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629 Cards in this Set
- Front
- Back
Cystic Fibrosis
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Peds hemoptysis, rectal prolapse
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mucormycosis
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black necrotic lesion
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Peds diarrhea SZ
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shigella
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Narcotics SZ
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bupropion
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AIDS SZ
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Toxo
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Guilian Barre diarrhea
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Campylobacter paralysis
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Tarantula
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hairs that irritate skin, eyes
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Aortic dissection
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right >left coronary artery involved
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Normal post-void residual
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< 50ml
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AAA rupture risk
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> 5cm
|
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Epidemic HUS
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E coli O157:H7 or shigella
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Prostatitis tx
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Cipro 500 BID x 30d
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WPW
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delta wave: short PR, delayed QRS upstroke
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FB good prognosis
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early pliability, nl sensation CLEAR blebs
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Immed Post Partum SZ
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Amniotic Fluid embolism
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A-a gradient
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150 - (PaCO2/0.8) - PaO2
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Pleural effusion vol to see on CXR
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200ml
|
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↓Ca Chvostek sign
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upper lip twitch c tap of face CN VII
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↓Ca Trrousseau sign
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hand spasm c BP cuff
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↑Ca tx
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fluids, furosemide; NO HCTZ
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Pilon Fx
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comm, intra-artic of distal tibia
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Acute Interstital Nephritis-causing drugs
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PCN, NSAIDs, sulfa, dilantin, diuretic, also inf, imm
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Anterior epistaxis (90%)
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Kisselbach plexus
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Posterior Epistaxis
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Sphenopalatine artery
|
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Battle sign
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mastoid ecchymosis
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Monocular diplopia
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lens disloc
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PCP: steroid use
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PO2 < 70; A-a > 35
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↑QTc
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hyper and hypo thermia
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6 P's of ischemia
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pain, pallor, pulseless, paresthesia, paralysis, poik (↓temp)
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ASA tox
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resp alk; met acid
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Electric shock
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AC worse than DC, 10% dysrhythmia: VF most common
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Boring, tearing HA
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Cluster HA
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Throbbing HA
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MHA
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Potassium in MI
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5x risk of VF if K<4.0
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Most common non-EtOH alcohol
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Isopropanol
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Chronic orbital cellulitis
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Aspergillus
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T. capitus
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Oral griseo; selenium decreases infectivity
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Hamman's crunch
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pneumomediatinum
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Stener lesion
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Skiers thumb: APL tendon between split UCL
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Microcytic anemia
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Lead tox, Fe def, sideroblastic, thalassemia
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Patella Fx
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transverse most common; vertical on sunrise views
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HIV & meningitis
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Cryptococcus; India ink 80% sens: send Ag
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Osborn/J wave
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hypothermia: junction of QRS and ST
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LGIB etiols
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Diverticulosis, angiodysplasia, tumors,polyps, rhoids, UGI, A-EF
|
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UGIBleed etiols
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PUD, esoph, M-W, gast, varices, stress ulcers, AVM, malig
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LBO
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Ca, tics,Sig volv, Cecal volv, Intuss, Ogilvie
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SBO
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Adhesions, CA, hernia, Crohn, volv, Intuss, stricture, GS ileus, FB
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Diarrhea that mimics Appy
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Yersinia (campylo)
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Diarrhea: pet turtles, chicks, lizards
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Salmonella
|
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Diarrhea within 6 hrs
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Ham/potatos salad: S. aureus; Fried rice:Bacillus cereus.
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Rice water diarrhea
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seafood: vibrio Tx; fluids, cipro or bactrim
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Diarrhea and 3rd world travel
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E. histolytica. Bloody. Flagyl then iodoquinol
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Sandpaper rash
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SSSS, scarlet fever
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Pain immed after eating
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Gastric ulcer
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Pain better c food, worse later (middle of night)
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Duodenal ulcer
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Bowel Obst, <2yo
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Intuss. Bloody stool, severe pain
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Non-bilious, projectile vomiting
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pyloric stenosis
|
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Hirschprung
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string sign; no mec by DOL#2, aganglionic
|
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Painful vision loss
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glaucoma
|
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Painless vision loss
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CRAO, CRVO, retinal detach, vitreous hem
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Arsenic Tx
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dimercaparol, BAL
|
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Wernicke
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MS changes, ataxia, nystagmus. Tx: Thiamine, Mg
|
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OM viral etiol
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RSV
|
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Palpable purpura on buttocks and legs
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HSP
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Chronic cough
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B. pertussis. Tx: erythro
|
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Posterior elbow dislocation complications
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Most common: ulnar nerve; most serious: brachial artery
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Young man: dry cauliflower warts
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C. accuminatum (HPV)
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weeping warts, foul odor
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C. lata (syphillis)
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KBT test
|
detects > 5ml hem (to determine need for additional Rhogam
|
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Apt test
|
to differentiate fetal from maternal blood in neonatal GI bld
|
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Pericardial effusion volume to see on cxr
|
250 ml
|
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TTP
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fever, anemia, low plts, ↑Cr, neuro sx, schistocytes. NO plt tx.
|
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Decels
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late: U-P insuff; early: head compression; variable: cord compression
|
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Most common bacteria in diarrhea
|
campylobacter
|
|
MeOH OD
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HCO3, ADH inhibitors, dialysis, folate (breaks down folic acid)
|
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Cental Cord synd
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most common; hyper ext in eld; M>>S, U>L, D>P. Sacral sparing
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Almonds, fish, glue, garlic, rotten eggs
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CN, zinc, toluene, OPP, H2S
|
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Earliest cardiac marker
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myoglobin: detect at 2h, peak at 5h, gone by 12h
|
|
Peds C-spine
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pseudosublux at C2-3 (50%), C3-4 (15%)
|
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sympatho vs anticholinergic
|
symp: diaphoresis and nl bowel sounds; antichol: dry skin, no BS
|
|
cholinergic syndrome sx
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diarrhea, urin, miosis, bronchorrhea, brady, emesis, lac, sal
|
|
cholinergic agents
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OPP,carbamates, sarin, pilocarpine, cytocybe/inocybe mushrooms
|
|
anticholinergic agents
|
antipsych, scopo, mus relaxer, gi antispas, antihist, jimson, deadly nightshade
|
|
OsmOL gap
|
methanol, ethanol, isopropanol, ethylene glycol and diuretics(glyc, man, sorb)
|
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Mees' lines
|
white lines onnails in chronic Arsenic tox
|
|
HBO for CO
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neuro/psych abn, CV instability, CO>25, CO>15 in preg
|
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Chronic toluene abuse
|
distal renal tubular acidosis
|
|
Hemodialysis in MeOH or EG OD
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acidosis, renal compromise, visual changes or level > 20 of either
|
|
Hemodialysis in ASA OD
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>100, coma, renal/lver fail, non-card pulm edema, severe acid/base, rising levels
|
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PCP
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hallucinations, euphoria, violence in mild; severe: rigidity, SZ, fever, coma
|
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Cocaine chest pain
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O2, benz, CCB; NO Bblockers (unopposed alpha: HTN and coronary spasm)
|
|
Multi-dose charcoal
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ASA, phenobarb, theo, tegretol
|
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Urine Alk
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ASA, phenobarb, formic acid(MeOH)
|
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Hemodialysis in OD
|
Li, ASA, Alcohols, metformin, VPA, phenobarb
|
|
Alcohols that cause AGMA
|
MeOH, EG only (all alcohols cause AG)
|
|
SSRI SX Serotonin syndrome
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Fever, sweats, AMS, tremor, increased reflexes. Rare: SZ, CV tox
|
|
SSRI antidote
|
Cyprohepatidine - oral only
|
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MAOI Sx
|
excessive symp activity (AMS, mydriasis, Inc T, HR, BP, rigid, SZ, coma
|
|
Antidepressant & SZ
|
Welbutrin (bupropion)
|
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Anticholinergic Tx
|
benzos, physostigmine; avoid Bblockers, sedatives c antichol (benadryl, haldol)
|
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Immediate reversal of Coumadin
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Prothombin complex concentrate and Recomb VIIa
|
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HIT
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up to 3w later; causes thrombotic events
|
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VPA tox
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elevated ammonia level, HD OK, not in other Sz med ODs
|
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BB and CCB OD Tx
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atropine, pressors, Ca(if no dig tox), HD glucagon, Insulin & glucose
|
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Bidirectional VT
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Dig tox
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Dig tox tachydysrhythmias
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Tx: phenytoin, lido
|
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Digibind indications
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K>5 in acute; Vent dysrhythmias, Brady unresp to tx, Massive OD
|
|
Miosis
|
Horner, narcs, cholinergics, clonidine, barbs,
|
|
Sulfonylurea OD (glip, glyb)
|
Octreotde, diazoxide
|
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Narcotics without miosis
|
propoxyphene (darvon), pentazocine (talwin), demerol
|
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Narcotics and SZ
|
propoxyphene, demerol
|
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Narcotic and wide-complex
|
propoxyphene
|
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Liver tx in tylenol OD
|
pH < 7.3, INR > 7, Cr > 3.4, Grade3 or 4 Liver failure
|
|
Fe tox
|
Sx w/i 6h, severe= hep failure, +/- on xray,
tx: deferoxamine comp: yersinia |
|
OPP vs carbamates
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OPP irreversible bond to cholinesterae; both tx c atropine, 2-PAM
|
|
CN tox
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Kit; amyl nit, sod nit, sod thio (only sod thio if ?CO); TX: hydroxycobalamin
|
|
Mushroom and SZ
|
Gyrometra; tx: pyridoxine (like INH OD)
|
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Cholinergic Killer B's
|
bradycardia, bronchorrhea, bronchospasm
|
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Bite and SZ
|
black widow, brown recluse
|
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Scorpion bite and pancreatitis
|
Tityus trinitatus
|
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Bark scorpion
|
Centuroides (AZ) roving eye movements, muscle spasm, xs secretions
|
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Octopus bites
|
tetrodotoxin: flaccid paralysis
|
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Roseola infantum
|
High fever (SZ ) x 3days without URI; then sudden rash upon decreased temp
|
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Rubella
|
lymphadenopthy
|
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Erythema infectiosum
|
slapped cheek
|
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Scarlet fever
|
GAS; sandpaper rash
|
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Diptheria
|
grayish tonsillar pseudomembrane
|
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herpangina
|
temp, myalgias, dysphagia, painful ulcers that spare ging and ard palte
|
|
Thrombosed hemorrhoids tx time
|
Excise within 48hrs, no point afterwards
|
|
Peds retinal hemorrhage
|
shaken baby; also normal birth in 50% for up to 1 month
|
|
T1 miscarriage causes
|
>50% genetic, mostly trisomy, mostly tri 16
|
|
ConVEX St elevation
|
acute MI (concave - pericarditis, most specific for pericarditis is dec PR)
|
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Jones Fx
|
> 1.5cm from bse of 5th or distal to cuboid; SL splint, NWB, usually surgery
|
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gonococcal arthritis
|
F>M, G-stain pos> Cx, rare GU sx, rarely need surgery; tx: 3Ceph
|
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DCS
|
DCS I: m-s, skin, lymphatics (shoulders, elbows); DCS II: all others N2
|
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Kidney stones Calcium
|
2/3 of all; HyperCa: hyperpara, milk-alkali, lax abuse, sarcoid, Crohn's/UC
|
|
Kidney stones MAP
|
aka stuvite (20%) UTIs due to Proteus, Klebsiella, Pseudomonas
|
|
Kidney stones Uric Acid
|
gout; radiolucent - not seen on plain films
|
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Kidney stones Cystine
|
least common; hypercytinuria an inborn error of metabolism
|
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Anion gap
|
Na-Cl-HCO3; unmeasured anion in normal = albumin
|
|
Oligoclonal bands
|
Multiple sclerosis
|
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Guillain-Barre
|
prog weakness > one limb & global dec reflex; CSF: inc protein, nl WBC
|
|
CT dye risks
|
atopy, CAD, Bblockers, prior event; not shellfish
|
|
Sickle Cell Aplastic Crisis
|
low H/H, retic<2%; usually post-infectious and cause 5% of SC deaths
|
|
Anal fissures
|
>90% midline except in Crohn's
|
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Crohn's v UC
|
toxix megacolo, rectal invol: UC; perianal comp, EN in women: Crohn's
|
|
LBO causes
|
1- Ca 2- Volvulus 3-diverticulitis
|
|
McMurray test
|
medial meniscus
|
|
Pertussis complications
|
common: effects of severe cough; worst: apnea in infants; rare SZ, CA dissect
|
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Kawasaki tx
|
high dose ASA
|
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HSP
|
palp purp on buttocks, abd pain, jt pain, hematuria; ileoileal intuss
|
|
Cecal Volvulus
|
25%; plain films dx <50%; classic = dil cec in LUQ; late 50's; tx: surg
|
|
Ischemic colitis
|
50% misDx as InfBD; Classic xray=thumbprinting 20%;tx: supportive
|
|
Hep A
|
No chronic carriers; Sx in 5% kids, 75% adults;
|
|
Hep E
|
worse in preg; worse later in preg
|
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Nocturnal diarrhea
|
Crohn's disease
|
|
OM bacteria
|
1- Strep pneumoniae 2- Moraxella catarhalis; viruses 1/6
|
|
Narrowest part of pedi airway
|
Cricoid cartilage
|
|
Tinea versiocolor
|
seb areas: trunk, arms, neck; gris NOT effective; recur common;
|
|
Thyroid storm
|
Stach, GC helpful
|
|
Maisonneuve Fx imaging
|
stress x-rays of ankle to r/o instability
|
|
Central Venous Thrombosis
|
Sx: HA; freq present late;Dx: MRI; Tx: heparin, even c bleed; F>M (bcp, preg); FOCAL sz
|
|
B Pertussis
|
GNCB; Tx: macolides only effective 1-2w, but decreases infecivity
|
|
Hep viral carriers
|
A- none; B- <5%; C- 80-90%
|
|
Hep C
|
IVDA, blood tx, esp outside US
|
|
Viral Hep and Fulminant failure
|
least common: Hep C; Most ommon Hep B+D coinfection
|
|
Uncal herniation
|
CNIII compressed -> parasymp paralysis -> mydriasis
|
|
tonsillar herniation
|
posterior fossa increased pressure -> cardiopulm failure
|
|
Gonococal urethritis
|
GN IC diplos; always symptomatic (1/4 not in chlam)
|
|
Cerebral edema
|
vasogenic: white matter, dysfunction of endothel/BBB; Cytotox: ischemia
|
|
AAA risk factors
|
FH (20x), age>50, PVD, Htn, other aneurysms
|
|
Peds cyanotic heart disease
|
Truncus art, TGV, tricuspid atresia, ToF, TAPVR; central cyanosis (periph=dehydration or hypothermia)
|
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Anxiety d/o tx
|
SSRI, benzo for breakthrough, Bblocker for performance anxiety
|
|
Penetrating abd trauma injuries
|
1- SB 2-liver 3-LB
|
|
Preg u/s: snowstorm
|
complte molar pregnancy
|
|
amebic liver abscess
|
fecal-oral; E. hist; lab: inc alk phos #1, then bili, rare inc bili; tx: flagyl
|
|
SLE
|
malar after sun, fever, sym arth; #1 sens test: ANA; #1 spec test anti-Sm
|
|
TB Sx
|
1-cough, 2- Wt loss; night sweats, cp, sob, hemopt
|
|
Headache prophylaxis
|
Tension: amitriptyline; migraine: propranolol; cluster: verapimil
|
|
Corrected Na = ?
|
Na + 1.6(Glu-100)/100
|
|
Cardiac Contusion test
|
best= EKG; enzymes not helpful
|
|
Older Male alcoholic Pneuumonia
|
Klebsiella
|
|
Pre-school pneumonia (6m-5y)
|
#1 RSV; #1 bact= strep pneuma
|
|
Pneumonia 5-15 yrs
|
Mycoplasma
|
|
Yersinia enterocolitica
|
ileocecitis mimics appy, sx > 2w, mostly kids, complications = polyarthritis, EN
|
|
HyperCalcemia EKG
|
#1= QTc short, ST depression, Wide T, brady
|
|
Retropharyngeal Abscess
|
Supine; kids (nodes) > adults (trauma); #1=Staph; rare C1-2 separation
|
|
soft-tissue neck spaces
|
C-2 > 7mm (all); C-6 >14mm (kids), 22mm (adults)
|
|
Mult Sclerosis tx
|
High dose IV Steroids; resistance develops; baclofen for spasticity
|
|
Pregnancy N/V tx
|
Vitamin B6
|
|
Appy in kids
|
<3yo: 90% perf; teens 15%; <2 usually diffuse pain; 15% 'liths
|
|
Post viral polyarthritis
|
Rheumatic fever; complications = conduction/vavle problems
|
|
Bronchiololitis Rx
|
O2; ribavirin only in premies or kids c congential heart/lung
|
|
Alcohol Dehydrogenase affinity
|
Ethanol>Methanol> EG
|
|
MeOH Tox
|
40%: 1 Tsp (adults) may be fatal; 1 tspn - blindness
|
|
Thoracic Aortic Dissection
|
Stanford - involves ascending +/- desc tx: surgery
|
|
Erysipelas
|
GAS, red, painful, demarcated, lymphatics, #1 legs, #2 face
|
|
Postpartum Endometritis Risks
|
#1 C/S; young, low S-E, PROM, prolonged labor, mult exams
|
|
Lung abscess risks
|
altered MS; poor dentition
|
|
PALPABLE purpura
|
HSP, cryoglobulinemia, CT disorders, viral hep, Hairy cell leukemia
|
|
Haldol advantages
|
no antichol or hypotensive effects
|
|
Pseudomonas
|
neutropenia, mech ventilation, CF
|
|
Prinzmetal's Angina
|
CA vasospasm, may be better c exercise, hx/tx as angina
|
|
Drugs causing lupus-like syndrome
|
INH, hydralizine, procainamide
|
|
Warm ischemia times
|
6hrs 10%, 12 hrs 90% permanent damage
|
|
Primary Liver CA
|
AFP>500; most c Hep B
|
|
TCA OD wide complex tachy tx
|
HCO3, most anti-arrythmics don't help (lido) or worsen (procainamide)
|
|
SAH tx
|
SZ meds, lower BP, nimodipine
|
|
Kidney stone composition frequency
|
Calcium, struvite, UA, cystine
|
|
Alcoholic pneumonias
|
#1 Strep; inc risk of Klebsiella; TX unchanged: 3GCeph + mac/FQ
|
|
Calcium tx in Hyperkalemia
|
ok in Dig tox but dilute; lasts 30-60 min
|
|
SPS in hyperkalemia complications
|
volume overload: colonic necrosis and ischemic colitis, esp c enema
|
|
Raynaud's color sequence
|
white (dec flow), blue (initial reflow c cyanosis), red (hyperemia)
|
|
Peds painless rectal bleeding
|
Meckel's
|
|
Scabies and head live tx
|
Permethrin; alt: scabies(lindane transderma tox) lice (malthion need 8hrs )
|
|
Ethylene glycol Urine tests
|
Crystals and flourecence present in 50% (confirms, doesn't r/o)
|
|
Fever, HA, ocular paralysis
|
Cavernous sinus thrombosis; Staph/strep; tx abx, surg, hep; high mortality
|
|
AV node blood supply
|
1- RCA 2- left circ
|
|
Alcoholic Ketoacidosis
|
AGMA, nl OG, BHB (false neg u/a ketone)
|
|
Osler nodes, Janeway, splinter hemorrhage
|
Endocarditis
|
|
Cord prolapse tx
|
C/S; trend, knee to chest, elevate presenting, fill bladder
|
|
Chalcosis
|
golden deposits from Copper IO fb
|
|
Coloboma
|
teardrop pupil; congenital iris ring defect
|
|
Seidel test
|
streaming flourescein due to ant chamber leakage
|
|
Iridodonesis
|
shimmering iris: posterior lens dislocation
|
|
Iridodialysis
|
double pupil from blunt trauma
|
|
Optic neuritis
|
pain, vision loss, color problems; 25% get MS
|
|
Gout in women
|
rare before menopause; risks:diuretics, renal insufficiency
|
|
Hemi-inattention stroke
|
non-dom (usually right) parietal infarct
|
|
Pontine hemorrhage
|
mimics narc OD
|
|
Lateral medullary syndrome
|
PICA infarct
|
|
Locked-in Syndrome
|
basilar artery infarct
|
|
Pseudobulbar palsy
|
affects lower CNs: dysphagia, -arthria, -phonie; no visual sx
|
|
Antichol
|
musc>nic, death from hypertherm; SZ: kids>adults; skin, mucosa early, CNS gI late
|
|
Biliary CA
|
#1- GB; rare mets; almost all h/o stones; porcelain GB
|
|
Rheumatic Fever EKG
|
prolonged PR
|
|
Pressure gun injuries tx
|
OR debridement; no digital block (compartment syndome risk)
|
|
Rhabdo dx
|
most sens=CK, most spec=MB (short T1/2); Dip+Mic- 50%
|
|
Rhabdo etiol
|
Gemfibrozil, 10% of High Voltage, Flu,Legionella, HIV, Coxsackie
|
|
Rhabdo electrolye abnormailty
|
HypoCalcemia; avoid Ca due to assoc HyperPO4 -> precip
|
|
Mushroom - amATOxin
|
liver toxicicty
|
|
Mushroom - COPrine
|
disulfiram-like
|
|
Mushroom - gyromitrin
|
SZ
|
|
Mushroom - ibotenic Acid
|
anticholinergic
|
|
Mushroom - muscarine
|
Cholinergic
|
|
Mushroom - oREllanine
|
Nephrotoxicity
|
|
Psilocybin
|
hallucinations
|
|
CRAO risks
|
Htn, DM, AF, SLE
|
|
ICH Htn Tx
|
labetalol and/or Nicardipine
|
|
M.A.T. associations
|
COPD, CHF, hypokalemia, hypocalcemai
|
|
False-positive nitrazine test
|
blood, semen, xs cerv mucus, T. vaginitis
|
|
Magnesium toxicity tx
|
Calcium
|
|
Fever, ST, gray pseudomembrane
|
C. Diptheria; tx: macrolides, horse anti-toxin, immunization
|
|
Viral causes of encephalitis
|
#1 - enteroviruses( coxsackie); most severe - herpes
|
|
Hirudin risks/benefits
|
more bleeding, less thrombocytopenia than heparin/lovenox
|
|
Goodpasture's Syndrome
|
glomerulonephritis, diffuse alveolar hemorrhage, anti-basement membrane ab
|
|
Ventilation in asthmatics
|
high flow, short insp times, long exp times, low vol, Plateau pressure <35
|
|
Primary aDreNal insufficiency
|
↓Na, ↑K, ↓glu
hyperpigmentation due to inc ACTH |
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Adult epiglottitis tx
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3GCeph, humidified O2; No steroids nor racemic epi
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Rash on wrists and ankles
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meningiococcemia
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HAPE
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#1 cause of alt death; periph cyanosis, worse at night, tx: descent, O2, nifedipine, morphine, furosemide
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Traveler's diarhhea etiols
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1- ETEC, 2- Shigella, 3- viral, 4- protozoa
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MI criteria in LBBB
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1- Concord ST elevation >1mm; ST dep V1-3; Discord ST elevation >5mm
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EBV Pharyngitis complications
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Common: rash c amp/amox, asympt ↑LFTs; rare: splenic rupt, Hemolytic anemia, enceph
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Nephrotic Syndrome
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Proteinuria, fluid overload (periorbital), Htn, thrombophilia, micro hematuria
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Clozapine side effect
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agranulocytosis
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Haldol mechanism/effect
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anti-dopamine D2 (sedation); α-1 blocker (orthostatic hypotension); antihist; no lowering of SZ threshhold
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Ethylene Glycol OD Tx
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ethanol, fomepizole, pyridoxine, thiamine temporize. Definitive= hemodialysis.
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Anterior Circulation Ischemia
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hemiparesis/sensory loss (ant cerb art); Transient Monoc blindness (ophthalm art); aphasia and hemiparesis (MCA); all are branches of carotid
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Post Circulation ischemia
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ataxia, vertigo, N/V
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Extrapulmonary TB
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painLESS (cerv) adenopathy, pericarditis, meningigitis (↑↑prot), spine (Pott's disease, ant wedge Fx), bilat adrenals
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Radiation exposure in Pregnancy
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5 Rads safe (10 Rads inc risk of childhood CA, not malformations); periph xrays <5mrad; Ct abd 2.6 Rad; highest risk: 2-7weeks
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Painless hematuria Dx
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Childrren: glomnerulonephritis; old men: bladder CA; others: UTI
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Meningitis tx >50yo
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Ceftriaxone (S. pneumo), Vanco (resistant S. pneumo); Ampicillin (listeria); dexamethasone
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Pulmonary Contusion complications
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Atelectasis, pneumonia
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Sarcoid
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B>W, F>M, 20-40;presenting Sx: fatigue, fever, anorexia, pulm; Skin sx (25%) EN, lupus pernio; Symmetric, laarge-joint arthralgias
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Chancroid
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painFUL ulcer with tender unilat LN; H ducreyi (GNB); tx: zith or ceftriaxone
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Wellen's Sydrome EKG
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Prox LAD angina; deeply inverted T waves anteriorly
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Pericarditis EKG
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ConCAVE ST elevation, STach, PR depression
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Left Circ lesion EKG
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lateral (I,L, V5-6) and posterior (V1-2) findings
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Right sided CAD EKG
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Inferior or Posterior (V1-2)
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Tularemia
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tick-born, spirochete from rabbits. Sx:skin ulcers, painful nodes; O-P, lung, ocular less. Tx: streptomycin IM
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Conjunctivitis Findings
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Dendrites (HSV), pseudodendrites/facial rash (VZV), contact lens (Pseudomonas)
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Ciguatera
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#1 fish-related poisoning; N/V/D, neuro: distal/perioral paresthesias, cold allodyna. Sx x 1-2w. Rare: cholinergic.
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O-P Dysphagia
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#1 - CVA; #2 - poly-/dermatomyositis. 2/3 of MG pts have it. Liquids worse than solids. Sx intermittant.
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Brown Recluse Tx
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supportive only, even hemorrhagic vesicles. No dapsone.
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Young adult c trigeminal neuralgia
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Consider MS, esp if recurrent or other neuro Sx
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Priapism tx
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Corpora cavernos aspiration
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Backblows for FB
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pedi only
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Posterior MI EKG
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posterior leads most accurate; V1-2 most specific ant leads; sx opposite anterior MI: ST depression, R waves (not Q), upright T (not inverted)
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Jones Criteriua for Rheumatic Fever
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2maj polyarth, EM, chorea, carditis, subQ nodules; or 1 maj + 2 minor ( arthralgias, fever, ↑ESR or CRP, ↑PR)
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Thoracic outlet syndrome
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#1 Ulnar nerve
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Prophylaxis for AMS
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Acetazolamide, dexamethasone
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CRPS aka RSD Dx
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allodynia, burning, bone scan/xray abn, change in sweat/temp/hair/color
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Vertical or Rotatory nystagmus
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PCP
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Descending paralysis
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Botulism (with CN abnormalities and parasymp blockage)
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Central Cord Syndrome
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Upper > lower motor weakness
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Achalasia
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dysphagia; LES spasm & absence of esoph peristalsis;
solids worse than liquids; raise arms/ straighten back |
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Schatzki's ring
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stricture at dist esophagus in 15%; presenting sx: acute obstruction
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Benzo side effects in Status epilepticus
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1- hypotension; 2- hypoventilation
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Status epilepticus - adult etiols
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1- subtherapeutic med levels; 2- CVA
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Highest electrical resistance
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Bones, tendons, fat
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Heparin/LMWH pharmacol
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Heparin inactivates thrombin (Factor II); LMWH inhibits factor Xa
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TMJ
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young, female, psych, unilateral
Tx: NSAIDs, muscle relaxers, soft food |
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Facial Droop types
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complete (lower motor neuron (pons/brainstem)), incomplete - spares forehead (cortical)
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Botulism
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descending paralysis, bulbar first. No sensory changes. Antichol (mydriasis) differentiates from MG,Sx 6-48 hrs p ingestion
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Valve prophylaxis
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dental, brochoscopy, ERCP, cystoscopy
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BP in ischemic stroke
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tx at 220/120; tPA goal 185/115; nipride, labetalol, enalapril
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Oculogyric crisis
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form of dystonia, eyes look upward, worse c emotional state; tx: benadryl or benztropine 1mg IM
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Cerebellar infarcts
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vertigo, HA, N/V, truncal ataxia, dysarthria, ipsilateral defects; risk: drop attach (vert-basilar insuff)
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Pulsus paradoxus
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nl=10 mmHg; audible heart sounds without paplable pulse; asthma PTX
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Lipase false positives
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GU/DU , severe renal insufficiency, bowel obstruction; remains ↑ 8-14d (amy 5-7)
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Gastric volvulus
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#1 - HH in old; or cong diaphragm defect in <1yo; long axis; abd pain , vom, dist, can't pass NGT (sometimes NGT reduces); infarct only 25%
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Pseudogout
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CPPD. 1- idio others:hyperpara, hemochrom, hypomag, hypothyroid
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GI Bleed drugs
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Continuopus PPI ('prazoles); octreotide for variceal hemorrhage
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Vomiting 'lytes
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hypochloremic, hypokalemic met acidosis
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Polyarteritis Nodosa
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mononeuritis multiplex, mes ischemia, skin changes
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Takayasu's Arteritis
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coronary ischemia
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Wegener's
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early: URI; later: glomerulonephritis
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Behcet's Disease
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recurrent oral and genital ulcers; rare: hypopyon is pathognomonic
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Churg-Strauss
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pulmonary/asthma
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PCP + sulfa allergy
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primaquine and clinda(CAP) PO; pentamidine IV/inhaled
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Aortic trauma
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usually descending; tx: surgery, bp/hr control (Bblockers)
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OB terms
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lie: position within uterus; presentation: fetal part at mat pelvis; position rot pos of occiput/sacrum; station rel to ischial spines
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Diarrhea etiols
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viral (norovirus includes Norwalk); campylobacter in those seeking tx
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HIV Crypo diarrhea tx
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HAART
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Pyogenic liver abscess
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less common than amebic; seen c biliary infections, polymicrob,
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Traumatic iritis
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painful, red (perilimbic/ciliary flush), consticted. Tx: cycloplegics, 'roids; better in 1w
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Postpartum hemorrhage etiols
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1- Uterine atony, 2- tears, 3-RPoC
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U/A Casts
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white = pyelo or other inflamm; red=GN; transitional usually nl; pH=5-8 except RTA, UTI
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DIP arthritis
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OA; RA:symmetric, UE, females, c-spine; 15% RF neg
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Status epilepticus defintion
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any SZ > 5 minutes
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Afib/flutter tx
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rate control to < 100, anticoag if > 48 hrs unless no clot on cardiac echo
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Neck mass dx
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80% in kids benign; 80% of non-thyroid in adults CA; ear pain, OM ↑risk of CA
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Sausage-shaped digits
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Reiter's syndrome
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Abductected, Ext Rotated Hip in Neonate
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Infection
|
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Arthritis + Cardiac Rub
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SLE
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RA joints
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MCP, PIP
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OA joints
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CMC1, PIP, DIP
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Blindess causes in US
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1- age-related macular degeneration
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Follicular cysts
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usually asymptomatic; else: pelvic pain, urinary freq/constipation if large; don't rupture
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Corpus Luteum cysts
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may bleed, then rupture
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Theca lutein sycsts
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rare, bilat, associated with prolonged ovarian stimulation
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Dermoid cysts
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benign ovarian teratomas; but may transform to malig esp if >40yo
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Ovarina fibroma
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most common benign solid neoplasm; may get very large
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CXR in aspiration
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1- obstructive emphysema; atelectasis, pneumonia
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Painless abd mass in neonates
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Neuroblastoma (adrenal), Wilm's tumor (renal)
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HSV encephalitits
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temporal lobe; HSV-1 in adults (2, maternal in neonates); Cx usually neg; tx: acyclovir
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Tylenol tox markers
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increased tylenol level, AST
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Non-reducible dorsal PIP dislocations
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Volar plate entrament
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Jersey finger
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FDP avulsion at DIP; 75% = ring finger
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Trigeminal neuralgia
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spont remission; neuro referral & MRI: 3% have MS, 10% IC lesion; 30% need ablation; tx: carbamazepine 100 bid
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MDAC
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carbamazepine, dapsone, phenobarb, quinine, theo. ?dig, dilantin, amitriptyline, ASA
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Dig Fab indications
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HyperKalemia, Ventricular dysrhythmias, unstable SVTs, co-ingest of other carditox; relative: lg ingestion, high level
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Viral prodrome, then rash on wrists and ankles
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RMSF; tx doxy, chloamphenicol
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DIC labs
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Decrease: pt/ptt, fibrinogen, plts; increase FSP
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Fat embolism
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s/p long bone fx; resp distress, AMS, temp, petechiae
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HSP Sx
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palpable purpura on thighs/buttocks, arthralgias (ankle), abd pain, GN; ileoileal intus, worse in adults due to GN
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Hypothyroid (myxedema) Sx
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hypothermia, delayed DTR relaxation, carpal tunnel, periorbital edema
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HHS (vs DKA)
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bigger fluid and K deficit; more thrombo-emb events due to increased viscocity
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COHb T1/2
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RA: 6hrs; 100% 02: 90 min; HBO: 30 min
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Ranson's 5 early criteria
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Glu>200; age>55, LDH>350; AST>250; WBC>16K
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Carpal tunnel associtaions
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DM, hypothroidism, pregnancy, RA
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Calcium Ox kidney stone risks
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Hyperparathyroid, milk-alkali, laxative abuse, sarcoid (Ca); Inflamm bowel disease (oxalate)
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Strep Pharyngitis Criteria
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fever, NO cough, ANTERIOR cervical adenopathy, exudative tonsillitis; 0/4 - 2.5% +strep; 4/4 56%
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Osteomyelitis
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non-toxic, nl VS, usually Staph aureus, ESR & CRP very sensitive, early xray not, MRI>CT
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Intussusception
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95% peds; Adults: 75% CA; Triad (pain, vom, bloody stools) only 33%; U/S best non-invasive; air enema dx & tx c less comp than Ba
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Aplastic anemia causing drug
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Chloramphenicol complication
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Meningiococcemia complication
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Bilateral Adrenal infarction (W-F syndrome)
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Acute Cholangitis Sx
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Charcot's triad: fever, RUQ pain, jaudice (low BP and AMS = Reynold's Pentad: G- sepsis)
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Gingival hyperplasia drugs
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phenytoin, CCBs; not dose dependent, worse c poor oral hygiene (<50% of phenytoin pts)
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Intussusception in ADULTS
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small bowel, almost all c lead point (75% malig; inflamm, Meckel's); Dx c CT scan; most are partial obstructions c CC abd pain
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Inherited hypercoagulable disorders
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Suspect in PE <40yo, +FH, recurrent PE. #1- Factor V Leiden; >> plasimonogen deficency, Protein S deficiency
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Lateral canthotomy
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retrobulbar hematoma
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Risks for contrast-induced ATN
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Pre-existing renal disease, DM, hypovolemia, MM, age
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Abruptio Placentae risks
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1- Pre-eclampsia
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Hypertrophic Cardiomyopathy tx
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B-blockers
|
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SJS/TEN drug causes
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sulfonamides, anticonvulsants
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Cluster HA
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Symp ( ptosis, miosis) and parasymp ( rhinorrhea, lacrimation)
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HyperCalcemic crisis
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Ca > 14, AMS, polyuria, dehydration; tx: fluids, pamidronate/bisphosphates, loop diuretics no (HCTZ), steroids in malig
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Normal Pressure Hydrocephalus
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Triad: AMS, ataxia, urinary incontinence. Hydrocepphalus, normal CSF pressure
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Aortic Stenosis progression
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usually congen bicuspid SX: 1- Angina, 2- Syncope, 3- CHF; TX: surgery
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Arthritis + renal stones
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gout
|
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Periph (versus central) vertigo
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severe N/V, aufitory Sx, Nystagmus: no direction change, fatigues
|
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Central (versus periph) vertigo
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severe ataxia, nystagmus: +change of direction, vertical
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Judet view x-ray
|
acetabulum
|
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Basilar Skull Fx's location
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anterior (CSF rhinorrhea, racoon eyes); middle (Hemotmp, Battle's, otorrhea, CN VII palsy, hearing loss); posterior (CN IX, X (swallowing , airway))
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Adenopthy; Koplik's; Febroile SZ; Pastia's Lines
|
Roseola (German measles); measles; roseola infantum (exanthem subitum); scarlet fever
|
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Rheumatic Fever Sx (major)
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Polyarthritis(#1), carditis(#2), chorea, erythema MARGINATUM, subcut nodules; Minor: arthralgia, FEVER, ESR/CRP, PR interval
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Specific valve involvement
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Mitral - RHD #1; Tricuspid - IVDA; Pulmonic - none; Aortic - congenital, cacific, RHD #2
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Parasite and Sx
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T. Cruzi(chagas-cmp); T saginata(beef tapeworm-G/E); T trichura(whipworm-G/E c Fe-def anemia); L braziliensis-skin ulcers
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T. solium (pork tapeworm)
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neurocysticercosis: ring-enhancing cysts, inc ICP; SZ; Tx: praziquantel, steroids, neurosurg
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Propranolol OD
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worst B-blocker; SZ, coma, brady, AVBlock, hypotension, hyperK, renal failure; hypoglycemia in kids; tx: atropine, glucagon, insulin, glucose
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Malrotation c midgut volvulus
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toxic-appearing, sudden onset bilious vomiting in week #1; double bubble (pylorus separting stomach from duodenum
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Osmotic Demyeliantion Syndrome
|
alcoholics/chronic mal; 1-6d s/p tx of chronic hyponatremia; Sx: AMS, pseudobulbar palsies, spastic quadraparesis; no tx
|
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Toxoplasmosis/HIV
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ring -enhancing lesion on CT; tx:sulfadiazine, pyrimethamine, leucovorin; steroids if severe; no surgery
|
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Hand splint position
|
wrist 30; MCPs 90; IPs extended
|
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Septic Arthritis WBC
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>50,000
|
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SCFE
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fat, black, male, teen; hypothyroidism; loss of int rotation, atrophy, shortened leg
|
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Adynamic ileus causes
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post-op; hypokalemia; uremia
|
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Troponin I
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starts 3-6h; peaks12-24h; baseline 7d; highly specific at 6h; highly sensitive at 12
|
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Abx in damaged/prosthetic valves
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dental; rigid bronch; ERCP; cysto
|
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Non-midline anal fissures
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Crohn's (#1) leukemia, HIV, TB, syphilis
|
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Facial rash: perioral &nasolabial sparing
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Erythema infectiosum (fifth disease) parvovirus B19
|
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Bilateral facial nerve palsies
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Lyme (#1), MG, lymphoma,sarcoidosis, brainstem tumor, GBS
|
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SBP WBC
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>100
|
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Diabetic neurop CN III v PCOM aneurysm
|
Both have CN III (ptosis, loss of superior and medial eye movement; PCOM aneurysm involves parasym as well, has pupil effects
|
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E coli o157:H7
|
undercooked hamburger; causes HUS (kids), TTP (adults); NO Abx: increases risk of HUS
|
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Diarrhea, febrile SZ
|
shigella
|
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Diarrhea + cafeteria food, turtles, eggs
|
Salmonella (osteo in SCD)
|
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Diarrhea: frothy, foul-smllling, borbor, floating, backpacker
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Giardia
|
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Campylobacter v Giardia
|
both "backpackers" camp: 2-6 d, bloody, mimics IBD, appy, erythro (peds) FQ adult; Giardia: 1-4w, foul, float, frothy, flagyl
|
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Scromboid
|
heat stabile toxin; dark fish c poor refrig, peppery taste; histamine-like, w/I 30 min; tx: antihistamine; suspect if mult pts c allergic rxn
|
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Ciguatera
|
fish ingest dinoflag contianing toxins; weakness, perioral/hands/feet paresthesias, hot/cold rev; worse c EtOH; Tx: mannitol, amitript, diphen
|
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Rectal prolapse v int 'rhoids v Intus
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Prolapse: circular folds; Int 'rhoids: spokes on a wheel; Intuss: space between protruding rectum and anus
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Botuism
|
heat labile neurotoxin; short onset (30 min): bulbar sx(earliset-diplopia; descending paralysis, anticholinergic. Infants: honey, floppy, constipation, feeble cry
|
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Tumor Lysis syndrome
|
Hyper- -uricemia, -phosphatemia, -kalemia; HYPOcalcemia
|
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Adolescent menorrhagia
|
#1 hered: vWD; Tx, mild: IN/IV desmopressin; severe: Cryoprecipitate; OC's too
|
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Opisthotonos
|
tetanus, strychnine; tx: benzos
|
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Risk of AVN
|
femoral head, talus, scaphoid, capitate
|
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Toddler fx
|
distal tib; prox fib suspicious for abuse
|
|
Max lido doses
|
5mg/kg; 7mg/kg c epi; Lido 1% = 10mg/ml
|
|
Pneumonic Plague
|
Asia/India/ W. US; Yersinia pestis; hemoptysis, resp failure, shock; CXR: lobar pneumonia + effusion; tx: strept, gent, doxy, cipro, or CAM
|
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ESRD Narcotics
|
No demerol: SZ risk
|
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Ischemic CMP/CHF tx
|
B-blockers, ACEI, spironolactone; NO CCBs
|
|
LOW anion gap
|
MM, waldenstrom's, bromide, LI; low albumin
|
|
Vom/Diarrhea 'lytes
|
Vom: hypochloremic alkalosis; Diarrhea: hyperchloremic acidosis (normal AG)
|
|
Calcium EKG
|
inverse to QT length
|
|
Hyper Ca
|
kid stones, Fx's. anorexia, vom, constipation, fatigue, psych
|
|
Milk-alklai
|
Hyper CA; DI
|
|
MTX drug interactions
|
folate (PNV) may decrease MTX effectiveness; fatal interacton c ASA/NSAIDs
|
|
Endometriosis
|
abd pain, dysmenorrhea, dyspareunia
|
|
MAOI meds
|
Bad: amphetamine, reserpine, guanethidine, TCA, Meperidine, etc. OK: morphine
|
|
Severe HTN in kids
|
Renal: chronic GN, chronic pyelo, renal art stenois; CV: Coarctation of aorta
|
|
Peds CHF
|
Sweating c PO; poor feeds, poor wt gain, weak cry
|
|
Tet spell tx
|
knee-to-chest, O2, morphine 0.1-0.2 mg/kg
|
|
Post-MI Pericarditis v. Dressler's
|
2-4 days after transmural MI(20%; less after tPA) , +/- friction rub, EKG changes masked by evolving MI, Inc risk of dysrhyth, CHF; tx: ASA; Hep OK
|
|
Wide-complex tachy in WPW
|
Procainamide, amiodarone
|
|
Hypertrophic CMP
|
50% hered; LV enlarged -> diastolic dysfunction; sudden death, typical younf, after exertion; No BB or NTG
|
|
Dilated CMP
|
all 4 chambers; systolic dysfunction, low output; CHF, angina
|
|
Congenital Prolonged QT
|
FH of exercise induced syncope, sudden death, +/- deafness
|
|
EKG in MVP
|
PACs, PVCs. PSVT > prolonged QT; inferior St depressions; inc risk of WPW
|
|
CPAP in CHF
|
dec intubation, no mortality difference;decreased pre- and after-load
|
|
Cardiac mmanifestations of Lyme
|
bundle branch or heart block; may present as syncope from brady from 3red degree
|
|
Cocaine MI
|
Most sx w/I 1 hr; no adverse effects after 12 hrs in ER; CP associated SX: SOB>sweat>nausea; tachycardia only 16%
|
|
Commotio cordis
|
sudden VF arrest after blow to chest
|
|
Lung CA
|
#1 = adenocarcinoma; best chemo resp: small cell; Central Mass and SVC (squam, small) Periph (adeno, large); Cavitation (squam, large)
|
|
Hiccups
|
Chlorpromazine (fda), metoclopramide
|
|
Leishmania
|
Iraq, sandfly, chronic ulcer; refer to ID/derm for bx, sodium stibogluconate
|
|
Cluster HA
|
Knife-like (also in Trigem Neuralgia) rhinorrea, lacrimation, miosis, ptosis; men, suddden severe, unilat intraoc pain; O2
|
|
Increased risk of ICH c tPA for stroke
|
Increased stroke severity, signs of infarction (hypodensity or mass effect) on CT
|
|
Magnet on AICD
|
won't defib; still paces if brady
|
|
Fetal radiatin exposure
|
2-8 weeks organogensis; 8-15 weeks neuro development. Threshhold = 10 rad for teratogenesis
|
|
Kawasaki Sx, Dx
|
Fever x 5d + 4/5 bilat conj, oral mucosa(red lips, strawberry tongue, red o-p), hands and feet (ery, edema, desq), rash(perineal), (unilateral) cerv LN;
|
|
Kawasaki Comp, Tx
|
Coronary aneurysm (dec risk c IVIG 2g/kg, and ASA 100m/k divided qid
|
|
Kawasaki v scarlet fever
|
conjunctivitis rare in scarlet fever
|
|
Measles v kawasaki
|
kawasaki has minimal resp sx
|
|
Measles
|
fever, cough, coryza, conj precede rash by 2-4 days; koplik spots
|
|
TEN
|
sloughing, associated c PCN, Sulfa, dilantin; +MM involvement; death from infection, hypovol/'lyte disturbances
|
|
Chicken Pox v Small Pox
|
Chicken pox: lesions in different stages; rash trunk/scalp first, then extremities; Small pox face/extremities first, then trunk
|
|
EM vs Urticaria
|
Both better c antihistamines; only urticaria better c epi
|
|
Herpes Zoster prodrome
|
1-5d before rash: HA, photophobia, malaise, abnormal skin sensations; rarely fever
|
|
Purpura characteristics
|
symmetrical LEs -HSP; Pressure/minor trauma (ITP); distal, then spread centrally -RMSF; bulla/infarctions -DIC; necrotizing ecchymosis - warfarin vasculopathy
|
|
Decub Ulcers
|
I non-blanchign erythema (padding/posotioning); II epiderm/dermis (local debride, w->d dsg); III subcut like II, + adjunctives; IV deep fascia/musce/bone (surg)
|
|
Erythema Infectiosom
|
Fifth disease, slapped cheek c circumoral, eyelid sparing, school aged, 1-2 days later: rash on trunk/limbs central clearing
|
|
Kawasaki
|
concurrent conjunctivitis, straberry tongue (lg papillae), periph edema/erythema; fever and rash at same time
|
|
Scarlet fever
|
F, ST, HA, vom, abd pain; rash 1-2 days later starts neck/axillae/groin; sandpaper feel; pastia's lines in AC fossa and axialllae, circumoral pallor, GABHS
|
|
Roseola infantum/exanthema subitum
|
well-appearing infant, high temp (? Febrile SZ), then rash on neck, trunk, buttocks c defervescence, HHV-6
|
|
Symptomatic Hyponatremia tx
|
Vol (L) of hypertonic saline = 4*0.6(kg)/(513-Na); approx 400-450 ml over 2 hrs
|
|
Cerebral edema in kids c DKA
|
low init PCO2; bicarb use; hign BUN; no relation to glu, Na, insulin bolus
|
|
Anion gap
|
Na-Cl-HCO3; nl <=12
|
|
Osmol gap
|
2*Na + Glu/18 + BUN/2.8 +
|
|
Thyroid storm tx order
|
Propranolol (esmolol in COPD)- blocks effects, PTU-blocks synthesis, Iodine (Li if allergic)-blocks release, dexamethasone
|
|
Adreanl Crisis tx
|
Fluids, glucose, dexamethansone(better than hydrocort: no CST effect), later:fludrocotisone
|
|
Hypothyroidism-inducing meds
|
Li, amiodarone, Iodine and contrast, sulfonamides
|
|
HHNS v DKA
|
No ketosis, no acidosis, higher BS, assoc c NIDDM, more gradual onset, higher Na, more volume loss, higher mortality
|
|
Bite prophylaxis in PCN allergic
|
Cefotaxime or Ceftriaxone (dogs and cats); Clinda AND bactrim (humans)
|
|
Heat stroke tx
|
ER - evaporative; field - ice water immersion
|
|
Hypothermia cutoffs
|
definition: below 35°C; shivering stops below 32°C, pupils fixed and dilated below 30°C
|
|
Insect bite: target rash, hypertension
|
Black widow; tx: opioids, benzos; IV NTG/nipride if necessary; antivenin if no horse serum allergy
|
|
Rattlesnake
|
AKA pit viper, crotaladae (coral snakes=elapidae); Sx: local tissue destruction, coagulopathy, neuro sx(metallic taste) tx: antivenin
|
|
Hereditary angioedema
|
not IgE mediated; only Epi helps (subQ or neb); nonpruritic, but painful
|
|
Otitis externa tx
|
ofloxacin ok in perf, kids; no others; suspensions better than solutions; avoid neomycin, polymixin, acetic acid
|
|
Hyphema
|
inc risk in SCD; complicaton: glaucoma; tx: topocal Bblockers and A-agonists, IV mannitol, carbonic anhydrase inhibitor (not in sickler: increases IO sickling)
|
|
Sinusitis complications
|
Cavernous sinus thrombosis; orbital/periorbital cellulitis; Pott's Puffy Tumor; Subdural empyema, meningitis
|
|
Unilateral Neck mass etiol
|
Kids (benign: hemangioma, congenital cysts, LNs); Young adults: Mono, congenital, Hodgkin's, Lymphoma; Older adults: Sq cell mets to nodes, other CA (75%)
|
|
ANUG tx
|
chlorhex rinse; debridement; flagyl, soft, protein-rich diet; herpesgingivostomatitis: smaller, vesic lesoons, less bleeding, more systemic, no interdental pap involved
|
|
Malignant otitis externa
|
Elderly, diabetic, HIV; granualtion tissue on the floor of the canal; Pseudomonas>aspergillus>>staph, strep. (HIV: usually not pseudomonas, worse prog)
|
|
TTP
|
Pentad: low plts, MAHA, renal impair, neuro impair, fever; precip: preg (T2), HIV, lupus; INR normal (no fibrin: unlike DIC); Tx: Plasma exchange, NO plts, support
|
|
Basophilic stippling
|
lead poisoning
|
|
Hypersegmented PMNs
|
Vit B12 & folate deficiency
|
|
Multisystems, bleeding, thrombosis
|
DIC, TTP, HUS: all have schistocytes
|
|
HUS vs TTP
|
Both: anemia, MAHA; HUS: kids, predom renal sx, suportive tx, good prog; TTP: adults, low plts, predom CNS Sx, Tx: plasmapheresis, 'roids, poor prog
|
|
ITP vs TTP tx
|
ITP: IVIG, 'roIds; TTP: exchange Transfusions, sTeroids
|
|
HUS vs HSP
|
kids c MAHA, RF, usually precip by bloody diarrhea; vasulitis c abd pain, palp, purp and hematuria, precip by URI - may cause bloody diarrhea
|
|
Splenic seq vs Aplastic crisis
|
Splenic seq: elevated retics; Aplastic: low retic
|
|
G6PD deficiency
|
10% black males; triggers cause hemolytic crisis, 'Heinz bodies" (RBCs c precip HgB); Triggers: infection, fava beans, macrobid, pyridium, dapsone, sulfa, malarials
|
|
Methemoglobinemia
|
Shoes, sausages; Cyanosis: Oxidized iron in HgB doesn't bind O2; nitrates/ites, benzocaine, sulfa, dapsone, pyridium; Pox=85%; chocolate; left shift; tx: IV methylene blue
|
|
Hemophilia A
|
Classic hemophilia; Factor VIII, delayed bleeding after trauma; Tx: Factor VIII units = wt/2*% desired (100: nose, GI, CNS, else 50); VIIa if inhibitors
|
|
Hemophilia B
|
christmas disease, Factor IX; Factor IX units = wt*desired (100: nose, GI, CNS, else 50); VIIa if inhibitors
|
|
Prolonged PT
|
Liver disease, Vit K deficienccy, warfarin
|
|
Prolonged aPTT
|
Hem A, Hem B, vWD, heparin
|
|
Von Willebrand Disease
|
inadequate vWFactor: Inc BT, nl plt, PT, PTT(or sl prolonged PTT); Type I: dec vWF; II: dysfunctional; III: none
|
|
vWD Tx
|
DDAVP (I) releases vWF and VIII from vasc endo cells (all others from liver); Factor VIII conc c vWF (II, III, serious bleed); Cryoprecip if no other (infectious risk)
|
|
Anaphylaxis in pt on B-blockers
|
add glucagon to tx; reverses B-blockade that makes epi less effective
|
|
Reiter's Syndrome
|
arthritis (lover's heel, sausage digits), urethritis, conjunctivitis; typically WM, 15-35, 2-6wks after chlamydia, shigella, salmonella,campy; tx supportive
|
|
Ankylosing Spondylitis
|
young males, chronic back pain, sacro-iliitis
|
|
SLE
|
familial; black women; fever, rash (after sun), arthritis (MCP, PIP), multiple other Sx; Tx; Steroids
|
|
West Nile Virus
|
most asympt; flu-like, c rare: enceph, menin, acute flaccid paralysis (assymet, prog, dec reflexes, bowel/bladder, but no sens), long-term seq; LP: asceptic men
|
|
Strongyloides stercoralis
|
enters skin (pruritis, eryth rash); migrates to intestine; Fatal hyperinfection when immunocompromised: HIV, riods, etc
|
|
Hand-Foot-Mouth
|
vesicles on palms, soles, buttocks; ulcerating vesicles anterior mouth, not lips; Coxsackie A16; comp: orchitis, myocarditis, puln edema, ascept men
|
|
Unpateurized milk/cheese
|
Listeria; tx: ampicillin
|
|
Raw seafood
|
Vibrio; may cause severe septicemia in IC, especially liver disease; Tx:doxy, ceftaz, cefotoxime, FQs. (Norwalk also c seafood; tx: supportive)
|
|
Malaria
|
Falciparum is worst: Lact acid, hypogly, pul edema, DIC; Cerebral Malaria (20% mort); Blackwater fever (hemol ->ARF); Tx: Quinidine+Doxy, Exchange Tx
|
|
Onchocerciasis
|
filarial, River Blindness, black flies; skin nodules, lg numbers of larva -> eye; Tx prednisone (prevents tox from worm death) & Ivermectin
|
|
MRSA
|
sports teams, jail; TX: bactrim, rifampin
|
|
Relapsing fever
|
borreliosis, tick-borne spirochete; eschar at site, then F/C, myalgias, arthralgias;
Tx: doxy or erythro x 10 days |
|
Babesiosis
|
summer, northease, ixodes ticks, malaria-like protozoan invades RBC -> HA. Maltese cross on smear, severe in splenectomy; Tx: quinine+clinda; Ex TX
|
|
Ottawa Knee rules
|
Xray if any of: can't walk 4 steps(regardless of limping), can't flex at least 90 deg, tender fibular head, age 55+ (valid for ages 2 and up
|
|
Ottawa Ankle rules
|
Xray if any of: can't walk 4 both at time of inj and in ER, tenderness along posterior distal 6cm of tib, fib, or tips of lat or medial malleolus
|
|
Carpal tunnel
|
Pain, paresthesia, weakness in median dist; thenar atrophy, Tinel ( tapping on median n), Phalen (hyperflexion of wrists back-to-back )
|
|
Gonococcal tenosynovitis
|
Teen girls; several wks after sexual exposure; wrist, hand, ankle
|
|
Felon in fish handler or IC
|
Aeromonas hydrophilia (gram neg) tx: FQ
|
|
Psoriatic arthritis
|
usually PIP, DIP; sometimes SI joint
|
|
Back pain instructions
|
Activity as tolerated; NSAIDs relaxers scheduled, not PRN; PT delayed several weeks
|
|
Rhabdo tx
|
fluids: if CK > 6000, acidemia, dehydration or underlying renal disease: urine alk after volume restored; loop diuretics, mannitol (Ca if hyperkkalemic)
|
|
Soft-tissue calcifications
|
skin-popping, underlying fx, dermatomyosisits (rash and prox muscle weakness); myositis ossificans (arm, thigh, periph @metaphysis) v osteosarcoma centrally @ epiph)
|
|
CT v GRE MRI in acute stroke
|
equivalent for identifying acute hemorrhage; MRI better for detecting hemorrhage in ischemic CVAs
|
|
ALS
|
Upper and lower motor neurons: extremity weakness, dysarth/phagia, spasticity, hyperreflexia; normal sensation
|
|
Tick paralysis
|
female dermacentor tick; ascending: mimics GBS, but no sensory sx
|
|
Familial periodic paralysis
|
extremity weakness; no CN, sensory, or mentation changes
|
|
MG
|
Abs to Ach receptor; bulbar, facial, proximal weakness; no sensory sx
|
|
MCA infarct
|
most common; contralateral motor/sensory: F, A>L; Aphasia if dominant hemi; neglect, dysarth in non-dom (left is dom in R and 80% of L), homonymous hemianopsia
|
|
Basilar artery infarct
|
severe quad, coma, locked-in (pons) - upward gaze only
|
|
Carotid dissection
|
sudden ALOC, contralateral motor and sensory
|
|
Lacunar infarcts
|
isolated motor OR sensory; associated c Htn
|
|
Post Cerebral Art infarct
|
Predom visual: HH; minimal motor abnormailities; no aphasia; severe sensory; memory loss, hallucinations
|
|
PICA (lat medullary) infarct (X=P/T)
|
Wallenberg S.: Ipsi CN V (face: P/T, corneal reflex); Descending Symps (ipsi Horner)l Lat Spino-Thal (Contra extremity P/T); Vestib (nystagmus)
|
|
Anterior Cerebral Artery infarct
|
Contralat L>F,A ; minimal sensory; altered judgement
|
|
Vertebrobasilar infarct (X=M)
|
ipsi CN c contra weakness; drop attacks
|
|
Sjogrens
|
F>>M, dry eyes, dry mouth; multiorgan problems; similar to SLE, RA
|
|
Pseudotumor Cerebrii (Idio Intracran Htn)
|
dec CSF uptake; fat, young, F; HA, vision changes, N/V, dizzy; CN VI, pappiledema; CT: small vents, big cisterna magna; LP: inc pressure; Tx: diamox, LPs
|
|
Butyrophenones
|
Haldol, droperidol; cause drug-induced Parkinson's aka EPS, dystonia due to dopamine block, xs cholinergic
|
|
Parkinson's drugs
|
levo-dopa (precursor); carbidopa (enzyme inhibotor); dopamine agonists (bromocriptine, pergolide); MAO-B inhibitor (selegiline); antichol (benztropine)
|
|
SAH etiol
|
saccular (berry) aneurysm
|
|
Simple febrile SZ
|
<15 min; 6m-5y; one/24hrs; well-appearing c normal neuro after post ictal; recurrence risks: age<12-18m, short duration of fever, lower fever, Fam hx
|
|
Febrile SZ LP indications
|
<12-18mos; irritable,lethargic, dec feeding pre-ictal; post-postictal AMS; menineal s/s; current /recent Abx; focal sx; Sz > 15 min; 2 or more SZ/24h
|
|
Empiric meningitis therapy
|
3GCeph + Vanco (+ampicillin in young and old)
|
|
Drugs in breastfeeding women
|
Bad: ergotamine (V/D/SZ in baby); Good: Morphine (very low concentrations in breast milk)
|
|
Trichomonas vaginalis
|
profuse, frothy, yellow-green d/c; flagellated parasite; Exam: vag walls erythem, edematous, tender; Dx: seen on wet mount; Tx: metronidazole
|
|
Emergency contraception side effects
|
Minimize by using progestin-only
|
|
Molar pregnancy
|
Sx: T1, T2 bleeding; size, HCG> dates; pass "grape-like cluster"; hyperemesis, hyperthyroid, pre-eclampsia, PE; US: "snowstorm"; complete mole: inc risk of malig
|
|
HELLP vs TTP
|
both c "LP"; TTP: neuro, renal sx, nl antithrombin III, 50% occur earlier than 24wks; tx: pheresis, roids, antiplt meds; HELLP: inc LDH, RUQ pain, almost always T3, Tx: Mg, roids, delivery
|
|
Hemolysis
|
schistocytes, increased LDH, bilirubin
|
|
Positive direct Coombs
|
hemolysis caused by immune process
|
|
Contrast-induced renal insufficiency
|
ATN; Protective: fluids, HCO3, NAC(2d before!); inc Cr in 3d, recovery by 10-14d
|
|
Contrast & Metformin
|
renal insuff -> inc metformin levels -> inc risk of DKA; hold for 48 hrs
|
|
Post-transplant renal failure
|
Increased cyclosporine level: drug-induced nephrotox; normal level: acute rejection (tenderness at graft site, increased BP, Cr, wt, edema,
|
|
Balanitis - Balanoposthitis
|
inflammation of glans; inflammation of glans and foreskin
|
|
SBP in PD
|
Cloudy fluid, abd pain, fever; Dx: >100 WBC, 50%neutrophils, or positive gram stain
|
|
Peds UTI presentation
|
neonate - sepsis work up; pre-school - abd pain, vom, no diarrhea, enuresis, accidents; school-age: like adults
|
|
Renal failure: Ca - PO4
|
RF -> dec PO4 excretion -> Inc PO4 levels; Ca x PO4 > 72 causes systemic calcifications: pseudogout, finger/toes/cardipulm vasc; tx: PO4-binding gel, low Ca dialysate
|
|
Priapism drugs
|
Cause priapism: trazodone(#1), hydralizine, CCb, chlorpromazine, SSRIs (venlafexaine -Effexor), ED tx (inj, PO); TX: terbutaline subcut, sudafed, alpha ag inj
|
|
Dialysis shunt complications
|
#1 - Clot, infection, steal syndrome, hemorrhage (tx: protamine .01mg/U heparin or 1:1 for enoxaparin, DDAVP stimulates plts, fluids, blood prn)
|
|
Testicular torsion
|
peak = 13yo; inc risk c bell-clapper deformity (tunica vag doesn't fix the testis normally; elevated; absent cremaster; no relief c elevation (prehn sign: epidid)
|
|
Conversion disorder
|
Women, lower class, M>S, La Belle Indifference NOT sens or spec; no insight; wide differential (SLE, MS, hyperthyroidism);
|
|
Wernicke's Syndrome
|
Confusion, ataxia, ocullomotor, TX: lg doses of thiamine
|
|
Anorexia
|
begins in adolescence, personality d/o's (O-C); low wt, fear of overweight, absence of 3 menses; rarer than bulimia
|
|
Bulimia
|
strict dieting, binge eating, purging, excessive exercise, fasting, overconcern c body shape
|
|
Wells PE Criteria
|
Sx of DVT; HR>100; Immob or surgery w/I 4 wks; h/o previous DVT or PE; hemoptysis; malig w/I 6 mos or palliation
|
|
PE EKG findings
|
tachy, RAD, p-pulmonale, RBBB, S1Q3T3, TWI V1-4
|
|
PE CXR findings
|
common, non-specific: elevated diaphragm; less common, nore specific: Hampton's hump (pleural-based wedge), Westernark (dec vascularity distal to PE)
|
|
False-positive D-dimer test
|
Trauma, pregnacy, recent surgery, stroke/MI, infection, new line, Inflammatory disease (SLE etc)
|
|
Heparin dose in PE
|
80U/kg bolus, then 18U/kg/hr or enoxaparin 1mg/kg q12h
|
|
Asbestosis
|
CXR: early: lower and periph; late: middle/upper; Associated Cas: Sqamous, adenocarcinoma; mesotheliomas
|
|
Mesotheiomas
|
asbestos-related; not related to tobacco; 50% metastasize
|
|
Primary Spont PTX associations
|
Tall, male, smoker, MVP, Marfan, NOT exertion (#1 In secondary: COPD)
|
|
Acute chest syndrome in SCD
|
CP, T, ↑RR, wheeze/cough, new infiltrate of one complete lung segment; infection (chlamydia, mycoplasma); infarction, fat emboli
|
|
CXR in emphysema
|
hyperinflation, decreased vascular markings, small cardiac silhouette, flat diaphragm,increased retosternal space, bullae
|
|
Bronchiectasis
|
medium airways at segmental level; Viruses (adeno, flu), bacteria (Staph, klebs, pseud, H flu, myco); purulent cough, hemoptysis
|
|
Fat embolism
|
long-bone fx's; can enter systemic circulation; petechial rash on UPPER body; low platelets early; (fat in urine NOT specific); no heparin; steroids
|
|
Mediastinal disease
|
Acute mediastinitis: esoph perf, sternotomy; chronic: TB, histo, sarcoid; Hamman crunch: left lat recumbant; Ba useful for posterior mediatinal eval (esoph…)
|
|
Cystic fibrosis
|
recess, w>b, exocrine abnormal; Early: S Aureus, H flu; Late: Pseudomonas, aspergillus, non-TB myco; CXR: hyperinflation esp RUL; PTX, hemopt, rect prolapse, intuss, decreased Na, Cl, K
|
|
Atypical pneumonias by age
|
<40: Mycoplasma; Elderly: Legionaella
|
|
Croup tx
|
Oral dex = IM, epi nebs: both help; cool mist: no help
|
|
Croup vs bronchiolitis
|
Croup: #1=parainfluenza, upper airway, bark like a seal, steeple sign, tx: dex, epi nebs; Bronchiolitis: #1=RSV, lower airways, retract/flare, tx: O2, racemic epi, no steroids
|
|
Primary spont PTX tx
|
stable: observe if <20%; resorbs at 1-2%/day (3-4x faster c O2)
|
|
Post Lung transplant infections
|
PCP proph c septra; bacterial in first 3 mos; #1 viral = CMV; aspergillus: invasive disease
|
|
Asthma deaths
|
systemic steroids, low S-E, urban, black, female, 15-34, at night
|
|
Lung abscess
|
Immunocompetent: anaerobic; compromised: aerobic (not strep); lower lobe basal segs, upper lobe post segs; anterior: inc CA risk; communicates c bronchiole
|
|
Large vessel vasculitis
|
Tx: prednisone; Giant Cell arteritis: carotid artery: head, face, vision; Takayasu's: aorta: finger ischemia, arm claud
|
|
Medium vessel vasculitis
|
PAN: skin, nephritis, mes isc; Wegener: sinus, pulm, nephritis; Behcet: oral & genital ulcers, eye sx; microscopic polyangitis: pulm, nephriris; tx: cyclophos, pred
|
|
Small vessel vasculitis
|
HSP: palp purp, abd pain, n/v/d, hematuria (pred); Goodpasture: cough, dyspnea, hemopt, GN (pred, cyclophos, plasmapheresis
|
|
ARDS
|
caused by trauma, infection aspiration, mult drugs; CXR: bilat diffuse infiltrates, heart WNL; tx: low TV (6ml/kg) vent; no steroids
|
|
Intubation and asthma
|
ketamine, propafol bronchodilate; TV= 6-8ml/kg (nl=8-10); RR=8-10/min (nl=10-12); I:E = 1:5; Insp flow rate 80-100 (nl= 60L/min) Pplateau <30
|
|
Male breast CA
|
testicular abnormalities, Klinefelter, FH, nipple d/c, Jewish; not a/w gynecomastia; Most: painless subareolar mass;
|
|
Peds pneumonia tx
|
0-3w amp and gent; 3w-3m erythro/zith; 4m-4y amox; 5-15 ertyth (doxy >8); can sub/use IV cefotaxime & add vanco to all if sick
|
|
Adult pneumonis tx
|
out-pt <60: macro or doxy; >60 or in-pt: (macro&ceph) or FQ; ICU
|
|
Hydroflouric acid
|
rust remover, glass etching, semiconductors; delayed sx = lower conc; pain out of prop; acidosis, hypo-calcemia, -magnesemia (bind to F); hyperlkalemia; Tx: Ca Gluconate
|
|
Warfarin effects
|
blocks Vit K-dependent factors: II, VII, IX,X, and anticoag factors Prot C and S; initial increased thrombogenesis early (Prot C def): skin necrosis (3-8d)
|
|
Warfarin interactions
|
most block coumadin metabolism, increasing INR; exceptions: antacids, antihists, antipsych/anxiety, OCPs, barbs, non-dil anti-SZ
|
|
GHB OD
|
identical to pure benzo, but suddenly awake
|
|
benzo/opiod urine screen false negative
|
lorazepam; fentanyl, meperidine, methadone, propoxyphene, tramadol
|
|
Moonshine
|
lead poisoning; encephalopathy (kids>adults) (inhaltion in industrial); motor, not sensory neuropathy: wrist drop; dx: levels, "basophilic stippling" tx: chelation
|
|
Valproic acid lab effects
|
OD: met acid, hyperNa, hypoCa; therapeutic and OD: elevated NH3
|
|
NMS v serotonin syndromesx
|
both: autonomic instability, rigidity; NMS: slow onset, bradykinesia "lead pipe"; Serotonin: hyperkinesia, worse in LEs, rhabdo; hyperreflexia and clonus can coexist
|
|
NMS v serotonin syndrome tx
|
NMS: , benzos, dantrolene, bromocriptine, paralysis (non-depol: roc, vec); serotonin: cooling, cyprohepatidine
|
|
Ketamine
|
dissociative: blocks aud/visual, painful: analgesia, amnesia, sedation; airway preserved; inc HR, BP; rapid onset, 1.5m/k IV 4-5 IM; atropine to dec secretins, benzos for emergence, transient laryngospasm
|
|
Li tox
|
confusion, tremor, hyperreflexia; DI, not DM; serotonin synd, not NMS; tox precip by RF or dehydration; acute: GI>CNS; chronic: opposite; fluids, HD, no phenytoin (dec excretion of Li)
|
|
Cat vs Dog bites
|
Cats: virulent P multocida; usually not polymicrob, all get abx; dogs: non-virulent, polymicrob, prophylax only hands, DM, ec
|
|
Burn classifications
|
Mod risk in 10-50 yo c partial thickness= 15-25%; 10-20% in <10, >50yo; full thick 2-10%
|
|
Brown-Sequard
|
penetrating trauma; hemisection; ipsi motor, vib/position; contralateral pain/temp
|
|
Anterior Cord Syndrome
|
loss of motor, pain/temp; preservation of vib/position
|
|
Cauda equina syndrome
|
bowel/bladder dysfuntion, perineal anesthesia, variable LE motor/sens
|
|
GCS
|
Motor: none, decerbrate, decorticate, withdraw, localize, follow; Verbal: none, moan, nonsense, confused, oriented; Eye: none, pain, verbal, spont
|
|
Parkland Burn formula
|
4ml * %BSA * kg. Give 1/2 in first 8hrs, rest over next 16.
|
|
Argyl Robertson pupil
|
prostitute's pupil (syph); accommodate, but don't react (to light); normal constricts for both
|
|
NEXUS C-spine
|
Low risk: no midline tenderness, alert, not intoxicated, no focal sx, no distracting injury
|
|
TBI tx
|
NO steroids; Maintain BP: fluids OK; Hypervent to 30-35 if other measures fail
|
|
Traumatic TM rupture
|
Blunt: usually anterior, inferior: no f/u; superior/posterior: ENT w/i 24 hrs; no swimming; flying OK
|
|
Traumatic Aortic teat CXR
|
wide mediastinum, obscured aortic knob, apical capping, wide paratracheal stripeesoph displaced to right, inferior displacement of left mainstem; not R1-2 fx
|
|
Basilar Skull Fx
|
most common:: temporal bone, external canal, and TM c dural tear
|
|
Types of blood for transfusion
|
Leukocyte-poor RBCs (previous (non-hemolytic) febrile; Irradiated (neonates, imm-compromised);
|
|
IO complications
|
Prolonged us (>1-2d): cellulitis; D50: osteomyelitis; NaHCO3: sterile bone inflammation
|
|
Preferred IO sites
|
Adults: distal tib, prox to medial malleolus; Peds: anteromedial surface of proximal tibia
|
|
Airborne precautions
|
measles, varicella, TB
|
|
Ramsay Hunt
|
H Zoster infection of geniulate gang; facial pain/paralysis, tinnitus/hearing loss, lesions on TM/canal; Tx: prednisone, antivirals
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LP: Increased Protein
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MS, GBS
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Neuromuscular junction diseases
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No sensory findings: MG, Eaton-Lam, Botulism, Tick paralysis
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