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PFT finding in obstructive lung disease.
FEV1/FVC is less than normal (which is 0.75-0.8)
PFT finding in restrictive lung disease.
FEV1/FVC is normal or close to normal.
Three types of sleep apnea and their differences
Obstructive: Restricts inspiratory airflow.
Central: Lack of signal from resp. center, no drive to breathe.
Mixed: Combination of above.
Most common cause of pneumonia
S. pneumoniae
Clinical features of typical pneumonia
Short prodrome, high fever, occurs in people over 40, typically lobar on CXR
Clinical features for atypical pneumonia
Longer prodrome (more than 3 days), low fever (less than 102), occurs in ppl younger than 40, CXR shows diffuse, multilobar involvement
Pneumonia in college student, cold agglutinins
Mycoplasma
Pneumonia in an alcoholic, currant jelly sputum
Klebsiella
Pneumonia in CF patient: most likely bug
Pseudomonas
Pneumonia in AIDS or HIV pt
Pneumocystis carinii or CMV
Wheezing in child less than 1 year old
RSV
Pulmonary hypertension CXR findings
Enlarged cardiac silhouette with bulging anterior cardiac border
Tx of mild intermittent asthma
No daily drugs required. Rescue beta-agonist inhaler. Systemic corticosteroids for exacerbations.
Tx of mild persistent asthma.
Low-dose inhaled corticosteroids and rescue beta-agonist inhaler. Alternative: Mast cell stabilizer, leukotriene modifiers, or theophylline, and rescue beta-agonist inhaler
Tx of moderate persistant asthma
Medium-dose inhaled corticosteroids and long acting beta-agonist, and rescue beta-agonist inhaler.
Alternative: Add leukotriene modifier or theophylline.
Emphysema in a young person with minimal smoke exposure may indicate...
alpha-1-antitrypsin deficiency
Pneumothorax clinical presentation
Acute onset dyspnea and chest pain, diminished breath sounds, diminished tactile fremitus, increased resonance on percussion.
Type of pleural effusion that results from CHF, cirrhosis, and nephrotic syndrome
Transudative
Type of pleural effusion that results from inflammatory processes such as TB, pneumonia, carcinoma, infarction, trauma, rheumatic disorders
Exudative
Diagnosis of pleural effusion: imaging study
anteroposterior CXR shows blunting of the costophrenic angel, shows effusions up to 300ml. Lateral decubitus XR may show smaller fluid amounts.
Most common tumor originating in the mediastinum
Thymoma
Three compartments of mediastinum
Anterior, middle, posterior
Anterior mediastinal tumors include:
thymoma, teratoma, thyroid lesions, lymphoma
Middle mediastinal tumors include:
lymphadenopathy, pulmonary artery enlargement, great vessel aneurysm, developmental cyst, diaphragmatic hernia
Posterior mediastinal tumors include:
Neurogenic or diaphragmatic tumors
Risk factors for pulmonary embolism
cancer, OCPs, smoking, immobility, post-op, MI, CHF, obesity, orthopedic injury of pelvis, hips, or lower extremities.
Don't forget risk factors BESIDES Virchow's triad.
Pulmonary embolism presentation
Tachypnea, pleuritic chest pain, dyspnea, anxiety. Massive PE may have right ventricular failure and systemic hypotension.
Virchow's triad
Venous stasis, hypercoagulable state, venous endothelial injury. Predisposes to venous thrombus/PE.
Therapeutic mainstay for interstitial lung disease
Corticosteroids
Presence of a chronic productive cough for 3 months in each of 2 consecutive years, with other causes of cough excluded, is most likely..
Chronic bronchitis
Forced vital capacity is:
a measurement of the volume of airflow expired with the patient blowing as hard and fast as possible.
Causes of restrictive lung disease (Acronym PAINT)
Pleural (fibrosis, effusions, pneumothorax, empyema)
Alveolar (edema, hemorrhage, pus)
Interstitial lung dz (inflammatory- sarcoid, or idiopathic)
Neuromuscular (myasthenia)
Thoracic wall (kyphoscoliosis, obesity, ascites, ankylosing spondylitis)
CXR diagnosis of interstitial lung disease
Reticular, nodular, or ground-glass pattern. Honeycomb pattern if severe.
Features of sarcoidosis (Acronym GRUELING)
Granulomas
R-thritis (arthritis)
Uveitis
Erythema nodosum
Lymphadenopathy
Interstitial fibrosis
Negative TB test
Gammaglobulinemia
Reversible airway obstruction secondary to bronchial hyperreactivity, airway inflammation, mucus plugging, and smooth muscle hypertrophy
Asthma
Terminal airway destruction and dilation that may be due to smoking or alpha-1-antitrypsin deficiency
Emphysema
Emphysema (pink puffer) clinical features
dyspnea, pursed lip breathing, thin, wasted appearance, minimal cough, decreased breath sounds
Productive cough, cyanosis, mild dyspnea, overweight, peripheral edema, rhonchi, barrel chest, use of accessory resp. muscles, JVD, end-respiratory wheezing, muffled breath sounds
Chronic bronchitis
COPD treatment
Smoking cessation, pneumococcal and flu vaccines, systemic or inhaled corticosteroids, oxygen, inhaled beta-agonists and anticholinergics
Pleural effusion that is due to increased pulmonary capillary wedge pressure or decreased oncotic pressure
Transudate
Pleural effusion that is due to increased pleural vascular permeability
Exudate
Left axis deviation ECG finding
Upright QRS in lead I and downward QRS in lead aVF
Right axis deviation ECG finding
Downward QRS in lead I and upright QRS in lead aVF
AV block ECG finding
PR interval greater than 200 msec, or P with no QRS following
Left bundle branch block ECG finding
QRS duration >120msec, no R wave in V1, and wide tall R waves in I, V5, and V6
RBBB ECG finding
QRS >120msec, wide R wave in V1, QRS pattern with wide S wave in I, V5, and V6
Atrial fibrillation management (Acronym ABCD)
Anticoagulate
Beta-blockers
Cardioversion
Calcium channel blockers
Digoxin
Most common cardiomyopathy
Dilated cardiomyopathy
Dilated cardiomyopathy CXR finding
Enlarged balloon like heart, pulmonary congestion
Dilated cardiomyopathy clinical findings
Gradual development of CHF, S3 gallop.

May have cardiomegaly, and tricuspid and mitral regurge
Atrial fibrillation etiology (Acronym PIRATES)
Pulmonary disease
Ischemia
Rheumatic heart disease
Anemia, Atrial myxoma
Thyrotoxicosis
EtOH
Sepsis
Physical exam finding in atrial fibrillation
Pulse is irregularly irregular
2nd degree AV block (Mobitz I/Wenckebach) etiology
Drugs: digoxin, beta-blockers, or CCBs
Increased vagal tone (which is caused by inferior MI, sleep apnea, hypothyroid, among others)
ECG shows wavy baseline without discernible P waves, with variable and irregular QRS response
Atrial fibrillation
ECG shows regular rhythm, but sawtooth appearance of P waves
Atrial flutter
ECG shows early wide QRS not preceded by P wave, followed by a compensatory pause.
PVC
ECG shows 3 or more consecutive PVCs, wide QRS complexes in a regular rapid rhythm
Ventricular tachycardia
Treatment for V-tach
Cardioversion, antiarrhythmics (amiodarone, lidocaine, procainamide)
Treatment for dilated cardiomyopathy
D/C EtOH, treat CHF (diuretics, ACEIs, beta-blockers)
If ejection fraction is less than 35%, consider implantable cardiac defibrillator.
Physical exam findings for hypertrophic cardiomyopathy
Sustained apical impulse, S4 gallop, systolic ejection crescendo-decrescendo murmur that gets louder with Valsava maneuver
Most common cause of sudden death in young, healthy athletes in the U.S.
Hypertrophic cardiomyopathy
Treatment for hypertrophic cardiomyopathy
Beta-blockers initially for symptomatic relief, CCBs for 2nd line tx. Refer to cardiologist for surgical options.
Avoid intense athletic training.
Beta blockers: common side effects
bradycardia, fatigue, sexual dysfunction
beta blockers: contraindications/cautions
sinus bradycardia, cardiogenic shock, use caution in diabetes, asthma, COPD, PVD. Do not discontinue abruptly.
Dihydropyridine CCBs (e.g. amlodipine (Norvasc)): Contraindications/cautions
hepatic dysfunction, hypotension
Non-dihydropyridine CCBs (e.g. verapamil, diltiazem): contraindications/cautions
sick sinus syndrome, 2nd or 3rd degree heart block, hypotension <90mmHg systolic, acute MI, pulmonary congestion, renal/hepatic dysfunction
ACEIs contraindications/cautions
renal artery stenosis, hx of angioedema
ACEIs adverse effects
cough, angioedema, hyperkalemia, leukopenia, loss of taste
5 most common.
ARBs adverse effects
hyperkalemia, cough, URI
alpha/beta adrenergic blockers (e.g. labetalol, carvedilol) are used for:
CHF, HTN
Centrally acting antiadrenergic agents: examples
Clonidine (Catapres), Methyldopa (Aldomet)
Nitroglycerin contraindications/cautions
severe anemia, closed angle glaucoma, postural hypotension, early MI, head trauma or cerebral hemorrhage
Causes of right sided heart failure
Pulmonary disease, pulmonary HTN, rt ventricular infarction, mitral stenosis, left sided HF
Causes of left sided heart failure
MI with lt ventricular infarction, systemic HTN, cardiomyopathy, endocarditis, aortic valve dz and mitral regurge
left sided heart failure results in _______ congestion.
pulmonary
right sided heart failure results in ________ congestion
systemic venous
Systolic heart failure involves...
Decreased cardiac contractility and ejection fraction
Diastolic heart failure involves...
Poor ventricular compliance and relaxation, impaired ventricular filling.
Causes of heart failure
MI, afib, infection, shock/trauma, thyroid disease, PE, excess salt, medication noncompliance, beta blockers, NSAIDs
Physical findings of heart failure
JVD, tachypnea, bibasilar crackles, wheezing, S3 gallop, split S2, ascites, cyanosis, peripheral edema
CXR findings in CHF
Cardiomegaly, right or bilateral pleural effusions, Kerley's B lines, increased pulmonary vascular markings and pulmonary cephalization, interstitial edema, butterfly pattern of pulmonary edema
Laboratory findings in CHF
elevated BNP, respiratory alkalosis, increased BUN/Cr, dilutional hyponatremia, elevated liver enzymes, proteinuria
Mainstay of therapy for CHF
ACEIs
Drug therapy for CHF
ACEIs, loop diuretics, digoxin in systolic failure, beta blockers (low dose, increase slowly), vasodilators (hydralazine, oral nitrates, IV NTG)
Diastolic BP >140, fundoscopic changes (hemorrhage, exudates, papilledema), confusion, stupor
hypertensive crisis (aka malignant hypertension)
Complications of HTN
retinopathy, coronary artery disease, CHF, PVD, nephropathy, TIA/CVA
Don't forget what it does to the vascular system.
Fundoscopic findings in HTN
A-V nicking, copper wiring of arterioles, hemorrhages, exudates, papilledema
Nonpharmacologic management of HTN
salt restriction (2.4g Na/day), weight reduction, decrease alcohol, smoking cessation, aerobics, stress reduction (relaxation exercises)
Prinzmetal angina
Chest pain at rest with ST segment elevation
Levine's sign
Pt describes chest pain using clenched fist over his/her sternum
Gold standard study to evaluate CAD
cardiac cath with angiography
Pericarditis: clinical features
sharp retrosternal CP w/radiation to back & shoulder, intensifies with inspiration & lying supine, relieved by sitting up and leaning forward. odynophagia, anorexia, anxiety, myalgia.
dyspnea, tachycardia, cyanosis, JVD, hypotension, pulsus paradoxus, muffled heart tones may indicate..
pericardial tamponade
constrictive pericarditis PE
asymptomatic early. dyspnea, fatigue, JVD, peripheral edema, hepatomegaly, ascites
pericarditis ECG findings
acute phase with concave-up ST elevation in precordial leads, esp with absence of reciprocal ST depression seen in AMI. Intermediate phase ST segment returns to baseline, T waves invert. Late phase may have normal ECG.
Cardiac tamponade ECG findings
electrical alternans
pericardial effusion diagnostic study
echo
Uncomplicated acute pericarditis: treatment
ASA, NSAIDs, or prednisone; analgesics; rest; observe for signs of tamponade; treat underlying etiology
Cardiac tamponade: treatment
Immediate pericardiocentesis. If recurrent, refer to cardiothoracic surgeon.
Aortic stenosis murmur
mid-systolic ejection murmur best heard at the 2nd right intercostal space
Early decrescendo high-freq blowing diastolic murmur best heard at lt sternal border/3rd and 4th ICS; accentuated by having pt sit up, lean forward, hold breath after deep expiration, or by squatting.
Aortic regurge
Mitral stenosis most common etiology
Rheumatic fever
Mitral stenosis murmur
early to mid diastolic low pitch rumble murmur best heard at apex in left lateral decubitus position. May also have presystolic murmur.
Mitral regurge murmur
high frequency blowing holosystolic murmur best heard at apex with radiation to axilla in chronic cases. Can be accentuated by squatting. May be decrescendo if acute.
Mitral valve prolapse murmur
late-systolic murmur best heard at apex, increases in intensity with standing and handgrip.
CHF in newborn may indicate...
pulmonary stenosis
Harsh mid-systolic crescendo-decrescendo murmur loudest at left upper sternal border with radiation to neck, increased with inspiration.
Pulmonic stenosis
Pulmonic stenosis etiology
Usually congenital, may be associated with rubella.
Aortic aneurysm most common etiology
atherosclerosis
Most aortic aneurysms are located...
in abdominal aorta just below level of renal arteries
Complications of aortic aneurysm
Rupture, thromboembolism, distal ischemia
AAA Management
If <4cm and asymptomatic, watch and follow with serial U/S. If >4cm, surgical referral for elective surgery.
Aortic dissection most common etiology
HTN
Aortic dissection clinical features
Sudden onset tearing severe anterior chest pain with radiation to interscapular region.
Aortic dissection CXR findings
Widening of superior mediastinum, displacement of trachea, left pleural effusion, enlargement of aortic knob.
Aortic dissection gold standard diagnostic study
Aortic angiogram
Rheumatic fever etiology
GABHS pharyngitis
Jones' Criteria for diagnosis of rheumatic fever
Documented preceding GABHS infection (throat cx, rapid strep test, elevated aso titer) with 2 major and 2 minor manifestations.
Jones' criteria: major manifestations of RF
Carditis, polyarthritis, chorea (late finding), erythema marginatum, subcutaneous nodules
Jones' criteria: minor manifestations of RF
arthralgia, fever (101-104), prolonged PR interval, elevated acute phase reactants (ESR, C-RP)
Common amount of time elapsed between pharyngitis episode and rheumatic fever
1-3 weeks
Most common cause of acute bacterial endocarditis
Staph aureus
Most common cause of SBE
Strep viridans
Acute bacterial endocarditis etiology
S. aureus; Group A, B, C, and G strep; H. flu; S. pneumo; N. gonorrhea; enterococcus
SBE etiology
S. viridans; S. fecalis (enterococci); S. aureus; HACEK (haemophilus, actinobacillus, cardiobacterium, eikenella, kingella)
IV drug abuse endocarditis organisms
S. aureus (MRSA); P. aeruginosa; enterococcus; candida
Endocarditis that is caused by virulent organisms and has an aggressive course
Acute bacterial endocarditis
Endocarditis that occurs in pts with preexisting valvular heart disease and has a slower course.
SBE
Classic triad of endocarditis
fever, heart murmur, positive blood culture.
Endocarditis physical findings
Murmurs; Fever; conjunctival hemorrhage; petechiae on LE or oropharynx; splinter hemorrhages; Osler's nodes; Janeway's lesions; Roth's spots on fundoscopy
Tests besides ECG to diagnose MI
Serial CK-MBs, troponin I or T, or myoglobin every 8 hours x 3. Elevated LDH, AST
MI Treatment
Admit to ICU. Early thrombolysis if less than 6 hrs from onset if pt meets strict criteria, otherwise PTCA or CABG. If symptomatic V-tach or V-fib, use lidocaine or amiodarone. Maintain O2 sat >90%. Control pain with morphine. NTG. Beta blockers for life. ASA, ACEIs, statins.
Who should receive endocarditis prophylaxis?
People with known valvular heart disease or prosthetic valves.
Protocols for endocarditis prophylaxis
Amoxicillin before and after oral surgery, or clindamycin or azithromycin in pts with PCN allergy. For GI or GU procedures, use ampicillin plus gent before the procedure and amoxicillin after; vanc if PCN allergy.
Most important side effect of heparin
Thrombocytopenia on day 3 to day 7 of heparin administration. D/C immediately if platelet count falls.
1. Heparin is monitored with...
2. Warfarin is monitored with...
1. PTT.
2. PT
Drug used to reverse the effects of heparin and LMWH.
Protamine
Warfarin reversal
Fresh frozen plasma (immediate effect) and/or Vitamin K (takes a few days)
Aspirin reversal
Platelet transfusions
How does hemophilia A or B affect coagulation tests?
Prolongs PTT. Hemophilia A will also have low levels of factor 8; hemophilia B will have low levels of factor 9
How does vWF deficiency affect coagulation tests?
Prolongs bleeding time and PTT. Normal factor 8 and 9, normal PT.

(autosomal dominant so look for family history)
How does DIC affect coagulation tests?
Prolongs PT, PTT, and bleeding time. Positive D-dimer or FDPs. Associated with postpartum, infection, and malignancy. Schistocytes and fragmented cells on peripheral smear.
How does liver disease affect coagulation tests?
Prolongs PT. PTT may be normal or prolonged, and all factors but 8 are low.
How does Vitamin K deficiency affect coagulation studies?
Prolongs PT, slightly prolongs PTT. Normal bleeding time.
Right ventricular enlargement, hypertrophy, and failure due to primary lung disease.
Cor pulmonale
Common causes of cor pulmonale
COPD, PE, primary pulmonary HTN (young female age 20-40 with no other risk factors), sleep apnea
Signs and symptoms of cor pulmonale
tachypnea, cyanosis, clubbing, parasternal heave, loud P2, right sided S4, in addition to signs of pulmonary disease.
Wolff-Parkinson-White syndrome treatment
Procainamide, quinidine. AVOID digoxin and verapamil
Endocrine disease suggested when pt presents with sinus tachycardia or atrial fibrillation?
Hyperthyroidism. Screen with TSH.
Classic presentation of Wolff-Parkinson-White syndrome
Child becomes dizzy or dyspneic or passes out after playing, then recovers with no other symptoms. ECG will show delta wave.
Most common cyanotic congenital heart defect
Tetralogy of Fallot
Most common congenital heart defect.
Ventricular septal defect. Characterized by holosystolic murmur next to sternum.
Name that congenital heart defect! Upper extremity HTN only; radiofemoral delay; systolic murmur over mid-upper back; rib notching on x-ray; associated with Turner syndrome
Coarctation of the Aorta
Major risk factors for coronary artery disease
Age (Men > 45, women > 55 or with premature menopause and no ERT)
Family hx premature MI
Smoking (>10/day)
HTN (>140/90)
Low HDL (<40mg/dl)
High LDL (based on risk factors - if no risk, should be below 160. if high risk, should be below 70)
First line therapy for hypercholesterolemia, after lifestyle modifications
HMG CoA reductase inhibitors (statins)
Rare but serious side effects to watch for with statins
Liver and muscle damage
2nd line therapy for tx of hypercholesterolemia.
Niacin and bile acid binding resins (cholestyramine)
What raises HDL?
Moderate alcohol consumption, exercise, estrogens
Lifestyle modifications for HTN
Diet: low salt, low fat, low calorie
Reduced smoking
Reduced alcohol intake
Weight loss
Exercise
5 classes of drugs considered 1st line therapy for HTN
ACEIs/ARBs
Beta Blockers
CCBs
Diuretics (thiazide)
AABBCCD
In diabetics, ACEIs are protective against _____ and _____
Nephropathy and neuropathy
Pregnant women with HTN should be treated with...
Labetalol, hydralazine, or alpha-methyldopa
The number 1 modifiable risk factor for stroke
HTN
Which 3 tests should be ordered for every patient with a diagnosis of HTN, and why?
ECG: determine if the heart has been affected (LVH)
BMP: Look for 2ndary cause
UA: Look for 2ndary cause or kidney damage
How is endocarditis diagnosed and treated?
Diagnosed by blood cultures. Empiric treatment with broad-spectrum IV antibiotics such as 3rd gen cephalosporin or PCN plus an aminoglycoside until C&S results return.
Corticosteroid nasal spray will provide symptomatic relief in patients with allergic rhinitis in approximately how much time?
1-2 weeks
How can oral lichen planus be differentiated from oral candidiasis?
Oral lichen planus cannot be rubbed off, and oral candidiasis can be removed, leaving erythema.
Primary feature differentiating Meniere's disease from vestibular neuronitis.
Hearing loss
Most common cause of acute pharyngotonsillitis in a young child.
Rhinovirus
Chalky patch on the TM in a patient with recurrent OM is most likely...
Tympanosclerosis
Most common bacterial causes of acute sinusitis in a 6 year old.
H. flu and S. pneumo
Small child with 2 day history of painful ulcerative lesions on the buccal mucosa with a high fever. Most likely cause?
Herpetic gingivostomatitis
Small child with unilateral purulent odorous rhinorrhea, most likely cause?
Nasal foreign body
Most likely organism in a swimmer with ear pain that is increased with manipulation of the tragus or pinna
Pseudomonas aeruginosa
Pathology in the cochlea will cause which type of hearing loss?
Sensorineural
First choice of antibiotic in a child with acute OM
Amoxicillin
Acute tonsillitis and splenomegaly is suggestive of...
Epstein-Barr virus (infectious mononucleosis)
Vertigo, hearing loss, and tinnitus
Meniere's disease
Child with fever, arthralgia, rash on cheeks with "slapped cheek" appearance
Erythema infectiosum
Treatment of GABHS pharyngitis in a patient with PCN allergy
Erythromycin
What is Koebner's phenomena?
Linear lesions caused by allergic contact dermatitis
"target" lesions on hands and feet is suggestive of...
erythema multiforme
Purplish dermal plaque in a patient with HIV
Kaposi's sarcoma
Sudden painless loss of vision in one eye
Retinal artery occlusion
Vitiligo may indicate what disease?
Hypothyroidism
Raised papule on a chronic sun-exposed area with telangiectasias and a pearlescent border
Basal cell carcinoma
Small child who has had a high fever for several days develops an erythematous maculopapular rash on the trunk as the fever subsides.
Roseola
Child develops expanding erythematous rash associated with arthralgias, myalgias, headache, fatigue.
Lyme disease
Small child with lymphadenopathy followed by an erythematous maculopapular rash that begins on the face
Rubella
Staph toxin-mediated painful, tender, diffuse erythema followed by desquamation. Occurs mostly in babies.
Staph Scalded Skin Syndrome
Discrete, solid, skin-colored papules with central umbilication
Molluscum contagiosum
Sharply demarcated, tender, elevated, erythematous rash on face associated with fever
Erysipelas
Petechial lesions, fever, tachycardia, shock
Meningococcemia
Age group most likely to have testicular cancer.
15-35
Best initial test for someone presenting with signs of BPH
DRE
Inability to replace the foreskin over the glans penis in an uncircumcised male.
Paraphimosis
Middle aged male with signs of BPH. On DRE, the prostate is enlarged, nodular, nontender.
Prostate cancer
Sexually active heterosexual male with clear urethral discharge, dysuria, painful testicle
Chlamydia
Tumor associated with elevated alpha-fetoprotein AND beta HCG
embryonal carcinoma
Most likely site for prostate metastasis
Bone
False-negative rate of a screening PSA
20-25%
Initial diagnostic study for painless lump in testicle in a male 15-35 years of age
Ultrasound
Most likely type of testicular cancer in a young male (20s)
Choriocarcinoma
Infant with white reflex on fundoscopy
Retinoblastoma
Child with high fever, sore throat, drooling, sitting in tripod position
Epiglottitis
Dendritic ulcer on the cornea most likely indicates...
Viral keratitis
Cerumen impaction causes which type of hearing loss?
Conductive
Petechial rash that begins on wrist and ankles
Rocky Mountain Spotted Fever
Small child with high fever for several days, conjunctivitis, pharyngeal erythema, swollen lips that are cracked and fissured, rash on hands and feet
Kawasaki's disease
Treatment of choice for rocky mountain spotted fever
Doxycycline 100mg po BID x 10 days
Causative organism in Lyme disease
Borrelia burgdorferi
Name that STD: Gram stain of penile discharge reveals gram-neg intracellular diplococci
Gonorrhea
Anatomical portion of the prostate that becomes hyperplastic with BPH
transition zone
Primary symptom of bladder cancer
painless hematuria
Painless lesion on the penis
chancre
Minimal change disease presents as (nephrotic/nephritic) syndrome
Nephrotic
Poststrep glomerulonephritis presents as (nephrotic/nephritic) syndrome
Nephritic
Inability to retract the foreskin from the glans penis due to inflammation or infection
Phimosis
Most helpful test to differentiate testicular torsion from epididymitis
Nuclear medicine scan
Patients with Meniere's disease should limit their intake of _____
salt
leading cause of vision loss in Caucasians
Macular degeneration
Leading cause of vision loss in African Americans
Glaucoma
Normal pressure encephalopathy: 3 signs
ataxia, incontinence, dementia
Acronym: AID
itchy rash associated with asthma and allergic rhinitis
atopic dermatitis
Contact dermatitis therapy
Burrow's solution dressings for weeping vesicobullous eruptions. High potency topical steroids. Severe cases get a tapering course of oral steroids. Newer therapy includes topical anti-inflammatories such as tacrolimus
Recurrent episodes of pruritis of lateral fingers, palms, or soles with tapioca-like vesicles followed by papules, fissures, scaling, and lichenification
Dyshidrotic eczema (hand eczema)
lichen planus description "five p's"
pruritic purple (violaceous) planar (flat) polygonal papules. Usually seen on the wrists, lumbar area, shins, and penis
a single oval/round scaly patch resembling tinea corporis followed in days to weeks by crops of smaller lesions on the trunk and proximal extremities "Christmas tree" pattern
pityriasis rosea
Upper respiratory infection prodrome for 1-14 days followed by widespread vesicles and bullae on purpuric targetoid macules with severe mucous membrane involvement
Stevens-Johnson Syndrome
Stevens Johnsons syndrome is actually relatively benign as long as it doesn't progress into what?
Toxic epidermal necrolysis. Characterized by diffuse painful erythematous skin and epidermal shearing from friction (Nikolsky's sign)
Painful or painless bite by this spider is followed by generalize abdominal, back, and leg pain, possibly spreading within minutes to hours to include the entire torso and legs with severe abdominal pain. Subsides in 2-3 days.
What is a black widow?
A bite from this spider causes a reaction ranging from mild urticaria to full-thickness skin necrosis, followed in several hours by central bulla with surrounding gray to purple discoloration surrounded by erythema.
(Classic "red, white, and blue" sign)
What is a brown recluse?
Verrucous "cauliflower" papules and plaques in the anogenital region
condyloma acuminata, caused by HPV. (genital warts)
True or False: Molluscum contagiosum will resolve without treatment
True, unless the patient is infected with HIV.
What is the rule of nines to estimate extent of a burn?
Each leg is 18%, each arm is 9%, front of trunk is 18%, back of trunk is 18%, the head is 9%.
Type of hearing loss resulting in decreased volume for low tones and vowels
Conductive
Type of hearing loss in which bone conduction is normal and air conduction is abnormal.
Conductive.
Type of hearing loss in which the tuning fork during the Weber test is heard more loudly in the affected ear.
Conductive
Type of hearing loss involving difficulty perceiving high tones
Sensorineural
Type of hearing loss in which air conduction is worse than bone conduction
Mixed
First line therapy for acute otitis media
amoxicillin
Hallmark of 1st degree heart block
PR interval >0.20 seconds
Main treatment goal for patients with hypoxic OR hypercapnic respiratory failure
Maintain partial pressure of oxygen in arterial blood levels
Common side effects of clonidine
sedation, fatigue, dry mouth
Most appropriate treatment for a patient with temporal arteritis
High dose long term steroids
Thrombolytic therapy in MI should be used within how many hours of the onset of chest pain?
12
True or false: Corticosteroids are only minimally effective in the treatment of emphysema
True: Only 20-30% of patients with COPD improve on chronic oral steroids
AAAs greater than ___ cm should be referred for surgical eval for consideration of elective repair to prevent rupture.
4 cm
Most common etiology of pulmonic stenosis
Congenital
Current recommendation for endocarditis prophylaxis before a dental procedure in patients with valvular heart disease
Amoxicillin 2g 1hr before procedure
An infant evaluated with failure to thrive is found to have a continuous machine murmur. Most likely diagnosis?
Patent Ductus Arteriosis
What signs are seen in hypertensive retinopathy but not on diabetic retinopathy?
AV nicking, copper and silver wiring, papilledema
Unilateral headache, visual changes, jaw claudication in an older woman
Temporal arteritis
2 most effective agents for lowering triglycerides and raising HDL
fibric acid derivatives (like gemfibrozil) and nicotinic acid
Effective medication for symptomatic mitral valve prolapse
Beta blockers
Barking "seal like" cough is what illness?
Laryngotracheitis (Croup)
Major caution with chemotherapy drug Doxorubicin?
Cardiotoxicity. Monitor for signs of cardiomegaly!
What anti-anginal agents are contraindicated in patients with closed-angle glaucoma?
Nitrates
CHF causes which type of pleural effusion?
Transudative
Best treatment for torsades de pointes
Magnesium sulfate
Obstructive pulmonary disease PFT findings
Decreased FEV1/FVC and maximal midexpiratory flow rate, high residual volume, and increased RV/total
Heart failure with a normal left ventricular ejection fraction is probably which type?
Diastolic
What anti-anginal medication requires drug-free periods of 8-12 hours to avoid tolerance effect?
long-acting nitroglycerin like isosorbide dinitrate
Heart murmur that is accentuated by sitting up, leaning forward, and holding breath after deep expiration
Aortic regurge
Common adverse effect of amlodipine?
Edema.
Medication used to prevent further eclamptic seizures?
Magnesium sulfate
ECG shows an irregularly irregular ventricular rhythm with no discernible p waves
Atrial fibrillation
Antihypertensive drug that inhibits the reabsorption of sodium and chloride
Loop diuretics (furosemide)
What, if any, symptoms can delineate patients with hypoxic respiratory failure between those with hypercapnic-hypoxic respiratory failure?
None! Check the ABGs.
The most important initial treatment for patients with diffuse parenchymal lung disease?
Stop exposure to pulmonary irritants
Hypoxic respiratory failure will have what CXR finding?
"white" lung or "white out"
What is the pattern of genetic transmission of cystic fibrosis?
Autosomal recessive
Otherwise health tall, thin cigarette smoker presents with dyspnea and pleuritic chest pain, is in mild distress.
Spontaneous pneumothorax
Anti-arrhythmic agent that prolongs repolarization and is used in atrial or ventricular arrhythmias?
Amiodarone.
Henoch-Schonlein purpura has what effect on coag studies?
None - normal clotting parameters. It is purpura due to vasculitis rather than a bleeding disorder.
Persistent fever following treatment for bacterial pneumonia is suggestive of...
empyema
Most common causative organism for laryngotracheitis (croup)?
Parainfluenza
ST segment elevation, leukocytosis, elevated ESR, and pericardial effusion on CXR
Pericarditis
What class of anti-arrhythmics is verapamil?
Class IV
2 intrathoracic complications of pneumonia
Empyema and lung abscess
Asthma medication that inhibits inflammation, edema, and bronchoconstriction.
Leukotriene modifiers
Removal of pleural fluid during pleurocentesis should not exceed ___mls at one time.
Why is this?
1500 mls. To prevent possibility of pulmonary edema in the reexpanded lung.
Development of hypertension with proteinuria, edema, and other organ disturbances induced by pregnancy in the 2nd half of gestation
Preeclampsia
Dyspnea, substernal chest pain triggered by exertion, exertional dyspnea, and syncope.
pulmonary hypertension
RVH, ventricular septal defect, infundibular pulmonary stenosis, and an aorta overriding the VSD.
Tetralogy of Fallot
What clinical sign differentiates between arterial and venous disease?
Pulses. Absence of pulses correlates with arterial disease.
Sudden onset severe hypertension refractory to treatment, with an abdominal bruit.
Secondary hypertension due to renal artery stenosis.
Pleural fluid with high protein content, associated with inflammation or malignancy
Exudative
Most serious complication of pertussis
Bronchopneumonia from superinfection
Name the only beta blocker approved for use in CHF
Carvedilol
Which type of heart failure is caused by hyperthyroidism and anemia, high output or low output?
High output
A patient comes into the ED with SOB, hives, and hypotension. First medication to give?
Epinephrine. Hives and hypotension should signal the practitioner to begin therapy for anaphylactic reaction.
This congenital heart defect is more common in females than males, in preterm infants weighing less than 1500g. Produces a left-to-right shunt. PE shows a prominent apical pulse and a loud, harsh continuous murmur at the 2nd left interspace.
Patent ductus arteriosus
Mechanism of action of penicillins and cephalosporins
Inhibit bacterial cell wall synthesis
CXR shows cephalization of pulmonary vascular markings. Likely cause?
CHF
Most common pathogen of bronchiolitis
Respiratory syncytial virus (RSV)
CXR finding in hypoxic respiratory failure
"white" lungs
Most common serious consequence of untreated giant cell arteritis?
Blindness
Common adverse effects of systemic corticosteroids
Weight gain, increased appetite, blurry vision, hyperglycemia, and slow healing of cuts and bruises.
Therapeutic mainstay for interstitial lung disease
Corticosteroid therapy
What is the appropriate management for a patient with asymptomatic 2nd degree heart block, type II, with a heart rate of 40?
Permanent pacemaker
Patent ductus arteriosus: cyanotic or acyanotic?
Acyanotic.
Tetrallogy of Fallot: cyanotic or acyanotic?
Cyanotic
Treatment for hypertrophic cardiomyopathy.
Beta blockers
Angina, syncope, systolic murmur heard best at 2nd right interspace that radiates to the carotids. Also narrow pulse pressure and delayed carotid upstroke.
Aortic stenosis
What are the dermatologic findings of secondary syphilis?
Patchy hair loss, diffuse erythematous maculopapular rash, and condylomata lata
What is the dermatologic finding of primary syphilis?
A papule at the site of inoculation that evolves into a painless ulceration with raised borders
What are the dermatologic findings of tertiary syphilis?
Plaques, nodules, and gumma
What type of shock: Decreased cardiac output (CO), decreased pulmonary capillary wedge pressure (PCWP), increased peripheral vascular resistance (PVR)
Hypovolemic shock
Type of shock: Decreased CO, increased PCWP, increased PVR
Cardiogenic shock
Type of shock: Increased CO, decreased PCWP, decreased PVR
Septic or anaphylactic shock
Signs of neurogenic shock
Hypotension and bradycardia after trauma to the spinal column
Signs of increased intracranial pressure (Cushing's triad)
Hypertension, bradycardia, abnormal respirations
Treatment of septic shock
Fluid and antibiotics
Treatment of cardiogenic shock
Identify cause. Give pressors (dopamine)
Treatment of hypovolemic shock
Identify cause. Fluids and blood repletion
Treatment of anaphylactic shock
Diphenhydramine (Benadryl) or epinephrine 1:1000
Supportive treatment for ARDS
Continuous positive airway pressure
Signs of air embolism
A patient with chest trauma who was previously stable and suddenly dies.
Trauma radiographic series should include...
AP chest, AP/lateral C-spine, AP pelvis
Normalizing PCO2 in a patient having an asthma exacerbation may indicate?
Fatigue or impending respiratory failure
Treatment for SVC syndrome
Radiation
What is the acid-base disorder in pulmonary embolism?
respiratory alkalosis (hypoxia and hypercarbia)
What NSCLC is associated with hypercalcemia?
Squamous cell carcinoma
What type of lung cancer is associated with SIADH?
SCLC
What type of lung cancer is highly associated with cigarette exposure?
SCLC
What is the treatment for tension pneumothorax?
Immediate needle thoracostomy
Hypoxemia and pulmonary edema with normal pulmonary capillary wedge pressure. Diagnosis?
ARDS
Silicosis increases the risk of what pulmonary infection?
TB
What are the classic CXR findings for pulmonary edema
Cardiomegaly, prominent pulmonary vessels, Kerley B lines, "bat's wing" appearance of hilar shadows, and perivascular and peribronchial cuffing