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Last Minute Flashcards

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1
Q

6 possible exogenous causes of hyponatremia?

A 
Oxytocin
Surgery
Narcotics
Inappropriate IV fluid administration
Diuretics
Antiepileptics
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2
Q

ECG findings in electrolyte disturbances?

A

HyperK - tall, tented T waves
HypoK - loss of T waves/T-wave flattening and U waves
HyperCa - QT shortening
HypoCa - QT prolongation

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3
Q

Mainstays of therapy for CHF?

A

Sodium restriction
Diuretics (furosemide, spironolactone, metolazone)
ACEIs (first line)
Beta-blockers (if stable)

Digoxin (ONLY moderate-to-severe CHF with low EF or systolic dysfunction)
Vasodilators

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4
Q

Most common type of esophageal cancer and cause? Second most common and causes?

A

Most common - adenocarcinoma 2/2 long-standing reflux and Barrett esophagus

2nd most common - SqCC - smoking and alcohol

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5
Q

Screen for hereditary hemochromatosis?

A

Transferrin saturation test (serum iron/TIBC) and ferritin

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6
Q

Cause of bronchiolitis vs. croup?

A

B - RSV, parainfluenza, influenza

C - parainfluenza, influenza

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7
Q

Rx bronchiolitis vs. croup?

A

B - humidified O2, bronchodilators (?), ribavirin if severe

C - dexamethasone, nebulized epinephrine, humidified O2

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8
Q

3 sequelae of strep infection? Which are prevented by treatment?

A

Rheumatic fever*
Scarlet fever*
PSGN

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9
Q

Odds Ratio =?

A

AD/BC

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10
Q

RR = ?

A

(A/A+B)/(C/C+D)

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11
Q

Attributable Risk?

A

A/A+B - C/C+D

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12
Q

The P-value reflects the likelihood of making a ___ error.

A

Type 1

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13
Q

Causes of low maternal serum AFP?

A

Down syndrome
Inaccurate dates (most common)
Fetal demise

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14
Q

Causes of high maternal AFP?

A

Neural tube defects
Ventral wall defects
Inaccurate dates
Multiple gestation

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15
Q

Always perform ___ before ___ in the setting of third trimester bleeding in case placenta previa is present.

A

U/S; pelvic exam

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16
Q

Humeral fracture may present with what motor/sensory dysfunction? Nerve involved?

A

Wrist drop
Back of forearm and hand (first 3 digits)
Radial

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17
Q

Elbow dislocation may present with what motor/sensory dysfunction? Nerve involved?

A

Claw hand
Front and back of last 2 digits
Ulnar nerve

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18
Q

Carpal tunnel syndrome and humeral fracture may present with what motor/sensory dysfunction? Nerve involved?

A

Impaired pronation, thumb opposition
Palmar surface of hand (first 3 digits)
Median nerve

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19
Q

Upper humeral dislocation or fracture may present with what motor/sensory dysfunction? Nerve involved?

A

Impaired abduction, lateral rotation
Lateral shoulder
Axillary nerve

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20
Q

Knee dislocation may present with what motor/sensory dysfunction? Nerve involved?

A

Impaired dorsiflexion/eversion, possible foot drop
Dorsal foot, lateral leg
Peroneal nerve

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21
Q

Compare the presentation, symptoms/signs, and treatment of LCPD vs. SCFE.

A

LCPD: 4-10 y/o, short male with delayed bone age; Rx with orthoses

SCFE: 9-13 y/o, overweight M adolescent; Rx with surgical pinning

BOTH have knee, thigh, groin pain, limp

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22
Q

Pulsatile abdominal mass + hypotension = ruptured AAA until proven otherwise. Immediate next step?

A

Immediate laparotomy

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23
Q

BPH can present as acute renal failure. Patients have what exam findings? Management?

A

Distended bladder and bilateral hydronephrosis on U/S without “medical” renal disease

Drain the bladder first (cath), then TURP

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24
Q

Metabolic derangements caused by thiazide diuretics?

A

Hyper: Ca, glycemia, uricemia, lipidemia

Hypo: Na, K (metabolic alkalosis), volemia

Watch out for sulfa allergy

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25
Metabolic derangements of loop diuretics?
Hypokalemic metabolic alkalosis Hypovolemia Ototoxicity Hypocalcemia Watch out for sulfa allergy
26
Metabolic deranagemnets of carbonic anhydrase inhibitors?
Metabolic acidosis
27
What are the potassium-sparing diuretics?
Spironolactone
28
Benzodiazepine OD - antidote?
Flumazenil
29
Beta blocker OD - antidote?
Glucagon
30
Cholinesterase inhibitor OD - antidote?
Atropine, pralidoxime (anticholinergics)
31
Copper or gold OD - antidote?
Penicillamine
32
Lead OD - antidote?
Edetate (EDTA); succimer in children
33
Methanol or ethylene glycol OD - antidote?
Fomepiazole, ethanol
34
Muscarinic blockers - antidote?
Physostigmine
35
Quinidine or TCA OD - antidote?
Sodium bicarbonate (cardioproective)
36
Aspirin OD can be fatal and classically leads to what metabolic derangements
Both metabolic acidosis and respiratory alkalosis [Look for coexisting tinnitus, hypoglcyemia, vomiting, history of swallowing pills
37
Alkalosis and acidosis can cause symptoms of K and/or Ca derangement. What should be done in these settings and what derangements are caused?
Alkalosis - hypoK, hypoCa Acidosis - hyperK, hyperCa Rx the acid-base disturbance, not the levels
38
What can make hypoCa and hypoK unresponsive to replacement therapy?
Hypomag
39
Hemolysis can falsely elevate what lab?
K
40
Hypoalbuminemia can falsely decrease what lab?
Ca
41
Hyperglycemia can falsely decrease what lab?
Na
42
"Bitot spots"
Vitamin A deficiency
43
Cherry-red spot on the macula WITHOUT HSM
Tay-Sachs
44
Cherry-rod spot on the macula WITH HSM
Niemann-Pick disease
45
Cafe-au-lait spots with normal IQ
NF
46
Cafe-au-lait spots with intellectual disability
McCune-Albright or Tuberous sclerosis
47
Postpartum fever unresponsive to broad-spectrum ABX?
Septic pelvic thromboplehbitis
48
Low grade fever in the first 24 hours after surgery?
Atelectasis
49
Claudication and atrophy of the buttocks with impotence?
Aortoiliac occlusive disease (aka Leriche syndrome)
50
True or false - the body does not compensate beyond a normal pH.
True
51
Should you give bicarbonate to a patient with acidosis?
For boards, almost never. First try IV fluids and correction of the underlying disorder. If all other measures fail and pH remains less than 7.0, then give bicarbonate.
52
Signs and symptoms of hyponatremia?
``` Lethargy Seizures Mental status changes or confusion Cramps Anorexia Coma ```
53
Rx SIADH if water restriction fails?
Demeclocycline (induces nephrogenic DI)
54
Rate of correction in chronic, severe symptomatic hyponatremia?
Should not exceed 0.5 to 1.0 mEq/L/hr
55
Once glucose is >200, sodium decreases by ___ for each rise of ___ in glucose.
1.6 mEq/L; 100 mg/dL
56
Signs and symptoms of hypernatremia?
AMS Seizures Hyperreflexia Coma
57
Rx hypernatremia?
Water replacement (usually severely dehydrated) -> NS, then switch to 1/2 NS when hemodynamiccaly stable NEVER D5W
58
Signs and symptoms of hypokalemia?
``` Muscle weakness (paralysis, ventilatory failure, ileus, hypotension) EKG - T wave loss/flattening, U waves, PVCs, PACs, tachyarrhythmias ```
59
Potassium levels should be monitored carefully in all patients taking ___.
Digoxin
60
Signs and symptoms of hyperkalemia?
Weakness and paralysis | EKG - tall peaked T waves, QRS widening, PR prolongation, loss of P waves, sine wave
61
First consideration in an asymptomatic patient with a normal EKG and hyperkalemia?
Hemolysis of lab specimen -> repeat the test
62
Rx hyperkalemia
In general, decrease K intake and given Kayexalate (resin) If >6.5 or cardiac toxicity is apparent -> 1. Calcium gluconate (cardioprotective) 2. Sodium bicarbonate (alkalosis -> shifts K inside cells) 3. Glucose with insulin (ditto) Beta2 agonists are an option Dialysis if failure or renal failure
63
Signs and symptoms of hypocalcemia?
Tetany (Chvostek, Trousseau) Convulsions/seizures EKG - QT prolongation
64
Signs and symptoms of hypercalcemia?
``` Often asymptomatic Osteopenia Kidney stones/polyuria Abdominal pain, N/V, constipation, anorexia Depression, psychosis, AMS EKG - QT shortening ```
65
Rx hypercalcemia
1. IV fluids 2. Once well-hydrated, give furosemide (calcium diuresis) +/- phosphorus administration, calcitonin, bisphosphonates, plicamycin, prednisone, etc.
66
In what clinical scenario is hypomagnesemia usually seen?
Alcoholism
67
Signs and symptoms of hypomagnesemia?
Similar to hypocalcemia (prolonged QT, tetany)
68
Signs and symptoms of hypermagnesemia?
Decreased DTRs, hypotension, respiratory failure | Rx of preeclampsia, renal failure
69
Maintenance fluid of choice for patients who are not eating?
Half normal saline with 5% dextrose (adults) Add KCl to prevent hypokalemia
70
What may happen if you give glucose WITHOUT thiamine?
Precipitate Wernicke (give thiamine BEFORE glucose)
71
Rx bleeding esophageal varices?
1. ABCs 2. IV fluids and blood if needed. 3. Correct clotting factor deficiencies with FFP, fresh blood, and vitamin K, if needed. 4. Upper endoscopy -> sclerotherapy (cauterization, banding, or vasopressin)
72
Rx varices with no history of bleeding?
Non-selective beta blockers (propranolol, nadolol, timolol) to relieve portal HTN (so long as there is no contraindication)
73
If a question asks you to calculate the RR from retrospective data, what is the answer?
None of the above or cannot be calculated
74
Positive skew is an asymmetric distribution with an excess of ___ values; the tail of the curve is on the ___. Relationship between mean, median, and mode?
High; right; mean > median > mode
75
The incidence of a disease is equal to the absolute or total risk of developing a condition (as distinguished from relative or attributable risk).
Cool beans.
76
What test compares percentages or proportions (non-numeric or nominal data)?
Chi-squared test
77
What is a type II error?
Null hypothesis is accepted when in fact it is false (null should be rejected but isn't)
78
Rx MI.
1. Early reperfusion (fibrinolysis, PCI, etc.) 2. EKG monitoring (if VTach -> amiodarone) 3. O2 (>90%) 4. Morphine 5. Aspirin 6. Nitroglycerin 7. Beta blockers (unless contraindicated) 8. Clopidogrel 9. Unfractionated or LMWH (unstable angina, cardiac thrombus, CHF on echo, unless contraindicated) 10. ACEI or ARB within 24 hours 11. Statin
79
Presentation of variant (Prinzmetal) angina? Rx?
Pain at rest (unrelated to exertion) + ST-segment elevation with NORMAL cardiac enzymes Responds to nitroglycerin, Rx long term with CCBs
80
Late diastolic blowing murmur best heard at the apex +/- opening snap, loud S1, AF, LA enlargement, pulmonary hypertension
Mitral stenosis
81
Early diastolic decrescendmo murmur best heard at apex +/- widened pulse pressure, LVH, LV dilation, S3
Aortic regurgitation
82
Harsh systolic ejection murmur, best heard at aortic area, radiates to carotids +/- slow pulse upstroke, S3/S4, ejection click, LVH, cardiomegaly, syncope, angina, heart failure
Aortic stenosis
83
Midsystolic click, late systolic murmur +/- panic disorder
Mitral prolapse
84
Holosystolic murmur that radiates to the axila +/- soft S1, LAE, PH, LVH
Mitral regurgitation
85
Rx mitral stenosis
Balloon valvotomy or surgery if severe Medical management (diuretics, digoxin, beta blockers) is ONLY adjunctive.
86
Rx mitral regurgitation?
Corrective surgery if indicated (flail leaflet, severe regurgitation) Vasodilators (nitroprusside, hyralazine) if symptomatic AFIb is common
87
Rx aortic stenosis
Aortic valve replacement if symptomatic (essentially all patients)
88
Rx aortic regurgitation?
Replacement or repair if symptomatic, or asymptomatic with certain indications (progressive LV enlargement) Vasodilators to reduce hemodynamic burden
89
Rx superficial thrombophlebitis (erythema, tenderness, edema, palpable clot in superficial vein)
NSAIDs and warm compress
90
How are heparin, warfarin, and aspirin monitored?
Heparin -> PTT Warfarin -> PT/INR Aspirin -> Bleeding time (platelet function) Note - LMWH doe snot affect any of these
91
Reverse heparin/LMWH?
Protamine
92
Reverse warfarin?
FFP (immediate) and/or vitamin K (several days)
93
Reverse aspirin?
Platelet transfusions
94
Rx acute CHF?
Inpatient O2, diuretics, positive inotropes Digoxin if stable IV sympathomimetics (dobutamine, dopamine, amrinone) if severe
95
Rx 1st degree heart block
None; avoid BBs, CCBs (slow conduction)
96
Rx 2nd degree heart block
Mobitz type I - pacemaker or atropine only if symptomatic Mobitz type II - pacemaker in all patients
97
Rx 3rd degree heart block
Pacemaker
98
Rx WPW syndrome
Procainamide or quinidine NO digoxin or verapamil
99
Rx VTach
Pulseless - immediate defibrillation followed by epi, vasopressin, amiodarone, or lidocaine Pulse - amiodarone and synchronizde cardioversion
100
Rx VFib
Immediate defibrillation followed by epi, vasopressin, amiodarone, or lidocaine
101
Rx PVCs
Usually not treated; if severe and symptomatic, BBs or amiodarone
102
Major risk factors for CHD?
Age (M 45+, F 55+ or with premature menpause) Family history of premature heart attacks (MI or sudden death in F/first degree M relative <55, mother/first degree F relative <65) Cigarette smoking HTN DM Low HDL (<40)
103
LDL = ?
Total cholesterol - HDL - (TG/5)
104
Macule and patch?
Flat spot (<1 cm and >1 cm)
105
Papule and plaque?
Solid, elevated (<1 cm, >1 cm)
106
Dry, well-circumscribed, silverly, scaling papules and plaques that are NOT pruritic
Psoriasis
107
Rx pityriasis rosea?
Reassurance
108
Causes of erythema multiforme?
Sulfa drugs, penicillins Herpes SJS if severe
109
Squamous cell cancer often develops in areas with pre-existing ___ or burn scars.
Actinic keratoses (hard, sharp, red, often scaly lesions in sun-exposed areas)
110
Best prognostic factor of malignant melanoma?
Thickness of tumor
111
Potential concern of giving beta-blockers to hypoglycemic diabetic patients?
May mask hypoglycemia symptoms (caused by catecholamine release)

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