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66 Cards in this Set
- Front
- Back
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2 things IV drug users are prone to getting:
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-Monoarticular septic arthritis
-Endocarditis |
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What organism?
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Staph aureus
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Most important first step in diagnostic workup for septic joint:
2 reasons? |
Diagnostic arthrocentesis
1. Nature of Effusion - trans/exudate 2. Rule out crystals - gout/pseudogout |
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What should you NOT do prior to diagnosing septic arthritis?
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DONT give empiric antibiotics - you need to isolate the pathogen to give the appropriate antibiotics
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What is suggested by 3d history of:
-Malaise, fever, chills -Nausea, headaches, anorexia -Painless macules on palms/soles -New onset holosystolic murmur |
Acute bacterial endocarditis!
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What murmur is consistent with a loud, holosystolic murmur at the sternal border that increases with inspiration?
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TRICUSPID regurgitation murmur
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What is responsible for the tricuspid regurgitation murmur of ABE?
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Staph aureus vegetations on the right heart tricuspid valve
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What is the most appropriate step in diagnosing the cause of a new onset tricuspid regurg murmur in a pt with history of IV drug use?
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Echocardiogram!
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What are the 2 most common sites in the brain for a HYPERTENSIVE HEMORRHAGE to be located?
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-Caudate
-Putamen |
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What is the greatest risk of hypertensive hemorrhage?
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High ICP - brain herniation
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What is an important piece of evidence that can help to rule out epidural hemorrhage in a patient with hypertensive hemorrhage?
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-HTN will be skyrocketed, not in epidural bleed
-No history of trauma to the squamous temporal bone |
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What are the 2 most common causes of Subarachnoid hemorrhage?
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-Trauma
-Berry aneurysms in the anterior portion of the circle of willis |
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What causes a subdural hematoma?
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Tearing of bridging subdural veins due to trauma/falls
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What is usually associated with "worst headache of my life"?
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Subarachnoid hemorrhage
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What are the 5 medications that can help save a life in unstable angina with critical CA stenosis?
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-B-blocker
-Oxygen -Nitroglycerin -Aspirin -Heparin IV |
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Why is Heparin so important?
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It is the most effective proven thing to prevent progression from unstable angina to MI
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What can Heparin cause in about 10% of cases?
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Delayed thrombocytopenia - HIT
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What is Nifepidine? How does it affect the heart?
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Ca Ch Blocker
-Reduces afterload -Causes reflex tachycardia |
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What criteria make patients with unstable angina candidates for IV thrombolytic therapy?
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Significant ECG changes like ST elevation or new LBBB
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What types of EKG changes PRECLUDE patients from IV thrombolytic therapy?
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-T wave inversions (not severe yet)
-ST depression (historical) -Nonspecific ST-T wave changes -Chest pain |
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What is presbyacusis?
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The progressive loss of sensitivity to high frequencies that occurs with age
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What is Progressive Supranuclear Palsy?
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Progressive deterioration of the basal ganglia and midbrain
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What are the 3 hallmarks of PSP?
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-Symmetric parkinsonism
-Vertical gaze limitation -Axial rigidity |
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What is a common earliest symptom of Progresive supranuclear palsy?
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Falls early in age
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What type of dementia is associated with PSP?
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-Frontal lobe dementia
(not so much memory loss) |
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What is a common finding in the basal ganglia and in what patients?
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-Small lacunar infarcts
-Diabetes/Hypertensive patients |
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What symptoms would result from a unilateral, Left Putamen lacunar infarct?
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Right sided motor weakness
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What can carbon monoxide poisoning cause in the brain?
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Bilateral pallidal (globus pallidus) necrosis
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How would a patient s/p CO poisoning and bilateral pallidal necrosis compare to the PSP patient?
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-Both would have symmetric parkinsonian symptoms
-Only PSP would have vertical gaze limits |
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What 4 clinical findings are consistent with Cervical Stenosis?
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-Falls on history
-Spastic gait -Hyperreflexia -Upgoing toes |
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22 yr old man with burning on urination and milky urethral discharge of 3 days:
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Gonorrhea
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What is the treatment of choice for uncomplicated gonococcal urethritis or cervicitis?
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125 mg Ceftriaxone, one-time IM injection
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What 3 drugs/doses are effective against Chlamydia?
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-Erythromycin 500mg 4/day 1week
-Azythromycin 1 g PO, single dose -Doxycycline 100mg BID 1week |
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What is the classic triad of Carcinoid syndrome?
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-Flushing
-Watery diarrhea -Valvular heart disease |
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What is the screening test of choice for Carcinoid syndrome?
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Urine 5-HIAA - serotonin metabolite!
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What type of urine sample needs to be collected to test for carcinoid?
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24-hr urine - in carcinoid syndrome the 5-HIAA may be >25 mg/day
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What are 4 other clinical manifestations of Carcinoid syndrome?
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BATH
-Bronchospasms -Abdominal cramps -Telangiectasias -Hypotension |
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What other triad can develop secondary to the overproduction of serotonin?
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Niacin deficiency!
-Diarrhea -Depression -Dermatitis |
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How is Carcinoid syndrome treated?
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Based on symptoms with Octreotide
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Where is the most common location of the primary tumor in carcinoid syndrome?
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Distal ileum
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What cell stain is often positive in malignant melanoma biopsies?
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S-100 - neurohistochemical!
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What feature of melanomas is closely related to prognosis?
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Depth of lesion
>1 mm is more likely to metastasize bc it reaches the lymphatics of dermis |
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How wide of margins should be taken for malignant melanomas?
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1cm
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What tumors is a-FP a marker for?
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-Ovarian/testicular with yolk sac cells
-Hepatocellullar carcinoma |
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CA-125 is a marker for:
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some ovarian cancers
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LCA is a marker for:
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some lymphoid neoplasms
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What is the correct treatment of choice for giardia lamblia and backpackers diarrhea?
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Metronidazole
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What is the typical presentation of a patient with giardia lamblia?
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Gas, bloating, and diarrhea with onset several days after getting home from Mexico
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How does the onset of Traveler's diarrhea due to E. coli compare to Giardiasis?
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Sooner - the day of, or after the day of travel
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What types of diarrheal infections are treated with Cipro?
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Shigella and Salmonella
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What is Mebendazole used for?
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Treating helminth infections
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What is the most common cause of chronic renal failure in the US?
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Diabetic kidney disease
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When does CRF due to DM manifest? When can screening begin?
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Manifests 10-15 yrs later
Screen while still asymptomatic with 24-hr urine microalbuminuria tests |
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What is an alternative way to screen for diabetic nephropathy than collecting a 24 hr urine?
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Measure morning urine Albumin:Creatinine ratio
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What is a normal vs abnormal Alb:Cr ratio? What if it's between the two?
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Normal is <3.5
Abnormal is >10 If between 3.5-10, re-evaluate |
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What should be done if elevated microalbuminuria IS found during screening?
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Agressive glycemic and BP control is in order!
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What drug has been shown to slow the progression of renal nephropathy in DM if microalbuminuria and hypertension are present?
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ACE inhibitor
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What type of cancer is linitis plastica?
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Agressive adenocarcinoma of the stomach
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What is the clinical presentation of Menetrier disease?
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-Protein wasting
-Weight loss |
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What is the problem with the gastric mucosa in Menetrier disease?
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-Very THICK gastric folds
-Mucous gland hyperplasia |
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What is TLS?
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Tumor lysis syndrome - the result of giving chemotherapy which kills a ton of cells and releases all the uric acid waste
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What results from precipitation of Uric Acid and Hypoxanthine in TLS?
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Acute renal failure
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What are 2 ways to prevent TLS?
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-Give Allopurinol
-Give lots of water to drink |
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What are 2 instances in which N-acetylcysteine might be given?
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-Acetominophen overdose
-Hemorrhagic cystitis due to cyclophosphamide or ifosfam |
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What type of acid/base change to the urine would help in TLS?
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Alkalinization
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How can you alkalinize the urine?
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Give IV sodium bicarb
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