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431 Cards in this Set
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Diagnostic driteria for random plasma glucose in Diabetes
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greater than or equal to 200 with accompanying symptoms
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Diagnostic criteria for serum fasting glucose in diabetes
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blood sugar >126 on two separate occasions
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Diagnostic criteria for oral glucose tolerance test
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>200 2 hours post prandial
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Impaired glucose tolerance criteria
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blood sugar between 100 and 125
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General rule of thumb for insulin dosing
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0.5u/kg/day with 2/3 in the morning and 1/3 in the evening
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Definition of Somogyi Effect
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patient is hypoglycemic at 0300 but rebounds with an elevated glucose levels at 0700
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Treatment for Somogyi effect
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Reduce or omit the h.s. dose of insulin
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Definition of Dawn phenomenon
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Pt gets desensitized to insulin nocturnally
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Treatment for Dawn Phenomenon
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Add or increase the h.s. dose of insulin
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Procedure for administration of fluids for a patient with DKA
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Isotonic fluids during the first hour, thend 500c/.hr the 1/2 NS if glucose >500, then D51/2NS if glucose falls <250
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Diagnostic test used to establish etiology of hyperthyroidism.
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Thyroid radiocative iodine uptake and scan
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A high iodine uptake is indicative of what thyroid disorder?
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Grave's disease
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A low iodine uptake is indicative of what thyroid disorder?
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subacute thyroiditis
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Which medication should be avoided during a thyroid crisis?
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ASA
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What is Cushing's triad?
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Hyperglycemia, hypernatremia, hypokalemia
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Which test is used to differentiate the cause of Cushing's
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Dexmethasone suppression test
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Skin changes in Addison's disease
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Hyperpigmentiation in buccal mucosa and skin creases, diffuse tanning and freckles, scant axillary and pubic hair
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Addison's disease triad
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Hypoglycemia, hyponatremia, hyperkalemia
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Labs changes in SIADH
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Hyponatremia, decreased serum osmolality <280, increased urine osmolality >100, Urine sodium >20, normal renal, cardiac and thyroid function
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Lab changes in diabetes insipidus
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Hypernatremia, elevated renal, serum osmolality >290, urine osmolality <100, Low urine s.g. <1.005
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A positive desmopressin challenge test indicates:
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Central diabetes insipidus
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A negative desmopressin challenge test indicates:
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Nephrogenic diabetes insipidus
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Lab changes in pheochromocytoma
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plasma-free metanephrines, urine catecholamines, VMA
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Treatment of choice for pheochromocytoma
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Surgical removal of tumor
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What to look out for postoperatively for tumor removal status post treatment of pheochromocytoma
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Hypotension, adrenal insufficiency, hemorrhage
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Cutaneous pain
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localized on skin or surface of the body
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Description of visceral pain
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poorly localized pain as with internal organs
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Description of somatic pain
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non localized originates in muscle bone, nerves and supporting tissue
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Description of neuropathic pain
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frequently caused by a tumor, involves nerve pathway injury or compression
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Most common cause of non infectious post operative fever
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atelectasis
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The single most common type of headache
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tension headaches
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Type of headache that is unilateral throbbing and occurs episodically
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migraine
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Most prevalent headache in middle age men
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Cluster headaches
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Type of headache that is characterized by severe, unilateral, periorbital pain occurring daily for several weeks
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Cluster headache
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Albumin levels that indicate protein malnutrition
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<3.5
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Albumin level where edema is expected
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<2.7
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The most common electrolyte abnormality
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hyponatremia
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Treatment for symptomatic hyponatremia
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NS IV with a loop diuretic
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Urine osmolality < 250 in hypernatremia indicates:
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central and nephrogenic DI
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Urine osmolality >400 in hypernatremia indicates:
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Water conserving ability
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Treatment of severe hypernatremia with hypovolemia
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NS IV followed by 1/2 NS
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Treatment of hypernatremia with euvolemia
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D5W (free water)
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Treatment of hypernatremia with hypervolemia
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Free water and loop diuretics
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Normal serum calcium range
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8.5-10.5
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Normal ionized calcium level
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4.6-5.3
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Calcium level considered a medical emergency
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>12
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Adult rule of nines
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arm: 1%, leg:18%, head:9%, thorax: (front)18%, (back) 18%, Perineum/genitals:1%
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Overall fluid requirements for burns
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4ml/kg X TBSA
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General rule for fluid requirements of burn patients over 24 hour period
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1/2 within first 8 hours, 1/2 over the next 16 hours
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Treatment for tar burn injury
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petroleum based product to remove the burning tar
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Key symptoms of organophosphate poisoning
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Blurred vision and miosis, bradycardia
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Drug of choice for organophosphosphate toxicity
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Atropine
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Medication used to treat serotonin syndrome in antidepressant toxicity
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Dantrium
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Narcotic toxicity effect on pupils
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miosis
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Cocaine effect on pupils
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mydriasis
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Standard therapy for transplant
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Calcineurin inhibitor (Prograft or Cyclosporine) and antimetabolite (Imuran or Cellcept) and a steriod
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Treatment for acyclovir resistant herpes zoster
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Foscarnet
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Treatment for post herpetic neuralgia
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gabapentin, pregabalin
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First step for a patient with suspected ocular involvement with herpes zoster
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immediate referral to ophthalmologist
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Valves that close with S1
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mitral and tricuspid
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Valves that close with S2
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aortic and pulmonic
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Disease states associated with S3 sound
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Increased fluid states
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Disease states associated S4 sound
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Previous MI, chronic hypertension, LVH
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Description and location of mitral stenosis
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loud S1 murmur, low pitched, mid diastolic, apical "crescendo" rumble
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Description and location of mitral regurgitation
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S3 with systolic murmur @ 5th ICS MCL, may radiate to base or left axilla, musical, blowing, or high pitched
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Description and location of aortic stenosis
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Systolic, blowing, rough harsh murmur @ 2nd right ICS usually radiating to the neck
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Description and location of aortic regurgitation
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diastolic, blowing murmur @ 2nd left ICS
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Preferred treatment for SBP <100 in acute pulmonary edema
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dopamine
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Criteria for hypertensive urgency
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systolic >220, DBP >125 or symptomatic SBP >200 and DBP >120 with accompanying headache, heart failure, angina, etc
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General classification of hypertensive emergency
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DBP > 130
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Initial goal of treatment of hypertensive emergency
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To reduce MAP by no more than 25% within 2 hours
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Fundoscopic changes with malignant hypertension
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flameshaped retinal hemorrhages, soft exudates and papilledema
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Drug of choice for hypertensive emergencies
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Nipride
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Hypertensive medication indicated in pregnancy for hypertensive emergency
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hydralazine
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Key skin changes in PVD (arteriosclerosis)
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Shiny hairless skin, pallor, dependent rubor
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Most definitive test for PVD
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arteriography
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Medications used to treat PVD
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Trental or Pletal
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Key skin changes in chronic venous insufficiency
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trophic changes with brownish discoloration
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Most commom cause of pericarditis
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Viruses
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Lab/diagnostics of pericarditis
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ST segment elevation in all leads, depression of PR segment, ESR elevation
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Mainstay of treatment for pericarditis
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NSAIDS
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Physical findings in pericarditis
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Medium to high grade fever, Osler's nodes, Petechia, purpura, pallor, Splinter hemorrhages, Janeway lesions, Roth spots
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Osler's nodes
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Painful red nodules in the distal phalanges
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Splinter hemorrhages
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linear, subungal splinter appearing
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Janeway lesions
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macules on the palms and soles
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Roth spots
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small retinal infarcts, white in color encircled by areas of hemorraghe
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Common empiric treatment for endocarditis
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Penicillin G with Gentimicin, Nafcillin
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Antibiotic used for penicillin resistant streptococci and MRSA
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Vancomycin
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Common age for duodenal ulcers
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30-55
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Common age for gastric ulcers
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55-65
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Characteristic pain of PUD
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gnawing epigastric pain characterized by rhythmicity and periodicity
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Type of ulcer in which pain is relieved with eating
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duodenal
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Type of ulcer in which pain increases with eating
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gastric
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Time period when gastric ulcers should be evaluated by endoscopy
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8-12 weeks
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Medication that is used for prophylaxis against NSAID induced ulcers
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Cytotec
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Combination options for H. pylori eradication
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2 antibiotics and either a PPI or bismuth
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Recommended time for antiulcer therapy
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3 to 7 weeks
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Transmission of Hep A
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fecal-oral route
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Most common cause of Hepatitis C
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IV drug use
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Pre icteric signs of Hepatitis C
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Fatigue, malaise, anorexia, n/v, headache
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Icteric signs of Hepatitis C
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weight loss, jaundice, pruritis, RUQ pain, clay colored stool, dark urine
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Serology for Active hepatitis A
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Anti-HAV, IgM
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Serology for recovered hepatitis A
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Anti-HAV, IgG
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Serology for Active Hep B
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HBsAg, HBeAg, Anti-HBc, IgM
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Serology for Chronic Hep B
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HBsAg, AntiHBc, Anti-HBe, IgM, IgG
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Serology for recovered Hep B
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Anti-HBc, Anti-HBsAg
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Serology for Acute and Chronic Hep C
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Anit-HCV, HCV RNA
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Diagnostic test used to differentiate acute from chronic Hep C
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PCR
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General management for Hep C
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Rest, increased fluids, no protein diet, Lactulose
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Preferred medication for sedation in Hepatitis C patients
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Oxazepam (Serax)
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Key symptom in diverticulitis
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LLQ pain
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Key symptoms of Cholecystitis
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pain preciptiated by fatty meal, sudden epigastric and RUQ pain, pain relief with vomiting
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Physical findings in choleycystitis
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Murphy's sign, RUQ tenderness with palpation, Muscle guarding, rebound tenderness, Fever
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Common medications that may contribute to acute pancreatitis
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Sulfonamides, thiazides, lasix, estrogen, Imuran
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Description of Murphy's sign
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deep pain on inspiration while fingers are placed under the right rib cage
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Key symptoms of Acute pancreatitis
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Abrupt onset of steady, severe epigastric pain worsened by walking and lying supine, pain improved by sitting and leaning forward, N&V
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Physical findings of acute pancreatitis
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Upper abdomen tender to palpation w/o guarding, rigidity or rebound, abdominal distention, mild jaundice
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Signs of hemorrhagic pancreatitis
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Grey Turner's sign, Cullen's sign
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Description of Grey Turner's sign
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flank discoloration in acute pancreatitis
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Description of Cullen's sign
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umbilical discoloration in acute pancreatitis
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Key lab values in acute pancreatits
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hyperglycemia, LDH and AST elevation, serum amylase and lipase elevation
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An elevated CRP in acute pancreatitis suggests
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pancreatic necrosis
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Description of Ranson's criteria
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evaluates prognosis of acute pancreatitis. 5-6 risk factors = 40% mortality, >7 risk factors=100% mortality
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Ranson's prognostic signs at admission for acute pancreatitis
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>55 years old, WBC's >16,000, glucose >200, LDH >350, AST >250
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Ranson's prognostic signs during the first 48 hours
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Hct drop of >10, BUN increases >5, Calcium <8, Arterial O2<60, Base deficit >4, Estimated fluid sequestrian > 6,000 ml
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Key management interventions for pancreatitis
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bed rest, NPO, aggressive IV volume repletion, NGT suction, pain control
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Key symptoms of bowel obstruction
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cramping periumbilical pain later becoming constant and diffuse, vomiting, abdominal distention, high pitched, tinkling bowel sounds, unable to pass flatus.
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Vomiting within minutes of pain with bowel obstruction indicates:
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proximal bowel obstruction
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Vomiting within 2 hours of pain with bowel obstruction indicates
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distal bowel obstruction
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Minimal abdominal distention wit bowel obstruction indicates:
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proximal bowel obstruction
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Pronounced abdominal distention in bowel obstruction indicates
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distal bowel obstruction
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Plain films of bowel obstruction show
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dilated loops of bowel and air-fluid levels
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Plain film of bowel obstruction with horizontal pattern indicates
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SBO
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Plain film of bowel obstruction with frame pattern
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LBO
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Key definition of ulcerative colitis
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diffuse mucosal inflammation of the colon
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Hallmark symptom of ulcerative colitis
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bloody diarrhea
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Managment of Ulcerative colitis
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Mesalamine suppositories or enemas and hydrocortisone suppositories
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Key symptoms of appendicitis
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RLQ guarding, psoas sign, obturator sign, positive Rovsing's sign
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Description of Psoa's sign
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pain with right thigh extension
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Description of Obturator sign
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pain with internal rotation of flexed right thigh
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Description for positive Rovsing's sign
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RLQ pain when pressure is applied to the LLQ
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Labs/Diagnostics with appendicitis
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WBC's 10,000 to 20,000, CT or ultrasound
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Most common causative organism of UTI in women
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E. coli
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Most common causative organism of UTI in men
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proteus
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Commonly used agents for management of UTI's
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Bactrim, Cipro, and Augmentin
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Commonly used agents for UTI's in pregnant patients
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Amoxicillin, Macrobid, Keflex for 7-10 days
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Key symptoms of Upper UTI's
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flank, low back pain, and abdominal pain, Fever and chills, N/V, mental status changes in elderly
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Laboratory/diagnostics of lower UTI
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Pyuria, >10 wbc/ml
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Laboratory/diagnostics of upper UTI
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White blood cell casts, elevated ESR
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Commonly used agents for patients with Upper UTI's
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Bactrim, Cipro, Augmentin, aminoglycosides
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Stages of Renal Failure: Diminished Renal Reserve
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50% nephron loss- creatinine doubles
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Stages of Renal Failure: Renal insufficiency
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75% nephron loss, mild azotemia present
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Stages of Renal failure: ESRD
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90% nephron damage, azotemia, metabolic alterations
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Prerenal causes of kidney failure
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Conditions that impair renal perfusion such as shock, etc
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Intrarenal causes of of renal failure
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Disorders that affect the renal cortex or medulla such as hypersensitivity, nephrotoxic agents, and mismatched blood transfusions
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Most common cause of intrarenal failure
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nephrotoxic agents
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Postrenal cause of renal failure
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urine flow obstruction
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Prerenal disease laboratory values
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BUN:creatinine ratio >10:1, Urine sodium <20, specific gravity >1.015, Urinary Sediment few hyaline casts, Fractional excretion of sodium <1
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Intrarenal disease laboratory values
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Serum BUN: creatinine ratio 10:1, Urine sodium >40, s.g. <1.015, urinary sediments granular/white casts, fractional excretion of sodium >3
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Postrenal disease lab values
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Serum BUN: creatinine ratio 10:1, urine sodium >40, s.g. <1.015, Urinary sediment normal, Fractional excretion of sodium >3
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Most common cause of renal artery stenosis in middle aged and elderly
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atheromatous plaque at the origin of the renal artery
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When renal artery stenosis should be suspected in a patient over 50 years or under 30
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When hypertension suddenly develops in a previously normotensive state
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Key symptom of renal artery stenosis
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high pitched epigastric bruit
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Most definitive test for renal artery stenosis
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Bilateral arteriography
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Purpose of a Captopril test
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identifies hypertension d/t renal artery stenosis vs. essential HTN
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Most frequent type of renal calculi
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Calcium stones
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Type of stones in renal calculi
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Calcium, uric acid stones, struvite stones, cystine stones
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Type of kidney stone that occurs mainly in women
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Struvite stones
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Indication of radiation of pain downward to the groin with a kidney stone patient
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stone has passed to the lower third of the ureter
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Symptoms associated with a stone in the portion of the ureter of the bladder wall
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frequency, urgency, and dysuria
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Main diagnostic test for kidney stones
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Abdominal x-ray
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Normal PSA values
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<4
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Diagnostic test for palpable prostate nodule or elevated PSA
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Transrectal ultrasound
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Medications to avoid with BPH
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Decongestants, sympathomimetics, anticholinergics/antihistamines, antidepressants, and antipsychotics
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Leading cause of infertility among females in the US.
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Gonorrhea
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Common symptom of gonorrhea in females
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mucopurulent discharge
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Common symptom of gonorrhea in males
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White/yellow-green penile discharge
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Labs/diagnostics of gonorrhea
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gram stain, cervical culture
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Management for gonorrhea
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Rocephin IM 125-250mg
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Organism responsible for syphilis
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treponema pallidum
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Clinical stages of syphilis
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Primary, secondary, latent, and tertiary
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Presentation of primary syphilis
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chancre usually on genitals 3-4 weeks post exposure, regional lymphadenopathy
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Presentation of secondary syphilis
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flu like symptoms 6-8 weeks post exposure, generalized macropapular rash, especially palms and soles
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Presentation of latent syphilis
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asymptomatic
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Presentation of tertiary syphilis
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cardiovascular involvement, CNS disorders, meningitis, or neurosyphilis
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Description of chancre
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indurated and painless lesion with syphilis
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Definitive test for syphilis
|
Positive dark field microscopic exam and direct fluorescent antibody test of lesion exudate
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Purpose of RPR and VDRL tests
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diagnosis of syphilis
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Primary treatment of syphilis
|
Penicillin G
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Most common STD in the US
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Chlamydia
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Most definitive test for chlamydia
|
chlamydia culture
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Common medications for chlamydia
|
Azithromycin and Doxycycline
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Herpes Simplex Virus Type I primarily affects:
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Lips, face, and mucosa
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Herpes Simplex Virus Type II primarily affects:
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genitalia
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Intitial symptoms of HSV
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fever, malaise, dysuria, painful/pruritic ulcers for 12 days
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Recurrent symptoms of HSV
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pruritic ulcers for 5 days
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Symptoms of Trichomonas vulvovaginitis
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malodorous, frothy yellowish-green discharge, pruritis, vaginal erythema, "strawberry patches" on cervix and vagina, dyspareunia, dysuria
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Symptoms of Bacterial vaginosis
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"fishy" smelling discharge, vaginal spotting
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Symptoms of Candidiasis
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thick, white, curd-like discharge, vulvovaginal erythema with pruritis
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Diagnostic test for Trichomonas
|
NS mixture with motile trichomonads
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Diagnostic test for Bacterial vaginosis
|
NS mixture with clue cells
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Diagnostic test for Candiasis
|
KOH mixture with pseudo hyphae
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Common treatment for Trichomonas
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Flagyl
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Common treatment for Bacterial vaginosis
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Flagyl, Clindamycin
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Common treatment for Candidiasis
|
Miconazole, terconazole, butaconazole
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Normal Hgb in males/females
|
14-18 males
12-16 females |
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Normal Hct in males/females
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40-54% males
37-47% females |
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Normal TIBC
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250-450
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Normal serum iron
|
50-150
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Normal MCV
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80-100 (normocytic)
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Normal MCH
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26-34
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Normal MCHC
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32-36% (normochromic)
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Differential diagnosis of low MCV.
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Iron deficiency anemia and thalassemia.
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Differential diagnosis of high MCV
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B12 deficiency, folate deficiency, alcoholism, liver failure and drug effects
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Differential diagnosis for normocytic anemia
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Anemia of chronic disease, sickle cell disease, renal failure, blood loss and hemolysis
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Most common cause of anemia
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Iron deficiency anemia
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Key labs/diagnostics of Iron Deficiency Anemia
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Decreased H&H, microcytic, hypochromic, decreased RBC, low serum iron, low serum ferritin, high TIBC, high RDW
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Thalassemia is which type of anemia?
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microcytic, hypochromic
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Populations in which thalassemia is commonly found?
|
Mediterranean populations, African, Middle Eastern, Indian, and Asian descent
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Labs/diagnostics of thalassemia
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decreased Hgb, Low MCV, Low MCHC, normal TIBC, Normal ferritin, Decreased alpha or beta Hgb chains.
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Medication contraindicated in thalassemia.
|
Iron
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Folic acid deficiency is which type of anemia?
|
Macrocytic, normochromic anemia
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Common causes for Folic acid deficiency anemia.
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inadequate intake or malabsorption of folic acid
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Symptoms that differentiate B12 from Folic Acid Deficiency
|
neurological deficiency
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Key symptoms of Folic acid deficiency anemia
|
DOE, tachycardia, glossitis
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Consequence of administering folate to a patient with B12 deficiency
|
Exacerbation of neuro symptoms
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Common foods high in folic acid
|
bananas, peanut butter, fish, green leafy vegetables
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Key symptoms of B12 deficiency
|
Glossitis, Weakness, Paresthesia
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Labs/diagnostics for Pernicious anemia
|
H&H and RBC's decreased, MCV increased, Serum B12 decreased.
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Management for B12 deficiency
|
cyanocobalamin 100 mcg IM daily x 1 week then monthly
|
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Anemia of Chronic Disease is which type of anemia?
|
normocytic, normochronic
|
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Labs/Diagnostics with Anemia of Chronic Disease
|
H&H low, MCV and MCHC normal, serum iron and TIBC low, Serum ferritin is high
|
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|
Symptoms of sickle cell anemia crisis
|
Sudden onset of severe pain in extremities, back, chest, and abdomen, aching joint pain, weakness, dyspnea, leg ulcers
|
|
|
Precipitating factors of Sick cell crisis
|
hypoxia, infections, dehydration, stress, blood loss
|
|
|
Diagnostic test for sickle cell anemia
|
peripheral smear
|
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|
Most common leukemia in adults
|
CLL
|
|
|
Most common leukemia in children
|
ALL
|
|
|
Hallmark symptom of CLL
|
lymphocytosis
|
|
|
Hallmark symptom of ALL
|
Pancytopenia with circulating blasts
|
|
|
Hallmark of CML
|
Philadelphia chromosone in leukemic cells
|
|
|
CML occurs more often in which age group?
|
40 and older
|
|
|
Confirmatory diagnostic test of leukemia
|
bone marrow aspiration
|
|
|
Stage I classification of Lymphoma description
|
localized to single lymph node or group.
|
|
|
Stage II classification of lymphoma description
|
more than one lymph node group involved but confined to one side of the diaphragm.
|
|
|
Stage III classification of lymphoma description
|
disease in th elymph nodes or the spleen and occurring on both sides of the diaphragm
|
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|
Stage IV classification of lymphoma description
|
Liver or bone marrow involvement
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|
Non-Hodgkins lymphoma is most common in which age group?
|
20 to 40 years
|
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|
Reed-Sternberg cells are common in which disease
|
Hodgkin's lymphoma
|
|
|
Management of ITP
|
high dose steroids, IV gamma globulin, platelets
|
|
|
Labs/diagnostics of DIC
|
thrombocytopenia, hypofibrinogenemia, decrease RBC's, increased fibrin degredation products, prolonged PT and PTT, Elevated D-dimer
|
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|
Intervention to replace clotting factors in DIC
|
Platelets and FFP
|
|
|
Intervention to maintain fibrinogen levels in DIC
|
cryoprecipitate
|
|
|
Goals of therapy in DIC
|
Cessation of bleeding, increasing plasma fibrinogen and decreasing fibrin degredation products.
|
|
|
Medicare Part A covers;
|
inpatient hospital and post hospital skilled nursing care, home health and hospice
|
|
|
Medicare part B covers:
|
physician visits, outpatient care, home care, lab, x-ray and DME
|
|
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Identify CN I
|
Olfactory nerve, sensory
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|
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Identify CN II
|
Optic nerve, sensory
|
|
|
Identify CN III
|
Oculomotor nerve, motor
|
|
|
Identify CN IV
|
Trochlear nerve, motor
|
|
|
Identify CN V
|
Trigeminal nerve, sensory and motor
|
|
|
Identify CN VII
|
Facial nerve, sensory and motor
|
|
|
Identify CN VIII
|
Acoustic nerve, sensory
|
|
|
Identify CN IX
|
Glossopharyngeal nerve, sensory and motor
|
|
|
Identify CN X
|
Vagus nerve, sensory and motor
|
|
|
Identify CN XI
|
Spinal accessory nerve, motor
|
|
|
Identify CN VI
|
Abducens nerve, motor
|
|
|
Identify CN XII
|
Hypoglossal nerve, motor
|
|
|
Signs and symptoms of vertebrobasilar TIA
|
vertigo, ataxia, dizziness, visual field deficits, weakness, confusion
|
|
|
Signs and symptoms of Carotid TIA
|
aphasia, dysarthria, altered LOC, weakness, numbness
|
|
|
The #1 cause of heart failure
|
HTN
|
|
|
Common side effects associated with Ticlid
|
agranulocytosis, thrombotic thrombocytopenia purpura and GI intolerance
|
|
|
Indications for a carotid endarterectomy
|
When there is > 70-80% stenosis of vessels for symptomatic patients
|
|
|
Type of CVA that presents with acute onset of focal neurologic deficits
|
Hemorrhagic
|
|
|
Key symptoms of CVA with left hemisphere involvement
|
right hemiparesis, aphasia, dysarthria, difficulty reading/writing
|
|
|
Key symptoms of CVA with right hemisphere involvement
|
left hemiparesis, right visual field changes, spatial disorientation
|
|
|
Overall goal with CVA
|
maintain cerebral perfusion pressure and limit increases in ICP <20
|
|
|
Key symptom of simple partial seizure
|
No loss of consciousness with paresthesia, flashing lights, vocalizations and hallucinations
|
|
|
Key symptom of complex partial seizure
|
simple partial seizure followed by impaired level of consciousness with aura, staring, or automatisms
|
|
|
Description of absence seizure
|
sudden arrest of motor activity with blank stare
|
|
|
Key components of seizure assessment
|
prescence of aura, onset, spread, type of movement, body parts involved, pupil changes and reactivity, duration, LOC, incontinence, behavioral and neurological changes after seizure
|
|
|
Most important test in determining seizure classification
|
EEG
|
|
|
Key laboratory change in seizures
|
Serum prolactin levels rise 2 to 3 times normal
|
|
|
Diagnostic tests for new onset seizures
|
CT or MRI of the head
|
|
|
Key signs and symptoms of Myasthenia Gravis
|
Ptosis, diplopia, extremity weakness which is typically worse after exercise and better after rest
|
|
|
Purpose of a Tensilon test
|
differentiate myasthenic or cholinergic crisis in a patient diagnosed with myasthenia gravis
|
|
|
Drugs used for symptomatic improvement of Myasthenia Gravis
|
Anticholinesterase drugs
|
|
|
Treatment used for generalized or disabling ocular myasthenia
|
Thymectomy
|
|
|
Treatment used to treat acute exacerbations of myasthenia gravis
|
plasmapheresis
|
|
|
Key signs and symptoms of Guillain-Barre Syndrome
|
rapidly progressive ascending paralysis, hypoactive or absent reflexes
|
|
|
Most common organisms that cause meningitis
|
S. pneumoniae, H. influenze, N. meningitidis
|
|
|
CSF characteristics in meningitis
|
cloudy or yellow, elevated pressure, elevated protein, decreased glucose, presence of WBC's
|
|
|
Common antibiotics used for broad spectrum management of meningitis
|
PCN G with a third generation cephalosporin, or fluoroquinolones
|
|
|
Significance of a lucid interval with a head trauma
|
Expanding hematoma
|
|
|
Description of Cushing's Triad in head trauma
|
Widening pulse pressure, decreased respiratory rate, decreased heart rate
|
|
|
Effect of spinal cord trauma on the cervical veterbrae
|
diaphragm and arms
|
|
|
Effect of spinal cord trauma on thoracic vertebrae
|
chest and abdomen
|
|
|
Effect of spinal cord trauma on lumbar vertebrae
|
bowel and bladder
|
|
|
Management of spinal cord injury
|
Solumedrol bolus followed by an infusion for 23 hours within 8 hours of injury, surgical decompression
|
|
|
Spinal cord injury level that lead to autonomic dysreflexia
|
T4-T6
|
|
|
Key symptoms of autonomic dysreflexia
|
Diaphoresis and flushing above the level of injury, chills and severe vasoconstriction below the level of injury
|
|
|
Spinal cord injury level that can lead to neurogenic shock
|
T6 or above
|
|
|
Usual onset of Parkinson's
|
45 and 65 years of age
|
|
|
Significance of Myerson's sign
|
tests for Parkinson's in which repetitive tapping over the bridge of the nose produces a sustained blink response
|
|
|
Percussion sounds expected with asthma
|
Hyperressonance
|
|
|
Ominous signs of asthma
|
Fatigue, absent breath sounds, inability to maintain recumbency, cyanosis
|
|
|
PFT's of asthma patients show which type of respiratory dysfunction?
|
obstructive
|
|
|
When hospitalization is recommended for asthma patients in regards to PFT's
|
Initial FEV1 <30% or does not increase to at least 40% predicted ater 1 hour vigorous therapy, if peak flow is <60 initially or does not improve to >50% predicted after 1 hour of treatment
|
|
|
Initial ABG values in asthma
|
respiratory alkalosis with mild hypoxemia
|
|
|
Ominous finding on ABG's in astham patient
|
hypercapnia
|
|
|
ABG value that indicates an emergency situation in an asthma patient
|
pCO2>45
|
|
|
First line outpatient treatment for asthma
|
short acting B2 agonist (Albuterol)
|
|
|
Outpatient treatment for daily maintenance of asthma
|
inhaled corticosteroids
|
|
|
Intervention for persistent symptoms in outpatient asthma patients
|
increase corticosteroids or add long acting B2 adrenergic agonist
|
|
|
Category of medications uses for increased secretions in asthma
|
anticholinergics (atrovent)
|
|
|
Medications useful in the maintenance of chronic asthma
|
antileukotrienes
|
|
|
Description of chronic bronchitis
|
excessive secretion of bronchial mucus manifested by productive cough for 3 months or more in at least 2 consecutive years in the absence of any other disease
|
|
|
Description of emphysema
|
abnormal, permanent enlargement of air spaces distal to the terminal bronchiole
|
|
|
Type of dyspnea present with chronic bronchitis
|
intermittent mild to moderate dyspnea
|
|
|
Type of dyspnea present with emphysema
|
progressive constant dyspnea
|
|
|
Age which is common for onset of symptoms of chronic bronchitis
|
>35 years of age
|
|
|
Age which is common for onset of symptoms of emphysema
|
>50
|
|
|
Sputum characteristics of chronic bronchitis
|
Copious and purulent
|
|
|
Sputum characteristics of emphysema
|
mild and clear
|
|
|
Body habitus of chronic bronchitis
|
stocky and obese
|
|
|
Body habitus of emphysema
|
thin and wasted
|
|
|
Chest A-P diameter of Chronic bronchitis
|
normal
|
|
|
Chest A-P diameter of emphysema
|
increased
|
|
|
Percussion finding with chronic bronchitis
|
normal
|
|
|
Percussion finding with emphysema
|
hyperresonant
|
|
|
CXR findings on patients with chronic bronchitis
|
bulla, blebs and hyperinflation
|
|
|
Effects of chronic bronchitis on hematocrit
|
increased
|
|
|
Effects of emphysema on hematocrit
|
none
|
|
|
ABG findings with chronic bronchitis
|
hypercapnea, hypoxemia on ABG
|
|
|
Mainstay of therapy for patients with COPD
|
Inhaled Ipratropium bromide or sympathomimetics
|
|
|
Key labs/diagnostics for TB
|
M. tuberculosis culture x 3, AFB smears, small homogeneous infiltrate in the upper lobes
|
|
|
Recommended length of treatment for HIV patients with TB
|
nine months
|
|
|
Monitoring therapy for patients with pulmonary TB
|
weekly sputum smears and cultures for first six weeks after initiation of therapy, then monthly until negative
|
|
|
Special tests required for patients taking ethambutol
|
Visual acuity and red-green color perception
|
|
|
Most common bacteria in pneumonia
|
S. pneumoniae
|
|
|
Management of CAP in healthy patients <60 without previous antibiotic therapy
|
Macrolides,erythromycin or doxcycline, Fluoroquinolones
|
|
|
Management of CAP in healthy patients <60 with previous antibiotic therapy in last 3 months
|
Macrolide plus high dose amoxicillin or combo
|
|
|
Management of CAP in patients > 60 or with health problems with no previous therapy
|
Macrolides or fluoroquinolone
|
|
|
Management of CAP in patients >60 with health problems with previous therapy in 3 months
|
Flouroquinolone, macrolide plus high dose Augmentin, or Cefzil, or Ceftin
|
|
|
Optimal empiric montherapy for nosocomial pneumonia
|
Cefepime, meropenem or piperacillin
|
|
|
Optimal combination regimens for nosocomial pneumonia (p. aeruginosa)
|
Cefepime or Meropenem plus Aztreonam, amikacin or piperacillin
|
|
|
Hallmark feature of ARDS
|
refractory hypoxemia
|
|
|
Type of respiratory diseases characterized by reduced airflow rates
|
Obstructive diseases
|
|
|
Type of respiratory diseases characterized by reduced volumes
|
Restrictive diseases
|
|
|
Features of exudative effusions
|
pleural fluid protein to serum protein ratio >0.5, pleural fluid LDH to serum LDH ratio > 0.6, pleural fluid LDH greater than two-thirds the upper limit of normal serum LDH
|
|
|
Components required for the diagnosis of AIDS
|
CD4<200 and/or the presence of an opportunistic infection
|
|
|
Screening test for HIV
|
ELISA
|
|
|
Confirmatory test for AIDS
|
Western Blot test
|
|
|
Normal CD4 count
|
>800
|
|
|
Inflammation pattern in osteoarthritis
|
Asymmetrical
|
|
|
Inflammation pattern in RA
|
Symmetrical
|
|
|
Joints affect by osteoarthritis
|
weight bearing
|
|
|
Joint complaints in osteoarthritis
|
Swelling and edema but no redness or heat complaints
|
|
|
Joint complaints in RA
|
Swelling and edema with redness and heat complaints to joints
|
|
|
Description of Heberden's nodes
|
Distal interphalangeal joints affected by osteoarthritis
|
|
|
Description of Bouchard's nodes
|
Proximal interphalangeal joints affected by osteoarthritis
|
|
|
Stiffness and pain pattern with osteoarthritis
|
better in the morning, wore as the day progresses, aggravated by activity, relieved by rest
|
|
|
Stiffness and pain pattern with RA
|
Worse in the morning better as the day progresses
|
|
|
Synovial aspirate changes in patients with osteoarthritis
|
normal clear/yellow
|
|
|
Synovial aspirate changes in patients with RA
|
inflammatory changes and WBC's
|
|
|
X ray findings of osteoarthritis
|
Narrowing of joint space, osteophytes, juxta-articular sclerosis, subchondral bone
|
|
|
X ray finding of RA
|
Joint swelling, progressive cortical thinning, osteopenia, joint space narrowing
|
|
|
Key management of osteoarthritis
|
ASA, and NSAIDs
|
|
|
Key management of RA
|
High dose salicylates, NSAIDs and DMARDS
|
|
|
Supportive care for osteoarthritis
|
Weight loss, ice and moist heat, PT
|
|
|
Supportive care for RA
|
referal, rest, PT, Surgery
|
|
|
Definition of subluxation
|
incomplete dislocation
|
|
|
Demographic primarily affected by SLE
|
women of childbearing age
|
|
|
Key labs in SLE
|
ANA positive, antiphospholipid antibodies
|
|
|
Treatment for rashes or joint symptoms not responsive to NSAIDS in SLE
|
Hydroxychloroquine
|
|
|
Treatment of life threatening manifestations of SLE
|
Glucocorticoids
|
|
|
Drugs implicated in Lupus like syndrome
|
Thorazine, apresoline, INH, Aldomet, Pronestyl, quinidin
|
|
|
Key symptoms of Giant cell arteritis
|
Headache, scalp tenderness, visual symptoms, jaw claudication, throat pain, fever, rigor and chills
|
|
|
Key lab/diagnostic data for giant cell arteritis
|
Very high ESR, positive temporal artery biopsy
|
|
|
Complication of giant cell arteritis
|
permanent blindness
|
|
|
Management for giant cell arteritis
|
prednisone
|
|
|
Signs of bacterial conjunctivitis
|
purulent
|
|
|
Signs of gonococcal or chlamydial conjuntivitis
|
copious and purulent
|
|
|
Signs of allergic conjuntivitis
|
stringy and increased tearing
|
|
|
Signs of viral conjunctivitis
|
Watery
|
|
|
Signs and symptoms of chronic open angle glaucoma
|
Slight cupping of optic disc or asymmetry of eyes, visual fields gradually constrict, IOP >21
|
|
|
Signs and symtpoms of acute/angle closure glaucoma
|
Extreme pain and blurred vision, halos around lights, eye is red, cornea steamy, pupil moderately dilated and non reactive
|
|
|
Diagnostics of open angle glaucoma
|
tonometry 30-50mm Hg
|
|
|
Diagnostics of closed angle glaucoma
|
tonometry 40-90mm Hg
|
|
|
Treatment of chronic open angle glaucoma
|
Pilocarpine, betablocker, laser treatment of surgical trabeculectomy
|
|
|
Management of acute angle glaucoma
|
Diamox, osmotic diurectics, laser peripheral iridectomy
|
|
|
What does CVP measure?
|
pressure exerted by fluid in the right atrium
|
|
|
Examples of conditions that increase CVP
|
fluid overload, cardiogenic shock
|
|
|
Examples of conditions that decrease CVP
|
dehydration, distributive shock
|
|
|
Normal values of pulmonary artery pressure
|
15-25/5-15
|
|
|
Definition of mean arterial pressure
|
the average driving force in the arterial system throughout the cardiac cycle
|
|
|
Definition of pulmonary artery pressure
|
measure of the systolic and diastolic pressures in the pulmonary artery
|
|
|
Definition of pulmonary capillary wedge pressure
|
measures the pressure in the left ventricle at end diastole, indicative of left sided heart function, it is a reflection of the tendency to develop pulmonary edema.
|
|
|
Normal PCWP values
|
6-12 mm Hg
|
|
|
Normal CO values
|
4-8L/min
|
|
|
Normal values of cardiac index
|
2.5 - 4 L/min
|
|
|
Definition of systemic vascular resistance
|
resistance provided by the systemic circulation against which the left ventricle must pump blood
|
|
|
Normal values of SVR
|
800-1200 dynes
|
|
|
Definition of Mixed Venous O2 Saturation (SVO2)
|
continous display of mixed venous oxygen saturation by the pulmonary artery catheter, assesses the effectiveness of peripheral oxygen delivery
|
|
|
Normal values of SVO2
|
60-80%
|
|
|
Effect of hypovolemic shock on CO/CI
|
decreases
|
|
|
Effect of hypovolemic shock on CVP
|
decreases
|
|
|
Effect of hypovolemic shock on PCWP
|
decreases
|
|
|
Effect of hypovolemic shock on SVR
|
increases
|
|
|
Effect of hypovolemic shock on SVO2
|
decreases
|
|
|
Effect of Cardiogenic shock on CO/CI
|
decreases
|
|
|
Effect of Cardiogenic shock on CVP
|
increases
|
|
|
Effect of Cardiogenic shock on PCWP
|
increases
|
|
|
Effect of Cardiogenic shock on SVR
|
increases
|
|
|
Effect of Cardiogenic shock on SVO2
|
decreases
|
|
|
Effect of Distributive shock on CO/CI
|
decreases
|
|
|
Effect of Distributive shock on CVP
|
decreases
|
|
|
Effect of Distributive shock on PCWP
|
decreases
|
|
|
Effect of Distributive shock on SVR
|
decreases
|
|
|
Effect of Distributive shock on SVO2
|
decreases
|
|
|
Effect of Obstructive shock on CO/CI
|
decreases
|
|
|
Effect of Obstructive shock on CVP
|
increases
|
|
|
Effect of Obstructive shock on PCWP
|
decreases
|
|
|
Effect of Obstructive shock on SVR
|
increases
|
|
|
Effect of Obstructive shock on SVO2
|
increases
|
|
|
Most common cause of cardiogenic shock
|
Acute MI
|
|
|
Inotrope of choice for cardiogenic shock
|
dobutamine
|
|
|
3 types of distributive shock
|
septic, anaphylactic, and neurogenic
|
|
|
Characteristics of distributive shock
|
vasodilation, low central filling pressures, decreased intravascular volume, reduction in peripheral vascular resistance, loss of capillary integrity with leak, and initially an increased cardiac output
|
|
|
Labs/Diagnostics of Septic shock
|
Positive blood cultures, CI increased, Low PCWP, SVR decreased, leukocytosis, thrombocytopenia, evidence of DIC, increase SVO2
|
|
|
Treatment options for septic shock
|
Dopamine then dobutamine, may add norepinephrine
|
|
|
Most common cause of obstructive shock
|
Massive pulmonary embolus
|
