:

Graves disease during pregnancy
Thyroidectomy
Dx test:

Lumpy thyroid goiter
Radioactive Iodine uptake
MCC of thyroid nodule
Hyperplastic Colloid nodule
MC Thyroid CA
Papillary CA
First step:

patient presents with a thyroid nodule
measure TSH
Dx:

arthralgias, kidney stones, pancreatitis and depression or anxiety
Hyperparathyroidism
Dx:

increased skin pigmentation, hyponatremia and hyperkalemia
Addison's disease

(Primary Adrenal Insufficiency)
Tx:

Addison's Dz
Hydrocortisone + IV fluids
Tx:

Secondary Adrenal Insufficiency
Steroids + Mineralcorticoids
Drug Tx:

Hyperadrenalism (Cushings)
Mitotane
First test:

Hyperadrenalism (Cushings)
(2)
24hr Urine Free Cortisol

(+ Dexametasone suppression test)
Dx:

HTN, muscle weakness, hyperN, hypoK and low renin
Conn's Syndrome

(Primary Hyperaldosteronism)
First test:

Conn's syndrome
plasma Renin / Aldosterone levels
Next test:

Conn's syndrome suspected and you measured plasma renin and aldosterone
Aldosterone suppression test
Next step:

after Aldosterone suppression test has confirmed Conn's syndrome
CT scan of adrenals

(look for mass)
Next step:

after Aldosterone suppression test has confirmed Conn's syndrome and you cannot find a mass on a CT of adrenal glands
Adrenal Vein sampling
Dx:

High renin and renal bruit
Secondary Hyperaldosteronism
First step:

Pheochromocytoma possibility
24hr urine for Catecholamines
Drug Tx:

to stabilize Pheochromocytoma
Alpha-blocker, then Beta-blocker
Releases ADH from posterior pituitary
Supraoptic nucleus
Releases Oxytocin from posterior pituitary
Paraventricular nucleus
First test after Dx of:

Diabetes Insipidus
Give ADH to differentiate b/t Central and Nephrogenic

Central: responds to ADH

Nephrogenic no response to ADH
Tx:

Central DI
ADH
Tx:

Nephrogenic DI
Thiazide diuretics
Tx:

peripheral neuropathy of DM
Gabapentin

(+/- TCAs)
Dx:

Early marker of DM nephropathy
Microalbuminuria
Dx:

Physiological result of pericardial tamponade
Decreased Preload
EKG:

Pericardial tamponade
Electrical Alterans

(amplitude of QRS alternates as heart moves in fluid-filled chamber)
Tx:

Patient with chest pain and Mitral Valve Prolapse
Beta-blockers
Bug:

Immigrant with signs of constrictive pericarditis
TB
Vessel:

Inferior wall infarction
Right Coronary Artery
Vessel:

Inferior wall infarction
Right Coronary Artery
Vessel:

AMI with hypotension and bradycardia
Right Coronary Artery

(Right Ventricle)
Tx:

Ventricular Tachycardia with hemodynamic compromise
(i.e. BP changes)
Cardioversion
Additional Tx:

with ASA, Beta-blocker, ACEi and Statin post UA/NSTEMI after PCI w/ stent
Clopidogrel
Dx:

patient stabbed in leg and has wide pulse pressure, brisk carotid upstroke, tachycardia, flushed extremities and LVH and max heart impulse is displaced to left
AV fistula

(inc cardiac preload b/c blood is shunted from A to V, like L to R shunt)
MC AMI assoc with arterial thromboembolism
Anterior wall AMI

(vessel: LAD)
First Med:

Decreases mortality in Post-AMI
Beta-blocker

(Dec myocardial O2 demand by reducing HR and contractility)
Dx:

normal cardiac size, EF and LVEDV, S4 gallop, LVH, HTN
Hypertrophic cardiomyopathy

(LV diastolic dysfunction)
Dx:

A "3" sign on CXR with delayed femoral artery pulse
Coarctation of the aorta
Drug toxicity:

A-fib patient begins to feel decreased appetite, diarrhea, increased fatigue and palpitations
Digoxin toxicity
MCC of Mitral Regurgitation
Mitral Valve Prolapse
(4) AE of Amiodarone
Corneal deposits

Thyroid dysfunction (hypo/hyper)

Pulmonary toxicity

Hepatotoxicity
Dx:

pallor, jaundice, splenomegaly, increased Reticulocyte count and increased LDH
Autoimmune Hemolytic Anemia
First test:

suspect Autoimmune Hemolytic Anemia
Coombs
Dx:

Decreased Haptoglobin
Intravascular hemolytic anemia

(also with Inc Reticulcytes and Inc LDH)
Dx:

Eccchymosis in elderly on extensor surface of arms
Perivascular Connective Tissue atrophy

("senile purpura")
Test:

determine Dehydration
BUN / Creatinine ratio
Tx:

Hairy cell leukemia
Cladribine

(purine analog)
Dx:

Adolescent with congenital marrow failure, poor growth, skin hypopigmentation and congenital anomalies with aplastic anemia
Fanconi's anemia
Tx:

multiple Brain METS
Radiation

(but single mass is surgically resected)
Dx:

Hyperglycemia, weight loss and erythematous scaly plaques
GLUCAGONOMA
Rubella virus name
Togavirus
Dx:

possible late complication of anterior AMI with
"Double Apical Beat"
LV aneurysm
Dx:

patient from South America with cardiomyopathy
CHAGAS

(Trypanosoma Cruzi)
Dx:

new pansystolic murmur post AMI
Papillary muscle rupture
Dx:

Increased methylmalonic acid level in anemic patient
Cobalamin (Vit B-12) deficiency

(Inc Homocysteine is either this or Folate def.)
First step:

patient with prostate cancer who has back pain and brisk reflexes with weak sphinctor tone
IV Dexamethasone

(for Cauda Equina syndrome)
Tx:

Cancer-associated Anorexia
Megestrol acetate
How long after Dx of UC should patient get colonoscopy?
8 years
Asymptomatic patient presents with enlarged cervical LN. How large must they be before you should biopsy them?
2cm
First test:

Acromegaly
GH levels following Glucose load
MCC of edema in leg without any other Sx
Venous insufficiency

(venous valve incompetance)
Tx:

infant with Botulism
Support

(do not give anti-toxin)
Tx:

best post-coital contraception
E2/P4 immediately and then in 12 hours
Bug:

Endocarditis in IV drug user
Staph Aureus
Bug:

Endocarditis with prosthetic valve
Staph Epidermidis
Bug:

MCC of Endocarditis
Strep Viridians
Tx:

patient w/ HTN and Claudication
Amlodipine

(Calcium channel blocker)
Dx:

complication of ovarian hyperstimulation syndrome
Ovarian torsion / rupture
Drug Tx:

HTN who has Osteoporosis
HCTZ
MCC of middle ear problems in HIV pt
(will see air levels in middle ear)
Serosous Otitis Media
First step:

22-yo male with resting tremor, muscle rigidity, clusmy gait, slurred speech, drooling, occasional drinking with friends, hepatomegaly increased AP, AST and ALT
Serum Ceruloplasmin
(and slit-lamp exam of eyes)

(Wilson's disease)
Dx:

adolescent with bone pain, anemia, HSM, thrombocytopenia, cells with eccentric nucleoli and possible acid-schiff (PAS) inclusions
Gaucher's Disease
Next test:

after a barium enema shows possible Achlasia
ENDOSCOPY

(to rule-out mechanical cause of stricture or esophageal CA; then manometry)
Dx:

Non-tender mass that evolves to multiple abscesses, fistula and draining sinus tracts on neck and face
Actinomyces Israelii

(Tx: penicillin)
Tx:

Multiple Sclerosis during acute exacerbation
Steroids
Tx:

Prophylaxis for acute exacerbation in Multiple Sclerosis
INTERferon

(INTER = b/t the acute exacerbations)
Dx:

Precocious puberty, cafe-au-lait spots and multiple bone defects
McCune-Albright
Dx:

Vitamin deficiency in Carcinoid tumor
Niacin
MCC:

Increased AFP during pregnancy
Wrong Gestational Age
Next step:

no response after 48 hours of Abx Tx following Pyelonephritis Dx
Ultrasound kidney
main AE:

Cyclophophosphamide
Bladder CA
Dx:

"transient" vision loss in one eye
Amaurosis Faux

("transient" is key)
MC:

site of gallstone impaction
Cystic duct
Prophylaxis:

Malaria
Mefloquine