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REMEDIATION Flashcards

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1
Q

Achilles Rupture

A

CAUSE: FLUOROQUINOLONES, exercise

Presentation: “pop” and painful
Weakness in calf and heel + difficulty walking
Palpable gap + increased resting DORSIFLEXION in prone position

Dx: MRI
US
Ortho Test: THOMPSON TEST → Absent PLANTAR flex

Tx: Keep in plantar flexion + Posterior splint for 4 weeks

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2
Q

Pneumocystis Pneumonia

A

Patho: PMH of HIV
CD4 <200

Presentation: fever, cough, sob
LOW O2 even after tx

Dx: CXR (diffuse interstitial or bilateral perihilar infiltrates
PCR Bronchoalveolar Lavage
Methenamine Silver Stain

Tx: BACTRIM
If allergic: PENTAMIDINE
(if PaO2 → <70 = Prednisone)

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3
Q

Giardia

A

Patho: parasite in poor sanitation/unsafe water
- Loss of intestinal epithelial barrier

Presentation: camper’s diarrhea
Bloody diarrhea
Watery, foul smelling diarrhea

Tx: Metronidazole

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4
Q

Sickle Cell Anemia

A

Sickle Cell Anemia: (dx)
Patho: Autosomal Recessive hemolytic anemia → Defect in Beta Chain
African American = MC

Presentation: anemia, conjunctival pallor, weakness, expressive aphasia, fever

Dx: hemoglobin electrophoresis → Sickled Cells and Hemoglobin S
HbSS = Ds
HbAS = Trait
HbAA = normal
HIGH retic count
-Howell Jolly + Target Cells
Normochromic, normocytic

Tx: Crisis → oxygen, hydration

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5
Q

Von Willebrand Disease

A

Patho: missing protein for platelet function → platelets cannot stick to vessel walls at injury site → bleeding does not stop as quickly
Auto-dominant

Presentation: Decreased vW + Decreased Factor VIII

Dx: VWF antigen/factor will be decreased (possibly Factor VIII)

Tx: DESMOPRESSIN
Excessive → Transfusion of clotting factors

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6
Q

BPPV

A

Patho: Vertigo with positional changes

Presentation: positional vertigo NO HL, Tinnitus, or Ataxia

Dx: Dik-Hallpike

Tx: Epley Maneuver
Meclizine or BENZOS (DIAZEPAM)

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7
Q

Placenta Abruption

A

Patho: Placenta detaches after 35 weeks

Presentation: PAINFUL 3rd trimester bleeding
Pelvic & back pain
(placenta previa is painless)
Can lead to shock, DIC, fetal demise

Dx: Clinical
US determines if it is minor/stable

Tx: Emergency C-sectionDelivery
Blood type + cross + large bore IV

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8
Q

Posterior Shoulder DL

A

Patho:
SEIZURES

Presentation: Arm in INTERNAL rotation + ADDUCTED

Dx: Light-bulb sign on XR (AP or scapular Y)

Tx: Closed reduction + post reduction films

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9
Q

DVT

A

Patho: Atherosclerosis
Stasis + Hypecoag state + Trauma
Cancer, immoble, smoking, OCP, surgery

Presentation: Painful, swollen, red CALF

Dx: + Homan’s Sign
Duplex US
D-Dimer (in low risk)
Venography (GOLD)

Tx: IV Heparin → Warfarin
Recurrent = lifelong

**Women >35 who smoke = at risk → avoid OCPs
Progestin-Only is best

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10
Q

Priapism

A

Patho: MC in 30s, Sickle Cell pts
Trazodone, cocaine, Spider bite, scorpion bite

Presentation: prolonged erection (>4hr)

Dx: Clinical

Tx: PHENYLEPHRINE INJX

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11
Q

Vasovagal Syncope

A

Patho: Lack of O2 to the brain causing a brief LOC with loss of postural tone
- HAS A TRIGGER, warning sign → drop in BP and HR
Presentation: “Patient gives blood and passes out”

Dx: ECC, Pulse Ox, etc
Tilt table test

Tx: Avoidance
If needed → FLUDROCORTISONE ACETATE
SSRI possibly

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12
Q

AAA

A

Patho: blood filled area in the aorta

Presentation: Back + flank pain + pulsatile mass and HYPOTENSION
Dissection → tearing chest pain radiating to the back
Possible palpable pulsatile mass

Dx: US = Initial study of choice
CT (thoracic)
ANGIOGRAPHY = GOLD

Tx: Ascending → Surgery
Descending → Beta Blockers

**Screening → US > 65 + smoker
**Surgery → >5.5
**Monitor >3 1 xyr - >4 2 xyr

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12
Q

Dressler Syndrome

A

Patho: Pericarditis post MI
MI causes inflammation of the pericardium

Presentation: Retrosternal chest pain + “friction rub”

Dx: EKG → ST elevation in V1-V6
CXR → water bottle sign

Tx: NSAIDS

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13
Q

CHF

A

Patho: heart fails to pump correctly

Presentation:
Rt Sided: Lower extremity edema, JVD, Hepatomegaly
Lungs clear to ausc.

Lf Sided: Pulmonary Edema, cough, dyspnea, worse laying down
Lungs fluid filled

Systolic → S3, Reduced EF
Diastolic → S4, Preserved EF

Dx: ECHO
Ejection Fraction
Reduced EF (systolic) → <40%
Preserved EF (diastolic) → >50%

CXR → Kerley B + cardiomegaly

Tx:
Reduced EF (Systolic): BB, Furosemide, ACE
“Lol”, “pril”, Spironolactone
Bisoprolol, Carvedilol, Metoprolol, Entresto (alt of ACE)

Preserved EF (diastolic): Ace + BB/CCB

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14
Q

Corneal Ulcer

A

Patho: sore on eye from infx, injury, dry eyes, CONTACTS

Presentation: white spot on cornea → round ulceration

Dx: Fluorescein stain → Round/Ulcerative

Tx: OPHTHALMOLOGY REFERRAL + Ophthalmic ABX → CIPROFLOXACIN, Ofloxacin, gentamycin, erythromycin, Polymyxin B, tobramycin

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15
Q

Peptic Ulcers (included RUPTURED)

A

Patho: Irritation/wear down of gastric lining
Smoking increases risk
H. Pylori

Presentation: throwing up blood/hematemesis (if ruptured) or Melena
Epigastric pain

Duodenum (anterior) → decreased pain with food
Gastric (lesser curve) → gets worse with food

Dx: “FREE AIR ON XRAY” + Amylase → RUPTURED
Endoscopy
Urea Breath Test

Tx: PPI (Omeprazole) for 4-8 weeks
HPy → CAP
Clarithromycin + Amoxicillin + PPI
Or quad tx (PPI + Bismuth sub + Metro + Tetra)
RUPTURED → IMMEDIATE SURGERY

** STOP NSAIDS

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16
Q

what levels do you check with new onset afib?

A

TSH

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17
Q

Post MI –> what reduces mortality

A

ASA

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18
Q

+ straight leg raise –> tx?

A

NSAIDS

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19
Q

Shoulder ligament (bicep tendonitis pain) –> tx?

A

NSAIDS

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20
Q

Elevated Lipase (>140/160) –>

A

Pancreatitis

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21
Q

What are the components of a tetanus vaccine?

A

Tetani, Pertussis, Diphtheria

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22
Q

Patient bleeding + isolated thrombocytopenia (low platelets)

A

Idiopathic thrombocytopenia purpura

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23
Q

Pt with anemia + increased LDH + schistocytes

A

Autoimmune Hemolytic Anemia

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24
If woman is excessively bleeding what test needs to be ordered?
Pregnancy Test
25
Anechoic US -->
Hydatidiform Mole (molar preg)
26
HTN Emergency tx -->
Nicardipine
27
UVEITIS, URETHRITIS, CONJUNCTIVITIS + joint pain
Reactive Arthritis
28
Lachman's Test
ACL
29
Pt drinks lots of alcohol + vomits, now bleeding -->
Mallory Weiss
30
Initial tx for epiglottitis
Intubate (airway)
31
Pt's O2 is ~ 90% --> 1st step
airway
32
MC cause of Guillain Barre
Campylobacter
33
Hep B
Patho: needles, sex, maternal → inflammation of liver Presentation: jaundice + flu-like symptoms Dx: HepB Surface Antibody (Anti- HBs) = Immunity (post infx or vax) HepB Surface Antigen (sAg) = CURRENT INFX IgM = Acute IgG = Chronic Tx: Supportive
34
Essential Tremor
Patho: Autosomal Dominant Presentation: Bilateral + shaking hand/head during PURPOSEFUL, VOLUNTARY movements (not at rest) Dx: Clinical Tx: IF SYMPTOMS EFFECT ADLs → PROPRANOLOL Or Primidone, Alprazolam, Gabapentin, Topiramate or Nimofipine Alcohol helps stop tremor
35
HPV (Quadrivalent Vaccine)
Patho: Human Papillomavirus Presentation: Causes Warts (Condyloma Acuminatum - genital warts) Leads to cervical cancer Dx: Shave/Punch Biopsy → Koilocytic Squamous Epithelial cells in clumps → Pap Smear Tx: Removal Podophyllin or TCA (trichloroacetic acid) **VAX: Quadrivalent (covers genital and cervical cancer) → aka Gardasil → HPV 6, 11 (genital warts) + 16, 18 (cervical cancer) 9-Valent Vax (Gardasil 9) → 6,11, 16, 18 + 31, 33, 45, 52, and 58 ONLY ONE AVAILABLE IN US 11-12 yr (CAN BE GIVEN AT 9) <15 = 2 doses >15 + IC = 3 doses
36
Worst sign of injury regarding the spinal cord?
Loss of rectal tone
37
Pt comes in with a back injury and cannot pee --> order ? --> concerned for ?
MRI --> Cauda Equina
38
Pt gets diarrhea after every meal
Celiac Ds
39
Kid who is always wheezing
Asthma
40
Definitive test for an asthmatic patient?
Pulmonary Fnx Test
41
Pt swallows a battery, stuck where?
Right Main Bronchus
42
Cause of Orchitis
Not getting MMR vax
43
Manic Symptom
Irritability
44
Mallot Finger
Patho: flexion deformity of the fingertip (DIP JOINT) caused by avulsion/rupture of the extensor tendon Sudden blow to finger tip Presentation: Unable to straightenin DIP Dx: XR → Bony avulsion of DIP Tx: Splint in extension 6-8 weeks
45
What happens if you don't splint mallet finger?
Swan Neck Deformity
46
Finkelstein
DeQuerves Tendosynovitis
47
Tx for Bradycardia
Atropine
48
Distant heart sounds, JVD, Hypotension =
Beck's triad --> Cardiac Tamponade
49
Patient rollover golf cart wreck, pulseless, paresthesia in limbs → Check for ?
Compartment Syndrome
50
LP Glucose <30 = Tx?
Bacterial Meningitis -Ceftriaxone + Vancomycin
51
List 4 MC NSAIDS
Ibuprofen Naproxen Diclofenac Celecoxib
52
Cherry Red Fovea indicates
Central Retinal Artery Occlusion
53
HYPERPIGMENTATION, CONSTIPATION, FATIGUE
Adrenal Insufficiency --> Addisons
54
TX for depression
SSRI
55
Bacterial Pneumonia
Patho: fluid build up in the lung aveloi Strep Pneumonia (rust colored + splenectomy) Staph Aureus (post Flu + salmon colored) Mycoplasma (walking pneumonia) Klebsiella (alcohol + current jelly) Legionella (air conditioning) Pseudomonas (ventilators, CF) Pneumocystis (HIV) Apical → TB Lobar → Community Acquired Presentation: Cough, fever, crackles on auscultation, SOB, Tachycardia/tachypnea + egophony, tactile fremitus, dullness to percussion Dx: CXR Cultures x2 Tx: Azithromycin or Amoxicillin or Doxy (if no morbidities) IF pt has comorbidities (CHF, Disease, DM, Alcohol use, Cancer, Immunosuppression, no spleen) → Levofloxacin or Augmentin ** Empyema = pus in pleural space → complication of pneumonia**
56
Pneumothorax
Patho: Collapsed lung → air in pleural space Spontaneous: tall, thin male Tension: trauma (penetration/blunt) Mediastinal shift to other side Presentation: Sudden SOB, absent lung sounds unilateral, unilateral chest pain (-) tactile fremitus, deviated trachea, hyperresonance Dx: Stable → CXR Unstable → US Tx: <15% → spontaneous resolve + O2 if symptomatic >15% CHEST TUBE TENSION → MEDICAL EMERGENCY LARGE BORE NEEDLE IN CHEST + CHEST TUBE`
57
Cardiac Tamponade
Patho: Fluid build up around the heart Decreased CO, perfusion MI, trauma, AD, Pericardial effusion, cancer, etc. Presentation: Beck’s Triad → DISTANT HEART SOUNDS, JVD, HYPOTENSION Dx: Clinical Dx ECHO = Gold (diastolic collapse of rt ventricle) PULSUS PARADOXUS (narrow pulse pressure) EKG →ELECTRICAL ALTERNANS + low volt QRS CXR → water bottle sign Tx: IV fluids + Pericardiocentesis Decompression → Balloon Pericardiotomy and pericardial windows
58
Compartment Syndrome
Patho: Pressure build up within the compartments MC in Tibia TRAUMA, snake bite Presentation: PAIN, PARALYSIS, PARESTHESIA, PALLOR, PULSENESS, Poikilothermia (can’t regulate temp) Dx: Measure pressure of compartment >30-45 (normal = 0-8) Delta Pressure = DBP - compartment pressure Increase CK + myoglobin (muscle breakdown) Tx: Emergency Faciotomy >30mm
59
Bacterial Meningitis
Patho: Inflammation of the meninges due to bacteria MC = Strep Pneumonia, Listeria Monocytogenes or N. Meningitidis (if pt has rash) Presentation: FEVER + nuchal rigidity + HA Photophobia ** ENCEPHALITIS = AMS + Petechiae) Dx: LP GLUCOSE <30 Increased Protein + increased OP *** (Bacteria love to eat the glucose) *** + Kernig → knee extension = neck pain + Brudzinski → bend neck and leg raises Tx: CEFTRIAXONE & VANCOMYCIN >50: VANC + ROCEPHIN + AMPICILLIN Household → Rifampin or Ciprofloxacin or Rocephin Vax: Meningococcal Vax at 11-12 yrs + booster at 16 yo ** Viral → enterovirus or coxsackie → normal pressure and increased lymphocytes) ** Guillain Barre → Increased protein + normal glucose
60
Cauda Equina
Patho: inflammation of the nerves at the end of the spinal cord Ruptured disk in the lumbar spine Presentation: “saddle anesthesia” + Urinary retention + fecal continuous + decrease/loss of sensation of lower extremities Dx: MRI Tx: Surgery → Lumbar Laminectomy + admission after
61
Celiac Disease
Patho: Gluten Intolerance → inflammation of small bowel secondary to gluten Autoimmune Wheat, Rye, Barley = malabsorption Presentation: Diarrhea, steatorrhea, gas, wt loss Dx: IgA endomysial antibody (EMA) and Anti-Transglutaminase (anti-tTG) antibodies IF (+) → Upper Endoscopy with Small Bowel Biopsy Tx: Avoid Gluten + iron, B12, folate, calcium, Vit D supplements if needed
62
Pericarditis
Patho: Inflammation of the pericardium Presentation: Friction rub, Pleuritic chest pain worse lying down, better sitting up and leaning forward Dx: CXR EKG → Diffuse ST elevation Tx: NSAIDS
63
Intracranial hemorrhages
Patho: brain bleed → blood vessels rupture and causes a hematoma within the brain Extra-axial: outside brain tissue -Epidural Hematoma Transient LOC then lucid Middle Men Lens shaped “E-E” -Subdural Hematoma Elderly falls Crescent moon -SAH Worst HA oml Intra-axial: inside brain tissue - Intracerebral hemorrhage HTN !!! - Stroke like symptoms Intraventricular hemorrhage Presentation: headache possible nuchal rigidity or loc Dx: CT head if normal LP Tx: Surgery
64
Central Rental Arterial Occlusion
Patho: Occluded flow through the CRA from embolism Presentation: Sudde, PAINLESS, unilateral severe vision loss + CHERRY RED FOVEA Dx: Fundoscopic exam Tx: Emergent Ophthalmic Consult Reduces IOP (Timolol or Acetazolamide) Digital massage
65
Acute otitis media + pneumonia symptoms tx?
Amoxicillin??
66
DKA
Patho: increased acidity in blood Elevated blood sugar and MC in DM1 5 I’s: infx, intoxication, infarction, illness, inap. Withdrawal of insulin Presentation: N/V, Polydipsia, Polyuria, Wt. Loss + fruity breath Kussmaul Breathing Dx: Glucose >250, PH <7.3, + ketones in the bloodstream/urine → BICARB <18 (bicarb is basic and DKA is acidic) Tx: Fluids, Insulin
67
Orchitis: (MCC?)
Patho: inflammation of testes due to bacteria from urinary tract DIDN’T GET MMR VAX = MCC Commonly present with epididymitis Presentation: unilateral scrotal swelling, painful, tender swelling Dx: UA with cultures → polyuria and bacteriuria Tx: <35: Ceftriaxone + Doxy >35: Levofloxacin
68
Ramsey Hunt
Patho: Chickenpox or Shingles Ramsey Hunt = shingles of facial nerve → facial palsy auditory symptoms Presentation: ULCERATION OF EAR → ZOSTER OTICUS Dx: Clinical or Tzanck SMear and multinucleated giant cells Tx: Oral Acyclovir and Steroids
69
Adrenal Insufficiency
Patho: Decreased Cortisol and Aldosterone, increased ACTH Addison’s = AI disease Secondary = Steroid use Presentation: HYPERPIGMENTATION, CONSTIPATION, FATIGUE HYPERkalemia and Hyponatremia Dx: 8am cortisol + ACTH Low Na = Aldosterone causes sodium reabsorption and potassium excretion = low aldosterone = low NA and high K) Low glucose (bc cortisol stimulates gluconeogenesis) CRH Stim. Test Tx: Hydrocortisone + Fludrocortisone
70
Depression
Patho: Decrease in Serotonin, Dopamine, and Norepinephrine Presentation: sad, feeling down, worthless for > 2 weeks “SIGECAPS” Dx: Criteria Tx: SSRI → increase dose every 3-4 weeks until symptoms are gone SSRI's: Citalopram (Celexa) Escitalopram (Lexapro) Fluoxetine (Prozac) Paroxetine (Paxil, Pexeva) Sertraline (Zoloft)
71
Bipolar 1
Presentation: MANIC EPISODES +/- depressive episodes Dx: Criteria Tx: Lithium (1st line), Valproate, SGAS (olanzapine, aripiprazole), carbamazepine Maintence- SGAs, Gabapentin, Lamotrigine
72
Psychosis Tx
Haloperidol, Risperidone, or Benzos
73
Atrial Fibrillation
Presentation: palpations, syncope, dyspnea Dx: EKG No p wave Irregularly Irregular Tx: Diltiazem, Verapamil or Metoprolol If <48 = cardiovert, amiodarone >48 = anticoag for 21 days prior to cardiovert Unstable Pt = synchronized cardiovert *what levels do you check with new onset afib? → TSH*
74
Atypical Pneumonia tx
Low risk → Amoxi or Azithro or Doxy High risk → Augmentin or Levofloxacin
75
Myasthenia Gravis
Patho: Decreased ACH → muscle weakness, Autoimmune, Presentation: drooping eye (ptosis), worsening weakness throughout the day, fatigue, weak chewing Dx: PLASMAPHERESIS AchR antibodies, Muscle-specific serum kinase, LRP4 antibody Single fiber electromyography Tx: Acetylcholinesterase Inhibitor Pyridostigmine/neostigmine (Stops ACH breakdown) Prednisone Thymectomy <60 = curative
76
Unstable Bradycardia
Transcutaneous Pacing
77
Colles Fracture
Patho: distal radial fracture Dinner Fork → posterior angulation Presentation: FOOSH Dx: XR → “Dorsally (upward) angulated” Tx: Volar Splint or Sugar Tong at 15-30 degree extension ** Median Nerve can be injuried → index finger tingles **
78
Pancreatitis
Patho: Inflammation of the pancreas → gallstones, trauma, alcohol, etc. Presentation: epigastric pain radiates to back + bruising of flank + umbilical bruising Dx: CT ab + Lipase Xr → Sentinel Loops + Diminished bowel sounds Tx: Acute → Supportive = IV Fluids, Pain control Antibiotics, ERCP (if gallstones) Pancreatic Pseudocyst (collection of fluid rich in pancreatic enzymes, blood, necrotic tissue) ****IF LIPASE IS MENTION → Pancreatitis**
79
MC Murmur with Endocarditis
Aortic Regurgitation
80
MC organism from IVDU
Staph Aureus
81
MC pt with endocarditis
IVDU
82
If a person hates public speaking they have
Social Phobia
83
TX for endocarditis: - IVDU? - Non-IVDU? - Prosthetic Valve?
- IVDU --> IV Nafcillin - Non-IVDU --> IV ampicillin + nafcillin + gentamicin - Pros.--> IV vancomycin + gentamicin + rifampin
84
SJS
Patho: Sulfa/Anticonvulsants → Epidermal Necrosis Presentation: “SLOUGHING OF THE SKIN” (+ Nikolsky) <10% Dx: Skin Biopsy Serum Granulysin Tx: Fluids + IVIG + Burn Unit
85
PEMPHIGUS VULGARIS
Patho: Autoimmune Blistering ds → PAINFUL mucocutaneous lesions Mediterranean/Jew Presentation: Pain blisters/ulcer all over skin Mouth, back, chest, cheeks, scalp Dx: + NIKOLSKY Immunofluorescence of serum Biopsy → Acantholysis IgG against DESMOSOMES → separates epidermis Tx: ORAL PREDNISONE + Immunosuppressive agent, Azathioprine, Methotrexate Refractory → Dapsone, Gold, Cyclophosphamide
86
ITP
Patho: decrease platelets Autoimmune → Splenic platelet destruction AFTER INFECTION Presentation: Bleeding with low platelets Petechia, Purpura, Mucosal Bleeding, easy bruising Dx: CBC → platelets < 100,000 Tx: >30,000 = observe <30,000 = Steroids IVIG if can’t take steroids Refractory = Splenectomy
87
Autoimmune Hemolytic Anemia
Patho: AI → Following Viral infx Presentation: Bruising + Petechiae on lower extremities Dx: Schistocytes (+ COOMBS TEST) Elevated LDH Elevated Indirect Hemoglobin Tx: STEROIDS Kids = No tx Adult = IVIG Splenectomy
88
HTN Urgency vs Emergency
Patho: >180/120 Urgency = no end organ damage Emergency = end organ damage Presentation: HA, BLURRED VISION EOD = Papilledema, retinal hemorrhages, ACI, encephalopathy, pulmonary edema, angina, hemorrhage Tx: Urgency → DO NOT TX IMMEDIATELY Clonidine Emergency → Must reduced within 1 hour NITROPRUSSIDE + ICU (or Nicardipine) 10-20% to prevent EOD Target 1st hr → <180/120 Next 23 hrs → <160/110
89
Glaucoma
Patho: Impaired aqueous flow Presentation: PERIPHERAL VISION LOSS + cloudy cornea + red conjunctiva + fixed dilated pupil Acute angle closure = SUDDEN pain + halos Open angle = HTN/DM Dx: Tonometry → Increased IOP Cupping of optic nerve Gonioscopy = Gold standard Tx: Acute Narrow-Angle Closure Glaucoma → IV Acetazolamide BB → TIMOLOL Chronic Open-Angle → Prostaglandin analogs (Latanoprost = increased outflow of humor) BB ** All Pts screened at 40 yo **
90
Aortic Stenosis
Patho: narrowing of aortic valve = reduces blood flow = makes heart work harder Rheumatic Fever Presentation: syncope, angina, dyspnea, “CRESCENDO-DECRESCENDO” RADIATES TO CAROTIDS Radiates to neck + apex Better leaning forward Worse - valsalva + standing Split S2 Dx: ECHO EKG → LVH CXR → Cardiomegaly, calcified valve, prom ascending aorta BNP > 550 Helmet Cells (fragment RBC from AS) Tx: surgery
91
Reactive Arthritis
Patho: Reiters Syndrome → AI response from chlamydia/gonorrhea or GI infx Presentation: UVEITIS, URETHRITIS, CONJUNCTIVITIS Arthritis 2 or more joints Dx: Clinical → joint pain + infx HLA-B27 Synovial fluid = aseptic Tx: NSAIDS +/- ABX
92
ACL
Patho: rotational injury Quick plant and twist Presentation: “pop” + swelling + knee giving out Dx: LACHMAN, Anterior Drawer, Lateral Pivot-Shift MRI Tx: Can do PT or Lifestyle in some patients Surgery
93
Mallory Weiss
Patho: throwing up → tear in esophagus at the gastroesophageal junction→ bleeding Hx of alcohol Presentation: PT DRINKS LOTS OF ALCOHOL → VOMITS Dx: Upper Endoscopy Tx: Self-Limiting 1st Line → UPPER GI ENDOSCOPY (both dx and tx) Clipping (with adrenaline) High Dose PPI (don’t give before endoscopy) 2nd line → Surgical Repair
94
Epiglottis
Patho: H.influenza → inflammation of the Glottis Emergency Presentation: drooling, tripod position, respiratory distress, fever Dx: Lateral Neck XR → Thumbprint Elevated Lymphocytes Definitive Dx → Laryngoscopy Cherry Red epiglottis Tx: Airway + IV Ceftriaxone or Vancomycin Immunization!!
95
Guillain Barre
Patho: COMMON AFTER CAMPYLOBACTER or immunization Presentation: ascending paralysis that spreads upward after a recent infx Dx: LP = elevated protein, normal WBC Tx: Plasma exchange IVIG
96
Cluster HA
Patho: Alcohol can trigger Presentation: UNILATERAL, SHARP< excruciating pain Teary eyed, worse at night, repeat occurrences Started in the eye Awakes them from sleep Dx: Clinical → Periorbital/Temporal pain Tx: 100% OXYGEN + Sumatriptan “Triptans” → relief Verapamil = prophylaxis Lithium(2nd)
97
Hyphema
Patho: trauma → blunt/penetrating trauma → baseball, assault → tears the vessel of the ciliary body or iris Presentation: Blood in anterior chamber of eye Dx: Clinical Dx CT if suspicious of globe fx Ophthalmologist eval Tx: RAISE HEAD OF BED + Eyeshield Optho eval ** NO NSAIDS = Worsens **
98
Papilledema
Patho: swelling of optic disc due to increased intracranial pressure Malignant hypertension, thrombosis Presentation: LOSS OF OPTIC DISC Dx: LOOK for cause MRI/CT → tumor, bleed, cerebral edema, CSF outflow obstruction LP → Increased opening pressure Tx: Treat underlying cause
99
Allergic Rhinitis
Patho: inflammation and swelling of mucous of nose Immunoglobulin E (IgE) mediated reactivity Presentation: NASAL CREASE, BAGS UNDER THE EYES Dx: History → skin tests or IgE can be done Tx: H2 Blockers → Famotidine, Cimetidine, “dine” Do not use nasal decongestants > 5 days → rebound ** Rhinitis Medicamentosa
100
Testicular Torsion
Patho: Twist of the spermatic cord Presentation: Severe lower abd. Pain that radiates to the thigh + vomiting Hx of cryptorchidism Elevated tested Dx: testicular doppler US (-) Prehn Sign Loss of cremaster reflex Blue Dot Sign Tx: CALL UROLOGY → Orchiopexy → “Open-Book” technique to de-torse
101
Prostatitis
Patho: E.COLI >35 <35 = Chlamydia/Gonarrhea Inflammation of prostate Presentation: Fever, chills, urinary symptoms Perineal/Low back pain Warm, tender, enlarged prostate Dx: (+) prehn sign UA → Increased WBC Cultures, US/CT, Blood Tests Tx: <35: Ceftriaxone + Doxycycline >35 → Bactrim or Azithromycin 4-6 weeks
102
Thyroid Storm
Patho: Acute hyperthyroidism from untreated/inadequate treatment of hyperthyroidism Graves Disease or Toxic Multinodular Goiter → infx, trauma, surgery, DKA, preeclampsia Presentation: Fever, weakness, restlessness, confusion, psychosis, coma, nausea, vomiting, diarrhea, hepatomegaly, jaundice Dx: Increased T3/T4, Decreased TSH Tx: PROPYLTHIOURACIL
103
Diabetes Insipidus
Patho: Decreased ADH Central = Not being made Nephrogenic = Kidneys not responding (Lithium) Presentation: POLYURIA, POLYDIPSIA Dx: Water Deprivation Test SERUM OSMOL: HIGH URINE OSMOL: LOW Desmopression Stim Test → Central = will decreased urine output Nephrogenic = will not change Tx: Central = Desmopressin Nephrogenic = Na/Protein restriction Hydrochlorothiazide, Indomethacin

ER ROTATION (4 decks)

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