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85 Cards in this Set

  • Front
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Anion Gap Met Acidosis
Methanol
Uremia
Diabetic Ketoacidosis
Paraldehyde/Phenformin
Iron/Isoniazid
Lactate
Ethylene Glycol
Salicylates
Methanol toxicity
- windshield cleaning solution
- anion gap met acidosis
- visual disturbances
Ethylene Glycol toxicity
- windshield cleaning solution
- anion gap met acidosis
- calcium oxalate --> renal tubular damage --> hematuria, flank pain
Ecythema gangrenosum
- Pseudomonas Aeruginosa
- round lesion, halo erythema, necrotic center (invasion blood vessels)
--> anti-pseudomonal penecillin
Pseudomonas Aeruginosa
"AERuginosa = AERobic"
Pnemonia - CF
Sepsis
External otitis - swimmers ear
UTI
Drug use
Diabetic osteomyelitis
hot tub folliculitis
- gram neg
- "grapelike odor"
Treatment = aminoglycoside + extended spectrum penicillin (piperacillin, ticarcillin)
Viral pericarditis
- retrosternal chest pain --> L arm & shoulder
--> Cardiac tamponade:
- impaired RA filling
- Pulsus paradoxus = decrease systolic BP on inspiration, "radial pulse disappears when inspiring"
- clear lungs, no blood back up
HSV Encephalitis
- EEG/MRI = temporal lobe abnormalities
- bizarre behavior
- CSF: increased WBCs, increased protein, increased RBCs, normal glucose
** RBCs b/c temporal lobe damage **
treatment = IV acyclovir
Restrictive lung disease
- decrease FEV1 & FVC
- FEV1/FVC = normal, slight increase
** normal FEV1/FVC = 80-120% predicted
Lumbar spinal stenosis
e.g osteoarthritis of spine
** Pseudoclaudication: lower extremity pain with walking/standing, worse walking downhill
Paraneoplastic Cushings
- ACTH = polypeptide hormone **
- small cell lung carcinoma
- cannot be surpressed by dexamethasone
** hyperpigmentation
Exudative Pleural effusion
- protein > 4g/dL
** TB = most common
- empyema
- malignancy
- RA
- esophageal rupture
- pancreatitis
- pulmonary infarction
SVC Syndrome
- headaches worse when leaning forward
- JVD, no peripheral edema
- facial, upper extremity swelling
- lung cancer, lymphoma
--> palliative radiation
Aspiration Pneumonia
- impaired consciousness
- trachial/NG tube
** impaired gag reflex -- post stroke or intubation
** CXR = consolidation post basal R lung
Spontaneous Bacterial Peritonitis
- assoc with cirrhosis (ascites- peritoneal fluid infected via intestinal wall leak)
- Diagnosis = ascitic fluid neutrophils > 250 neut./microL
Bullous Pemphigoid
- > 60 y/o
- flexor surfaces
- biopsy = subepidermal blister
--> topical/systemic corticosteroids
Polymyositis
- symmetric prox muscle weakness
- increased CPK & LDH
CXR tension pneumothorax
- thin white line de-marking lung parenchyma --> no pulmonary vasculature beyond line
- flattening ipsilateral hemidiaphragm
Complex Partial Seizures
- complex = LOC (vs. simple)
- partial = focal part of brain
- blank stare for several minutes, lip smacking, chewing
- postictal state, Ex. Todds paralysis: focal weakness, R or L, "leg dragging"
** MC= temporal lobe epilepsy
-
Ventricular Tachycardia
- assoc. w. CAD, MI, structural heart disease
- nonsustained = often asymptomatic
- sustained = palpitations, hypotension, angina, syncope
-> -> VF -> death :(
ECG: 3 or more consecutive PVCs, wide QRS in regular rapid rhythm, AV dissociation
Treatment = cardioversion, antiarrhythmics - amiodarone, lidocaine, procainamide
Complications esophageal dilation
** Esophageal rupture:
- chest pain, hematemesis, SOB
- L sided pleural effusion
- pneumomediastinum (mediastinitis --> sepsis, death)
Conns syndrome
primary hyperaldosteronism
- usually adrenocortical hyperplasia (unilat. adrenal adenoma)
- ** hypertension, headache, polyuria, muscle weakness
- tetany, paresthesias, peripheral edema
- high Na+, low K+, metabolic alkalosis, hypomagnesia
* increased aldosterone/plasma renin activity (>30)
- surgical resection
- bilat. --> Spironolactone (aldosterone antagonist)
Gastric bypass - gallstone prophylaxis
- previous history --> cholecystectomy
- ursodeoxycholic acid 6 months post
Renal osteodystrophy
** high phosphate low Ca++
- renal disfunction --> retained phosphate
- renal disfunction --> low vit D --> low Ca++
--> parathyroid hypertrophy = secondary hyperPT
Somatic vs. Visceral pain
Somatic = sharp, severe (ex. peritonitis and free air under diaphragm)
Visceral = general, hard to pinpoint (ex. bowel obstruction)
Overflow incontinence
- neurogenic bladder, detrusor underactivity (ex. diabetes)
- frequent small leaks, high post-void residual volume
- Treatment: timed voiding, indwelling/intermittent catheter, ** cholinergic agonists
Urge incontinence - medication
- detrusor instability
--> ** muscarinic antagonists
- intense urge to urinate
Aortic stenosis- murmur
- systolic
- R upper sternal border
- radiates to carotids
Aortic stenosis - cause
- elderly = calcification of valve leaflets
- young = bicuspid valve
- developing country = rheumatic fever
Spontaneous bacterial peritonitis - treatment
- broad spectrum antibiotics (not pericentesis)
Prevention - esophageal varice hemmorhage
- non-selective beta blockers: propranolol, nadolol
- other options: nitrates, band ligation, TIPS
Menisceal tear
- twisting motion
- not severe enough to prohibit normal activities
- knee swelling the following day
- "locking sensation"
Astrocytomas
- most common adult brain tumor
- diagnosis based on grade = atypia, vascularity, necrosis, mitosis
- glioblastoma multiforme = grade IV astrocytome
CLL
- 60-70 y/o
** painless lymphadenopathy
- smudge cells
- treatment = Rituximab = monoclonal AB CD20
Tricuspid regurg
- holosystolic
- L lower sternal border (e.g xiphoid process)
Sickle cell -bacteremia
** MCC = strep. pneumonia --> encapsulated organism
treatment of EPS (anti-psychotics)
anti-cholinergics: diphenhydramine, benztropine, trihexphenidyl
Gallstone disease vs. pancreatic cancer
Gallstone disease = pain after meals, biliary colic - short episodes pain
Pancreatic cancer = painless jaundice!! loss of appetite, vague symptoms
Benign Paroxysmal Positional Vertigo (BPPV)
** episodic dizziness while rolling over in bed
- b/c displacement otoliths
- Diagnosis = "Dix-Hallpike" = put head in certain positions look for nystagmus
** Treatment = reposition otoliths, e.g Epley maneuver (head positioning excersises)
Atrial Fibrillation - approach
ECG: loss P waves, irregularly irregular QRS
Treatment:
1. rate control: metoprolol, esmolol, dilitiazam, verapamil
2. rhythm control: cardioversion
3. prevention embolization: warfarin, aspirin
Mobitz I (Wenkebach)
- second degree AV block
- ECG: progressively longer PR until dropped P & QRS
- usually asymptomatic
Mobitz II (Hay)
- second degree AV block
- ECG: dropped QRS with normal PR interval
- more likely structural defect
- more likely to progress to heart failure
ASD
- L->R shunt
** wide fixed splitting S2
** increased flow across pulmonary valve --> systolic murmur L upper sternal border
C. diff - treatment
- Metronidazole, Vancomycin
Alzheimers vs. Multi-infarct dementia
Alzheimers = gradual
Multi-infarct = "step-wise", presence of risk factors
Septic Shock - treatment
** 1. IV fluids
2. vasopressors: dopamine, NE
- antibiotics
Multiple Myeloma & renal failure
** MCC = toxic effect of light chain casts --> renal tubular damage
- glomerular damage = less common = amyloidosis, monoclonal immunoglobulin deposition
Fragile X
- CGG repeats, FMR-1 gene
- more common males
- autistic like features
- seizures
- long ears
- big balls
Acute delerium
- increased risk with chronic dementia
- triggered by medical condition
- "sundowning" = worse with nightfall
- waxing and waning
** danger to self/others --> haloperidol (soft restraints = last resort)
Evaluation LSIS/CIN I
adolescents = pap smear 12 months
premenopause = colposcopy (targeted biopsy)
postmenopause = reflex HPV testing/colposcopy
Cone biopsy vs. targeted biopsy
cone biopsy: more dramatic --> entire transitional zone, endocervical canal, used for more aggressive lesions
Vulvovaginal candidiasis
- perineal itching and discharge
- dyspereunia
- increased incidence with sex
** vaginal pH = 4-4.5 (normal) --> elevated pH in bacterial or trichomonas
- KOH = pseudohyphae & budding
alpha thalassemia minima
- three alphas (missing one)
** no clinical or lab abnormalities - totally asymptomatic
Thalassemia Minor
- cis or trans mutation: (a,a) (-, -) or (a, -) (a, -)
- asymptomatic
- mild chronic anemia, microcytosis
* target cells
Crossed paralysis
- hemiparalysis with contralateral malfunctioning of cranial nerve
which CNs originate in the pons?
5, 6, 7
(Trigeminal, Abducens, Facial,)

(8 - vestibulocochlear = cerebellarpontine angle, lateral to 7)
which CNs originate in the medulla?
9, 10, 12
(glossopharyngeal, vagus, hypoglossal)
where does CN 11 originate?
- accessory
- cranial and spinal roots
Initial workup - onset psychotic symptoms
** urine toxicology --> rule out drugs
- head CT, CBC, thyroid, syphillis tests, metabolic panel
Post MI VSD
- 3-5 days post
- holosystolic murmur L sternal border
- hemodynamic instability
- Pulmonary artery cath.: RV more oxygenated than RA (normally should be equal)
PE
- chest pain, SOB, hemodynamically unstable
** clear lungs
- soft holosystolic murmur L sternal border b/c tricuspid regurg
Cardiac cath.:
- low CO (normal = 5L/min)
- elevated right heart P
- elevated P between pulmonary A and PCWP
Pressure Heart Chambers: RA
<5
Pressure Heart Chambers: RV
< 25/ <5
Pressure Heart Chambers: LA
< 12
Pressure Heart Chambers: LV
<130/10
Pressure Heart: Aorta
< 130/90
Pressure Heart: PA
<25/10
Septic arthritis vs. RA flare up
- septic more likely in joint affected by RA
- fever can happen in both (RA = mild)
- monoarthritis more likely septic
when can pap smears be discontinued?
> 65 y/o
preventive health recommendations - women over 50
** annual mammogram
- fasting lipid profile every 5 yrs
- sigmoidoscopy/colonoscopy every 5 yrs
- pap smears til 65
Hypertrophic Cardiomyopathy - murmur
- holosystolic L sternal border
- worse when standing (decreased preload)
Pressure ulcers on heels
** put heels on pillows
- if break in skin --> moist dressings
(massage contraindicated!)
Hemothorax
- assoc. w. thoracentesis
- decreased LV preload
Cisplatin toxicity
- nephrotoxicity
- tinnitus and hearing loss
Focal segmental glomerulonephrosis
** MCC idiopathic nephrotic syndrome in adults
- increased risk - african americans, obese, HIV, heroin
- nephrotic = >3.5 g protein/day, hypoalbuminemia, hyperlipidemia
Juvenile Myoclonic Epilepsy
- absence seizures (10 y/o) --> myoclonic seizures (15 y/o)
(myoclonic = jerking/twitching)
--> tonic-clonic seizures (16 y/o)
** seizures upon wakening
- worse with sleep deprivation
- genetic
Role of nitrates in treating MI
venodilation --> reduces ventricular preload --> decreases O2 demand
** reduces pain
Midgut volvulus
- bilious vomiting
** imagine = corkscrew shaped duodenum in R abdomen
Listeria monocytes
- meningitis > 60 y/o
- immunocompromised
** ampicillin
Parkinsons
- festinating gait
- cogwheel rigidity
- slow speech
- resting tremor
** loss dopaminergic neurons substantia nigra
- lewy bodies
Pancoast tumor
- pulmonary apex
- thoracic outlet syndrome
- horners syndrome
- SVC syndrome
polyps vs. celiac
- both may cause diarrhea but only celiacs will have significant malapsorption (e.x osteopenia from vit D deficiency)
Aortic regurgitation murmur
diastolic decrescendo L sternal border
Guillanne Barre - CSF
- normal WBCs, high protein = albumincytologic dissociation
Pott disease vs. epidural abscess
- Potts = insidious onset
- Epidural abscess = acute onset back pain and fever
spinal epidural abscess
- acute onset back pain and fever
- neurologic signs
- risk factors: diabetes, IV drugs, trauma
** usually staph. A --> broad spectrum antibiotics, e.g vancomycin