dec 13 firecracker cases etc Flashcards Preview

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Flashcards in dec 13 firecracker cases etc Deck (232):
1

cardiac tamponade, compressed right atrium

JVD

2

cardiac tamponade, compressed left atrium

pulmonary edema

3

cardiac tamponade preload/etc

decrease preload
decrease systolic stroke volume
diminished CO

4

cardiac tamponade etiologies

post viral
uremia
neoplastic

5

acute hemopericardium

blunt/penetrating chest trauma
reputure of free wall of LV following MI
complication of retrograde aortic dissection

6

Beck's triad + one more

JVD, muffled heart sounds, systemic hypotension
pulsus paradoxus

7

Kussmaul sign

JVD with inspiration
constrictive pericarditis

8

pulsus paradoxus

drop of 10 or more systolic with inspiration
exaggeration of normal physiology

9

cardiac tamponade - ec ho

severe compression of RA and RV

10

cardiac tamponade definitive diagnosis

cardiac catheterization

11

cardiac tamponade treatment

pericardiocentesis

12

what to avoid in cardiac tamponade

positive pressure ventilation

13

untreated cardiac tamponade

extra-cardiac obstructive shock

14

abd aorta screening

65-75
less than 4cm, yearly
4 cm, 6months
5 cm - surgery

15

achalasia LES

elevated LES pressure
inability to relax LES during swallowing

16

Waldenstrome macroglobinuria

igm spike
hyperviscosity

17

organism involved in RHD vegetations

streptoccus mutans

18

NMS

fever, rigidity, increased CK
treat with dantrolene, bromocriptine

19

Renal Cell Carcinoma

hematuria
left sided variocele
paraneoplastic symptoms: anemia/eryhtocytosis, leukocytosis

20

Hep C and pregnancy

low chance of transmission

21

Proteus UTI

ph >7
struvite stones

22

cutaneous ulcer + hemoptysis

wegners

23

chronic pancreatitis

inflamm process
- fibrosis
-calcification
- irreversible damage

24

number one cause of chronic pancreatitis

alcohol

25

chronic pancreatiitis risk factors

male, recurrent acute attacks
gallstones, triglycerides
CF, PBC, PSC

26

difference between acute and chronic pancreatitis

irreversibly of damage

27

pathogenesis of chronic pancreatitis

repeated bouts of acute pancreatitis
- loss of parencyhma
- duct distortion
- fibrosis
- impaired secretion

28

duct flow becomes obstructed as a result of

fibrosis
pancreatic concretions

29

pancreatic concretions

due to increased protein concentration in pancreatic fluid

30

chronic pancreatitis - s/sx

epigastric pain
steatorrhea
wt loss, nausea
mild fever

31

gold standard diagnosis for chronic pancreatitis

72 hr quantitative fecal fat determination

32

chronic pancreatitis complications

fat/fat soluble vit/b12 malabsoprtion
pseudocyst, abscess formation
glucose intolerance
bile duct obstruction

33

pancreatitic insuff can be due to

cystic fibrosis
cancer causing obstruction (pancratitc)
pancreatic failure

34

pancreatic insufficiency diagnosis

fecal elastase
<200

35

pancreatic insuff treatment

pancreatic enzyme supplementation (lipases, proteases, amylases)
low fat diet

36

treatmetn of chornic pancreatitis

alcohol/smoking cessation
pain control
b12/adek suppl
pancreatic enzyme suppl

37

chronic pancreatitis - strictures

ERCP to dilate and stent pancreatic ducts

38

spontaneous ptx

due to rupture of apical blebs
(tall, thin, healthy males)

39

secondary spontaneous ptx

underlying path: COPD, trauma, infections

40

tension ptx

one-way valve effect
air can enter pleural space but not not exit
pressure on mediastinum --> hemodynamic instability
- mediastinal shift, tracheal deviation AWAY

41

tracheal deviation in tension ptx

AWAY

42

pneumothorax presentation

Pleuritic Chest Pain, Tracheal Deviation, Hyperresonace, Occurs Suddenly, reduced breath sounds, absent fremitus, x ray shows collapse

43

ptx diagnosis

chest xray
hyperlucent lung fields due to air accumulation
visceral pleural line

44

spontaneous ptx - tracheal deviation

spontateous: deviates towards affected lung due to decreased pressure from atelectasis on that side

45

tension ptx - tracheal deviation

away from affected lung, due to increased pressure on that side

46

tension ptx symptoms

can also have shock, JVD due to compression of SVC

47

spontaneous ptx if untreated

progress to tension ptx

48

large tension ptx

hemodynamic instability due to pressure on great vessels

49

treatment of small spontaneous ptx

resolves spontenous
o2 can expedite recovery

50

large, simple pneumothorax treatment

chest tube

51

treatment of secondary spontaneous ptx

hospitalized and pneumo drained

52

tension ptx treatment

needle decompression (needle thoracostomy)

53

needly thoracostomy placement

bottom of 2nd intercostal space at midclavicular line

54

PCP type of pneumonia

atypical pneumonia with dry cough, diffuse interstitial

55

PCP histological

fluffy, foamy exudate in alveolar spaces
BAL - silver stain

56

PCP clinical presentation

HIV cd4 <200
dry cough, fatigue, fevers, chills
- pnemothorax

57

PCP CXR

diffuse bilateral ground glass infiltrates extending from perihilar region

58

PCP treatment

tmp-smx
po2 less than 70 give prednisone (21 days)

59

PCP prophylaxis if sulfa allergic

dapsone (test g6pd def first)

60

cytoisospora

cd4 <50
diarrhea, wt loss
treat with tmp-smx or cipro

61

Kaposi sarcoma clinical presentation

rash that is non responsive to treatments
associated with HHV-8
low cd4 count makes visceral involvement more likely

62

kaposi sarcoma treatment

HAART
chemotherapy for lesions

63

hemothorax

blood in pleural space
- trauma, pulmonary infarction, TB, malignacy

64

hemothorax cxr

blunting of costophrenic angles

65

hemothorax treatment

underlying cause
supplemental o2
chest tube

66

hemothorax untreated

formation of thrombi and fibrosis

67

hypomagnesmia

<1.3

68

impaired intestinal absorption of magnesium in

alcoholics, malabsorption, diarrhea, NG suction

69

increased renal excretion of magnesium in

increased renal tubular flow such as osmotic diuresis, diuretic use

70

meds associated with hypomagnesium

aminoglycosides, amph b
cisplatin, pentamidine, cyclosporine

71

s/sx hypomagnesemia

neuromusculuar and cardiac

72

neuromuscular symptoms of hypomagnesemia

tremor, ataxia, nystagmus, tetany, seizures

73

cardiac symptoms of low mag

atrial and ventricular arrhythmias
- especially in pts being treated with digoxin

74

low mag can also cause

low calcium and potassium

75

low mag EKG

pr, qt prolong
widened qrs
potential torsades de pointes

76

mag replacement

asymptomatic - oral
symptomatic - IV mag sulfate, check tendon reflexes

77

Familial Adenomatous Polyposis

- AD, APC gene
- hundreds of adenomas
- treatment is proctocolectomy

78

Good Pasture's symptoms

renal + lung
dysmoprhic RBCs

79

Good Pastures' antibody

alpha 3 chain of type IV collagen

80

pt has LDL >/= 190

high intensity statin

81

pt has ASCVD 10 year higher than 7.5%

moderate-high intensity statin

82

pt is 40-75 yr old with DM

high intensity if ASCVD greater tahn 7.5
moderate intensity if ASCVD less than 7.5

83

pt has clinical atherosclerotic disease

less than or equal to 75, high intensity
older than 75, moderate intensity

84

crystal induced nephropathy in HIV pts

indinaivr (protease inhibitor)

85

didanosine

reverse transcripatse inhibitor
pancreatitis

86

abacavir

NRTI
hypersensitivity syndrome

87

NRTIs

nucleoside reverse transcripatase inhibitor
lactic acidosis

88

NNRTIs

SJS

89

Nevirpine

liver failure, NNRTI

90

cyclosporine AE

nephrotoxitiy/neurotoxicity
glucose intolerance
gingivial hypertrophy

91

cafe au lait spots

neurofibromatosis

92

chagaz dz

megacolon/esophagus + cardiac disease
protozoan

93

hep c virus type

single stranded RNA flavivirus

94

initial diagnostic test for hep C

anti-HCV antibody test

95

test for confirmation of Hep C

qualitative PCR

96

other tests for Hep C

quantitatie HCV testing
genotype testing

97

HCV treatment standard of care

pegylated interferon and ribavirin

98

2014 HCV recommendations

add polymerase inhibitor --> sofosbuvir

99

time period for spontaneous clearance of HCV

12 weeks

100

most common causes of digital clubbing

lung malignancy
cystic fibrosis
r to l shunt

101

Pseudogout

calcium pyrophosphate deposition
rhomboid shaped crystals with positive bireferengence

102

most common cause of liver malignancy

metastasis

103

PAD treatment

exercise
antiplatelet

104

pain relief related to malignacy

start with short acting morphine

105

HACEK

hameophilus
aggregitabcteier(actinobaccilus)
cardiobacterium hominis
e corrodens
kingella kingae

106

d xylose test

absorption in proximal SI
(celiac sprue)

107

widened mediastinum and gi symptoms

esophageal perforation
order water soluble contrast esophogram

108

rifampin ae

red urin

109

extramsucular findings of dermatomyositis

interstitial lung dz, dysphagia, myocarditis
association with malignancy

110

wisconsin

blastomycosis

111

blastomycosis

lung/tb like symptoms
skin lesions

112

most common complication of PUD

hemorrhage

113

cervical sponyldosis xray

bony spurs
sclerotic facet joints

114

toxo infections in immunosuppressed

pneumonitis
myocarditis
necrotiizing encephalitis

115

SIADH meds

antidepressants, antipsychotics
narcotics, nsaids
chlorpropamide

116

antipseudomonal B lactam

cefotaxime, ceftriaxone, or ampicillin-sulbactam

117

what are ranson's criteria

WBC count of >16,000 on admission
Age >55, Glucose >200 mg/dL on admission
AST >250 on admission
LDH >350 on admission

118

what kind of defect is osteoporosis

quantittive

119

osteoprosis =

loss of osteoid (organic bone matrix)

120

WHO osteoporosis defintion

L2-L4 2.5 sd below normal

121

decreased bone mass manifests as`

decreased thickness of cortical and trabecular bone
fewer trabecular interconnections

122

why is osteoporosis more common in women?

- they have lower peak bone mass
- live longer
- rapid bone loss during menopause secondary to decreased estrogen production

123

role of genetics in osteoporsis

greater than daily activity or calcium intake

124

osteoporosis most common patient type

older caucasion postmenopausal woman

125

decreased peak bone mass

- due to malnutrition
- malabsorptive dz (celiac)

126

increased resportion

old age (decreased osteoblasts)
sex steroid def
decreased load bearing
glucocorticoid use

127

lifestyle factors associated with osteoporosis

alcohol
smoking

128

most common fractures in osteoporosis

vertebral > hip > Colles

129

hip fractures

femoral head

130

colles fracture

radial fractue

131

osteoporosis diagnosis

DEXA
also look for hypothyroidism, hypercortisoloism, hyperPTH, renal/hepatic dysfxn

132

DEXA scan age

65

133

treatment of osteoporis

vit d and calcium supplementation
bisphosphonates

134

osteoporosis - lifestyle adjustments

wt bearing exercise, smoking cessation, limit alcohol, more calcium and vit d

135

raloxifene

SERM, inhibits bone turnover
anatgnoist to estrogen on breast and endometrial tissue
decrease risk of breast and uterine cancer
increased risk of thromboembolic events

136

PTH - osteoporosis

pts with one fracture, intolerance to bisphosphonates
osteoblastic activation in periodic doses

137

DJD also called

osteoarthritis

138

DJD =

chronic noninflammatory deterioration of articular cartilage

139

DJD pathophysiological

cartilage deteriorates
lytic lesions with sclerotic edges

140

DJD most common joints

knee, hand, hip

141

DJD modificable risk factors

obestiy
trauma
labor-intensive occupations

142

non-modifiable DJD risk factors

age
family hx
female gender

143

DJD presentation

joint pain, stiffness
worse with activity, wt bearing

144

DJD PE findings

decreased ROM
effusion
malalignment
joint creptius
DIP, PIP joint osteophytes with MCP sparing

145

DJD xray

joint space narrowing, osteophytes, subchondral sclerosing, subchondral cysts

146

DJD first line

acetaminophen if no symptoms of inflamm
NSAIDs

147

nonoperative DJD treatment

bracing
wt loss if bmi >25
pt
corticosteroid injection

148

DJD operative treatment

arthrosocopy in degenerative meniscal tears
total joint replacement

149

causes of pulseless electrical activity

6hs and 5ts

150

6 h's

hypovolemia, hypoxia, hydorgen ions (acidosis) hyper/hypokalemia, hypoglycemia, hypothermia

151

5 t's

toxins/drugs, tamponade, tension ptx, thrombosis (myocardial or PE), trauma

152

diffuse esophageal spasm

chest pain and dysphagia

153

osteomalacia - lab valuves

low ca, phosphate
increased pth, alk phos

154

osteomalacia - xray

pseudofractures

155

laryngeal edema

acute onset dyspnea

156

splenic abscess triad

fever, leukocytosis, LUQ pain

157

splecic abscess cause

staphylococcus, streoptocccus, salmonella

158

splenic abscess treatment

bs antibiotics and splenectomy

159

RA - part of spine invovled

cervical

160

gastric adenocarcinoma diagnosis

endoscopy/biposy
CT abd/pelvis

161

hereditary spherocytosis genetics

AD
defective proteins - spectrin, ankyrin

162

hereditary spherocytosis - defect in RBC

spherical shape, causes them to get stuck in narrow passages of splenic cord --> destroyed = extravascular hemolysis

163

hereditary spherocytosis presentation

hemolytic anemia
jaundice
splenomegaly, gallstone formation

164

hereditary spherocytosis labs

anemia, reticulorcytosis
MCHC elevated
increased membrane fragility

165

hereditary spherocytosis complications

hemolytic crises
leg ulcers
priapism
hypertrophic cardiomyopathy

166

hereditary spherocytosis treatment

splenectoy

167

herediatary sphereocytosis supportive care

folic acid
blood transfusions
EPO

168

abnormal eosin 5-maleimide binding test

hereditary spherocytosis

169

causes of epididymitis

young - chlyamydia, gonorrhea
old - GNR (e coli)

170

antiphospholipid lab abnormality

elevated PTT due to phopholipids binding in vitro

171

PTHrp associated with

squamous cell carcinomas

172

s sanguininis

viridians group, endocarditis after dental procedures

173

antithyroidperoxidase antibody

hasiomoto

174

pneumonia with GI symptoms

legionella!!!

175

legionella treatment

azithromycin or fluoroquinolone

176

acromegaly - first test to order

IGF-1

177

erytheum nodosum differential

streptococcus, TB/histo, sarcoid, IBD

178

infective endocarditis - what valve

tricuspid
holosytolic murmur that increases with inspiration

179

paget's disease treatment

bisphosphonates

180

vipoma - symptoms

watery diarrhea, flushing
hypokalemia, hypercalecemia, hyperglycemia
pancreatic mass

181

malt treatment if no metastases

treat for h pylori
omperazole + clarithomycin + amoxicillin

182

periotonsillar bascess

muffled voice/hot potato voice
unilated LAD
deviated uvula

183

prevention of uric acid stones

potassium citrate to alkalinize urine

184

zinc def

alopeica
skin lesions
abnormal taste

185

cutaneous larva migrans

creeping eruption
sand boxes/beaches

186

lymph nodes <1 cm

benign

187

rubella in adults

arthralgia/arthritis

188

rubella in children

conjunctivitis, coryza, cervical LAD
forschemier spots
cephalocaudal spread of blancing maculopapular rash

189

ADPCK complications

intracranila aneurysms
valvular heart disease
hepatic cysts, colonic diverticula, abdomainal wall and inguinal hernia

190

complications of anklyosing spondylitis if present for two decades

osteopenia/osteoporisi

191

spinal ostemomyelitis physical exam

tender to percussion

192

reactive arthritis

urethritis, oligoarthirit, conjunctiviti
achilles tendon pain

193

AVF

high output cardiac failure

194

conn syndrome

low renin, increased aldosterone

195

lidocaine in ACS

don't use
decreases VF but increases asystole

196

hereditary spherocytosis symptoms

hemolytic anemia
splenomegaly
jaundice

197

RPGN presentation

acute renal fialure, oliguria, nephritic

198

How is echocardiography used in cardiac arrest?

distinguish pulseless electrical activity (PEA) that results in myocardial contraction from patients with no mechanical activity

199

bone marrow biopsy of multiple myeloma patients?

myeloma cells are present on bone marrow biopsy, which are plasma cells in various stages of maturation. They will have acidophilic cytoplasmic inclusions of immunoglobulin called Russell bodies.

200

What is the role of lidocaine in adult cardiac arrest?

v. fib/v. tach cardiac arrest if amiodarone fails.

201

What antiplatelet medications are indicated for patients who have received coronary interventions for STEMI?

aspirin and a P2Y12 blocker (ticagrelor, prasugrel)

202

CO =

SV x HR

203

SV is and =

LVEDV - LVESV
blood ejected from ventricle during systolic

204

SV and hypovolemic shock

decrease in SV --> increase in HR

205

MAP =

average arterial pressure over cardiac cycle
(CO x SVR) + CVP

206

MAP calculation

1/3 systolic + 2/3 diastolic

207

main resistance vessels

arterioles
determine SVR

208

septic shock and CO

decrease in SVR
increase CO

209

causes of pulsus paradoxus

cardiac tamponade
copd, asthma

210

arrhythmia in digitalis

atrial tachycardia with AV block

211

drug that causes prolong QRS during exercise

flecainamide (IC)

212

Acute infective endocarditis caused by

S. aureus

213

subacute infective endocarditis caused by

viridans streptococci
s epidermis
enterococci
HACEK

214

HACEK =

hameophilus, actinobacillus, cardiobacterium, eikenella, kingella

215

culture negative cause of endocarditis

HACEK

216

nonbacterial thrombotic endocarditis

sterile vegetations of platelets and thrombi form on valves
highly susceptible to emoblization

217

marantic endocarditis

NBTE in setting of advanced malignancy

218

s bovis

infective endocarditis in colon cancer

219

veridans group

occurs on native valves
sanguinis

220

infective endocarditis - FROM JANE

fever, roth's spots, osler's nodes, murmur
janeway lesions, anemia, nailbed hemorrhage, emboli

221

roth's spots

retinal hemorrhages around white spots

222

osler's nodes

tender raised lesions on toes and fingers

223

janeway lesions

nontender erythematous lesions on sole and palm

224

empiric infective endocarditis therapy

vancomycin + aminoglycoside (gentamicin)

225

therapy for Viridans, Strep bovis

(Penicillin or ceftriaxone) + gentamicin
or
vancomycin

226

therapy for staph endocarditis

Oxacillin + gentamicin, or
Nafcillin + gentamicin, or
Cefazolin + gentamicin, or
Vancomycin for patients with penicillin allergy or MRSA endocarditis.

227

if pt has prosethic valve and endocarditis

need gentamicin and rifampin

228

antibiotic prophylaxis for infective endocarditis

Congenital cyanotic lesions (ventricular septal defect and atrial septal defects should NOT be treated)
Prior valve repair using prosthetic material (mitral valve prolapse should not be treated)
A prior history of endocarditis
A history of heart transplant

229

untreated endocarditis

heart failure, abscess formation, emboliation causing end-organ damage

230

reversible cause of HF

hemochromatosis

231

cardiac myoxoma

left atrium
constitutional symptoms
diastolic heart sound
embolization

232

acute limb ischemia after MI

arterial embolus from LV thrombus (order TEE)