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Flashcards in Review with Michelle Deck (238):
1

short term effects of lithium

LMN (loose stool, memory loss and nausea)

2

the most common cause of acute kidney failure?

dehydration

3

seizure med known for causing gingival hyperplasia?

Phenytoin (dilantin)

4

antibiotic most likely to cause c.dif?

Clindamycin

5

bug that causes whooping cough

bordatella

6

bilateral peripheral vestibular dysfunction

oscillopsia (blurring with head movement

7

two meds used to treat HTN with preclampsia

labetalol and methyldopa

8

uterine procidentia

uterus descends beyond vulva

9

Ethambutol an HIV drug can cause?

vision loss

10

stroke + fever =

endocarditis

11

how does the K+ level change in chronic renal failure?

increased serum potassium

12

cardiac nuclear scan looks for?

vessel patency

13

Romberg tests

proprioception of the posterior/dorsal column of the spinal cord

14

if patient is ataxic but romberg is negative what part of the brain is likely affected?

Cerebellum=soberity and balance

15

patient's taking valproate (depakote) must have what labs drawn?

Liver enzymes

16

spontaneous pneumo is caused by

sub pleural apical bleb due to high negative pressure

17

test of choice for DVT

doppler and human's sign..... it will be swollen

18

test of choice for arterial claudiation

arterial duplex scan

19

you say mesthelioma, I say.....

asbestos

20

Kleb pneumonia = what type of antibiotic

IV-cefoxamine

21

prognosis of lung CA with liver mets

horrible ----no resection

22

dull aching, heaviness, in LE brought on by standing

Venous thrombosis

23

pain in calf with ambulation

Claudication - Arterial

24

OSA can cause what heart problem

right sided heart failure

25

S1 references what heart valve?

mitral

26

bones, stones, and groins =

hypercalcemia

27

vitamin deficiency = smooth red tongue

B12 (also think neuropathy of hands and feet)

28

hemarthrosis means?

bleeding into joint space

29

glucose 6 phosphate deficiency

x linked genetic deficiency

30

primaquine is a anti malaria drug, it may trigger

hemolysis

31

Philly chromosome

CML ( philly sandwich: Cheese, Meat, or Long bread)

32

Hyperthyroid med

propylthiouracil (PTU)

33

most common cause of hyperthyroidism

graves

34

gentamicin is toxic to....

fetus and ears

35

brown recluse bite description

ring of pallor/bleb in middle

36

erythema nodosum

unknown cause, may be post viral.. located on shins, red spots/inflammation. linked to HLA-B27. may also appear with sarcoidosis.

37

McMurray tests what in the knee?

positive McMurray = torn medial/lateral meniscus

38

bladder infection but allergic to sulfa, best alternative antibiotic?

Ampicillin

39

define pulse pressure

difference between systolic and diastolic BP

40

RA-hand deformities

swan neck, button hook, boutonniere and ulnar deviation

41

uterine leiomyomas

common, benign, represent localized proliferation of smooth muscle cells surrounded by compressed muscle fibers

42

During inhalation _______valve abnormalities are heard?

Right side-tricuspid

43

During exhalation________valve abnormalities are heard?

Left sided- mitral valve

44

double bubble sign---GI imagining

Pylori stenosis

45

Seidel's sign / Waterfall

Flurosein pouring out of ruptured globe

46

Cloudy cornea, mid-fixed pupil and firm

acute angle glaucoma

47

abnormal swing flashlight test

marcus-gunn

48

bloody diarrhea, occurs at night, and exacerbated at night

UC

49

how many fasting glucose tests to dx DM

2

50

Rheumatic fever causes what heart condition

mitral stenosis

51

type of murmur heard with cardiac rheumatic fever, mitral stenosis?

apical diastolic murmur

52

mono virus causes lymphadenopathy of what lymph chain

posterior chain

53

lab test to evaluate and dx hemochromatosis?

Ferritin and iron studies

54

I say Bence Jones, you say?

MM

55

Patient has known Aortic stenosis, can you do a treadmill stress echo?

No, do a drug stress echo

56

lung findings-Asbestosis

dyspnea, interstitial fibrosis of lower lobes, thickened pleura plaques

57

Asbestosis is a restrictive or congestive lung disease?

Restrictive

58

exposure to silica = lung findings

small rounded opacities throughout the lungs and calcified hilar lymph nodes

59

how do you dx nephrotic type of proteinuria

24 hour urine catch

60

I say polymyagia rheumatic, you say

giant cell arteritis

61

100% of dermatitis herpetiform have....

celiac dz

62

tx for chronic psoriasis

light treatment

63

dermatitis herpetiform is

papules on the extensor surface of elbow and knees

64

malignant otitis media

cellulitis with DM or other immunocompromised illnesses

65

most common genital tract malignancy in US

Endometrial carcinoma

66

most common cancer in the world

breast cancer

67

4 things to know w/ molar pregnancy

1. painless bleeding 2. uterine size and date discrepancy 3. passage of tissue 4. exaggerated AM sickness

68

molimina

mild form of PMS-3 or 4 symptoms = fluid retention, fluctuation of mood, headache and food craving

69

why not use antihistamines for sinus infection?

impairs drainage

70

what CN may be effected with septic cavernous sinus thrombophlebitis?

3 (oculomotor), 4(trochlear), and 6(abducens)

71

how do you dx purulent otitis media?

needle aspiration

72

quinsy throat aka....

peritonsillar abscess. complication of of strep A

73

antibiotics for peritonsillar abscess

pen G with clindamycin or metronidazole

74

antibiotic for pneumonia bug h.flu and m.cat

levofloxacin

75

antibiotic for s.pneumo

erythromycin

76

antibiotic for m.pneuno

doxycycine

77

neuroleptic malignant syndrome (NMS)

abrupt withdrawal of antiparkinson drugs, many dopamine receptors go unfilled = muscular rigidity

78

psych med that reduces seizure threshold?

wellbutrin

79

uncommon psych disorder in which agitation progresses to muscle rigidity and hyperthermia

lethal catatonia

80

cat scratch fever

bartonella henslae, playing with cats

81

trench fever

bartonella quintana, human lice

82

carrion's disease

bartonella bacilliformes , sand fly bites

83

symptoms of cat scratch fever

fever, lymph node enlargement, papule or pustule at inoculation site

84

beta lactam work by

inhibit transpeptidation of the cell wall

85

Macrolide (azithromycin) works by

50S ribosomal subunit

86

Sulfa drugs work by...

inhibit dihydropterate and folate reproduction

87

Tetracycline works by....

binds 30S ribosomal subunits

88

Quinolones work by....

inhibit DNA replication

89

"B" symptoms refer to what disease?

non-hodgkin lymphoma

90

Amiodarone side effect?

hypothyroidism

91

Tendons involved in DeQuervian's tenosynovitis?

Extensor Pollcis brevis and abductor pollis tendon

92

Test performed to confirm DeQuerivian's

Finkelstein

93

Test performed to confirm ruptured achilles tendon

Thompson, place pt is prone position legs off of table, squeeze calf and watch for planter flexion

94


Ligament involved in Game keepers thumb

ulnar collateral ligament

95

homen's sign

make sure patient's knee is flexed and then dorsiflex foot forcefully

96

1st line treatment for Abnormal uterine bleeding in a 40 year old?

Levonorgestrol IUD

97

Best imaging to dx a PE?

CT

98

What murmur can be heard best when pt is placed in left lateral decubitus position

mitral stenosis

99

isometric handgrip increases arterial & left ventricular pressure, this increases what type of murmur?

Aortic regurgitation

100

most common drug to cause pill induced esophagitis?

Ibuprofen

101

skin tags are associated with what syndrome?

metabolic syndrome

102

Lyme dz symptoms

fever, vomiting, meningeal sign, and photophobia

103

treatment for clostridium tetani?

Tetanus immuneglobin, tetanus toxoid, and metronidazole

104

Breathing pattern associated with DKA

Kussmaul

105

First line treatment for giant cell arteritis is high dose steroids, how many mg of prednisone? And what is the dx modality?

60mg, dx with biopsy

106

meconium ileus

cystic fibrous

107

when does pylori stenosis most often occur?

3 to 6 months old

108

most common cause of non traumatic subarachnoid hemorrhage

cerebral aneurysm

109

how long should a non-complicated shoulder dislocation be in a sling?

2 to 4 weeks

110

fall onto outstretched abducted arm =

shoulder dislocation, majority are anterior

111

Cullen's sign

sign of retroperitoneal hemorrhage such as periumbicilical (Cullen's sign)

112

Grey-Turner's sign

flank ecchymosis, a sign of retroperitoneal hemorrhage

113

AAA larger than ____cm are at higher risk of rupturing

5cm

114

How is a AAA diagnosed?

US is unstable or CT is the gold standard if patient is stable.

115

Risk factors AAA?

Hypertension, congenital heart disease, pregnancy, Marfans or iatrogenic from cardiac cath

116

how dissections occur

Intima is damaged allowing blood to enter the media and dissect between the initial and adventitial layers, developing a false lumen.

117

Common sites of AAA?

ascending aorta and the region of the ligamentum arteriosum

118

Gold standard to dx AAA?

Angiography

119

ER care of AAA-control hypertension with...

B-Blockers

120

where are most of DVTs located?

80% are located in or proximal to the popliteal vein.

121

negative ELISA D-dimer tell you that....

97% sure there is no clot

122

Treatment for DVT?

low molecular weight heparins (LMWH)

123

Common low molecular weight heparins?

dalteparin, enoxaparin, and tinzaparin

124

what is phlegmasia cerulean dolens

is an uncommon severe form of dvt which results from extensive thrombotic occlusion of the major and the collateral veins of an extremity. It is characterized by sudden severe pain, swelling, cyanosis and edema of the affected limb.

125

common location for acute arterial occlusion?

femoropopliteal, tibial, aortoiliac, and brachiocephalic

126

treat acute arterial occlusion with?

unfractionated heparin, catheter embolectomy using Fogarty ballon. All patient's should be admitted and placed on telemetry.

127

dilated myopathy causes what type of heart failure?

Systolic, due to dilatation of the ventricle

128

Aortic regurgitation causes what type of heart failure?

Systolic

129

Beriberi, anemia, thyrotoxicosis, and pheochromocytoma all cause what type of heart failure?

High output failure --high metabolic output

130

Where is BUN produced? When is it increased?

Produced in the liver as a byproduct of protein metabolism and secreted by kidneys. Increased in dehydration, GI bleeding, and if renal excretion of urea is decreased (renal failure)

131

BNP stands for? Level that suggests cardiac cause of dyspnea?

Brain natriuretic peptide >200 =coronary cause of dyspnea

132

BNP <100 and dyspnea = what type of etiology?

pulmonary

133

patient is 65 years old, anemic, has bone pain, proteinuria and renal failure, this is.....

Multiple myeloma

134

cushing's syndrome is a disorder of ?

cortisol

135

true or false cushing's syndrome can cause osteopenia?

true

136

needle shaped crystals?

gout

137

Aspiration of joint shows >50,000 cell count?

septic joint

138

you think a patient has a lower leg DVT, how is this dx?

LE Doppler US

139

what is more specific and sensitive a myocardial perfusion scan (MPI) or an exercise stress test?

myocardial perfusion scan, is a nuclear medicine procedure that illustrates the function of the heart muscle

140

Glucose level, CSF mononuclear, and total protein level in Viral meningitis will be increased or decreased?

Viral meningitis: Increase in mononuclear cells and total protein. Glucose may be normal

141

Is C-reactive protein elevated in viral or bacterial meningitis?

Bacterial, glucose will be low

142

patient is female with a hx of iritis and erythema nodosum, fever, malaise, and dyspnea. Think?

Sarcoidosis

143

Iritis is a hint for?

autoimmune disorders

144

most common congenital viral infection in US?

CMV

145

babies infected with CMV prior to birth will have:

hearing loss, visual impairment, mental retardation and enlargement of liver / spleen.

146

What is sarcoidosis

idiopathic disease, noncaseating granulomatous inflammation in affected organs. 90% have lung involvement.

147

Physiological changes during severe hypothermia

fixed pupils, ventricular fibrillation

148

palmar cord causing palmar flexion of 4th and 5th fingers

Dupuytren's

149

Red reflex tests?

corneal clarity and retinal mass

150

test done for strabismus?

corneal light reflex and uncover/cover test

151

Corneal light reflex is used on PE to evaluate?

Strabismus

152

Patient has AIDS and interstitial infiltrates, what is the most common opportunistic infection in HIV?

Pneumocystis jiroveci (PCP pneumonia)

153

what can be used as prophylaxis for pneumocystis jiroveci in HIV patient when CD4 count is below 200?

Bactrim

154

Patient presents complaining of 12 plus weeks of laryngitis and a slight cough. She has a h/o mitral regurg. Indirect laryngoscopy performed in the office reveals vocal cords that do not move with phonation. what is the next step in her evaluation?

If the vocal cords do not move it is no longer an ENT problem, but a chest or left recurrent laryngeal nerve problem. It is possible that mitral regurg has caused increase of her marked enlargement of her atrium, putting tension on the nerve

155

What is the most common anomaly associated with coarctation?

Bicuspid aortic valve (congenital)

156

reduced HCO3 bicarbonate concentration on the ABG may be due to....

anytime there is a significant change in the HC03 you are looking at a metabolic problem. Loss of bicarb means a loss of a base, and would therefore cause a metabolic acidosis.

157

do changes in CO2 affect the metabolic or respiratory side of the equation?

respiratory

158

highest populations affected by sarcoidosis

north american blacks and northern europeans

159

Organs affected in sarcoidosis?

Lungs, lymph nodes, eyes, skin, liver, spleen, parotid glands, heart and nervous system

160

Symptoms of sarcoidosis?

fever, cough, chest discomfort, erythema nodosum, malasie

161

How do you dx sarcoidosis?

Transbronchial biopsy of the lung or fine needle node biopsy. It will show noncaseating granulomas

162

treatment for sarcoidosis?

steroids

163

What labs are elevated in sarcoidosis?

Eosinophilia, erythrocyte sedimentation rate, angiotensin-converting enzyme.

164

Frost bite 1st degree

freeze no blister

165

Frost bite 2nd degree

freeze + blister

166

3rd stage frost bite

freeze = dead skin

167

4th stage frost bite

full thickness including bone

168

treatment for high altitude sickness

descent, oxygen, dexamethasome, acetazolamide

169

antidote for acetaminophen

acetylcysteine

170

antidote for organophosphate

atropine

171

antidote for benzos

flumazenil

172

antidote for b-blockers

glucagon

173

antidote for CCB

calcium

174

Antidote for digoxin

digibind

175

antidote for heparin

protamine

176

antidote for narcotics

naloxone (narcan)

177

antidote for tricyclic antidepressants?

sodium bicaronate

178

antidote for warfarin?

vitamin K

179

what electrolyte abnormality causes paralytic ileus

hypokalemia

180

sudden painless complete vision loss eye with cherry red fovea. treatment?

this is central retinal artery occlusion
tx with ocular massage and acetazolamide ( same drug used for altitude sickness

181

what electrolyte abnormality goes with DKA

hyperkalemia and low bicarb

182

Type II DM, with infection, weakness, polydipsia, glucose >600 most likely has?

hyperosmolar hyperglycemic state

183

Hypoglycemia is BG <50, what is the treatment

IV glucose or IM glucagon, thiamine to alcoholics

184

Thyroid storm treatment

volume replacement. b-bloker, PTU, methimazole and steroids

185

EKG changes that occur with thyroid storm?

tachycardia, a fib or flutter and prolonged QRS

186

absent cremasteric reflex =

testicular torsion (this is a surgical fix)

187

what cardiac med is responsible for angioedema

ACE

188

do steroids help with steven johnson syndrome?

no, just stop the offending agent

189

treatment for staph scalded skin syndrome

tx nafacillin or oxacillin

190

pemphigus vulgaris

loss of cohesion between keratinocytes in the epidermis, classified as a type II hypersensitivity reaction (in which antibodies bind to antigens on the body's own tissues). It is characterized by extensive flaccid blisters and mucocutaneous erosions. Tx is fluids and steroids

191

#1 cause of hypercalcemia?

primary hyperparathyroidism

192

#2 cause of hypercalcemia?

malignancies

193

cardiac symptoms of hypercalcemia

short QT, bradycardia, hypertension

194

band keratopathy in the eye are associated with what electrolyte abnormality?

hypercalcemia

195

a patient with vomiting, lower chest pain and subcutaneous emphysema most likely has?

Esophageal rupture (boerhaaves syndrome)

196

tx for esophageal rupture?

NPO, IV antibiotics and surgery

197

What drug do you give for any pulseless rhythm?

Epi 1mg

198

what drug do you give for SVT?

Adenosine 6-6-12mg

199

What drug do you give for bradycardia?

Atropine 0.5-1mg

200

what node does atropine excite?

AV node

201

Patient presents with torsades de points

give Mg 1-2grams

202

For VF and pulseless VT give?

vasopressin

203

Hypertensive emergency give?

IV labetalol and IV Nitroprusside

204

What type of aortic dissection is fixed surgically?

Type A (ascending aorta)

205

most likely cause of metabolic alkalosis

vomiting-volume depletion

206

what is the pH and bicarb level in metabolic alkalosis

pH is >7.45 and bicarb is >26

207

Treatment for metabolic alkalosis?

acetazolamide ( this is also given for altitude sickness and central retinal artery occlusion

208

Name two conditions that cause Carpopedal spasm (painful contractions with adduction of the thumb, flexion of MCP joint, extension of the IP joints and flexion of the wrist)

Hypocalcemia and Respiratory acidosis

209

what are level of Ca+ that are considered hypo and hyper?

hypo <11

210

most common cause of hypocalcemia?

Chronic kidney disease, others include: hypoalbuminemia, hypoparathyroidism, vitamin d deficiency and low Mg

211

Signs and symptoms of hypocalcemia?

Tetany, tingling paresthesias and carpopedal spasm

212

A patient with MM is found to have hypercalcemia, what is the first line treatment?

Glucocorticoid steroids

213

Name 3 treatments for hypercalcemia

1. Hydration to diruesis 2. IV biphosphonates to inhibit osteoclasts 3. Calcitonin

214

asthmatic attack will show what on ABGs?

respiratory acidosis

215

how does BiPAP help asthmatics

lowers the CO2 level

216

treatment for hypocalcemia

calcium chord of calcium gluconate

217

chvostek's sign, what electrolyte imbalance is it testing?

tap the cheek causes contraction, hypocalcemia

218

Trousseau's sign

hypocalcemia, use BP cuff to induce carpel spasm

219

EKG findings with hypocalcemia?

QT is prolonged (quite tense and longing for ca+)

220

Respiratory acidosis pH level and CO2 level

pH 45

221

guillian barre and myasthenia gravis will have what type of acid/base disorder?

respiratory acidosis

222

pH >7.45 and pCO2 <35

respiratory alkalosis

223

A patient presents with symptoms of pituitary tumor, what is the next step in evaluating whether or not this tumor is causing bitemporal hemianopsia?

since the question is asking about vision the next step is to formally evaluate peripheral field testing. Adenomas that affect the optic chiasm may cause irreversible vision changes.

224

Peripheral blood cell count in AIDS are best characterized as?

Decreased helper T cells and Lymphopenia

225

name the splint for the scaphoid fracture

thumb spica splint, refer to ortho

226

kiddo swallows battery- next step?

esophagogastroduodenoscopy b/c battery can cause a caustic erosion of the esophagus

227

Explain S4?

S4 is the sound of blood ejected during atrial contraction and striking the stiff ventricular wall of hypertrophy or stunned myocardium

228

If S4 is the sound of blood hitting the stiff enlarged ventricle or stunned myocardium. What heart conditions will you hear S4

Left or right Ventricle hypertrophy (heart failure), post MI, and cor pulmonale

229

If thyroid gland and parathyroid is removed, why may a patient have a positive chvostek sign?

Likely to have hypocalcemia, b/c parathyroid is responsible for calcium regulation

230

what does the Glasgow coma scale measure

Best eye movement, verbal response, and motor response

231

One category of the GCS is eye response, name the 4 levels of eye movement

1pt. no eye opening
2pt. eyes open to pain
3pt. eyes open to verbal response
4pt. eyes open spontaneously

232

Name the 5 levels of motor response according to the GCS

1pt. no response
2pt. extension to pain
3pt. flexion to pain
4pt. withdrawal to pain
5pt. localizes to pain
6pt. obeys commend

233

Name the 5 levels of verbal response according to the GCS

1pt no verbal
2pt incomprehensible sounds
3pt inappropriate sound
4pt confused
5pt orientated

234

What class of drug is Verapamil

CCB

235

what are CCB avoided in CHF

significant negative inotropic effect and reduces the EF and CO

236

What CCB is sometimes used in CHF due to it's semi positive effects on contractility?

Amlodipine

237

what tests are the most S&S for RA?

CCP (cyclic citrullinated peptide) is 96%

238

Cholesteatoma

destructive/expanding growth consisting of keratinizing squamous epithelium in the middle ear and/or mastoid process. Can still cause problems because of their erosive and expansile properties resulting in the destruction of the ossicles and spread through the base of the skull into the brain.