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93 Cards in this Set

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what is the #1 cause of preventable morbidity and mortality in the U.S.?

what can it cause?
smoking

1. atherosclerosis
2. cancer
3. COPD
what is the #2 cause of preventable morbidity and mortality in the U.S.?
alcohol
more than 50% of accidental and intentional deaths involve what drug?
alcohol
what is the number 1 cause of preventable mental retardation?

what else can it cause
alcohol

fetal alcohol syndrome

cancer, cirrhosis, and potentially fatal in withdrawal
in alcoholic hepatitis, the ratio of what enzymes is >= 2.0?
AST : ALT
what vitamin do you give reproductive age women to prevent neural tube defects?
folate
how do you tx pernicious anemia? what are possible sequalae of pernicious anemia?
vitamin B12

neurologic deficits
what drug can cause vitamin B6 (pyridoxine) deficiency?
isoniazid
tx alcoholics with what vitamin to avoid Korsakoff dementia?
thiamine
what type of encephalopathy can alcoholics get?
Wernicke's
what is the most common cause of anemia?

what can cause it?
iron-deficiency anemia

- menstrual loss in reproductive age women
- CA in men and older women
what vitamin is a known teratogen?
vitamin A
what group of pts shouldn't treat acne with isotretinoin? why?
pregnant women; isotretinoin is a vitamin A analog
name 4 complications of atherosclerosis
1. MI
2. heart failure
3. stroke
4. gangrene
what are the top 7 primary risk factors for atherosclerosis?
1. age/sex
2. family history
3. cigarette smoking
4. HTN
5. DM
6. high LDL chol.
7. low HDL chol.
diabetes can lead to atherosclerosis and its complications. name them
1. retinopathy
2. nephropathy
3. peripheral vascular disease
4. peripheral neuropathy
5. increased incidence of infx
severe HTN can lead to acute problems, or a hypertensive emergency. what are those problems? [name 6 out of the 12]
1. HA
2. dizziness
3. blurry vision
4. papilledema
5. cerebral edema
6. altered MS
7. seizures
8. intracerebral hemorrhage (classically in the basal ganglia)
9. renal failure/azotemia
10. angina
11. MI
12. heart failure
what part of the brain is classically affected in intracerebral hemorrhage due to severe HTN?
basal ganglia
certain lifestyle changes can improve the sx of mild cases of what diseases?
1. HTN
2. hyperlipidemia
3. diabetes
4. GERD
5. insomnia
6. obesity
7. sleep apnea
what lifestyle changes can help improve sx in mild cases of HTN, hyper-lipidemia, DM, GERD, insomnia, obesity, sleep apnea?
1. diet
2. exercise
3. weight loss
4. cessation of alcohol/tabacco use
5. elevation of head of bed
how do you analyzed ABG's?
1. pH tells you primary event (acidosis vs. alkalosis)
2. CO2 and bicarb tell you cause (same direction as pH) and suggest compensation (opposite direction of pH)
exogenous causes of hyponatremia?
1. oxytocin
2. surgery
3. narcotics
4. inappropriate IV fluid administration
5. diuretics
6. antiepileptic meds
EKG in hyperkalemia?
tall, tented T waves
EKG in hypokalemia?
loss of T waves/T wave flattening and U waves
EKG in hypocalcemia? hypercalcemia?
QT prolongation

QT shortening in hypercalcemia
what do you do in case of shock?
1. give pt oxygen
2. start IV
3. monitor (pulse ox, EKG, vitals)
4. fluid bolus (1L of normal saline or Ringer's lactate) if no signs of CHF (bibasilar rales)
Virchow's triad of DVT, with examples for each?
1. endothelial damage (surgery, trauma)
2. venous stasis (immobilization, surgery, severe heart failure)
3. hypercoagulable state (malignancy, birth control pills, pregnancy, lupus anticoagulant, inherited deficiencies)
therapy for CHF?
diuretics (furosemide and ACE inhibitors) and beta blockers (stable pts) are mainstays of tx

screen for and address underlying atherosclerosis risk factors (smoking, hyperlipidemia)
what is cor pulmonale?
right-sided heart enlargement, hypertrophy, or failure due to primary lung disease (usually COPD)
what is most common cause of left heart failure?
right heart failure
what are the 2 main issues in pts with atrial fibrillation?
1. ventricular rate (slow it if needed)
2. atrial clot formation/embolic disease (consider anticoagulation)
how do you treat ventricular fibrillation?
immediate defibrillation
how do you treat ventricular tachycardia?
amiodarone or lidocaine if stable; else defibrillate
how do you distinguish obstructive from restrictive lung disease?
FEV1/FEV ratio

the FEV1 may be the same
what are the 2 most common causes of esophageal CA?
1. reflux -> Barrett metaplasia -> adenocarcinoma

2. smoking and alcohol abuse are 2nd most common causes (squamous cell CA)
all gastric ulcers must be biopsied or followed to resolution to exclude what?
malignancy
what is the first step in distinguishing an upper from lower GI bleed?
testing a nasogastric tube aspirate for blood; bright red blood via mouth or anus is fairly reliable as well for a nearby bleeding source
what is the classic pt of irritable bowel syndrome?
young female adult with chronic hx of alternating constipation and diarrhea

- IBD is one of most common GI complaints
- dx of exclusion with negative physical and basic exams
Crohn's v. UC: place of origin?
C's: distal ileum, proximal colon

UC: rectum
Crohn's v. UC: thickness of pathology?
C's: transmural

UC: mucosal/submucosal only
Crohn's v. UC: progression?
C's: irregular (skip lesions)

UC: proximal, continuous from rectum with NO skipped areas
Crohn's v. UC: location?
C's: from mouth to anus

UC: involves only colon; rarely extends to ileum
Crohn's v. UC: bowel habit changes?
C's: obstruction, abdominal pain

UC: bloody diarrhea
Crohn's v. UC: classic lesions?
C's: fistulas/abscesses, cobblestoning, string sign on barium X-ray

UC: pseudopolyps, lead-pipe colon on barium X-ray, toxic megacolon
Crohn's v. UC: which presents with lead-pipe colon on barium X-ray and toxic megacolon?
ulcerative colitis
Crohn's v. UC: colon CA risk?
C's: slightly increased

UC: markedly increased
Crohn's v. UC: surgery?
C's: NO, may make it worse

UC: YES, proctocolectomy with ileoanal anastomosis
what 3 hepatitis viruses are transmitted parenterally, and can lead to chronic infx, cirrhosis, and hepatocellular carcinoma?
hep B
hep C
hep D
what is the most common known genetic disease in white people?
hereditary hemochromatosis
what are some sx of hereditary hemochromatosis?
fatigue, impotence, and hepatomegaly
how do you screen, test, and treat hereditary hemochromatosis?
screen: transferrin saturation test (serum iron/TIBC) and ferretin level

confirm with genetic testing and liver biopsy

treat with phlebotomy
sequelae of liver failure? (name 4 of 8)
1. coagulopathy (that can't be fixed with vitamin K)
2. jaundice/hyperbilirubinemia
3. hypoalbuminemia
4. ascites
5. portal hypertension
6. hyperammonemia/encephalopathy
7. hypoglycemia
8. DIC
main 2 reasons for pancreatitis?
1. alcohol or gallstones
how do pts with pancreatitis present? treatment?
1. abdominal pain, n/v, elevated amylase and lipase

2. treat supportively and avoid morphine (causes sphincter of Oddi spasm) for pain control
complications of pancreatitis?
1. pseudocyst formation
2. infx/abscess
3. adult respiratory distress syndrome
most common cause of jaundice/hyperbilirubinemia in neonates?
physiologic (need only monitoring and follow-up labs)
is jaundice present at birth pathologic?
YES
are Graves, Hashimoto, and Addison's disease 1* or 2* endocrine disorders?
primary
how do you differentiate primary and secondary endocrine disturbances?
primary: gland malfunctions, but pituitary or another gland and CNS respond appropriately

secondary: the gland is, appropriately, doing what it is directed to do by other, malfunctioning, organs
ACTH-secreting lung carcinoma, heart-failure induced hyperreninemia, renal-failure induced hyperparathyroidism are 1* or 2* endocrine disturbances?
secondary
side effects of corticosteroids
1. weight gain
2. easy bruising
3. acne
4. hirsutism
5. emotional lability
6. depression
7. psychosis
8. menstrual changes
9. sexual dysfunction
10. insomnia
11. memory loss
12. buffalo hump
13. truncal and central obesity with wasting of extremities
most common cause of arthritis (>=75% of cases)? do findings include hot, swollen joints?
osteoarthritis

NO - few if any physical findings
highest incidence cancer in men and women (top 3)?
Men:
1. prostate
2. lung
3. colon

women:
1. breast
2. lung
3. colon
highest mortality cancer in men and women (top 3)?
men:
1. lung
2. prostate
3. colon

women:
1. lung
2. breast
3. colon
sequelae of lung cancer?
1. hemoptysis
2. Horner syndrome
3. superior vena cava syndrome
4. phrenic nerve involvement - diagphragmatic paralysis
5. hoarseness from recurrent laryngeal nerve involvement
6. parpaneoplastic syndromes (Cushing, SIADH, hypercalcemia, Eaton-Lambert syndrome)
what is bitemporal hemianopsia? what causes bitemporal hemianopsia? what's the work-up?
A. loss of peripheral vision in both eyes

B. space-occupying lesion pushing on the optic chiasm (classically a pituitary tumor) until proven otherwise

C. CT or MRI of brain
what are the potential risks and side effects of estrogen therapy (eg. contraception, post-menopausal hormone replacement)?
1. endometrial CA (possibly breast CA)
2. hepatic adenomas
3. glucose intolerance, diabetes
4. DVT
5. cholelithiasis
6. HTN
7. endometrial bleeding
8. depression
9. weight gain
10. nausea/vomiting
11. headache
12. weight gain
13. teratogenesis
14. aggravation of pre-existing fibroids (uterine leiomyomas)
15. migraines
16. epilepsy
ABCD of a mole that should make you think of malignant transformation? work-up?
Asymmetry
Borders (irregular)
Color (change, or multiple colors)
Diameter (the bigger, the more likely it is to be malignant)

biopsy moles, especially if they itch or bleed
sequelae of streptococcal infection? can they be avoided?
1. rheumatic fever
2. scarlet fever
3. poststreptococcal glomerulonephritis

only #1,2 can be prevented with abx
young adult with recurrent, varied neuro symptoms and signs. probable diagnosis?
multiple sclerosis, if nothing obvious is causing sx
name 3 tests used to diagnose multiple sclerosis.
1. MRI (most sensitive)
2. LP
3. evoked potentials
in multiple sclerosis, what do you expect to find in the LP and evoked potentials?
LP: elevated IgG oligoclonal bands and myelin basic protein levels; mild elevation in lymphs and protein

evoked potentials: slowed conduction through areas with damaged myelin
what do you think about in the unconscious or delirious patient in the ED with no hx or signs of trauma?
1. empirical tx for hypoglycemia with glucose
2. opioid o/d (naloxone)
3. thiamine deficiency (thiamine before glucose in suspected alcoholic)
4. alcohol, illicit drugs, prescription drugs
5. DKA
6. stroke
7. postictal state
8. subarachnoid hemorrhage
bronchiolitis v. croup (acute laryngotracheitis) v. epiglottitis: common ages?
B: 0-18 mos

C: 1-2 yrs

E: 2-5 yrs
bronchiolitis v. croup (acute laryngotracheitis) v. epiglottitis: are they common?
B,C: yes

E: no
bronchiolitis v. croup (acute laryngotracheitis) v. epiglottitis: common causes?
B: RSV (75%+), Parainfluenza, Influenza

C: Parainfluenza (50-75%), Influenza

E: H. influenza, Staphylococcus spp., Streptococcus spp.
signs & sx of bronchiolitis?
- initial viral URI sx followed by tachypnea and expiratory wheezing
signs & sx of croup?
- initial viral URI sx follwed by 'barking' cough, hoarseness, and inspiratory stridor
signs & sx of epiglottitis?
- rapid progression to high fever, toxicity, drooling and respiratory distress
bronchiolitis v. croup (acute laryngotracheitis) v. epiglottitis: x-ray findings?
B: hyperinflation

C: subglottic tracheal narrowing on frontal x-ray ('steeple sign')

E: swollen epiglottis on lateral neck x-ray ('thumb sign')
bronchiolitis v. croup (acute laryngotracheitis) v. epiglottitis: treatment?
B: humidified O2, bronchodilators, ribavarin (for high risk pts.)

C: humidified O2, bronchodilators

E: prepare to establish airway, abx (3rd gen. cephalosporin)
delirium v. dementia: onset?
delirium: acute and dramatic

dementia: chronic and insidious
delirium v. dementia: common causes?
delirium: illness, toxin, withdrawal

dementia: Alzheimer's, multi-infarct dementia, HIV/AIDS
delirium v. dementia: attention and arousal level?
delirium: poor attention, fluctuating arousal

dementia: unaffected attention, normal arousal
delirium v. dementia: which is reversible?
delirium is reversible
rule out pregnancy when ordering teratogenic tests - give 3 examples of such tests.
1. antiepileptic drugs
2. x-ray
3. CT scan
how do you treat anaphylactic reactions?
1. secure airway (if laryngeal edema prevents intubation, do a cricothyrotomy)
2. give subQ or IV epinephrine
are antihistamines and corticosteroids useful for immediate, severe reactions involving the airway?
NO! use sub Q or IV epinephrine
how do you screen for colorectal CA?
sigmoidoscopy or double contrast barium enema q5yrs after 50yo

stool guaiac/hemoccult annually after 50yo
how do you screen for colon and prostate CA?
digital rectal exam annually after 40yo
how do you screen for cervical CA?
pap smear 18-65yo (or before 18 if sexually active); after 2 normal exams 1yr apart, do q3yrs
how do you screen for gynecologic CA?
pelvic exam 20-40yo q3yrs, then annually after 40yo
when do you do mammography in women?
after 40yo, annually