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160 Cards in this Set
- Front
- Back
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friction, pressure and shear force cause ulcerations in the foot; which is the most responsible
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shear
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wagner classification
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0: skin intact, osseous deformint
1: superficial ulcer 2: deep ulcer with extension to tendon, bone, lig, joint 3: deep abscess with OM 4: gangrene of FF 5: gangrene of whole foot |
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UT classification
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0-3, A-D
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NPUAP pressure ulcer classification
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1. non blanchable
2. partial thickness 3. full thickness, no bone 4. exposed bone |
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risk factors for DM ulceration (4)
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-peripheral neuropathy (Sensory, autonomic, motor)
-deformity and dec joint mobility -poor glucose control -hx of previous ulcer or amp |
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what causes a DM pt to develop neuropathy
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Two schools of thought
-vascular basis -hyperglycemia |
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sorbinol
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long acting aldose reductase inhibitor that slightly increases NCV
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creatinine clearance formula
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(140-age) x kg /72 x serum Cr
multiply by 0.85 for women N = 90-120 |
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Dm pt is going to OR in the am, he normally gets 25 units NPH in am, 20 units NPH pm; what fluids would you put him on and what insulin dose
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-he gets half his normal NPH insulin dose in AM
-hold his regular insulin to prevent hypoglycemia -start pt on 1/2 D5W and NS at 6cc/hr at 6 am -oral DM agents should be held |
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Somoygi effect
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rebound hyperglycemia following an epidosode of hypoglycemia
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dawn phenomenom
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-early rise in the morning BG that requires inc amts of insulin
-caused by nocturnal surge of growth hormone release |
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tx for hypoglycemia
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IV dose of 25-50 g as a 50% solution
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osteomyelitis
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-infection of the cortex and bone marrow
(osteotitis - infection of cortex) |
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classifications of OM
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Cierny mader (anatomic)
Walvogel (etiology) |
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sequestration
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-dead devascularized bone due to haversian and volkman canal and osteocyte destruction
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involucrum
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-as infection progresses, the periosteum is elevated by purulent material
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cloaca
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-formation seen at the bone periosteal interface to extrude sequestrum and other necrotic material from infected bone (tract)
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when treating DM foot infections with oral abx, what must you consider
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-diabetic gastropathy (alters the absorption of any oral med)
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radiographic stages of charcot (Eichenholtz)
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1. development
2. coalescence 3. reconstruction |
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sanders classification
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1. forefoot
2. tarsometatarsals 3. midtarsal and NC 4. ankle, STJ 5. calc distal to proximal |
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pretibial myxedema
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hyperthyroid
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Leriches syndrome
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-impotence with buttock, calf and back pain
-normally occurs with aorta iliac dz |
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MC site of peripheral aneurysms that dvlp in the LE from arteriosclerosis
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-popliteal artery
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define HTN emergency
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-diastolic pressure > 115 with associated end organ dysfunction or damage
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livedo reticularis
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-blueish discoloration of skin from vasospasm of arterioles
-mc on legs -worse in cold exposue |
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virchows triad
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-endothelium injury
-stasis -hypercoagable state |
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what does normal ventilation adn dec lung perfusion suggest
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PE
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gold std for dx of DVT
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-venography (duplex is new std)
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gold std for PE dx
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-pulmonary angiography
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atelectasis account for what % of post op fevers
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90%
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why do we care about post op atelectasis
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-if persists for >72 hours, pneumonia may develop
-prevent with incentive spirometry |
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what is the risk of placing a pt with COPD on high flow O2
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-supression of the hypoxic ventilatory drive
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anticoag tx for PE
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-IV heparin until PTT is 2-2.5 times normal
-after a day, warfarin is added unitl INR >2 -consider a greenfield filter in IVC if clot recurs |
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sarcoidosis is MC in what age and race
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AA between 20-40 yo
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signs of TB
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-night sweats
-fever -weight loss -malaise -cough -greenish sputum |
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tx for TB
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INH (can cause neuropathy, pyridoxine loss, lupus like symptoms, anion gap acidosis, hepatitis)
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defining characterisitc of obesity
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20% above height/weight combination
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whar principle hormone protects th body from hypoglycemia
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glucagon
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signs and symptoms of primary adrenal insufficiency
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-fatigue
-weakness -weight loss -anorexia -hyperpigmentation -N/V -orthostatic hypotension |
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MC cause of hyperglycemia seen in the ER
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-insulin reaction in DM pt
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what is the MC cause of secondary adrenal insufficiency and adrenal crisis
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-iatrogenic adrenal supression from prolonged steroid use
-rapid withdrawl of steroids may lead to collapse and death |
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pseudohypertrophy of the calves is characterisitic of which type of muscular dystrophy
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duchennes
-hypertrophy is caused by fatty infiltration of the muscle |
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most common presenting symptom of MS
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optic neuritis (25%)
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MC cause of syncope
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-vasovagal or simple fainting
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toxic dose of naloxone
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-none, narcan is a safe drug
-usual dosage is 0.4-3 mg IV |
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MC pharm cause of allergic reaction
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-PCN
-accounts for 90% of drug reactions and 95% of fatal drug reactions |
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next to PCN, what is the most common cause of allergic rxn
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insect stings
-100 deaths per year |
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erythema nodosum - what is it and what is their distribution
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-red tender nodules under the skin
-symmetrical dstribution on the shins usually |
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tx for erythema nodosum
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-you can only treat the symptoms of pain with NSAIDS or other pain meds
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Lhermitte sign in ankylosing spondylitis
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-sensation of electric shock that radiates down the back when the neck is flexed
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what other dz may produce Lhermitte sign
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-RA
-MS |
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a pt on chronic steroids presents with weakness, depression, fatigue and postural dizziness; what is the pathology and tx
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-adrenal insufficiecy
-give large doses of steroids |
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if adrenal insufficiency is suspected, what test should be performed
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-a serum cortisol level should be ordered
-then administer large doses of steroids (dexamethasone) |
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what cardiac complication comonly occurs with SLE, Juv RA and RA
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pericarditis
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how should a new monoarthritis be approached in a pt wtih RA
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-assume septic until proven otherwise
-the risk for infection is higher in a joint that has previoulsy been injured or affected by arthritis |
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what painful bone abnormality often complicates steroid therapy in pts with RA or SLE
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-AVN of femoral head or bones of the foot
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what dz produces red plaques with dusky centers and red borders resembling bulls eye targets
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erythema multiforme
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what can cause erythema multiforme
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viral or bacterial infections, drugs and malignancy
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what spinal lesions can produce shin splints
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-compromise of L5 and S1
-lesion may also cause calf pain and mimic DVT |
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pt with back pain who cant walk on their toes
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cant PF, so S1
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pt with back pain who cant walk on his heels
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cant DF, so L5
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MC cause of renal failure
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NIDDM
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below what platlet count is spontaneous hemorrhage likely to occur
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<10,000
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how would you treat an OD of warfarin
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-FFP or vitamin K
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only coag factor not synthesized by hepatocytes
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factor 8
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what 4 hemostatic alterations are seen in pts with liver disease
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1. dec protein synthesis leading to coag factor deficiency
2. thrombocytopenia 3. inc fibrinolysis 4. vit K deficiency |
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von Willebrands dz
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-autosomal dominant disorder of platelet fxn
-interfers with factor 8 -pts are at risk fro mucous membrane bleeding and bleeding from wounds |
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when using a doppler, how do you differ arterial from venous sound
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-arterial is sharp, brisk changes in pitch from systole and diastole phase
-venous flow are lower pitched and more consistent through cardiac cycles (monphasic) -venous are more compressible |
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accuracy of physical exam for dx of DVT
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50%
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what substances inc PVC's
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caffeine
alcohol tobacco |
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animal bite wound bacteria
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-pasteurella
-staph aureus |
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MC cause of secondary lymphedema
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malignant metastasis to lymph nodes
-lymphatic fibrosis secondary to sx is another cause |
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under what conditions does trench (immersion) foot occur
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-extermity is exposed to days of wet, cold conditions at temps above freezing
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describe pernio (chilblains)
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-exposure to temps above freezing for extended time
-pt dvlps superficial ulcers |
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reverse heparin
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-protamine sulfate
-1mg for 100 units heparin |
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an absent knee jerk involves which spine level
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L4
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absent achilles reflex invovles which spine level
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S1
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parasthesia of great toe involves which spine level
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L5
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parasthesia of little toe involves which spine level
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S1
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cause of erysipelas
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Group A beta hemolytic strep
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Brudzinksi sign
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-flexion of the neck causes flexion of the knees
-sign of meningitis |
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Kernig sign
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extension of the knees from flexed thigh is met with resistance
-meningitis sign |
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elements of non invasive vascular studies
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-ABI
-arterial doppler waveforms -segmental pressures -PVR -PPG waveforms |
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characteristics of normal waveform
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-triphasic waveforms with rapid upstroke, large amp, dichrotic nothc, rapid downstroke
-the faster the flow, the steeper the wave |
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minimal rate of flow in artery to give an audible signal
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4 cm/sec
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what does the dichrotic nothc in arterial doppler represent
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reverse blood flow
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what is the diff between the tracing made with a unidirectional doppler and that of a bi directional doppler
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-with unidirectional doppler, both forward and reverse flow is seen above the baseline
-with bi directional doppler, forward flow is above the baseline and reverse flow is below the baseline |
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half of all pts with valvular dz present with a definite history of what
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acute rheumatic fever
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MC heart valve affected in valvular heart disease
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mitral valve
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IV drug abusers with valvular heart disease usually have which valve affected
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tricuspid valve
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cause of SBE in IV drug users
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staph
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pt is having an MI, what extra heart sound is heard
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S4 or atrial gallop
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what enzymes are detected in blood after MI
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-CPK rises and falls most rapidly
-SGOT is inc 6-12 hours and peaks in 2-3days -LDH is elevated for longer periods |
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which enzyme seen after MI is an index of myocardial necrosis
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LDH
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what are classic ECG findings seen in the leads overlying the infarcted cardiac muscle
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-significant Q waves in leads ordinarily dominated by R waves
-abnormal ST segment elevation -abnormal inverted T waves |
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two types of HTN
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-essential HTN (unknown cause)
-secondary HTN |
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MC reason a male would have an iron deficiency
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GI blood loss
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polycythemia vera
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-neoplastic myeloproliferative disorder with red cell proliferation
-hyper viscous blood |
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hemophilia A is caused by
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factor 8
-only men are clinically affected |
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what tests confirm hemophilia A
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-prolonged PTT and low factor 8
-bleeding time and PT are normal |
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Christmas disease
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this is hemophilia B
-deficient in factor 9 |
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von willebrands dz
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-hereditary bleeding disorder
-prolonged bleeding time -normal platelet count -prolonged PTT |
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at what platlet level does spontaneous bleeding occur
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<20,000
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causative organism for pitted keratolysis
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corynebacteria
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SWO infecting organism
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T menta
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Madura foot bacteria and clincal presentation
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-weeping granulomas
-sinus tracts of the foot -pseuodoescheria boydii |
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tx for cutanea larva migrans
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topical thiobendazole
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highly contagious form of scabies seen in pts with HIV
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norwegian scabies
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red itchy macules on the LE after walking in a river in upstate NY
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cercarial dermatitis (swimmers itch)
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cause of hand, foot, mouth
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coxsackie virus (commonly A16)
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16 yo boy with asymptomatic umbilicated papules on dorsum of his foot
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molluscum contagiosum
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chromoblastomycosis and what is used to treat it
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long term, tropical, fungal infection of the skin
-tx with itraconazole |
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MC cause of septic arthritis
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-staph aureus
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what abx is contraindicated in pts with seizure history
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-imipenem/cilistatin
(primaxin) |
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what oral antifungal is known to cause bony malformations and CNS defects in fetus when given to pregnant women
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-fluconazole (diflcan)
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what antifungal is known to cause taste disturbances and green vision
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terbinafine (lamisel)
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what malignancy can dvlp in an area of chronic OM
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epidermoid carcinoma
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brodies abscess
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metaphyseal bone abscess surrounded by granulation tissue and sclerotic bone in cases of chronic OM
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erysipelas organism
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group A strept
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what cultures would you order to diagnose an extrapulomnary TB infection of a phalanx
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acid fast cultures
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in what type of infections is eosinophilia seen
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parasitic
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what titers are drawn to aid in the diagnosis of rheumatic fever
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anti-streptolysin O titers
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what antigens are present on the cell membrane of staph that may be diagnositc benefit when cultures are unavailable
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teichoic acid
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you see Oslers nodes and Janeway lesions in this pathology
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infectious endocarditis
-janeway lesions (red or purple spots on palms and soles) -oslers nodes (painful red lesions on palms and soles) |
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name of the lesion a tthe bite of a tick in Lymes disease
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erythema chronicum migrans
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what abx should be used with extreme caution in DM pts on oral sulfonylureas
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sulfonamides; may increase the action of the DM drugs
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why is ceftin (cefuroxime) contraindicated in pregnant pts
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chance of renal tubular lesion formation in the fetus and mother
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what skin manifestation is seen in 2-6% of pts with sepsis secondary to pseudomonas auruginosa
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ecthyma gangrenosum
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in which genetic dz is pseudo infection a common problem
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cystic fibrosis
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infection with fruity odor
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pseudomonas
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pt presents with dystrophic nails that have flecks of pigmentation through the nail plate: which pathogen caused this onychomycosis
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aspergillis niger
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using cierny mader: classify an HIV pt with diffuse OM of foot
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4B
1. medullary canal 2. superficial cortex 3. cortex 4. cortex and medullary A - normal host B - compromised or with risk factors C - tx worse then disease |
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what organism causes lyme dz
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borrelia burgerdorferi
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concomitant use of fluoroquinolone and what drug can cause seizures
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NSAIDs - may inc hte penetration of drug into the CSF
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Cipro and Itraconazole are inhibitors of what enzyme pathway - which makes them subject to some drug interactions
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-inhibit hepatic cytochrome P450 enzyme pathway
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what test is often positive in pts with septic arthritis caused by mycobacterium tuburculosis
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PPD
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55 yo male gardner steps on a rose bush and penetrates the MPJ - what could cause his painful swollen joint
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sporothrix schenckii
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list 2 WBC labeled bone scans
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INdium 111
Tc HMPAO (ceretec) |
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what group of organisms does clinda NOT cover
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gram negeative aerobes
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which group does Levofloxacin not cover
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anerobes
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what organism is the major concern in pts with lymphangitis and cellulitis of the LE
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Beta hemolytic strep (strept agalactia)
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infection in salt water trauma
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vibrio
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in which type of puncture wound of the foot would you see Eikinella corrodens
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toothpick wound
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gardners in their bare feet that are immunocompromised can get a life threatening sepsis from an infection in their feet by waht bacteria
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fusarium (a filamentous fungi)
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how is cutanea larva migrans transmitted to humans
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contact with hook worm infested cat or dog feces on beaches
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what LE manifestations may presents in a person with neisserial meningitis
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palpable purpura on the lower legs
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what color do mycobacteria appear against a dark background on acid fast stains
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yellow or red
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why are anti - diarrheals contraindicated in pseduomembranous colitis
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toxic mega colon (dilated colon)
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Reiters syndrome is associated with what bacterial infection
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chlamydia
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Rocky moutain spotted fever - cause and presentation?
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-Rickettsia ricketsi carried by a tick
-red macules on the wrists and ankles |
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3 causes of steven johnson syndrome
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-Herpes infection
-pregnancy -drugs |
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strawberry tongue is seen in what infection
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-Scarlet fever
-caused by Group A strept (Strept pyogenes) -presents with fever, sore throat and red tongue |
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for what infection are multinucleated giant cells on Tzanck smear seen
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Herpes
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which class of abx interfers with Digoxin
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macrolides (erythromycin, azithromycin and clarithromycin)
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which oral antifungal interfers with tricyclic antidepresents
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Terbinafine (lamisel)
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pts with sickle cell and other hemoglobinopathies have a higher incidence of OM with what organism
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salmonella
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what does gas in the soft tissues indicate
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anerobic infection
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calssic signs of nec fas
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blistering and necrosis are LATE findings
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what is an early clue for diagnosing nec fas
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-pts systemic toxicity in light of what seems to be "ordinary" cellulitis
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what is another name for clostridial myonecrosis
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gas gangrene
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