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41 Cards in this Set
- Front
- Back
Dx and antibx tx for cholecystitis
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dx: US #1, HIDA if necessary
tx: cefazolin, cefoxitin 1.5g IV one dose |
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Charcots Triad
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cholangitis:
1. fever/chills 2. juandice 3.RUQ pain |
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Reynold Pentad
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charcot triad + hypotension and altered mental status
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Dx of Cholangitis
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RUQ u/s if ERCP is not available
-elevated LFTs usually |
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DDx of episgastric pain (name 5)
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Acute pancreatitis
MI GI bleed Peptic ulcer dz GERD |
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Ransons Criteria for Pancreatitis
5 items |
1. glucose >200
2.Age>55 3.LDH>350 4.AST>250 5.WBC>16,000 |
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DDx for lower quadrant/pelvic pain
9 items |
1. appendicitis
2.ovarian torsion 3.ovarian cyst rupture 4.ectopic 5.PID 6. Hernia 7.neprholithiasis 8.diverticulitis 9.uti |
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3 signs done on PE for appendicitis
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1. Psoas: pain with active flexion against resistance or passive extension of R leg
2. rovsing: RLQ pain with palpatin of LLQ 3.obturator: pain wiht internal rotation of the flexed R hip |
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Dx study for appendicitis
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Abdominal CT with oral contrast
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antibx tx for appendicitis
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cefoxitin or cefotetan 2 g IV within 2 hours of surgery
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Dx test for ovarian torsion
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Pelvic U/S with doppler is test of choice
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Direct vs Indirect Hernia
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Indirect: contents pass through internal inguinal ring and canal, protrude lateral to inferior epigastric vessel
Direct: contents protrude medial to inferior epigastric vessels through Hesslebach triangle |
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Outpatient antibx tx for diverticulitis
(two drug regimen) |
Bactrim DS po BID or Cipro 500-750mg po bid PLUS
Flagyl 500 mg po QID or Augmentin 500/125mg po TID X 10-14 days |
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inpatient antibx tx for diverticultiis
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amp 1-3g q4-6hrs, gentamicin 2mg/kg IV and flagyl 1g IV
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Ruptured AAA triad
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1. back pain
2. hypotension 3.pulsatile abdominal mass |
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HCO3 is down in _________
and ________ in acid/base disorders |
metabolic acidosis and respiratory alkalosis
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hco3 is up in _____ and ______ in acid/base disorders
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metabolic alkalosis and respiratory acidosis
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CAUSES OF METABOLIC ACIDOSIS WITH ANION GAP
*MUDPILES |
Methanol
Uremia DKA Paradehyde iron/isoniaxid od lactic acidosis Ethanol Salicylate OD |
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Causes of metabolic acidosis WITHOUT anion gap
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Carbonic anyhdrase inhibitor tx
Hyperalimentation Addisons dz Renal tubular acidosis Diarrhea Fanconi Syndrome |
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Causes of respiratory alkalosis
Chloride responsive (>15) |
Vomiting
Diarrhea Diuretic overuse NG suction Volume depletion |
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Causes of Respiratory Alkalosis
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CNS lesion
PRegnancy Sepsis High altitude Salicylate tox Liver failure hyperventilation CHF PE PNA Hyperthyroidism |
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Causes of Metabolic alkalsosi
Chloride unresponsive (Cl<15) |
Diretic overuse
Bartter syndrome hypomagnesemia hyperaldosteronism liddle dz |
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Name three intial things you would do to manage DKA
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1. Bolus IV fluids 1-2 L initially, dont overhydrate too fast!
2. 10 units insulin at first, then 0.1mg/kg insulin drip if needed, stop drip if glucose reaches 250 3.KCl with fluid if less than 4.5 (will be elevated at first, then drop once acidosis is corrected, give after correction) |
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Sodium Correction with hyperglycemia
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For Q 100mg/dL glucose more than 100, Na+ drops 1.6meq from 140.
ex Glucose-200-->Na+=138.4 |
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Causes of hyponatremia of Urine Na+ is > 20meq
(Na lost renally) |
Hypovolemic: Diuretic overuse, salt wasting nephrophaty, mineralocorticoid def.
Euvolemic: SIADH, hypothyroidms, glucocorticoid def. Hypervolemic: ARF/CRF |
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Causes of hyponatremia with Urina Na < 10meq (implies extrarenal Na loss)
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Hypovolemic: vomiting, diarrhea, NGT drainage, third spacing
Euvolemic: Psychogenic polydipsia, dilution of infant formula Hypervolemic: Decrease effective IVF, CHF, Cirrhosis, asictes, nephrotic syndrome |
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Tx of hyponatremia:
1.hypovolemic cause 2. euvolemic cause 3.hypervolemic cause |
1. hypovolemic: volume and Na+ restoration with NS, correct over 24 hours
2. restrict free water intake 3. fluid restriction, lasix 10-40mg IV X 1to prevent or treat volume overload |
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central pontine myelinolysis
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occurs from excessvely rapid correction, consists of dysarthria, sx, quadriparesisi and hypotension
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RBC cast in ARF indicates _________
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glomerulonephritis
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WBC cast in ARF indicates _________
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pyelonephritis
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granular cast in ARF indicates _________
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ATN
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Fatty cast in ARF indicates___________
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Nephrotic syndrome
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hyaline cast in ARF indicates _________
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dehydration, low renal blood flow
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Prerenal causes of ARF
(3 main causes) |
1. Dehydration ( decreased renal perfusion from volume depletion)
2.postsurgical third spacing (volume redistribution) 3.CHF (decreased cardiac output) |
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Intrinsic causes of ARF
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1. ATN most common
2. neprhotoxic agent ie IV contrast, Aminoglycoside, acute rhabdo 3.vasculitis, hetaic failure, renal vascular thrombosis or embolization 4. NSAIDs, Acute interstitial nephritis from drug exposure ie PCN, NSAIDs, diuretics |
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Causes of Postobstructive ARF
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1. prostatism, prostate CA, bladder neck obstruction
2.STD hx, urethral obstruction 3. hx of malignancy, late term pregnancy, radiation tx, b/l renal stones 4. neurogenic bladder |
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Fomepizole is drug used for what type of intoxication?
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methanol/ethylene glycol
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Causes of Altered Mental Status
*AEIOUTIPS* |
Alcohol, arrythmia
Epilepsy, encephalopathy, endocrinopathy, electrolyte abnormality Insulin Overdose, oxygen Uremia Trauma, tumor,thermal Infection Psychiatric Stroke, SAH, SDH, seizure,shock |
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tx of cat/dog/human bites
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Augementin
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organism of cat/dog bites
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Pasteurella multocida
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organism of human bites
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Eikenella
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