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87 Cards in this Set
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Patient with very developed muscles presents to ER with new onset seizures. Prior to onset, his workout partner stated that he had seemed lethargic, weak, and irritable. What's going on?
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A: Hypernatremia secondary to steroids use.
- Also happens in patients with fluid loss and those on hypertonic fluids What is the treatment? |
A: Correct underlying cause (pg. 133) 1/2 nml saline or water - Correct 1/2 the water deficit in the first 24 hrs, then second 1/2 over the next 2-3 days |
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76 yo M POD 3 s/p TURP has been under going bladder irrigation. He develops nausea and vomiting, followed by seizures and coma. What's up?
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A: Hyponatremia
- Also found in high-output iliostomy pt, hyperglycemia, adrenal insufficiency What's the Tx? |
A: Determine value status and cause (pg. 132) - If eu- or hypervolemic, water restrict Correct hyperglycemia For refractory Dz --> hypertonic saline |
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Patient with extensive 2nd and 3rd degree burns. EKG shows flattened P waves, peaked T waves, and a wide QRS before he goes into V-fib and dies. What caused this arrythmia?
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A: Hyperkalemia (>5) secondary to fluid shift
- Also found in DKA, leukocytosis, and crush injuries What's the Tx? |
A: 1) Calcium gluconate (stabilizes the myocardium; onset 2 min, duration 30 min) 2) HCO3- (further stabilizes myocardium w/ duration = 90 min) 3) Glucose and insulin 4) Albuterol and loop diuretics 5) Kayexalate and/or diuresis 6) Address underlying cause AFTER all previous steps! |
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54 yo F POD 3 s/p bowel resection has an NG in place. After her daily digoxin dose, she develops NV, hyper salivation, and sees green halos around objects. EKG finds depressed T waves and prominent U waves. What's up?
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A: Hypokalemia secondary to chronic NG suction
- Also seen in chronic diarrhea and vomiting, diuretic use, met. alkalosis, hyperaldosteronism (Cushing's, Conn's, CHF, RAS), burns, beta-agonist use, and hypomagnesemia - Could go into V-tach - Will have increased sensitivity to digoxin!!! What's the Tx? |
Depends on the cause |
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Patient with renal carcinoma develops a kidney stone. Later he gets constipation and AMS. EKG shows shortened QT interval. What's the Dx?
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A: Hypercalcemia
- Also found in bone, kidney, and parathyroid disorders, and acute pancreatitis What's the Tx? |
A: hydration and loop diuretics, bisphosphates, and calcitonin |
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After receiving a blood transfusion, and patient's left face twitches when the left jaw angle is tapped (Chvostek's sign) and the hand spasms when a BP cuff is inflated (Trousseau's sign). EKG shows QT prolongation. What's the Dx?
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A: Hypocalcemia secondary to blood transfusion
- Also seen in parathyroid resection, low Mg++, and renal failure What's the Tx? |
A: Calcium gluconate, Vit D |
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A CKD patient has decreased DTRs and muscle weakness. When taking her vital signs, the nurse notices that she is bradycardic and has a low BP. EKG shows PR and QT interval prolongation. What's the Dx?
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A: Hypermagnesemia secondary to excessive Mg replacement for CKD
What's the Tx? |
Calcium gluconate Nml saline infusion with loop diuretics Dialysis |
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Patient presents to the ER in an arrhythmia found to be Torsades and soon dies. The paramedics tell the ER doc that the strip in the ambulance showed widened T waves and QRS, prolonged PR and QT intervals. The family later tells the doctor that the deceased patient was an alcoholic who had suffered a stomach bug with extreme NVD for the past week. What's the Dx?
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A: hypomagnesemia
- found in NVD, malabsorption conditions, aggressive diuresis, alcoholism, and chemoTx What's the Tx? |
MgSO4 |
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Patient being treated for a malignant villous adenoma c/o hard masses under the skin. Xray shows them to be soft tissue calcifications. EKG shows a new onset heart block. What's the Dx?
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A: High phosphorous
- usually an iatrogenic condition - Also seen in rhabdomyolysis, hypoparathyroidism, and hypocalcemia What is the Tx? |
- Decrease dietary phosphorus (animal products, dark green vegetables) - Aluminum hydroxide - Hydration and acetazolamide (carbonic anhydrase inhibitor) - Dialysis |
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After a week of NPO feeding and a NG tube, the tube is DCed and the hungry patient consumes a large, high glucose meal. He develops diffuse muscle weakness, followed by flaccid paralysis. What's up?
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Low phosphorus caused by refeeding syndrome.
- Also seen in excessive IV glucose use, hyperparathyroidism, and osmotic diuresis - Refeeding syndrome = Low Mg, K, and Phos cause by a large glucose load after long periods of NPO. What's the Tx? |
Potassium phosphate or sodium phosphate |
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Vertigo, tinnitus, hearing loss
(-) Dix-Hallpike |
Meniere's Dz
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Syncope lasting 8-15 minutes
Facial numbness Parathesias Visual changes |
Vertibrobasilar insufficiency
Hx arthrosclerosis and CV risk factors |
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AA female
red nodules on legs joint pain vision changes |
Sarcoidosis
Labs: elevated Ca, Vit D, ACE |
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Conditions with erythema multiforme
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HSV
Recent URI mycoplasma |
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Conditions with erythema nodosum
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1. Sarcoidosis
2. Bacterial infections (Streptococcal, TB, Yersinia, Salmonella, Legionella) 3. Fungal infections (Coccidiodomycosis, Histoplasma, Blastomycosis) 4. Drugs: sulfonamides, OCPs 5. Enteropathies such as Crohn’s disease and UC 6. Hodgkin’s lymphoma 7. Behcet disease (= vasculitis w/ recurrent oral ulcers, genital ulcers, and uveitis) 8. Pregnancy |
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Waxy casts
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Advanced CKD
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Hyaline casts
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non-specific
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Granular "muddy brown" casts
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ATN (Causes: persistent hypovolemia, shock, sepsis, severe hemolysis, rhabdomyolysis, amino glycosides, and amphotericin B)
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Red blood cell casts
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Nephritic syndromes (post-streptococcal glomerulonephritis, IgA nephropathy, and rapidly progressive glomerulonephritis),
malignant hypertension. |
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WBC casts
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tubulointerstitial inflammation,
acute pyelonephritis transplant rejection. |
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Tense (hard to rupture) bullae,
Ab against dermo-epidermal junction, anti-epidermal basement membrane antibodies, IF: linear band of inc. eosinophils along BM Characteristics: mucosal involvement rare, typical age 70-80, Nikolsky (-) |
Bullous pemphigoid
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Flaccid blisters
all epidermal surfaces (including mucosal) typical age 30-40, Nikolsky (+) Anti-epithelial cell Ab, anti-keratinocyte Ab IF: "tombstone" pattern around epidermal cells Seen always in toxic epidermal necrolysis and sometimes in scalded skin syndrome |
Pemphigus vulgaris
Seen always in toxic epidermal necrolysis and sometimes in scalded skin syndrome |
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Breast cancer tumor marker
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CEA
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Malabsorption syndrome + joint pain
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Whipple's Disease
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HLA- DR4
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RA
Also ANA, RF, ESR, anti-CCP (anti-cyclic citrullinated peptide; most specific!) |
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Anti-histone Ab
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Drug-induced SLE
SHIP: Sulfas, hydralazine, isoniazid, procainamide |
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Meds the predispose to latent TB reactivation
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Etanercept (TNFa receptor analog)
Infliximab **Both are RA drugs** |
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HLA-DR2
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Multiple sclerosis
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HLA-DR3
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Diabetes mellitus
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HLA-DR5
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JRA
Kaposi's sarcoma Hashimoto's thyroiditis |
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Painless vaginal bleeding during preg
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Placenta previa
Incidence = 1:200 Risk factors: prior c-section, grand multiparity, advanced maternal age, multiple gestation and prior placenta previa Tx: deliver via C-section |
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Painful vaginal bleeding during pregnancy
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Placental abruption
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Head trauma --> lucid interval followed by LOC
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Epidural hematoma
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Head trauma --> ruptured middle meningial artery
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Epidural hematoma
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Head trauma --> ruptured subcortical veins
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Subdural hematoma
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mcc of endocarditis in IV drug users
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Staph Aureus
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mcc endocarditis in prosthetic valves
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steph. epidermidis
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MCC endocarditis in left-sided subacute endocarditis
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strep viridians
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MCC endocarditis in patients long-term indwelling catheters, malignancy, AIDS, or organ transplant (i.e. immunosuppressed)
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Candida albicans
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Endocarditis associated with GI malignancies (like colon cancer)
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Strep bovis
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Innervates biceps brachii, brachialis, and caracobrachialis
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Musculocutaneous N.
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Innervates the subscapularis
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Upper subscapular N
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Innervates teres major
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Lower subscapular N
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Muscle increases in length w/ contraction
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Eccentric contraction
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Muscle shortens while contracting
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Concentric contraction
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Muscle is loaded and contracted in rapid sequence
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Plyometric contraction
The short cycle affects the sensory response of the muscles spindles and golgi tendon organs --> greater contraction force than normal strengthening exercises |
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Muscle contraction where veolcity remains constant while the force of contraction varies
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Isokinetic/isovelocity contraction
Never occurs naturally in the body |
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Muscle contracts while maintaining constant length
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Isometric contraction
Ex: pushing against a wall |
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Proximal muscle weakness, depression, myalgias, dysphagia, dysphonia, periorbital heliotrophic rash, Gottron's papules
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Dermatomyositis
Guttron's papules = purple papules on DIP and MCP joints Lab: elevated CK, (+) ANA and anti-Jo-1 Ab (polymyositis has these, too. Be careful!) |
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Proximal muscles tenderness, stiffness, and arthralgias
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Polymalgia rheumatica
**Proximal muscles will be tender, but NOT WEAK (unlike dermatomyositis and polymyocitis) |
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Esophageal wall rupture 2o to excessive vomiting (usually in eating disorders)
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Boerhaave's syndrome
Tx: IVF, broad-spectrum Abx, prompt surgical intervention **Can cause pneumomediastinum -->subcutaneous emphysema, mediastinitis, sepsis |
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Parkinson's tetrad
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Resting tremor, cog-wheel rigidity, bradykinesia, postural instability
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Aniline dye exposure increases risk of which cancer?
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Transitional cell bladder cancer
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Gynecomastia + spider angiomata + asterixis + testicular atrophy
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Cirrhosis
-gyncomastia & spider angiomata from elevated estrogen levels - asterixis (hand flapping) from heptic encephalopathy |
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What PSA level is a positive screen (i.e. suspicious for prostate cancer)?
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PSA > 4 ng/mL
*PSA > 10 --> transrectal US |
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Skin pigmentation + diabetes + arthritis + FHx
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Hemochromatosis
Labs: elevated transferrin saturation |
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Decreased ceruloplasmin seen in?
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Wilson's disease
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Anti-mitochondrial Ab
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Primarily biliary cirrhosis
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Decreased alpha-1 antitrypsin levels indicates?
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Liver disease
emphyseam alpha-1 antitrypsin deficiency |
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the probability of finding a significant statistical association in your study if one truly exists
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Power
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the risk of the disease in people exposed to a given factor
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Relative risk
- determined through cohort studies |
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the null hypothesis is rejected even though it is true
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Alpha error (also known as Type 1)
- aka a false-positive! |
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null hypothesis is not rejected even though it is false
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Beta error (also known as Type 2)
- aka a false-negative! |
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the measure of how far a set of numbers is spread out. It describes how far the numbers lie from the mean.
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Variance
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AA male + HIV + nephrotic syndrome
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Focal segmental glomerulosclerosis
- Also seen in chronic HTN & obesity Bx: sclerosis w/ renal capillary tufts Tx: prednisone, cytotoxic meds, ACEi/ARB |
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MCC nephrotic syndrome in white adults
Hx of HBV, syphilis, malaria, or exposure to gold salts (common in RA meds) |
Membranous nephropathy
Bx: spike and dome appearance d/t granular deposits of IgG and C3 in BM |
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Drug used for CML and GI stromal cell tumors. It's a Philadelphia Chrom bcr-abl tyrosine kinase inhibitor
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Imatinib
SE: fluid retention (use w/ caution in CHF and CKD patients) |
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Monoclonal Ab against HER-2 (erb-B2) used in HER-2 (+) breast cancer
Major SE of cardiotoxicity |
Trastuzumab
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Alkylating agent used in Tx of CML. Can also be used for ablating bone marrow in hematopoietic stem cell transplant patients
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Busulfan
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Head and neck autonomic innervation
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S: T1-T4
P: CN X |
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Heart autonomic innervation
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T1-T6
CN X |
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Lungs autonomic innervation
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T1-T6
CN X |
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Spleen autonomic innervation
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T5-T9
CN X |
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Stomach autonomic innervation
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T5-T9
CN X |
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Liver autonomic innervation
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T5-T9
CN X |
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Gallbladder autonomic innervation
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T5-T9
CN X |
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Proximal duodenum autonomic innervation
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T5-T9
CN X |
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Middle GI (distal duodenum - proximal 2/3 of transverse colon) autonomic innervation
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T10-T11
CN X (from lesser splanchnic nerve all sup. mesenteric ganglion) |
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Kidneys autonomic innervation
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T10-T11
CN X |
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Testes/ovaries autonomic innervation
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T10-T11
CN X |
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Adrenal medulla autonomic innervation
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T10
CN X |
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Leg structure autonomic innervation
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T11-T12
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Arm structure autonomic innervation
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T2-T8
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Lower GI (distal 1/3 of transverse colon - rectum) autonomic innervation
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S: T12-L2 from least splanchnic off inf. mesenteric ganglion
P: S2-S4 via pelvic splanchnic nerve |
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Appendix autonomic innervation
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T12
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Bladder and distal ureter
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S: T12-L2
P: S2-S4 via pelvic splanchnic nerve |
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Clitoral/penile erectile tissue
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S: L2
P: S2-S4 via pelvic splanchnic nerves |
