Family Medicine Flashcards
(187 cards)
1
Q
Lateralized, pulsating/throbbing HA w/ N/V, photophobia and phonophobia. Lasts 4-72 hrs and is worse with physical activity. The person says the saw flashing lights prior to onset. Trx and diagnosis
A
Migraine
-resting in quiet dark room may help or simple analgesic (acetaminophen, naproxen, ibuprofen, aspirin) These should be limited to less than 15 days per month, and less than 10 if combined
Abortive:
- Triptan or Ergotamines: 5HT-1 agonists (CI if coronary artery or peripheral vasc. Disease, uncontrolled HTN)
- Dopamine blockers: IV phenothiazines, metoclopramide, promethazine, prochlorperazine (give w/ Benadryl to prevent EPS)
-ergotamines
Prophylactic: B-blocker (propranolol), CCB (verapamil), TCA, anticonvulsants (valproate, topiramate), NSAIDs , acupuncture
2
Q
What causes a HA that is typically worse on awakening?
A
Intracranial mass or sleep apnea
3
Q
What type of HA typically occurs at the same time each day or night?
A
Cluster HA
4
Q
What HA signs would make you want to get a CT/MRI to r/o intracranial mass?
A
Progressive HA, new onset occurring middle/late life, HA that disturbs sleep, causes neuro/focal neuro symptoms
5
Q
What is the MC type of HA?
A
Tension HA
6
Q
Constant daily tight HA that is generalized, no focal deficits. Diagnosis and trx
A
Tension HA
Pretty much the same as migraine, but no triptan
7
Q
Who gets cluster HA?
A
Middle aged men
8
Q
Patient has recurrent bouts of a HA that last for 4-8 weeks, then go away for a while. The patient says that they when the come back is has congestion, runny nose, and a watery eye. What syndrome is a associated w/ this disease, what is the diagnosis, and what is the treatment?
A
Abortive:
100% oxygen First line
Anti migrain meds
Prophylaxis:
Verapamil First line
Lithium carbonate, topiramate, prednisone, ergotamine
9
Q
What is the MC cause of death in young people?
A
Trauma, and head injury is almost half
10
Q
What are signs that indicate a cranial mass?
A
- HA worse when lying down
- HA awaken patient at night
- HA peak in the morning
- New in middle or later life (key feature)
- Sign of malignancy: fever, night sweat, weight loss, hx of malignancy, signs of intracranial pressure (papilledema, vomiting, worsening HA, increasing disorientation, changes in LOC)
11
Q
What meds can cause rebound HA?
A
Ergotamines, Tristan’s, opioids when taken >10 days per month
acetaminophen, acetysalicylic acid, NSAIDs when taken more than 15 days per month
These patients have HA where no effect from pain meds in 3 months
Treatment is migraine prevention therapy
(Beta blocker, CCB, TCA, anticonvulsants (topiramate/valproate)
12
Q
When should you refer someone for a HA?
A
- Thunderclap onset
- Increasing HA unresponsive to simple measures
- HX of trauma, HTN, fever, visual changes
- Presence of neurological signs or scalp tenderness
13
Q
When to admit for a HA?
A
Suspected subarachnoid hemorrhage, structural cranial lesion
14
Q
Patient presents w/ sudden onset HA that they describe as a thunderclap/ worst HA of their life. In addition they have mineral sx (stiff neck, photophobia, delirium), and they are obtunded. What is most likely diagnosis, what is wrong, what imaging, and what is the treatment?
A
- Subarachnoid hemorrhage
- ARTERIAL bleed: MC berry aneurysm, AV malformation
- CT
- Admit(typ 14 days) & neuro consult, Bed rest, stool softeners, lower ICP, surgery, gradually lower ICP (nicardipine, nimodipine, labetalol)
15
Q
79 y/o presents w/ lancinating HA on left temple. Complains of pain with chewing and sudden painless unilateral blidness, fever, and scalp tenderness. What is the lab, what is the dx, and what is the treatment?
A
- ESR >100 / temporal biopsy
2. IV methylprednisolone 40-60 mg/day then prednisone 60 mg for 6 weeks
16
Q
Patient presents with stabbing pain near corner of mouth that radiates to their ear. They say that it’s made worse with eating, drafts, or touching their face. During the exam it appears they are trying to hold still. They have no neuro abnormalities on exam. What must you r/o, what is the diagnosis, what is the treatment?
A
- R/o Multiple sclerosis
- Trigeminal neuralgia
- Trx
Carbamazepine first line (LFT and Blood count)
Then gabapentin
Valproate, phenytoin, topiramate
Surgery if recalcitrant to decompress
17
Q
Patient complains of stabbing pain in throat, around tonsils, deep in their ear. They say that it is exacerbated by swallowing, yawning, chewing, and sometimes talking. They tell you that they have even passed out. Neuro exam is normal. Diagnosis and treatement?
A
- Glossopharyngeal neuralgia
2. Carbamazepine, oxcarbazepine
18
Q
what is the treatment for acute bacterial sinusitis?
A
- amoxicillin first line
- pencillin allergy: doxycycline
- risk for pneumococcal resistance/recent hospitalization last 5 days/ >65/ abx in last month/immunocompromised (s. pneumo MC): augmentin
19
Q
what are the MC causes for sinusitis?
A
S. pneumo MC
H. influenza, GABHS, M. cattarrhalis
20
Q
What test is used to evaluate epilepsy?
A
Electroencephalography (EEG)
21
Q
What are the essentials for epilepsy?
A
- Recurrent unprovoked seizures,
- Characteristic EEG accompanying seizures
- Mental status abnormalities or focal neurological sx. May persist for hours postictally
22
Q
what are red flag symptoms for GERD?
A
- dysphagia
- odynophagia
- weight loss
- bleeding
23
Q
recurrent abdominal pain or discomfort at least 3 days per month in the last 3 months with 2 or more of the following:
- improvement with defecation,
- onset associated with a change in frequency of stool, or
- onset associated with a change in form (appearance) of stool
A
irritable bowel syndrome
24
Q
indications for GI referral
A
- More than minimal rectal bleeding dis
- Weight loss
- Unexplained iron deficiency anemia
- Nocturnal symptoms
- Family history of selected organic diseases including colorectal cancer, inflammatory bowel disease, or celiac sprue
WABNFam
25
what is the confirmatory test for seizures activity?
EEG electroencephalogram, MRI is a must, but in the ER consider CT
26
what are the generalized seizures?
1. absence (petit mal)
2. tonic-clonic (tonic clonic)
3. atonic
4. myoclonic
27
child presents w/ brief lapse of consciousness that includes a vacant stare and lack of response. The patients teacher says that sometimes this will even happen mid sentence. At some points the patient may have mild jerking, and wetting himself. The child is unaware and does not have a post ictal phase (flaccid coma/sleep). you get an EEG and it shows bilateral symmetric 3 hz spike and wave action. What is the diagnosis and treatment?
absence (petit mal)
ethosuximide first line (only for absence)
valproate second line
28
what hormone is elevated in a seizure and can help you identify a difference between an actual seizure and a pseudoseizure?
prolactin levels
29
what labs should you monitor for a patient on anti-epileptics?
CBC and LFT for hematologic and hepatotoxicity
30
pt. has sudden loss of consiousness. They become rigid and falls to the ground and their respiration is arrested this (tonic phase) lasts <1 min and is followed by a jerking of the body musculature (clonic) that lasts for 2-3 min and then is followed by a flaccid coma. During the coma the patient has incontinence (attic and basement) is injured, and bit their tongue. following the attack they behave abnormally and have no awareness of the even (postictal). the EEG shows high amplitude rapid spiking that may be normal in between seizures. what is the diagnosis and treatment
tonic-clonic (grand mal)
| valproic acid, phenytnin, carbamazepine, lamotrigine
31
auras, and automatisms (lip smacking, manual picking, patting, coordinated motor mvmt (walking)) and seizures that are associated w/ marching symptoms are what kind of seizures?
focal onset. they are charaterized as such because only one hemisphere has been activated. They are classified by motor or non motor, and aware vs. impaired awareness
32
what is the treatment and time frame fror status epilepticus?
30 min, dextrose then lorazepam or diazepam (repeated at 10min) then phenytoin then phenobarbital
33
patient has sudden brief, sporadic muscle twitching and no loss of consiousness
myoclonus valproic acid, clonazepam
34
what kind of seizure is called a drop attack?
sudden loss of postural tone
35
what is a common side effect of valproic acid?
tremor, but also try and remember hepatotoxicity, thrombocytopenia, and pancreatitis
36
what kind of tremor does someone with essential tremor have?
an INTENTIONAL TREMOR (upper extremities>lower extremities) increased w/ stress and intentional MVMT, you will see it on finger to nose test. RELIEVED W/ ALCOHOL
treatment is propanolol
Autosomal dominant disorder
37
initial treatment for hypertension in african americans?
CCB then thiazide diuretics, then add on ACEI/ARB
38
what are non pharm recommendations for treatment of HTN?
weight loss
decrease ETOH
exercise
DASH: increase fruits and veges and dec. fats and sodim
39
what should be the initial hypertensive medication treatment for someone w/ DM or CKD?
ACEI or ARB
40
what is are the initial meds that are used for uncomplicated HTN in non-blacks?
In no particular order
1. thiazide diuretics
2. ACEI
3. ARB
4. CCB
41
what are side effect of thiazide-type diuretics and mech of action?
prevent NA reabsorption in distal convoluted tubule
hypercalcemia, hyperuricemia, hyperglycemia (careful DM and gout)
42
what are side effect of loop diuretics and mech of action (furosemide, bumetanide)?
inhibits H2O at loop of henle
hypokalemia, ototoxicity
43
what is the renal trifecta?
diuretics and acei/arb and nsaids
essentially starving the kidneys
44
what population groups are good candidates for ACEI?
post MI, HF, stroke, DM, high CAD risk
45
mech of action of ACEI and side effects?
cardioprotective syndergitic effect w/ used w/ thiazides
angioedema, cough, hyperkalemia
46
what is the first line agent for HTN in pregnancy?
methyldopa
47
side effect of abrupt clonidine stoppage?
hypertensive crisis
48
when are non-dihydropyridine CCB used to treat htn?
AFIB when a B blocker can't be tolerated
verapamil, diltiazem
49
why are dihydropyridines (nifedipine and amlodipine) used more than non-dihydropyridines when treating HTN?
dihydropyridines are potent vasodilators and do not affect contractility or conduction
50
sde effects of CCB?
peripheral edema
51
MC cause of CAD?
atherosclerosis
52
risk factors for CAD?
```
DM (worst)
smoking
hyperlipidemia
HTN
males
age (45 m, 55 w)
fam hx
```
53
what is angina?
substernal chest pain brought on by exertion
54
what is levine's sign?
clenched fist over chest
55
substernal chest pain, poorly localized, may radiate, less than 20 min that is relieved w/ rest/nitro and precipitated by exertion/anxiety?
angina
consider sx of dyspnea, epigastric pain/ shoulder pain anginal equivalent
56
what will you see on ECG during angina typically?
st depression, f/u w/ stress test for angina because 50% have normal ECG
57
when do you use a myocardial perfusion imaging stress test when diagnosing ischemic heart disease?
when patient has baseline ECG abnormalites
can be stress or pharm w/ thallium 201 or 99m. localize regions of ischemia.
pharm agents: adenosine or dipyridamole when patients cant tolerate exercese.
58
what is the definitive managment of angina?
1. percutaneous transluminal coronary angioplasty: if 1 or 2 vessel dieseae not involving the L main coronary artery and in whom ventricular function is normal/near normal
2. Coronary Artery bypass graft CABG: if L main coronary artery disease, symptomatic or critical stenotic 3 vessel disease or decreased L ventricular ejection fraction <40%
59
contraindications for using NITRo?
SBP <90
RV infarction
sildenafil other PDE-5 inhibitor
60
first line drug therapy for chronic management of stable angina?
beta blocker: reduces mortality
B1 selective: metoprolol, atenolol
nonselective: propranolol, nadolol
61
anterior wall infarction: ECG and artery?
V1-V4 LAD
62
lateral wall infarction: ECG and artery?
I, aVL, V5, V6 Circumflex
63
anterolateral wall infarctoin: ECG and artery?
I, avl, V4, V5, V6 LAD and circumflex
64
inferior infarction: ECG and artery?
II, III, aVF right coronary artery
65
posterior wall infarction: EC and artery?
ST depression V1 and V2 RCA, circumflex
66
what is the treatment for prinzmetals angina?
CCBs,
occurs at rest, vasospasm of coronary arteries
67
rate and treatment for sinus tachycardia?
>100, USUALLLY NONE
68
rate for sinus bradycardia and treatment?
<60
atropine
69
what is sinus arrhythmia?
HR increases during inspiration
70
what does sick sinus syndrome look like and treatment??
sinus arrest w/ alternating paroxysms of atrial tachyarrhythmias and bradyarrhythmias.
secondary to SA node disease
trx: pacemaker
71
what is first degree av block and management?
constant prolonged PRI (>.20), P for every QRS
observation
72
what is key about second degree heart blocks
not all SA node make it to ventricles so some P have no QRS
73
what is second degree MOBITZ I (wenckebach)?
PROGRESSIVE PRI lengthening then dropped QRS (going going gone).
if symptomatic atropine
74
what is second degree mobitz II?
CONSTANT prolonged PRI w/ dropped QRS
management atropine and pacing then definitive treatment is permanent pacemaker because 3rd degree will develop
75
what is third degree heart block?
AV dissociation: P waves not related to QRS
P waves are not followed by qrs (leads to dec. cardiac output)
trx: temporary pacing then permanent pacemaker.
76
what is atrial flutter
saw tooth
250-350 bpm (no p waves)
rate usually regular
trx:
stable vagal, B-blocker, CCB
unstable: direct current (synchronized) cardioversion
definitive: radio frequency ablation
77
what is a. fib?
irregularly irregular w/ narrow QRS
NO Pwaves
350-600(atrial)
80-140(vent)
```
stable trx:
1. RATE CONTROL
B-blocker (metoprolol, esmolol)
CCB (diltazem, verapamil)
digoxin (preferred if hypotension or CHF)
```
2. RHYTHM CONTROL
cardioversion: <48 hrs or 3-4 wks anticoag
pharm: ibutilide, flecainide, sotalol, amiodarone
radiofrequency: perm pacemaker
```
unstable
direct current (synchronized) cardioversion
```
anticoagulation:
- assess for embolization risk: CHAD2DS2-VASc (>=2 give oral anticoagulation) recommend
- determination of the benefits vs. risk of anticoagulation: embolization vs. bleeding risk
anticoags:
non vit K antagonist oral anticoags
- dabigatran: direct thrombin
- rivaroxaban, apixaban, edoxaban: factor Xa inhibitors
warfarin: preferred for severe chronic kidney disease goal INR2-3
78
what is the CHA2DS2-VASc criteria for anticoag?
```
CHF
HTN
A2ge >=75
DM
S2 stroke, TIA, thrombus
Vascular disease (MI, aortic plaque, PAD)
Age 65-74
Sex
```
79
what is the treatment for stable SupraVentricularTachycardia?
adenosine
HR>100
regular rhythm w/ narrow QRS
80
what is the for wolff-parkinson- white?
procainamide
81
what is the treatment for unstable SVT?
direct current (synchronized) cardioversion
definitive: radiofrequncy ablation
82
what are the 2 rhythms that you can defibrillate?
1. vfib
| 2. pulseless vtach
83
what is wandering atrial pacemaker?
<100 bpm and 3 p wave morphologies
84
what is multifocal atrial tachycardia?
>100 BPM and 3 p wave morphologies
85
MAT is associated w/ what disease?
COPD
86
signs of wolf parkinson white?
delta wave, wide qrs, short PR interval
trx: procainamide
avoid use of AV node blocker (ABCD)
adenosine, betablocker, CCB, digoxin
87
what is the rate for a junctional rhythm?
40-60
pwaves inverted or not present, w/ narrow QRS
88
what is premature ventricular contaction?
wide, bizarre QRS earlier than expected, t wave typically opposite direction of QRS
no treatment
89
what is vtach?
>=3 consecutive PVCs at a rate of >100 BPM (sustained if >30 sec.)
stable sustained VT: antiarrhythmics (amiodarone, lidocaine, procainamide)
unstable VT w/ pulse: synchronized cardioversion
VT w/ no pulse: defib, adn CPR
90
what is the cause and treatment for torsades?
IV magnesium, commonly due to hypomagnesium, and hyperkalemia
91
what is a common predisposing factor for vtach?
prolonged QT interval
92
treatment for Vfib?
defibrillatin
93
treatment for asystole and pulseless electrical activity?
CPR + epinephrine + shockable rhythm q 2 min
94
treatment for unstable bradycardia?
atropine
95
treatment for unstable tachycardia?
synchronized cardioversion
96
treatment for unstable wide QRS tachycardia
antiarrhythmia
97
what does acute pericarditis look like on EKG?
diffuse ST elevations in V1-V6
PR depression in the same leads at ST elevations
98
what test should be used to monitor palpitations?
holter monitor (continuous ECG testing worn 24-48 hrs)
think arrhythmia
Non cardiac: stimulant use, caffeine, ETOH, hyperthyroidism
99
what is brugada and what is it associated w/?
V1, V2 RBBB
V1-V3 ST elevation
sudden cardiac death
get automated implantable cardiac defibrillator
100
what will be low in hyperaldosteronism?
K
101
effects of angiotensin II?
1. inc. aldosterone: Na
2. inc. ADH: inc H2O
3. vasoconstriction
4 inc sympathetic tone
102
what is the gold standard for diagnosing coronary artery disease, renal artery stenosis, peripheral artery disease, and abdominal aortic aneurysms?
angiography
103
what test is most useful to diagnose HF?
echocardiogram
(transthoracic echo TTE: primary noninvasive test for cardiac anatomy and function)
(transesophageal echo TEE)
104
when is a treadmill test CI?
patient is unable to excercise or has baseline ECG abnomalities
105
what is a positive treadmill stress test?
st depression
2. exercise induced hyper/hypo tension
3. smptoms or HR abnormalities with normal resting ECG
106
what test can localize the region of ischemia?
radionuclide myocardial perfusion imaging
107
what are the vasodilators in pharmacologic stress testing?
adenosine or dipyridamole
preferred in patients w/ baseline ECG abn. and can localize region of ischemia
108
when is pharmacologic stress testing contraindicated?
bronchospastic disease (asthma, COPD)
2nd/3rd degree HB
sick sinus syndrome
109
what is a stress echo able to visualize and when is CI?
localizes the regions of ischemia, depicts wall mostion abnormalities, visualizes the structure and function of the heart (assess LV and valvular function)
110
what are AMI protocol?
ECG w/in 10 min
door to thrombolytics 30 min
door to PCI 90 min
```
MONA:
morphine
oxygen
nitrates
asprin
```
STEMI: B blocker, NTG, aspirin, heparin, ACEI, reperfusion
Nstemi, unstable angina: b blocker, NTG, aspirin, heparin
cocaine induced MI: ASA, NTG, heparin, anxiolytics (no B blockers!! unopposed alpha vasoconstriction)
R ventricular wall and inferior wall: must be careful because IV nitrates and morphine will reduce the preload.
if viagra: no nitrates (decreases preload)
111
what is conservative management for chest pain?
began >12 hrs prior (w/o current chest pain) or low TIMI
```
aspirin 9 months
statin
B-blocker
ACEI
Nitroglycerin PRN
```
112
what are the absolute contraindications to fibrinolytics?
- previous intracranial hemorrohage
- non hemorrhagic stroke w/in 6 months or closed head/facial trauma w/in 3 months
- intracranial neoplasm, aneurysm, AVM
- active internal bleeding
- suspected aortic dissection
113
MC cause of heart failure?
coronary artery disease
114
inability of the heart to pump sufficient blood to meet the metabolic demands of the body at normal filling pressures?
heart failure
115
MC causes of R side HF?
L side HF and pulmonary disease
116
what is the MC cause of L side HF?
coronary artery disease and HTN
117
what is more common systolic or diastolic HF?
systolic
118
HF w/ decreased ejection fraction, S3 gallop, and is usually secondary to MI, and dilated cardiomyopathy?
systolic HF
119
HF with normal/inc. EF, S4 gallop (forced atrial contraction into a stiff ventricle), typically caused by HTN, LVH, elderly
diastolic HF
120
NYHA classes w/ HF?
I: no sy or limitation of activity
II: mild sx (dyspnea/angina) w/ slight limitation
III: moderate symptoms cause marked limitation in activity even with minimal exertion, but comforatble at rest
IV: sx at rest, severe limitations
121
what are compensatory mechansims in HF?
sympathetic activation
myocyte hypertrophy remodeling
RAAS activation
122
what is the MC symptom of L side HF?
dyspnea
123
signs of L side HF
dyspnea, orthopnea, paraoxysmal nocturnal dyspnea, rales/rhonchi, chronic non productive cough, PINK FROTHY SPUTUM, S3, S4, MC cause of transudative pleural effusions, hypertension, cheyenne stokes breathing, cool extremities, dusk pale skin
124
signs of R sided failure
peripheral edema, JVD, GI /hepatic congestion (N/V, anorexia, RUQ tenderness, hepatojugular reflex)
125
what score from patient health questionnaire 9 (PHQ-9) is concerning for depression?
>=10
126
what do ARBs end w/?
-artan
127
what is the initial management for HF?
ACEI (and diuretic for symptomsL loop diurectics are most effective: furosemide, bumetanide, toresmide). Add on BB. Consider K sparing diruetic spironolactone (decreases mortality)
digoxin if HF + afib, but no mortality benefit
consider hydralazine + nitrates if unable to tolerate ACEI or BB. Good for african americans
128
what treatment is indicated in patients with HF and EF <35%?
Implantable cardioverter defibrillator
129
what treatment is indicated in patients with HF and EF <35%?
Implantable cardioverter defibrillator
130
what are findings indicative of CHF on CXR?
cephalization
kerley B lines, butterfly/batwing pattern, pulmonary edema, peribronchial cuffing, perihilar congestion, and cardiomegaly
131
what is the treatment for CHF?
LMNOP
Lasix (loop diruetic furosemide), morphine, nitrates, oxygen, position
morphine reduces preload
132
what is the treatment for diastolic HF?
HR control, BP control, relief os ischemia
BB
ACEI
CCB
133
acute fibrinous inflamation of the pericardium
acute pericarditis
134
clinical manifestations of pericarditis?
pleuritic chest pain, and positional chest pain that relieves when leaning fwd. and friction rub best heard at end respiration while upright and leaning fwd. fever typically present
135
what are 2 most common causes of pericarditis
idiopathic and viral ( enteroviruses, coxsackie, echovirus)
also consider dressler syndrome (post MI pericarditis)
136
what is the treatment for pericarditis?
aspirin/nsaids first line
colchicine second line
corticosteroids if sx >48 hrs and refractory
137
PE for pericardial effusion, ECG, treatment?
muffled heart sounds, electrical alternans/low voltage ecg
trx: observation if small
bigger: pericardiocentesis/ pericardial window
138
PE for pericardial effusion, ECG, treatment?
muffled heart sounds, electrical alternans/low voltage ecg
trx: observation if small
bigger: pericardiocentesis/ pericardial window
139
clinical manifestations of pericardial tamponade (so much fluid that filling is compromised and decrease output)?
beck's triad
1. JVD
2. muffled heart tones
3. hypotension
pulsus paradoxus: >10 mmHg decrease in systolic BP w/ inspiration
dyspeana fatigue, peripheral edema, shock: hypotension, reflex tachycardia, cool extremities
Immediate pericardiocentesis
140
what is the treatment for cardiac tamponade?
pericardiocentesis
141
what is the treatment for constrictive pericarditis?
pericardiectomy
142
ejection click is associated w/ what pathology?
MVP: chordae tendinae abruptly pulls the mitral valve tight
143
fixed split of s2 is heard w/ what?
ASD, VSD, pulmonary HTN and mitral regurgitation
144
opening snap is what pathology?
opening of a stenotic mitral valve
145
treatment for systolic crescendo-decrescendo murmur best heard at RUSB that radiates to neck?
surgery: valve replacement
aortic stenosis makes LVH
146
what are the modified duke criteria for infective endocarditis?
2 major or 1 maj and 3 minor or 5 minor
Bacterial Endcarditis FIVE PM
147
what are the diagnostic techniques for someone with peripheral artery disease? signs: claudication, acute arterial embolism, gangrene
arteriography (GOLD STANDARD), Ankle-brachial index (+
148
what are the diagnostic tests for aortic aneurysm?
1. abdominal ultrasound (initial test)
2. CT chest: thoracic aneurysms
3. angiography: gold standard
149
what are the treatments for aortic aneurysm?
>5.5 cm or >.5 cm in 6 months: immediate surgical repair (even if asymptomatic)
3-4 cm q 12 months
4-4.5 cm q 6 months
>4.5 cm vascular surgeon repair
150
pain in stomach/back. tender abdomen with palpable mass. syncope and hypotension. +/- flank ecchymosis
abdominal aortic aneurysm
151
what is the most important predisposing factor for aortic dissection?
hypertension
152
chest pain (sudden onset feels like ripping, tearing, knife like) chest/upper back. Decreased peripheral pulses w/ >20 mmHg between L and R arm. +/- Hyper/hypo-tension. acute new onset artic regurge (diastolic decresendo).
aortic dissection
153
what is the diagnosis of aortic dissection?
1. MRI angiography gold standard (time consuming)
2. CT scan with contrast (becoming test of choice)
3. TEE echo (may be used initially if unstable)
4. CXR (widening of the mediastinum)
154
what is the management of aortic dissection?
surgery (stanford A (all or ascending)/ debakeys I/II)
medical management: Descending
Esmolol, labetalol 1st Line
Sodium nitroprusside PRN
155
diagnosis of superficial thrombophlebitis (tenderness, pain, induration edema, erythema following superficial vein. Consider especially if hx of IV cath, trauma, pregnancy, varicose veins).
venous duplex ultrasound: noncompressible vein w/ clot
156
what are the diagnostic studies for DVT?
venous duplex ultrasound (first line non-invasive)
D-dimer: can r/o it low risk patient (wells <1), in high risk patients w/ NEGATIVE U/S can help decide if serial US are requeired.
Venography (GOLD STANDARD)
157
what is the treatment for DVT?
think LMWH/Unfractionated heparin to bridge gap to warfarin INR-2-3 and AT LEAST 5 DAYS. Vit K is antidote for warfarin. protamine sulfate is antidote for heparin
heparin: monitor CBC because of thrombocytopenia
```
1st DVT cause of surgery/trauma/OCP: 3 months
idiopathic proximal DVT: indefinite
idiopathic distal: 3 months
pregnancy: LMWH
malignancy: LMWH
```
IVC filter if contraindication/failed anticoag treatment
158
treatment for varicose veins?
1. conservative: compression, elevation, avoid long standing
| 2. sclerotherapy, radiofrequency, laser ablation, ambulatory phlebectomy
159
what is the gold standard test for diagnosing asthma?
pulmonary function test, (dec FEV1, dec FEV1/FVC)
160
rash that begins following an itch?
atopic dermatitis
161
what is the MC inflammatory skin disease?
eczema
162
what are the characteristics of eczema?
erythema, scale, vesicles
163
symmetric vesicular hand lesions (tapioca) and foot dermatitis w/ itch that precedes rash. associated w/ increased hand washing. vesicles slowly resolve then progresses to lichenificiation. at that point pain replaces pruritis. diagnosis and treatment?
itch-> vesicles-> lichenification/cracking/scaling->pain
dyshidrotic eczema (pomphylox)
```
potent steroid then wean
avoid excessive hand washing
+/- abx for secondary infection
elimination diet
hydroxyzine for itch
```
164
dry skin and scaling rash that develops on lower anterolateral legs. Has cracked red lines that resemble porcelain. more itch than rash. associated w/ long hot showers and worse in winter. diagnosis and treatment?
asteatotic eczema (eczema craquele)
decrease freq of bathing and water temp
apply emollients often and immediately after bath
steroids: III-IV
165
red, round, coin shaped lesions(plaque) that commonly occur on the back of elderly persons hands every winter. They may flake and can be misdiagnosed as tinea. diagnosis and treatment?
Nummular eczema
potent steroids for 4-6 weeks, group III-V (TAC MC)
antipruritic PRN
166
what are the 2 kinds of contact dermatitis?
1. irritant
| 2. allergic
167
how do you diagnose contact dermatitis?
patch testing to ID causative agent
168
what are the 2 most common types of irritant dermatitis?
occupational (hand dermatitis)
diaper dermatitis
169
- brush field spots (small, white, grayish/brown spots on the periphery of the iris)
- heart defects
- large tongue
- poor muscle tone
- sandal toe deformity
- single palmer crease
- upward slanting eye
- epicanthal fold
trisomy 21 (down syndrome)
170
mc site for fixed drug eruption
glans penis
171
what do you never do a shave on?
melanoma
172
where do you not use anesthesia?
ears, fingers, nose, toes, hose (penis)
173
greasy, stuck on appearnace?
seborrheic keraotsis
174
leser-trelat sign
associated w/ seborrheic keratosis, could be an indication of internal malignancy if many SKs appear all at once
175
dermatosis papulosis nigra
think morgan freeman, benign, smilar to S. MC africans and hispanics
176
stucco keratosis
white stuck on appearnce, associated w/ vasc. insufficiency so dont fix
177
acrochordon
skin tag
178
pink brown, slightly raised lesion that restracts beneath the surface w/ compression: retracts downward when squeezing around the lesion w/ thumb and index finger.
dermatofibromas
remove w/ punch biopsy or excision
179
tumor with central umbilication
sebaceous hyperplasia
180
lower eyelid/undereye, 1-3 mm small, firm flesh colored papules.
syringoma
181
button hole sign. pinkish white pedunculated tumor that invaginated through skin with pressure.
neurofibroma, look for axillary freckling and cafe-au-lait spots (von recklinhausen, NF1): if so consult neuro for cancer
182
what is the difference between hypertrophic scar and keloid?
keloid goes beyond borders of wounds site, starts later, and is stable. while a hypertrophic scar is confined to the wound site, starts early and regresses over time
183
this is a precursor to squamous cell carcinoma?
actinic keratosis
184
what's bowens diease?
carcinoma in situ, f/u q6 months, cryo, could become SCC
185
what is erythroplasia of queyrat?
SCC in situ on mucous membranes MC penis. red, moist, slightly raised plaque, associated w/ HPV-8. trx 5-fu or imiquod
186
treatment for bartonella henslae??
azithromycin
187
normal range of calcium, and what does hypo/hyper look like on ecg?
- 8.5 and 10.5 mg/dL
hypocalcemia will prolong the qt interval
hypercalcemia will shorten the qt interval
