Pance Review

Front 1

Dx and antibx tx for cholecystitis

Back 1

dx: US #1, HIDA if necessary
tx: cefazolin, cefoxitin 1.5g IV one dose

Front 2

Charcots Triad

Back 2

cholangitis:
1. fever/chills
2. juandice
3.RUQ pain

Front 3

Reynold Pentad

Back 3

charcot triad + hypotension and altered mental status

Front 4

Dx of Cholangitis

Back 4

RUQ u/s if ERCP is not available
-elevated LFTs usually

Front 5

DDx of episgastric pain (name 5)

Back 5

Acute pancreatitis
MI
GI bleed
Peptic ulcer dz
GERD

Front 6

Ransons Criteria for Pancreatitis
5 items

Back 6

1. glucose >200
2.Age>55
3.LDH>350
4.AST>250
5.WBC>16,000

Front 7

DDx for lower quadrant/pelvic pain
9 items

Back 7

1. appendicitis
2.ovarian torsion
3.ovarian cyst rupture
4.ectopic
5.PID
6. Hernia
7.neprholithiasis
8.diverticulitis
9.uti

Front 8

3 signs done on PE for appendicitis

Back 8

1. Psoas: pain with active flexion against resistance or passive extension of R leg
2. rovsing: RLQ pain with palpatin of LLQ
3.obturator: pain wiht internal rotation of the flexed R hip

Front 9

Dx study for appendicitis

Back 9

Abdominal CT with oral contrast

Front 10

antibx tx for appendicitis

Back 10

cefoxitin or cefotetan 2 g IV within 2 hours of surgery

Front 11

Dx test for ovarian torsion

Back 11

Pelvic U/S with doppler is test of choice

Front 12

Direct vs Indirect Hernia

Back 12

Indirect: contents pass through internal inguinal ring and canal, protrude lateral to inferior epigastric vessel

Direct: contents protrude medial to inferior epigastric vessels through Hesslebach triangle

Front 13

Outpatient antibx tx for diverticulitis
(two drug regimen)

Back 13

Bactrim DS po BID or Cipro 500-750mg po bid PLUS

Flagyl 500 mg po QID or Augmentin 500/125mg po TID

X 10-14 days

Front 14

inpatient antibx tx for diverticultiis

Back 14

amp 1-3g q4-6hrs, gentamicin 2mg/kg IV and flagyl 1g IV

Front 15

Ruptured AAA triad

Back 15

1. back pain
2. hypotension
3.pulsatile abdominal mass

Front 16

HCO3 is down in _________
and ________ in acid/base disorders

Back 16

metabolic acidosis and respiratory alkalosis

Front 17

hco3 is up in _____ and ______ in acid/base disorders

Back 17

metabolic alkalosis and respiratory acidosis

Front 18

CAUSES OF METABOLIC ACIDOSIS WITH ANION GAP

*MUDPILES

Back 18

Methanol
Uremia
DKA
Paradehyde
iron/isoniaxid od
lactic acidosis
Ethanol
Salicylate OD

Front 19

Causes of metabolic acidosis WITHOUT anion gap

Back 19

Carbonic anyhdrase inhibitor tx
Hyperalimentation
Addisons dz
Renal tubular acidosis
Diarrhea
Fanconi Syndrome

Front 20

Causes of respiratory alkalosis
Chloride responsive (>15)

Back 20

Vomiting
Diarrhea
Diuretic overuse
NG suction
Volume depletion

Front 21

Causes of Respiratory Alkalosis

Back 21

CNS lesion
PRegnancy
Sepsis
High altitude
Salicylate tox
Liver failure
hyperventilation
CHF
PE
PNA
Hyperthyroidism

Front 22

Causes of Metabolic alkalsosi
Chloride unresponsive (Cl<15)

Back 22

Diretic overuse
Bartter syndrome
hypomagnesemia
hyperaldosteronism
liddle dz

Front 23

Name three intial things you would do to manage DKA

Back 23

1. Bolus IV fluids 1-2 L initially, dont overhydrate too fast!
2. 10 units insulin at first, then 0.1mg/kg insulin drip if needed, stop drip if glucose reaches 250
3.KCl with fluid if less than 4.5 (will be elevated at first, then drop once acidosis is corrected, give after correction)

Front 24

Sodium Correction with hyperglycemia

Back 24

For Q 100mg/dL glucose more than 100, Na+ drops 1.6meq from 140.

ex Glucose-200-->Na+=138.4

Front 25

Causes of hyponatremia of Urine Na+ is > 20meq
(Na lost renally)

Back 25

Hypovolemic: Diuretic overuse, salt wasting nephrophaty, mineralocorticoid def.
Euvolemic: SIADH, hypothyroidms, glucocorticoid def.
Hypervolemic: ARF/CRF

Front 26

Causes of hyponatremia with Urina Na < 10meq (implies extrarenal Na loss)

Back 26

Hypovolemic: vomiting, diarrhea, NGT drainage, third spacing
Euvolemic: Psychogenic polydipsia, dilution of infant formula
Hypervolemic: Decrease effective IVF, CHF, Cirrhosis, asictes, nephrotic syndrome

Front 27

Tx of hyponatremia:
1.hypovolemic cause
2. euvolemic cause
3.hypervolemic cause

Back 27

1. hypovolemic: volume and Na+ restoration with NS, correct over 24 hours
2. restrict free water intake
3. fluid restriction, lasix 10-40mg IV X 1to prevent or treat volume overload

Front 28

central pontine myelinolysis

Back 28

occurs from excessvely rapid correction, consists of dysarthria, sx, quadriparesisi and hypotension

Front 29

RBC cast in ARF indicates _________

Back 29

glomerulonephritis

Front 30

WBC cast in ARF indicates _________

Back 30

pyelonephritis

Front 31

granular cast in ARF indicates _________

Back 31

ATN

Front 32

Fatty cast in ARF indicates___________

Back 32

Nephrotic syndrome

Front 33

hyaline cast in ARF indicates _________

Back 33

dehydration, low renal blood flow

Front 34

Prerenal causes of ARF
(3 main causes)

Back 34

1. Dehydration ( decreased renal perfusion from volume depletion)
2.postsurgical third spacing (volume redistribution)
3.CHF (decreased cardiac output)

Front 35

Intrinsic causes of ARF

Back 35

1. ATN most common
2. neprhotoxic agent ie IV contrast, Aminoglycoside, acute rhabdo
3.vasculitis, hetaic failure, renal vascular thrombosis or embolization
4. NSAIDs, Acute interstitial nephritis from drug exposure ie PCN, NSAIDs, diuretics

Front 36

Causes of Postobstructive ARF

Back 36

1. prostatism, prostate CA, bladder neck obstruction
2.STD hx, urethral obstruction
3. hx of malignancy, late term pregnancy, radiation tx, b/l renal stones
4. neurogenic bladder

Front 37

Fomepizole is drug used for what type of intoxication?

Back 37

methanol/ethylene glycol

Front 38

Causes of Altered Mental Status

*AEIOUTIPS*

Back 38

Alcohol, arrythmia
Epilepsy, encephalopathy, endocrinopathy, electrolyte abnormality
Insulin
Overdose, oxygen
Uremia
Trauma, tumor,thermal
Infection
Psychiatric
Stroke, SAH, SDH, seizure,shock

Front 39

tx of cat/dog/human bites

Back 39

Augementin

Front 40

organism of cat/dog bites

Back 40

Pasteurella multocida

Front 41

organism of human bites

Back 41

Eikenella