B&w: Surgery

Front 1

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?

Back 1

A: Hypernatremia secondary to steroids use.
- Also happens in patients with fluid loss and those on hypertonic fluids

What is the treatment?

Hint 1

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

Front 2

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?

Back 2

A: Hyponatremia
- Also found in high-output iliostomy pt, hyperglycemia, adrenal insufficiency

What's the Tx?

Hint 2

A: Determine value status and cause (pg. 132)
- If eu- or hypervolemic, water restrict

Correct hyperglycemia

For refractory Dz --> hypertonic saline

Front 3

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?

Back 3

A: Hyperkalemia (>5) secondary to fluid shift
- Also found in DKA, leukocytosis, and crush injuries

What's the Tx?

Hint 3

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!

Front 4

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?

Back 4

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?

Hint 4

Depends on the cause

Front 5

Patient with renal carcinoma develops a kidney stone. Later he gets constipation and AMS. EKG shows shortened QT interval. What's the Dx?

Back 5

A: Hypercalcemia
- Also found in bone, kidney, and parathyroid disorders, and acute pancreatitis

What's the Tx?

Hint 5

A: hydration and loop diuretics, bisphosphates, and calcitonin

Front 6

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?

Back 6

A: Hypocalcemia secondary to blood transfusion
- Also seen in parathyroid resection, low Mg++, and renal failure

What's the Tx?

Hint 6

A: Calcium gluconate, Vit D

Front 7

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?

Back 7

A: Hypermagnesemia secondary to excessive Mg replacement for CKD

What's the Tx?

Hint 7

Calcium gluconate

Nml saline infusion with loop diuretics

Dialysis

Front 8

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?

Back 8

A: hypomagnesemia
- found in NVD, malabsorption conditions, aggressive diuresis, alcoholism, and chemoTx

What's the Tx?

Hint 8

MgSO4

Front 9

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?

Back 9

A: High phosphorous
- usually an iatrogenic condition
- Also seen in rhabdomyolysis, hypoparathyroidism, and hypocalcemia

What is the Tx?

Hint 9

- Decrease dietary phosphorus (animal products, dark green vegetables)
- Aluminum hydroxide
- Hydration and acetazolamide (carbonic anhydrase inhibitor)
- Dialysis

Front 10

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?

Back 10

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?

Hint 10

Potassium phosphate or sodium phosphate

Front 11

Vertigo, tinnitus, hearing loss
(-) Dix-Hallpike

Back 11

Meniere's Dz

Front 12

Syncope lasting 8-15 minutes
Facial numbness
Parathesias
Visual changes

Back 12

Vertibrobasilar insufficiency

Hx arthrosclerosis and CV risk factors

Front 13

AA female
red nodules on legs
joint pain
vision changes

Back 13

Sarcoidosis

Labs: elevated Ca, Vit D, ACE

Front 14

Conditions with erythema multiforme

Back 14

HSV
Recent URI
mycoplasma

Front 15

Conditions with erythema nodosum

Back 15

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

Front 16

Waxy casts

Back 16

Advanced CKD

Front 17

Hyaline casts

Back 17

non-specific

Front 18

Granular "muddy brown" casts

Back 18

ATN (Causes: persistent hypovolemia, shock, sepsis, severe hemolysis, rhabdomyolysis, amino glycosides, and amphotericin B)

Front 19

Red blood cell casts

Back 19

Nephritic syndromes (post-streptococcal glomerulonephritis, IgA nephropathy, and rapidly progressive glomerulonephritis),
malignant hypertension.

Front 20

WBC casts

Back 20

tubulointerstitial inflammation,
acute pyelonephritis
transplant rejection.

Front 21

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 (-)

Back 21

Bullous pemphigoid

Front 22

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

Back 22

Pemphigus vulgaris

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

Front 23

Breast cancer tumor marker

Back 23

CEA

Front 24

Malabsorption syndrome + joint pain

Back 24

Whipple's Disease

Front 25

HLA- DR4

Back 25

RA

Also ANA, RF, ESR, anti-CCP (anti-cyclic citrullinated peptide; most specific!)

Front 26

Anti-histone Ab

Back 26

Drug-induced SLE

SHIP: Sulfas, hydralazine, isoniazid, procainamide

Front 27

Meds the predispose to latent TB reactivation

Back 27

Etanercept (TNFa receptor analog)
Infliximab

**Both are RA drugs**

Front 28

HLA-DR2

Back 28

Multiple sclerosis

Front 29

HLA-DR3

Back 29

Diabetes mellitus

Front 30

HLA-DR5

Back 30

JRA
Kaposi's sarcoma
Hashimoto's thyroiditis

Front 31

Painless vaginal bleeding during preg

Back 31

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

Front 32

Painful vaginal bleeding during pregnancy

Back 32

Placental abruption

Front 33

Head trauma --> lucid interval followed by LOC

Back 33

Epidural hematoma

Front 34

Head trauma --> ruptured middle meningial artery

Back 34

Epidural hematoma

Front 35

Head trauma --> ruptured subcortical veins

Back 35

Subdural hematoma

Front 36

mcc of endocarditis in IV drug users

Back 36

Staph Aureus

Front 37

mcc endocarditis in prosthetic valves

Back 37

steph. epidermidis

Front 38

MCC endocarditis in left-sided subacute endocarditis

Back 38

strep viridians

Front 39

MCC endocarditis in patients long-term indwelling catheters, malignancy, AIDS, or organ transplant (i.e. immunosuppressed)

Back 39

Candida albicans

Front 40

Endocarditis associated with GI malignancies (like colon cancer)

Back 40

Strep bovis

Front 41

Innervates biceps brachii, brachialis, and caracobrachialis

Back 41

Musculocutaneous N.

Front 42

Innervates the subscapularis

Back 42

Upper subscapular N

Front 43

Innervates teres major

Back 43

Lower subscapular N

Front 44

Muscle increases in length w/ contraction

Back 44

Eccentric contraction

Front 45

Muscle shortens while contracting

Back 45

Concentric contraction

Front 46

Muscle is loaded and contracted in rapid sequence

Back 46

Plyometric contraction

The short cycle affects the sensory response of the muscles spindles and golgi tendon organs --> greater contraction force than normal strengthening exercises

Front 47

Muscle contraction where veolcity remains constant while the force of contraction varies

Back 47

Isokinetic/isovelocity contraction

Never occurs naturally in the body

Front 48

Muscle contracts while maintaining constant length

Back 48

Isometric contraction

Ex: pushing against a wall

Front 49

Proximal muscle weakness, depression, myalgias, dysphagia, dysphonia, periorbital heliotrophic rash, Gottron's papules

Back 49

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!)

Front 50

Proximal muscles tenderness, stiffness, and arthralgias

Back 50

Polymalgia rheumatica

**Proximal muscles will be tender, but NOT WEAK (unlike dermatomyositis and polymyocitis)

Front 51

Esophageal wall rupture 2o to excessive vomiting (usually in eating disorders)

Back 51

Boerhaave's syndrome

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

**Can cause pneumomediastinum -->subcutaneous emphysema, mediastinitis, sepsis

Front 52

Parkinson's tetrad

Back 52

Resting tremor, cog-wheel rigidity, bradykinesia, postural instability

Front 53

Aniline dye exposure increases risk of which cancer?

Back 53

Transitional cell bladder cancer

Front 54

Gynecomastia + spider angiomata + asterixis + testicular atrophy

Back 54

Cirrhosis

-gyncomastia & spider angiomata from elevated estrogen levels
- asterixis (hand flapping) from heptic encephalopathy

Front 55

What PSA level is a positive screen (i.e. suspicious for prostate cancer)?

Back 55

PSA > 4 ng/mL

*PSA > 10 --> transrectal US

Front 56

Skin pigmentation + diabetes + arthritis + FHx

Back 56

Hemochromatosis

Labs: elevated transferrin saturation

Front 57

Decreased ceruloplasmin seen in?

Back 57

Wilson's disease

Front 58

Anti-mitochondrial Ab

Back 58

Primarily biliary cirrhosis

Front 59

Decreased alpha-1 antitrypsin levels indicates?

Back 59

Liver disease
emphyseam
alpha-1 antitrypsin deficiency

Front 60

the probability of finding a significant statistical association in your study if one truly exists

Back 60

Power

Front 61

the risk of the disease in people exposed to a given factor

Back 61

Relative risk

- determined through cohort studies

Front 62

the null hypothesis is rejected even though it is true

Back 62

Alpha error (also known as Type 1)

- aka a false-positive!

Front 63

null hypothesis is not rejected even though it is false

Back 63

Beta error (also known as Type 2)

- aka a false-negative!

Front 64

the measure of how far a set of numbers is spread out. It describes how far the numbers lie from the mean.

Back 64

Variance

Front 65

AA male + HIV + nephrotic syndrome

Back 65

Focal segmental glomerulosclerosis
- Also seen in chronic HTN & obesity

Bx: sclerosis w/ renal capillary tufts
Tx: prednisone, cytotoxic meds, ACEi/ARB

Front 66

MCC nephrotic syndrome in white adults

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

Back 66

Membranous nephropathy

Bx: spike and dome appearance d/t granular deposits of IgG and C3 in BM

Front 67

Drug used for CML and GI stromal cell tumors. It's a Philadelphia Chrom bcr-abl tyrosine kinase inhibitor

Back 67

Imatinib

SE: fluid retention (use w/ caution in CHF and CKD patients)

Front 68

Monoclonal Ab against HER-2 (erb-B2) used in HER-2 (+) breast cancer

Major SE of cardiotoxicity

Back 68

Trastuzumab

Front 69

Alkylating agent used in Tx of CML. Can also be used for ablating bone marrow in hematopoietic stem cell transplant patients

Back 69

Busulfan

Front 70

Head and neck autonomic innervation

Back 70

S: T1-T4
P: CN X

Front 71

Heart autonomic innervation

Back 71

T1-T6

CN X

Front 72

Lungs autonomic innervation

Back 72

T1-T6

CN X

Front 73

Spleen autonomic innervation

Back 73

T5-T9

CN X

Front 74

Stomach autonomic innervation

Back 74

T5-T9

CN X

Front 75

Liver autonomic innervation

Back 75

T5-T9

CN X

Front 76

Gallbladder autonomic innervation

Back 76

T5-T9

CN X

Front 77

Proximal duodenum autonomic innervation

Back 77

T5-T9
CN X

Front 78

Middle GI (distal duodenum - proximal 2/3 of transverse colon) autonomic innervation

Back 78

T10-T11

CN X

(from lesser splanchnic nerve all sup. mesenteric ganglion)

Front 79

Kidneys autonomic innervation

Back 79

T10-T11

CN X

Front 80

Testes/ovaries autonomic innervation

Back 80

T10-T11

CN X

Front 81

Adrenal medulla autonomic innervation

Back 81

T10

CN X

Front 82

Leg structure autonomic innervation

Back 82

T11-T12

Front 83

Arm structure autonomic innervation

Back 83

T2-T8

Front 84

Lower GI (distal 1/3 of transverse colon - rectum) autonomic innervation

Back 84

S: T12-L2 from least splanchnic off inf. mesenteric ganglion

P: S2-S4 via pelvic splanchnic nerve

Front 85

Appendix autonomic innervation

Back 85

T12

Front 86

Bladder and distal ureter

Back 86

S: T12-L2

P: S2-S4 via pelvic splanchnic nerve

Front 87

Clitoral/penile erectile tissue

Back 87

S: L2

P: S2-S4 via pelvic splanchnic nerves