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629 Cards in this Set
- Front
- Back
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Cystic Fibrosis
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Peds hemoptysis, rectal prolapse
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mucormycosis
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black necrotic lesion
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Peds diarrhea SZ
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shigella
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Narcotics SZ
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bupropion
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AIDS SZ
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Toxo
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Guilian Barre diarrhea
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Campylobacter paralysis
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Tarantula
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hairs that irritate skin, eyes
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Aortic dissection
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right >left coronary artery involved
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Normal post-void residual
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< 50ml
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AAA rupture risk
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> 5cm
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Epidemic HUS
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E coli O157:H7 or shigella
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Prostatitis tx
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Cipro 500 BID x 30d
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WPW
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delta wave: short PR, delayed QRS upstroke
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FB good prognosis
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early pliability, nl sensation CLEAR blebs
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Immed Post Partum SZ
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Amniotic Fluid embolism
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A-a gradient
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150 - (PaCO2/0.8) - PaO2
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Pleural effusion vol to see on CXR
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200ml
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↓Ca Chvostek sign
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upper lip twitch c tap of face CN VII
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↓Ca Trrousseau sign
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hand spasm c BP cuff
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↑Ca tx
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fluids, furosemide; NO HCTZ
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Pilon Fx
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comm, intra-artic of distal tibia
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Acute Interstital Nephritis-causing drugs
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PCN, NSAIDs, sulfa, dilantin, diuretic, also inf, imm
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Anterior epistaxis (90%)
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Kisselbach plexus
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Posterior Epistaxis
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Sphenopalatine artery
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Battle sign
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mastoid ecchymosis
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Monocular diplopia
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lens disloc
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PCP: steroid use
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PO2 < 70; A-a > 35
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↑QTc
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hyper and hypo thermia
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6 P's of ischemia
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pain, pallor, pulseless, paresthesia, paralysis, poik (↓temp)
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ASA tox
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resp alk; met acid
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Electric shock
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AC worse than DC, 10% dysrhythmia: VF most common
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Boring, tearing HA
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Cluster HA
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Throbbing HA
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MHA
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Potassium in MI
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5x risk of VF if K<4.0
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Most common non-EtOH alcohol
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Isopropanol
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Chronic orbital cellulitis
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Aspergillus
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T. capitus
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Oral griseo; selenium decreases infectivity
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Hamman's crunch
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pneumomediatinum
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Stener lesion
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Skiers thumb: APL tendon between split UCL
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Microcytic anemia
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Lead tox, Fe def, sideroblastic, thalassemia
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Patella Fx
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transverse most common; vertical on sunrise views
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HIV & meningitis
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Cryptococcus; India ink 80% sens: send Ag
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Osborn/J wave
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hypothermia: junction of QRS and ST
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LGIB etiols
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Diverticulosis, angiodysplasia, tumors,polyps, rhoids, UGI, A-EF
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UGIBleed etiols
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PUD, esoph, M-W, gast, varices, stress ulcers, AVM, malig
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LBO
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Ca, tics,Sig volv, Cecal volv, Intuss, Ogilvie
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SBO
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Adhesions, CA, hernia, Crohn, volv, Intuss, stricture, GS ileus, FB
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Diarrhea that mimics Appy
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Yersinia (campylo)
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Diarrhea: pet turtles, chicks, lizards
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Salmonella
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Diarrhea within 6 hrs
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Ham/potatos salad: S. aureus; Fried rice:Bacillus cereus.
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Rice water diarrhea
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seafood: vibrio Tx; fluids, cipro or bactrim
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Diarrhea and 3rd world travel
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E. histolytica. Bloody. Flagyl then iodoquinol
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Sandpaper rash
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SSSS, scarlet fever
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Pain immed after eating
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Gastric ulcer
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Pain better c food, worse later (middle of night)
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Duodenal ulcer
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Bowel Obst, <2yo
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Intuss. Bloody stool, severe pain
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Non-bilious, projectile vomiting
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pyloric stenosis
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Hirschprung
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string sign; no mec by DOL#2, aganglionic
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Painful vision loss
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glaucoma
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Painless vision loss
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CRAO, CRVO, retinal detach, vitreous hem
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Arsenic Tx
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dimercaparol, BAL
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Wernicke
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MS changes, ataxia, nystagmus. Tx: Thiamine, Mg
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OM viral etiol
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RSV
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Palpable purpura on buttocks and legs
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HSP
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Chronic cough
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B. pertussis. Tx: erythro
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Posterior elbow dislocation complications
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Most common: ulnar nerve; most serious: brachial artery
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Young man: dry cauliflower warts
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C. accuminatum (HPV)
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weeping warts, foul odor
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C. lata (syphillis)
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KBT test
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detects > 5ml hem (to determine need for additional Rhogam
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Apt test
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to differentiate fetal from maternal blood in neonatal GI bld
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Pericardial effusion volume to see on cxr
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250 ml
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TTP
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fever, anemia, low plts, ↑Cr, neuro sx, schistocytes. NO plt tx.
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Decels
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late: U-P insuff; early: head compression; variable: cord compression
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Most common bacteria in diarrhea
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campylobacter
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MeOH OD
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HCO3, ADH inhibitors, dialysis, folate (breaks down folic acid)
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Cental Cord synd
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most common; hyper ext in eld; M>>S, U>L, D>P. Sacral sparing
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Almonds, fish, glue, garlic, rotten eggs
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CN, zinc, toluene, OPP, H2S
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Earliest cardiac marker
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myoglobin: detect at 2h, peak at 5h, gone by 12h
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Peds C-spine
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pseudosublux at C2-3 (50%), C3-4 (15%)
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sympatho vs anticholinergic
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symp: diaphoresis and nl bowel sounds; antichol: dry skin, no BS
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cholinergic syndrome sx
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diarrhea, urin, miosis, bronchorrhea, brady, emesis, lac, sal
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cholinergic agents
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OPP,carbamates, sarin, pilocarpine, cytocybe/inocybe mushrooms
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anticholinergic agents
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antipsych, scopo, mus relaxer, gi antispas, antihist, jimson, deadly nightshade
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OsmOL gap
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methanol, ethanol, isopropanol, ethylene glycol and diuretics(glyc, man, sorb)
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Mees' lines
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white lines onnails in chronic Arsenic tox
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HBO for CO
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neuro/psych abn, CV instability, CO>25, CO>15 in preg
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Chronic toluene abuse
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distal renal tubular acidosis
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Hemodialysis in MeOH or EG OD
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acidosis, renal compromise, visual changes or level > 20 of either
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Hemodialysis in ASA OD
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>100, coma, renal/lver fail, non-card pulm edema, severe acid/base, rising levels
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PCP
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hallucinations, euphoria, violence in mild; severe: rigidity, SZ, fever, coma
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Cocaine chest pain
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O2, benz, CCB; NO Bblockers (unopposed alpha: HTN and coronary spasm)
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Multi-dose charcoal
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ASA, phenobarb, theo, tegretol
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Urine Alk
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ASA, phenobarb, formic acid(MeOH)
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Hemodialysis in OD
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Li, ASA, Alcohols, metformin, VPA, phenobarb
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Alcohols that cause AGMA
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MeOH, EG only (all alcohols cause AG)
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SSRI SX Serotonin syndrome
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Fever, sweats, AMS, tremor, increased reflexes. Rare: SZ, CV tox
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SSRI antidote
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Cyprohepatidine - oral only
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MAOI Sx
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excessive symp activity (AMS, mydriasis, Inc T, HR, BP, rigid, SZ, coma
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Antidepressant & SZ
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Welbutrin (bupropion)
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Anticholinergic Tx
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benzos, physostigmine; avoid Bblockers, sedatives c antichol (benadryl, haldol)
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Immediate reversal of Coumadin
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Prothombin complex concentrate and Recomb VIIa
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HIT
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up to 3w later; causes thrombotic events
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VPA tox
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elevated ammonia level, HD OK, not in other Sz med ODs
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BB and CCB OD Tx
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atropine, pressors, Ca(if no dig tox), HD glucagon, Insulin & glucose
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Bidirectional VT
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Dig tox
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Dig tox tachydysrhythmias
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Tx: phenytoin, lido
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Digibind indications
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K>5 in acute; Vent dysrhythmias, Brady unresp to tx, Massive OD
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Miosis
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Horner, narcs, cholinergics, clonidine, barbs,
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Sulfonylurea OD (glip, glyb)
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Octreotde, diazoxide
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Narcotics without miosis
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propoxyphene (darvon), pentazocine (talwin), demerol
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Narcotics and SZ
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propoxyphene, demerol
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Narcotic and wide-complex
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propoxyphene
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Liver tx in tylenol OD
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pH < 7.3, INR > 7, Cr > 3.4, Grade3 or 4 Liver failure
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Fe tox
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Sx w/i 6h, severe= hep failure, +/- on xray,
tx: deferoxamine comp: yersinia |
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OPP vs carbamates
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OPP irreversible bond to cholinesterae; both tx c atropine, 2-PAM
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CN tox
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Kit; amyl nit, sod nit, sod thio (only sod thio if ?CO); TX: hydroxycobalamin
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Mushroom and SZ
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Gyrometra; tx: pyridoxine (like INH OD)
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Cholinergic Killer B's
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bradycardia, bronchorrhea, bronchospasm
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Bite and SZ
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black widow, brown recluse
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Scorpion bite and pancreatitis
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Tityus trinitatus
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Bark scorpion
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Centuroides (AZ) roving eye movements, muscle spasm, xs secretions
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Octopus bites
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tetrodotoxin: flaccid paralysis
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Roseola infantum
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High fever (SZ ) x 3days without URI; then sudden rash upon decreased temp
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Rubella
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lymphadenopthy
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Erythema infectiosum
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slapped cheek
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Scarlet fever
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GAS; sandpaper rash
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Diptheria
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grayish tonsillar pseudomembrane
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herpangina
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temp, myalgias, dysphagia, painful ulcers that spare ging and ard palte
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Thrombosed hemorrhoids tx time
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Excise within 48hrs, no point afterwards
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Peds retinal hemorrhage
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shaken baby; also normal birth in 50% for up to 1 month
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T1 miscarriage causes
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>50% genetic, mostly trisomy, mostly tri 16
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ConVEX St elevation
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acute MI (concave - pericarditis, most specific for pericarditis is dec PR)
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Jones Fx
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> 1.5cm from bse of 5th or distal to cuboid; SL splint, NWB, usually surgery
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gonococcal arthritis
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F>M, G-stain pos> Cx, rare GU sx, rarely need surgery; tx: 3Ceph
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DCS
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DCS I: m-s, skin, lymphatics (shoulders, elbows); DCS II: all others N2
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Kidney stones Calcium
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2/3 of all; HyperCa: hyperpara, milk-alkali, lax abuse, sarcoid, Crohn's/UC
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Kidney stones MAP
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aka stuvite (20%) UTIs due to Proteus, Klebsiella, Pseudomonas
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Kidney stones Uric Acid
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gout; radiolucent - not seen on plain films
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Kidney stones Cystine
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least common; hypercytinuria an inborn error of metabolism
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Anion gap
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Na-Cl-HCO3; unmeasured anion in normal = albumin
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Oligoclonal bands
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Multiple sclerosis
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Guillain-Barre
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prog weakness > one limb & global dec reflex; CSF: inc protein, nl WBC
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CT dye risks
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atopy, CAD, Bblockers, prior event; not shellfish
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Sickle Cell Aplastic Crisis
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low H/H, retic<2%; usually post-infectious and cause 5% of SC deaths
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Anal fissures
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>90% midline except in Crohn's
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Crohn's v UC
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toxix megacolo, rectal invol: UC; perianal comp, EN in women: Crohn's
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LBO causes
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1- Ca 2- Volvulus 3-diverticulitis
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McMurray test
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medial meniscus
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Pertussis complications
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common: effects of severe cough; worst: apnea in infants; rare SZ, CA dissect
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Kawasaki tx
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high dose ASA
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HSP
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palp purp on buttocks, abd pain, jt pain, hematuria; ileoileal intuss
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Cecal Volvulus
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25%; plain films dx <50%; classic = dil cec in LUQ; late 50's; tx: surg
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Ischemic colitis
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50% misDx as InfBD; Classic xray=thumbprinting 20%;tx: supportive
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Hep A
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No chronic carriers; Sx in 5% kids, 75% adults;
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Hep E
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worse in preg; worse later in preg
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Nocturnal diarrhea
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Crohn's disease
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OM bacteria
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1- Strep pneumoniae 2- Moraxella catarhalis; viruses 1/6
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Narrowest part of pedi airway
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Cricoid cartilage
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Tinea versiocolor
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seb areas: trunk, arms, neck; gris NOT effective; recur common;
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Thyroid storm
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Stach, GC helpful
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Maisonneuve Fx imaging
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stress x-rays of ankle to r/o instability
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Central Venous Thrombosis
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Sx: HA; freq present late;Dx: MRI; Tx: heparin, even c bleed; F>M (bcp, preg); FOCAL sz
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B Pertussis
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GNCB; Tx: macolides only effective 1-2w, but decreases infecivity
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Hep viral carriers
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A- none; B- <5%; C- 80-90%
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Hep C
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IVDA, blood tx, esp outside US
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Viral Hep and Fulminant failure
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least common: Hep C; Most ommon Hep B+D coinfection
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Uncal herniation
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CNIII compressed -> parasymp paralysis -> mydriasis
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tonsillar herniation
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posterior fossa increased pressure -> cardiopulm failure
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Gonococal urethritis
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GN IC diplos; always symptomatic (1/4 not in chlam)
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Cerebral edema
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vasogenic: white matter, dysfunction of endothel/BBB; Cytotox: ischemia
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AAA risk factors
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FH (20x), age>50, PVD, Htn, other aneurysms
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Peds cyanotic heart disease
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Truncus art, TGV, tricuspid atresia, ToF, TAPVR; central cyanosis (periph=dehydration or hypothermia)
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Anxiety d/o tx
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SSRI, benzo for breakthrough, Bblocker for performance anxiety
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Penetrating abd trauma injuries
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1- SB 2-liver 3-LB
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Preg u/s: snowstorm
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complte molar pregnancy
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amebic liver abscess
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fecal-oral; E. hist; lab: inc alk phos #1, then bili, rare inc bili; tx: flagyl
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SLE
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malar after sun, fever, sym arth; #1 sens test: ANA; #1 spec test anti-Sm
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TB Sx
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1-cough, 2- Wt loss; night sweats, cp, sob, hemopt
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Headache prophylaxis
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Tension: amitriptyline; migraine: propranolol; cluster: verapimil
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Corrected Na = ?
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Na + 1.6(Glu-100)/100
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Cardiac Contusion test
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best= EKG; enzymes not helpful
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Older Male alcoholic Pneuumonia
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Klebsiella
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Pre-school pneumonia (6m-5y)
|
#1 RSV; #1 bact= strep pneuma
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Pneumonia 5-15 yrs
|
Mycoplasma
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Yersinia enterocolitica
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ileocecitis mimics appy, sx > 2w, mostly kids, complications = polyarthritis, EN
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HyperCalcemia EKG
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#1= QTc short, ST depression, Wide T, brady
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Retropharyngeal Abscess
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Supine; kids (nodes) > adults (trauma); #1=Staph; rare C1-2 separation
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soft-tissue neck spaces
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C-2 > 7mm (all); C-6 >14mm (kids), 22mm (adults)
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Mult Sclerosis tx
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High dose IV Steroids; resistance develops; baclofen for spasticity
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Pregnancy N/V tx
|
Vitamin B6
|
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Appy in kids
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<3yo: 90% perf; teens 15%; <2 usually diffuse pain; 15% 'liths
|
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Post viral polyarthritis
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Rheumatic fever; complications = conduction/vavle problems
|
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Bronchiololitis Rx
|
O2; ribavirin only in premies or kids c congential heart/lung
|
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Alcohol Dehydrogenase affinity
|
Ethanol>Methanol> EG
|
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MeOH Tox
|
40%: 1 Tsp (adults) may be fatal; 1 tspn - blindness
|
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Thoracic Aortic Dissection
|
Stanford - involves ascending +/- desc tx: surgery
|
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Erysipelas
|
GAS, red, painful, demarcated, lymphatics, #1 legs, #2 face
|
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Postpartum Endometritis Risks
|
#1 C/S; young, low S-E, PROM, prolonged labor, mult exams
|
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Lung abscess risks
|
altered MS; poor dentition
|
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PALPABLE purpura
|
HSP, cryoglobulinemia, CT disorders, viral hep, Hairy cell leukemia
|
|
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Haldol advantages
|
no antichol or hypotensive effects
|
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Pseudomonas
|
neutropenia, mech ventilation, CF
|
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Prinzmetal's Angina
|
CA vasospasm, may be better c exercise, hx/tx as angina
|
|
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Drugs causing lupus-like syndrome
|
INH, hydralizine, procainamide
|
|
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Warm ischemia times
|
6hrs 10%, 12 hrs 90% permanent damage
|
|
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Primary Liver CA
|
AFP>500; most c Hep B
|
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TCA OD wide complex tachy tx
|
HCO3, most anti-arrythmics don't help (lido) or worsen (procainamide)
|
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SAH tx
|
SZ meds, lower BP, nimodipine
|
|
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Kidney stone composition frequency
|
Calcium, struvite, UA, cystine
|
|
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Alcoholic pneumonias
|
#1 Strep; inc risk of Klebsiella; TX unchanged: 3GCeph + mac/FQ
|
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Calcium tx in Hyperkalemia
|
ok in Dig tox but dilute; lasts 30-60 min
|
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SPS in hyperkalemia complications
|
volume overload: colonic necrosis and ischemic colitis, esp c enema
|
|
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Raynaud's color sequence
|
white (dec flow), blue (initial reflow c cyanosis), red (hyperemia)
|
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Peds painless rectal bleeding
|
Meckel's
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|
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Scabies and head live tx
|
Permethrin; alt: scabies(lindane transderma tox) lice (malthion need 8hrs )
|
|
|
Ethylene glycol Urine tests
|
Crystals and flourecence present in 50% (confirms, doesn't r/o)
|
|
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Fever, HA, ocular paralysis
|
Cavernous sinus thrombosis; Staph/strep; tx abx, surg, hep; high mortality
|
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AV node blood supply
|
1- RCA 2- left circ
|
|
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Alcoholic Ketoacidosis
|
AGMA, nl OG, BHB (false neg u/a ketone)
|
|
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Osler nodes, Janeway, splinter hemorrhage
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Endocarditis
|
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Cord prolapse tx
|
C/S; trend, knee to chest, elevate presenting, fill bladder
|
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Chalcosis
|
golden deposits from Copper IO fb
|
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Coloboma
|
teardrop pupil; congenital iris ring defect
|
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Seidel test
|
streaming flourescein due to ant chamber leakage
|
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Iridodonesis
|
shimmering iris: posterior lens dislocation
|
|
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Iridodialysis
|
double pupil from blunt trauma
|
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Optic neuritis
|
pain, vision loss, color problems; 25% get MS
|
|
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Gout in women
|
rare before menopause; risks:diuretics, renal insufficiency
|
|
|
Hemi-inattention stroke
|
non-dom (usually right) parietal infarct
|
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Pontine hemorrhage
|
mimics narc OD
|
|
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Lateral medullary syndrome
|
PICA infarct
|
|
|
Locked-in Syndrome
|
basilar artery infarct
|
|
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Pseudobulbar palsy
|
affects lower CNs: dysphagia, -arthria, -phonie; no visual sx
|
|
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Antichol
|
musc>nic, death from hypertherm; SZ: kids>adults; skin, mucosa early, CNS gI late
|
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Biliary CA
|
#1- GB; rare mets; almost all h/o stones; porcelain GB
|
|
|
Rheumatic Fever EKG
|
prolonged PR
|
|
|
Pressure gun injuries tx
|
OR debridement; no digital block (compartment syndome risk)
|
|
|
Rhabdo dx
|
most sens=CK, most spec=MB (short T1/2); Dip+Mic- 50%
|
|
|
Rhabdo etiol
|
Gemfibrozil, 10% of High Voltage, Flu,Legionella, HIV, Coxsackie
|
|
|
Rhabdo electrolye abnormailty
|
HypoCalcemia; avoid Ca due to assoc HyperPO4 -> precip
|
|
|
Mushroom - amATOxin
|
liver toxicicty
|
|
|
Mushroom - COPrine
|
disulfiram-like
|
|
|
Mushroom - gyromitrin
|
SZ
|
|
|
Mushroom - ibotenic Acid
|
anticholinergic
|
|
|
Mushroom - muscarine
|
Cholinergic
|
|
|
Mushroom - oREllanine
|
Nephrotoxicity
|
|
|
Psilocybin
|
hallucinations
|
|
|
CRAO risks
|
Htn, DM, AF, SLE
|
|
|
ICH Htn Tx
|
labetalol and/or Nicardipine
|
|
|
M.A.T. associations
|
COPD, CHF, hypokalemia, hypocalcemai
|
|
|
False-positive nitrazine test
|
blood, semen, xs cerv mucus, T. vaginitis
|
|
|
Magnesium toxicity tx
|
Calcium
|
|
|
Fever, ST, gray pseudomembrane
|
C. Diptheria; tx: macrolides, horse anti-toxin, immunization
|
|
|
Viral causes of encephalitis
|
#1 - enteroviruses( coxsackie); most severe - herpes
|
|
|
Hirudin risks/benefits
|
more bleeding, less thrombocytopenia than heparin/lovenox
|
|
|
Goodpasture's Syndrome
|
glomerulonephritis, diffuse alveolar hemorrhage, anti-basement membrane ab
|
|
|
Ventilation in asthmatics
|
high flow, short insp times, long exp times, low vol, Plateau pressure <35
|
|
|
Primary aDreNal insufficiency
|
↓Na, ↑K, ↓glu
hyperpigmentation due to inc ACTH |
|
|
Adult epiglottitis tx
|
3GCeph, humidified O2; No steroids nor racemic epi
|
|
|
Rash on wrists and ankles
|
meningiococcemia
|
|
|
HAPE
|
#1 cause of alt death; periph cyanosis, worse at night, tx: descent, O2, nifedipine, morphine, furosemide
|
|
|
Traveler's diarhhea etiols
|
1- ETEC, 2- Shigella, 3- viral, 4- protozoa
|
|
|
MI criteria in LBBB
|
1- Concord ST elevation >1mm; ST dep V1-3; Discord ST elevation >5mm
|
|
|
EBV Pharyngitis complications
|
Common: rash c amp/amox, asympt ↑LFTs; rare: splenic rupt, Hemolytic anemia, enceph
|
|
|
Nephrotic Syndrome
|
Proteinuria, fluid overload (periorbital), Htn, thrombophilia, micro hematuria
|
|
|
Clozapine side effect
|
agranulocytosis
|
|
|
Haldol mechanism/effect
|
anti-dopamine D2 (sedation); α-1 blocker (orthostatic hypotension); antihist; no lowering of SZ threshhold
|
|
|
Ethylene Glycol OD Tx
|
ethanol, fomepizole, pyridoxine, thiamine temporize. Definitive= hemodialysis.
|
|
|
Anterior Circulation Ischemia
|
hemiparesis/sensory loss (ant cerb art); Transient Monoc blindness (ophthalm art); aphasia and hemiparesis (MCA); all are branches of carotid
|
|
|
Post Circulation ischemia
|
ataxia, vertigo, N/V
|
|
|
Extrapulmonary TB
|
painLESS (cerv) adenopathy, pericarditis, meningigitis (↑↑prot), spine (Pott's disease, ant wedge Fx), bilat adrenals
|
|
|
Radiation exposure in Pregnancy
|
5 Rads safe (10 Rads inc risk of childhood CA, not malformations); periph xrays <5mrad; Ct abd 2.6 Rad; highest risk: 2-7weeks
|
|
|
Painless hematuria Dx
|
Childrren: glomnerulonephritis; old men: bladder CA; others: UTI
|
|
|
Meningitis tx >50yo
|
Ceftriaxone (S. pneumo), Vanco (resistant S. pneumo); Ampicillin (listeria); dexamethasone
|
|
|
Pulmonary Contusion complications
|
Atelectasis, pneumonia
|
|
|
Sarcoid
|
B>W, F>M, 20-40;presenting Sx: fatigue, fever, anorexia, pulm; Skin sx (25%) EN, lupus pernio; Symmetric, laarge-joint arthralgias
|
|
|
Chancroid
|
painFUL ulcer with tender unilat LN; H ducreyi (GNB); tx: zith or ceftriaxone
|
|
|
Wellen's Sydrome EKG
|
Prox LAD angina; deeply inverted T waves anteriorly
|
|
|
Pericarditis EKG
|
ConCAVE ST elevation, STach, PR depression
|
|
|
Left Circ lesion EKG
|
lateral (I,L, V5-6) and posterior (V1-2) findings
|
|
|
Right sided CAD EKG
|
Inferior or Posterior (V1-2)
|
|
|
Tularemia
|
tick-born, spirochete from rabbits. Sx:skin ulcers, painful nodes; O-P, lung, ocular less. Tx: streptomycin IM
|
|
|
Conjunctivitis Findings
|
Dendrites (HSV), pseudodendrites/facial rash (VZV), contact lens (Pseudomonas)
|
|
|
Ciguatera
|
#1 fish-related poisoning; N/V/D, neuro: distal/perioral paresthesias, cold allodyna. Sx x 1-2w. Rare: cholinergic.
|
|
|
O-P Dysphagia
|
#1 - CVA; #2 - poly-/dermatomyositis. 2/3 of MG pts have it. Liquids worse than solids. Sx intermittant.
|
|
|
Brown Recluse Tx
|
supportive only, even hemorrhagic vesicles. No dapsone.
|
|
|
Young adult c trigeminal neuralgia
|
Consider MS, esp if recurrent or other neuro Sx
|
|
|
Priapism tx
|
Corpora cavernos aspiration
|
|
|
Backblows for FB
|
pedi only
|
|
|
Posterior MI EKG
|
posterior leads most accurate; V1-2 most specific ant leads; sx opposite anterior MI: ST depression, R waves (not Q), upright T (not inverted)
|
|
|
Jones Criteriua for Rheumatic Fever
|
2maj polyarth, EM, chorea, carditis, subQ nodules; or 1 maj + 2 minor ( arthralgias, fever, ↑ESR or CRP, ↑PR)
|
|
|
Thoracic outlet syndrome
|
#1 Ulnar nerve
|
|
|
Prophylaxis for AMS
|
Acetazolamide, dexamethasone
|
|
|
CRPS aka RSD Dx
|
allodynia, burning, bone scan/xray abn, change in sweat/temp/hair/color
|
|
|
Vertical or Rotatory nystagmus
|
PCP
|
|
|
Descending paralysis
|
Botulism (with CN abnormalities and parasymp blockage)
|
|
|
Central Cord Syndrome
|
Upper > lower motor weakness
|
|
|
Achalasia
|
dysphagia; LES spasm & absence of esoph peristalsis;
solids worse than liquids; raise arms/ straighten back |
|
|
Schatzki's ring
|
stricture at dist esophagus in 15%; presenting sx: acute obstruction
|
|
|
Benzo side effects in Status epilepticus
|
1- hypotension; 2- hypoventilation
|
|
|
Status epilepticus - adult etiols
|
1- subtherapeutic med levels; 2- CVA
|
|
|
Highest electrical resistance
|
Bones, tendons, fat
|
|
|
Heparin/LMWH pharmacol
|
Heparin inactivates thrombin (Factor II); LMWH inhibits factor Xa
|
|
|
TMJ
|
young, female, psych, unilateral
Tx: NSAIDs, muscle relaxers, soft food |
|
|
Facial Droop types
|
complete (lower motor neuron (pons/brainstem)), incomplete - spares forehead (cortical)
|
|
|
Botulism
|
descending paralysis, bulbar first. No sensory changes. Antichol (mydriasis) differentiates from MG,Sx 6-48 hrs p ingestion
|
|
|
Valve prophylaxis
|
dental, brochoscopy, ERCP, cystoscopy
|
|
|
BP in ischemic stroke
|
tx at 220/120; tPA goal 185/115; nipride, labetalol, enalapril
|
|
|
Oculogyric crisis
|
form of dystonia, eyes look upward, worse c emotional state; tx: benadryl or benztropine 1mg IM
|
|
|
Cerebellar infarcts
|
vertigo, HA, N/V, truncal ataxia, dysarthria, ipsilateral defects; risk: drop attach (vert-basilar insuff)
|
|
|
Pulsus paradoxus
|
nl=10 mmHg; audible heart sounds without paplable pulse; asthma PTX
|
|
|
Lipase false positives
|
GU/DU , severe renal insufficiency, bowel obstruction; remains ↑ 8-14d (amy 5-7)
|
|
|
Gastric volvulus
|
#1 - HH in old; or cong diaphragm defect in <1yo; long axis; abd pain , vom, dist, can't pass NGT (sometimes NGT reduces); infarct only 25%
|
|
|
Pseudogout
|
CPPD. 1- idio others:hyperpara, hemochrom, hypomag, hypothyroid
|
|
|
GI Bleed drugs
|
Continuopus PPI ('prazoles); octreotide for variceal hemorrhage
|
|
|
Vomiting 'lytes
|
hypochloremic, hypokalemic met acidosis
|
|
|
Polyarteritis Nodosa
|
mononeuritis multiplex, mes ischemia, skin changes
|
|
|
Takayasu's Arteritis
|
coronary ischemia
|
|
|
Wegener's
|
early: URI; later: glomerulonephritis
|
|
|
Behcet's Disease
|
recurrent oral and genital ulcers; rare: hypopyon is pathognomonic
|
|
|
Churg-Strauss
|
pulmonary/asthma
|
|
|
PCP + sulfa allergy
|
primaquine and clinda(CAP) PO; pentamidine IV/inhaled
|
|
|
Aortic trauma
|
usually descending; tx: surgery, bp/hr control (Bblockers)
|
|
|
OB terms
|
lie: position within uterus; presentation: fetal part at mat pelvis; position rot pos of occiput/sacrum; station rel to ischial spines
|
|
|
Diarrhea etiols
|
viral (norovirus includes Norwalk); campylobacter in those seeking tx
|
|
|
HIV Crypo diarrhea tx
|
HAART
|
|
|
Pyogenic liver abscess
|
less common than amebic; seen c biliary infections, polymicrob,
|
|
|
Traumatic iritis
|
painful, red (perilimbic/ciliary flush), consticted. Tx: cycloplegics, 'roids; better in 1w
|
|
|
Postpartum hemorrhage etiols
|
1- Uterine atony, 2- tears, 3-RPoC
|
|
|
U/A Casts
|
white = pyelo or other inflamm; red=GN; transitional usually nl; pH=5-8 except RTA, UTI
|
|
|
DIP arthritis
|
OA; RA:symmetric, UE, females, c-spine; 15% RF neg
|
|
|
Status epilepticus defintion
|
any SZ > 5 minutes
|
|
|
Afib/flutter tx
|
rate control to < 100, anticoag if > 48 hrs unless no clot on cardiac echo
|
|
|
Neck mass dx
|
80% in kids benign; 80% of non-thyroid in adults CA; ear pain, OM ↑risk of CA
|
|
|
Sausage-shaped digits
|
Reiter's syndrome
|
|
|
Abductected, Ext Rotated Hip in Neonate
|
Infection
|
|
|
Arthritis + Cardiac Rub
|
SLE
|
|
|
RA joints
|
MCP, PIP
|
|
|
OA joints
|
CMC1, PIP, DIP
|
|
|
Blindess causes in US
|
1- age-related macular degeneration
|
|
|
Follicular cysts
|
usually asymptomatic; else: pelvic pain, urinary freq/constipation if large; don't rupture
|
|
|
Corpus Luteum cysts
|
may bleed, then rupture
|
|
|
Theca lutein sycsts
|
rare, bilat, associated with prolonged ovarian stimulation
|
|
|
Dermoid cysts
|
benign ovarian teratomas; but may transform to malig esp if >40yo
|
|
|
Ovarina fibroma
|
most common benign solid neoplasm; may get very large
|
|
|
CXR in aspiration
|
1- obstructive emphysema; atelectasis, pneumonia
|
|
|
Painless abd mass in neonates
|
Neuroblastoma (adrenal), Wilm's tumor (renal)
|
|
|
HSV encephalitits
|
temporal lobe; HSV-1 in adults (2, maternal in neonates); Cx usually neg; tx: acyclovir
|
|
|
Tylenol tox markers
|
increased tylenol level, AST
|
|
|
Non-reducible dorsal PIP dislocations
|
Volar plate entrament
|
|
|
Jersey finger
|
FDP avulsion at DIP; 75% = ring finger
|
|
|
Trigeminal neuralgia
|
spont remission; neuro referral & MRI: 3% have MS, 10% IC lesion; 30% need ablation; tx: carbamazepine 100 bid
|
|
|
MDAC
|
carbamazepine, dapsone, phenobarb, quinine, theo. ?dig, dilantin, amitriptyline, ASA
|
|
|
Dig Fab indications
|
HyperKalemia, Ventricular dysrhythmias, unstable SVTs, co-ingest of other carditox; relative: lg ingestion, high level
|
|
|
Viral prodrome, then rash on wrists and ankles
|
RMSF; tx doxy, chloamphenicol
|
|
|
DIC labs
|
Decrease: pt/ptt, fibrinogen, plts; increase FSP
|
|
|
Fat embolism
|
s/p long bone fx; resp distress, AMS, temp, petechiae
|
|
|
HSP Sx
|
palpable purpura on thighs/buttocks, arthralgias (ankle), abd pain, GN; ileoileal intus, worse in adults due to GN
|
|
|
Hypothyroid (myxedema) Sx
|
hypothermia, delayed DTR relaxation, carpal tunnel, periorbital edema
|
|
|
HHS (vs DKA)
|
bigger fluid and K deficit; more thrombo-emb events due to increased viscocity
|
|
|
COHb T1/2
|
RA: 6hrs; 100% 02: 90 min; HBO: 30 min
|
|
|
Ranson's 5 early criteria
|
Glu>200; age>55, LDH>350; AST>250; WBC>16K
|
|
|
Carpal tunnel associtaions
|
DM, hypothroidism, pregnancy, RA
|
|
|
Calcium Ox kidney stone risks
|
Hyperparathyroid, milk-alkali, laxative abuse, sarcoid (Ca); Inflamm bowel disease (oxalate)
|
|
|
Strep Pharyngitis Criteria
|
fever, NO cough, ANTERIOR cervical adenopathy, exudative tonsillitis; 0/4 - 2.5% +strep; 4/4 56%
|
|
|
Osteomyelitis
|
non-toxic, nl VS, usually Staph aureus, ESR & CRP very sensitive, early xray not, MRI>CT
|
|
|
Intussusception
|
95% peds; Adults: 75% CA; Triad (pain, vom, bloody stools) only 33%; U/S best non-invasive; air enema dx & tx c less comp than Ba
|
|
|
Aplastic anemia causing drug
|
Chloramphenicol complication
|
|
|
Meningiococcemia complication
|
Bilateral Adrenal infarction (W-F syndrome)
|
|
|
Acute Cholangitis Sx
|
Charcot's triad: fever, RUQ pain, jaudice (low BP and AMS = Reynold's Pentad: G- sepsis)
|
|
|
Gingival hyperplasia drugs
|
phenytoin, CCBs; not dose dependent, worse c poor oral hygiene (<50% of phenytoin pts)
|
|
|
Intussusception in ADULTS
|
small bowel, almost all c lead point (75% malig; inflamm, Meckel's); Dx c CT scan; most are partial obstructions c CC abd pain
|
|
|
Inherited hypercoagulable disorders
|
Suspect in PE <40yo, +FH, recurrent PE. #1- Factor V Leiden; >> plasimonogen deficency, Protein S deficiency
|
|
|
Lateral canthotomy
|
retrobulbar hematoma
|
|
|
Risks for contrast-induced ATN
|
Pre-existing renal disease, DM, hypovolemia, MM, age
|
|
|
Abruptio Placentae risks
|
1- Pre-eclampsia
|
|
|
Hypertrophic Cardiomyopathy tx
|
B-blockers
|
|
|
SJS/TEN drug causes
|
sulfonamides, anticonvulsants
|
|
|
Cluster HA
|
Symp ( ptosis, miosis) and parasymp ( rhinorrhea, lacrimation)
|
|
|
HyperCalcemic crisis
|
Ca > 14, AMS, polyuria, dehydration; tx: fluids, pamidronate/bisphosphates, loop diuretics no (HCTZ), steroids in malig
|
|
|
Normal Pressure Hydrocephalus
|
Triad: AMS, ataxia, urinary incontinence. Hydrocepphalus, normal CSF pressure
|
|
|
Aortic Stenosis progression
|
usually congen bicuspid SX: 1- Angina, 2- Syncope, 3- CHF; TX: surgery
|
|
|
Arthritis + renal stones
|
gout
|
|
|
Periph (versus central) vertigo
|
severe N/V, aufitory Sx, Nystagmus: no direction change, fatigues
|
|
|
Central (versus periph) vertigo
|
severe ataxia, nystagmus: +change of direction, vertical
|
|
|
Judet view x-ray
|
acetabulum
|
|
|
Basilar Skull Fx's location
|
anterior (CSF rhinorrhea, racoon eyes); middle (Hemotmp, Battle's, otorrhea, CN VII palsy, hearing loss); posterior (CN IX, X (swallowing , airway))
|
|
|
Adenopthy; Koplik's; Febroile SZ; Pastia's Lines
|
Roseola (German measles); measles; roseola infantum (exanthem subitum); scarlet fever
|
|
|
Rheumatic Fever Sx (major)
|
Polyarthritis(#1), carditis(#2), chorea, erythema MARGINATUM, subcut nodules; Minor: arthralgia, FEVER, ESR/CRP, PR interval
|
|
|
Specific valve involvement
|
Mitral - RHD #1; Tricuspid - IVDA; Pulmonic - none; Aortic - congenital, cacific, RHD #2
|
|
|
Parasite and Sx
|
T. Cruzi(chagas-cmp); T saginata(beef tapeworm-G/E); T trichura(whipworm-G/E c Fe-def anemia); L braziliensis-skin ulcers
|
|
|
T. solium (pork tapeworm)
|
neurocysticercosis: ring-enhancing cysts, inc ICP; SZ; Tx: praziquantel, steroids, neurosurg
|
|
|
Propranolol OD
|
worst B-blocker; SZ, coma, brady, AVBlock, hypotension, hyperK, renal failure; hypoglycemia in kids; tx: atropine, glucagon, insulin, glucose
|
|
|
Malrotation c midgut volvulus
|
toxic-appearing, sudden onset bilious vomiting in week #1; double bubble (pylorus separting stomach from duodenum
|
|
|
Osmotic Demyeliantion Syndrome
|
alcoholics/chronic mal; 1-6d s/p tx of chronic hyponatremia; Sx: AMS, pseudobulbar palsies, spastic quadraparesis; no tx
|
|
|
Toxoplasmosis/HIV
|
ring -enhancing lesion on CT; tx:sulfadiazine, pyrimethamine, leucovorin; steroids if severe; no surgery
|
|
|
Hand splint position
|
wrist 30; MCPs 90; IPs extended
|
|
|
Septic Arthritis WBC
|
>50,000
|
|
|
SCFE
|
fat, black, male, teen; hypothyroidism; loss of int rotation, atrophy, shortened leg
|
|
|
Adynamic ileus causes
|
post-op; hypokalemia; uremia
|
|
|
Troponin I
|
starts 3-6h; peaks12-24h; baseline 7d; highly specific at 6h; highly sensitive at 12
|
|
|
Abx in damaged/prosthetic valves
|
dental; rigid bronch; ERCP; cysto
|
|
|
Non-midline anal fissures
|
Crohn's (#1) leukemia, HIV, TB, syphilis
|
|
|
Facial rash: perioral &nasolabial sparing
|
Erythema infectiosum (fifth disease) parvovirus B19
|
|
|
Bilateral facial nerve palsies
|
Lyme (#1), MG, lymphoma,sarcoidosis, brainstem tumor, GBS
|
|
|
SBP WBC
|
>100
|
|
|
Diabetic neurop CN III v PCOM aneurysm
|
Both have CN III (ptosis, loss of superior and medial eye movement; PCOM aneurysm involves parasym as well, has pupil effects
|
|
|
E coli o157:H7
|
undercooked hamburger; causes HUS (kids), TTP (adults); NO Abx: increases risk of HUS
|
|
|
Diarrhea, febrile SZ
|
shigella
|
|
|
Diarrhea + cafeteria food, turtles, eggs
|
Salmonella (osteo in SCD)
|
|
|
Diarrhea: frothy, foul-smllling, borbor, floating, backpacker
|
Giardia
|
|
|
Campylobacter v Giardia
|
both "backpackers" camp: 2-6 d, bloody, mimics IBD, appy, erythro (peds) FQ adult; Giardia: 1-4w, foul, float, frothy, flagyl
|
|
|
Scromboid
|
heat stabile toxin; dark fish c poor refrig, peppery taste; histamine-like, w/I 30 min; tx: antihistamine; suspect if mult pts c allergic rxn
|
|
|
Ciguatera
|
fish ingest dinoflag contianing toxins; weakness, perioral/hands/feet paresthesias, hot/cold rev; worse c EtOH; Tx: mannitol, amitript, diphen
|
|
|
Rectal prolapse v int 'rhoids v Intus
|
Prolapse: circular folds; Int 'rhoids: spokes on a wheel; Intuss: space between protruding rectum and anus
|
|
|
Botuism
|
heat labile neurotoxin; short onset (30 min): bulbar sx(earliset-diplopia; descending paralysis, anticholinergic. Infants: honey, floppy, constipation, feeble cry
|
|
|
Tumor Lysis syndrome
|
Hyper- -uricemia, -phosphatemia, -kalemia; HYPOcalcemia
|
|
|
Adolescent menorrhagia
|
#1 hered: vWD; Tx, mild: IN/IV desmopressin; severe: Cryoprecipitate; OC's too
|
|
|
Opisthotonos
|
tetanus, strychnine; tx: benzos
|
|
|
Risk of AVN
|
femoral head, talus, scaphoid, capitate
|
|
|
Toddler fx
|
distal tib; prox fib suspicious for abuse
|
|
|
Max lido doses
|
5mg/kg; 7mg/kg c epi; Lido 1% = 10mg/ml
|
|
|
Pneumonic Plague
|
Asia/India/ W. US; Yersinia pestis; hemoptysis, resp failure, shock; CXR: lobar pneumonia + effusion; tx: strept, gent, doxy, cipro, or CAM
|
|
|
ESRD Narcotics
|
No demerol: SZ risk
|
|
|
Ischemic CMP/CHF tx
|
B-blockers, ACEI, spironolactone; NO CCBs
|
|
|
LOW anion gap
|
MM, waldenstrom's, bromide, LI; low albumin
|
|
|
Vom/Diarrhea 'lytes
|
Vom: hypochloremic alkalosis; Diarrhea: hyperchloremic acidosis (normal AG)
|
|
|
Calcium EKG
|
inverse to QT length
|
|
|
Hyper Ca
|
kid stones, Fx's. anorexia, vom, constipation, fatigue, psych
|
|
|
Milk-alklai
|
Hyper CA; DI
|
|
|
MTX drug interactions
|
folate (PNV) may decrease MTX effectiveness; fatal interacton c ASA/NSAIDs
|
|
|
Endometriosis
|
abd pain, dysmenorrhea, dyspareunia
|
|
|
MAOI meds
|
Bad: amphetamine, reserpine, guanethidine, TCA, Meperidine, etc. OK: morphine
|
|
|
Severe HTN in kids
|
Renal: chronic GN, chronic pyelo, renal art stenois; CV: Coarctation of aorta
|
|
|
Peds CHF
|
Sweating c PO; poor feeds, poor wt gain, weak cry
|
|
|
Tet spell tx
|
knee-to-chest, O2, morphine 0.1-0.2 mg/kg
|
|
|
Post-MI Pericarditis v. Dressler's
|
2-4 days after transmural MI(20%; less after tPA) , +/- friction rub, EKG changes masked by evolving MI, Inc risk of dysrhyth, CHF; tx: ASA; Hep OK
|
|
|
Wide-complex tachy in WPW
|
Procainamide, amiodarone
|
|
|
Hypertrophic CMP
|
50% hered; LV enlarged -> diastolic dysfunction; sudden death, typical younf, after exertion; No BB or NTG
|
|
|
Dilated CMP
|
all 4 chambers; systolic dysfunction, low output; CHF, angina
|
|
|
Congenital Prolonged QT
|
FH of exercise induced syncope, sudden death, +/- deafness
|
|
|
EKG in MVP
|
PACs, PVCs. PSVT > prolonged QT; inferior St depressions; inc risk of WPW
|
|
|
CPAP in CHF
|
dec intubation, no mortality difference;decreased pre- and after-load
|
|
|
Cardiac mmanifestations of Lyme
|
bundle branch or heart block; may present as syncope from brady from 3red degree
|
|
|
Cocaine MI
|
Most sx w/I 1 hr; no adverse effects after 12 hrs in ER; CP associated SX: SOB>sweat>nausea; tachycardia only 16%
|
|
|
Commotio cordis
|
sudden VF arrest after blow to chest
|
|
|
Lung CA
|
#1 = adenocarcinoma; best chemo resp: small cell; Central Mass and SVC (squam, small) Periph (adeno, large); Cavitation (squam, large)
|
|
|
Hiccups
|
Chlorpromazine (fda), metoclopramide
|
|
|
Leishmania
|
Iraq, sandfly, chronic ulcer; refer to ID/derm for bx, sodium stibogluconate
|
|
|
Cluster HA
|
Knife-like (also in Trigem Neuralgia) rhinorrea, lacrimation, miosis, ptosis; men, suddden severe, unilat intraoc pain; O2
|
|
|
Increased risk of ICH c tPA for stroke
|
Increased stroke severity, signs of infarction (hypodensity or mass effect) on CT
|
|
|
Magnet on AICD
|
won't defib; still paces if brady
|
|
|
Fetal radiatin exposure
|
2-8 weeks organogensis; 8-15 weeks neuro development. Threshhold = 10 rad for teratogenesis
|
|
|
Kawasaki Sx, Dx
|
Fever x 5d + 4/5 bilat conj, oral mucosa(red lips, strawberry tongue, red o-p), hands and feet (ery, edema, desq), rash(perineal), (unilateral) cerv LN;
|
|
|
Kawasaki Comp, Tx
|
Coronary aneurysm (dec risk c IVIG 2g/kg, and ASA 100m/k divided qid
|
|
|
Kawasaki v scarlet fever
|
conjunctivitis rare in scarlet fever
|
|
|
Measles v kawasaki
|
kawasaki has minimal resp sx
|
|
|
Measles
|
fever, cough, coryza, conj precede rash by 2-4 days; koplik spots
|
|
|
TEN
|
sloughing, associated c PCN, Sulfa, dilantin; +MM involvement; death from infection, hypovol/'lyte disturbances
|
|
|
Chicken Pox v Small Pox
|
Chicken pox: lesions in different stages; rash trunk/scalp first, then extremities; Small pox face/extremities first, then trunk
|
|
|
EM vs Urticaria
|
Both better c antihistamines; only urticaria better c epi
|
|
|
Herpes Zoster prodrome
|
1-5d before rash: HA, photophobia, malaise, abnormal skin sensations; rarely fever
|
|
|
Purpura characteristics
|
symmetrical LEs -HSP; Pressure/minor trauma (ITP); distal, then spread centrally -RMSF; bulla/infarctions -DIC; necrotizing ecchymosis - warfarin vasculopathy
|
|
|
Decub Ulcers
|
I non-blanchign erythema (padding/posotioning); II epiderm/dermis (local debride, w->d dsg); III subcut like II, + adjunctives; IV deep fascia/musce/bone (surg)
|
|
|
Erythema Infectiosom
|
Fifth disease, slapped cheek c circumoral, eyelid sparing, school aged, 1-2 days later: rash on trunk/limbs central clearing
|
|
|
Kawasaki
|
concurrent conjunctivitis, straberry tongue (lg papillae), periph edema/erythema; fever and rash at same time
|
|
|
Scarlet fever
|
F, ST, HA, vom, abd pain; rash 1-2 days later starts neck/axillae/groin; sandpaper feel; pastia's lines in AC fossa and axialllae, circumoral pallor, GABHS
|
|
|
Roseola infantum/exanthema subitum
|
well-appearing infant, high temp (? Febrile SZ), then rash on neck, trunk, buttocks c defervescence, HHV-6
|
|
|
Symptomatic Hyponatremia tx
|
Vol (L) of hypertonic saline = 4*0.6(kg)/(513-Na); approx 400-450 ml over 2 hrs
|
|
|
Cerebral edema in kids c DKA
|
low init PCO2; bicarb use; hign BUN; no relation to glu, Na, insulin bolus
|
|
|
Anion gap
|
Na-Cl-HCO3; nl <=12
|
|
|
Osmol gap
|
2*Na + Glu/18 + BUN/2.8 +
|
|
|
Thyroid storm tx order
|
Propranolol (esmolol in COPD)- blocks effects, PTU-blocks synthesis, Iodine (Li if allergic)-blocks release, dexamethasone
|
|
|
Adreanl Crisis tx
|
Fluids, glucose, dexamethansone(better than hydrocort: no CST effect), later:fludrocotisone
|
|
|
Hypothyroidism-inducing meds
|
Li, amiodarone, Iodine and contrast, sulfonamides
|
|
|
HHNS v DKA
|
No ketosis, no acidosis, higher BS, assoc c NIDDM, more gradual onset, higher Na, more volume loss, higher mortality
|
|
|
Bite prophylaxis in PCN allergic
|
Cefotaxime or Ceftriaxone (dogs and cats); Clinda AND bactrim (humans)
|
|
|
Heat stroke tx
|
ER - evaporative; field - ice water immersion
|
|
|
Hypothermia cutoffs
|
definition: below 35°C; shivering stops below 32°C, pupils fixed and dilated below 30°C
|
|
|
Insect bite: target rash, hypertension
|
Black widow; tx: opioids, benzos; IV NTG/nipride if necessary; antivenin if no horse serum allergy
|
|
|
Rattlesnake
|
AKA pit viper, crotaladae (coral snakes=elapidae); Sx: local tissue destruction, coagulopathy, neuro sx(metallic taste) tx: antivenin
|
|
|
Hereditary angioedema
|
not IgE mediated; only Epi helps (subQ or neb); nonpruritic, but painful
|
|
|
Otitis externa tx
|
ofloxacin ok in perf, kids; no others; suspensions better than solutions; avoid neomycin, polymixin, acetic acid
|
|
|
Hyphema
|
inc risk in SCD; complicaton: glaucoma; tx: topocal Bblockers and A-agonists, IV mannitol, carbonic anhydrase inhibitor (not in sickler: increases IO sickling)
|
|
|
Sinusitis complications
|
Cavernous sinus thrombosis; orbital/periorbital cellulitis; Pott's Puffy Tumor; Subdural empyema, meningitis
|
|
|
Unilateral Neck mass etiol
|
Kids (benign: hemangioma, congenital cysts, LNs); Young adults: Mono, congenital, Hodgkin's, Lymphoma; Older adults: Sq cell mets to nodes, other CA (75%)
|
|
|
ANUG tx
|
chlorhex rinse; debridement; flagyl, soft, protein-rich diet; herpesgingivostomatitis: smaller, vesic lesoons, less bleeding, more systemic, no interdental pap involved
|
|
|
Malignant otitis externa
|
Elderly, diabetic, HIV; granualtion tissue on the floor of the canal; Pseudomonas>aspergillus>>staph, strep. (HIV: usually not pseudomonas, worse prog)
|
|
|
TTP
|
Pentad: low plts, MAHA, renal impair, neuro impair, fever; precip: preg (T2), HIV, lupus; INR normal (no fibrin: unlike DIC); Tx: Plasma exchange, NO plts, support
|
|
|
Basophilic stippling
|
lead poisoning
|
|
|
Hypersegmented PMNs
|
Vit B12 & folate deficiency
|
|
|
Multisystems, bleeding, thrombosis
|
DIC, TTP, HUS: all have schistocytes
|
|
|
HUS vs TTP
|
Both: anemia, MAHA; HUS: kids, predom renal sx, suportive tx, good prog; TTP: adults, low plts, predom CNS Sx, Tx: plasmapheresis, 'roids, poor prog
|
|
|
ITP vs TTP tx
|
ITP: IVIG, 'roIds; TTP: exchange Transfusions, sTeroids
|
|
|
HUS vs HSP
|
kids c MAHA, RF, usually precip by bloody diarrhea; vasulitis c abd pain, palp, purp and hematuria, precip by URI - may cause bloody diarrhea
|
|
|
Splenic seq vs Aplastic crisis
|
Splenic seq: elevated retics; Aplastic: low retic
|
|
|
G6PD deficiency
|
10% black males; triggers cause hemolytic crisis, 'Heinz bodies" (RBCs c precip HgB); Triggers: infection, fava beans, macrobid, pyridium, dapsone, sulfa, malarials
|
|
|
Methemoglobinemia
|
Shoes, sausages; Cyanosis: Oxidized iron in HgB doesn't bind O2; nitrates/ites, benzocaine, sulfa, dapsone, pyridium; Pox=85%; chocolate; left shift; tx: IV methylene blue
|
|
|
Hemophilia A
|
Classic hemophilia; Factor VIII, delayed bleeding after trauma; Tx: Factor VIII units = wt/2*% desired (100: nose, GI, CNS, else 50); VIIa if inhibitors
|
|
|
Hemophilia B
|
christmas disease, Factor IX; Factor IX units = wt*desired (100: nose, GI, CNS, else 50); VIIa if inhibitors
|
|
|
Prolonged PT
|
Liver disease, Vit K deficienccy, warfarin
|
|
|
Prolonged aPTT
|
Hem A, Hem B, vWD, heparin
|
|
|
Von Willebrand Disease
|
inadequate vWFactor: Inc BT, nl plt, PT, PTT(or sl prolonged PTT); Type I: dec vWF; II: dysfunctional; III: none
|
|
|
vWD Tx
|
DDAVP (I) releases vWF and VIII from vasc endo cells (all others from liver); Factor VIII conc c vWF (II, III, serious bleed); Cryoprecip if no other (infectious risk)
|
|
|
Anaphylaxis in pt on B-blockers
|
add glucagon to tx; reverses B-blockade that makes epi less effective
|
|
|
Reiter's Syndrome
|
arthritis (lover's heel, sausage digits), urethritis, conjunctivitis; typically WM, 15-35, 2-6wks after chlamydia, shigella, salmonella,campy; tx supportive
|
|
|
Ankylosing Spondylitis
|
young males, chronic back pain, sacro-iliitis
|
|
|
SLE
|
familial; black women; fever, rash (after sun), arthritis (MCP, PIP), multiple other Sx; Tx; Steroids
|
|
|
West Nile Virus
|
most asympt; flu-like, c rare: enceph, menin, acute flaccid paralysis (assymet, prog, dec reflexes, bowel/bladder, but no sens), long-term seq; LP: asceptic men
|
|
|
Strongyloides stercoralis
|
enters skin (pruritis, eryth rash); migrates to intestine; Fatal hyperinfection when immunocompromised: HIV, riods, etc
|
|
|
Hand-Foot-Mouth
|
vesicles on palms, soles, buttocks; ulcerating vesicles anterior mouth, not lips; Coxsackie A16; comp: orchitis, myocarditis, puln edema, ascept men
|
|
|
Unpateurized milk/cheese
|
Listeria; tx: ampicillin
|
|
|
Raw seafood
|
Vibrio; may cause severe septicemia in IC, especially liver disease; Tx:doxy, ceftaz, cefotoxime, FQs. (Norwalk also c seafood; tx: supportive)
|
|
|
Malaria
|
Falciparum is worst: Lact acid, hypogly, pul edema, DIC; Cerebral Malaria (20% mort); Blackwater fever (hemol ->ARF); Tx: Quinidine+Doxy, Exchange Tx
|
|
|
Onchocerciasis
|
filarial, River Blindness, black flies; skin nodules, lg numbers of larva -> eye; Tx prednisone (prevents tox from worm death) & Ivermectin
|
|
|
MRSA
|
sports teams, jail; TX: bactrim, rifampin
|
|
|
Relapsing fever
|
borreliosis, tick-borne spirochete; eschar at site, then F/C, myalgias, arthralgias;
Tx: doxy or erythro x 10 days |
|
|
Babesiosis
|
summer, northease, ixodes ticks, malaria-like protozoan invades RBC -> HA. Maltese cross on smear, severe in splenectomy; Tx: quinine+clinda; Ex TX
|
|
|
Ottawa Knee rules
|
Xray if any of: can't walk 4 steps(regardless of limping), can't flex at least 90 deg, tender fibular head, age 55+ (valid for ages 2 and up
|
|
|
Ottawa Ankle rules
|
Xray if any of: can't walk 4 both at time of inj and in ER, tenderness along posterior distal 6cm of tib, fib, or tips of lat or medial malleolus
|
|
|
Carpal tunnel
|
Pain, paresthesia, weakness in median dist; thenar atrophy, Tinel ( tapping on median n), Phalen (hyperflexion of wrists back-to-back )
|
|
|
Gonococcal tenosynovitis
|
Teen girls; several wks after sexual exposure; wrist, hand, ankle
|
|
|
Felon in fish handler or IC
|
Aeromonas hydrophilia (gram neg) tx: FQ
|
|
|
Psoriatic arthritis
|
usually PIP, DIP; sometimes SI joint
|
|
|
Back pain instructions
|
Activity as tolerated; NSAIDs relaxers scheduled, not PRN; PT delayed several weeks
|
|
|
Rhabdo tx
|
fluids: if CK > 6000, acidemia, dehydration or underlying renal disease: urine alk after volume restored; loop diuretics, mannitol (Ca if hyperkkalemic)
|
|
|
Soft-tissue calcifications
|
skin-popping, underlying fx, dermatomyosisits (rash and prox muscle weakness); myositis ossificans (arm, thigh, periph @metaphysis) v osteosarcoma centrally @ epiph)
|
|
|
CT v GRE MRI in acute stroke
|
equivalent for identifying acute hemorrhage; MRI better for detecting hemorrhage in ischemic CVAs
|
|
|
ALS
|
Upper and lower motor neurons: extremity weakness, dysarth/phagia, spasticity, hyperreflexia; normal sensation
|
|
|
Tick paralysis
|
female dermacentor tick; ascending: mimics GBS, but no sensory sx
|
|
|
Familial periodic paralysis
|
extremity weakness; no CN, sensory, or mentation changes
|
|
|
MG
|
Abs to Ach receptor; bulbar, facial, proximal weakness; no sensory sx
|
|
|
MCA infarct
|
most common; contralateral motor/sensory: F, A>L; Aphasia if dominant hemi; neglect, dysarth in non-dom (left is dom in R and 80% of L), homonymous hemianopsia
|
|
|
Basilar artery infarct
|
severe quad, coma, locked-in (pons) - upward gaze only
|
|
|
Carotid dissection
|
sudden ALOC, contralateral motor and sensory
|
|
|
Lacunar infarcts
|
isolated motor OR sensory; associated c Htn
|
|
|
Post Cerebral Art infarct
|
Predom visual: HH; minimal motor abnormailities; no aphasia; severe sensory; memory loss, hallucinations
|
|
|
PICA (lat medullary) infarct (X=P/T)
|
Wallenberg S.: Ipsi CN V (face: P/T, corneal reflex); Descending Symps (ipsi Horner)l Lat Spino-Thal (Contra extremity P/T); Vestib (nystagmus)
|
|
|
Anterior Cerebral Artery infarct
|
Contralat L>F,A ; minimal sensory; altered judgement
|
|
|
Vertebrobasilar infarct (X=M)
|
ipsi CN c contra weakness; drop attacks
|
|
|
Sjogrens
|
F>>M, dry eyes, dry mouth; multiorgan problems; similar to SLE, RA
|
|
|
Pseudotumor Cerebrii (Idio Intracran Htn)
|
dec CSF uptake; fat, young, F; HA, vision changes, N/V, dizzy; CN VI, pappiledema; CT: small vents, big cisterna magna; LP: inc pressure; Tx: diamox, LPs
|
|
|
Butyrophenones
|
Haldol, droperidol; cause drug-induced Parkinson's aka EPS, dystonia due to dopamine block, xs cholinergic
|
|
|
Parkinson's drugs
|
levo-dopa (precursor); carbidopa (enzyme inhibotor); dopamine agonists (bromocriptine, pergolide); MAO-B inhibitor (selegiline); antichol (benztropine)
|
|
|
SAH etiol
|
saccular (berry) aneurysm
|
|
|
Simple febrile SZ
|
<15 min; 6m-5y; one/24hrs; well-appearing c normal neuro after post ictal; recurrence risks: age<12-18m, short duration of fever, lower fever, Fam hx
|
|
|
Febrile SZ LP indications
|
<12-18mos; irritable,lethargic, dec feeding pre-ictal; post-postictal AMS; menineal s/s; current /recent Abx; focal sx; Sz > 15 min; 2 or more SZ/24h
|
|
|
Empiric meningitis therapy
|
3GCeph + Vanco (+ampicillin in young and old)
|
|
|
Drugs in breastfeeding women
|
Bad: ergotamine (V/D/SZ in baby); Good: Morphine (very low concentrations in breast milk)
|
|
|
Trichomonas vaginalis
|
profuse, frothy, yellow-green d/c; flagellated parasite; Exam: vag walls erythem, edematous, tender; Dx: seen on wet mount; Tx: metronidazole
|
|
|
Emergency contraception side effects
|
Minimize by using progestin-only
|
|
|
Molar pregnancy
|
Sx: T1, T2 bleeding; size, HCG> dates; pass "grape-like cluster"; hyperemesis, hyperthyroid, pre-eclampsia, PE; US: "snowstorm"; complete mole: inc risk of malig
|
|
|
HELLP vs TTP
|
both c "LP"; TTP: neuro, renal sx, nl antithrombin III, 50% occur earlier than 24wks; tx: pheresis, roids, antiplt meds; HELLP: inc LDH, RUQ pain, almost always T3, Tx: Mg, roids, delivery
|
|
|
Hemolysis
|
schistocytes, increased LDH, bilirubin
|
|
|
Positive direct Coombs
|
hemolysis caused by immune process
|
|
|
Contrast-induced renal insufficiency
|
ATN; Protective: fluids, HCO3, NAC(2d before!); inc Cr in 3d, recovery by 10-14d
|
|
|
Contrast & Metformin
|
renal insuff -> inc metformin levels -> inc risk of DKA; hold for 48 hrs
|
|
|
Post-transplant renal failure
|
Increased cyclosporine level: drug-induced nephrotox; normal level: acute rejection (tenderness at graft site, increased BP, Cr, wt, edema,
|
|
|
Balanitis - Balanoposthitis
|
inflammation of glans; inflammation of glans and foreskin
|
|
|
SBP in PD
|
Cloudy fluid, abd pain, fever; Dx: >100 WBC, 50%neutrophils, or positive gram stain
|
|
|
Peds UTI presentation
|
neonate - sepsis work up; pre-school - abd pain, vom, no diarrhea, enuresis, accidents; school-age: like adults
|
|
|
Renal failure: Ca - PO4
|
RF -> dec PO4 excretion -> Inc PO4 levels; Ca x PO4 > 72 causes systemic calcifications: pseudogout, finger/toes/cardipulm vasc; tx: PO4-binding gel, low Ca dialysate
|
|
|
Priapism drugs
|
Cause priapism: trazodone(#1), hydralizine, CCb, chlorpromazine, SSRIs (venlafexaine -Effexor), ED tx (inj, PO); TX: terbutaline subcut, sudafed, alpha ag inj
|
|
|
Dialysis shunt complications
|
#1 - Clot, infection, steal syndrome, hemorrhage (tx: protamine .01mg/U heparin or 1:1 for enoxaparin, DDAVP stimulates plts, fluids, blood prn)
|
|
|
Testicular torsion
|
peak = 13yo; inc risk c bell-clapper deformity (tunica vag doesn't fix the testis normally; elevated; absent cremaster; no relief c elevation (prehn sign: epidid)
|
|
|
Conversion disorder
|
Women, lower class, M>S, La Belle Indifference NOT sens or spec; no insight; wide differential (SLE, MS, hyperthyroidism);
|
|
|
Wernicke's Syndrome
|
Confusion, ataxia, ocullomotor, TX: lg doses of thiamine
|
|
|
Anorexia
|
begins in adolescence, personality d/o's (O-C); low wt, fear of overweight, absence of 3 menses; rarer than bulimia
|
|
|
Bulimia
|
strict dieting, binge eating, purging, excessive exercise, fasting, overconcern c body shape
|
|
|
Wells PE Criteria
|
Sx of DVT; HR>100; Immob or surgery w/I 4 wks; h/o previous DVT or PE; hemoptysis; malig w/I 6 mos or palliation
|
|
|
PE EKG findings
|
tachy, RAD, p-pulmonale, RBBB, S1Q3T3, TWI V1-4
|
|
|
PE CXR findings
|
common, non-specific: elevated diaphragm; less common, nore specific: Hampton's hump (pleural-based wedge), Westernark (dec vascularity distal to PE)
|
|
|
False-positive D-dimer test
|
Trauma, pregnacy, recent surgery, stroke/MI, infection, new line, Inflammatory disease (SLE etc)
|
|
|
Heparin dose in PE
|
80U/kg bolus, then 18U/kg/hr or enoxaparin 1mg/kg q12h
|
|
|
Asbestosis
|
CXR: early: lower and periph; late: middle/upper; Associated Cas: Sqamous, adenocarcinoma; mesotheliomas
|
|
|
Mesotheiomas
|
asbestos-related; not related to tobacco; 50% metastasize
|
|
|
Primary Spont PTX associations
|
Tall, male, smoker, MVP, Marfan, NOT exertion (#1 In secondary: COPD)
|
|
|
Acute chest syndrome in SCD
|
CP, T, ↑RR, wheeze/cough, new infiltrate of one complete lung segment; infection (chlamydia, mycoplasma); infarction, fat emboli
|
|
|
CXR in emphysema
|
hyperinflation, decreased vascular markings, small cardiac silhouette, flat diaphragm,increased retosternal space, bullae
|
|
|
Bronchiectasis
|
medium airways at segmental level; Viruses (adeno, flu), bacteria (Staph, klebs, pseud, H flu, myco); purulent cough, hemoptysis
|
|
|
Fat embolism
|
long-bone fx's; can enter systemic circulation; petechial rash on UPPER body; low platelets early; (fat in urine NOT specific); no heparin; steroids
|
|
|
Mediastinal disease
|
Acute mediastinitis: esoph perf, sternotomy; chronic: TB, histo, sarcoid; Hamman crunch: left lat recumbant; Ba useful for posterior mediatinal eval (esoph…)
|
|
|
Cystic fibrosis
|
recess, w>b, exocrine abnormal; Early: S Aureus, H flu; Late: Pseudomonas, aspergillus, non-TB myco; CXR: hyperinflation esp RUL; PTX, hemopt, rect prolapse, intuss, decreased Na, Cl, K
|
|
|
Atypical pneumonias by age
|
<40: Mycoplasma; Elderly: Legionaella
|
|
|
Croup tx
|
Oral dex = IM, epi nebs: both help; cool mist: no help
|
|
|
Croup vs bronchiolitis
|
Croup: #1=parainfluenza, upper airway, bark like a seal, steeple sign, tx: dex, epi nebs; Bronchiolitis: #1=RSV, lower airways, retract/flare, tx: O2, racemic epi, no steroids
|
|
|
Primary spont PTX tx
|
stable: observe if <20%; resorbs at 1-2%/day (3-4x faster c O2)
|
|
|
Post Lung transplant infections
|
PCP proph c septra; bacterial in first 3 mos; #1 viral = CMV; aspergillus: invasive disease
|
|
|
Asthma deaths
|
systemic steroids, low S-E, urban, black, female, 15-34, at night
|
|
|
Lung abscess
|
Immunocompetent: anaerobic; compromised: aerobic (not strep); lower lobe basal segs, upper lobe post segs; anterior: inc CA risk; communicates c bronchiole
|
|
|
Large vessel vasculitis
|
Tx: prednisone; Giant Cell arteritis: carotid artery: head, face, vision; Takayasu's: aorta: finger ischemia, arm claud
|
|
|
Medium vessel vasculitis
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PAN: skin, nephritis, mes isc; Wegener: sinus, pulm, nephritis; Behcet: oral & genital ulcers, eye sx; microscopic polyangitis: pulm, nephriris; tx: cyclophos, pred
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Small vessel vasculitis
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HSP: palp purp, abd pain, n/v/d, hematuria (pred); Goodpasture: cough, dyspnea, hemopt, GN (pred, cyclophos, plasmapheresis
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ARDS
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caused by trauma, infection aspiration, mult drugs; CXR: bilat diffuse infiltrates, heart WNL; tx: low TV (6ml/kg) vent; no steroids
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Intubation and asthma
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ketamine, propafol bronchodilate; TV= 6-8ml/kg (nl=8-10); RR=8-10/min (nl=10-12); I:E = 1:5; Insp flow rate 80-100 (nl= 60L/min) Pplateau <30
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Male breast CA
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testicular abnormalities, Klinefelter, FH, nipple d/c, Jewish; not a/w gynecomastia; Most: painless subareolar mass;
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Peds pneumonia tx
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0-3w amp and gent; 3w-3m erythro/zith; 4m-4y amox; 5-15 ertyth (doxy >8); can sub/use IV cefotaxime & add vanco to all if sick
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Adult pneumonis tx
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out-pt <60: macro or doxy; >60 or in-pt: (macro&ceph) or FQ; ICU
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Hydroflouric acid
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rust remover, glass etching, semiconductors; delayed sx = lower conc; pain out of prop; acidosis, hypo-calcemia, -magnesemia (bind to F); hyperlkalemia; Tx: Ca Gluconate
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Warfarin effects
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blocks Vit K-dependent factors: II, VII, IX,X, and anticoag factors Prot C and S; initial increased thrombogenesis early (Prot C def): skin necrosis (3-8d)
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Warfarin interactions
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most block coumadin metabolism, increasing INR; exceptions: antacids, antihists, antipsych/anxiety, OCPs, barbs, non-dil anti-SZ
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GHB OD
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identical to pure benzo, but suddenly awake
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benzo/opiod urine screen false negative
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lorazepam; fentanyl, meperidine, methadone, propoxyphene, tramadol
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Moonshine
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lead poisoning; encephalopathy (kids>adults) (inhaltion in industrial); motor, not sensory neuropathy: wrist drop; dx: levels, "basophilic stippling" tx: chelation
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Valproic acid lab effects
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OD: met acid, hyperNa, hypoCa; therapeutic and OD: elevated NH3
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NMS v serotonin syndromesx
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both: autonomic instability, rigidity; NMS: slow onset, bradykinesia "lead pipe"; Serotonin: hyperkinesia, worse in LEs, rhabdo; hyperreflexia and clonus can coexist
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NMS v serotonin syndrome tx
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NMS: , benzos, dantrolene, bromocriptine, paralysis (non-depol: roc, vec); serotonin: cooling, cyprohepatidine
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Ketamine
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dissociative: blocks aud/visual, painful: analgesia, amnesia, sedation; airway preserved; inc HR, BP; rapid onset, 1.5m/k IV 4-5 IM; atropine to dec secretins, benzos for emergence, transient laryngospasm
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Li tox
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confusion, tremor, hyperreflexia; DI, not DM; serotonin synd, not NMS; tox precip by RF or dehydration; acute: GI>CNS; chronic: opposite; fluids, HD, no phenytoin (dec excretion of Li)
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Cat vs Dog bites
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Cats: virulent P multocida; usually not polymicrob, all get abx; dogs: non-virulent, polymicrob, prophylax only hands, DM, ec
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Burn classifications
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Mod risk in 10-50 yo c partial thickness= 15-25%; 10-20% in <10, >50yo; full thick 2-10%
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Brown-Sequard
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penetrating trauma; hemisection; ipsi motor, vib/position; contralateral pain/temp
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Anterior Cord Syndrome
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loss of motor, pain/temp; preservation of vib/position
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Cauda equina syndrome
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bowel/bladder dysfuntion, perineal anesthesia, variable LE motor/sens
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GCS
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Motor: none, decerbrate, decorticate, withdraw, localize, follow; Verbal: none, moan, nonsense, confused, oriented; Eye: none, pain, verbal, spont
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Parkland Burn formula
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4ml * %BSA * kg. Give 1/2 in first 8hrs, rest over next 16.
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Argyl Robertson pupil
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prostitute's pupil (syph); accommodate, but don't react (to light); normal constricts for both
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NEXUS C-spine
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Low risk: no midline tenderness, alert, not intoxicated, no focal sx, no distracting injury
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TBI tx
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NO steroids; Maintain BP: fluids OK; Hypervent to 30-35 if other measures fail
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Traumatic TM rupture
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Blunt: usually anterior, inferior: no f/u; superior/posterior: ENT w/i 24 hrs; no swimming; flying OK
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Traumatic Aortic teat CXR
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wide mediastinum, obscured aortic knob, apical capping, wide paratracheal stripeesoph displaced to right, inferior displacement of left mainstem; not R1-2 fx
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Basilar Skull Fx
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most common:: temporal bone, external canal, and TM c dural tear
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Types of blood for transfusion
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Leukocyte-poor RBCs (previous (non-hemolytic) febrile; Irradiated (neonates, imm-compromised);
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IO complications
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Prolonged us (>1-2d): cellulitis; D50: osteomyelitis; NaHCO3: sterile bone inflammation
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Preferred IO sites
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Adults: distal tib, prox to medial malleolus; Peds: anteromedial surface of proximal tibia
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Airborne precautions
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measles, varicella, TB
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Ramsay Hunt
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H Zoster infection of geniulate gang; facial pain/paralysis, tinnitus/hearing loss, lesions on TM/canal; Tx: prednisone, antivirals
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LP: Increased Protein
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MS, GBS
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Neuromuscular junction diseases
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No sensory findings: MG, Eaton-Lam, Botulism, Tick paralysis
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