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87 Cards in this Set

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Patient with very developed muscles presents to ER with new onset seizures. Prior to onset, his workout partner stated that he had seemed lethargic, weak, and irritable. What's going on?
A: Hypernatremia secondary to steroids use.
- Also happens in patients with fluid loss and those on hypertonic fluids

What is the treatment?
A: Correct underlying cause (pg. 133)

1/2 nml saline or water
- Correct 1/2 the water deficit in the first 24 hrs, then second 1/2 over the next 2-3 days
76 yo M POD 3 s/p TURP has been under going bladder irrigation. He develops nausea and vomiting, followed by seizures and coma. What's up?
A: Hyponatremia
- Also found in high-output iliostomy pt, hyperglycemia, adrenal insufficiency

What's the Tx?
A: Determine value status and cause (pg. 132)
- If eu- or hypervolemic, water restrict

Correct hyperglycemia

For refractory Dz --> hypertonic saline
Patient with extensive 2nd and 3rd degree burns. EKG shows flattened P waves, peaked T waves, and a wide QRS before he goes into V-fib and dies. What caused this arrythmia?
A: Hyperkalemia (>5) secondary to fluid shift
- Also found in DKA, leukocytosis, and crush injuries

What's the Tx?
A: 1) Calcium gluconate (stabilizes the myocardium; onset 2 min, duration 30 min)

2) HCO3- (further stabilizes myocardium w/ duration = 90 min)

3) Glucose and insulin

4) Albuterol and loop diuretics

5) Kayexalate and/or diuresis

6) Address underlying cause AFTER all previous steps!
54 yo F POD 3 s/p bowel resection has an NG in place. After her daily digoxin dose, she develops NV, hyper salivation, and sees green halos around objects. EKG finds depressed T waves and prominent U waves. What's up?
A: Hypokalemia secondary to chronic NG suction
- Also seen in chronic diarrhea and vomiting, diuretic use, met. alkalosis, hyperaldosteronism (Cushing's, Conn's, CHF, RAS), burns, beta-agonist use, and hypomagnesemia
- Could go into V-tach

- Will have increased sensitivity to digoxin!!!

What's the Tx?
Depends on the cause
Patient with renal carcinoma develops a kidney stone. Later he gets constipation and AMS. EKG shows shortened QT interval. What's the Dx?
A: Hypercalcemia
- Also found in bone, kidney, and parathyroid disorders, and acute pancreatitis

What's the Tx?
A: hydration and loop diuretics, bisphosphates, and calcitonin
After receiving a blood transfusion, and patient's left face twitches when the left jaw angle is tapped (Chvostek's sign) and the hand spasms when a BP cuff is inflated (Trousseau's sign). EKG shows QT prolongation. What's the Dx?
A: Hypocalcemia secondary to blood transfusion
- Also seen in parathyroid resection, low Mg++, and renal failure

What's the Tx?
A: Calcium gluconate, Vit D
A CKD patient has decreased DTRs and muscle weakness. When taking her vital signs, the nurse notices that she is bradycardic and has a low BP. EKG shows PR and QT interval prolongation. What's the Dx?
A: Hypermagnesemia secondary to excessive Mg replacement for CKD

What's the Tx?
Calcium gluconate

Nml saline infusion with loop diuretics

Dialysis
Patient presents to the ER in an arrhythmia found to be Torsades and soon dies. The paramedics tell the ER doc that the strip in the ambulance showed widened T waves and QRS, prolonged PR and QT intervals. The family later tells the doctor that the deceased patient was an alcoholic who had suffered a stomach bug with extreme NVD for the past week. What's the Dx?
A: hypomagnesemia
- found in NVD, malabsorption conditions, aggressive diuresis, alcoholism, and chemoTx

What's the Tx?
MgSO4
Patient being treated for a malignant villous adenoma c/o hard masses under the skin. Xray shows them to be soft tissue calcifications. EKG shows a new onset heart block. What's the Dx?
A: High phosphorous
- usually an iatrogenic condition
- Also seen in rhabdomyolysis, hypoparathyroidism, and hypocalcemia

What is the Tx?
- Decrease dietary phosphorus (animal products, dark green vegetables)
- Aluminum hydroxide
- Hydration and acetazolamide (carbonic anhydrase inhibitor)
- Dialysis
After a week of NPO feeding and a NG tube, the tube is DCed and the hungry patient consumes a large, high glucose meal. He develops diffuse muscle weakness, followed by flaccid paralysis. What's up?
Low phosphorus caused by refeeding syndrome.
- Also seen in excessive IV glucose use, hyperparathyroidism, and osmotic diuresis
- Refeeding syndrome = Low Mg, K, and Phos cause by a large glucose load after long periods of NPO.

What's the Tx?
Potassium phosphate or sodium phosphate
Vertigo, tinnitus, hearing loss
(-) Dix-Hallpike
Meniere's Dz
Syncope lasting 8-15 minutes
Facial numbness
Parathesias
Visual changes
Vertibrobasilar insufficiency

Hx arthrosclerosis and CV risk factors
AA female
red nodules on legs
joint pain
vision changes
Sarcoidosis

Labs: elevated Ca, Vit D, ACE
Conditions with erythema multiforme
HSV
Recent URI
mycoplasma
Conditions with erythema nodosum
1. Sarcoidosis
2. Bacterial infections (Streptococcal, TB, Yersinia, Salmonella, Legionella)
3. Fungal infections (Coccidiodomycosis, Histoplasma, Blastomycosis)
4. Drugs: sulfonamides, OCPs
5. Enteropathies such as Crohn’s disease and UC
6. Hodgkin’s lymphoma
7. Behcet disease (= vasculitis w/ recurrent oral ulcers, genital ulcers, and uveitis)
8. Pregnancy
Waxy casts
Advanced CKD
Hyaline casts
non-specific
Granular "muddy brown" casts
ATN (Causes: persistent hypovolemia, shock, sepsis, severe hemolysis, rhabdomyolysis, amino glycosides, and amphotericin B)
Red blood cell casts
Nephritic syndromes (post-streptococcal glomerulonephritis, IgA nephropathy, and rapidly progressive glomerulonephritis),
malignant hypertension.
WBC casts
tubulointerstitial inflammation,
acute pyelonephritis
transplant rejection.
Tense (hard to rupture) bullae,
Ab against dermo-epidermal junction,
anti-epidermal basement membrane antibodies,
IF: linear band of inc. eosinophils along BM
Characteristics: mucosal involvement rare, typical age 70-80, Nikolsky (-)
Bullous pemphigoid
Flaccid blisters
all epidermal surfaces (including mucosal)
typical age 30-40,
Nikolsky (+)
Anti-epithelial cell Ab, anti-keratinocyte Ab
IF: "tombstone" pattern around epidermal cells

Seen always in toxic epidermal necrolysis and sometimes in scalded skin syndrome
Pemphigus vulgaris

Seen always in toxic epidermal necrolysis and sometimes in scalded skin syndrome
Breast cancer tumor marker
CEA
Malabsorption syndrome + joint pain
Whipple's Disease
HLA- DR4
RA

Also ANA, RF, ESR, anti-CCP (anti-cyclic citrullinated peptide; most specific!)
Anti-histone Ab
Drug-induced SLE

SHIP: Sulfas, hydralazine, isoniazid, procainamide
Meds the predispose to latent TB reactivation
Etanercept (TNFa receptor analog)
Infliximab

**Both are RA drugs**
HLA-DR2
Multiple sclerosis
HLA-DR3
Diabetes mellitus
HLA-DR5
JRA
Kaposi's sarcoma
Hashimoto's thyroiditis
Painless vaginal bleeding during preg
Placenta previa

Incidence = 1:200
Risk factors: prior c-section, grand multiparity, advanced maternal age, multiple gestation and prior placenta previa

Tx: deliver via C-section
Painful vaginal bleeding during pregnancy
Placental abruption
Head trauma --> lucid interval followed by LOC
Epidural hematoma
Head trauma --> ruptured middle meningial artery
Epidural hematoma
Head trauma --> ruptured subcortical veins
Subdural hematoma
mcc of endocarditis in IV drug users
Staph Aureus
mcc endocarditis in prosthetic valves
steph. epidermidis
MCC endocarditis in left-sided subacute endocarditis
strep viridians
MCC endocarditis in patients long-term indwelling catheters, malignancy, AIDS, or organ transplant (i.e. immunosuppressed)
Candida albicans
Endocarditis associated with GI malignancies (like colon cancer)
Strep bovis
Innervates biceps brachii, brachialis, and caracobrachialis
Musculocutaneous N.
Innervates the subscapularis
Upper subscapular N
Innervates teres major
Lower subscapular N
Muscle increases in length w/ contraction
Eccentric contraction
Muscle shortens while contracting
Concentric contraction
Muscle is loaded and contracted in rapid sequence
Plyometric contraction

The short cycle affects the sensory response of the muscles spindles and golgi tendon organs --> greater contraction force than normal strengthening exercises
Muscle contraction where veolcity remains constant while the force of contraction varies
Isokinetic/isovelocity contraction

Never occurs naturally in the body
Muscle contracts while maintaining constant length
Isometric contraction

Ex: pushing against a wall
Proximal muscle weakness, depression, myalgias, dysphagia, dysphonia, periorbital heliotrophic rash, Gottron's papules
Dermatomyositis

Guttron's papules = purple papules on DIP and MCP joints

Lab: elevated CK, (+) ANA and anti-Jo-1 Ab (polymyositis has these, too. Be careful!)
Proximal muscles tenderness, stiffness, and arthralgias
Polymalgia rheumatica

**Proximal muscles will be tender, but NOT WEAK (unlike dermatomyositis and polymyocitis)
Esophageal wall rupture 2o to excessive vomiting (usually in eating disorders)
Boerhaave's syndrome

Tx: IVF, broad-spectrum Abx, prompt surgical intervention

**Can cause pneumomediastinum -->subcutaneous emphysema, mediastinitis, sepsis
Parkinson's tetrad
Resting tremor, cog-wheel rigidity, bradykinesia, postural instability
Aniline dye exposure increases risk of which cancer?
Transitional cell bladder cancer
Gynecomastia + spider angiomata + asterixis + testicular atrophy
Cirrhosis

-gyncomastia & spider angiomata from elevated estrogen levels
- asterixis (hand flapping) from heptic encephalopathy
What PSA level is a positive screen (i.e. suspicious for prostate cancer)?
PSA > 4 ng/mL

*PSA > 10 --> transrectal US
Skin pigmentation + diabetes + arthritis + FHx
Hemochromatosis

Labs: elevated transferrin saturation
Decreased ceruloplasmin seen in?
Wilson's disease
Anti-mitochondrial Ab
Primarily biliary cirrhosis
Decreased alpha-1 antitrypsin levels indicates?
Liver disease
emphyseam
alpha-1 antitrypsin deficiency
the probability of finding a significant statistical association in your study if one truly exists
Power
the risk of the disease in people exposed to a given factor
Relative risk

- determined through cohort studies
the null hypothesis is rejected even though it is true
Alpha error (also known as Type 1)

- aka a false-positive!
null hypothesis is not rejected even though it is false
Beta error (also known as Type 2)

- aka a false-negative!
the measure of how far a set of numbers is spread out. It describes how far the numbers lie from the mean.
Variance
AA male + HIV + nephrotic syndrome
Focal segmental glomerulosclerosis
- Also seen in chronic HTN & obesity

Bx: sclerosis w/ renal capillary tufts
Tx: prednisone, cytotoxic meds, ACEi/ARB
MCC nephrotic syndrome in white adults

Hx of HBV, syphilis, malaria, or exposure to gold salts (common in RA meds)
Membranous nephropathy

Bx: spike and dome appearance d/t granular deposits of IgG and C3 in BM
Drug used for CML and GI stromal cell tumors. It's a Philadelphia Chrom bcr-abl tyrosine kinase inhibitor
Imatinib

SE: fluid retention (use w/ caution in CHF and CKD patients)
Monoclonal Ab against HER-2 (erb-B2) used in HER-2 (+) breast cancer

Major SE of cardiotoxicity
Trastuzumab
Alkylating agent used in Tx of CML. Can also be used for ablating bone marrow in hematopoietic stem cell transplant patients
Busulfan
Head and neck autonomic innervation
S: T1-T4
P: CN X
Heart autonomic innervation
T1-T6

CN X
Lungs autonomic innervation
T1-T6

CN X
Spleen autonomic innervation
T5-T9

CN X
Stomach autonomic innervation
T5-T9

CN X
Liver autonomic innervation
T5-T9

CN X
Gallbladder autonomic innervation
T5-T9

CN X
Proximal duodenum autonomic innervation
T5-T9
CN X
Middle GI (distal duodenum - proximal 2/3 of transverse colon) autonomic innervation
T10-T11

CN X

(from lesser splanchnic nerve all sup. mesenteric ganglion)
Kidneys autonomic innervation
T10-T11

CN X
Testes/ovaries autonomic innervation
T10-T11

CN X
Adrenal medulla autonomic innervation
T10

CN X
Leg structure autonomic innervation
T11-T12
Arm structure autonomic innervation
T2-T8
Lower GI (distal 1/3 of transverse colon - rectum) autonomic innervation
S: T12-L2 from least splanchnic off inf. mesenteric ganglion

P: S2-S4 via pelvic splanchnic nerve
Appendix autonomic innervation
T12
Bladder and distal ureter
S: T12-L2

P: S2-S4 via pelvic splanchnic nerve
Clitoral/penile erectile tissue
S: L2

P: S2-S4 via pelvic splanchnic nerves