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684 Cards in this Set
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|
signs of pneumothorax |
absent breath sounds
hyperresonance to percussion decreased fremitus transmitted voice sounds |
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pleural effusion signs
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dullness to percussion
decreased breath sounds decreased fremitus decreased transmitted voice sounds |
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hepatic hydrothorax
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transudate pleural effusion in cirrhotic patient in the right side
1st choice is salt restriction and diuretics if refractory --> TIPS (transjugular intrahepatic portosystemic shunt) |
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mechanical ventilation mechanics
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end inspiratory hold --> compliance/elastic pressure
end expiratory hold --> PEEP resistive pressure --> tube resistance + ventilator resistance + airway resistance peak airway pressure = elastic pressure + resistive pressure + PEEP |
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V/Q scan findings in PE
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perfussion defect without ventilation defect
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PCWP is indicator of what
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left atrial pressure
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aspirin exacerbated respiratory disease
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asthma
chronic rhinosinusitis nasal polyps bronchospasm following aspirin |
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pulmonary embolism treatment
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start heparin and warfarin
stop heparin in 5-6 days and continue warfarin in 6 months |
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new clubbing in COPD
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lung cancer
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hypoxemia
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PaO2 < 80
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normal A-a gradient
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< 15 in young
< 30 in old |
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hypoxemia differential
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increased PaCO2 + normal A-a --> hypoventilation
normal PaCO2 + normal A-a --> decreased inspired O2 normal PaCO2 + increased A-a that does not correct with O2 --> shunt normal PaCO2 + increased A-a that corrects with O2 --> V/Q mismatch |
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pulmonary shunt causes
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pulmonary edema
pneumonia vascular shunt |
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hyperventilation causes
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repiratory depression
anesthesia |
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V/Q mismatch causes
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asthma exacerbation
pulmonary embolism |
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criteria for O2 in COPD
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prolongs survival
PaO2 < 55 SaO2 < 88 hematocrit > 55 evidence of cor pulmonale |
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symptomatic relief in COPD
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antimuscarinic ipatropium and short acting beta agonist
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cor pulmonale
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signs of right heart failure
increased JVD hepatomegaly ascites lower extremity edema w/o evidence of pulmonary congestion |
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most common findings in PE
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hypoxemia and hypercabia
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non-cardiogenic Vs. cardiogenic pulmonary edema
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if PCWP > 18 --> cardiogenic
if PCWP < 18 --> ARDS |
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non-cardiogenic pulmonary edema causes
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ARDS is caused by sepsis, bleeding, pneumonia, toxicity, burns
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ARDS criteria
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acute respiratory distress
inciting condition bilateral infiltrates PCWP < 18 PAO2/FiO2 < 200 |
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diagnosis of PE
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most used is CT
gold standard is angiography V/Q scan also used |
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tension pneumothorax
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sudden shortness of breath
hypotension tachycardia contralateral tracheal deviation ipsilateral absence of breath sounds ipsilateral hyperresonance to percussion |
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complications of PEEP
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tension pneumothorax
alveolar damage hypotension |
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spirometry algorhythm
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low FEV1/FVC --> obstructive --> bronchodilator challenge -->
if FEV1 increases --> asthma no change in FEV1 --> COPD high FEV1/FVC --> DLCO --> if normal --> chest wall weakness if decreased --> interstitial lung disease |
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aspiration pneumonia
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systemic signs + foul-smelling sputum
due to anaerobics treat with clindamycin (anaerobic coverage) predisposed by --> alcohol intoxication dysphagia dementia from impaired epiglottic reflex sedation altered consciousness |
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outpatient community-acquired pneumonia treatment
|
macrolide
if resistance add doxycycline |
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management of DVTs
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first heparin
then warfarin till INR = 2 compression stockings if this fails --> IVC filter |
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MCC of pneumonia in HIV
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pneumococcus
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smoker with Horner
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do CXR for lung cancer
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exudative Vs. transudative pleural effusion
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for exudative 1 or more -->
fluid protein/serum protein > 0.5 fluid LDH/serum LDH > 0.6 fluid LDH > 2/3 upper serum limit if adenosine deaminase --> TB for transudative requires all criteria reversed |
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recurrent pneumonia at same anatomic site
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obstruction until proven otherwise
think CA do CT |
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indications for thoracostomy
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effusion pH < 7.2
effusion glucose < 60 effusion gram stain is positive pus in effusion |
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glucose levels in pleural effusion
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effusion glucose levels are low in -->
RA TB empyema malignancy |
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solitary neck mass in smoker
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probable SCC metastasis from lung
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cirrhotic pleural effusion
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usually on right
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primary pulmonary HTN
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exertional dyspnea
prominent pulmonary arteries right heart enlargement clear auscultation |
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COPD exacerbation management
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O2
inhaled beta agonist and ipatropium broad spectrum antibiotics 2 weeks of steroids |
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CMV pneumonia
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post-transplant patients with pneumonitis and colitis
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bronchiectasis diagnosis
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high-res CT showing cystic dilation of bronchi
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Eaton-Lambert
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SCC paraneoplastic syndrome due to antibodies against pre-synaptic Ca channels
proximal muscle weakness due to decreased Ach release diagnosis with electromyography treatment is plasmapheresis and immunosuppression |
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CO2 narcosis
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from COPD exacerbation
confusion, somnolence, seizures, coma avoid sedatives |
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inhaled O2 theraphy in COPD criteria
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SaO2 < 88%
PaO2 < 55mmHg hematocrit > 55% nocturnal hypoxia |
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low-probability solitary pulmonary nodules
|
serial CTs every 3 months for 1 year then every 6 months for 1 year
do this also if no previous CXR found |
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meniere
|
sensation of ear fullness
vertigo nausea inner ear disease |
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initial work-up of delirium
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confusional state due to organic illness often superimposed on dementia
need to do electrolytes and urinalysis first |
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myasthenia crisis
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often due to excess anticholinesterases
intubate and stop anticholinesterases if respiratory function is compromised |
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functional impairment in dementia
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differentiates it from normal aging
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lacunar stroke pathology
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microatheromas and lypohyalinosis cause obstruction of small vessels
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Lewy body dementia
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cognitive impairment
parkinsonism hallucinations |
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Dejerine-Rousy syndrome
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VPL stroke at thalamus
transient hemiparesis athetosis dysestesia thalamic pain hemihypoesthesia |
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brain death
|
absent corneal reflex
absent gag reflex absent oculovestibular reflex pupils fixed and dilated must be confirmed by 2 physicians |
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new-onset seizures initial test
|
CT
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craniopharyngioma
|
hypopituitarism, headache, bitemporal blindness, benign
diagnosis --> CT or MRI treat --> surgery |
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lacunar stroke syndromes
|
pure motor hemiparesis -->
posterior limb of internal capsule; hemiparesis, mild dysarthria, no sensory or visual loss pure sensory stroke --> VPL nucleus; hemiparesthesia only ataxic- hemiparesis --> posterior limb of internal capsule; weakness more prominent in lower limb with ipsilateral arm and leg incoordination dysarthria-clumsy hand --> basis pons; hand weakness, mild motor aphasia, no sensory loss |
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complex partial seizure Vs. absence seizure
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complex partial has post-ictal state ans usually normal EEG
absence has 3Hz spike-and-wave EEG |
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reversible causes of confusion
|
wernicke encepahlopathy --> thiamine
hypoglycemia --> dextrose opiates --> naloxone hypoxia --> oxygen |
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brain death
|
clinical diagnosis
cortical and brainstem function is lost |
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aura in seizures
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indicates partial seizure with secondary generalization
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neurofibromatosis
|
type 1 --> café-au-lait spots, Lisch iris nodules, neurofibromas
type 2 --> bilateral acoustic neuromas |
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Sturge-Weber
|
port-wine stain on V1 distribution
angiomas seizures contralateral hemiparesis |
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tuberous sclerosis
|
hypopigmented spots
rhabdomyoma kidney angioleiomyoma retardation seizures |
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lumbar pain differential
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metastasis --> constant, at night, subacute or chronic
lumbar strain --> acute, relieved by rest, no point tenderness spinal stenosis --> subacute, relieved by rest compression --> history of osteoporosis or trauma disk herniation --> radiates to butt or leg, in a dermatone, positive leg raise |
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hypertensive encephalopathy
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headache
nausea/vomit visual disturbance seizures if in the setting of preeclampsia --> eclampsia |
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first step in seizure management
|
respiratory rescucitation and secure airway
then anticonvulsants |
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hypertensive intraparenchymal hemorrhage
|
HTN is most important risk factor
most common sites: 1) putamen 2) cerebellum 3) pons focal neurological deficits are sudden and progress in minutes to hours (different from subarachnoid) |
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cerebellar hypertensive hemorrhage
|
2nd most common site
ataxia vomiting occipital headache gaze palsy focal weakness coma no hemiparesis |
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pontine hemorrhage
|
3rd most common site
deep coma paraplegia abrupt onset pinpoint reactive pupils decerebrate rigidity no horizontal eye movements |
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subarachnoid hemorrhage
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suddenly abrupt headache without focal deficits due to aneurysm rupture
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brain solitary metastasis management
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1) surgery
2) radiotherapy if multiple --> whole brain radiation |
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intracraneal hypertension
|
headaches
nausea/vomit blurry vision papilledema cranial nerve deficits somnolence confusion Cushing reflex --> hypertension and bradycardia seen in obese women and isotretinoin intoxication do CT or MRI |
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lumbar spinal stenosis
|
MCC is degenerative disk disease
low back pain and leg pain pain is worse with extension and relieved by lumbar flexion neuroexam and straight leg raise is normal diagnose with MRI |
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multiple system atrophy
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AKA Shy-Drager
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internuclear opthalmoplegia
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demyelination of MLF in MS
conjugate gaze palsy nystagmus |
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cerebellar signs
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ataxia
broad-based gait dysmetria intention tremor difficulty with rapid alternating movements nystagmus |
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dystonia
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sustained muscle contracture
twisting repetitive movements abnormal postures due to typical antipsychotics, metoclopramide, prochlorperazine or primary |
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pseudotumor cerebri work-up
|
diagnosis of exclusion
do MRI first to exclude mass LP for increased ICP all else is normal |
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metastatic cord compression algorhythm
|
1) neuroexam
2) steroids 3) MRI 4) consider radiotherapy |
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tick paralysis
|
ascending paralysis
arreflexia normal sensation no fever remove tick |
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resting Vs. essential Vs. cerebellar tremor
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resting does not involve the head
cerebellar may have nystagmus and gait imbalance essential involves the head |
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wernicke encephalopathy
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altered mental status
gait instability nystagmus conjugate gaze palsy clinical diagnosis give thiamine |
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cavernous sinus thrombosis
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periorbital edema with headache
exopthalmus chemosis papilledema dilated tortous retinal veins usually bilateral with involvement of CN3, 4, 6 and early visual loss from skin, nose infections, sinusitis do contrast CT or MRI treat with IV antibiotics |
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CNS lymphoma in HIV
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altered mental status
EBV DNA in CSF ring-enhancing lesion periventricular mass on MRI |
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pellagra
|
diarrhea
dermatitis dementia |
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acute intermittent porphyria
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abdominal and neurologic signs without rash
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monitor respiratory function in GBS
|
with bedside measurement of vital capacity
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carotid endarterectomy indication
|
obstruction > 60-70% except complete occlusion
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acute back pain management
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if no neurologic deficits --> early mobilization and NSAIDs
if pain persists --> MRI conservative management for 4-6 weeks |
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MRI in multi-infarct dementia
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multiple hyperintesities in T-2 in periventricular areas
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MS treatment
|
acute attacks --> steroids
decrease exacerbations with B-interferon |
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ascites management
|
1) Na and H2O restriction
2) spironolactone 3) loop diuretic < 1L diuresis/day 4) frequent paracentesis 2-4L/day |
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HCV with normal transaminases
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no treatment necessary
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HCV recommendations
|
all shouldreceive HBV or HCV vaccines if not already immune including in pregnancy
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SAAG
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difference > 1.1 is transudate; else exudate
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fulminant hepatitis B
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acute liver failure + encephalopathy
needs transplant |
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post-exposure prophylaxis for HBV
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to patients with unknown immunity
give HBIG + HBV vaccine |
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hepatic encephalopathy precipitating factors
|
high protein diet
alkalosis diuretics GI bleed sedatives narcotics amoinium-containing medications infections portocaval shunt |
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PTT and PT normal values
|
PTT --> 25-40s
PT --> 25-40s |
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inherited hyperbilirubinemia
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Gilbert --> mild unconjugated
Crigler-Nager 1 --> unconjugated > 20 with kernicterus, doesn't respond to phenobarbital Crigler-Nager 2 --> unconjugated < 20, no kernicterus, responds to phenobarbital Rotor --> mixed mild hyperbilirubinemia Dubin-Johnson --> |
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HBV and HCV screening
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blood transfusions before 1986 for HCV and 1992 for HBV
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liver in preeclampsia
|
centrilobular necrosis, hematoma and thrombi
causes distention of liver capsule and RUQ pain |
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acute fatty liver of pregnancy
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mild elevation of liver enzymes with increased PT and PTT
acute hepatic failure |
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hepatic adenoma
|
solitary mass with cells that contain lipids and glycogen
hepatomegaly jaundice increased AP and GGT can progress to hepatocellular CA treat with resection withdraw contraceptives |
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focal nodular hyperplasia of liver
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mass due to hyperperfusion
sinusoids and Kupfer cells |
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hydatid cyst of liver
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echinococus
hepatomegaly RUQ pain nausea/vomit calcified cysts with fluid and budding cells |
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causes of ductopenia
|
PBC
failed liver transplant Hodgkin graft Vs. host disease |
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acetaminophen toxicity pathology
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centrilobular or diffuse liver necrosis
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alcoholic hepatitis pathology
|
steatosis reverses with alcohol cessation
hepatocyte swelling and necrosis mallory bodies and neutrophil infiltrate |
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hepatitis B chronic pathology
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hepatocellular injury
reactive sinusoidal changes |
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liver function tests
|
PT for function
transaminases for destruction of tissue |
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liver metastasis
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firm hepatomegaly
RUQ pain increased liver enzymes is mild MCC is colon CA |
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conjugated hyperbilirubinemia
|
conjugated is filtered by kidney and causes coluria
due to Rotor |
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cirrhosis pathology
|
regenerative nodules
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choledocal cyst
|
congenital anomaly of billiary ducts
jaundice light-colored stools recurrent pancreatitis do ultrasound followed by CT or MRI |
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HEV infection
|
similar to HAV
can progress to fulminant hepatitis in pregnant women no chronic progression |
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non-alcoholic fatty liver
|
insulin resistance leads to increased fat deposition in hepatocytes by increasing lypolysis -->
pro-inflammatory cytokines --> liver inflammation diagnose with biopsy |
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chronic hepatitis C
|
intermittent arthrlagias with waxing and waning transaminase levels
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hydatid cyst of liver
|
cyst with calcifications from contact with dogs due to echinococud
do not aspirate do surgery |
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hepatomegaly causes
|
portal HTN
CHF alcoholic liver nonalcoholic steatohepatitis |
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angiofibroma
|
epistaxis
localized mass bony erosion of bone |
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reiter
|
non-gonococcal urethritis
asymetric arthritis conjunctivitis treat with NSAIDs |
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osteosarcoma
|
periosteal elevation and sunburst appearance
|
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psoriatic arthritis
|
DIP involvement
morning stiffness defmornity and nail involvement |
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IBD arthritis
|
lower extremities and sacroiliac joints
waxes and wanes with bowel symptoms GIT symptoms |
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sarcoidosis arthritis
|
ankles and knees with cutaneous and pulmonary manifestations
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migratory thrombophlebitis
|
occults maliganancy can be pancreas, lung, stomach or prostate
|
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dermatomyositis complications
|
internal organ malignancy
pulmonary fibrosis |
|
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hyperthyroid myopathy
|
proximal muscle weakness with conserved reflexes
eye muscles are affected additional hyperthyroid signs |
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polymyositis
|
progressice proximal muscle weakness with spared muscles of face or eyelids
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avascular necrosis
|
excessive alcohol and chronic steroids account for 90%
do MRI |
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disseminated gonococcus
|
polyarthrlagia
tenosynovitis vesiculopustular lesions on skin |
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baker cyst
|
inflamed synovium with tender mass in popliteal fossa in RA
|
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Charcot's joint
|
complication of neuropathy
deformity, degenerative joints, osteophytes and pain |
|
|
myopathies
|
drug-induced
hypothyroid myopathy muscular dystrophy myositis myasthenia |
|
|
Paget disease of bone
|
osteoclast hyperfunction
bone pain and lesions skeletal defomities hearing loss increased AP |
|
|
first line in disease-modifying agents for RA
|
methotraxate
|
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lupus pancytopenia cause
|
autoimmune
|
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puncture osteomyelitis
|
pseudomonas
|
|
|
RA patient is at risk of
|
osteoporosis and osteopenia
|
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complication of temporal arteritis
|
aortic aneurysm
do serial x-rays |
|
|
increased AP in asymptomatic elderly
|
Paget disease of bone
|
|
|
amyloidosis Vs. sarcoidosis
|
amyloidosis usually has liver and kidney involvement
sarcoidosis has lung involvement and erythema nodosum |
|
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varicocele fails to empty in recumbent position
|
think renal cell carcinoma obstructing gonadal vein where it enters left renal vein
may also have thrombocytosis and polycythemia due to increased EPO |
|
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corrected calcium
|
correction is needed if there's hypoalbuminemia
corrected calcium = 0.8 (normal albumin - measured albumin) + Ca++ |
|
|
testicular cancer markers
|
seminoma --> PLAT
embryonal --> AFP chorio --> b-hCG |
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abdominal bruit
|
renal artery stenosis has systolic/diastolic bruit
AAA has systolic bruit |
|
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hypokalemia and digoxin
|
increases toxicity
|
|
|
types of solution
|
crystalloid --> NaCl
colloid --> albumin |
|
|
HIV glomerulonephritis
|
focal segmental glomerulosclerosis
|
|
|
nephrolithiasis recommendations
|
decrease intake of proteins, oxalate, Na, calcium
increase intake of water |
|
|
alcoholic refractory hypokalemia
|
due to hypomagnasemia
|
|
|
most common glomerulonephritis
|
IgA nephropathy
|
|
|
radiolucent stone
|
uric acid
alkalinize the urine with K citrate |
|
|
most effective non-drug intervention for HTN
|
weight loss then physical acitivty
salt restriction moderation of alcohol |
|
|
reduce progression of diabetic nephropathy
|
tight BP control < 130/80
|
|
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urine dipstick
|
detect nitrites and leukocyte esterase
|
|
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UTI with alkaline urine
|
proteus
|
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|
MC complication of mumps
|
orchitis
|
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treatment of hypercalcemia
|
saline
furosemide |
|
|
acute renal transplant rejection treatment
|
steroids
|
|
|
MCCOD in dyalisis
|
1) cardiac (sudden death and MI)
2) infections |
|
|
severe symptomatic hyponatremia
|
hypertonic saline
watch out for central pontine myelinolysis |
|
|
painless hematuria
|
kidney, urether or bladder malignancy
do contrast CT or pyelogram for upper urinary tract endoscopy for bladder and urether |
|
|
hepatorenal syndrome
|
decreased GFR in absence of shock
proteinuria fails to respond to saline bolus cirrhotic patient deadly and requires liver transplant |
|
|
mixed acid-base disorders
|
inapropriately normal lab values
|
|
|
DI Vs. primary polydipsia
|
DI has dilute urine in prescence of increased serum osmolarity
primary polydipsia has diluted plasma and urine |
|
|
IV fluid solutions use
|
mild hypovolemic hypernatremia --> dextrose 0.45% saline
severe hypovelemic hypernatremia --> 0.9% saline euvolemic and hypervolemic hypernatremia --> D5W asymptomatic hypervolemic hypernatremia --> oral free water IV free water --> never due to osmotic RBC damage |
|
|
anion gap metabolic acidosis causes
|
lactic acidosis
ketoacidosis methanol/formic ethylene/oxallic salicylates uremia |
|
|
lupus nephritis
|
need to do kidney biopsy because treatment changes
|
|
|
microalbuminuria
|
measured in spot urine
calculate microalbumin/creatinine ratio |
|
|
simple renal cyst
|
asymptomatic, benign
contrast CT to rule-out multilocular mass, irregular walls, septae (shows enhancement) |
|
|
Hep B + nephrotic syndrome
|
membranous glomerulonephritis
|
|
|
secondary hyperparathyroidism from CRF
|
PTH is high but calcium is low
|
|
|
prerenal failure findings
|
increased creatinine + decreased urine sodium
|
|
|
shift potassium intracellularly
|
insulin + glucose
sodium bicarbonate B2 agonists |
|
|
urinalysis casts
|
RBCs --> GN
WBCs --> interstitial nephritis or pyelonephritis muddy brown casts --> ATN fatty casts --> nephrotic syndrome broad --> chronic renal failure |
|
|
acute tubular necrosis
|
BUN/Cr < 20:1
urine osm 300-350 urine Na > 20 fractional Na 2% |
|
|
most effective lifestyle modification for HTN
|
alcohol cessation
also salt restriction, weight loss, exercise |
|
|
mixed alkalosis and acidosis
|
aspirin toxicity
|
|
|
Witer's formula
|
PaCO2 = 1.5 (HCO3) + 8
|
|
|
acid base disturbance from vomiting
|
hypochloremic hypokalemic metabolic alkalosis from H and Cl loss
|
|
|
EPO side effects
|
worsening HTN
headaches flu-like syndrome red cell aplasia |
|
|
interstitial cystitis
|
urgency, frequency, chronic pelvic pain in absence of other pathology
relieved by voiding |
|
|
idiopathic hypercalciuria stones
|
treat with increased fluids
dietary sodium restriction thiazides |
|
|
cystinuria
|
recurrent stones since childhood
postitive family history radiopaque stones with hexagonal crytals urinary cyanide nitroprusside test (+) |
|
|
hyposthenuria
|
inability to concentrate urine --> nocturia in sickle cell and trait
|
|
|
hypercalcemia in inmobilized patients
|
treat with biphosphonates whoch decreases osteoclast activation
|
|
|
hyperkalemia management
|
membrane stabilization with calcium gluconate, insulin/glucose, resins, dyalisis
|
|
|
renal complication of Hodgkin lymphoma
|
minimal change disease
|
|
|
benign prostatic hyperplasia initial tests
|
creatinine for kidney function and urinalysis to rule out infection
|
|
|
MCC of HTN in children
|
fibromuscular dysplasia
bruit at CVA and string of beads on angiography |
|
|
MEN IIa
|
medullary thyroid CA
pheochromocytoma parathyroid hyperplasia due to ret protopncogene mutation |
|
|
MEN IIb
|
medullary thyroid CA
pheochromocytoma neuromas marfanoid habitus due to ret protooncogene mutation |
|
|
osteomalacia
|
low-normal serum calcium
low phosphate increased PTH defective mineralization of bone from vitamin D deficiency (IBD, ADEK malabsorption) |
|
|
thyroid lymphoma
|
hashimoto predisposes
|
|
|
follicular CA Vs. follicular adenoma
|
need invasion of tumor capsule and blood vessels for CA
|
|
|
glucagonoma
|
hyperglycemia
necrolytic migratory erythema diarrhea |
|
|
MEN IIa screening
|
genetic analysis for ret protoncogene mutation
if (+) --> total thyroidectomy |
|
|
hypercalcemia mechanisms in metastasis
|
cytokines IL-1, TNF --> metastatic solid tumor
calcitriol --> Hodgkin PTH-like --> non metastatic solid tumors |
|
|
atypical CAH
|
21OH deficiency with virilization in early adulthood and no salt wasting
|
|
|
cosyntropin stimulation test
|
to rule out Addison's
increase in serum cortisol above 20 1 hour after consyntropin injection rules our Addison's |
|
|
somogyi effect
|
nocturnal hypoglycemia from NPH insulin leads to epinephrine and glucagon release with early morning hyperglycemia
|
|
|
vitamin D toxicity
|
hypercalcemia
constipation abdominal pain weight loss polyuria polydypsia |
|
|
indecations for parathyroidectomy
|
calcium > 1 above upper limit
24h urine calcium > 400 <50 yo bone mineral density < T-2..5 reduced renal function |
|
|
hypogonadotropic hypogonadism
|
low FSH, LH
complications are amenorrhea, weak muscle bulk, osteoporosis, infertility causes --> excessive exercise, anorexia, marihuana, starvation, depression, chronic illness |
|
|
thyrotoxicosis with low radioactive iodine uptake
|
lymphocytic subacute thyroiditis
subacute granulomatous iodine-induced thyrotoxicosis levothyroxine overdose struma ovarii (teratoma) |
|
|
low T3 syndrome
|
any patient with acute severe illness
decreased peripheral conversion sick euthyroid syndrome |
|
|
metabolic syndrome
|
abdominal obesity
insulin resistance hypertension hypertriglyceridemia decreased HDL |
|
|
MEN I
|
pituitary
parathyroid pancreas tumors |
|
|
weight gain from OCPs?
|
no weight gain
|
|
|
congenital aromatase deficiency
|
no conversion of androgens to estrogen by ovaries
maternal and fetal virilization then delayed puberty, osteoporosis, decreased estrogens, increased LH/FSH, polycystic ovaries |
|
|
leydig cell tumor
|
high testosterone and estradiol --> low LH and FSH --> gynecomastia in males
|
|
|
VDRL (+) in pregnancy
|
treat with penicillin
if allergic --> confirm allergy with skin test then penicillin desensitization |
|
|
fetal demise diagnosis
|
ultrasound then if no heart sounds --> real time U/S for fetal movement and heart activity
do autopsy for cause |
|
|
emergency contraception
|
plan B levonogestrel up to 120 hours after unprotected sex
|
|
|
asymptomatic chlamydia infection
|
treat with single-dose azythromycin
|
|
|
nipple discharge
|
can be any color in galactorrhea
alarm signs are lump on breast, guaiac(+), discharge and unilateral secretions |
|
|
types and causes of decelerations
|
early --> fetal head compression
variable --> cord compression late --> uteroplacental insufficiency |
|
|
active herpes in delivery
|
inmediate c-section
|
|
|
lactating mother contraceptive
|
progestin only
|
|
|
uterine atony
|
bimanual uterine massage
fluid rescucitation oxytocin blood transfusion if needed |
|
|
Lyme in pregnant treatment
|
amoxicillin
|
|
|
breast engorgement
|
24-72 hours post-partum secondary to milk accumulation
breast tenderness, fullness and warmth cool compresses, acetaminophen and NSAIDs |
|
|
mastitis Vs. plugged ducts
|
mastitis has fever
treat mastitis with antistaph drugs |
|
|
ABO antibodies Vs. Rh antibodies
|
ABO --> are IgM and don’t cross the placenta
Rh --> are IgG and cross the placenta |
|
|
post CIN procedure
|
pap + colposcopy every 3 months until 3 negative consecutively
then normal pap every year |
|
|
RhoGam administration
|
give at 28 weeks of uncomplicated pregnancy
if there's abruption then do rossette test and if positive --> need to correct dose of RhoGam |
|
|
variable decelerations
|
due to umbilical cord compression
administer O2 and change mother's position if persistance --> trendelenburg +- amnioinfusion |
|
|
chorioamnionitis
|
PROM + fever + tachycardia
also leukocytosis > 15,000 uterine tenderness foul-smelling amniotic fluid treat with broad spectrum antibiotics and expedite delivery |
|
|
PROM and GBS status unknown
|
GBS prophylaxis with penicillin
|
|
|
Rh antibody testing
|
at first prenatal visit
if unsensitized or Rh status of partner unknown --> repeat testing at 24-28 weeks |
|
|
endometriosis diagnosis
|
laparoscopy is gold standard
|
|
|
uterine rupture Vs. abruptio placenta
|
UR has intense abdominal pain
hypovolemia palpability of fetal extremities on abdominal exam |
|
|
post-partum endometritis
|
fever
uterine tenderness foul-smelling lochia in the presence of PROM due to prolonged labor or operative labor polymicrobial infection treat with clinda + genta |
|
|
eclampsia drugs
|
labetalol or hydralazine for hypertension
magnesium sulfate to prevent further seizures |
|
|
causes of prolonged latent phase
|
hypotonic contractions
uncoordinated contractions fetopelvic disproportion premature or excessive anesthesia |
|
|
GBS screening
|
at 35-37 weeks
if positive or previous culture or previous GBS infection --> prophylactic penicillin at delivery |
|
|
breech presentation
|
vertex at fundus
usually corrects by week 37 if not --> external cephalic version contraindications --> placental abnormalities, fetopelvic disproportion, hyperextended fetal head |
|
|
vaginismus
|
contraction of perineal muscles
psychological dyspareunia treat with Kegel exercises |
|
|
fetal growth retardation
|
fundus less than dates
do ultrasound for abdominal circumference because it is affected in symetrical and asymetrical |
|
|
sudden hirsutism in pregnancy
|
PE + sonogram --> if no ovarian mass --> abdominal CT for adrenal mass
bilateral cystic --> theca/lutein cysts bilateral solid --> benign pregnancy luteoma unilateral solid --> laparotomy or laparoscopic biopsy for malignancy |
|
|
increased MS-AFP causes
|
MCC is gestational age error
also NTDs, abdominal wall defects, multiple gestation do ultrasound +- amniocentesis |
|
|
spontaneous abortion diagnosis
|
ultrasound
|
|
|
hyperemesis gravidarum
|
severe vomiting causes electrolyte disturbance
there is ketonuria and mild increase in amylase, lipase, transaminases and AP |
|
|
sheehan
|
post-partum necrosis of anterior pituitary
|
|
|
tamoxifen
|
increases risk of endometrial cancer and DVT
|
|
|
uterine fibroids
|
dysmenorrhea
heavy menses enlarged uterus |
|
|
adenomyosis
|
symetrically enlarged tender uterus
menorrhagia dysmenorrhea if > 35yo --> endometrial curetage to rule out endometrial CA |
|
|
cervical dysplasia algorhythm
|
adolescents --> repeat pap in 1 year
premenopausal --> colposcopy postmenopausal --> HPV DNA --> colposcopy |
|
|
false labor
|
no cervical changes
contractions are irregular and relieved by sedation |
|
|
corionic vilus sampling
|
can be done earlier than amniocentesis at 10-12 weeks in women over 35 with abnormal ultrasound
earlier gestational age has risk of limb reduction defects |
|
|
biophysical profile
|
BPP 8-10 --> reasurance and repeat BPP
BPP 6 --> contraction test; if non-reasuring --> delivery BPP 4 --> lung maturation and delivery if oligohydramnios --> consider delivery |
|
|
PID management
|
if high fever
or failure to respond to antibiotics or inability to take oral medications due to nausea or risk of noncompliance --> hospitalization and empiric cefoxitin/doxy or cefotetan/doxy |
|
|
cervical insuficiency diagnosis
|
transvaginal sonogram for short cervix
|
|
|
phenytoin toxicity
|
horizontal nystagmus
ataxia confusion |
|
|
mucus in ovulatory phase
|
profuse clear and thin
stretches 6cm vertically fern (+) evaluate in infertility |
|
|
PID screening tests to perform
|
HIV
syphilis HBV pap HCV if IV drug use |
|
|
risks and benefits of OCPs
|
risks -->
venous thromboembolism CV events and stroke hypertriglyceridemia cholecystitis DM HTN protection benefits --> ovarian cysts and cancer endometrial cancer benign breast disease dysmenorrhea |
|
|
asymptomatic bacteriuria in pregnancy treatment
|
nitrofurnatoin
1st gen ceph or amoxicillin for 7 days |
|
|
pseudocyesis
|
all signs of pregnancy but no ultrasound evidence
form of conversion disorder requires psychiatric consultation |
|
|
cervicitis treatment
|
may have gonococus and chlamydia coinfection
ceftriaxone + azithro or doxycyline |
|
|
abnormal MS-AFP
|
do ultrasound to confirm gestational age
|
|
|
amniocentesis Vs. corionic vilus sampling
|
CVS at 10-12 weeks
while AC is 16-20 weeks |
|
|
primary amenorrhea work-up
|
1) determine if central or peripheral with FSH levels
2) if decreased FSH --> do GnRH 3) if increased FSH --> karyotype |
|
|
mallory weiss tear
|
tears in the mucosa of the cardias and sometimes distal esophagus from vomiting
|
|
|
billroth II gastrojejunostomy side effects
|
bacterial overgrowth leads to abdominal pain, watery diarrhea, weight loss and sucussion splash; may also have ADEK deficiency
|
|
|
manometry in achalasia
|
decreased esophageal peristalsis and poor relaxation of LES
|
|
|
HIV esophagitis
|
first fluconazole
if failure to respond --> endoscopy |
|
|
toxic megacolon
|
mostly due to ulcerative colitis
emergency steroids, decompression and fluids |
|
|
esophageal varices treatment
|
1) large IV lines
2) octeotride 3) endoscopic sclerotherapy if obscured field of vision but may also use band ligation |
|
|
zenker diverticulum
|
posterior outpouching above upper esophageal sphincter due to motor dysfunction
surgical excision |
|
|
causes of constipation
|
hyercalcemia
obstruction anti-cholinergics hypothyroidism |
|
|
colonic angiodysplasia
|
intermittent occult bleeding with anemia can be missed by colonoscopy
|
|
|
esophageal dysmotility in scleroderma
|
absent peristaltic waves of lower esophagus and weak LES tone in manometry
|
|
|
laxative abuse factitious diarrhea
|
frequent watery nocturnal diarrhea
biopsy shows melanosis coli (dark diiscoloration of colon with lymph follicles) |
|
|
strep bovis endocarditis
|
do colonoscopy due to occult colon cancer
|
|
|
splenectomy risk for sepsis
|
>30 years after
vaccinations are antipneumococcal, haemophilus, meningococcal |
|
|
splenectomy mechanism for sepsis
|
impaired antibody-mediated opsonization in phagocytosis
B cells in spleen normally produce the antibodies |
|
|
leukoplakia
|
localized plaque, witish with granular appearance and hard to remove
premalignant, associated with smoking do biopsy |
|
|
GERD Vs. MI
|
GERD has no shortness of breath nor diaphoresis
|
|
|
virchow's node
|
enlarged left supraclavicular node may be the presentation of gastric cancer
|
|
|
gastric cancer types
|
intestinal type --> intestinal metaplasia of gastric mucosal cells; due to diet with nitrites and salt low in vegetables, H. pylori and chronic gastritis
diffuse type --> poorly differentiated; unlnown origin; signet cells |
|
|
krukenberg tumor
|
gastric adenocarcinoma metastasis to ovary
|
|
|
acute PUD management
|
rule out bleeding with serial hematocrit, rectal exam and Guaiac and NG lavage
IV hydration and medications if perforation --> surgery |
|
|
complications of PUD
|
hemorrhage --> posterior ulcers erode gastroduodenal artery
gastric outlet obstruction perforation --> anterior ulcers intractable pain |
|
|
clostridium difficile diarrhea complication
|
toxic megacolon
|
|
|
entamoeba diarrhea complications
|
perforation if steroid use
amebic liver cyst |
|
|
campylobacter treatment
|
erythromycin
|
|
|
salmonella treatment
|
oral quinolone or TMP-SMX
|
|
|
shigella complications
|
febrile seizures in infants
severe dehydration |
|
|
chronic dirrhea with normal osmotic gap and normal stool weight
|
irritable bowel syndrome
factitious dirrhea |
|
|
chronic dirrhea with normal osmotic gap and increased stool weight
|
secretory
laxative abuse |
|
|
chronic dirrhea with increased osmotic gap and fecal fat
|
malabsoprtion syndrome
bacterial overgrowth chronic pancreatitis |
|
|
chronic diarrhea with increased osmotic gap and normal fecal fat
|
lactose intolerance
sorbitol lactulose laxative abuse |
|
|
treatment of chronic diarrhea
|
treat underlying cause
loperamide opiods octeotride cholestyramine |
|
|
causes of malabsorption
|
pancreatic insufficiency
celiac whipple's tropical sprue bile salt deficiency --> bacterial overgrowth, ileal disease short bowel syndrome |
|
|
diagnosis of lactose intolerance
|
increased breath hydrogen
|
|
|
small bowel obstruction presentation
|
cramping abdominal pain in intervals
vomiting flatus in partial, obstipation in complete high pitched bowel sounds and peristaltic rushes if rebound and guarding --> peritonitis leukocytosis if ischemia or necrosis dehydrationand metabolic alkalosis from vomit air-fluid levels in AXRif radiopaque material in cecum --> gallstone ileus |
|
|
small bowel obstruction treatment
|
partial --> NPO, NG suction, hydration, electrolytes
complete, necrosis or >3 days --> surgery |
|
|
ileus
|
causes --> surgery, severe illness, hypokalemia, hypothyroidism, anticholinergics, opioids
presentation --> abdominal discomfort, nasusea, absence of flatus or bowel sounds treat --> discontinue meds, NG suction, parenteral feed |
|
|
ogilvie's syndrome
|
large bowel pseudo-obstruction
|
|
|
most malignant polyp
|
villous sessile
|
|
|
HIDA scan
|
for acute cholecystitis if ultrasound is equivocal
dye is injected and uptaken by liver then secreted to common bile duct nonvisualization of gallbladder is diagnostic |
|
|
treatment of ascending cholangitis
|
ERCP for diagnosis and biliary decompression
if ERCP contraindicated --> percutaneous transhepatic drainage or open decompression |
|
|
primary sclerosing cholangitis associated disease
|
ulcerative colitis
|
|
|
spontaneous bacterial peritonitis
|
fever
abdominal pain altered mental status >250 PMN or >500 WBCs |
|
|
ransons criteria
|
on admission -->
glucose > 200 age > 55 LDH > 350 AST > 250 WBC > 16000 48 hours --> Ca < 8 Hct decreased 10% PaO2 < 60 BUN incresaed 5 |
|
|
metoclopramide side effects
|
it’s a dopamine antagonist and produces agitation, loose stools and extrapyramidal symptoms
|
|
|
criteria for metastasis surgery
|
1) primary tumor is controlled
2) no other sites of disease exist 3) no significant co-morbidity 4) complete resection is possible |
|
|
warfarin bleed management
|
fresh frozen plasma
|
|
|
aspirin pseudo allergy
|
prostaglandin/leukotriene imbalance
avoid NSAIDs and leukotriene antagonists |
|
|
amiodarone side effects
|
pulmonary fibrosis
hypothyroidism hepatotoxicity corneal deposits bluish discoloration of skin |
|
|
cyclosporine side effects
|
nephrotoxicity
HTN neurotoxicity hyperglycemia gingival hypertrophy hirustism |
|
|
tacrolimus side effects
|
nephro and neurotoxicity
HTN hyperglycemia no gingival hypertrophy no hirsutism |
|
|
azathioprine side effects
|
diarrhea
leukopenia |
|
|
mycophenolate side effects
|
bone marrow supression
|
|
|
breaking bad news
|
1) quiet comfortable environment
2) ask how much he knows 3) ask how much he wants to know 4) warning shot 5) break the news if he wants to 6) give prognosis 7) explain as clear as possible |
|
|
heparin-induced thrombocytopenia
|
antibodies activate platelets with consequent removal
thrombocytopenia and thrombosis |
|
|
hydroxycloroquine side effects
|
retinopathy or corneal damage
need eye exams every 6 months |
|
|
influenza vaccine
|
adults 0-59 with close contact with children
|
|
|
claridibine
|
for hairy cell leukemia
SE --> tobone marrow and kidney damage |
|
|
digoxin interactions and side effects
|
anorexia
nausea/vomit bidirectinal ventricular tachycardia accelerated junctional rhythms verapamil --> decreases renal clearance |
|
|
lead poisoning
|
basophilic stipling and microcytic hypochroanemia
|
|
|
warfarin interactions
|
decrease INR --> dark green vegetables rich in vitamin K
increase INR --> alcohol, vit E, gingko, ginseng, St. Johns |
|
|
alcohol withdrawal
|
hypertension
tremors tachycardia treat with benzodiazepine chlordiazepoxide |
|
|
TCA overdose management
|
first ABCs
then sodium bicarbonate to improve BP, shorten QRS and prevent arrhythmia |
|
|
influenza vaccine in pregnancy
|
all women should be vaccinated
|
|
|
succinylcholine
|
life threatening hyperkalemia
not used in --> crush injuries demyelinating diseases (GBS) tumor lysis syndrome use veraconium or rocuronium |
|
|
niacin side effects
|
flushing
pruritus due to increased prostaglandins treat with aspirin |
|
|
vaccinations in HIV
|
influenza
HBV HepA if sex with men tetanus and diptheria boosters |
|
|
diseases associated with carpal tunnel syndrome
|
RA
sarcoidosis amyloidosis |
|
|
diseases associated with aortic stenosis
|
Behecet
takayasu temporal arteritis ankylosing spondylitis RA psoriasis reiter |
|
|
decubitus ulcer pathogenesis
|
continuous pressure > 2 hours in individuals with decreased sensation causes ischemic necrosis
|
|
|
catheterism complications
|
blue toe syndrome is atheroembolism from aorta to toes
presents with cyanosis, pain and intact pulses |
|
|
TCA intoxication
|
EKG + sodium bicarbonate
|
|
|
mycobacterium avium prophylaxis
|
CD4 < 50 --> azythro or clarythro
|
|
|
acyclovir side effect
|
crystalline nephropathy prevented by hydration
|
|
|
opioid intoxication
|
miosis
respiratory depression somnolence bradycardia hypotension decreased bowel sounds |
|
|
pneumococcal vaccine
|
23 valent polysacchride
T-cell independent B-cell response |
|
|
types of shock
|
cardiogenic
septic hemorrhagic neurogenic heat |
|
|
ciprofloxacin coverage
|
gram (-) but not anaerobes or gram (+)
|
|
|
ampicillin + genta coverage
|
gram (-) anaerobes
|
|
|
when does eclampsia occur
|
25% before labor
50% during labor 25% following delivery |
|
|
lipid screening
|
age 35 in men w/o risk factors
if risk factors --> age 20 |
|
|
side effects of beta 2 agonists
|
tremor
hypokalemia headache palpitations |
|
|
warfarin side effects
|
skin necrosis
bleeding hematomas retroperitoneal hematoma |
|
|
vaccines in immunosupressed
|
pneumococcal with booster in 5 years
influenza yearly |
|
|
vipoma
|
severe diarrhea
hypokalemia leg cramps decreased gastric acid pancreatic cholera |
|
|
fluphenazine side effects
|
hypothermia
also other antipsychotics |
|
|
methanol poisoning
|
anion gap metabolic acidosis
optic hyperemia vision loss coma |
|
|
methotrexate side effects
|
antimetabolite is dihydrofolate reductase inhibitor
causes megaloblastic anemia give folic acid |
|
|
transplant patient opportunistic prevention
|
TMP-SMX for PCP
ganciclovyr for CMV influenza, pneumococcus and HBV vaccines |
|
|
contraindications of triptans
|
hemiplegic migraine
uncontrolled HTN CAD prinzemetal pregnancy ischemic stroke basilar migraine |
|
|
antithyroid drug side effects
|
agranulocytosis
if fever, sore throat and WBC < 1000 --> stop drug |
|
|
thrombosis of subclavian line
|
from parenteral nutrition in a couple of weeks
remove catheter |
|
|
pica
|
apetite for paper, ice and clay
indicates iron deficiency |
|
|
intial step in management of ARF
|
foley catheter
specially in post-operative obstructive ARF |
|
|
glomerulopathy in HIV
|
focal segmental glomerulosclerosis
|
|
|
acute pyelonephritis routine cultures
|
urine and blood before antibiotics
|
|
|
metformin contraindications
|
renal failure
hepatic failure sepsis due to increased risk of lactic acidosis |
|
|
uncomplicated acute cystitis
|
routine urine culture not indicated
give oral TMP-SMX |
|
|
nephropathy after URI
|
IgA nephropathy
|
|
|
kidney lesion in hypertension
|
arteriosclerotic lesions of efferent and afferent arterioles
glomerular capillary tufts sclerosis intimal thickening |
|
|
kidney lesion in diabetic nephropathy
|
increased extracellular matrix
basement membrane thickening mesangial expansion fibrosis focal segmental (most characteristic) or diffuse (most common) glomerusclerosis |
|
|
test of choice for hydronephrosis
|
do ultrasound in severe benign prostatic hyperplasia
|
|
|
chlamydial Vs. gonococcal urethritis
|
chlamydia --> mucopurulent discharge, absent bacteria
gonococcal --> purulent discharge, positive gram stain |
|
|
focal segmental glomerulosclerosis associations
|
african americans
obesity heroin users HIV |
|
|
contrast nephropathy prevention in renal insuficiency
|
non-ionic contrast agent
IV hydration acetylcysteine |
|
|
children with nephrotic syndrome and HBeAg(+)
|
membranous glomerulonephritis
|
|
|
aortic stenosis Vs. hypertrophic cardiomyopathy murmur
|
AS radiates to carotids and is in upper right sternal border
HC is in lower left sternal border and does not radiate to carotids and increases with maneuvers that increase preload |
|
|
right ventricular MI management
|
fluid rescusitation and avoid nitrates
|
|
|
septic shock management
|
IV antibiotics + normal saline
|
|
|
pulsatile abdominal mass
|
AAA
|
|
|
heart pressures
|
right atrium --> 4-6
pulmonary artery --> 25/15 PCWP --> 6-12 |
|
|
premature ventricular beats post-MI
|
wide bizarre QRS
no treatment necessary unles symptomatic |
|
|
pulsus paradoxus
|
due to increased return to right heart with dilation of intervetricular septum into left ventricle
|
|
|
ventricular aneurysm
|
persistent ST elevation and may have CHF, arrhythmias, mural thrombus and mitral regurgitation
late complication of MI |
|
|
test of choice for abdominal aortic aneurysm
|
ultrasound has 100% sensitivity and specificity
|
|
|
S3
|
ken-tuc-KY
|
|
|
GERD Vs. MI
|
GERD has no shortness of breath nor diaphoresis
|
|
|
S4
|
stiff ventricle can be from diastolic dysfunction in MI
|
|
|
paroxysmal supravertricular tachycardia pathophysiology
|
due to re-entry into AV node
vagal maneuvers decrease conduction through AV node |
|
|
vagal maneuvers
|
valsalva
carotid sinus masage inversion in cold water |
|
|
strongest risk factor for abdominal aortic aneurysm enlargement
|
smoking
|
|
|
erectile dysfunction from trauma
|
when there is pelvic fracture with urethral damage the cause is nerve damage
|
|
|
lidocaine in acute coronary syndrome
|
decreases ventricular premature beats and risks of v-fib but prognosis is unafected and there's incresed risk of aystole
not used prophylactically in MI |
|
|
pulsus paradoxus
|
difference in blood pressure > 12 during inspiration due to tamponade, tension pneumothorax and severe asthma
|
|
|
target INR for DVT and a-fib
|
2 to 3
|
|
|
heat shock Vs. heat exhaustion
|
in heat shock the termoregulatory mechanisms fail and there's increased temperature
|
|
|
heart failure prognostic factor
|
hyponatrmemia
associated with high renin-aldosterone-vasopresin-norepinephrine |
|
|
exercise stress test medications to withdraw
|
anti-ischemics
digoxin beta-blockers CCBs |
|
|
ST findings in unstable angina Vs. prinzemetal
|
unstable angina --> ST depression
prinzemetal --> transiet ST elevation |
|
|
medications in prinzemetal
|
use CCBs or nitro
avoid beta blockers and aspirin |
|
|
electrical alternans
|
QRS complexes with varying amplitudes in pericardial efusion
|
|
|
vagal/neurocardiogenic syncope
|
nausea
diaphoresis tachycardia pallor syncope |
|
|
non-drug user infective endocarditis most common valvulopathy
|
mitral regurgitation is the cause
|
|
|
anti-arrhythmic in WPW
|
procainamide
|
|
|
constrictive pericarditis
|
thick pericardium due to cardiac surgery, viral pericarditis and radiation
hepatomegaly ascites increased JVP |
|
|
premature atrial beats
|
normal QRS
an abnormal P wave resets the rhythm benign and no treatment necessary |
|
|
MI with cold leg
|
do echo to rule out mural thrombus
|
|
|
orthostatic hypotension in elderly
|
due to decreased baroreceptor sensitivity
|
|
|
torsades de pointes
|
patients with hypogonadism (alcoholics)
tricyclics moxifloxacin fluconazole treatment is cessation of offending agents and magnesium sulfate |
|
|
ventricular tachycardia in the hemodynamically stable
|
amidarone or lidocaine
|
|
|
electrical pulseless activity
|
discernible rhythm such as Afib --> CPR
not a shockable rhythm epi, atropine, CPR |
|
|
lone Afib
|
no risk factors and asymptomatic
anticoagulation with aspirin alone |
|
|
coronary steal
|
during myocardial perfusion scanning in work-up of angina
dypiridamole vasodilates coronaries except diseased vessels and then blood is redistributed to healthy vessels which helps diagnosis |
|
|
left ventricular function in Afib
|
improved by rate and rhythm control
|
|
|
bradyarrhythmia Vs. tachyarrhythmia
|
increased QRS --> bundle brach block --> bradyarrhythmia
increased QT --> torsades --> tachy --> hypomagnesemia |
|
|
mitral prolapse progression
|
mitral regurgitation
Afib |
|
|
MCC of mitral regurgitation
|
MV prolapse
|
|
|
septic shock
|
increased cardiac output
decreased SVR decreased atrial pressure decreased PCWP normal mixed venous O2 |
|
|
paroxysmal nocturnal hemoglobinuria
|
pancytopenia + hemolytic anemia + thrombosis at unusual sites such as portal or hepatic veins
|
|
|
antibody in multiple myeloma
|
IgG causes M-spike in electrophoresis
|
|
|
autoinmune hemolytic anemia
|
associated to non-Hodgkin lymphoma
treat with steroids |
|
|
schistocytes
|
microangiopathic hemolytic anemias (TTP, HUS, DIC) and prosthetic heart valves
decreased haptoglobin, increased LDH and bilirubin |
|
|
tartrate-resistant acid-phosphatase stain (+)
|
hairy-cell leukemia
|
|
|
Hodgkin secondary malignancy
|
from radio and chemo up to 20 years later
|
|
|
febrile neutropenia treatment
|
monotherapy --> ceftazidine, imipenem, cefepime, meropenem
combo --> genta + antipseudomonal |
|
|
hairy cell leukemia
|
lymphocytes with hairy-like projections and tartrate-resistant acid phosphatase stain
treat with claridibine |
|
|
megaloblastic anemia increased substances
|
increased homocysteine
decreased methionine increased methylmalonic acid only in B12 deficiency |
|
|
acute homolytic transfusion reaction
|
donor RBCs destroyed by recipient antibodies due to ABO mismatch
fever chills flank pain hemoglobinuria direct Coombs (+) complications --> DIC, ARF treatment --> supportive |
|
|
non-hemolytic transfusion reaction
|
fever
chills due to cytokines prevented by leuko-reduced products and washed RBCs |
|
|
delayed hemolytic transfusion reaction
|
low-grade hemolysis 2-10 days after transfusion due to anamnesic antibody response to RBCs
|
|
|
cryoprecipitate
|
rich in factor VIII, fibrinogen and vonWillenbrand
|
|
|
vaso-oclusive crisis
|
stroke
priapism intractactable pain indication for exchange transfusion |
|
|
G6PDH deficiency
|
hemolysis after sulfa
x-linked G6PD levels often normal |
|
|
polycythemia vera
|
all cell lines can be increased
gout hypertension splenomegaly ulcers from histamine release pruritus after hot bath from histamine release treat with phlebotomy |
|
|
multiple myeloma
|
CRAB
hypercalcemia renal failure anemia bone lesions and pain infections from decreased antibodies increased total proteins with normal albumin |
|
|
senile purpura
|
echymotic lesion due to perivascular tissue atrophy
no action required |
|
|
inherited coagulation disorders
|
factor V leiden - MCC
protein C/S deficiency antithrombin III deficiency |
|
|
antiphospholipid syndrome in pregnancy
|
use heparin and aspirin
|
|
|
acute leukemias pathology
|
acute monocyttic --> increased blasts + alpha-napthyril
acute myeloblastic --> increased myeloblasts in M2 promyelocytic --> hypergranular promyelocyted, Auer rods lymphoblastic --> lymphoblasts are PAS+ erythroleukemia --> erythroblasts |
|
|
prevention of aplastic crisis
|
folic acid
|
|
|
waldestrom macroglobulinemia Vs. multiple myeloma
|
waldestrom has IgM spike
MM has IgG spike IgM increases blood viscosity |
|
|
micrcytosis and target cells
|
thalasemia minor
no transfusion needed reassurance |
|
|
MCC of anemia in elderly
|
iron-deficiency
MC due to GI bleed do colonoscopy |
|
|
epiglotitis
|
fever
odynophagia sore throat drooling airway obstruction MCC is haemophilus and strep pyogenes |
|
|
erythema nodosum
|
painful subcutaneous pretibial nodules signifies more serioud disease such as sarcoidosis, TB, histoplasmosis, strep infection, IBD
do appropriate tests |
|
|
shingles
|
rash and pain in dermatomal distribution in immunosuppressed
|
|
|
Lyme in pregnant treatment
|
amoxicillin
|
|
|
heterophile antibodies
|
may be negative early in the disease
|
|
|
work-up of initial HIV infection
|
VDRL
PPD hepatitis A and B serology and vaccine if seronegative antibodies for toxoplasma routine chem and hematology CD4 count HIV RNA levels |
|
|
cat scratch disease
|
bartonella
treat with azythromycin |
|
|
toxoplasmosis in AIDS
|
empirical sulfadiazine + pyrimethanine is diagnostic and therapeutic
|
|
|
primary HIV infection
|
mononucleosis-like
fever night sweats lymphadenopathy arthralgias diarrhea |
|
|
histoplasmosis
|
mississippi, ohio, carolinas
attacks hystiocytes and reticuloendothelial system lymphadenopathy hepatosplenomegaly pancytopenia |
|
|
blastomycosis
|
multiple lung nodules and consolidation
skin lesions lesions of mucous membranes osteolytic bone lesions prostate involvement |
|
|
coccidioides
|
southwestern deserts
pulmonary infiltrates hilar adenopathy maculopapular lesions bone lesions |
|
|
sporotrichosis
|
subcutaneous infection
papules along lymphatic tract |
|
|
rubella Vs measles
|
measles --> koplik spots
rubella --> posterior cervical lymphadenopathy and arthralgias |
|
|
legionella
|
typical pneumonia + GI symptoms
confusion fever > 39 no organisms in gram stain treat with azythro or levofloxacin |
|
|
babesiosis
|
parasite from tick in northeastern US
invades RBCs and causes hemolysis fever night sweats treat with quinine/clinda or atrovaquone/azythro |
|
|
erlichiosis
|
fever
malaise headache nausea/vomit leukopenia thrombocytopenia from tick |
|
|
tick removal
|
ASAP with tweezers
|
|
|
enterobious infection
|
anal pruritus
positive scotch-tape test treat with albendazole or mebendazole |
|
|
bacillary angiomatosis
|
bartonella in immunosupressed
cutaneous and visceral angioma-like blood vessel growth treat with antibiotics |
|
|
mononucleosis-like
|
CMV
monospot (-) atypical large vacuolated lymphocytes no sore throat or lymphadenopathy |
|
|
cryptococal meningitis treatment
|
ampB + flucytosine
|
|
|
community acquired pneumonia management
|
outpatient --> azythro or doxycyline
inpatient --> levofloxacin |
|
|
nocardiosis
|
gram-positive branching rods partially acid-fast
pulmonary disease in immunosupressed treat with TMP-SMX |
|
|
staph pneumonia
|
complication of influenza pneumonia
|
|
|
pneumocystis pneumonia treatment
|
TMP-SMX and steroids if PaO2 < 70 or A-a > 35
|
|
|
mucormycosis
|
nasal turbinate necrosis
chemosis proptosis plus systemic signs treat with surgical debridment + IV ampB |
|
|
MCC of conductive hearing loss
|
otosclerosis
|
|
|
cholesteatoma
|
in children
new-onset hearing loss chronic ear drainage despite antibiotics granulation and skin debris with intact timpanic membrane |
|
|
inverted nasal papyloma
|
tumor causes unilateral nasal obstruction +- epistaxis
|
|
|
acute otitis media
|
ear discharge
decreased hearing ear pain fever otoscopy shows erythema, retraction and decreased motility of tympanic membrane |
|
|
frostbite
|
rapid re-warming with water
no debridment |
|
|
serous otitis media
|
middle ear effusion without signs of infection
otoscopy shows dull tympanic membrane pneumatic otoscopy shows hypomobile tympanic membrane |
|
|
temporomandibular joint dysfunction
|
refererd pain to ear worsened by chewing and nocturnal teeth grinding
|
|
|
retropharyngeal abscess
|
throat pain
dysphagia xialorrhea worst complication is acute necrotizing mediastinitis |
|
|
peritonsillar abscess
|
complication of tonsilitis
muffled voice uvula deviation unilateral tender lymphadenopathy trerat with IV antibiotics and peritonsilar needle aspiration |
|
|
orbital cellulitis Vs preseptal cellulitis
|
preseptal is superficial and involves eyelid without proptosis or decreased visual acuity
|
|
|
presbycusis
|
sensorineural hearing loss of aging
symetrical high-frequency sound loss |
|
|
otosclerosis
|
chronic conductive hearing loss due to bony outgrowth of stapes
loss of low frequency sounds |
|
|
denys-drash syndrome
|
increased risk of Wilm's tumor
male pseudohermaphrodite renal failure |
|
|
galactosemia
|
liver failure
renal failure acidosis emesis failure to thrive bilateral cataracts jaundice hypoglycemia |
|
|
von-Gierke
|
glucose phosphatase deficiency
liver and kidney problems with severe fasting hypoglycemia |
|
|
intussusception treatment
|
air contrast enema
|
|
|
nursemaid's elbow
|
subluxed radial head
supination with pressure over radial head and click sound restores to normal no deformity (difference with elbow dislocation) |
|
|
kawasaki
|
need 4 or more -->
fever > 5 days bulbar conjunctivitis desquamation of fingers erythema and crusting of lips strawberry tongue oropharynx injection morbilliform rash cervical lymphadenopathy treat with aspirin and IVIG |
|
|
DTaP vaccine side effects
|
anaphylaxis
enecephalopathy or any CNS complication avoid pertussis component and give DT |
|
|
RSV virus and asthma
|
RSV infections increase risk of suffering from asthma
|
|
|
transient synovitis
|
limping and externally rotated hip with hip pain
difference with septic arthritis --> WBC > 12000, fever, ESR > 40) do x-ray to exlcude Legg-Calve-Perthers treat with NSAIDs |
|
|
neonatal abstinence syndorme
|
irritability
high-pitched cry poor sleep tremors seizures sneezing vomit diarrhea |
|
|
MCC of primary amenorrhea
|
Turner
|
|
|
aplastic sickle cell crisis
|
severe acute anemia without reticulocytes in peripheral blood
|
|
|
tricuspid atresia
|
early cyanosis
left axis deviation hypoplastic right ventricle ASD, VSD, PDA needed for survival |
|
|
McCune-Albright
|
precocious puberty
café-au-lait spots bone defects endocrine disorders (hypothyroidism, hypocortisolism) |
|
|
Peutz-Jeghers
|
polyposis and hyperpigmented spots +- precocious puberty
|
|
|
Sturge-Weber
|
retardation
seizures port-wine stain in V1 |
|
|
neonatal chlamydia conjunctivitis treatment
|
oral erhythromycin to decrease risk of pneumonia
|
|
|
rubella
|
low fever
suboccipital and posterior auricular lymphadenopathy rash |
|
|
infectious rashes
|
scarlet fever --> sandpaper, erythematous
chickenpox --> vesicles and crusts by day 6 fifth disease --> slapped cheek roseola --> maculopapular, high fever stops with rash rubella --> low fever, maculopapular rash, posterior lymphadenopathy rubeola --> koplik spots |
|
|
Beckwith-Wiedeman
|
macrosomia
macroglosia visceromegaly omphalocele hypoglycemia hyperinsulinemia microcephaly |
|
|
infants of diabetic mothers problems
|
caudal regression
transposition of great vesels duodenal atresia anencephaly NTDs |
|
|
separation anxiety disorder Vs. stranger anxiety
|
separation --> older children
stranger --> toddlers |
|
|
vaginal foreign body
|
if it is seen then try iriigation with warm fluid
if unsuccessful --> sedation, anesthesia and manual removal |
|
|
SCID
|
confirmed by absent thymus
absent lymph nodes and tonsils lymphopenia decreased B and T cells bacterial and viral infections |
|
|
Bruton's agammaglobulinemia
|
x-linked
no B cells no Igs bacterial infections after 6 months |
|
|
CGD
|
recurrent catalase (+) infections
normal lymphocytes decreased NADPH oxidase |
|
|
otitis media most specific sign
|
immobile tympanic membrane with insuflation
|
|
|
congenital adrenal hyperplasia
|
can be early or late onset
|
|
|
spondylolisthesis
|
palpable "step-off" at lumbosacral area
neurologic dysfunction back pain |
|
|
MCC of congenital hypothyroidism
|
thyroid dysgenesis
|
|
|
undetected hearing impairment
|
can be confused with autism
inatentivity refusal to listen poor eye contact low language abilities low social skills |
|
|
acute unilateral cervical lymphadenitis
|
staph
|
|
|
subarachnoid hemorrhage in children
|
AVM is MCC
history of seizures and migraines |
|
|
foreign body aspiration diagnosis and treatment
|
rigid bronchoscopy
|
|
|
mamary gland enlargement and vaginal discharge in newborn
|
physiologic
|
|
|
subcutaneous emphysema from cough
|
do chest x-ray for pneumothorax
|
|
|
guthre test
|
phenylketonuria screening
|
|
|
severe asthma attack unresponsive to treatment
|
mechanical ventilation
|
|
|
posterior urethral valve
|
MC congenital urethral obstruction
distended palpable bladder + oliguria |
|
|
meduloblastoma
|
trunk dystaxia + increased ICP signs
tumor arises from cerebellar vermis 90% |
|
|
ineffective potty training
|
stop for a few months then re-start
|
|
|
acute sinusitis
|
clinical diagnosis
treat with amoxicillin |
|
|
posturing of sandifier syndrome
|
GERD in toddler makes him arch back to left
diagnose with 24 hour pH monitoring |
|
|
metatarsus adductus
|
physiologic
|
|
|
septic arthritis in child
|
surgical emergency requires inmediate drainage
|
|
|
supracondylar fracture
|
can damage brachial artery
check radial pulse |
|
|
pompe disease
|
acid maltase deficiency
floppy baby macroglosia heart failure |
|
|
Osgood-Schlatter
|
traction apophysitis of tibial tubercle
|
|
|
diaphragmatic hernia first step
|
orogastric tube
|
|
|
night terrors
|
during non-REM sleep
fear crying screaming amnesia of the event |
|
|
epinephrine use in respiratory distress
|
used in croup before intubation
in asthma intubation is done first |
|
|
cyanosis in heart disease
|
transposition in 1st 24 hours
TOF in first couple of years |
|
|
pertussis treatment
|
macrolide
|
|
|
vitamin A in measles
|
reduces morbidity and mortality
|
|
|
leukocyte adhesion deficiency
|
delayed umbilical cord separation and recurrent bacterial infections
|
|
|
nocturnal enuresis treatment
|
desmopresin or imipramine
|
|
|
club foot
|
do stretching, manipulation and serial casts first
if not --> surgery by 3 months |
|
|
rotavirus vaccine
|
between 2 and 8 months
do not give later |
|
|
eye exam in children
|
screening recommended before 5 years of age
|
|
|
osteogenesis imperfecta
|
blue sclera
hearing loss joint hypermobility dentinogenesis imperfecta |
|
|
lyme disease treatment
|
if > 9 years --> doxycycline
if < 9 years --> amoxi |
|
|
hemophilic arthropathy
|
recurrent hemarthrosis leads to hemosiderin deposition, fibrosis, arthritis
|
|
|
MC risk for acute sinusitis
|
viral URI
|
|
|
pertussis prevention
|
erythromycin for 2 weeks to all close contacts regardless of age
|
|
|
breastfeeding jaundice
|
exageration of physiologic in babies without enough breastfeeding
unconjugated |
|
|
child with meningitis + increased ICP
|
first empiric ceph then CT then LP
|
|
|
intraventricular hemorrhage in neonate
|
due to prematurity
|
|
|
infantile colic
|
inconsolable crying > 3h per day
resolves by 4 months |
|
|
infantile Vs. adult botulism
|
infantile --> C botulinum in intestine
adult --> toxin ingestion |
|
|
cannot establish peripheral IV line in child
|
get intraosseous access
|
|
|
vesiculouretheral reflux
|
recurrent pyelonephritis
do voiding cystourethrogram complication is renal scarring |
|
|
impetigo treatment
|
topical mupirocin
|
|
|
Todd's palsy
|
postictal hemiparesis improves after 24 hours
|
|
|
lead screening
|
first fingerstick lead levels
if positive --> serum lead levels to confirm |
|
|
acquired torticolis
|
obtain cervical x-ray to rule out fracture or dislocation
|
|
|
PT Vs. PTT
|
PT --> warfarin, vitamin K, indirect, 2, 7, 9, 10
PTT --> heparin direct, 8 |
|
|
infantile spasms treatment
|
ACTH
|
|
|
myotonic muscular dystrophy
|
autosomal dominant
delayed relaxation of muscles with sustained hand-shake |
|
|
hydroxyurea
|
increases HbF
|
|
|
nocturnal enuresis work-up
|
urinalysis
behavioral modification desmopressin or imipramine |
|
|
chest x-ray in infant
|
large thymic shadow with sail sign
|
|
|
homocystinuria
|
Marfan features
mental retardation thromboembolic events dislocation of lens cysththione synthase deficiency treat with B6 and low methionine diet |
|
|
Henoch-Schonlein purpura
|
palpable purpura
scrotal swelling hematuria abdominal pain possible intuscuception |
|
|
late-onset GBS neonatal sepsis
|
often meningitis
|
|
|
Blackfan-Diamond
|
congenital hypoplastic anemia
pure red cell macrocytic aplasia congenital anomalies |
|
|
chronic pyelonephritis
|
focal parenchymal scarring and blunting of calices on intravenous pyelography
complication of vesicoureteral reflux |
|
|
rickets
|
cranitabes (pin pong ball on occiput)
rachitic rosary (costochondral junction enlargement) thickened bones defective mineralization of osteoid |
|
|
sickle cell trait
|
HbS 35-40%
painless gross hematuria is MC presentation |
|
|
breath-holding spells
|
episodes of apnea from crying with LOC
normal reasurance |
|
|
trachoma
|
due to chlamydia
follicular conjunctivitis and neovascularization pannus in cornea Dx --> giemsa stain Tx --> topical tetracycline or oral azythro |
|
|
postop endopthalmitis
|
within 6 weeks of eye surgery
decreased visual acuity swollen eyelids and conjunctiva hypopion corneal edema do gram stain and culture of vitreous give intravitreal antibiotic injection |
|
|
uveitis
|
pain
conjunctival injection miosis hypopion keratic precipitates associated with HLA-B27 |
|
|
cavernous sinus thrombosis
|
proptosis
opthalmoplegia chemosis visual loss |
|
|
dacryocistitis
|
infection of lacrimal sac with pain and redness of medial canthal region
use systemic antistaph drugs |
|
|
chalazion
|
chronic granulomatous inflamation of meibomian gland
hard painless lid nodule |
|
|
episcleritis
|
infection between conjunctiva and sclera with photophobia and watery discharge
|
|
|
optic neuritis
|
acute decreased acuity
color perception deficitis afferent pupillary defect central scotoma |
|
|
presbyopia
|
age-related decrease in lens elastivity
|
|
|
macular degeneration
|
distortion of straight lines
drunsen in the macula |
|
|
neurofibromatosis eye lesion
|
optic glioma
|
|
|
tuberous sclerosis eye lesion
|
retinal hamartoma
|
|
|
multiple sclerosis eye lesion
|
optic neuritis
|
|
|
herpes retinitis
|
in HIV
keratitis eye pain visual loss peripheral retinal lesions central necrosis of retina |
|
|
CMV retinitis
|
MC complication in HIV eye
painless fluffy granular retinal lesions no keratitis or conjunctivitis |
|
|
measles supplement
|
vitamin A
|
|
|
xanthelasma
|
soft yellow plaques on medial aspect of eyelids
lipid filled macrophages seen in OBC but also idiopathic |
|
|
recurrent chalazion
|
do histopathology for mebomian cancer or basal cell carcinoma
|
|
|
preseptal Vs. orbital cellulitis
|
eyelid discoloration --> preseptal
orbital has systemic signs, proptosis, decreased eye movements and decreased acuity |
|
|
types of hypersensitivity reactions
|
type I --> IgE mediated, atopy, urticaria, anaphylaxis
type II --> antibody mediated, inmune hemolytic anemia type III --> inmune complex mediated, serum sickness, arthus reaction type IV --> cell-mediated, contact dermatitis, nickel jewerly |
|
|
herpetic whitlow
|
viral infection of hand by type 1 or 2 HSV
dentists and sex workers at risk |
|
|
strawberry Vs cherry hemangioma
|
strawberry --> children
berry --> adults |
|
|
tinea corporis lesion
|
pruritic
erythematous scaly red ring with central necrosis |
|
|
photo-protection
|
avoidance of sun between 10am and 4pm is best
sunscreen should be applied 15-60 minutes before sun exposure |
|
|
dermatitis herpetiformis treatment
|
dapsone
|
|
|
tinea versicolor
|
pale velvety pink or whitish hypopigmented macules that do not tan and don’t appear scaly but scale on scrapping
treat with selenium sulfide |
|
|
pitiriasis rosea
|
oral fawn-colored plaques in a christmas tree pattern
|
|
|
eczema herpeticum
|
HSV infection associated with atopic dermatitis
umbilicated vesicles treat with acyclovir |
|
|
ichthyosis
|
dry, rough skin with horny plates over extensor surfaces of limbs
|
|
|
rosacea
|
telangiectasias over cheeks, nose, chin and flushing
treat with metronidazole |
|
|
perforated appendix management
|
if well loculated abscess and patient not septic --> percutaneous drainage
|
|
|
murphy's sign
|
halt of inspiration upon deep palpation of RUQ
|
|
|
intestinal adhesions diagnosis
|
more than 6 air-fluid levels on x-ray in patient with signs of bowel obstruction
|
|
|
abnormal location appendicitis
|
in elderly and pregnant and in those with retrocecal or pelvic appendix
|
|
|
carotid endarterectomy
|
symptomatic patients with >50% stenosis or assymptomatic in >60% do it within 2 weeks of TIA
|
|
|
posterior urethral injury sign
|
blood in meatus
high-riding prostate lack of palpable prostate |
|
|
pelvic gracture with hemodynamic instability
|
never explore due to pelvic or retroperitoneal hematoma
do serial hematocrits and fluid rescusitation + external fixation |
|
|
mesenteric ischemia management
|
IV fluids
heparin antibiotics emergency laparotomy for nonviable bowel resection |
|
|
HIDA scan
|
test to use in cholecystitis if U/S equivocal
imidoacetic acid is secreted to bile ducts and gallbladder won't be visualized |
|
|
tracheobronchial rupture
|
blunt trauma
can have subcutaneous emphysema or pneumothorax diagnose with bronchoscopy |
|
|
uncomplicated diverticulitis treatment
|
outpatient clear liquid diet and morxifloxacin or amoxi/clavulanic
|
|
|
partial small bowel obstruction management
|
in-hospital nasogastric suction to decompress proximal bowel
NPO fluid correction |
|
|
sliding hiatal hernia
|
heartburn worst on recumbency
wheezing dysphagia diagnose with barium swallow |
|
|
osteomyelitis in trauma patient
|
due to staph
coliform bacili and pseudomonas treat with nafcillin and gentamycin |
|
|
extraperitoneal bladder rupture
|
contrast extravasation confined to perivesical space, thighs, penis, perineum
if more severe into abdominal wall no reabsorption of urine into blood |
|
|
intraperitoneal bladder rupture
|
direct blow to distended bladder causes increase in intravesical pressure with horizontal tear at peritoneal portion of bladder
there's reabsorption of leaked urine from peritoneum into blood with hyperkalemia, uremia, acidosis there's contrast extravasation into peritoneal cavity |
|
|
MC complication of sigmoid diverticulitis
|
abscess
|
|
|
zone II penetrating injury
|
exploration if platysma is penetrated, if there's subcutaneous air or expanding hematoma
|
|
|
small bowel obstruction in kids
|
due to encarcerated hernia (MC inguinal)
|
|
|
chandelier sign
|
pain with cervical motion in PID
|
|
|
lead pipe appearance x-ray
|
ulcerative colitits
|
|
|
step ladder appearance x-ray
|
small bowel obstruction
|
|
|
air-fluid levels on x-ray
|
small bowel obstruction
|
|
|
pneumobilia
|
air in biliary tree in gallstone ileus
|
|
|
MCC of lower GI bleed
|
1) diverticulosis
2) cancer/polyps 3) angiodysplasia |
|
|
peritoneal signs in small bowel obstruction
|
laparotomy
|
|
|
ogilvie's syndrome
|
colonic pseudo-obstruction
no evidence of obstruction but colon is dilated and can perforate seen in elderly and trauma patients |
|
|
hip dislocation complications
|
posterior --> avascular necrosis
anterior --> femoral artery, nerve and vein damage |
|
|
indications of AAA repair
|
1) symptomatic
2) >5.5cm 3) increase in size >0.5cm in 6 months if 4-5.4cm --> U/S or CT every 6-12 months |
|
|
melanoma adjuvant treatment
|
(+) nodes without evidence of mets
give interferon alfa after surgery |
|
|
complication of ERCP
|
acute pancreatitis
|
|
|
hot thyroid nodule
|
almost never cancerous and should not be biopsied but followed clinically
|
|
|
MOHS surgery
|
microsurgery is best choice for SCC at high risk of recurrence
|
|
|
ranson criteria on admission
|
glucose >200
age > 55 LDH > 350 AST > 250 WBC > 16,000 |
|
|
bloody diarrhea w/fever
|
e. coli
|
|
|
types of melanoma
|
acral lentiginous --> on palms, soles, nailbeds or mucous membranes
superficial spreading --> most comon on sun-exposed areas lentigo maligna --> rarest, in sun-exposed area from premalignant lession |
|
|
informed consent components
|
BRAIN
Benefits Risks Alternatives Indications Nature |
|
|
parietal cell highly selective vagotomy
|
for refractory ulcers
|
|
|
trendelenburg sign
|
drooping of contralateral hemipelvis below horizontal line in nonpedal stance
due to paralysis of gluteal muscles innervated by superior gluteal nerve |
|
|
complications of central line placement
|
arterial puncture
pneumothorax hemothorax thrombosis air embolism myocardial perforation |
|
|
central line catheter placement
|
proximal to cardiac silhouette or proximal to angle of trachea and right stem bronchus
in the superior vena cava do chest x-ray to confirm |
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drop arm sign
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arm is abducted to >90 degrees and patient is asked to lower it slowly --> the arm drops when it reaches 90 degrees
means complete rotator cuff tear |
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rotator cuff
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from tendons of
supraspinatous infraspinatous teres minor subscapularis |
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klumpke palsy
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damages lower trunks C8-T1 from sudden upward pull of arm
damages ulnar nerve with weakness and atrophy of hypothenar and interosseous and claw hand |
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varicocele
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dilation of pampiniform plexus of veins surrounding spermatic cord and testis
often in left side feels like bag of worms and is worsened with valsalva |
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hydrocele
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fluid in tunica vaginalis transilluminates
observation in newborns for 12 months, else surgery |
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spermatocele
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cystic dilation of efferent ductules above testis and transilluminates
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urethral injuries
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anterior --> from urethral intrumentation or blunt perineum trauma; prostate is normal; blood at meatus; perineal tenderness/hematoma; no problem urinating
posterior --> from pelvic fracture; pain, inability to void, blood at meatus, high-riding prostate; scrotal hematoma |
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necrotizing wound infection
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laparotomy
|
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best test for abdominal abscess
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CT
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intraductal papilloma
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intermittent bloody nipple discharge; benign
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best way to establish airway in apneic
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orotracheal intubation or surgical cricothyroidectomy
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blunt splenic rupture management
|
IV fluids
if it responds --> CT then laparotomy if unresponsive --> laparotomy |
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Ludwig angina
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submaxillary and sublingual glands
infection from teeth microbes MCC of death is asphyxia |
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osteosarcoma Vs. Ewing
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osteosarcoma --> normal ESR; increased AP; lytic lesion with periosteal elevation
Ewing --> systemic signs fever, malaise, wight loss; lytic lesion with onion skin appearance |
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best study for blunt trauma in stable patients
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CT with contrast to evaluate solid organ damage
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goal of rib fracture management
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control pain to avoid hypoventilation --> atelectasis --> pneumonia
use opiods, NSAIDS or nerve block |
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Legg-Calve-Pethers Vs. SCFE
|
LCP --> kids < 10; femoral head out of acetabulum
SCFE --> overweight teenagers; femoral head in acetabulum |
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medial meniscus tear
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palpable or audible snap while extending the leg and applying tibial torsion
there's tenderness and locking |
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ligament Vs. meniscal tear
|
ligament tear --> swollen inmediately
meniscal tear --> popping sound; swollen 12-24 hours after |
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diaphragn rupture
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in blunt or penetrating trauma
elevated left hemidiaphragm respiratory distress deviated mediastinum +- atelectasis do CXR worst complication is herniation of bowels and strangulation |
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post-op atelectasis pathogenesis
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1) shallow rapid breathing
2) narcotics decrease respiration 3) decreased mucocilliary clearing 4) more common in obese 5) supine position all factors contribute to decreased vital capacity and decreased functional respiratory capacity first-line prevention is moving from supine to sitting which decreases pressure on diaphragms |
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pilonidal cyst
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acute pain and swelling of midline sacrococcygeal skin
due to infection of hair follicles --> abscess --> rupture --> pilonidal sinus tract --> recurrent infections |
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spetic arthritis management
|
antibiotics + surgical wash out of joint
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humeral shaft fracture management
|
attempt to realign humerus
if unsuccessful --> surgery |
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first step in diagnosis of peropheral artery disease
|
ankle-brachial pressure index --> systolic pressure of posterior tibial and dorsalis pedis by Doppler divided by systolic pressure in brachial artery
1-1.3 --> normal < 0.9 --> occlusion of major vessel follow with images |
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Leriche syndrome
|
occlusion of aorta at bifurcation of illiacs (aortoiliac)
1) bilateral hip, buttock and leg claudication 2) impotence 3) symmetric atrophy of lower limbs most commonly due to atherosclerosis |
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ileus Vs. small bowel obstruction
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ileus --> decreased bowel sounds
small bowel obstruction --> hyperactive high pitched bowel sounds |
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tetanus prophylaxis in trauma
|
< 3 doses of TT + clean wound --> TT
< 3 doses of TT + dirty wound --> TT + TIG >=3 doses of TT + clean wound --> TT if last dose >10y >=3 doses of TT + dirty wound --> TT if last dose >5y |
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tibial nerve
|
motor supply to posterior thigh, posterior leg, plantar muscles
flexes knee, plantar foot and toes sensation to leg except medial side, and plantar foot |
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obturator nerve
|
motor supply to medial thigh and controls adduction
sensation over medial thigh |
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common peroneal nerve
|
deep and superficial branches give motor and sensory supply to anterolateral leg and dorsom of foot
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femoral nerve
|
motor supply to anterior thigh
knee extension and hip flexion sensation to anterior thigh and medial leg via saphenous branch |
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massive atraumatic hemoptysis management
|
bronchoscopy
|
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acalculous cholecystitis
|
seen in ICU patients with multiorgan failure, severe trauma, surgery, burns
presents with vague RUQ signs and gallbladder distention thickening of gallbladder and pericholecystic fluid |
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torus palatinus
|
bony mass in hard palate
no treatment required unless symptomatic |
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developmental dysplasia diagnosis
|
<4 months --> U/S
> 4 months --> x-ray |
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fat necrosis of breast
|
similar to breast cancer with mass, nipple retraction and calcifications
biopsy shows fat globules and foamy macrophages self-limited, no treatment necessary |
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esophageal perforation diagnosis
|
gastrofin contrast esophagram
|
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pancreatic blunt trauma
|
may be missed by CT in first 6 hours following trauma
if untreated --> retroperitoneal abscess or pseudocyst |
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intra and retroperitoneal bleed diagnosis
|
intra --> FAST or peritoneal lavage
retro --> angiogram need to rule out both |
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acute blood loss
|
first 2L of crystalloids
if doesn't respond --> blood transfusion usually need transfusion if loss >1500ml |
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|
mid femur shaft fracture treatment
|
closed intramedullary fixation
closed reduction and nailing to skin |
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tibial stress fracture diagnosis
|
x-ray normal
do contrast CT |
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volkman ischemic contracture
|
final sequel of compartment syndrome with fibrous replacement of dead muscle
|
|
|
referred pain to shoulder
|
from irritation of diaphragm by bile, pancreatic secretions, blood or urine that spills into peritoneum (bladder dome is intraperitoneal)
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post op fever after transfusion
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from preformed antibodies
|
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transtentorial uncal herniation
|
compression of cerebral peduncle can be contralateral --> ipsilateral hemiparesis
compression of ipsilateral CNIII --> ipsilateral mydriasis, ptosis, down and out gaze compression of ipsilateral PCA --> contralateral homonymous hemianopsia compression of reticular formation --> coma |
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rupture of duodenum
|
retroperitoneal air is seen on x-ray
do abdominal CT with oral contrast has subtle epigastric signs |
