Carestandard Set 7

Front 1

4wAcuteStress4w
Adjustment Disorder

Back 1

Acute stress starts within 4 weeks of a stressor and ends within 4 weeks, so it can't last longer than 2 months !
Stop confusing with PTSD !!!
Adjustment disorder is out of proportion !!!

Front 2

Test for PVD ?
Locate lesion ?

Back 2

ABI, not Doppler US.
- Obtain "resting and post-exercise" systolic pressures in ankle and arm.
Locate: doppler US or segmental volume plethysmography

Front 3

MC injury following blunt thoracic trauma ?

Back 3

aortic rupture
- "pseudocoarctation" due to hematoma contained in mediastinum
- pressure on left recurrent laryngeal nerve = soft, hoarse, breathy voice

Front 4

rate control:
rate and rhythm control:

Back 4

metoprolol & diltiazem
amiodarone

Front 5

Best study to evaluate solid organs in stable patients.

Back 5

CT with contrast

Front 6

Indicated only in unstable patients where time is limited to get to CT.

Back 6

diagnostic peritoneal lavage

Front 7

genomic imprinting
narrow bifrontal diameter
diamond-shaped eyes
small, down-turned mouth

Back 7

Prader-Willi (GNDS)

Front 8

characteristic ear lobe crease
large size
macroglossia
neonatal hypoglycemia
omphalocele
viceromegaly

Back 8

Beckwith-Wiedemann (CLMNOV)
- visualize the ear lobe crease with an earring in it consisting of the letters "BW".

Front 9

VTAC with stable BP tx ?
VTAC with hemodynamic instability ?

Back 9

Amiodarone (DOC) or lidocaine
Cardioversion

Front 10

Used only for atrial arrhythmias:
(Would worsen VTAC)

Back 10

digoxin, IV Cardizem (Diltiazem)

Front 11

VTAC with stable BP tx ?
VTAC with hemodynamic instability ?

Back 11

Amiodarone (DOC) or lidocaine
Cardioversion

Front 12

Used only for atrial arrhythmias:
(Would worsen VTAC)

Back 12

digoxin, IV Cardizem (Diltiazem)

Front 13

Maneuver only useful for SVT (narrow complex), not for Vtac.

Back 13

carotid massage

Front 14

functional disorder of GI tract
- no lab or pathological hallmark

Back 14

Irritable Bowel Syndrome (IBS)

Front 15

pathologic hallmark of UC:

Back 15

crypt abscesses

Front 16

perianal fistulas:

Back 16

Crohn's disease

Front 17

hypoxemia (decr PaO2) & respiratory alkalosis (decr PaCO2) due to concommitant tachypnea:
NOTE: in alveolar hypoventilation expect hypoxemia (decr PaO2) and hypercapnea (incr PaCO2)!

Back 17

acute pulmonary embolism
atelectasis
pleural effusion
pulmonary edema

Front 18

always give tetanus IG when:
always give tetanus toxoid when:

Back 18

clean, minor wound & < 3 doses of tetanus toxoid given
clean minor wound & >= 3 doses > 10 years ago /
or dirty wounds >=3 doses > 5 years ago

Front 19

Group A strep producing erythrogenic exotoxins:
(Has same mode of transmission and age of distribution as streptococcal pharyngitis)
TX: ?

Back 19

scarlet fever
- sore throat for 2 days then rash on neck, chest, axillae
- submandibular tender lymphadenopathy
- sandpaper rash
- gray-white pharyngeal exudates
- circumoral pallor
- desquamation trunk to feet in a wk.
TX: Penicillin V

Front 20

Scarlet fever vs. Kawasaki ?

Back 20

changes in extremites & conjunctival injection in Kawasaki
- the real differentiator is that Scarlet fvr will quickly respond to Penicillin but K will not, and this is considered diagnostic.

Front 21

aplastic anemia vs. PNH

Back 21

reticulocytes very low in aa.
hypocellular marrow in aa.
no hemolysis or splenomegaly in aa.
PNH cx thrombosis at unusual sites like portal vein or Budd Chiari syndrome

Front 22

increased bone marrow iron (name 3 causes) - think "ASH" - breaking convention with my alphabetical ranking.

Back 22

ACD (anemia of chronic ds)
Sideroblastosis
Hemachromatosis

Front 23

anemia
increased neutrophils & band forms
leukocytosis
low LAP
Philidelphia chromosome

Back 23

CML

Front 24

celiac sprue
- lesion ?
- treatment ?

Back 24

- dermatitis herpetiformis
- dapsone (healing w/in hrs - is considered diagnostic)

Front 25

1% lindane

Back 25

scabies

Front 26

azathioprine to treat:

Back 26

pemphigus vulgarus
- suprabasal bullae

Front 27

posturing of Sandifer's syndrome
DX:

Back 27

tilted head and arched back assumed by a 6 mo old infant to protect its airway in GERD.
NOTE: infants with GERD can exhibit blood-stained projectile vomiting.
DX: 24-hr esophageal pH monitoring

Front 28

incr ESR, headaches, jaw claudication
likely complication:

Back 28

giant cell arteritis
aortic aneurysm

Front 29

nephrotic syndrome sx: (EHHP)
- what else might you expect in the setting of nephrotic syndrome ?

Back 29

edema
hyperlipidemia and lipiduria
hypoalbuminemia
proteinuria (>3-3.5 g / day)
- expect hypercoagubility

Front 30

ToF
Tricuspid Atresia
- both are cyanotic

Back 30

right atrium dilation + RVH
Left Axis Deviation, single S2, holosytolic murmur at left lower sternal border

Front 31

carpal tunnel syndrome in hypothyroidism is caused by:

Back 31

accumulation of matrix substances

Front 32

CTS diff:

Back 32

amyloid fibril deposition (ESRD, hemolysis)
tenosynovial tendon hyperplasia (RA)
synovial tendon hyperplasia (acromegaly)
fluid accumulation (pregnancy)

Front 33

Met Acidosis occurs in ARF due to failure to secrete acid causing primary decrease in HCO3- always check pCO2 to determine if pt is compensating. How ?

Back 33

pCO2 = 1.5 (HCO3) + 8

Front 34

defective bicarbonate reabsorption:
(remember, it's all about 2, as in CO2)

Back 34

type II RTA (remember it's a metabolic acidosis - the acid isn't in the renal tubules)
- urine is becoming basic
It's a NAGMA - non-anion gap met acidosis
- may be inherited in Fanconi syndrome
- also caused by carbonic anhydrase inhibitors (brush border)
- 90% of HCO3- is absorbed proximally, in the PCT
- so proximal pathology causes loss of HCO3- in the urine so loss of this buffer causes metabolic acidosis
- you can't reabsorb HCO3-, but you can still secrete H+ (K intact distally), so it's not as acidic as RTA1
- CX - heavy metal poisoning (Cu as in Wilson's and Lead)
- Fanconi syndrome is 2nd cause - loss of phosphate, glu, amino acids & HCO3- in the urine

Front 35

low tubular ammonium production

Back 35

type I RTA
- failure to excrete H+
- w/o hydrogen in tubular fluid ammonium can't be produced
- *A*lpha intercalated cells = *A*cid
- Most basic RTA b/c no H+ can be excreted

Front 36

high-pitched whistling noise made when narrowed airway passages cause difficulty in breathing. Common sign in asthma.

Back 36

wheeze

Front 37

immune response that does not involved antibodies
1. activation of M0 & NK cells
2. production of antigens-specific cytotoxic T-lymphocytes
3. release of cytokines in response to an antigen

Back 37

cell-mediated immunity

Front 38

G- + pseudomonas think:
MRSA think:
NPH peak is:

Back 38

ciprofloxacin
vancomycin
4 - 10 hr

Front 39

hypoglycemia causes:

Back 39

increased: epi, NE, glucagon leading to glycogenolysis and gluconeogenesis leading to increased blood glucose

Front 40

MCT, PHEO, Parathyroid hyperplasia
MCT, PHEO, mucosal neuromas, marfanoid features
What is the screen for MEN 2 ?

Back 40

MEN 2A
MEN 2B
Screen: calcitonin

Front 41

angioedema due to increased bradykinin
Mech:

Back 41

ACE-I
Mech: kinase degrades bradykinin

Front 42

DOC for SVT ?

Back 42

Adenosine push

Front 43

hyperactive DTRs:
Asystole:
U waves:

Back 43

hypocalcemia
severe hyperkalemia
severe hypokalemia

Front 44

doubles at 5 months, triples in a year:
increases 50% 1st year, dbls at 4, triples at 13

Back 44

birth weight
birth height

Front 45

pulsus parvus et tardus think:

Back 45

Ao stenosis

Front 46

crackles, rales, rhonchi or wheezes or pleural friction rubs:
rhonchi:
Skoda's crackles:

Back 46

adventitous
coarse gurgling indicating thick fluid
bronchial crackles heard from consolidated lung tissue in pneumonia

Front 47

Tx for SIADH:
these inhibit ADH:

Back 47

restrict H20, if Na < 120 or seizing then hypertonic saline to 125
Li & Demeclocycline

Front 48

hyponatremia
hyperkalemia
anemia
EOSINOPHILIA

Back 48

Addison's disease (HHAE)

Front 49

SE of Primidone for benign essential tremors ?

Back 49

acute intermittent porphyria

Front 50

broken femur treatment

Back 50

closed intramedullary fixation of the shaft

Front 51

- check for suicidality THEN thyroid function tests

Back 51

major depression

Front 52

18 month old neonate with meningitis and petechial rash

Back 52

meningococcemia

Front 53

initial test in enuresis ?

Back 53

UA

Front 54

most important factor for survival in heart attack ?

Back 54

time to defibrillation
- if unwitnessed or > 5 min perform trial of compressions first

Front 55

when are anti-virals helpful in influenza ?
TX: ?

Back 55

1st 2 days
Influenza A - Amantadine, Rimantadine
Influenza A & B - zanamivir, oseltimivir. Zanamivir approved only for tx, not for prevention of influenza.

Front 56

What causes metabolic acidosis in ARF ?
PCO2 compensation for met acidosis in ARF ?
How would this compensation occur ?

Back 56

Failure to excrete acids created during nl protein metabolism (inorganic phosphates & sulfates).
PCO2 = 1.5(HCO3-) + 8
Hyperventilation

Front 57

Type II RTA
What is the defect ?
How is type II RTA acquired ?
Is it as acidic as RTA I ? Why ?

Back 57

defective tubular bicarb reabsorption
acquired via inheritance or Fanconi's syndrome
not as acidic as RTA I b/c distal tubules can still excrete H+

Front 58

Type I RTA
What is the primary defect ?
Causes ? (list 3)
Result ? (expect these)

Back 58

- failure to excrete H+ in urine, think H+ is "1" in periodic table leading to low tubular NH4+ (ammon
- Auto1mmune (Shogren, SLE, RA causing distal dysfn of K)
- Stones - cx or result of distal RTA ? stones are a cause and effect.
- Obstruction or chronic urinary tract infection damaging distal cells

Front 59

What do renal tubular epithelial cells do ?
What happens when urine chloride is increased ?
So what happens in a pt w/ ARF ?

Back 59

Exchange chloride for bicarbonate.
HCO3- resorption into plasma is increased and urinary excretion of H+ is increased.
Chloride and acid excretion are inadequate relative to rate of acid production.

Front 60

What causes decreased anion gap metabolic acidosis ?

Back 60

Plasma cell dyscrasias & other paraproteinemias as well as Li intoxication.

Front 61

Result of alveolar diffusion block ?
What effect would this have on acid status ?

Back 61

hypoxia and tachypnea
tachypnea would lower pCO2 more quickly than O2 b/c CO2 is more readily diffusable.

Front 62

What is the respiratory compensation for metabolic acidosis ?
Relevant equation ?

Back 62

Tachypnea to blow off CO2.
PCO2 = (1.5 x HCO3-) + 8

Front 63

Acute life-threatening rxns associated with HIV drugs:

Back 63

indinavir - crystal nephropathy
didanosine - pancreatitis
NRTIs - lactic acidosis dazzls(didanosine, abacavir, zalcitabine, zidovudine, lamivudine, stavudine,)
NNRTIs - Stevens-Johnson syndrome (Nevirapine, Efavirenz, Delavirdine)
nevirapine - liver failure
efavirenz - neural tube defects

Front 64

worse supine or lying on left side
describe:
pulse pressure ?
how does this positioning work ?

Back 64

Ao regurgitation
"pounding or racing heart"
wide systolic-diastolic (ex. 150/55 = 95)
heart is closer to chest wall

Front 65

MC causes of Ao regurgitation in the US ? (AB)

Back 65

Ao root dilation
Bicuspid Ao valve

Front 66

Would pulmonary regurgitation cause widening of peripheral pulse pressure ?

Back 66

No

Front 67

expect pulmonary edema and hemoptysis
- would not cause widening of peripheral pressure
- generally expected etiology ?

Back 67

mitral stenosis
rheumatic heart disease

Front 68

valvular lesion causing right heart failure with clear lungs
- peripheral pressure would not be widened

Back 68

tricuspid stenosis

Front 69

water hammer pulse:
pulsus parvus et tardus:

Back 69

AR
Ao stenosis

Front 70

For each H+ lost to vomiting, what is produced.
What does the volume contraction of vomiting cause ?

Back 70

A single HCO3-
Activation of RAS, which also stimulates HCO3- reabsorption

Front 71

What causes hypokalemia in vomiting (3) ?

Back 71

GI loss of K+
Intracellular shift of K+ caused by alkalosis
increased renal excretion of K+ caused by aldosterone

Front 72

When to give tetanus toxoid ?
Go back to iphone and check these tetanus cards.

Back 72

In fully vaccinated (>=3 vaccinations) persons with a severe wound and it has been longer than 5 years since their last booster.

Front 73

Tetanus Treatment - This is the only card.
- Ignore all others.

Back 73

< 3 doses TT - clean minor: TT: Yes, TIG: No All others: TT Yes, TIG: Yes
>= 3 doses TT - clean minor TT: Yes if last dose > 10 years, TIG: No
>= 3 doses TT - all others TT: Yes if last dose > 5 years, TIG: No

TT - tetanus toxoid - active, prolonged, but delayed immunity
TIG - tetanus immunoglobulin - passive, temporary, immediate immunity

Front 74

if >= 3 doses tetanus toxoid:

Back 74

give TT in clean wounds if last dose > 10 yrs ago
give TT in dirty wounds if last dose > 5 years ago
never give TIG

Front 75

48 yo w/ harsh systolic murmur best heard at 2RICS w/ radiation to carotids
S4
Now, what is the 3rd cause of Ao stenosis ?

Back 75

Ao stenosis due to bicuspid Ao valve
if he were over 70 it would be due to senile calcific Ao stenosis
rheumatic heart disease

Front 76

typical pathologic entity causing mitral valve prolapse

Back 76

myxomatous valve degeneration

Front 77

describe the murmur of HCOM and Ao stenosis:
where is HCOM appreciated ?
where is Ao stenosis appreciated ?
what causes the S4 in either ?

Back 77

both cause systolic crescendo-decrescendo murmur with an S4
HCOM is appreciated in lower left sternal border and does not radiate to the carotids
Ao is appreciated at 2RICS with radiation to the carotids.
S4 caused by left atrial kick against stiffening of the left ventricle.

Front 78

typical pathologic entity causing mitral valve prolapse

Back 78

myxomatous valve degeneration

Front 79

differentiate murmur of HCOM from Ao stenosis:
what causes the S4 in either ?

Back 79

both cause systolic crescendo-decrescendo murmur with an S4
HCOM is appreciated in lower left sternal border and does not radiate to the carotids
Ao is appreciated at 2RICS with radiation to the carotids.
S4 caused by left atrial kick against stiffening of the left ventricle.

Front 80

Used to confirm MG.

Back 80

Tensilon test (edrophonium injection)
- positive if eyelid lag lessens

Front 81

anticholinergic that may be used to prevent the muscarinic SE of anticholinesterase therapy in pts w/ MG.

Back 81

atropine

Front 82

First 2 steps in mgt of myasthenia crisis:

Back 82

1. endotrachial intubation
2. withdrawl of anticholinesterases (e.g. pyridostigmine)

Front 83

Weakness of respiratory and pharyngeal mms.
- MC cause ?

Back 83

myasthenia crisis
- intercurrent infection - ABX are an important part of mgt

Front 84

begins with asymptomatic hyperuricemia and subsequently progresses to monoarticular arthritis.
- sever swelling and pain in the great toe due to deposition of monosodium urate crystals:

Back 84

gout
podagra

Front 85

DDX of tophi ?

Back 85

rheumatoid nodules
calcinosis cutis

Front 86

hard, bony nodules over the PIP and DIP respectively in OA.

Back 86

Bouchard nodes, Heberden nodes

Front 87

sausage digit DIPs

Back 87

psoriatic arthritis

Front 88

Tx for acetaminophen OD ?
(Rumack-Matthew nomogram)

Back 88

1. activated charcoal
2. serum acetaminophen level at 4 hrs
3. decision to administer N-acetylcysteine

Front 89

Sodium bicarb given in TCA OD acts how ?

Back 89

Sodium load of Sodium bicarb alleviates depressant action on Na channels of the heart, thus narrowing the QRS and preventing arrhythmia.

Front 90

How does NaHCO3 alleviate aspirin OD ?

Back 90

urine alkalinization increases salicylate excretion

Front 91

pathogenesis of OA

Back 91

cartilage degradation

Front 92

distal phalangeal resorption

Back 92

arthritis mutilans variant of psoriatic arthritis leading to "pencil-in-cup" deformities

Front 93

permanent joint deformity is uncommon

Back 93

SLE

Front 94

this, not PCO2 provides respiratory drive in COPD pts
So what happens if you just increase O2 in a hypoxic COPD pt ?
What to do ?

Back 94

hypoxia
- situation worsens due to decreased respiratory drive
NIPPV (non-invasive positive pressure ventilation) trial before entubation

Front 95

migratory thrombophlebitis is called:

Back 95

Trousseaus's syndrome

Front 96

hemophilic arthropathy

Back 96

hemosiderin deposition and fibrosis

Front 97

In up to 50% of pts with depression, this will be abnormal.

Back 97

DST (dexamethasone suppression test)

Front 98

recommended for HIV pts w/ CD4 > 200 cells/microL
- and what other vaccine ?

Back 98

pneumococcal vaccine
annual influenza

Front 99

recommended for HIV pts w/ HepB

Back 99

Hep A vaccine

Front 100

not recommended for HIV pts
recommended for pts w/ splenectomy, functional splenectomy or travel to high-risk countries

Back 100

meningococcal vaccine
- response to polysaccharide meningococcal vaccine in HIV pts is suboptimal

Front 101

Koplik spots
exanthema subium (6th ds)

Back 101

measles (Rubeola)
Roseola (HHV6) - infants - high fever 3-4 days - MC cx infant febrile seizures - rash spares face and appears after fever (unlike 5th ds)

Front 102

occurs in children < 10

Back 102

Kawasaki ds (mucocutaneous lymph node syndrome)

Front 103

adenovirus with no rash (PNF)

Back 103

pharyngoconjunctival fever
- pharyngitis (unilateral)
- non-purulent conjunctivitis
- fever

Front 104

rubella (RNA, Toga, Y, SSL, I) 3rd ds (MPPR)
- can you think of the relations between the name (3rd ds) and the presentation ? This will serve as the memory tie.

Back 104

mild fever & malaise
patchy erythema on throat & palate
posterior cervical & auricular lymphadenopathy
rash is fine, pink, maculopapular & occurs in rapid progression (3 days) from face to trunk ("3 day fever").

Front 105

What is the primary acid/base eqn ?

Back 105

CO2 + H2O <> H2CO3 <> H+ + HCO3-

Front 106

What are the 2 sources of NAGMA ?

Back 106

(Non-anion gap metabolic acidosis)
GI tract
Renal Tubule Acidosis (RTA)

Front 107

GI causes of NAGMA ?

Back 107

Diarrhea (loss of HCO3-)
- losing buffer from blood so blood becomes acidic

Front 108

Kidney causes of NAGMA ?

Back 108

Early CKD (chronic kidney disease)
RTAs

Front 109

hyporeninemic hypoaldosteronism
cause ?

Back 109

RTA 4
cx: failure of K to excrete renin
- usu caused by DM
- aldosterone increases H+ secretion so urine becomes more basic
- K+ goes up