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71 Cards in this Set
- Front
- Back
si/sx of a scaphoid fracture
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pain with wrist movement, history of falling on a outstretched hand, pain in anatomical snuff box
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management of suspected scaphoid fracture
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immobilization in a long arm cast--even if x-ray is negative. Make sure to get repeat x-rays every 2 weeks
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risk factors for cervical cancer
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multiple sex partners, early age of first coitus, smoking, high parity, low SES
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why does ammonia cause encephalopathy?
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it causes an increase in GABA inhibitory transmission
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precipitating factors for hepatic encephalopathy
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GI bleed, hypovolemia, metabolic acidosis, hyperkalemia, hypoxia, sedative use, infection, hepatic vascular occlusion
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how does lactulose work?
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it acidifies colonic contents, which converts absorbable ammonia into ammonium, which is not-absorbable (creates an ionic trap)
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what are treatment options for hepatic encephalopathy if lactulose doesn't work?
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sodium benzoate, ornithine aspartate, reduce protein intake (don't stop it though!)
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What is a TIPS procedure?
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bridge between hepatic vein and intrahepatic segment of portal vein
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what does TIPS treat?
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variceal bleeding, ascites, NOT hepatic encephalopathy
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best test to confirm intrauterine fetal demise
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ultrasound
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what is an important blood test to order after you confirm that pt has intrauterine fetal demise?
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coagulation studies (DIC is common!)
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si/sx of herpes encephalitis
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bizarre behavior, gustatory hallucinations, fever, impaired mental status, meningeal signs are frequently absent, non-specific CSF (may be grossly bloody)
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what test do you want to confirm HSV encephalitis
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CSF HSV PCR
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common causes of altered mental status in the elderly
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electrolyte imbalances, stroke, MI, infections
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what is the first line drug for HTN in the general population
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HCTZ or beta blocker
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what is the first line drug for HTN in diabetics`
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ACE inhibitors
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si/sx of HCOM?
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exertional dyspnea, syncope, chest pain
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what increases and decreases the murmur of HOCM?
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increases with Valsalva, decreases with leg elevation
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what does the murmur of HOCM sound like?
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harsh, diamond shaped murmur, best heard at left lower sternal border
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finding of HOCM on ech?
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interventricular septal hypertrophy, systolic anteriro motion of the mitral valve
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mechanism of methotrexate
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inhibits dihydrofolate reductase
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si/sx of vitreous hemorrhage
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sudden loss of vision, appearance of floaters
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causes of vitreous hemorrhage
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diabetic retinopathy
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five types of melanoma
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1. superficial sclerosing
2. lentigo maligna 3. acral lentiginous 4. amelanotic 5. nodular |
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describe superficial spreading melanoma
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most common type, on legs in females, trunk in males, irregular brown lesion, slightly elevated
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describe nodular melanoma
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dome shaped black or purple lesion, bleeds easily
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describe acral lentiginous melanoma
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lest common type of melanoma, on palms and soles of african american pts, beneath nail plate
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si/sx of coarctation
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Headaches, leg muscle fatigue, mild continuous murmur heard all over chest (because of collaterals)
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first test to get in suspected PE
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V/Q scanning
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what if a V/Q scan is indeterminate in a pt with suspected PE?
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Get venous doppler ultrasound
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when do you order pulmonary angiogram in suspected PE?
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If you have high suspicion but indeterminate V/Q, ultrasound and/or CT angiogram
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si/sx of atrial myxoma
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looks like mitral stenosis without opening snap, exertional dyspnea, fatigue weight loss
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drug of choice for increasing HDL
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fibrates, not nicotinic acid because of side effects
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CSF findings in MS
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normal protein, oligoclonal bands, usually an increase in IGG
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CSF findings in Guillain-Barre
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albumino-cytologic dissociation
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CD4 counds in AIDS pts with CMV?`
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less than 50
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si/sx of CMV retinitis
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yellow-white patches of retinal opacification
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si/sx of toxoplasmosis of the retina
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necrosis of the retina, fluffy white lesions, most pts also have toxoplasmosis encephalitis
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most common cause of septic arthritis
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staph aureus
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WBC of synovial fluid in septic arthritis?
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>50,000, may often be greater than 100,000
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what is a reversible ischemic neurologic deficit
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neuro sx that lasts longer than 24 hours but resolves within one week
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lab findings in tumor lysis syndrome
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hyperphosphatemia, hyperkalemia, hyperuricemia, LOW calcium because it binds with phosphate
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tumors most often assoc with tumor lysis syndrome
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Burkitt's, the leukemias
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what do you do if you suspect SBP?
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diagnostic pericentesis
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bacterial species assoc with struvite stones
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proteus, klebsiella because they split urea forming nitrogen, which alkalinizes the urine
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three types of diabetic retinopathy
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1. simple--microaneurysms, hemorrhages, edema
2. pre-prolierative--cotton wool spots 3. proliferative--newly formed vessels |
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what drugs can cause hypothermia
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phenothiazines, alcohol, benzos, any CNS depressant, opiates
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if you suspect hyperaldosteronism, what test should you get?
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aldosterone/renin ratio
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where does the ulnar nerve usually get entrapped?
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at the elbow
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what is the goal LDL?
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less than 100
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si/sx of vitamin D deficient rickets?
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craniotabes, rachitic rosary, enlarged wrists and ankles,
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what lab test confirms vitamin d deficiency
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calcefidiol
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si/sx of intertrochanteric fracture of hip
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leg is externally rotated and shortened
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management of hip fracture
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internal fixation with early mobilization
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si/sx of zinc deficiency
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alopecia, diarrhea, mental changes, maculopapular rash around eyes and mouth
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causes of zinc deficiency
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TPN, chronic diarrhea, inflammatory bowel disease
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classic presentation of choriocarcinoma
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hemoptysis, SOB, CP, post-partum female
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what test should you get if you suspect choriocarcinoma?
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quantitative hCG
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define an open fracture
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any fracture with a wound associated with it (NOT necessarily bone sticking out of it)
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management of open fractures
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stabilization with delayed primary closure
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what should you be worried about in pts with urinary voiding symptoms and negative urine culture?
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bladder cancer
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what tests should you get to rule out bladder cancer
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urine cytology and cystoscopy
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define childhood disintegrative disorder
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child has normal development for at least two years, then starts losing milestones, may have autistic features
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define autism
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impairments in communication and socialization, sx must be present before age three (often present very early), stereotypes, repetitive activity, poor eye contact
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define asperger syndrome
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like autism, but children have normal cognitive and language development, but still have repetitive movements
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define ADHS
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sx have to be present before age 7, inattention, hyperactivity, poor attention span, impulsiveness
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what tests do you get if ectopic pregnancy is suspected?
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transvaginal ultrasound and quantitative hCG
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si/sx of PCP overdose
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vertical nystagmus (only durg of abuse that causes this), hallucinations, sweating, HTN, hyperthermia
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what lab test should you get in every pt with suspected depression
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TSH
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what is the acid/base derangement in a pt with hepatic encephalopathy?
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metabolic alkalosis
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what supplement should all pts with sickle cell be on?
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folic acid
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