Exam 2 Flashcards
(299 cards)
1
Q
What is psuedohyponatermia & causes?
A
Serum level dec. but total body sodium normal
Severe
- Hyperglycemia
- Hyperproteinemia
- Hyperlipidemia
2
Q
S/S Hyponatremia
A
<113 - seizures & coma
High mortality w/ CNS findings
3
Q
Dx hyponatermia
A
True hyponatremia - osmolality dec
Factitious hyponatremia - osmolality normal or inc.
4
Q
Hypertonic hyponatermia
A
Osmotic pressure >295
MCC hyperglycemia
Each 100mg/dL inc. in glc dec. serum sodium by 1.7 due to water moving into ECF
5
Q
Isotonic hyponatremia
A
Osmotic pressure 275-295
High proteins & lipids cause a lab to report a falsely lowered sodium than what the serum actually contains
6
Q
Hypotonic hyponatremia
A
Osmotic pressure >275
Hypovolemic - loss of Na & water
Euvolemic - normal volume status
Hypervolemic - excess total body water
7
Q
Causes of renal losses of sodium
A
Hypovolemic hyponatremia
Urinary sodium >20
- Diuretics
- Renal tubular acidosis, chronic renal failure, nephritis
- Osmotic diuresis
- Addison’s
8
Q
Causes of extrarenal losses of sodium
A
Hypovolemic hyponatremia
Urinary sodium <20
- Vol replacement w/ hypotonic fluids
- GI loss (V/D, tube suction)
- 3rd space loss (burns, peritonitis, pancreatitis)
- Sweating (CF)
9
Q
Euvolemic hyponatremia
A
Urinary sodium >20
- SIADH - tumors, CNS disease, pulm disease, meds, idiopathic
- Hypothyroid
- Pain, stress, psychosis - stimulates ADH
- Drugs - carbamazepine, phenothiazines, TCAs
- Water intoxication
- Glucocorticoid deficiency
10
Q
Hypervolemic hyponatremia
A
Volume overload
Urinary sodium >20 - renal failure
Urinary sodium <20 - CHF, cirrhosis, nephrotic syndrome
11
Q
Tx hyponatremia
A
Hypervolemic or euvolemic hyponatremia - fluid restriction
SIADH - demeclocycline or furosemide
Hypovolemic hyponatremia - isotonic saline
12
Q
What can happen if you correct hyponatremia too rapidly?
A
Central pontine myelinolysis brain injury
13
Q
Acute Hyponatremia <120 w/ CNS Sx - how do you treat?
A
Give 3% hypertonic saline at 25-60 mL/hr
Do not raise Na >2mEq/L/hr
Stop when sodium reaches 120 or when Pt improves
14
Q
Tx chronic hyponatremia
A
Correction of Na no more than 0.5 mEq/L/hr
15
Q
When do you admit hyponatremia Pts?
A
- Na <125
- Require IV
- Significant comorbidities
16
Q
Hypernatremia causes
A
Na >150
- Reduced water intake
- Inc. water loss - hypervent., DI, osmotic diuresis, thyrotoxicosis, severe burns
- Inc. sodium intake/renal salt retention - hypertonic saline ingestion, sodium bicarb, hyperaldosteronism, Cushing’s
17
Q
Sx hypernatremia
A
Usually at Na>158 - rate of change important
- Confusion, weakness, irritable, restless, tremulous, seizures, coma
- Hypocalcemia may be present causing CNS Sx
- Flat neck veins, orthostatic HOTN, tachycardia, poor skin turgor, dry mucous membranes
18
Q
Tx hypernatremia
A
Severe dehydration - NS or LR
Then 0.45% saline
Sodium reduction should not exceed 15mEq/L/day
Reach normal serum sodium in 48-72hrs
19
Q
You lose 1L of water, how much does your serum sodium increase?
A
3-5
20
Q
What is the MC electrolyte abnormality?
A
Hypokalemia - <3.5
21
Q
Causes of hypokalemia
A
- Extrarenal - inadequate intake, V/D, inc. insulin, alkalosis
- Renal - diuretics, aldosteronism, renal tubular acidosis
- Lithium, heavy exercise, heat stroke, fever
22
Q
S/S hypokalemia
A
- Weakness, paresthesias, polyuria, orthostatic HOTN, areflexia, ileus, arrhythmias
- EKG - T wave flattening/inversion, U waves, ST depression, PVC’s, wide QRS, tachyarrhythmias
Want to get CK, Mg, UA, BMP
23
Q
Tx hypokalemia
A
K>2.5 w/o EKG findings - oral replacement daily until normal
K<2.5
24
Q
Hyperkalemia causes
A
K >5.5
- Factitious - release of intracellular K by hemolysis during phlebotomy
- Extrarenal causes - insulin deficiency, acidosis, hyperosmolality, beta-blockers, supplements, massive transfusion, crush injuries, burns, mesenteric or muscle infarction
- Renal causes - chronic renal insufficiency, acute renal failure, hypoaldosteronism, drugs (NSAIDs, ACEi, K-sparing diuretics)
25
S/S hyperkalemia
Weakness, paresthesias, confusion, paralysis, areflexia, V/D, ileus, arrhythmias (VF, heart block, asystole)
EKG changes
6.5-7.5 - Prolonged PR, tall peaked T waves, short QT
7.5-8 - Flattening of P wave, QRS widening
10-12 - QRS complex degradation into a sinusoidal pattern
26
Tx hyperkalemia
1. Albuterol
2. CaCl or gluconate
3. Sodium bicarb
4. Insulin & glc
5. Furosemide
6. Dialysis
7. Kayexalate
27
Causes of hypocalcemia
Ionized Ca <8.5
1. Shock, sepsis
2. Renal failure
3. Pancreatitis
4. Hypomagnesemia, alkalosis, phosphate overload, dec. albumin
5. Hypoparathyroidism
6. Malabsorption
7. Meds - phosphate lax, phenytoin, phenobarbital, theophylline, loop diuretics, glucocorticoids
8. Parathyroidectomy
28
S/S hypocalcemia
1. Circumoral & distal extremity paresthesis
2. Irritability, weakness, fatigue, muscle cramps
3. Seizures
4. Hyperreflexia
5. Carpopedal spasm, tetany, laryngospasm
6. Trousseau's sign
7. Chvostek's sign
8. Prolonged QT
9. Sinus bradycardia
10. Heart block
11. VT/VF
29
Tx hypocalecemia
Asymptomatic - oral therapy
Tx hypomagnesemia
<1.3 or Sx - IV Cagluconate over 10 min then maintenance infusion
-careful w/ Digoxin
30
Hypercalcemia Causes
Total Ca > 10.5
Ionized Ca >2.7
1. CA/hyperparathyroidism**
2. Endocrine - hyperthyroidism, pheochromocytoma, adrenal insufficiency
3. Granulomatous disorders - sarcoid, TB, histoplasmosis, coccidiomycosis
4. Immobilization, Paget's disease, dehydration, excess Ca ingestion, milk alkali syndrome
31
S/S hypercalcemia
1. Weakness, depression, confusion, lethargy, personality changes, N/V, anorexia, constipation, HA, abd pain
2. Dehydation, dec. motor strength
3. Dec. mental status
4. Ataxia, hyporeflexia
5. Fx
6. HTN, wt loss, renal insufficiency, cardiac arrest
7. Short QT, widened T waves, bradyarrhythmias, BBB, AV blocks
Stones, bones, moans & groans
32
Tx hypercalcemia
Any Sx Pt or total Ca >14
1. Vol replacement
2. Furosemide
3. Mithramycin
4. Pamidronate
5. Calcitonin
6. Hydrocortisone
7. Dialysis
Watch hypokalemia & hypomagnesemia
33
Causes of hypomagnesemia
<1
1. Alcoholism
2. Malnutrition
3. Cirrhosis
4. Pancreatitis
5. Excessive GI fluid losses (Diarrhea)
34
S/S hypomagnesemia
1. Malaise
2. Muscle weakness
3. Anorexia, N/V
4. Seizures
5. Chvostek & Trousseau's
6. Tremors, twitching, clonus, dec. DTR, carpopedal spasm, tetany, delirium, dysarthria
7. Tachyarrhythmias, Torsades, prolonged PR & QT
35
Tx hypomagnesemia
Mild - Mg(OH)2
Severe - neuro findings & arrythmias - MgSO4
Admit if <1 & Sx
Watch hypokalemia, hypocalcemia, hypophosphatemia
36
Hypermagnesemia Causes
>2.5 - Rare - usually w/ renal failure/iatrogenic cause
1. Rhabdo
2. Tumor lysis
3. Burns
4. Trauma
5. DKA
6. Hypothyroid
7. Antacids
8. Laxative abuse
9;. Eclampsia Tx
37
S/S hypermagnesemia
Nonspecific
1. N/V
2. Lethargy, confusion
3. Coma
4. If >4 - Dec. DTR's, muscle weakness, bulbar paralysis, resp. insufficiency
38
Tx hypermagnesemia
1. Cagluconate/chloride
2. Furosemide
3. Dialysis
Watch hyperkalemia/hypercalcemia
39
Causes of resp. acidosis
1. CNS lesions
2. Sedative therapy & overdose
3. Neuromuscular disorders
4. Pleural disease
5. COPD
40
Causes of resp. alkalosis
1. Anxiety - MCC
2. Hypoxia
3. Pulm. disorders
4. Salicylate toxicity
5. CNS disorders
6. Pregnancy
7. Early sepsis
41
At what pH is there dec. cardiac function?
>7.73
42
Causes of anion gap metabolic acidosis
```
Alcohol
Methanol
Uremia
DKA
Paraldehyde
Iron, Isoniazied
Lactic acidosis
Ethylene glycol
Carbon monoxide
Aspirin
Toluene
```
43
What is the MCC of anion gap met. acidosis?
Lactic acidosis - due to dec. oxygen to tissues, sepsis, shock
44
Causes of nonanion gap metabolic acidosis
1. Conditions that cause renal loss of bicarb - renal tubular acidosis, acetazolamide therapy
2. Conditions that lead to GI loss of bicarb - diarrhea, pancreatic fistula, ureterosigmoidostomy
3. HCl, ammonium chloride, oral CaCl2
45
S/S met. acidosis
pH s respiration - rapid regular deep resp. rate
46
Anion gap formula
Na - (HCO3 - Cl)
Normal is 10-12
>12 - met. acidosis
47
S/S met. alkalosis
1. Tetany
2. Seizures
3. Loss of Ca, K & Mg
48
MCC hypoglycemia?
Insulin
49
Causes of hypoglycemia
1. Inadequate food intake
2. Insulin/meds
3. Drug interaction
4. Infection
5. Renal/hepatic failure
6. ACS
7. Stress
50
Tx hypoglycemia
1. Glucose D50W
2. Glucagon
3. Octreotide - suppresses insulin secretion
If alcoholic - give thiamin to prevent Wernicke-Korsakoff's syndrome
51
Tx hypoglycemia cause by sulfonylurea?
Octreotide
52
Causes of DKA
1. Not taking insulin
2. Infection
3. Pregnancy
4. Hyperthyroidism
5. Substance abuse (Cocaine)
6. Meds - steroids, thiazides, antipsychotics, sympathomimetics
7. Heat-related illness
8. CVA
9. GI hemorrhage
10. MI
11. PE
12. Pancreatitis
13. Major trauma/surgery
53
S/S DKA & HHS
1. N/V, abd pain
2. Polyuria, polydipsia
3. AMS
4. Kussmaul's breathing
5. Fruity breath
6. Dehydration - HOTN, tachycardia, dry skin, dry mucous membranes
54
Labs DKA
1. Glc >250
2. Anion gap >10
3. Bicarb <7.3
5. Ketonemia
55
Tx DKA
1. NS
2. Follow K+
3. Insulin - 0.1/kg/hr
56
Causes of hyperosmolar hyperglycemia state
Diabetics
1. Stressor - infection, CVA, GI bleed, MI, pancreatitis
2. Meds - thiazide diuretics, corticosteroids, lithium, beta-blockers, Ca-channel blockers, phenytoin
Nondiabetics
1. Severe dehydration/excess glucose load - burns, heat stroke, dialysis, diet, hyperalimentation
57
Dx HHS
1. Glc >600
2. Osmolality >315
3. Bicarb >15
4. pH >7. 3
58
HHS Tx
1. IVF - correct 1/2 w/in 1st 12h then rest over next 24h
2. Once HOTN, tachycardia & urine output improve - switch to 0.45% NS
3. Potassium
4. Insulin
59
Who gets alcoholic ketoacidosis?
Alcoholics who abruptly stop drinking after a binge
| or 1st time drinkers
60
S/S alcoholic ketoacidosis
Binge drinking then
1. Abd pain - pancreatitis, gastritis, hepatitis
2. N/V
3. Alcohol withdrawal/DTs
4. Dehydration - HOTN, tachycardia
5. Kussmaul's respiration
6. +/- fever
7. NL MS/coma
8. Abd tenderness
9. Heme + stool
10. Hepatomegaly
61
Dx alcoholic ketoacidosis
1. Low/NL/slightly inc. glc
2. Wide anion gap met. acidosis
3. +serum ketones
62
Tx alcoholic ketoacidosis
1. Saline w/ glucose & thiamin
2. Insulin if DM
3. Consider Mg & multivitamin
4. Bicarb if pH<7.1
63
Type D lactic acidosis
Shortened bowel sundrome caused by bacterial fermentation
64
Type A lactic acidosis
Caused by tissue hypoxia
Has a high mortality
Related to hemorrhagic, hypovolemic, cardiogenic & septic shock
65
Type B lactic acidosis
No tissue hypoxia - may be abrupt in onset or over a few hours
Seen w/ DM, liver disease, seizures, renal disease, genetic disorders of metabolism, drugs (ethanol, metformin, salicylate ingestion)
66
S/S lactic acidosis
Produces anion gap acidosis
Abrupt onset - ill Pt
1. Hypoventilation or Kussmaul's breathing
2. Lethargy, coma
3. Vomiting, abd pain
67
Tx lactic acidosis
1. Ventilation & volume replacement
2. Diuresis
3. Bicarb if pH<7.2
Admit to ICU
68
Causes of thyroid storm
1. Infection - MCC
2. Trauma, surgery, hyperosmolar coma
3. DKA
4. Withdrawal of thyroid med, iodine or contrast administration, thyroid gland palpation, ingestion of thyroid hormone, amiodarone, large doses of povidone-iodine w/ skin breakdown
5. MI, CVA, PE
6. Parturition (childbirth), eclampsia
69
S/S thyroid storm
1. Exopthalmos
2. Widened pulse pressure
3. +/- Palpable goiter
4. Heat intolerance
5. Fever
6. Tachycardia out of proportion to fever
7. Profuse sweating
8. Dehydration
9. Hair loss
10. Inc. SBP
11. Inc. pulse pressure
12. Systolic flow murmur
13. Sinus tachycardia
14. AFib, CHF, pulm. edema
15. Agitation, restlessness, psychosis, confusion, obtundation, coma, proximal muscle weakness, hyperreflexia
16. Wt loss, N/V/D, anorexia, abd pain
70
Dx thyroid storm
1. Inc. FT4
2. Suppressed unmeasureable TSH
3. Sinus tach/AFib
71
Tx thyroid storm
1. IVF w/ dextrose
2. Oxygen
3. Acetaminophen
4. Cooling blankets
5. Cholestyramine
6. Propylthiouracil/Methimazole
7. Iodine, KI, NaI, Li
8. Propranolol
9. Hydrocortisone
72
Causes of myxedema coma
Infection, cold, trauma, MI, CHF, CVA, GI bleed, surgery, burns
Meds - beta-blockers, sedatives, narcotics, amiodarone
MC in winter months in old ladies
73
S/S myxedema coma
1. Hypothermia
2. Resp distress w/ hypoventilation, hypercapnia, hypoxia
3. Cardiomegaly, vent arrhythmias, HOTN, bradycardia
4. Seizures, ataxia, tremors, slow mentation, delusions, psychosis
5. Megacolon, urinary retention, abd distention
74
Dx myxedema coma
1. High TSH
2. Low T4
3. Dec. Na & Cl
4. Hypoxia & hypercapnea
75
Tx myxedema coma
Tx before labs confirm
Thyroid replacement therapy
Supportive care
76
S/S adrenal crisis
1. HOTN refractory to fluids & pressors
2. Dehydation
3. Weakness, lethargy
4. Shock
5. Delirium
6. Abd pain w/ N/V
7. +/- sepsis
77
Dx adrenal crisis
1. Hyponatremia
2. Hypoglycemia
3. Hypercalcemia
4. Inc. BUN
5. Mild met. acidosis
6. Flattened T waves, Prolonged QT & PR, low voltage, ST depression, signs of hypo/hyperkalemia
78
Tx adrenal crisis
1. IVF
2. Hydrocortisone
3. Vasopressors
79
Cause of Wernicke-Korsakoff's syndrome
Alcoholic w/ poor nutrition from thiamin deficiency
| PPTd by giving glucose to alcoholic w/ inadequate thiamin
80
S/S Wernicke-Korsakoff
Triad
1. AMS
2. Opthalmoplegia
3. Gait ataxia
Also
1. Hypothermia
2. HOTN
3. Coma
4. Circulatory collapse
81
Dx Wernicke-Korsakoff
Usually made clinically
| Tx immediately
82
Tx Wernicke-Korsakoffs
1. Thiamin
| 2. Mg
83
What is Cullen's sign & when is it seen?
Ecchymosis of umbilicus
From retroparitoneal hemorrhage from pancreatitis or trauma
84
What is Turner's sign & when is it seen?
Flank ecchymosis
From retroperitoneal hemorrhage from pancreatitis or trauma
85
What is caput medusae & when is it seen?
Dilated veins around umbilicus
Seen in liver disease
86
Tympanic abdomen percussion means??
Dilated bowel loops
87
Pt comes in w/ CP, given NTG & gets better. What was wrong?
Could be cardiac or esophageal...needs more testing
88
Tx esophageal food bolus
1. Carbonation - EZ gas
2. IV glucagon - smooth muscle relaxer
3. Acute endoscopy
89
MCC esophageal perforation?
Iatrogenic
90
What is Hamman crunch & when is it seen?
Heard on heart ascultation
Due to mediastinal emphysema
91
S/S esophageal perforation
1. Pain acute, severe, diffuse, located in chest, neck, abd w/ radiation to back/shoulders
2. Pain worse w/ swallowing
3. HOTN
4. Fever
5. Abd rigidity
6. Tachycardia, tachypnea
CXR - mediastinal air, SQ emphysema, wide mediastinum, effusion
92
Dx & Tx esophageal perforation
1. Chest CT/endoscopy
Tx
1. Shock resuscitation
2. IV abx
3. Surg. consult
93
S/S swallowed FB in kiddos
1. Refusal to eat
2. Inc. salivation
3. Odynophagia
4. Vomiting
5. Choking
6. Resp. Sx - stridor, cough, wheeze
7. Neck or throat pain
94
Tx FB swallow
Distal to pylorus - d/c & wait to pass
Obstruction? Emergent ednoscopy
-button batters, perf, coin at cricopharyngeus muscle, >24h
95
Swallowed button battery...what do you do??
Can cause corrosion & perf...get Xray
If above pylorus - endoscopy
If passed - watch & f/u in 24h, repeat films in 48h
96
Tx body packers
Observe or whole bowel irrigation
Endoscopy contraindicated - can rupture!
97
PUD Dx & Tx
1. CXR - free air in 75%
2. +/- CT
Tx
1. Labs - type & cross
2. 2 large bore IVs
3. O2
4. NG tube
5. Broad spectrum abx
6. Surg. consult
98
MCC Upper GI bleed?
PUD
99
Causes of upper GI bleeds
1. PUD - epigastric pain, melena/hematemesis, stool +
2. Variceal bleeding - painless, massive hematemesis, signs of chronic liver disease
3. Mallory-weiss tear - Hx of forceful vomiting
100
Tx upper GI bleed
1. 2 large bore IVs
2. Transfusion of PRBCs
3. PUD? IV PPI/H2 blocker
4. +/- vasopressin
5. Mallory weiss tear? d/c after bleeding stops
101
MCC N/V?
Viral gastroenteritis
102
What is dysentery diarrhea?
Contains blood, mucus & pus
103
What is gastroenteritis?
Acute intestinal inflammation causing diarrhea w/ N/V
104
What should you suspect if you see systemic illness, fever & bloody stools?
1. Salmonella
2. Shigella
3. Campylobacter
4. Toxin producing E. coli
105
What is a BRAT diet & who should use it?
Bananas
Rice
Apple sauce
Toast
diarrhea Pts
106
When should you avoid antidiarrheals?
ex. Loperamide
Don't use w/ toxigenic gastroenteritis
1. Toxin producing E. coli
2. Staph aureus
3. Bacillus cereus
4. C. diff
107
S/S diarrhea caused by abx or other meds
No cramps, fever or fecal leukocytes
| Diarrhea goes away after meds stopped
108
MCC infectious diarrhea
Virus
Norovirus
109
Which abx is most often assoc. w/ C. diff?
Clindamycin
also cephalosporings, PCN & fluoroquinolone
110
Dx & Tx C. diff
C. diff toxin in stool
Colonoscopy? Yellowish plaques in lumen
Mild - monitor
Moderate - Flagyl for 10-14 days
Severe - hospitalize, Vanco PO x 10days
111
What is tenesmus?
Feeling like you have to poop but your bowels are empty
112
Dx & Tx Crohn's & ulcerative colitis
CT
1. Restore fluids & electrolytes
2. NPO
3. NG suction for obstruction, ileus, toxic megacolon
4. Narcotics
5. Abx
113
Causes of toxic megacolon
1. Antidiarrheals
2. Hypokalemia
3. Narcotics
4. Cathartics
5. Pregnancy
6. Enemas
7. Recent colonoscopy
Ulcerative colitis & Crohn's at inc. risk
114
MCC small bowel obstruction??
Adhesions from abdominal surgery
2nd MCC? Incarceration of groin hernia
115
MCC large bowel obstruction?
CA
2nd MCC? Diverticulitis
116
Dx bowel obstruction
Abd CT w/ contrast
Xray - air fluid levels
WBC >20k - gangrene, intra-abd abscess, peritonitis
WBC >40k - mesenteric vasc. occlusion
Inc. Hct, BUN & Cr - vol. depletion & dehydration
Inc. urine spef. gravity, ketonuria, elevated lactate & met. acidosis - severe disease
117
Tx bowel obstruction
1. Surg. consult
2. NG tube if severe distention & vomiting
3. IVF
118
Which types of bowel obstructions are surgical emergencies?
1. Closed-loop obstruction
2. Bowel necrosis
3. Cecal volvulus
119
Tx adynamic ileus
1. IVF
| 2. Observation
120
What is pseudo-obstruction?
aka Ogilvie syndrome
Distention of colon but no obstruction
Xray - dilated bowel w/o air fluid levels
Risk factors - age, anticholinergics/TCAs, recent surg.
Avoid barium studies
Tx - colonoscopy or neostigmine infusion
121
Dx & Tx diverticulitis
Abd CT - inc. soft tissue density w/ pericolic fat, bowel wal lthickening
1. Supportive - bowel rest & IVF
2. Cipro & Flagyl
3. Surgery if perforation, obstruction or abscess
122
S/S diverticulitis
1. LLQ pain
2. Fever
3. N/V
4. Anorexia
5. Dysuria
123
Rome Criteria for Dx of constipation
2 or +
1. Straining at defecation at least 25% of time
2. Hard stools at least 25% of time
3. Incomplete evacuation at least 25% of time
4. <3 BM/wk
5. Chronic constipation includes Sx for at least 12 wks in the past 12 mo
124
MCC acute hepatitis?
Acetaminophen overdose
125
Types of hepatorenal syndrome
Spontaneous bacterial peritonitis leading to renal failure w/ hepatic failure
1. More serious. Progressive oliguria & doubling serum Cr in 2wks
2. Gradual impairment of renal function that may or may not advance
126
Stages of hepatic encephalopathy
Accumulation of nitrogenous waste products cuz liver sucks
1. General apathy
2. Lethargy, drowsiness, variable orientation, asterixis
3. Stuper w/ hyperreflexia, extensor plantar reflexes
4. Coma
127
Hallmarks of liver failure
Hepatic encephalopathy & coagulopathy
HOTN, hypoglycemia, adrenal insufficiency
128
Tx hepatic encephalopathy
Lactulose
129
Tx liver failure
1. Intubation
2. IVF
3. Blood products
4. Vasopressors PRN
5. Mannitol if cerebral edema
130
Alcoholic LFT
AST:ALT >2
131
HELLP syndrome
Hemolysis - elevated LFT - low platelets
Occurs w/ preeclampsia-eclampsia in late 3rd trimester or postpartum period
Tx >34 - immediate delivery
132
Causes of pancreatitis
1. Cholelithiasis
2. Alcohol
Others - trauma, infection, meds, hyperparathyroidism, hyperlipidemia
133
S/S pancreatitis
1. N/V
2. Epigastric pain radiates to back may be relieved by leaning forward
3. Epigastric tenderness
4. Diminished bowel sounds
5. Fever
6. Jaundice
7. Cullens/Turners sign if retroperitoneal hemorrhage
134
Dx pancreatitis
Use Ranson's criteria >3
1. Amylase
2. Lipase**
3. Xray - 'cutoff' sign
4. US
5. CT - best test, but not needed if no complications
135
Tx pancreatitis
1. NG suction
2. Antiemetics
3. IVF
4. Foley cath to monitor fluids
5. Analgesics
6. +/- abx
136
Risk factors for gall stones
```
Forty
Fat
Female
Fertile
Flatulent
Fair
```
137
S/S cholecystitis
1. RUQ pain radiate to scapula
2. Post-prandial pain after eating fatty foods
3. Murphy's sign
4. +/- fever
5. Jaundice
138
Dx & Tx cholecytitis
Labs elevated
US**
1. NG suction
2. Bowel rest
3. IVF
4. Surg. consult
139
What is Charcot's triad & when is it seen?
1. RUQ pain
2. Fever
3. Chills & jaundice
Seen w/ ascending cholangitis
Infection of biliary system from stone in bile duct
Tx - same as cholecystitis but add abx
140
What is Reynold's pentad & when is it seen?
1. RUQ pain
2. Fever & chills
3. Jaundice
4. AMS
5. HOTN
Tx - same as cholecystits but add abx
141
MCC appendicitis?
Fecalith
142
S/S appendicitis
1. Gen. umbilical pain then localized to RLQ
2. Anorexia
3. N/V
4. McBurney's point
5. Involuntary guarding & rebound tenderness
6. Rovsing's sign
7. Psoas sign
8. Obturator sign
143
Dx & Tx appendicitis
All the dumb signs
Labs
CT w/ contrast
1. NPO
2. IVF
3. Antiemetics + narcotics
4. Abx
5. Surgery
144
MC surgical emergency in pregnant ladies?
Appendicitis
145
Causes of AMS & Coma
```
Alcohol
Endocrine & Environmental
Insulin & impaired glucose utilization***
Ox deprivation & opiate OD
Uremia
Trauma
Infection
Psychiatric causes & porphyria
Space occupying lesions - inc. pressure on RAS
```
146
Causes of fixed dilated pupil
Temporal lobe herniation on same side or if alert - could be from drops or compression of CN III
147
Causes of miosis
```
COPS
Clonidine
Cholinergics
Opiates
Organophosphates
Phenothiazines
Pontine hemorrhage
Sedative hypnotics
Sleep
```
148
Causes of mydriasis
1. Anticholinergics
| 2. Sympathomimetics
149
Causes of Cheyne-Stokes respirations
Crescendo-decrescendo pattern
1. Bilat hemisphere dysfunction, intact brain stem
2. Metabolic disorder
2. Transtentorial herniation
150
Causes of apneustic breathing
Prolonged pause after inspiration
| -pontine infarct
151
Causes of hyperventilation
1. Met. acidosis
2. Salicylate OD
3. Hypoxia
4. Hypercarbia
152
S/S toxic-metabolic coma
1. Lack of focal exam findings
| 2. Pupillary response usually preserved
153
S/S supratentorial lesion coma
1. Progressive hemiparesis
2. Asymmetric strength & reflexes
Ex. Uncal herniation
Also see w/ inc. ICP - HTN & bradycardia = Cushing's triad
154
S/S infratentorial lesions - posterior fossa coma
Cerebellar hemorrhage or infarction may cause coma
1. Abnormal extensor posturing
2. Loss of pupillary reflexes
3. Loss of EOM
Ex. pontine hemorrhage - pinpoint pupils
155
S/S pseudocoma
Pupillary responses, EOM, muscle tone & reflexes normal
156
Dx & Tx coma
Hx - look for reversible causes
If on meds that can check levels - check it!
CT
Tx - ABCs
157
MC location of SAH HA?
Occipitonuchal
158
Jaw claudication w/ HA?
Temporal arteritis
159
Facial painw/ HA?
Sinusitis
160
Vision change & eye pain w/ HA?
Glaucoma
161
POUNDing approach to HA
```
Pulsatile
Duration of 4-72h
Unilat
N/V
Disabling intensity
```
if 4/5 - most likely migraine
162
HA w/ fever?
1. Meningitis
2. Sinusitis
3. SAH
163
Causes of HA w/ HIV?
1. Toxoplasmosis
2. CNS lymphoma
>3days? Higher risk of AMS & new seizure
164
Thunderclap HA?
SAH
CT w/o contrast or CT angio
LP if no Dx
1. LOC
2. Seizure
3. Diplopia
4. Other neuro signs
Exercise, intercourse or defecation sets it off
MCC ruptured aneurysm
165
Tx SAH
1. Control BP, pain & nausea
2. Prevent vasospasm w/ Nimodipine
3. Refer to surg.
166
Risk factors of subdural hematoma
Remote trauma w/ HA
1. Anticoagulants
2. Chronic alcohol abuse
3. Old people
Get noncontrast CT
167
S/S Cerebral venous thrombosis
1. HA
2. Vomiting
3. Seizures
Common w/ hypercoagulable state, OCs, postpartum/postop
Need magnetic resonance venogram
168
S/S & Tx temporal arteritis
1. HA - severe & throbbing over frontotemporal area
2. Jaw claudication
3. Hx of polymyalgia rheumatica
4. +/- loss of vision
5. High ESR
Tx - prednisone
169
S/S & Tx pseudotumor cerebri
1. Young Pt w/ chronic Has
2. N/V
3. Visual problems
4. Papilledema
5. Normal CT
6. Elevated CSF pressure
Tx - Acetazolamide
170
S/S internal carotid dissection & Dx
1. Unilat neck pain or HA usually by eye/frontal area
Dx - angiography
171
S/S & Dx vertebral artery dissection
Occipital or posterior neck pain
Dx - angiography
172
Tx migraine
1. DHE - don't use in pregnancy, uncontrolled HTN, CAD, causes N/V
2. Triptans
3. Metoclopramide, prochlorperazine - dystonic rxns
4. Ketorolac
5. Narcotics
6. Dexamethasone
173
S/S & Tx tension HA
1. Bilat, nonpulsating
2. Not worsened by exertion
3. No N/V
Severe HAs may cause N/V
Tx - NSAIDs/analgesics
174
S/S & Tx cluster HAs
1. Rare, short lived, MC men >20
2. Severe unilat orbital, supraorbital or temporal pain lasting 15-180mins
3. Pacing & restless
4. Conjunctival injection, lacrimation, nasal congestion, rhinorrhea, facial swelling, miosis, ptosis
Tx
1. Oxygen
2. DHE
3. Triptans
4. Analgesics
175
Tx Trigeminal neuralgia
Carbamazepine
MC in women
176
MCC disability?
CVA
177
Types of ischemic stroke
1. Thrombotic
2. Embolic
3. Hypoperfusion
178
Main areas affected by hypoperfusion ischemic stroke?
Watershed areas - periphery of major vessels
179
MCC intracerebral hemorrhagic stroke?
Chronic HTN
MC in Asians & Blacks
180
S/S middle cerebral artery stroke
MC type
1. Contralat hemiparesis
2. Facial plegia
3. Sensory loss
4. Homonymous hemianopsia & gaze preference toward side of infarct
5. Face & upper extremities affected more than lower
181
S/S anterior cerebral artery stroke
1. Contralat sensory & motor Sx in lower extremity, sparing hands & face
2. +/- aphasia neglect
3. +/- incontinence
182
S/S Posterior cerebral artery stroke
1. Unilat HA
2. Contralat homonymous hemianopsia
3. Unilat cortical blindness
183
S/S Vertebrobasilar stroke
1. Vertigo - w/ cerebellar or brainstem signs
2. HA
3. Nausea
4. Visual disturbances
5. Oculomotor palsies
6. Ataxia
7. Sensory disturbance
8. Bilat limb weakness
184
S/S cerebellar stroke
1. Vertigo
2. Gait instability
3. Ataxia
4. Dysarthria
5. N/V
6. Cranial nerve abnormalities
185
S/S lacunar stroke
Assoc. w/ HTN
Involve basal ganglia, internal capsule, thalamus & brainstem
1. Pure motor deficit of face, arm & leg
2. May be subclinical
Better prognosis
186
Dx & Tx ischemic stroke
CT w/o contrast
May get other tests to see where emboli came from
1. If no thrombolytics & has HTN - lower if >220/120
2. If getting thrombolytics - lower to <185/110 w/ Labetalol, Nicardipine & Esmolol
3. tPA w/in 3h of stroke
4. Aspirin w/in 24-48h
187
Tx TIA
1. Aspirin +/- Clopidogrel
188
Dx & Tx cervical artery dissection
MRI/MRA & CT/CTA
Tx - heparin then Coumadin
189
Causes of ataxia
Systemic
1. Intoxication - ethanol, sedative hypnotics, phenytoin, carbamazepine, valproic acid
2. Hyponatremia
Nervous system
3. Cerebellum - hemorrhage, infarct
4. Cortex - tumor, hemorrhage, trauma, hydrocephalus
5. Subcortical - infarct, Parkinson's
6. Spinal cord - cervical spondylosis
7. Peripheral nervous system - neuropathy
190
+ Rhomberg?
Sensory ataxia w/ problem in posterior column, vestibular dysfunction or peripheral neuropathy
Ataxia w/ - Rhomberg?
Motor ataxia w/ problem in cerebellum
191
S/S Sensory ataxia
Loss of proprioception
Abrupt mvmt of legs & slapping of feel w/ each step
192
Apraxic gait?
Lost ability to initiate walking
Seen w/ nondominant hemispheric lesions
193
Festinating gait?
Narrow based shuffling steps
Seen w/ Parkinson's
194
What is vertigo?
Perception of mvmt when none exists
195
Causes of peripheral vertigo
1. Vestibular neuritis
2. Labyrinthitis
3. Meniere's disease
4. Benign paroxysmal positional vertigo
5. Drug induced vertigo
196
Causes of central vertigo
1. Acoustic schwannoma or meningioma
2. Cerebellar pontine angle tumors
3. Cerebellar infarct
4. Cerebellar hemorrhage
5. Vertebrobasilar insufficiency
197
MCC vertigo in old people?
Benign paroxysmal positional vertigo
Do Dix-Hallpike Maneuver - Nystagmus toward affected ear for 10-40 secs
198
Tx vertigo
Peripheral
1. Hydration
2. Antihistamines
3. Anticholinergics
4. Antiemetics
5. Benzos
6. Reassurance
Central
Refer to neuro!
199
Tx seizures in pregnant eclampsia Pt?
IV magnesium
Definitive Tx - delivery
Pregnant >20wks, HTN, edema & proteinuria
200
Tx peripheral neuropathies
Neuro!
201
S/S botulism
Sx w/in 48h of ingestion of tainted food/wound infections/IVDU
1. N/V/D
2. Abd cramps
3. Descending symmetric paralysis - CN & bulbar muscles affected first
4. Diplopia, dysarthria, dysphagia
5. Pupils dilated & nonreactive
202
S/S botulism in baby
1. Constipation
2. Poor feeding
3. Lethargy
4. Weak cry
5. "Floppy infant"
203
Tx botulism
1. Supportive
| 2. Botulinum antitoxin
204
Tick paralysis S/S & Tx
Sx 2-6 days after tick
Ataxia of LE then UE then resp. failure
Tx - remove tick
205
Giullan-barre syndrome
Peripheral nerve myelin sheath destruction
Subacute ascending symmetric weakness or paralysis & loss of DTRs, watch resp. function
Tx - IVIG & plasmapharesis
206
Rhabdomyolysis
Skeletal muscle injury causing release of cell contents into plasma
Inc. PCK
Urine dipstick +blood - microscopic myoglobin
Tx - Tx cause
1. Hydration
2. Alkalinization of urine >6
207
Myasthenia crisis
Extreme weakness w/ resp. failure
May be triggered by infection, surgery or tapering meds
Give Neostigmine
208
Cholingergic crisis
Side effect of too much meds
Worsens w/ Edrophonium
May need intubation & mgmt of secretions & bronchospasm
Tx - Atropine
209
Causes of neuroleptic malignant syndrome
```
Hyperthermia, rigidity, AMS, fever
1. Dopamine antagonists
Prolixin, Haldol, Regla, Clozapine
2. W/D dopamine agonist
L-dopa, Bromocriptine, Amantadine
3. Dopamine depletion
Xenazine
```
Elevated CK, leukocytosis
Tx
1. Cooling
2. Fluids & alkaline diuresis to Tx rhabdo
3. Dantrolene, Bromocriptine, Nondepolarizing NMB, Nipride
210
MCC rectal bleeding?
Hemorrhoids
211
Tx hemorrhoids
1. Manual reduction if nonthrombosed, sitz-baths
2. Topical analgesics & steroids
3. Bulk laxatives/stool softeners, high fiber diet, fluids
Thrombosed internal - surgery
Thrombosed external - cut it out
212
Location of anal fissures
Posterior or anterior midline
Any other area suggestive of Crohn's, ulcerative colitis, carcinoma, infection
Usually due to passage of large hard stool or frequent diarrhea, consider child abuse
213
S/S & Tx anorectal abscesses
1. Constant throbbing pain, worse w/ BMs
2. Purulent d/c
3. Polymicrobial
Tx
1. I&D
2. +/- abx
214
Types of rectal prolapse & Tx
1. Rectal mucosa only
2. All layers
3. Intussusception of upper rectum through the lower
Tx
1. Reduce w/ analgesia & sedation
2. Can't do it? Surg.
215
MCC lower GI bleeds
1. Diverticular disease
2. Colitis
3. Polyps
4. CA
216
MCC intestinal ischemia?
Ischemic colitis
217
MC type of hernia?
Indirect inguinal hernia
Get US
218
S/S, Dx & Tx mesenteric ischemia
Acute onset of periumbilical pain out of proportion to physical findings
Dx - CT angio
Tx - IVF, surg consult
219
MCC blindness in kids?
Eye trauma
220
S/S, Dx & Tx blowout Fx
From blunt force trauma
1. Diplopia
2. Periorbital ecchymosis & edema
3. Anesthesia of maxillary teeth & upper lip
4. Step off deformity over infraorbital ridge
5. Orbital crepitus
6. Xray - teardrop sogm
Dx - CT
Tx - Surgery
221
Severe conjunctivitis in 12-24h?
Gonococcal
Tx
1. Lavage mucus
2. Ceftriaxone or Azithromycin
222
Tarsal/bulbar conjunctival inclusion follicles?
Chlamydia conjuncitivits
Tx
1. Tetracycline, doxy, erythromycin, azithrymycin
2. +/- topical abx
223
Subconjunctival hemorrhages w/ itchy, tearing eyes?
Viral conjunctivitis
Tx
1. Artificial tears
2. Cool compresses
Herpes? Use acyclovir
224
Tx bacterial conjunctivitis
Broad spectrum abx
| Sulfonamides, tetracycline, erythromycin
225
Tx allergic conjunctivitis
1. Topical antihistamines
| 2. Short course of topical steroids
226
Dx & Tx corneal abrasion
1. Fluorescein eye drops
2. Slit lamp for intraocular FB
```
Tx
1. Cotton tip
2. 25 guage needle
3. Topical abx - Tobramycin, polymyxin-bacitracin ointment, erythromycin ointment
Contacts? Need Cipro
4. NSAID Diclofenac or Mydriacyl
5. Anesthetic eye drop
```
227
S/S iritis
All normal eye complaints +
1. Cells in flare in anterior chamber
2. Ciliary flush
3. Keratic precipitates
4. Unilat/bilat
5. Adhesions to the iris (posterior synchiae)
6. Brow ache/HA
228
Tx iritis
1. Cycloplegics - homoatropine or atropine drops
2. Prednisilone acetate
3. Refer to ophthamologist
229
Dx & Tx corneal ulcer
1. Fluorescein eye drops
2. Culture - bacterial & viral
If non infectious? Look at rheumatoid arthritis
```
Tx
1. Gentamicin or Cefazolin
Contacts? Cipro
2. Cycloplegic eye drops
3. Refer
```
230
Corneal ulcer w/ contacts - what's the bacteria?
Pseudomonas
Staph is also common
231
Causes of angle closure glaucoma
1. Sulfa drugs
2. OTC decongestants
3. Motion sickness meds
4. Adrenergic agents
5. Antipsychs
6. Antidepressants
7. Anticholinergics
232
S/S Angle closure glaucoma
All other eye complaints:
1. Halos around lights
2. Pain ppt by dark conditions***
3. Elevated IOP - maybe >60
4. Steamy cornal edema**
5. Mid dilated fixed pupil
6. Shallow anterior chamber
233
Tx angle closure glaucoma
Reduce IOP & break angle closure
1. Beta-adrenergic drops
2. Topical steroid drops
3. Alpha-adrenergic agonists
4. Carbonic anhydrase inhibitor acetazolamide
5. Hyperosmotic agents if IOP very high
6. Laser peripheral iridotomy to relieve pressure
EMERGENCY!
234
Tx secondary angle closure glaucoma
From Topiramate/sulfa use
1. D/c med
2. Cycloplegia - atropine
3. IV hyperosmotic agents
4. IV steroids
5. Refer
235
MC site of bleeding for hyphema?
Anterior aspect of the ciliary body
236
Dx & Tx hyphema
Hx of trauma
1. Blood/clot in anterior chamber
2. R/o ruptured globe
3. Measure IOP
Tx
1. Acetaminophen
2. Bed rest/limited activity
3. Elevate head
4. Eye shield
5. Atropine
6. Refer
237
Dx & Tx orbital cellulitis
1. Hx sinus infection/surgery/insect bid/stye chalazion/infection
2. CT w/ contrast
Tx
1. Nasal decongestants & vasoconstrictors to drain sinuses
2. Augmentin/Ceftriaxone
3. I&D of abscess
Immunosuppressed? Antifungal - Amphotericin-B
238
Dx & Tx preseptal cellulitis
1. CT scan/MRI
Tx
1. Antihistamines
2. Cool compresses - insect bite
3. Amoxicillin
239
What is normal eye pressure?
10-22
240
S/S retinal artery occlusion
1. Painless, acute vision loss (over seconds)
2. Cherry red fovea
3. Causes irreversible cell injury in 100min
4. HA, wt loss, jaw claudication, scalp tenderness, fever, proximal joint pain
5. Hx Afib, endocarditis, coagulopathies, atherosclerotic disease
6. Fell asleep on eye
241
Dx retinal artery occlusion
1. Whitening of retina on posterior pole
2. Cherry red spot macula
3. + APD
4. Narrowed retinal arterioles
5. Boxcarring/segmentation of blood columns in arterioles
6. Find out where emboli came from
242
Tx retinal artery occlusion
1. Ocular massage w/ firm pressure
2. Anterior chamber paracentesis
3. IOP reduction - Acetazolamide/topical beta-blockers
4. Hypervent. to induce resp. acidosis & vasodilation
Must be done 90-120min after event
REFER
243
Cherry red macula?
Retinal artery occlusion
244
Tx chemical burns
1. Topical anesthesia
2. Irrigation - check pH
3. Artificial tears
4. Bandage contact lens
5. Amniotic membrane transplant
6. Topical steroids
7. Abx eye drops
8. IOP>30 needs Tx
9. Cycloplegics for pain
245
What is keratitis?
Inflammation of the cornea
Infection/dry eyes/contacts/injury/Vit A deficiency
246
S/S & Tx herpes simplex keratitis
1. Unlat
2. Mild conjunctival injection
3. Epithelial dendrites
4. Stromal scarring & vascularization w/ advanced disease
Tx -
1. Cycloplegic
2. Trifluridine
3. Acyclovir
247
S/S & Tx herpes zoster ophthalmicus
1. Vesicular rash of CN 5
2. Hutchinson's sign - lesion on tip of nose
3. Conjunctivitis
4. Uveitis
5. Glaucoma
6. Scleritis
Tx
1. Acyclovir
2. Tears
248
S/S & Dx & Tx Fusarium fungal keratitis
1. Conjunctival injection
2. Epithelial defect
3. Stromal infiltration
4. Gray-white color & rough corneal surface
5. Irregular feathery edge infiltrates
6. White ring on cornea
May develop ulcer
Dx - corneal scrapings, gram & giemsa stain
Tx
1. Natamycin or Amphotericin B
2. Cycloplegics
249
S/S & Dx & Tx bacterial keratitis
1. Conjunctival hyperemia
2. Folds in Descemet's membrane
3. Upper eyelid edema
4. Posterior synchiae
5. Focal/diffuse corneal edema
6. Mucopurulent exudate
Dx - corneal scraping on chocolate, blood & Sabouraud agar
Smears for gram, giemsa & AF stain
Tx
1. Tobramycin alternateing w/ Cefazolin
250
S/S & Dx & Tx Acanthameoba keratitis
1. Conjunctival hyperemia
2. Corneal ulcer
3. Lid edema
4. Corneal ring stromal infiltrate
5. Inc. IOP
6. Hypoyn
7. Cataract
Dx - Corneal scraping on non-nutrient agar
Smears for gram, giemsa & calcofluor white stain (+cysts)
Tx
1. Polyhexamethyl biguanide
2. Propamidine isethionate
3. Itraconazole
4. D/c contacts
5. Cycloplegics
251
S/S & Dx & Tx Keratitis sicca
1. Hyperemia
2. Mucus
3. High tear lakes from reflex tearing
4. Low tear lakes
5. Epiphoria
Dx - measure tear breakup time
measure tear production - Schirmer tear test
Tx
1. Artificial tears
2. Lubricating ointment at bedtime
3. Restasis
4. Punctal plugs
252
S/S temporal arteritis
1. +APD
2. Visual field loss
3. Pale swollen disc +/- flame hemorrhages
4. Tender palpable temporal artery
5. Central retinal artery occlusion
6. Cranial nerve palsy
7. Scalp necrosis
253
Dx & Tx temporal arteritis
Bx
Tx -
1. Prednisone
254
Which quadrant of the retina is the MC site of retinal detachment?
Superior temporal
255
Anaphylaxis
IgE dependent
Anaphylactoid - does not require sensitizing exposure
Typical rxn & HOTN
1. ABCs
2. Epi
3. IVF
4. Steroids IV, antihistamines, albuterol, glucagon
256
Tx urticaria
1. Antihistamines (H1 +/- H2)
2. +/- steroids
If severe - epi
257
Tx angioedema
1. Stop ACEi
Not great but use:
Epi, antihistamines & steroids
Hereditary? C1 esterase inhibitor or FFP
258
What to give in anaphylaxis on beta-blockers?
May not respond to epi so give glucagon
259
S/S back pain due to cancer
Usually >50
Only 1/3 w/ known CA Hx
1. Unremitting pain
2. Night pain
3. Wt loss
260
Straight leg raise
+ test = L4-L5 or L5-S1 herniated disc
Pain lifting other leg = herniated disc
Could also do by sitting knee extension
Dx w/ MRI
261
S/S cauda equina
1. Pain
2. Neuro deficits - urinary incontinence, perianal sensory loss
3. Sciatica
4. Urinary retention
5. Weak/stiff lower extremities
6. Paresthesias
7. Abnl straight leg raise
Give Dexamethasone before MRI
262
S/S Vertebral osteomyelitis
```
Sx >3mo
1. Fever
2. TTP
3. Inc. ESR, NL WBC
Xray NL until bone demineralizes
Consult surg before abx
```
263
S/S discitis
1. Constant back pain, awaken at night - not relieved by rest/meds
2. +/- fever
3. +/- neuro deficits
4. ESR inc. +/- inc. WBC
264
S/S spinal epidural abscess
1. Pain, fever, neuro deficits
2. Localized pain then radicular then neuro deficits then paralysis
3. Xrays NL
GET MRI - emergent Surg.
265
Sickle cell Pt w/ septic arthritis..what's the bacteria & Tx?
Salmonella - vanco + cipro
266
Tx gonococcal septic arthritis
3rd gen cephalosporin
| Tx if suspected before cultures come back
267
Tx nongonoccocal septic arthritis
Vanco + Ceftriaxone
| Refer
268
Negative birefrigence crystals on joint aspiration?
uric acid - gout
269
Positive birefrigence crystals on joint aspiration?
calcium pyrophosphate - pseudogout
270
Tx gout & pseudogout
1. NSAIDs
2. Colchicien
3. Prednisone if not working
Renal failure? narcotics
271
Lyme septic arthritis?
Mono/oligoarticular
Larger joints more - may be migratory
Doxy, Pen G, amoxicillin, Ceftriaxone
272
MC locations of bursitis
Prepatellar or olecranon bursa
273
Tx dog/cat bite
Pasturella
Augmentin or moxiflocin
274
Flexor tenosynovitis
Kanavel 4 cardinal signs
1. Percussion tenderness over flexor tendon sheath
2. Uniform swelling
3. Intense pain w/ passive extension
4. Flexion posture
Surgical emergency - staph MC
Tx 1. Augmentin
2. Immobilize & elevate
275
Do you drain herpetic whitlows?
No mammary glands
| Give acyclovir - immobilize & elevate
276
FInkelstein?
DeQuervian tenosynovitis
extensor pollicis brevis & abductor pollicis tendons
Immobilize, ROM exercises, NSAIDs
277
Tx ganglion cysts
NSAIDs
278
S/S SJS
1. URI
2. Fever
3. HA
4. Hematuria
5. Diarrhea
6. Arthralgias
7. Rash - bullae on skin & mucus membranes, ulcers on cornea & stoma, vesicles that rupture
Tx the cause, +/- steroids
279
S/S & Tx Toxic epidermal necrolysis
1-2 wk prodome
1. Fever
2. Malaise
3. Arthralgias
4. URI
5. Skin tenderness, tingling/burning
6. Erythema intially on face & genitals becoming generalized & tender & confluent rapidly then bullae
7. Nikolsky sign
Tx
1. Hospitalize in ICU/burn unit
2. ABCs
3. Elecrolyte & fluid replacement
4. Debridement & dressing
280
S/S Dx & Tx Staphylococcal scalded skin syndrome
Common in kids <6
1. Painful erythema & blistering of skin w/ fever
2. NO mucus membrane involvement
3. + Nikolsky sign
Skin Bx, cultures on skin, throat & blood
Tx - IVF & abx
281
What is Ramsey Hunt syndrome?
Herpes Zoster of CN VII - vesicles in ear canal/pinna
| Hearing loss, facial paralysis, loss of taste
282
Tx Rhus Dermatitis
Poison ivy, oak, sumac
1. Antihistamines
2. Oatmeal baths
3. Topical steroids
4. Prednisone
283
S/S & Tx meningococcemia
1. Pharyngitis, meningitis, bacteremia
2. HA, fever, AMS, N/V, myalgias, stiff neck
3. Rash - petechiae, hemorrhagic vesicles
Pt in shock & can develop DIC
Tx - abx ASAP - Ceftriaxone
284
Pemphigus vulgaris & Tx
Old people - usually from steroids, infection, dehydration/thromboembolism
Vesicles or bullae that vary in size, blisters clear & tense then become flaccid & burst
+ Nikoslky
Tx
1. Admit
2. IVF & electrolytes
3. Steroids
4. Immunosuppressants - Azathioprine
5. Plasmapheresis
6. IVIG
285
TM rupture
Only give abx if contaminated
1. Polymyxin B
2. Ciprodex
3. Floxin
286
Ludwig's angina
Abscess of submaxillary, sulingual & submental spaces w/ tongue elevation, usually due to lower 2nd & 3rd molars
1. Jaw swelling
2. Stiff tongue
3. Trismus
4. Fever, chills
5. Difficulty swallowing
Dx - CT
Tx - ABCs, IV abx (PCN + Flagyl), OR for drainage
287
Dry socket
2-3 days post extraction - Severe pain d/t clot displacement of dissolving
Local/topical anesthesia, irrigate, suction fluid, pack
Abx - dental referral
288
MCC death assoc. w/ ARF?
Sepsis & cardiopulm failure
289
Dx ARF
Labs + Renal US
| Avoid contrast dyes
290
Dx & Tx Priapism
Color doppler US
Aspiration of dark intracevernosal blood from copus
Tx - Terbutaline SQ in deltoid
Corporal aspiration followed by irrigation
Surgery
291
MC opportunistic infection in AIDS?
PCP
292
MCC PNA AIDS Pts?
Strep pneumoniae
293
Pt is on AZT, what should you suspect their CD4 count to be?
<500
294
What is Brudzinski sign?
Hips & knees flex when you flex neck
| Sign of meningitis
295
What is Kernig sign?
Hamstrings contract when knee extended w/ hip flexed
Sign of meningitis
296
MC bacterial cause of meningitis?
Strep pneumo
also N. meningitidis & Listeria
Tx - Ceftriaxone/Cefotaxime
297
Causes of encephalitis?
1. Arbovirus
2. HSV
3. HZV
4. CMV
298
Ring of enhancement on CT?
Brain abscess
299
Dx rabies
Brain Bx
Tx - Rabies IVIG & vaccine
