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71 Cards in this Set

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