_\ 35 y/o:_ Ciprofloxacin or TMP/SMX

ROSH, EMERGENCY EOR Flashcards by Karina Borges

Patient will be a young athlete
Complaining of dyspnea on exertion (most common presenting symptom)
PE will show harsh crescendo-decrescendo systolic murmur which increases in intensity with Valsalva maneuver and decreases with squatting
Diagnosis is made by echocardiography
Most commonly caused by an autosomal dominant genetic defect

Hypertrophic Cardiomyopathy

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RED FLAG OF BACK PAIN Urinary retention

cauda equina syndrome

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Patent Ductus Arteriosus Treatment is:

indomethacin

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Giardiasis Treatment:

metronidazole

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History of recent minor respiratory or GI illness
Complaining of symmetric, progressive ASCENDING muscle weakness
PE will show LACK of deep tendon reflexes

Guillain-Barré Syndrome

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Diabetic Ketoacidosis treatment:

Treatment is IV fluids
insulin infusion

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PE will show:

Dry macular degeneration (85% of cases): Atrophic changes and yellow retinal deposits (DRUSEN spots)
Wet macular degeneration: Vascular changes

Macular Degeneration

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Most commonly caused:

Stasis
hypercoagulable state
trauma (Virchow triad)

Deep Vein Thrombosis (DVT)

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Prostatitis tx:

< 35 y/o: Ceftriaxone or ofloxacin and doxycycline
> 35 y/o: Ciprofloxacin or TMP/SMX

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hx of alcohol abuse
Complaining of dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea
PE will show an S3 GALLOP on auscultation
Echo will show 4 dilated chambers (ventricles > atria)
Most commonly caused by idiopathic or alcohol abuse
Management includes abstaining from alcohol

Dilated Cardiomyopathy

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pH: < 7.35
PaCO2: > 45
HCO3: Normal

Respiratory Acidosis

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older, male
With a history of HTN, Marfan syndrome
Complaining of sudden “ripping” or “tearing” CP radiating to back
PE will show asymmetric pulses/BP

Aortic Dissection

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*Patient will be complaining of sudden onset sensation of room spinning in connection with positional changes of the head, lasting seconds to minutes *Diagnosis is made by Dix-Hallpike *Most commonly caused by the presence of an otolith in the labyrinth system

Benign paroxysmal positional vertigo (BPPV)

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Complaining of fever, monoarticular pain with decreased ROM
Labs from arthrocentesis will show WBC > 50,000 with > 75%PMNs
Diagnosis is made by arthrocentesis

Septic Arthritis

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Benign paroxysmal positional vertigo (BPPV) Treatment:

Epley maneuver

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Deep Vein Thrombosis (DVT) treatment :

anticoagulation

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X-ray will show fracture of middle to distal radius + disruption of distal radioulnar joint

Galeazzi Fracture

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first symptom of COMPARTMENT SYNDROME

Pain

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sudden onset of fever
headache
cough
myalgia
sore throat
fatigue

Influenza

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Spinal Epidural Abscess Most commonly caused by__________

S. aureus

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Pelvic Inflammatory Disease (PID) PE will show:

Mucopurulent Cervical Discharge

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Elderly bedridden patient or patient with psychiatric/neurological history
History of constipation
Sigmoidoscopy

Sigmoid Volvulus

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Complaining of severe pruritus that is worse at night
PE will show small papules, vesicles, and burrows in the webbed spaces of the fingers and toes

Scabies

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Subarachnoid Hemorrhage Most commonly caused by a

ruptured aneurysm

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Pericarditis ***_treatment:_***

* NSAIDs * colchicine

***_Most common_*** cause of blindness in the elderly:

Macular Degeneration

caused by ***_Graves disease_*** (autoimmune against TSH receptor)

Hyperthyroidism

***_Hyperthyroidism_*** treatment if ***_pregnant_***

Propylthiouracil (PTU) if Pregnant

Subarachnoid Hemorrhage ***_Treatment_*** is:

* supportive * nimodipine (decreases vasospasm)

Most common cause of ***_viral pneumonia_*** In adults:

Influenza

Pulmonary Embolism **treatment:**

* ***_Anticoagulation_*** (heparin, LMWH, novel oral anticoagulant (NOAC) * supportive care * thrombolytics in hemodynamically unstable patients

Bladder Cancer **Most common type** is:

urothelial (transitional cell) carcinoma

Central Retinal Artery Occlusion ***_treatment:_***

* Globe massage * ↓ IOP * ophthalmology consultation

* Epigastric pain radiating to the back * nausea * vomiting * PE will show flank ecchymosis **(Grey Turner sign),** umbilical ecchymosis **(Cullen sign)** * Labs will show elevated _{lipase (best)} and amylase

Acute Pancreatitis

Benign paroxysmal positional vertigo (BPPV) treatment:

Epley maneuver

* Patient will be complaining of low-grade fever, increased urinary frequency, dysuria, and suprapubic or abdominal pain. * Labs will show **positive leukocyte esterase** and **nitrites** * Definitive diagnosis is made by urine culture * Most commonly caused by _{^{Escherichia coli}}

Cystitis

Testing will show IOP ( ***_\> 21 mm Hg_***)

Acute Angle-Closure Glaucoma

***_PE will show:_*** * ↓ breath sounds * dull percussion * ↓ tactile fremitus

Pleural Effusion

* Pain with brushing hair or teeth * Pain at night when rolling onto shoulder * Baseball pitchers

Rotator Cuff Impingement and Tear

***_history of_*** * trauma * incomplete closure * extended contact lens use ***_PE will show:_*** * oval ulcer with ragged edges * severe conjunctival inflammation ***_Most commonly caused by_*** * Staphylococcus * Pseudomonas(contact lens wearers) * Streptococcus pneumoniae

Corneal Ulcer

Atrial Fibrillation **Treatment:**

* **Unstable:** cardioversion * **Stable:** rate control is mainstay

Pediculosis Capitis (Head Lice) ***_treatment:_***

permethrin

Suicide ***_Protective_*** factors:

* marriage * pregnancy

Tension Pneumothorax ***_tx_***

* ***_needle decompression_*** of the chest in the second intercostal space in the midclavicular line or fifth intercostal space in the midaxillary line * followed by ***_chest tube insertion_***

***_Patient with a history of:_*** * Diabetes * HIV * recent abx use ***_Complaining of:_*** * pruritus * dysuria * dyspareunia ***_PE will show:_*** * white * cottage cheese-like discharge ***_Labs will show:_*** * pH \< 4.5 * pseudohyphae * spores

Vulvovaginal Candidiasis

Patient will be complaining of: Abrupt onset of ***_"worst headache of their life"_*** or ***_"thunderclap"_*** headache

Subarachnoid Hemorrhage

Hepatic Encephalopathy **Treatment**:

lactulose

* Labs will show **_positive** pregnancy test and ***_LOWER_*** than expected serum beta-hCG levels * Most commonly located in a **fallopian tube**

Ectopic Pregnancy

Epistaxis ***_Anterior_*** bleeds:

Kiesselbach plexus

Patient will be complaining: * heat intolerance * palpitations * weight loss * tachycardia * anxiety

Hyperthyroidism

Felon ***_Treatment_***

incision and drainage

PE will show ***_cloudy cornea_*** and fixed mid-dilated pupil

Acute Angle-Closure Glaucoma

Nephrogenic Diabetes Insipidus ***_Treatment:_***

* HCTZ * amiloride * indomethacin

Laryngotracheitis (Croup) ***_Treatment_*** is:

* steroids * aerosolized epinephrine

Most common cause of ***_sudden_*** ***_death_*** in ***_young athletes_***

Hypertrophic Cardiomyopathy

Patient will be complaining of: * **dyspnea** (most common symptom) PE will show**:** * **tachypnea** (most common sign)

Pulmonary Embolism

* **pH:** \> 7.45 * **PaCO2:** Normal * **HCO3:** \> 26

Metabolic Alkalosis

Ethambutol ***_ADR:_***

* optic neuritis * red-green color blindness * hepatotoxicity

PE will show ***_CVA tenderness:_***

Acute Pyelonephritis

complaining of**:** * **fatigue**, **fever** * **chest discomfort**, **dyspnea** * **palpitations** PE will show**:** * **tachycardia** that is **disproportionate to fever or discomfort**

Myocarditis

* hx of ***_blunt_*** or ***_penetrating trauma_*** * Complaining of ***_blurry vision_*** * PE will show **unequal pupils**, **injected conjunctiva/sclera**, and ***_blood in anterior chamber_***

Hyphema

* adolescent female, dancers, or athlete * PE will show the ***_patella displaced laterally_*** over the **lateral condyle** * Diagnosis is made by clinical exam and X-ray to rule out fracture * Most commonly caused by a **twisting injury**, **valgus stress** combined with flexion and external rotation * Most common type is ***_lateral dislocation_*** * Treatment is ***_reduction, knee immobilizer_***

Patellar Dislocation

Pericardial Tamponade ***_Treatment is_*** :

pericardiocentesis

CXR ***_will show:_*** * nonspecific abnormalities * Hampton hump (pleural-based wedge infarct) * Westermark sign (vascular cutoff sign)

Pulmonary Embolism

Acute Angle-Closure Glaucoma ***_treatment:_***

* topical ***_beta-blockers_*** * topical ***_alpha-agonists_*** * carbonic anhydrase inhibitors * miotics * ***_Iridotomy_*** is definitive treatment, but not used for initial management

PE will show: * periorbital edema * dry skin * coarse brittle hair

Hypothyroidism

**≥ 2** symptoms: * Delusions * hallucinations * disorganized speech * grossly disorganized or catatonic behavior * negative symptoms

Schizophrenia

Impetigo **tx:**

* Limited number of lesions: ***_topical mupirocin_*** * Numerous lesions or involvement of more than one area: oral antibiotics ***_(cephalexin or dicloxacillin)_***

Fundoscopy will show ***_"boxcar"_*** look or ***_"cherry red spot"_***

Central Retinal Artery Occlusion

Acute Pyelonephritis **Inpatient/pregnant:**

* ampicillin/gentamicin ***_or_*** 3rd gen cephalosporin

* Acute monocular vision loss * PAIN worse with ***_eye movements_*** * Loss of color ***_(RED)_*** vision * Transient worsening of vision with increased body temperature (Uhthoff’s phenomenon) * ***_Diagnosis_*** is made clinically. MRI will confirm demyelination

Optic Neuritis

Ectopic Pregnancy treatment:

Treatment is methotrexate or surgery

Epistaxis ***_Posterior_*** bleeds:

Sphenopalatine artery

* generalized weakness * fatigue * facial swelling * constipation * cold intolerance * weight gain

Hypothyroidism

Cauda Equina Syndrome **Diagnosis** is made by\_\_\_\_\_\_\_\_\_\_\_

MRI or CT myelogram

Vulvovaginal Candidiasis treatment:

Treatment is fluconazole

\*Patient will be complaining of sudden unilateral electric shock-like pains in gums, cheek, chin, temporal forehead \*PE will show pain in V2 and V3 distributions, not V1

Trigeminal Neuralgia (Tic douloureux)

Hyphema ***_treatment:_***

* eye protection * limitation of activity * head elevation of 30–45 degrees

* **older** age * Complaining of **bilateral**, gradual **CENTRAL** field vision loss

Macular Degeneration

Patient will be complaining of: * Swelling of the tongue * Face * Neck in the absence of hives Most commonly caused by: * -Idiopathic -Drug-induced: ***_ACE inhibitors_*** (most common) -Hereditary: C1 esterase inhibitor deficiency

Angioedema

Pericarditis ***_causes_***

Most commonly caused by idiopathic then viral (Coxsackie)

Appendicitis Treatment is\_\_\_\_\_\_\_\_\_\_\_

surgery

Phencyclidine (PCP) Intoxication ***_treatment:_***

* BZDs * cooling * IVF * charcoal

* ***_HR less than 60_*** * Asymptomatic * Symptomatic: Fatigue, syncope * Medication side effect * Normal in athletes and during sleep * Observation, atropine for unstable patients

Bradycardia

\*Pt will be complaining of ***_fever_***, ***_dysuria_***, and ***_flank pain_***

Acute Pyelonephritis

Epistaxis Treatment ***_Anterior bleeding_***

* Direct pressure * topical vasoconstriction (oxymetazoline, phenylephrine) * chemical cautery (if vessel visualized) * packing

Guillain-Barré Syndrome Most commonly ***_caused by_*** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Campylobacter jejuni

RED FLAG OF BACK PAIN Young ***_+_*** morning stiffness

seronegative spondyloarthropathy

Trigeminal Neuralgia (Tic douloureux) Treatment

carbamazepine

Pelvic Inflammatory Disease (PID) Most commonly caused by

Chlamydia trachomatis

* ***_child_*** younger than 6-years-old * Complaining of ***_non-painful, pruritic lesions_*** on the face * PE will show ***_honey-colored, weeping lesions_*** * Most commonly caused by ***_S.aureus, Streptococcus pyogenes_***

Impetigo

* Rhythm will be ***_irregular_*** * ***_PR_*** interval will be ***_progressively lengthening_*** * Notable feature: Progressive lengthening of the PR interval until QRS complex fails to appear after a P wave ***_("dropped beat")_***

Second-Degree Heart Block (Mobitz I / Wenckebach)

Campylobacter jejuni ***_tx:_***

* supportive * plasmapheresis, or IVIG

* pre or mid-cycle ***_Dysmenorrhea, Dyspareunia, Dyschezia_*** (painful bowel movement) * PE will show ***_uterosacral nodularity_*** or a ***_fixed or retroverted uterus_*** * Diagnosis is made by laparoscopy

Endometriosis

Bronchiolitis PE will show

* respiratory distress * polyphonic wheezing * rales

Erysipelas ***_Treatment_*** is:

* Infections with ***_systemic symptoms_*** parenteral cefazolin, ceftriaxone or flucloxacillin * **Mild to moderate** infections (without systemic symptoms) oral amoxicillin or cephalexin

Pelvic Inflammatory Disease (PID) ***_Out pt treatment is_***

***_ceftriaxone_*** + ***_doxycycline_***

* ***_Breastfeeding_*** mother * ***_Breast erythema, tenderness, fever_*** * caused by ***_Staph. aureus_*** * Management includes ***_cool compresses_*** and ***_analgesics_*** in between feedings

Mastitis

Felon Most commonly ***_caused by_***

Staphylococcus aureus

* Infection of ***_lateral nail fold_*** * Most commonly caused by ***_S. aureus_*** * Treatment is ABX, warm soaks, I and D

Paronychia

Testicular Torsion ***_Diagnosis_*** is made by \_\_\_\_\_\_\_\_\_\_

ultrasound with Doppler

* Associated with aging, digitalis, ischemia, inflammation, cardiomyopathies * Rhythm will be ***_regular_*** * ***_PR interval will be \> 0.20 s_*** (200 msec) and constant

First‐Degree Heart Block

* history of nasal ***_congestion, cough, and low-grade fever_*** * Complaining of rapid fire repetitive coughing followed by an inspiratory ***_whoop"_*** and post-tussive emesis

Pertussis ("Whooping Cough")

* HTN, tachycardia, hyperthermia * Vertical, horizontal, or rotatory nystagmus * Variable pupil size * Combative behavior * Complications: rhabdomyolysis, seizures

Phencyclidine (PCP) Intoxication

* Patient will be an overweight ***_(Fat),Fertile, Female_*** in her ***_Forties (4Fs)_*** * Complaining of colicky, steadily increasing ***_RUQ_*** or ***_epigastric pain after eating fatty foods_*** * PE will show ***_Murphy sign, Boas sign_*** (hyperaesthesia (increased or altered sensitivity) below the right scapula)

Cholecystitis

Most commonly caused by ***_Hashimoto’s thyroiditis_***

Hypothyroidism

Prostatitis most commonly caused by: ***_\> 35 y/o:_***

E. Coli

Myocarditis Echocardiogram will show

* ***_Decreased Ventricular Ejection Fraction_*** with hypokinesis * wall ***_motion_*** abnormalities

Optic Neuritis ***_Treatment_*** is\_\_\_\_\_\_\_\_\_\_

methylprednisolone IV

* ***_Rate_*** will be ***_irregular_*** * ***_Rhythm_*** will be ***_irregular_*** * Notable feature: ***_No defined P waves_***

Atrial Fibrillation

* pH: ***_\< 7.35_*** * PaCO2:***_Normal_*** * HCO3: ***_\< 22_***

Metabolic Acidosis

***_Hypercalcemia_*** Most commonly ***_caused by:_***

* _Malignancy_ (most common inpatient cause) * *Primary hyperparathyroidism* (most common outpatient cause)

Aortic Dissection ***_CXR_*** will show:

widened mediastinum

* right upper quadrant pain, jaundice, fever ***_(Charcot triad)_*** * Diagnosis is made by RUQ ultrasound, CT scan, or ERCP (gold standard)

Acute Cholangitis

Labs will show: * **high** TSH * **low** free T4 * antithyroid peroxidase * antithyroglobulin autoantibodies

Hypothyroidism

RED FLAG OF BACK PAIN Back pain + fever + neurological deficits=

epidural abscess

* Patient will be entering a dark room or movie theater * Complaining of ***_acute unilateral painful vision loss_***, vomiting, and seeing halos around lights

Acute Angle-Closure Glaucoma

***_Appendicitis_*** Most commonly ***_caused_*** by \_\_\_\_\_\_\_\_\_

fecalith

Complaining of ***_abdominal pain_***, ***_vomiting_***, and ***_fatigue_***

Diabetic Ketoacidosis

* middle-aged man * Complaining of acute onset of pain in the first MTP ***_(PODAGRA)_*** * Labs will show ***_needle-shaped_*** crystal with ***_NEGATIVE_*** birefringence * Most commonly caused by ***_uric acid crystals_***

Gout

Gout Can be ***_triggered by_***

***_loop_*** _and***_thiazide_*** diuretics

* complaining of **fever,** **chills**, **perineal/back pain**, and **dysuria** * PE will show a warm, ***_EXQUISITELY_*** tender prostate

Prostatitis

Gout ***_Treatment_*** is:

* Acute: NSAIDs, steroids, colchicine * Chronic: allopurinol or colchicine

* failure to thrive * poor feeding * tachycardia * tachypnea * PE will show continuous, rough, ***_"MACHINERY-LIKE"_*** murmur, heard best in the first interspaces of the LSB

Patent Ductus Arteriosus

Acute Cholangitis ***_treatment:_***

* Treatment is antibiotics * definitive treatment is ERCP with antibiotics typically an adjunct

Suicide RFs ***_(SAD PERSONS):_***

* Sex (male) * Age (teenager or elderly) * Depression * Previous attempt * Ethanol/drug use * Rational thinking loss * Separated, divorced, or widowed * Organized plan * No Social support * Stated future attempt

* Sludging → ↓ perfusion * MM, Waldenstrom macroglobulinemia, PV, leukemias * ↑ WBC, ↑ RBCs * Dysproteinemias: plasmaphoresis * Blast transformations: leukaphoresis

Hyperviscosity Syndrome

RED FLAG OF BACK PAIN Night pain +weight loss=

malignancy

* Patient with a history of prior ectopic, PID, tubal surgery, IUD * Complaining of ***_vaginal bleeding, abdominal pain, amenorrhea_*** * PE will show ***_adnexal tenderness_*** or ***_unexplained hypotension_***

Ectopic Pregnancy

Pericardial ***_Tamponade_*** Treatment is

pericardiocentesis

* complaining of **dyspnea** and **chest pain** * PE will show ***_muffled heart sounds_***, ***_JVD_***, ***_hypotension_*** (Beck triad), ***_pulsus paradoxus_*** * ECG will show low voltage QRS, electrical alternans

Pericardial Tamponade

***_Epiglottitis_*** Most commonly caused by:

* Strep. and Staph. species * H.influenzae

* Sx duration \> 1 month * Persistent re-experiencing of the event * Persistently **↑** arousal * Avoidance of stimuli * **↑** Risk for suicide, substance abuse

Post-Traumatic Stress Disorder (PTSD)

* Patient with a history of skiing * Complaining of pain, swelling, and tenderness on the **ulnar** side of the metacarpophalangeal joint of the thumb * Most commonly caused by the forceful radial **abduction** of the thumb

Gamekeeper’s Thumb - Skier's Thumb

* Patient with a history of a head injury with a loss of consciousness followed by a **lucid interval** * CT will show a ***_biconvex opacity_*** * Most common artery ruptured is the ***_middle meningeal artery_*** * Treatment is emergent evacuation

Epidural Hematoma

Acute Pulmonary Edema treatment:

* **BiPAP:** ↑ oxygenation, ↓ work of breathing, ↓ preload, ↓ afterload * **Nitroglyerin:** ↓ preload, ↓ afterload * **Furosemide:** diuresis

* Patient will be a ***_diabetic_*** * With a history of Infection, Ischemia (cardiac, mesenteric), Infarction, Insulin deficit (poor control), Intoxication (FIVE I's)

Diabetic Ketoacidosis

* Patient with a history of multiple sexual partners or unprotected sex * Complaining of lower abdominal pain, cervical motion tenderness ***_("Chandelier sign")_***, painful sexual intercourse

Pelvic Inflammatory Disease (PID)

* Patient will be complaining of pleuritic chest pain radiating to the back * **worse** when lying back and **improved** when leaning forward

Pericarditis

* **older** man * With a history of **smoking** and **HTN** * Complaining of **abdominal pain** or **asymptomatic** * PE will show ***_hypotension_*** and ***_pulsatile abdominal mass_***

Abdominal Aortic Aneurysm (AAA)

* **Pink puffer**, blue bloater * Excessive O2 → ↓ respiratory drive * Bronchodilators, anticholinergics, steroids, NIPPV, smoking cessation

Chronic Obstructive Pulmonary Disease (COPD)

Bell Palsy **treatment:**

* prednisone * artificial tears * tape eyelid shut * antivirals (for severe cases)

* Patient with a history of viral prodrome * Complaining of waking up with **unilateral** facial nerve paralysis, hyperacusis, and taste disturbance * PE will show **CN VII** nerve palsy that does not spare the forehead Most commonly caused by HSV

Bell Palsy

* Patient will be complaining of rapid onset of ***_fever_*** and ***_dysphagia_*** * PE will show patient leaning ***_forward, drooling, inspiratory stridor_*** * Imaging will show **"thumbprint"** sign

Epiglottitis

Testicular Torsion ***_Treatment_*** is\_\_\_\_\_\_\_\_

manual detorsion or surgical

Radial Nerve Palsy **(Saturday Night Palsy)** treatment:

Treatment is splinting the wrist, physical therapy, and pain management

* PE will show tachycardia and **pericardial friction rub** * ECG will show **PR depression, PR elevation** (aVR), diffuse ST-segment elevation (concave)

Pericarditis

* Patient will be complaining of bone pain (**Bones**), kidney stones (**Stones**), abdominal pain (**Groans**), lethargy, psychosis (**Psychiatric overtones**) * ECG will show shortened QT interval

Hypercalcemia

RED FLAG OF BACK PAIN Acute bony tenderness

fracture

**Pericardial Tamponade** Echocardiography will show:

* Diastolic collapse of RA (highly sensitive and specific) * Early diastolic collapse of RV (less sensitive, but is very specific)

* child * Complaining of itching on their head * PE will show **nits (eggs)** or actual lice * Most commonly caused by Pediculus humanus capitis

Pediculosis Capitis (Head Lice)

Patient will be complaining of **gnawing epigastric** pain

Peptic Ulcer Disease

Ethambutol MOA:

Bacteriostatic against actively growing TB bacilli

**Endometriosis** Most common site is\_\_\_\_\_\_\_\_\_\_

ovaries

* Patient will be a non-toxic appearing child, 6-months to 3-years-old * Complaining of URI symptoms with **barky, seal-like cough,** inspiratory stridor, low-grade fever * X-ray will show **"steeple sign"** on PA view

Laryngotracheitis (Croup)

**Guillain-Barré Syndrome** Lumbar puncture results will demonstrate\_\_\_\_\_\_\_\_\_ CSF PROTEIN but a normal cell count

increased

Most common **cause** of **upper GI bleed**:

Peptic Ulcer Disease

* basketball or volleyball player * With a history of forced ***_hyperflexion of the DIP_*** * Complaining of ***_inability to extend the DIP_***

Mallet Finger

* sudden onset sensation of ***_room spinning_*** in connection with ***_positional changes_*** of the head, lasting seconds to minutes * Diagnosis is made by ***_Dix-Hallpike_*** * Most commonly caused by the presence of an otolith in the labyrinth system

Benign paroxysmal positional vertigo (BPPV)

Spontaneous Pneumothorax ***_Treatment_*** is:

* ***_\< 20%_*** in a healthy patient: observation with oxygen administration * ***_\> 20%:_*** chest tube thoracostomy

* Arboviruses, HSV * Fever, HA, AMS * Psychiatric sx * MRI

Encephalitis

Mallet Finger **treatment:**

Treatment is volar splinting the ***_DIP i_***n extension

Pertussis **("Whooping Cough")** Most commonly ***_caused by:_***

Bordetella pertussis

* PE will show abrupt ***_onset of tachycardia_*** with a ventricular rate of 120 to 200 beats per minute * caused by a ***_reentrant pathway_*** in the **atrioventricular node** * Treatment is vagal maneuvers, drug therapy ***_(adenosine),_*** and cardioversion

* Supraventricular Tachycardia (SVT) * Paroxysmal Supraventricular Tachycardia (PSVT)

Cystitis treatment:

* Acute uncomplicated cystitis: TMP-SMX, nitrofurantoin, or fluoroquinolone for 3-5 days * Acute uncomplicated cystitis with comorbid conditions: TMP-SMX, nitrofurantoin, or fluoroquinolone for 7 days

* history of smoking, long-distance travel, surgery, oral contraceptives use * Complaining of ***_unilateral leg edema, leg pain, tenderness, and warmth_***

Deep Vein Thrombosis (DVT)

* Patient with a history of diabetes or IVDA * Complaining of **back pain, fever**, and **neurological deficits** * Labs will show elevated ESR

Spinal Epidural Abscess

* Acute * painless monocular vision loss

Central Retinal Artery Occlusion

**Mastitis** treatment:

* Management includes cool compresses and analgesics in between feedings * Antibiotics: Dicloxacillin, cephalexin, TMP-SMX (MRSA), clindamycin (PCN allergic)

* Patient with a history of **ankle inversion** * PE will show **pain and swelling** * Imaging will show partial or complete tearing of ligaments * Most commonly injured **anterior talofibular ligament (ATFL)** * Treatment is RICE therapy

Ankle Sprain

Cauda Equina Syndrome Most commonly **caused** by a

herniated disc

* hx of **infection**, **dehydration**, **medications**, **GI bleed**, **hypoxia**, **hypoglycemia** * Complaining of **confusion** * PE will show ***_scleral icterus_*** and ***_asterixis_*** * Most commonly caused by **toxin** **accumulation** due to ***_liver dysfunction_***

Hepatic Encephalopathy

PE will show **fruity smelling** breath, dehydration, and AMS

Diabetic Ketoacidosis

PE will show: * ***_≥ 5 MINUTES OF CONTINUOUS_*** seizure activity * or more than one seizure without recovery from the postictal state in between episodes * \*Most commonly caused by a change in the medication regimen of someone with a seizure disorder

Status Epilepticus

* older than **60**-years-old * Complaining of intensely ***_pruritic papules_*** that became **large, tense blisters/bullae** * PE will show ***_tense_*** and ***_firm blisters_*** that do not extend with ***_lateral pressure_*** ***_(Nikolsky sign negative)_*** * Most commonly caused by chronic autoimmune blistering disease

Bullous Pemphigoid

Patient will be complaining of **pain _and itching** in the anal region

Hemorrhoids

what type of ulcer ? pain is **ALLEVIATED** by ingesting food _{(mnemonic: DUDe give me food)}

Duodenal ulcer

Laryngotracheitis ***_(Croup)_*** Most commonly _{caused by}

parainfluenza virus

**Cauda Equina Syndrome** _{Treatment is}

operative decompression

Ethambutol use:

usually in combination with other tuberculosis drugs (e.g. rifampicin, isoniazid, pyrazinamide, ethambutol (RIPE))

* **Hypotension**, JVD * Clear lungs * **ST elevation in V4R - V6R** * Preload dependent * Impaired filing of left ventricle * Reperfusion, dopamine/dobutamine

Right Ventricular Infarction

* Lifelong, recurrent mood episodes of either mood pole * **Mania, hypomania** * Inflated self esteem * Decreased need for sleep * Pressured speech * **Flight of ideas** * Excessive pleasurable activity

Bipolar disorder

* fever, pain that began **periumbilical** then moved to **RLQ**, nausea, and anorexia * PE will show **Psoas sign** (RLQ pain on extension of right hip), **Obturator sign** (RLQ pain on internal rotation of flexed right hip), **Rovsing sign** (right lower quadrant pain when the left lower quadrant is palpated)

Appendicitis

* ***_Infant_*** * Complaining of ***_difficulty breathing_*** * PE will show ***_respiratory distress_***, ***_polyphonic wheezing_***, and ***_rales_*** * Diagnosis is made by history and physical exam * Most commonly caused by ***_respiratory syncytial virus_*** (RSV) * Treatment is supportive care

Bronchiolitis

Most common ***_cardiomyopathy_***

Dilated Cardiomyopathy

Cholecystitis Most commonly ***_caused by_***

obstruction by a gallstone

Labs will show ***_low TSH_*** and ***_high free T4_***

Hyperthyroidism

* ***_pH:_*** \> 7.45 * ***_PaCO2:_*** \< 35 * ***_HCO3:_*** Normal

Respiratory Alkalosis

Epiglottitis **Treatment** is:

* IV antibiotics * airway management

* history of ***_dysrhythmias_*** (AF), recent MI, or CAD * Complaining of ***_abdominal pain out of proportion_*** to exam * Labs will show **lactic acidosis** * Diagnosis is made by CTA, angiography (gold standard)

Mesenteric Ischemia

Hypothyroidism ***_Treatment_*** is

levothyroxine

Labs ***_will show:_*** * hyperglycemia * ketonemia * anion gap metabolic acidosis

Diabetic Ketoacidosis

***_PE will show:_*** * hyperreflexia * goiter * exophthalmos * pretibial edema

Hyperthyroidism

**Optic Neuritis** Most commonly _{caused by_______}

multiple sclerosis

**Bronchiolitis** _Treatment

supportive care

**Peptic Ulcer Disease** Most commonly caused by

H. pylori infection or nonsteroidal anti-inflammatory use

* Patient with a history of **taking lithium** * Diagnosis is made by **water deprivation test**: no change in **urine osmolality** * Most commonly caused by _{renal unresponsiveness to ADH}

Nephrogenic Diabetes Insipidus

* Life-long disease, with initiation of symptoms in first ***_6-8 months of life_*** * Genetic mutation of hemoglobin gene leading to **sickling of red blood cells, easy red cell destruction, chronic anemia, vaso-occlusive crises, and multi-organ failure** * Patients are often **asplenic** by early childhood

Pediatric Sickle Cell Disease

* **Gamekeeper’s Thumb** - Skier's Thumb ***_treatment:_***

Treatment is thumb spica splint

**Acute Pyelonephritis** treatment

Treatment is fluoroquinolone or TMP-SMX

RED FLAG OF BACK PAIN Pain with extension + relief with flexion

spinal stenosis

CXR will show: * **blunting** of the **costophrenic angle** Most commonly caused by: * **Transudate:** heart failure * **Exudate:** infection \> malignancy, PE

Pleural Effusion

* history of a night of **heavy drinking** * PE will show a weakness of the wrist extensors, **WRIST DROP**, and weakness of the finger extensors

Radial Nerve Palsy (Saturday Night Palsy)

* Patient will be an infant or young man (bimodal) * Complaining of ***intense scrotal pain*** * PE will show **_exquisite**tenderness of the testicle and **no cremasteric reflex**

Testicular Torsion

***Hyperthyroidism*** Treatment is

methimazole or PTU

* Patient will be complaining of f**ever, rash, cough, and myalgias** * Physical exam will show: * Fever * Roth spots * Osler nodes * Murmur * Janeway lesions * Anemia * Nailbed hemorrhages * Emboli * **(FROM JANE)**

Bacterial Endocarditis

* Patient will be a **young, tall, thin, man** * PE will show: * **decreased breath sounds** * **decreased fremitus** * **hyperresonance to percussion** * CXR will show the absence of lung markings along lung periphery

Spontaneous Pneumothorax

Epistaxis Treatment is: **Posterior** bleeding

* ***_Packing_*** (foley, gauze pack, intranasal balloon device) * Admit patients with posterior packing to a monitored bed

* PE will show**:** * **Paresthesias** * **Pallor** * **Pulselessness** * **Poikilothermia** * **Paralysis** * **Pain out of proportion to exam** * (6 Ps) * Most commonly caused by **tibia fracture** * If delta pressure \< 30 mm Hg, treatment is fasciotomy * Most common sites: _{forearm, lower leg}

Compartment Syndrome

* **older** age * With a history of **smoking** * Complaining of **painless hematuria** * Diagnosis is made by cystoscopy

Bladder Cancer

Hypertrophic Cardiomyopathy treatment:

* refraining from vigorous physical activity * beta-blockers or calcium channel blockers

* Life-long disease, with initiation of symptoms in first **6-8 months of life** * Genetic mutation of hemoglobin gene leading to: * sickling of red blood cells * easy red cell destruction * chronic anemia * vaso-occlusive crises * multi-organ failure * Patients are often **asplenic** by early childhood * Patients are hundreds of times more likely to have **sepsis,** with the period of risk highest between 6 months and 5-years-old * Prophylactic antibiotics are often given when patients have fever until blood and urine cultures are deemed negative

Pediatric Sickle Cell Disease

**Prostatitis** most commonly caused by: \< 35 y/o:

\< 35 y/o: N. gonorrhoeae, C. trachomatis

Physical exam may show a **positive Homans sign**

Deep Vein Thrombosis (DVT)

* Patient with a history of **chest trauma** * PE will show: * **diminished or absent breath sounds** * **tracheal deviation away from the side of the injury** * **hypotension** * **jugular venous distension** * Diagnosis is made clinically

Tension Pneumothorax

* Sudden onset * Intense apprehension * fearfulness * terror * Peaks in 10 minutes * Concern about future attacks

Panic Attack

what type of ulcer ? pain is exacerbated by **ingesting food**

Gastric ulcer

* Associated with patients with COPD and the elderly * Rate will be **100-200** beats/min * **PR interval will be differing** * Notable feature: At least **3 different P-wave forms** * Treatment is to treat the underlying cause, calcium-channel blockers

Multifocal Atrial Tachycardia

**Septic Arthritis** Most commonly Age \< 35 caused by

N. gonorrhea, S.aureus overall

* Patient will be someone with a history of: * **TRAUMA** * **MALIGNANCY** * **EPIDURAL ABSCESS OR HEMATOMA** * Complaining of ACUTE onset of LOWER back pain with WEAKNESS and NUMBNESS * PE will show **urinary RETENTION**, saddle anesthesia, decreased rectal tone

Cauda Equina Syndrome

**Aortic Dissection** treatment:

Treatment is reduce BP/HR, surgery (depending on dissection type)

**Subarachnoid Hemorrhage** diagnosis:

* Diagnosis is made by noncontrast CT scan. Blood will appear white in color on the CT * If CT negative, and suspicion high, lumbar puncture

***Bullous Pemphigoid*** Treatment is\_\_\_\_\_\_\_\_\_\_\_\_

corticosteroids and immunosuppressants

Pertussis **("Whooping Cough")** treatment:

macrolide - azithromycin

* X-ray will show **periosteal elevation** or **bony erosions** * Diagnosis is made by bone scan or MRI

Osteomyelitis

* Complaining of **penile pain** * PE will show foreskin that, once retracted, ***_cannot be brought to the usual position_*** * Treatment is **manual reduction** or dorsal slit if reduction unsuccessful

Paraphimosis

Scabies **tx:**

permethrin 5%

* complaining of **dyspnea and chest pain** * PE will show muffled heart sounds, JVD, hypotension (Beck triad), pulsus paradoxus * ECG will show low voltage QRS, electrical alternans

Pericardial Tamponade

* Crackles, jugular venous distension * CXR: **cephalization, Kerley B lines, effusions**

Acute Pulmonary Edema

* Patient will be complaining of: * malaise * fever * chills * nausea * PE will show: * intense and deeply erythematous * sharply demarcated **elevated shiny patch** * Most commonly caused by **Streptococcus pyogenes** infection (group A beta strep)

Erysipelas

Status Epilepticus ***_treatment_*** is:

* ***_1st:_*** Benzodiazepines (lorazepam, etc.) * ***_2nd:_*** Phenytoin or fosphenytoin, valproic acid, phenobarbital, levetiracetam * ***_3rd:_*** Pentobarbital, propofol

* hx of **camping** and **drinking lake water** * Complaining of **sudden onset of explosive**, **foul-smelling**, and **non-bloody diarrhea** * Labs will show **flagellated protozoan**

Giardiasis

Cholecystitis Treatment is

cholecystectomy