Exam 2 Reverse Flashcards
(299 cards)
1
Q
Serum level dec. but total body sodium normalSevere1. Hyperglycemia2. Hyperproteinemia3. Hyperlipidemia
A
What is psuedohyponatermia & causes?
2
Q
<113 - seizures & coma High mortality w/ CNS findings
A
S/S Hyponatremia
3
Q
True hyponatremia - osmolality decFactitious hyponatremia - osmolality normal or inc.
A
Dx hyponatermia
4
Q
Osmotic pressure >295MCC hyperglycemiaEach 100mg/dL inc. in glc dec. serum sodium by 1.7 due to water moving into ECF
A
Hypertonic hyponatermia
5
Q
Osmotic pressure 275-295High proteins & lipids cause a lab to report a falsely lowered sodium than what the serum actually contains
A
Isotonic hyponatremia
6
Q
Osmotic pressure >275 Hypovolemic - loss of Na & waterEuvolemic - normal volume statusHypervolemic - excess total body water
A
Hypotonic hyponatremia
7
Q
Hypovolemic hyponatremiaUrinary sodium >201. Diuretics2. Renal tubular acidosis, chronic renal failure, nephritis3. Osmotic diuresis4. Addison’s
A
Causes of renal losses of sodium
8
Q
Hypovolemic hyponatremiaUrinary sodium <201. Vol replacement w/ hypotonic fluids2. GI loss (V/D, tube suction)3. 3rd space loss (burns, peritonitis, pancreatitis)4. Sweating (CF)
A
Causes of extrarenal losses of sodium
9
Q
Urinary sodium >201. SIADH - tumors, CNS disease, pulm disease, meds, idiopathic2. Hypothyroid3. Pain, stress, psychosis - stimulates ADH4. Drugs - carbamazepine, phenothiazines, TCAs5. Water intoxication6. Glucocorticoid deficiency
A
Euvolemic hyponatremia
10
Q
Volume overload Urinary sodium >20 - renal failureUrinary sodium <20 - CHF, cirrhosis, nephrotic syndrome
A
Hypervolemic hyponatremia
11
Q
Hypervolemic or euvolemic hyponatremia - fluid restriction SIADH - demeclocycline or furosemideHypovolemic hyponatremia - isotonic saline
A
Tx hyponatremia
12
Q
Central pontine myelinolysis brain injury
A
What can happen if you correct hyponatremia too rapidly?
13
Q
Give 3% hypertonic saline at 25-60 mL/hrDo not raise Na >2mEq/L/hrStop when sodium reaches 120 or when Pt improves
A
Acute Hyponatremia <120 w/ CNS Sx - how do you treat?
14
Q
Correction of Na no more than 0.5 mEq/L/hr
A
Tx chronic hyponatremia
15
Q
- Na <1252. Require IV3. Significant comorbidities
A
When do you admit hyponatremia Pts?
16
Q
Na >1501. Reduced water intake2. Inc. water loss - hypervent., DI, osmotic diuresis, thyrotoxicosis, severe burns3. Inc. sodium intake/renal salt retention - hypertonic saline ingestion, sodium bicarb, hyperaldosteronism, Cushing’s
A
Hypernatremia causes
17
Q
Usually at Na>158 - rate of change important1. Confusion, weakness, irritable, restless, tremulous, seizures, coma2. Hypocalcemia may be present causing CNS Sx3. Flat neck veins, orthostatic HOTN, tachycardia, poor skin turgor, dry mucous membranes
A
Sx hypernatremia
18
Q
Severe dehydration - NS or LR Then 0.45% saline Sodium reduction should not exceed 15mEq/L/day Reach normal serum sodium in 48-72hrs
A
Tx hypernatremia
19
Q
5-Mar
A
You lose 1L of water, how much does your serum sodium increase?
20
Q
Hypokalemia - <3.5
A
What is the MC electrolyte abnormality?
21
Q
- Extrarenal - inadequate intake, V/D, inc. insulin, alkalosis2. Renal - diuretics, aldosteronism, renal tubular acidosis3. Lithium, heavy exercise, heat stroke, fever
A
Causes of hypokalemia
22
Q
- Weakness, paresthesias, polyuria, orthostatic HOTN, areflexia, ileus, arrhythmias 2. EKG - T wave flattening/inversion, U waves, ST depression, PVC’s, wide QRS, tachyarrhythmias Want to get CK, Mg, UA, BMP
A
S/S hypokalemia
23
Q
K>2.5 w/o EKG findings - oral replacement daily until normalK<2.5
A
Tx hypokalemia
24
Q
K >5.5 1. Factitious - release of intracellular K by hemolysis during phlebotomy2. Extrarenal causes - insulin deficiency, acidosis, hyperosmolality, beta-blockers, supplements, massive transfusion, crush injuries, burns, mesenteric or muscle infarction 3. Renal causes - chronic renal insufficiency, acute renal failure, hypoaldosteronism, drugs (NSAIDs, ACEi, K-sparing diuretics)
A
Hyperkalemia causes
25
Weakness, paresthesias, confusion, paralysis, areflexia, V/D, ileus, arrhythmias (VF, heart block, asystole)EKG changes6.5-7.5 - Prolonged PR, tall peaked T waves, short QT7.5-8 - Flattening of P wave, QRS widening10-12 - QRS complex degradation into a sinusoidal pattern
S/S hyperkalemia
26
1. Albuterol 2. CaCl or gluconate 3. Sodium bicarb4. Insulin & glc5. Furosemide6. Dialysis 7. Kayexalate
Tx hyperkalemia
27
Ionized Ca
Causes of hypocalcemia
28
1. Circumoral & distal extremity paresthesis2. Irritability, weakness, fatigue, muscle cramps3. Seizures 4. Hyperreflexia 5. Carpopedal spasm, tetany, laryngospasm6. Trousseau's sign7. Chvostek's sign 8. Prolonged QT9. Sinus bradycardia10. Heart block11. VT/VF
S/S hypocalcemia
29
Asymptomatic - oral therapyTx hypomagnesemia <1.3 or Sx - IV Cagluconate over 10 min then maintenance infusion-careful w/ Digoxin
Tx hypocalecemia
30
Total Ca > 10.5Ionized Ca >2.7 1. CA/hyperparathyroidism**2. Endocrine - hyperthyroidism, pheochromocytoma, adrenal insufficiency3. Granulomatous disorders - sarcoid, TB, histoplasmosis, coccidiomycosis4. Immobilization, Paget's disease, dehydration, excess Ca ingestion, milk alkali syndrome
Hypercalcemia Causes
31
1. Weakness, depression, confusion, lethargy, personality changes, N/V, anorexia, constipation, HA, abd pain2. Dehydation, dec. motor strength3. Dec. mental status4. Ataxia, hyporeflexia5. Fx6. HTN, wt loss, renal insufficiency, cardiac arrest7. Short QT, widened T waves, bradyarrhythmias, BBB, AV blocksStones, bones, moans & groans
S/S hypercalcemia
32
Any Sx Pt or total Ca >14 1. Vol replacement2. Furosemide3. Mithramycin 4. Pamidronate5. Calcitonin6. Hydrocortisone7. DialysisWatch hypokalemia & hypomagnesemia
Tx hypercalcemia
33
<11. Alcoholism2. Malnutrition3. Cirrhosis4. Pancreatitis5. Excessive GI fluid losses (Diarrhea)
Causes of hypomagnesemia
34
1. Malaise2. Muscle weakness3. Anorexia, N/V4. Seizures 5. Chvostek & Trousseau's6. Tremors, twitching, clonus, dec. DTR, carpopedal spasm, tetany, delirium, dysarthria 7. Tachyarrhythmias, Torsades, prolonged PR & QT
S/S hypomagnesemia
35
Mild - Mg(OH)2Severe - neuro findings & arrythmias - MgSO4 Admit if <1 & SxWatch hypokalemia, hypocalcemia, hypophosphatemia
Tx hypomagnesemia
36
>2.5 - Rare - usually w/ renal failure/iatrogenic cause1. Rhabdo2. Tumor lysis3. Burns4. Trauma5. DKA6. Hypothyroid7. Antacids8. Laxative abuse9;. Eclampsia Tx
Hypermagnesemia Causes
37
Nonspecific1. N/V2. Lethargy, confusion3. Coma4. If >4 - Dec. DTR's, muscle weakness, bulbar paralysis, resp. insufficiency
S/S hypermagnesemia
38
1. Cagluconate/chloride2. Furosemide3. DialysisWatch hyperkalemia/hypercalcemia
Tx hypermagnesemia
39
1. CNS lesions2. Sedative therapy & overdose3. Neuromuscular disorders4. Pleural disease5. COPD
Causes of resp. acidosis
40
1. Anxiety - MCC2. Hypoxia3. Pulm. disorders4. Salicylate toxicity5. CNS disorders6. Pregnancy7. Early sepsis
Causes of resp. alkalosis
41
>7.73
At what pH is there dec. cardiac function?
42
AlcoholMethanolUremiaDKAParaldehydeIron, IsoniaziedLactic acidosisEthylene glycolCarbon monoxideAspirinToluene
Causes of anion gap metabolic acidosis
43
Lactic acidosis - due to dec. oxygen to tissues, sepsis, shock
What is the MCC of anion gap met. acidosis?
44
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, ureterosigmoidostomy3. HCl, ammonium chloride, oral CaCl2
Causes of nonanion gap metabolic acidosis
45
pH s respiration - rapid regular deep resp. rate
S/S met. acidosis
46
Na - (HCO3 - Cl)Normal is 10-12>12 - met. acidosis
Anion gap formula
47
1. Tetany2. Seizures3. Loss of Ca, K & Mg
S/S met. alkalosis
48
Insulin
MCC hypoglycemia?
49
1. Inadequate food intake2. Insulin/meds3. Drug interaction4. Infection5. Renal/hepatic failure6. ACS7. Stress
Causes of hypoglycemia
50
1. Glucose D50W2. Glucagon 3. Octreotide - suppresses insulin secretionIf alcoholic - give thiamin to prevent Wernicke-Korsakoff's syndrome
Tx hypoglycemia
51
Octreotide
Tx hypoglycemia cause by sulfonylurea?
52
1. Not taking insulin2. Infection3. Pregnancy4. Hyperthyroidism5. Substance abuse (Cocaine)6. Meds - steroids, thiazides, antipsychotics, sympathomimetics 7. Heat-related illness8. CVA9. GI hemorrhage10. MI11. PE12. Pancreatitis13. Major trauma/surgery
Causes of DKA
53
1. N/V, abd pain2. Polyuria, polydipsia3. AMS4. Kussmaul's breathing5. Fruity breath6. Dehydration - HOTN, tachycardia, dry skin, dry mucous membranes
S/S DKA & HHS
54
1. Glc >2502. Anion gap >103. Bicarb <7.35. Ketonemia
Labs DKA
55
1. NS 2. Follow K+3. Insulin - 0.1/kg/hr
Tx DKA
56
Diabetics1. Stressor - infection, CVA, GI bleed, MI, pancreatitis2. Meds - thiazide diuretics, corticosteroids, lithium, beta-blockers, Ca-channel blockers, phenytoinNondiabetics 1. Severe dehydration/excess glucose load - burns, heat stroke, dialysis, diet, hyperalimentation
Causes of hyperosmolar hyperglycemia state
57
1. Glc >6002. Osmolality >3153. Bicarb >154. pH >7. 3
Dx HHS
58
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
HHS Tx
59
Alcoholics who abruptly stop drinking after a binge or 1st time drinkers
Who gets alcoholic ketoacidosis?
60
Binge drinking then1. Abd pain - pancreatitis, gastritis, hepatitis2. N/V3. Alcohol withdrawal/DTs4. Dehydration - HOTN, tachycardia5. Kussmaul's respiration6. +/- fever7. NL MS/coma8. Abd tenderness9. Heme + stool10. Hepatomegaly
S/S alcoholic ketoacidosis
61
1. Low/NL/slightly inc. glc2. Wide anion gap met. acidosis3. +serum ketones
Dx alcoholic ketoacidosis
62
1. Saline w/ glucose & thiamin 2. Insulin if DM3. Consider Mg & multivitamin 4. Bicarb if pH<7.1
Tx alcoholic ketoacidosis
63
Shortened bowel sundrome caused by bacterial fermentation
Type D lactic acidosis
64
Caused by tissue hypoxiaHas a high mortalityRelated to hemorrhagic, hypovolemic, cardiogenic & septic shock
Type A lactic acidosis
65
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)
Type B lactic acidosis
66
Produces anion gap acidosisAbrupt onset - ill Pt1. Hypoventilation or Kussmaul's breathing2. Lethargy, coma3. Vomiting, abd pain
S/S lactic acidosis
67
1. Ventilation & volume replacement2. Diuresis 3. Bicarb if pH<7.2 Admit to ICU
Tx lactic acidosis
68
1. Infection - MCC2. Trauma, surgery, hyperosmolar coma3. DKA4. Withdrawal of thyroid med, iodine or contrast administration, thyroid gland palpation, ingestion of thyroid hormone, amiodarone, large doses of povidone-iodine w/ skin breakdown5. MI, CVA, PE6. Parturition (childbirth), eclampsia
Causes of thyroid storm
69
1. Exopthalmos2. Widened pulse pressure3. +/- Palpable goiter4. Heat intolerance5. Fever6. Tachycardia out of proportion to fever7. Profuse sweating8. Dehydration9. Hair loss 10. Inc. SBP11. Inc. pulse pressure12. Systolic flow murmur13. Sinus tachycardia14. AFib, CHF, pulm. edema 15. Agitation, restlessness, psychosis, confusion, obtundation, coma, proximal muscle weakness, hyperreflexia16. Wt loss, N/V/D, anorexia, abd pain
S/S thyroid storm
70
1. Inc. FT42. Suppressed unmeasureable TSH 3. Sinus tach/AFib
Dx thyroid storm
71
1. IVF w/ dextrose 2. Oxygen3. Acetaminophen 4. Cooling blankets5. Cholestyramine6. Propylthiouracil/Methimazole7. Iodine, KI, NaI, Li8. Propranolol9. Hydrocortisone
Tx thyroid storm
72
Infection, cold, trauma, MI, CHF, CVA, GI bleed, surgery, burns Meds - beta-blockers, sedatives, narcotics, amiodarone MC in winter months in old ladies
Causes of myxedema coma
73
1. Hypothermia2. Resp distress w/ hypoventilation, hypercapnia, hypoxia3. Cardiomegaly, vent arrhythmias, HOTN, bradycardia4. Seizures, ataxia, tremors, slow mentation, delusions, psychosis5. Megacolon, urinary retention, abd distention
S/S myxedema coma
74
1. High TSH2. Low T43. Dec. Na & Cl 4. Hypoxia & hypercapnea
Dx myxedema coma
75
Tx before labs confirm Thyroid replacement therapySupportive care
Tx myxedema coma
76
1. HOTN refractory to fluids & pressors2. Dehydation3. Weakness, lethargy4. Shock 5. Delirium6. Abd pain w/ N/V7. +/- sepsis
S/S adrenal crisis
77
1. Hyponatremia2. Hypoglycemia3. Hypercalcemia4. Inc. BUN5. Mild met. acidosis 6. Flattened T waves, Prolonged QT & PR, low voltage, ST depression, signs of hypo/hyperkalemia
Dx adrenal crisis
78
1. IVF2. Hydrocortisone3. Vasopressors
Tx adrenal crisis
79
Alcoholic w/ poor nutrition from thiamin deficiency PPTd by giving glucose to alcoholic w/ inadequate thiamin
Cause of Wernicke-Korsakoff's syndrome
80
Triad1. AMS2. Opthalmoplegia3. Gait ataxia Also1. Hypothermia2. HOTN3. Coma4. Circulatory collapse
S/S Wernicke-Korsakoff
81
Usually made clinicallyTx immediately
Dx Wernicke-Korsakoff
82
1. Thiamin2. Mg
Tx Wernicke-Korsakoffs
83
Ecchymosis of umbilicusFrom retroparitoneal hemorrhage from pancreatitis or trauma
What is Cullen's sign & when is it seen?
84
Flank ecchymosisFrom retroperitoneal hemorrhage from pancreatitis or trauma
What is Turner's sign & when is it seen?
85
Dilated veins around umbilicusSeen in liver disease
What is caput medusae & when is it seen?
86
Dilated bowel loops
Tympanic abdomen percussion means??
87
Could be cardiac or esophageal...needs more testing
Pt comes in w/ CP, given NTG & gets better. What was wrong?
88
1. Carbonation - EZ gas2. IV glucagon - smooth muscle relaxer3. Acute endoscopy
Tx esophageal food bolus
89
Iatrogenic
MCC esophageal perforation?
90
Heard on heart ascultationDue to mediastinal emphysema
What is Hamman crunch & when is it seen?
91
1. Pain acute, severe, diffuse, located in chest, neck, abd w/ radiation to back/shoulders2. Pain worse w/ swallowing3. HOTN4. Fever5. Abd rigidity6. Tachycardia, tachypnea CXR - mediastinal air, SQ emphysema, wide mediastinum, effusion
S/S esophageal perforation
92
1. Chest CT/endoscopyTx 1. Shock resuscitation2. IV abx3. Surg. consult
Dx & Tx esophageal perforation
93
1. Refusal to eat2. Inc. salivation3. Odynophagia4. Vomiting5. Choking6. Resp. Sx - stridor, cough, wheeze7. Neck or throat pain
S/S swallowed FB in kiddos
94
Distal to pylorus - d/c & wait to pass Obstruction? Emergent ednoscopy -button batters, perf, coin at cricopharyngeus muscle, >24h
Tx FB swallow
95
Can cause corrosion & perf...get XrayIf above pylorus - endoscopyIf passed - watch & f/u in 24h, repeat films in 48h
Swallowed button battery...what do you do??
96
Observe or whole bowel irrigationEndoscopy contraindicated - can rupture!
Tx body packers
97
1. CXR - free air in 75%2. +/- CTTx 1. Labs - type & cross2. 2 large bore IVs3. O24. NG tube5. Broad spectrum abx6. Surg. consult
PUD Dx & Tx
98
PUD
MCC Upper GI bleed?
99
1. PUD - epigastric pain, melena/hematemesis, stool +2. Variceal bleeding - painless, massive hematemesis, signs of chronic liver disease3. Mallory-weiss tear - Hx of forceful vomiting
Causes of upper GI bleeds
100
1. 2 large bore IVs2. Transfusion of PRBCs3. PUD? IV PPI/H2 blocker4. +/- vasopressin 5. Mallory weiss tear? d/c after bleeding stops
Tx upper GI bleed
101
Viral gastroenteritis
MCC N/V?
102
Contains blood, mucus & pus
What is dysentery diarrhea?
103
Acute intestinal inflammation causing diarrhea w/ N/V
What is gastroenteritis?
104
1. Salmonella2. Shigella3. Campylobacter4. Toxin producing E. coli
What should you suspect if you see systemic illness, fever & bloody stools?
105
BananasRiceApple sauceToastdiarrhea Pts
What is a BRAT diet & who should use it?
106
ex. LoperamideDon't use w/ toxigenic gastroenteritis 1. Toxin producing E. coli2. Staph aureus3. Bacillus cereus4. C. diff
When should you avoid antidiarrheals?
107
No cramps, fever or fecal leukocytes Diarrhea goes away after meds stopped
S/S diarrhea caused by abx or other meds
108
VirusNorovirus
MCC infectious diarrhea
109
Clindamycinalso cephalosporings, PCN & fluoroquinolone
Which abx is most often assoc. w/ C. diff?
110
C. diff toxin in stoolColonoscopy? Yellowish plaques in lumenMild - monitorModerate - Flagyl for 10-14 daysSevere - hospitalize, Vanco PO x 10days
Dx & Tx C. diff
111
Feeling like you have to poop but your bowels are empty
What is tenesmus?
112
CT 1. Restore fluids & electrolytes2. NPO3. NG suction for obstruction, ileus, toxic megacolon4. Narcotics5. Abx
Dx & Tx Crohn's & ulcerative colitis
113
1. Antidiarrheals2. Hypokalemia3. Narcotics4. Cathartics 5. Pregnancy6. Enemas7. Recent colonoscopy Ulcerative colitis & Crohn's at inc. risk
Causes of toxic megacolon
114
Adhesions from abdominal surgery2nd MCC? Incarceration of groin hernia
MCC small bowel obstruction??
115
CA2nd MCC? Diverticulitis
MCC large bowel obstruction?
116
Abd CT w/ contrast Xray - air fluid levels WBC >20k - gangrene, intra-abd abscess, peritonitisWBC >40k - mesenteric vasc. occlusion Inc. Hct, BUN & Cr - vol. depletion & dehydrationInc. urine spef. gravity, ketonuria, elevated lactate & met. acidosis - severe disease
Dx bowel obstruction
117
1. Surg. consult2. NG tube if severe distention & vomiting 3. IVF
Tx bowel obstruction
118
1. Closed-loop obstruction2. Bowel necrosis3. Cecal volvulus
Which types of bowel obstructions are surgical emergencies?
119
1. IVF2. Observation
Tx adynamic ileus
120
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
What is pseudo-obstruction?
121
Abd CT - inc. soft tissue density w/ pericolic fat, bowel wal lthickening 1. Supportive - bowel rest & IVF2. Cipro & Flagyl 3. Surgery if perforation, obstruction or abscess
Dx & Tx diverticulitis
122
1. LLQ pain 2. Fever3. N/V4. Anorexia5. Dysuria
S/S diverticulitis
123
2 or +1. Straining at defecation at least 25% of time2. Hard stools at least 25% of time3. Incomplete evacuation at least 25% of time4.
Rome Criteria for Dx of constipation
124
Acetaminophen overdose
MCC acute hepatitis?
125
Spontaneous bacterial peritonitis leading to renal failure w/ hepatic failure1. More serious. Progressive oliguria & doubling serum Cr in 2wks 2. Gradual impairment of renal function that may or may not advance
Types of hepatorenal syndrome
126
Accumulation of nitrogenous waste products cuz liver sucks1. General apathy2. Lethargy, drowsiness, variable orientation, asterixis3. Stuper w/ hyperreflexia, extensor plantar reflexes4. Coma
Stages of hepatic encephalopathy
127
Hepatic encephalopathy & coagulopathyHOTN, hypoglycemia, adrenal insufficiency
Hallmarks of liver failure
128
Lactulose
Tx hepatic encephalopathy
129
1. Intubation2. IVF3. Blood products4. Vasopressors PRN5. Mannitol if cerebral edema
Tx liver failure
130
AST:ALT >2
Alcoholic LFT
131
Hemolysis - elevated LFT - low plateletsOccurs w/ preeclampsia-eclampsia in late 3rd trimester or postpartum periodTx >34 - immediate delivery
HELLP syndrome
132
1. Cholelithiasis2. AlcoholOthers - trauma, infection, meds, hyperparathyroidism, hyperlipidemia
Causes of pancreatitis
133
1. N/V2. Epigastric pain radiates to back may be relieved by leaning forward3. Epigastric tenderness4. Diminished bowel sounds5. Fever6. Jaundice 7. Cullens/Turners sign if retroperitoneal hemorrhage
S/S pancreatitis
134
Use Ranson's criteria >31. Amylase2. Lipase** 3. Xray - 'cutoff' sign 4. US5. CT - best test, but not needed if no complications
Dx pancreatitis
135
1. NG suction2. Antiemetics3. IVF4. Foley cath to monitor fluids5. Analgesics6. +/- abx
Tx pancreatitis
136
Forty FatFemaleFertileFlatulentFair
Risk factors for gall stones
137
1. RUQ pain radiate to scapula2. Post-prandial pain after eating fatty foods3. Murphy's sign 4. +/- fever5. Jaundice
S/S cholecystitis
138
Labs elevatedUS**1. NG suction2. Bowel rest3. IVF4. Surg. consult
Dx & Tx cholecytitis
139
1. RUQ pain2. Fever3. Chills & jaundiceSeen w/ ascending cholangitis Infection of biliary system from stone in bile duct Tx - same as cholecystitis but add abx
What is Charcot's triad & when is it seen?
140
1. RUQ pain2. Fever & chills3. Jaundice4. AMS5. HOTN Tx - same as cholecystits but add abx
What is Reynold's pentad & when is it seen?
141
Fecalith
MCC appendicitis?
142
1. Gen. umbilical pain then localized to RLQ2. Anorexia3. N/V4. McBurney's point5. Involuntary guarding & rebound tenderness 6. Rovsing's sign 7. Psoas sign8. Obturator sign
S/S appendicitis
143
All the dumb signs LabsCT w/ contrast1. NPO2. IVF3. Antiemetics + narcotics4. Abx5. Surgery
Dx & Tx appendicitis
144
Appendicitis
MC surgical emergency in pregnant ladies?
145
AlcoholEndocrine & EnvironmentalInsulin & impaired glucose utilization***Ox deprivation & opiate ODUremiaTraumaInfectionPsychiatric causes & porphyriaSpace occupying lesions - inc. pressure on RAS
Causes of AMS & Coma
146
Temporal lobe herniation on same side or if alert - could be from drops or compression of CN III
Causes of fixed dilated pupil
147
COPSClonidineCholinergicsOpiatesOrganophosphatesPhenothiazinesPontine hemorrhageSedative hypnoticsSleep
Causes of miosis
148
1. Anticholinergics2. Sympathomimetics
Causes of mydriasis
149
Crescendo-decrescendo pattern1. Bilat hemisphere dysfunction, intact brain stem2. Metabolic disorder2. Transtentorial herniation
Causes of Cheyne-Stokes respirations
150
Prolonged pause after inspiration -pontine infarct
Causes of apneustic breathing
151
1. Met. acidosis2. Salicylate OD3. Hypoxia4. Hypercarbia
Causes of hyperventilation
152
1. Lack of focal exam findings2. Pupillary response usually preserved
S/S toxic-metabolic coma
153
1. Progressive hemiparesis2. Asymmetric strength & reflexes Ex. Uncal herniation Also see w/ inc. ICP - HTN & bradycardia = Cushing's triad
S/S supratentorial lesion coma
154
Cerebellar hemorrhage or infarction may cause coma1. Abnormal extensor posturing2. Loss of pupillary reflexes3. Loss of EOMEx. pontine hemorrhage - pinpoint pupils
S/S infratentorial lesions - posterior fossa coma
155
Pupillary responses, EOM, muscle tone & reflexes normal
S/S pseudocoma
156
Hx - look for reversible causes If on meds that can check levels - check it!CTTx - ABCs
Dx & Tx coma
157
Occipitonuchal
MC location of SAH HA?
158
Temporal arteritis
Jaw claudication w/ HA?
159
Sinusitis
Facial painw/ HA?
160
Glaucoma
Vision change & eye pain w/ HA?
161
PulsatileDuration of 4-72hUnilatN/VDisabling intensityif 4/5 - most likely migraine
POUNDing approach to HA
162
1. Meningitis2. Sinusitis3. SAH
HA w/ fever?
163
1. Toxoplasmosis2. CNS lymphoma>3days? Higher risk of AMS & new seizure
Causes of HA w/ HIV?
164
SAHCT w/o contrast or CT angioLP if no Dx1. LOC2. Seizure3. Diplopia4. Other neuro signsExercise, intercourse or defecation sets it offMCC ruptured aneurysm
Thunderclap HA?
165
1. Control BP, pain & nausea2. Prevent vasospasm w/ Nimodipine3. Refer to surg.
Tx SAH
166
Remote trauma w/ HA1. Anticoagulants2. Chronic alcohol abuse3. Old peopleGet noncontrast CT
Risk factors of subdural hematoma
167
1. HA2. Vomiting3. SeizuresCommon w/ hypercoagulable state, OCs, postpartum/postopNeed magnetic resonance venogram
S/S Cerebral venous thrombosis
168
1. HA - severe & throbbing over frontotemporal area2. Jaw claudication3. Hx of polymyalgia rheumatica4. +/- loss of vision 5. High ESR Tx - prednisone
S/S & Tx temporal arteritis
169
1. Young Pt w/ chronic Has2. N/V3. Visual problems4. Papilledema5. Normal CT6. Elevated CSF pressureTx - Acetazolamide
S/S & Tx pseudotumor cerebri
170
1. Unilat neck pain or HA usually by eye/frontal areaDx - angiography
S/S internal carotid dissection & Dx
171
Occipital or posterior neck pain Dx - angiography
S/S & Dx vertebral artery dissection
172
1. DHE - don't use in pregnancy, uncontrolled HTN, CAD, causes N/V2. Triptans3. Metoclopramide, prochlorperazine - dystonic rxns4. Ketorolac5. Narcotics6. Dexamethasone
Tx migraine
173
1. Bilat, nonpulsating2. Not worsened by exertion3. No N/VSevere HAs may cause N/VTx - NSAIDs/analgesics
S/S & Tx tension HA
174
1. Rare, short lived, MC men >202. Severe unilat orbital, supraorbital or temporal pain lasting 15-180mins3. Pacing & restless4. Conjunctival injection, lacrimation, nasal congestion, rhinorrhea, facial swelling, miosis, ptosisTx1. Oxygen2. DHE3. Triptans4. Analgesics
S/S & Tx cluster HAs
175
CarbamazepineMC in women
Tx Trigeminal neuralgia
176
CVA
MCC disability?
177
1. Thrombotic2. Embolic3. Hypoperfusion
Types of ischemic stroke
178
Watershed areas - periphery of major vessels
Main areas affected by hypoperfusion ischemic stroke?
179
Chronic HTNMC in Asians & Blacks
MCC intracerebral hemorrhagic stroke?
180
MC type1. Contralat hemiparesis2. Facial plegia3. Sensory loss4. Homonymous hemianopsia & gaze preference toward side of infarct5. Face & upper extremities affected more than lower
S/S middle cerebral artery stroke
181
1. Contralat sensory & motor Sx in lower extremity, sparing hands & face2. +/- aphasia neglect3. +/- incontinence
S/S anterior cerebral artery stroke
182
1. Unilat HA2. Contralat homonymous hemianopsia 3. Unilat cortical blindness
S/S Posterior cerebral artery stroke
183
1. Vertigo - w/ cerebellar or brainstem signs2. HA3. Nausea4. Visual disturbances5. Oculomotor palsies6. Ataxia7. Sensory disturbance8. Bilat limb weakness
S/S Vertebrobasilar stroke
184
1. Vertigo2. Gait instability3. Ataxia4. Dysarthria5. N/V6. Cranial nerve abnormalities
S/S cerebellar stroke
185
Assoc. w/ HTNInvolve basal ganglia, internal capsule, thalamus & brainstem1. Pure motor deficit of face, arm & leg2. May be subclinicalBetter prognosis
S/S lacunar stroke
186
CT w/o contrast May get other tests to see where emboli came from1. If no thrombolytics & has HTN - lower if >220/1202. If getting thrombolytics - lower to
Dx & Tx ischemic stroke
187
1. Aspirin +/- Clopidogrel
Tx TIA
188
MRI/MRA & CT/CTATx - heparin then Coumadin
Dx & Tx cervical artery dissection
189
Systemic1. Intoxication - ethanol, sedative hypnotics, phenytoin, carbamazepine, valproic acid2. HyponatremiaNervous system3. Cerebellum - hemorrhage, infarct4. Cortex - tumor, hemorrhage, trauma, hydrocephalus5. Subcortical - infarct, Parkinson's6. Spinal cord - cervical spondylosis7. Peripheral nervous system - neuropathy
Causes of ataxia
190
Sensory ataxia w/ problem in posterior column, vestibular dysfunction or peripheral neuropathyAtaxia w/ - Rhomberg?Motor ataxia w/ problem in cerebellum
#NAME?
191
Loss of proprioceptionAbrupt mvmt of legs & slapping of feel w/ each step
S/S Sensory ataxia
192
Lost ability to initiate walkingSeen w/ nondominant hemispheric lesions
Apraxic gait?
193
Narrow based shuffling stepsSeen w/ Parkinson's
Festinating gait?
194
Perception of mvmt when none exists
What is vertigo?
195
1. Vestibular neuritis2. Labyrinthitis3. Meniere's disease4. Benign paroxysmal positional vertigo5. Drug induced vertigo
Causes of peripheral vertigo
196
1. Acoustic schwannoma or meningioma2. Cerebellar pontine angle tumors3. Cerebellar infarct4. Cerebellar hemorrhage5. Vertebrobasilar insufficiency
Causes of central vertigo
197
Benign paroxysmal positional vertigo Do Dix-Hallpike Maneuver - Nystagmus toward affected ear for 10-40 secs
MCC vertigo in old people?
198
Peripheral1. Hydration2. Antihistamines3. Anticholinergics4. Antiemetics5. Benzos6. ReassuranceCentralRefer to neuro!
Tx vertigo
199
IV magnesiumDefinitive Tx - deliveryPregnant >20wks, HTN, edema & proteinuria
Tx seizures in pregnant eclampsia Pt?
200
Neuro!
Tx peripheral neuropathies
201
Sx w/in 48h of ingestion of tainted food/wound infections/IVDU1. N/V/D2. Abd cramps3. Descending symmetric paralysis - CN & bulbar muscles affected first 4. Diplopia, dysarthria, dysphagia5. Pupils dilated & nonreactive
S/S botulism
202
1. Constipation2. Poor feeding3. Lethargy4. Weak cry5. "Floppy infant"
S/S botulism in baby
203
1. Supportive2. Botulinum antitoxin
Tx botulism
204
Sx 2-6 days after tickAtaxia of LE then UE then resp. failureTx - remove tick
Tick paralysis S/S & Tx
205
Peripheral nerve myelin sheath destructionSubacute ascending symmetric weakness or paralysis & loss of DTRs, watch resp. functionTx - IVIG & plasmapharesis
Giullan-barre syndrome
206
Skeletal muscle injury causing release of cell contents into plasmaInc. PCKUrine dipstick +blood - microscopic myoglobinTx - Tx cause1. Hydration2. Alkalinization of urine >6
Rhabdomyolysis
207
Extreme weakness w/ resp. failure May be triggered by infection, surgery or tapering meds Give Neostigmine
Myasthenia crisis
208
Side effect of too much meds Worsens w/ Edrophonium May need intubation & mgmt of secretions & bronchospasmTx - Atropine
Cholingergic crisis
209
Hyperthermia, rigidity, AMS, fever 1. Dopamine antagonistsProlixin, Haldol, Regla, Clozapine 2. W/D dopamine agonistL-dopa, Bromocriptine, Amantadine3. Dopamine depletionXenazine Elevated CK, leukocytosisTx 1. Cooling2. Fluids & alkaline diuresis to Tx rhabdo3. Dantrolene, Bromocriptine, Nondepolarizing NMB, Nipride
Causes of neuroleptic malignant syndrome
210
Hemorrhoids
MCC rectal bleeding?
211
1. Manual reduction if nonthrombosed, sitz-baths 2. Topical analgesics & steroids 3. Bulk laxatives/stool softeners, high fiber diet, fluidsThrombosed internal - surgeryThrombosed external - cut it out
Tx hemorrhoids
212
Posterior or anterior midlineAny other area suggestive of Crohn's, ulcerative colitis, carcinoma, infection Usually due to passage of large hard stool or frequent diarrhea, consider child abuse
Location of anal fissures
213
1. Constant throbbing pain, worse w/ BMs2. Purulent d/c3. Polymicrobial Tx1. I&D 2. +/- abx
S/S & Tx anorectal abscesses
214
1. Rectal mucosa only2. All layers3. Intussusception of upper rectum through the lower Tx1. Reduce w/ analgesia & sedation2. Can't do it? Surg.
Types of rectal prolapse & Tx
215
1. Diverticular disease2. Colitis3. Polyps4. CA
MCC lower GI bleeds
216
Ischemic colitis
MCC intestinal ischemia?
217
Indirect inguinal hernia Get US
MC type of hernia?
218
Acute onset of periumbilical pain out of proportion to physical findingsDx - CT angioTx - IVF, surg consult
S/S, Dx & Tx mesenteric ischemia
219
Eye trauma
MCC blindness in kids?
220
From blunt force trauma 1. Diplopia2. Periorbital ecchymosis & edema3. Anesthesia of maxillary teeth & upper lip4. Step off deformity over infraorbital ridge5. Orbital crepitus6. Xray - teardrop sogm Dx - CTTx - Surgery
S/S, Dx & Tx blowout Fx
221
GonococcalTx 1. Lavage mucus2. Ceftriaxone or Azithromycin
Severe conjunctivitis in 12-24h?
222
Chlamydia conjuncitivitsTx1. Tetracycline, doxy, erythromycin, azithrymycin2. +/- topical abx
Tarsal/bulbar conjunctival inclusion follicles?
223
Viral conjunctivitisTx1. Artificial tears2. Cool compressesHerpes? Use acyclovir
Subconjunctival hemorrhages w/ itchy, tearing eyes?
224
Broad spectrum abxSulfonamides, tetracycline, erythromycin
Tx bacterial conjunctivitis
225
1. Topical antihistamines2. Short course of topical steroids
Tx allergic conjunctivitis
226
1. Fluorescein eye drops 2. Slit lamp for intraocular FBTx1. Cotton tip2. 25 guage needle3. Topical abx - Tobramycin, polymyxin-bacitracin ointment, erythromycin ointmentContacts? Need Cipro4. NSAID Diclofenac or Mydriacyl5. Anesthetic eye drop
Dx & Tx corneal abrasion
227
All normal eye complaints +1. Cells in flare in anterior chamber2. Ciliary flush3. Keratic precipitates 4. Unilat/bilat5. Adhesions to the iris (posterior synchiae)6. Brow ache/HA
S/S iritis
228
1. Cycloplegics - homoatropine or atropine drops2. Prednisilone acetate3. Refer to ophthamologist
Tx iritis
229
1. Fluorescein eye drops2. Culture - bacterial & viralIf non infectious? Look at rheumatoid arthritisTx1. Gentamicin or CefazolinContacts? Cipro2. Cycloplegic eye drops3. Refer
Dx & Tx corneal ulcer
230
Pseudomonas Staph is also common
Corneal ulcer w/ contacts - what's the bacteria?
231
1. Sulfa drugs2. OTC decongestants3. Motion sickness meds4. Adrenergic agents5. Antipsychs6. Antidepressants7. Anticholinergics
Causes of angle closure glaucoma
232
All other eye complaints:1. Halos around lights2. Pain ppt by dark conditions***3. Elevated IOP - maybe >60 4. Steamy cornal edema**5. Mid dilated fixed pupil6. Shallow anterior chamber
S/S Angle closure glaucoma
233
Reduce IOP & break angle closure 1. Beta-adrenergic drops2. Topical steroid drops3. Alpha-adrenergic agonists4. Carbonic anhydrase inhibitor acetazolamide5. Hyperosmotic agents if IOP very high 6. Laser peripheral iridotomy to relieve pressureEMERGENCY!
Tx angle closure glaucoma
234
From Topiramate/sulfa use1. D/c med2. Cycloplegia - atropine3. IV hyperosmotic agents4. IV steroids 5. Refer
Tx secondary angle closure glaucoma
235
Anterior aspect of the ciliary body
MC site of bleeding for hyphema?
236
Hx of trauma1. Blood/clot in anterior chamber2. R/o ruptured globe3. Measure IOPTx1. Acetaminophen2. Bed rest/limited activity3. Elevate head 4. Eye shield 5. Atropine6. Refer
Dx & Tx hyphema
237
1. Hx sinus infection/surgery/insect bid/stye chalazion/infection2. CT w/ contrast Tx1. Nasal decongestants & vasoconstrictors to drain sinuses2. Augmentin/Ceftriaxone3. I&D of abscessImmunosuppressed? Antifungal - Amphotericin-B
Dx & Tx orbital cellulitis
238
1. CT scan/MRITx 1. Antihistamines2. Cool compresses - insect bite3. Amoxicillin
Dx & Tx preseptal cellulitis
239
22-Oct
What is normal eye pressure?
240
1. Painless, acute vision loss (over seconds)2. Cherry red fovea3. Causes irreversible cell injury in 100min 4. HA, wt loss, jaw claudication, scalp tenderness, fever, proximal joint pain5. Hx Afib, endocarditis, coagulopathies, atherosclerotic disease6. Fell asleep on eye
S/S retinal artery occlusion
241
1. Whitening of retina on posterior pole2. Cherry red spot macula3. + APD4. Narrowed retinal arterioles5. Boxcarring/segmentation of blood columns in arterioles 6. Find out where emboli came from
Dx retinal artery occlusion
242
1. Ocular massage w/ firm pressure 2. Anterior chamber paracentesis3. IOP reduction - Acetazolamide/topical beta-blockers4. Hypervent. to induce resp. acidosis & vasodilationMust be done 90-120min after eventREFER
Tx retinal artery occlusion
243
Retinal artery occlusion
Cherry red macula?
244
1. Topical anesthesia2. Irrigation - check pH3. Artificial tears4. Bandage contact lens5. Amniotic membrane transplant 6. Topical steroids7. Abx eye drops8. IOP>30 needs Tx9. Cycloplegics for pain
Tx chemical burns
245
Inflammation of the cornea Infection/dry eyes/contacts/injury/Vit A deficiency
What is keratitis?
246
1. Unlat2. Mild conjunctival injection3. Epithelial dendrites4. Stromal scarring & vascularization w/ advanced diseaseTx - 1. Cycloplegic2. Trifluridine3. Acyclovir
S/S & Tx herpes simplex keratitis
247
1. Vesicular rash of CN 52. Hutchinson's sign - lesion on tip of nose3. Conjunctivitis4. Uveitis5. Glaucoma6. ScleritisTx1. Acyclovir2. Tears
S/S & Tx herpes zoster ophthalmicus
248
1. Conjunctival injection2. Epithelial defect3. Stromal infiltration4. Gray-white color & rough corneal surface5. Irregular feathery edge infiltrates6. White ring on corneaMay develop ulcerDx - corneal scrapings, gram & giemsa stain Tx1. Natamycin or Amphotericin B2. Cycloplegics
S/S & Dx & Tx Fusarium fungal keratitis
249
1. Conjunctival hyperemia2. Folds in Descemet's membrane3. Upper eyelid edema4. Posterior synchiae5. Focal/diffuse corneal edema6. Mucopurulent exudateDx - corneal scraping on chocolate, blood & Sabouraud agarSmears for gram, giemsa & AF stain Tx 1. Tobramycin alternateing w/ Cefazolin
S/S & Dx & Tx bacterial keratitis
250
1. Conjunctival hyperemia2. Corneal ulcer3. Lid edema4. Corneal ring stromal infiltrate5. Inc. IOP6. Hypoyn7. CataractDx - Corneal scraping on non-nutrient agar Smears for gram, giemsa & calcofluor white stain (+cysts)Tx 1. Polyhexamethyl biguanide2. Propamidine isethionate3. Itraconazole4. D/c contacts 5. Cycloplegics
S/S & Dx & Tx Acanthameoba keratitis
251
1. Hyperemia2. Mucus3. High tear lakes from reflex tearing4. Low tear lakes5. EpiphoriaDx - measure tear breakup timemeasure tear production - Schirmer tear test Tx 1. Artificial tears2. Lubricating ointment at bedtime3. Restasis4. Punctal plugs
S/S & Dx & Tx Keratitis sicca
252
1. +APD2. Visual field loss3. Pale swollen disc +/- flame hemorrhages4. Tender palpable temporal artery5. Central retinal artery occlusion6. Cranial nerve palsy7. Scalp necrosis
S/S temporal arteritis
253
BxTx - 1. Prednisone
Dx & Tx temporal arteritis
254
Superior temporal
Which quadrant of the retina is the MC site of retinal detachment?
255
IgE dependentAnaphylactoid - does not require sensitizing exposureTypical rxn & HOTN1. ABCs2. Epi3. IVF4. Steroids IV, antihistamines, albuterol, glucagon
Anaphylaxis
256
1. Antihistamines (H1 +/- H2)2. +/- steroids If severe - epi
Tx urticaria
257
1. Stop ACEiNot great but use:Epi, antihistamines & steroidsHereditary? C1 esterase inhibitor or FFP
Tx angioedema
258
May not respond to epi so give glucagon
What to give in anaphylaxis on beta-blockers?
259
Usually >50 Only 1/3 w/ known CA Hx1. Unremitting pain2. Night pain3. Wt loss
S/S back pain due to cancer
260
#NAME?
Straight leg raise
261
1. Pain2. Neuro deficits - urinary incontinence, perianal sensory loss 3. Sciatica4. Urinary retention5. Weak/stiff lower extremities6. Paresthesias7. Abnl straight leg raise Give Dexamethasone before MRI
S/S cauda equina
262
Sx >3mo1. Fever2. TTP3. Inc. ESR, NL WBCXray NL until bone demineralizes Consult surg before abx
S/S Vertebral osteomyelitis
263
1. Constant back pain, awaken at night - not relieved by rest/meds2. +/- fever3. +/- neuro deficits4. ESR inc. +/- inc. WBC
S/S discitis
264
1. Pain, fever, neuro deficits2. Localized pain then radicular then neuro deficits then paralysis 3. Xrays NL GET MRI - emergent Surg.
S/S spinal epidural abscess
265
Salmonella - vanco + cipro
Sickle cell Pt w/ septic arthritis..what's the bacteria & Tx?
266
3rd gen cephalosporinTx if suspected before cultures come back
Tx gonococcal septic arthritis
267
Vanco + CeftriaxoneRefer
Tx nongonoccocal septic arthritis
268
uric acid - gout
Negative birefrigence crystals on joint aspiration?
269
calcium pyrophosphate - pseudogout
Positive birefrigence crystals on joint aspiration?
270
1. NSAIDs2. Colchicien3. Prednisone if not workingRenal failure? narcotics
Tx gout & pseudogout
271
Mono/oligoarticular Larger joints more - may be migratoryDoxy, Pen G, amoxicillin, Ceftriaxone
Lyme septic arthritis?
272
Prepatellar or olecranon bursa
MC locations of bursitis
273
PasturellaAugmentin or moxiflocin
Tx dog/cat bite
274
Kanavel 4 cardinal signs1. Percussion tenderness over flexor tendon sheath2. Uniform swelling3. Intense pain w/ passive extension4. Flexion posture Surgical emergency - staph MC Tx 1. Augmentin2. Immobilize & elevate
Flexor tenosynovitis
275
No mammary glandsGive acyclovir - immobilize & elevate
Do you drain herpetic whitlows?
276
DeQuervian tenosynovitis extensor pollicis brevis & abductor pollicis tendons Immobilize, ROM exercises, NSAIDs
FInkelstein?
277
NSAIDs
Tx ganglion cysts
278
1. URI2. Fever3. HA4. Hematuria5. Diarrhea6. Arthralgias7. Rash - bullae on skin & mucus membranes, ulcers on cornea & stoma, vesicles that ruptureTx the cause, +/- steroids
S/S SJS
279
1-2 wk prodome1. Fever2. Malaise3. Arthralgias4. URI5. Skin tenderness, tingling/burning6. Erythema intially on face & genitals becoming generalized & tender & confluent rapidly then bullae7. Nikolsky sign Tx1. Hospitalize in ICU/burn unit2. ABCs3. Elecrolyte & fluid replacement4. Debridement & dressing
S/S & Tx Toxic epidermal necrolysis
280
Common in kids <6 1. Painful erythema & blistering of skin w/ fever2. NO mucus membrane involvement3. + Nikolsky sign Skin Bx, cultures on skin, throat & bloodTx - IVF & abx
S/S Dx & Tx Staphylococcal scalded skin syndrome
281
Herpes Zoster of CN VII - vesicles in ear canal/pinnaHearing loss, facial paralysis, loss of taste
What is Ramsey Hunt syndrome?
282
Poison ivy, oak, sumac1. Antihistamines2. Oatmeal baths3. Topical steroids 4. Prednisone
Tx Rhus Dermatitis
283
1. Pharyngitis, meningitis, bacteremia2. HA, fever, AMS, N/V, myalgias, stiff neck 3. Rash - petechiae, hemorrhagic vesicles Pt in shock & can develop DICTx - abx ASAP - Ceftriaxone
S/S & Tx meningococcemia
284
Old people - usually from steroids, infection, dehydration/thromboembolismVesicles or bullae that vary in size, blisters clear & tense then become flaccid & burst+ NikoslkyTx1. Admit2. IVF & electrolytes3. Steroids4. Immunosuppressants - Azathioprine5. Plasmapheresis6. IVIG
Pemphigus vulgaris & Tx
285
Only give abx if contaminated 1. Polymyxin B2. Ciprodex3. Floxin
TM rupture
286
Abscess of submaxillary, sulingual & submental spaces w/ tongue elevation, usually due to lower 2nd & 3rd molars1. Jaw swelling2. Stiff tongue3. Trismus4. Fever, chills5. Difficulty swallowingDx - CTTx - ABCs, IV abx (PCN + Flagyl), OR for drainage
Ludwig's angina
287
2-3 days post extraction - Severe pain d/t clot displacement of dissolvingLocal/topical anesthesia, irrigate, suction fluid, pack Abx - dental referral
Dry socket
288
Sepsis & cardiopulm failure
MCC death assoc. w/ ARF?
289
Labs + Renal USAvoid contrast dyes
Dx ARF
290
Color doppler USAspiration of dark intracevernosal blood from copusTx - Terbutaline SQ in deltoid Corporal aspiration followed by irrigationSurgery
Dx & Tx Priapism
291
PCP
MC opportunistic infection in AIDS?
292
Strep pneumoniae
MCC PNA AIDS Pts?
293
<500
Pt is on AZT, what should you suspect their CD4 count to be?
294
Hips & knees flex when you flex neckSign of meningitis
What is Brudzinski sign?
295
Hamstrings contract when knee extended w/ hip flexedSign of meningitis
What is Kernig sign?
296
Strep pneumoalso N. meningitidis & Listeria Tx - Ceftriaxone/Cefotaxime
MC bacterial cause of meningitis?
297
1. Arbovirus2. HSV3. HZV4. CMV
Causes of encephalitis?
298
Brain abscess
Ring of enhancement on CT?
299
Brain BxTx - Rabies IVIG & vaccine
Dx rabies
