Ipsilateral loss of vibration/discrimination below lesion

Ipsilateral spastic paresis below lesion

Ipsilateral flaccid paralysis at level of lesion

Contralateral loss of pain/temperature below level of lesion

Neurological Deficits

1. ACA

2.  MCA

3. PCA

4. Lacunar Arteries

5. Basilar Artery

1.  Contralateral lower extremity and trunk weakness

2.  Contralateral face and upper extremity weakness and decreased sensation bilaterally, vision abn, aphasia (dom. hem.), neglect/no learned actions (non dom)

3.  Contralateral visual abd, blindness if bilat, unilateral hemianopia w/ macular sparing

4. Focal motor or sensory, loss of coordination, difficulty speaking

5.  CN abn, contralateral full body weakness / decreased sensation, vertigo, loss of coordination, difficulty speaking, visual abn, coma

AMS

Autonomic excitation

Ocular clonus

Venlafaxine

Buspirone

SSRI's

Beta Blockers

Hearing Loss

Seizure Disorder

Mental Retardation

Spastic paresis

Sympomatic: 

70-90% stenosis - both men and women benefit

50-69% stenosis - within two weeks of TIA/stroke, men benefit more

Asymptomatic:

80-99% - if survival greater than 5yrs, and surgeon w/ less than 3% complications, beneficial

Spinal Cord Lesions

1.  Fasciculations w/ spastic paresis

2.  Impaired proprioception and pupils do not react to light

3.  Bilat loss of pain/temp below lesion and hand weakness

4.  Bilat loss of vibration sense and spastic paresis of arms then legs

5.  Bilat loss of pain/temp below lesion + bilat spastic paresis below lesion +bilat spastic paralysis at level of lesion

1.  ALS

2. Syphilis

3.  Syringomyelia

4.  B12 deficiecy

5.  Anterior Spinal Artery Syndrome

The 3 W's

Wacky, Wobbly and Wet

Cognitive Impairment

Gait abnormalities

Urinary incontinence

Pt being treated with haloperidol develops sustained contraction of neck muscles

Tx?

Acute dystonic reaction

diphenhydramine

Benztropine

Pt on haloperidol gets fever, muscle rigidity, confusion and diaphoresis

Tx?

NMS

Dantroline

Bromocriptine

Amantadine

Risperidol

(atypcals)

Pure motor (MC)

Pure sensory

Sensorimotor

Ataxic hemiparesis

Dysarthria clumsy hand syndrome

CT of head shows a lacunar shaped lesion - what caused it?

Blunt head trauma

Subdural hematoma

Ruptured bridging veins

Adjustment disorder onset w/in 3 mo of stressor, and goes away w/in 6 mo of removal of stressor

No suicidal ideation

No loss of loved one

Does not meet criteria for MDD

Psychotherapy

SSRI's

Clomipramine

Atypicals

Haloperidol

CBC

Eletrolytes

Glucose

Mg/Ca

LP 

CT/MRI

LFT's

BUN/Cr

Tox screen

Clipping/ coiling

Maintain glucose, 02, electrolytes

BP <150/XX (labetalol)

Maintain volume status

Keep afebrile

Nimodipine

D/C anticoagulation

NO NITRATES!

adults - EDTA, dimercaprol

children - succimer

Calcim gluconate

steroids

methocarbamol

dapsone

erythromycin

X ray

irrigate

do not close

ABX

Remove clothes/ wash pt

Atropine

Do not place NG tube

Do not induce vomiting (ipicac)

Meds for cyanide poisoning

Sodium or amyl nitrate (not w/ carboxyhemoglobin)

Sodium thiosulfate

Hydroxycobalamin

Epi

Atropine

Transcutaneous pacing

Glucagon

Insulin/dextrose

Calcium

benzo's

calcium gluconate

nitrates

antivenom

Cardiotox

Neurotox

Anticholinergic sx

CT w/o contrast first

MRA/CTA

MRI

Carotid duplex ultrasound

Echocardiogram

No anticonvulsants!

Ibuprofen

Acetaminophen

Reassurance

Antidepressants:

1. SE = pripaism

2.  Lowers seizure threshold

3.  Works well w/ SSRI's and increases REM sleep

4.  Appetite stimulant leading to weight gain

5.  Smoking cessation

6.  Used to treat bedwetting in children

1.  Trazadone

2.  Bupropion

3.  trazadone

4.  mertazapine

5. bupropion

6.  imiprimine

Causes of Bacterial Meningitis

1.  Gram positive diplococci

2.  Gram negative diplococci

3.  Small pleomorphic gram negative coccobacilli

4. Gram positive rods and coccobacilli

1.  Strep pneumo

2.  neiseria

3.  H. flu

4.  listeria

Beta blockers

Ca channel blockers

30 yo female has a severe headache in left temporal region, along w/ visions of flashing lights and nausea

carbamazepine or valrpoic acid

NO lithium in renal failure!

Haloperidol

Droperidol

thiothixine

fluphenazine

Lambert-Eaton syndrome - antibodies to presynaptic calcium channels

Improves w/ use

Small Cell Lung CA

MRI of brain and spinal cord

Areas of demyelination

tilt table test / orthostatics

vasovagal syncope

EEG wave forms for sleep

Stage 1

Stage 2

Stages 3 and 4

REM

1 - theta

2 - sleep spindles and K complexes

3 and 4 - delta

REM - beta

Beta blockers

Benzo's

1. Alzheimers

2.  Picks

3.  Lewy Body

1. Dx of exclusion

2.  personality/behavior changes prior to dementia, progressive aphasia

3.  Parkinsonian sx, dementia, falls (sycopal episodes), visual hallucinations

Levadopa - carbidopa

Ropinerol

Pramipexol

executive dysfunction

asymmetric hand weakness

dysarthria/dysphagia

neuromuscular respiratory failure in 3-5 yrs

Memantine

Donepizil

Rivastigmine

Galantamine

(vit E)

10 yo boy develops worsening arm and leg weakness over 3 days that has now worsened to include symmetric facial muscle weakness.  DTR's are absent and sensation is intact

dx?

Marfans (up)

Homocysteinuria (downward)

Alports

Trauma

Neiman picks

Tay sachs

Central retinal artery occlusion

Laser/Intravitrious ranavizumab (exudative)

cryotherapy

Vit C, E, copper, zinc

Trauma

DM

Long term sunlight

Corticosteroids

Low education

Age 

Alcohol

Tobacco

Acetazolamide

Manitol IV

Timolol

Pilocarpine

Prostaglandins

Laser peripheral iridotomy

1. Chalazion

2.  Hordiolum (stye)

3.  Anterior blepharitis

1.  Inflammation of the internal meibomian and sebaceous glands (eyelid swelling) tx - usually self-limiting but can be treated w/ surgical excission or intralesional steroid injections

2.  Infection of the external sebaceous glands of Zeiss and Mol (tender red swelling at lid margin) tx - hot compresses 3-4X/day for 10-15 min; if unresolved in 48hrs, I and D +/- antibiotic ointment q3hrs

3.  Infection of eyelids and lashes secondary to seborrhea (red swollen lid margins and dandruff on lashs) tx - wash lid margins daily w/ shampoo; remove scales daily w/ cotton ball, antibiotic ointment qd to lid margins

LSD - hallucinations

PCP - aggitation / aggression

19 yo slender female presenting w/ recent weight loss found to have erythema of turbinates and nasal septum

Cause?

Increased r/o Hypertension

Must watch BP

Long acting benzo's - chlordiazapoxide

AA

fluphenazine

tetrabenazine

pimozide

Gastric emptying study

Cisapride, erythromycin, metaclopramide, domperidone

No cisapride w/ phenothiazines, macrolides or antifungals

Radioablation

Surgery if pregnant

What can cause hypoglycemia in a non-DM pt?

Insulinoma

Alcohol-induced fasting

Kussmaul's respiration

Abdominal pain w/o diarrhea

Urine/serum Ketones

Low pH

Polyuria / polydipsia

Elevated serum glucose

What lab abnormalities necessitate obtaining thyroid function testing to r/o thyroid disease?

hyperlipidemia

unexplained hyponatremia

elevated serum CPK

Causes of hyperthyroidism

1.  Extremely tender thyroid gland

2.  Pretibial myxedema

3.  Pride in recent weight loss - medical professional

4.  Palpation of single thyroid nodule

5.  Palpation of multiple thyroid nodule

6.  Recent study using IV contrast dye

7.  Eye changes - proptosis, edema, injection

8.  H/O thyroidectomy or radioablation of thyroid

1.  Dequervain's thyroiditis

2.  Graves

3.  Exogenous TH

4.  Toxic adenoma

5.  toxic multinodular goiter

6.  Jod-basedow phenomenon

7.  Graves

8.  Excess TH replacement

Next step in management in a pt w/ newly found thyroid nodule and hyperthyroidism

Check TSH and T4

Do sonogram to look for other nodes

If hyperthyroid - radionucleotide uptake scan

Hot - treat as hyperthyroid

Cold - FNA

Exanatide - glucagon-like peptide - gila monster saliva - prolongs incretin secretion to lower glucagon and elevate insulin secretion - delays gastric emptying

Sitagliptin - inhibits dipeptidyl transferase - prolongs incretin secretion

Pramlintide - amylin analog - decreases glucagon secretion and gastric emptying

R/O infection

UA

Tox Screen

Amylase / lipase

CXR

EKG if over 35 yrs

Hypoparathyroidism

REcurrent laryngeal nerve damage

Tx:

1.  Proliferative diabetic retinopathy

2.  Pereipheral neuropathy

1.  Laser photocoagulation

2.  gabapentin, pregabalin, duloxetine

For both, control glucose levels!

Plasma Aldosterone Concentration: Plasma Renin Concentration

1.  Up:Down

2.  Up:Up

3.  Down:Down

1.  Conn's - hyperaldosteronism

2.  Secondary hyperaldosteronism

3.  Chronic licorice ingestion or Cushings - high cortisol

D NAAACP

Drugs

Neoplasm

Asthma, allergy, churg strauss

Acute Interstitial Nephitis

Addisons (adrenal insufficiency)

Collagen vascular disease

Parasites (loffler's eosinophilic pneumonitis d/t ascaris lumbricoides)

4mL/Kg/hr for first 10kg

2mL/kg/hr for second 10kg

1mL/kg/hr for every kg after 20kg

1. Lactotroph adenoma

2.  Somatotroph adenoma

1.  Prolactin secreting

2.  Growth hormone secreting

Serum TSH

MRI

Empty sella syndrome

Asymptomtic - reassurance

Symptomatic - check for deficiency hormones and replace

Exogenous steroids - decreased serum cortisol

Pituitary adenoma - no low dose dexamethasone suppression, but high dose suppression

<50 years old

symptomatic - stones, moans, groans, bones

Serum Ca elevated 1 above normal

Creatinine clearance decreases by 30%

24hr urine Ca >400

BMD T score less than 2.5 SD's at any site

1.  17 alpha hydroxylase deficiency

2.  21 alpha hydroxylase deficiency

3.  11 beta hydroxylase deficiency

1.  amenorrhea in women, ambiguous genitalia in men, hypertension, hypokalemia, hypernatemia, decreased androgens

2. Ambiguous genitalia (female infants), virilization in women, macrogenitosomia/precocious puberty in men, dehydration, hypotension

3.  ambiguous genitalia (female infants), virilization in women, macrogenitosomia / precocious puberty in men, hypertension

Types of MEN Syndromes:

I

IIa 

IIb

I - pituitary, parathyroid, pancreas - ZE syndrome, ptuitary disorders

IIa - medullary thyroid, pheochromocytoma, parathyroid - medullary carcinoma, hyperparathyroid

IIb - medullary thyroid, pheochromocytoma, mucosal neuroma - medullary carcinoma, hyperparathyoid, marfanoid body habitus

Renal insufficiency

Renal artery occlusion

Glucocorticoids

Coarctation

Pheochromocytoma

Hyperaldosterone

OCP use

Hypothermia

Hydrogen Ion's (acidosis)

Hypokalemia

Hypoglycemia

Hypovolemia

Hypoxia

Toxins/tablets

Tamponade

Thrombosis (MI)

Thrombosis (PE)

Tension pneumothorax

Trauma

Everyone should have Tdap in place of Td between 19 and 64 yrs

Td to every adult every 10 years

Td in wounds:

1.  If wound is non-tetanus prone (lower extremity, clean, minor) and uncertain or < 3 prior Td - Td (DT if <7yo) ->complete series

2.  If non-tetanus prone and greater than or equal to 3 prior immunizations - Td if greater than 10 years since last does

3.  If tetanus-prone wound (dirt, contamination, punctures, crush components) Td (DT if less than 7yo) plus tetanus immune globulin 250 units IM at site other than Td -> complete series

4.  If tetanus prone wound and greater than or equal to 3 prior immunizations, Td if greater than 5 years since last dose

Somatoform disorders:

1  unexplained pain

2 pt w/ normal anatomy convinced part of their body is abnormal

3 unexplained loss of sensory or motor function (tests and PE are negative)

4 unwaivering belief by pt that she has a specific disease despite medical reassurance

5 unexplained complaints in multiple organ systems

6 false belief of being pregnant

1 pain disorder 

2 body dysmorphic disorder

3 conversion reaction

4 hypochondriasis

5 somatization disorder

6 pseudocyesis

child psych disorders

1 females only - loss of previously acquired language and motor skills

2 impairment in social interactions, play, repetitive behaviors

3 impairment in social interaction, but not avoidance, no language delay

4 stereotyped hand movements

5 ignoring basic rights of others

6 hostility, annoyance, vindictiveness, disobedience and resentfullness

7 impulsive and inattentive

8 7 yo that avoids going to school to stay home w/ parent

1 Rett disorder

2 autism

3 aspurgers

4 rett disorder

5 conduct disorder

6 oppositional defiant disorder

7 ADHD

8 separation anxiety

MCC of chest pain in a patient w/ sudden tearing chest pain radiating to back

Ventricular arrhythmias

V-tach

V-fib

Cardiogenic Shock

Mechanisms of:

1.  Streptokinase

2.  Aspirin

3. Clopidogrel

4. Abciximab

5. Tirofiban

6.  Ticlodipine

7. enoxaparin

8.  eptifibitide

1. thrombolytic: plasminogen -> plasmin (breaks up fibrin)

2.  COX I / COX 2 inhibitor of platelet aggregation

3.  blocks ADP receptors on platelets

4.  blocks GPIIbIIIa 

5. " "

6. blocks ADP receptors on platelets

7.  LMWH - catalizes reaction of antithrombin 3

8. GPIIbIIIa inhibitor

What medications should all post-MI pts receive as outpatients?

ASA / Clopidogrel

ACE's, ARB's

Statins

Low dose K+ sparring diarrhetics - spironolactone or eplerinone

Exercise

Stop smoking 

diet modifications

Decreased heart sounds

heard to palpate apical impulses

Endocarditis

Mitral Valve prolapse - midsystolic click - anxiety disorders

Exercise

Volume overloaded state

pregnancy

What pathology commonly causes heart failure in young patients?

JVD

Distant Heart Sounds

Hypotension

ACE/ARB

Loop

Beta Blocker

Spironolactone/ Eplerinone

+/- Digoxin

ASA

Acute treatment for exacerbations of CHF

Lasix

Morphine

Nitrates 02

Positioning 

Pressors (dobutamine)

Niseritide

Chest trauma + hypotension + JVD + distant heart sounds

Next step in management?

Chest trauma +hypotension + JVD + respiratory distress

Next step in management?

Head of bed to 30 degrees

Manitol

Intubate / hyperventilate w/ lidocaine

Craniectomy

DPL

Upright CXR

US

CT w/ contrast

Laproscopy

Ischemia / necrosis:

Fingers/toes

Mesenteric ischemia

Renal failure

What is the preferred antihypertensive therapy in a patient w/ no comorbidities?

Thiazide Diuretic:

HCTZ or Chlorthalidone

Compare the vasodilating effects of:

1. Nitroglycerine

2.  Dihydropyridine Calcium channel blockers

3. Hydralazine

4. Nitroprusside

1. Veins

2. Veins

3. Arterioles

4. Arteries and Veins

Compare the MAP, SVR, HR, PCWP (before and after fluid challenge) and treatment for the following types of shock:

1.  Hypovolemic

2. Cardiogenic (LV failure)

3. Extracardiac obstruction (tension pneumo, massive hemothorax)

4. Neurogenic

5. Septic

1. MAP is low, SVR is high, HR is high, PCWP is low and is unchanged or high after fluid challenge, Tx = fluids

2.  MAP is low, SVR is high, HR is variable, PCWP is high (d/t congestion of LV) and is very high after fluid challenge (DO NOT give fluids!), Tx = dopamine or dobutamine

3. MAP is low, SVR is high, HR is high, PCWP is low or normal and unchanged or increased after fluid challenge, Tx = chest tube

4. MAP is low, SVR is high, HR is high, PCWP is high  and remains high or very high after fluid challenge, Tx = pericardiocentesis

5.  MAP is low, SVR is low, HR is low, PCWP is low or normal and high after fluid challenge, Tx = IVF, pressors and atropine for HR

6. MAP is low, SVR is low, HR is high, PCWP is low or normal and high after fluid challenge, Tx = fluids, ABX and norepi

Compare the following classes of Shock with respect to blood loss, pulse rate and percentage of volume loss:

I

I

III

IV

I  blood loss < 800ml, no change in HR, 10-15% volume loss

II blood loss 800-1500,,  HR >100, 15-30% volume loss

III blood loss 1500-2000, HR >120, 30-40% volume loss

IV blood loss >2000, HR >140, >40% volume loss

Calcium

vitamin D

Prophylactic bisphosphonates

Tetrology of Fallot

Truncus arteriosus

Transposition of the great vessels

Tricuspid atresia

Total anomalous pulmonary venous return

CRASH

Conjunctivitis

Rash (truncal)

Adenopathy (of cervical nodes)

Strawberry tongue

Hands and feet have edema w/ induration, erythema or DESQUAMATION

Overriding aorta

Pulmonary valve stenosis

RVH

VSD

Exercise

Foot exams

Treat underlying disease

ASA/Plavix

Cilostazol (but not in HF!)

PTA

bypass grafting

smoking cessation

glucose control

Recent URI

Palpable purpura

Abdominal pain

RENAL ISSUES - proteinuria, hematuria

Arthritis

CBC 

Electrolytes

Glucose

BUN/Cr

Amylase

Lipase

Stool Guaiac

Beta-HCg

EKG/Enzymes if >45

Time frame for stopping warfarin prior to surgery?

ASA?

3-4 days before

ASA 5-7 days before

Within initial 48 hrs

Perioperative beta blockers, telemetry monitoring

incentive spirometry

deep breathing exercises

pain control

physical therapy

bronchodilators

inhaled steroids

Which blood products are most appropriate for the following scenarios?

1. severe anemia due to autoimmune hemolytic anemia

2. Hemophilia

3. DIC

4. Shock due to trauma or postpartum hemorrhage

5. to maintain blood volume during large volume paracentesis

6. hemorrhage due to warfarin overdose

7.  need for vWF-rich blood product

8. thrombocytopenia

1. packed RBC's

2. clotting factors: A-8 ; B-9

3. FFP +/- platelets

4.  whole blood or RBC's

5.  Albumin

6. FFP / Vit K

7. cryoprecipitate

8. platelets

Left subclavian

Right IG

Increased bilirubin

Decreased albumin

Prolonged PT/PTT

Encephalopathy

Decreased platelets

Decreased lipid profile

Increase or decrease in LFT's

IV hydration

Bicarb

N-acetylcysteine

CBC

CXR

U/A

Blood cultures

Assess for DVT

Assess for sinusitis

Indications for organ transplants:

1.  Bone marrow

2.  Heart

3. Lung

4. Liver

5. Renal

6. Pancreas

1. Aplastic anemia, induction chemotherapy

2. CAD, congenital defects, cardiomyopathy w/ estimated death w/in two years w/o transplant

3. COPD, alpha-1 antitrypsin deficiency, cystic fibrosis

4. Chronic hep B or C, alcoholic cirrhosis, PBC, PSC, biliary atresia, Wilson's disease

5. End stage renal disease requiring dialysis

6. DM type I w/ renal failure

Forms of Transplant Rejection:

1. Hyperacute

2. Acute

3. Chronic

1. Initial 24 hrs after transplantation - caused by donor antibodies, untreatable

2. 6 days to one year after transplantation - caused by anti-donor T cell proliferation in recipient, frequently reversible w/ immunosuppressive agents

3. >1 year after transplantation - caused by development of multiple cellular and humoral reactions to donor tissue - usually untreatable

Adverse reactions to immunosuppresive drugs:

1. Cyclosporine

2. Azathioprine

3. Tacrolimus

4. Corticosteroids

5. Muromumab (OKT3)

6. Rapamycin

7. Mycophenolic Acid

8. Antithymocyte globulin

9. Hydroxychloroquin

10. Thalidomide

1. Nephrotoxicity, adrenergic effects, HTN

2. Leukopenia - NO ALLOPURINOL!

3. Nephrotoxicity, neurotoxicity

4. Cushings syndrome, weight gain, AVN of bone

5. Induces one-time cytokine release (fever, bronchospasm), leukopenia

6. Thrombocytopenia, hyperlipidemia

7. Leukopenia, GI toxicity

8. Serum sickness

9. Visual disturbances

10. sedation, constipation

PCWP < 12 suggests ARDS

PCWP > 18 suggests left heart failure

Respiratory alkalosis

decreased 02

decreased CO2

PCWP <18

Bilateral infiltrates

Acute dyspnea

Pulmonary decompensation

Wheezing

rales

Ronchi

PaO2 / FiO2 <200mmHg

What infectious agent fits the following descriptions?

1. common cause of pneumonia in immunocompromised patients

2. most common cause of atypical / walking pneumonia

3. common causative agent for pneumonia in alcoholics

4. Often a cause of pneumonia in a patient w/ exposure to bats and bat droppings

5. Often a cause of pneumonia in a patient who has visited South California, New Mexico or west Texas

6. pneumonia associated w/ currant jelly sputum

7. a/w pneumonia acquired from air conditioners

8. MCC pneumonia in children one year old or younger

9. MCC of pneumonia in the neonate (<28 days old)

10. MCC of pneumonia in children and young adults (college, military, prisons)

11. MCC pneumonia in pts w/ other health problems

12. MCC viral pneumonia

13. common bacterial causes of COPD exacerbation

14. common pneumonia in ventilator pts and those w/ cystic fibrosis

1. PCP

2. mycoplasma

3. Klebsiella

4. histoplasmosis

5. Coccidioides

6. Klebsiella

7. Legionella

8. RSV

9. GBS or e. Coli

10. mycoplasma

11. Klebsiella

12. RSV, influenza

13. H. flu

14. pseudomonas

Criteria used to determine positive PPD's

1. 5mm induration

2. 10 mm induration

3. 15mm induration

1. HIV+, close contacts of TB patients, signs of TB on CXR

2. Homeless patients, immigrants from developing nations, IVDA's, chronically ill patients, patients w/ recent incarceration

3. ALWAYS considered positive!

uvula deviation AWAY from abscess

muffled hot potato voice

two months - macrolide

two years - amoxi / amp

What is the MCC of acute sinusitis?

What is the normal A-a gradient?

What can increase the gradient?

5-15mmHG

PE

pulmonary edema

right to left vascular shunts

Increases in the Fi02

Common  causes of pneumonia and empiric tx in the following age groups:

1.   newborn

2.   1-4 months

3.    4 months - 4 years

4.    5-15 years

1. GBS, e coli, listeria - use AMP + GENT, vanco, erythromycin in chlamydia suspected

2. RSV, strep pneumo, staph aureus - use Erytho/ azithro, +/- cefotaxime

3. RSV, strep pneumo - use amoxi or amp

4. strep pneumo > mycoplasma - use amoxi +clarithro (or erythro), or azithro, or amoxi +doxi

diffuse bilateral interstitial infiltrates

CD4 <200

LDH >220

Tx underlying disease, ICU support

Mechanical vent w/ low tidal volumes and PEEP

Conservative fluid to goal CVP of 4-6 mmH2O

Prone positioning

Prevent fever (thereby decreasing O2 demand)

Transfuse blood only if Hb drops below 7 g/dL (xfusion can increase death in ARDS pts)

How is idiopathic pulmonary fibrosis treated?

Acute exacerbations?

Corticosteroids

Azathioprine or cyclophosphamide

N-acetylcysteine

Acute exacerbations w/ increased steroids and ad ABX

Goodpastures - anti-GBM antibodies, IgG deposits along glomerular capillaries, affects lung and kidney, 

Wegener's - c-ANCA, granulomatous inflammation of lung and other organs, upper airway, saddle nose deformity, 

What types of lung cancers are associated with the following paraneoplastic syndromes?

1. Elevated ACTH ->glucocorticoid excess -> Cushings syndrome

2. Elevated PTHrP ->hypercalcemia

3. Elevated ADH -> SIADH -> hyponatremia

4. Antibodies to presynaptic calcium channels ->Lambert-eaton syndrome

1. Small cell

2. Squamous cell

3. Small cell

4. Small cell

What is the initial treatment for small cell lung cancer?

What is the initial treatment or localized non-small cell lung cancer?

Honeycomb lung

Ground-glass appearance

What type of pneumoconiosis matches the following description?

1. progressive fibrosis

2. increased risk of TB

3.  a/w electronics -> increased cancer risk

4. malignant mesothelioma and bronchogenic carcinoma

1. coal miner's dz

2. Silicosis

3. berylliosis

4. Asbestosis

Stage III COPD

steroids

bronchodilator

as needed short-acting bronchodilator

risk factor reduction

anual influenza vaccine

Wegener's granulomatosis

cyclophosphamide

corticosteroids

Superior vena cava syndrome

Steroids

Endovascular stent

Describe the following classifications of asthma, the FEV1 and the medication recommendations for each:

1. Mild intermittent

2. Mild persistent

3. Moderate persistent

4. Severe persistent

1. less than or equal to two daytime episodes per week and less than or equal to two night time episodes per month / FEV1 is greater than or equal to 80% / PRN albuterol

2. 3-6 daytime episodes per week and 3-4 night time episodes per month / FEV1 is greater than or equal to 80% / PRN albuterol + low-dose inhaled steroid +/- montelukast +/- cromolyn

3. daily daytime episodes or greater than one night time episode per week / FEV1 is 60-80% / PRN albuterol +moderate dose inhaled steroid +/- long acting beta-2 agonist +/- montelukast +/- theophylline

4. Continual daytime episodes or frequent night time sx / FEV1 is less than 60% / PRN albuterol _ high dose inhaled steroid + long acting beta-2 agonist + PO steroid +/- montelukast +/- theophylline....FOUR DRUGS

What are the general strategies for treating the pulmonary component of cystic fibrosis?

DNase

chest therapy

fluoroquinolones / azithromycin

N-acetylcysteine

Beta-2 agonists

Keep child calm throughout interview

intubate

ABX 7-10 days

CHF

Nephrotic sydrome

Cirrhosis

What xray finding is indicative of:

1. Croup

2. Epiglottitis

1.  Steeple sign

2. Thumb sign

What is the treatment for RSV bronchiolitis?

Hydration

humidified air

corticosteroids

Beta-2 agonists

02 

Racemic epinephrine

Ground glass

air bronchograms

LOW lung volumes 

acetazolamide

theophylline

Zenkers

Traction 

Epiphrenic

What is the the treatment for the following diarrheal illnesses?

1. Entamoeba histolytica

2.  Giardia lamblia

3. Salmonella

4. Campylobacter

1. Metronidazole

2. Metronidazole

3. Hydration / fluoroquinolones

4. Hydration, cipro, TMP-SMX

5. hydration / erythromycin

How does the treatment differ for:

1. diffuse esophageal spasm

2. Achalasia

1. Calcium channel blockers, nitrates, TCA's

2. Nitrates, botox injections, myotomy, pneumatic dilation

Pegalated interferon alpha

Ribavirin

Interferon Alpha (standard or pegylated)

OR

Antiviral (lamivudine, adefovir, entecavir or telbivudine)

Give Hep B vaccine if not vaccinated!

What anatomical structures can be viewed by the following radiographic studies?

1. barium swallow

2. gastric emptying study

3. small bowel followthrough

4. barium enema

1. esophagus, LES, stomach

2. stomach, pyloric sphincter, duodenum

3. stomach -> terminal ileum

3. colon, appendix

What are the presenting features that help to distinguish:

1. Gastric ulcer

2. Duodenal ulcer

1. worse w/ food, normal or low acid level, gastrin level high

2. better with food, almost all are H. pylori positive, high acid level, normal gastrin level

PPI

Eliminate H. pylori

Stop alcohol

Opioid analgesia (morphine or meperidine)

enzyme supplementation

surgery may be required to repair ductal damage

Whipple procedure: removal of pancreativ head, duodenum, proximal jejunum, CBD, gall bladder and distal stomach

Chemotherapy

Subtotal gastrectomy for lesions in the distal third of the stomach

Total gastrectomy for lesions in the upper or middle stomach or invasive lesions

Adjuvant chemotherapy or radiation

PPI

Clarithromycin

and either

amoxicillin OR metronidazole

What are the tumor markers for:

1. pancreatic cancer

2.  Gastric cancer

1. CEA, CA 19-9

2. CEA

Alcohol

Gall stones

When is the odds ratio a good approximation of relative risk?

Reportable disease

Homicidal / suicidal

If pt allows it

Penetrating assault wound

Pregnancy

STD's

Emergencies

Contraception

Elicit drug treatment / counseling

Small bowel - 24hrs

Stomach - 72hrs

Large bowel - 3-5 days 

Typically lasts < 5 days

Volvulus

Colonoscopic decompression

Surgical repair

McBurney's

Rovsings

Psoas

Obturator

What is the treatment for Crohn's disease?

Mesalamine (5 ASA) or sulfasalazine (works in colon only)

Corticosteroids

Azathiaprine, mercaptopurine

Anti-TNF alpha agents

ABX

Adhesions

Incarcerated hernias

Cancer

Yes - change in stool form or frequency, straining, urgency, feeling of incomplete passing of stool, bloating/distention, mucus, lasts at least 12 weeks

No - anorexia, weight loss, malnutrition, progressively worsening pain, pain that prevents sleep

Carcinoid

Gastrinoma

VIPoma

Medullary thyroid carcinoma

anti-gliadin

anti-endomisial

Crohns - +ASCA, -P-ANCA

UC - -ASCA, +P-ANCA

TPN

ICU patients

Charcot's triad = RUQ pain, Fever/chills, jaundice

Add AMS and hypotension (shock) to get Reynold's pentad

Cholecystitis - remove GB

Cholangitis - unblock bile ducts w/ ERCP, THEN cholecystectomy

Fluoroquinolone + metronidazole

TMP SMX +metronidazole

amoxicillin + clavulonate

Stool softeners

topical nitroglycerine

botox injection

topical nifedipine, diltiazem or bethanacol

Partial sphincterotomy (10-30% chance of incontinence)

PUD

mallory weiss tears

esophagitis

esophageal varices

gastritis

diverticulosis

neoplasm

ulcerative colitis

mesenteric ischemia

AVM's

hemorrhoids

Meckel's diverticulum

BP 

HR 

Urine output

lactulose

ABX to reduce toxins in gut - neomycin or refaxamin

Protein restriction

ascites

abdominal pain

hematemesis

sx of cirrhosis

hepatomegaly

splenomegaly

fever

abdominal wall varices

gynecomastia

testicular atrophy

phlebotomy

defuroxime

PBC - female >male, +ana and antimitochondrial antibodies

PSC - male > female, a/w ulcerative colitis, +P-ANCA, ERCP shows "pearls on a string"

ursodeoxycholic acid w/ or w/o colchicine

Liver transplant

What are the following tumor markers?

1. HCC

2. Colon

3. Gastric

4. Pancreatic

1. alpha fetoprotein

2. CEA

3. CEA

4. CEA and CA 19-9

bilious vomiting

hematochezia

premature or low birthweight infant started on tube feeds

1. physiologic jaundice

VS

2. exaggerated physiologic jaundice

VS

3. Breast milk jaundice

1. starts on day 2-3, peaks at <10mg/dL at day 3-5

2. occurs in first week, peaks at 12-15 mg/dL, due to dehydration (AKA breast feeding jaundice!)

3. Days 4-14, due to substances in breast milk, improvement in 48-72 hours when formula is substituted is diagnostic

Renal cell carcinoma

Get CT of abdomen

hydration

adequate dietary calcium

decrease sodium intake

decrease dietary protein and oxalate

corticosteroids

cyclophosphamide

oliguria

edema

brown urine

hypertension

Proteinuria >3grams/day

hypoalbuminemia

hyperlipidemia

Acute Interstitial Nephritis

MCC's = drugs (sulfa, PEN, NSAIDs)

UTI

Exercise

Trauma

Endometriosis

Nephrolithiasis

Spironolactone (anti-androgen effects!)

Eplerinone

Emiloride

Triamterine

What electrolyte abnormality fits the following descriptions?

1.  peaked T waves on EKG

2. flattened T waves on EKG

3. U waves on EKG

4. QT prolongation

5. QT shortening

1. Hyperkalemia

2. hypokalemia

3. hypokalemia

4. hypocalcemia

5. hypercalcemia

What are the distinguishing characteristics of the following types of renal tubular acidosis?

(urine pH, Serum K, serum bicarb)

Type I

Type II

Type IV

Type I - distal - urine pH >5.3, serum K is low, serum bicarb is variable

Type II - proximal - urine pH is <5.3, serum K is low, serum bicarb is low

Type IV - hypoaldosterone - urine pH is <5.3, serum K is high, serum bicarb is in normal range

Cerebral edema

No fast than 12 mEq/day

Central pontine myelinosis

No faster than 12 mEq/day

insulin/glucose

beta-agonists (albuterol nebulizer)

sodium bicard

loops 

Kaexalate

polydipsia

SIADH

hypothyroidism

What medications are known for causing hyperkalemia?

Hypokalemia?

 Hyper - potassium sparing diuretics

digoxin

ACE/ARB's

beta blockers

Hypo - loops

thiazides

albuterol

Insulin

acetazolamide

Salt restriction

Increased water intake

thiazides w/ or w/o indomethacin

LITHIUM TOX = HCTZ w/ amiloride!!

Diarrhea

Renal tubular acidosis

TPN

Mehtanol

Uremia

DKA

Pparaldehyde

INH

Lactic acidosis

Ethanol or ethylene glycol

Salicylates

Statins

Vit D

Iron

EPO

Phosphate binders

Daily ASA

BP control to <130/80

Glucose levels to HbA1C <6.5

loops to decrease fluids

Ceftriaxone, doxycycline or fluoroquinolone

NSAIDs

Scrotal support

Testosterone

LH 

Prolactin

TSH

PSA

Enuresis alarm

dietary modifications

desmopressin

imiprimine

DX cannot be made until 5 years of age (older if retarded) and usually not treated until 7 years of age

Saw palmetto

Alpha blockers 

5 alpha reductase inhibitors (finasteride)

Tobacco smoking

analine dye

shistosomiasis

petroleum byproducts

cyclophosphamide

Torsion - acute onset, pain not relieved w/ elevation of testicle, decreased blood flow on doppler, no signs of infection, no cremasteric reflex

Epididymitis - subacute, associated w/ STD's,  normal testicular position / lye, normal blood flow on doppler

back of worms

left-sided more common

A/W renal cell carcinoma

Scrotal mass that transilluminates

manual detorsion

bilateral orchipexy

ABX: if there is a high likelihood of STD's or the patient is <35, ceftriaxone and doxycycline

If >35, h/o anal intercourse, give fluoroquinolone or TMP-SMX for 4-6 weeks

admit to hospital

blood/urine cultures

Broad-spectrum antibiotics IV - cefepime, ceftazadine

decreased haptoglobin

increased bilirubin

increased LDH

Low H&H 

Normal MCV

High reticulocyte count

Identify which RBC disorders have the following findings:

1. schistocytes

2. acanthocytes

3.bite cells

4. basophilic stippling

5. peripheral neuropathy + sideroblastic RBC's

6. Hypersegmented neutrophils

7. Heinz bodies

1. intravascular hemolysis

2. abetalipoproteinemia

3. G6PD deficiency

4. lead poisoning

5. lead poisoning

6. Folate deficiency

7. G6PD deficiency

HIB 

Flu

Hep B

Pneumococcal

Hemolysis

Anemia

Acute renal failure

Fever

AMS

**The first three are the triad for HUS!!

What is the mechanism of action of the following drugs?

1. streptokinase

2. ASA

3. clopidogrel

4. abciximab

5. ticlodipine

6. enoxaparin

7. eptifibitide

1. cleaves fibrin clots

2. irreversibly acetylates a serine residue on COX

3. blocks ADP receptors

4. GPIIbIIIa inhibitor

5. blocks ADP receptors

6. blocks factor Xa

7. GPIIbIIIa inhibitor

What lab test is used to monitor:

1. Warfarin

2. Heparin

3. LMWH

1. PT

2. PTT

3. anti-Xa

desmopressin

vWF concentrate or factor VIII concentrate before surgery

What lab changes would you see in the following diseases?

1. HUS or TTP

2. Hemophilia A or B

3. Von Willebrand's

4. DIC

5. Warfarin use

6. End stage liver disease

7. ASA use

1. decreased platelet count and increased bleeding time

2. increased PTT

3. Increased bleeding time and increased PTT

4. decreased platelets, increased bleeding time, increased PT and increased PTT

5. Increased PT and PTT

6. decreased or normal platelet count, increased or normal bleeding time, increased PT and increased PTT

7. increased bleeding time

Fever > 38C, or hypothermia <35C

Tachypnea >20

Tachycardia >90

Leukocytosis >12000 or <12000 or bandemia >10% bands

Sepsis

Trauma

Obstetric complications

Pacreatitis

Malignancy

Transfusions

What type of leukemia match the following descriptions?

1. most common neoplasm in children (peak 3-4 yrs)

2. most common leukemia in adults (avg is 50 yrs)

3. Philadelphia chromosome almost always seen

4. smudge cells on peripheral smear

5. peripheral blasts are PAS+ and TdD+

6. peripheral blasts are PAS- and myeloperoxidase positive +have auer rods

7. Pancytopenia in a Down Syndrome patient

1. ALL

2. CLL

3. CML

4. CLL

5. ALL

6. AML

7. ALL

Which blood cell pathology matches the following descriptions?

1. A/W EBV in Africa

2. Reed-Sterburg cell, cervical lymphadenopathy and night sweats

3. Bence Jones proteins, osteolytic lesions and high calcium

4. Translocation 14;18

5. MC lymphoma in US

6. Translocation 8;14

7. Translocation 9;22

8. Most common form of Hodgekins

9.  Starry sky pattern due to phagocytosis of apoptotic tumoe cells

10. High hematocrit/hemoglobin, pruritis (esp after taking a hot bath or shower), burning in hands or feet

11. Blood smear w/ hair-like projections, splenomegaly

1. Burkitts

2. Hodgekins

3. Multiple myeloma

4. Follicular

5. Diffuse large B cell

6. Burkitts

7. Philadelphia chromosome - CML

8. Nodular sclerosing

9. Burkitts

10. PCV

11. hairy cell leukemia

what antiretroviral or antiretroviral class matches the following statements?

1. lactic acidosis

2. GI intolerance

3. pancreatitis

4. peripheral neuropathy

5. megaloblastic anemia

6. rash

7. hyperglycemia, diabetes, lipid abnormalities

8. bone marrow suppression

9. given to pregnant women with HIV

10. regimen for occupational HIV exposures

1. NRTI's

2. protease inhibitors

3. zalcytabine, stavudine, didanosine, ritinovir(protease inhib)

4. 

5. zidovudine

6. NNRTI's

7. indinavir, sequinavir, amorinavir

8. sydovudine

9. HAART, zidovudine in labor

10. zidovudine +lamivudine

CD4 <200 - tmp smx or dapson (PCP)

CD4 <100 - erythro or clarythro (MAC)

thenar atrophy

numbness in the thumb, index and middle fingers

pain radiating up arm with hand flexion and grasping

decreased palmar two-point discrimination, except on radial side of palm

What is the difference between:

1. Montaggia's fracture

2. Galeazzi's fracture

1. dislocation of radial head and diaphyseal fracture of ulna

2. distal ulnar joint dislocation and radial diaphyseal fracture

What complication should you look for with the following injuries?

1. AVN

2. axillary nerve

3. bite wound

4. radial nerve

5. DVT, AVN

6. fat embolus, blood loss

7. compartment syndrome

8. hypovolemia / blood loss

What is the cause of low back pain given the following presentations?

1. pain increases with passive straight leg raise

2. pain lessens with flexion at the hips (ie bending over a shopping cart)

3. elderly, weight loss, pain constant but worse when supine

4. acute urinary retention

5. pain made worse by walking and standing (AKA pseudoclaudication)

6. loss of foot dorsiflexion and pain on crossed straight leg raise

7. pain limited to the paraspinal region

1. disc herniation

2. spinal stenosis

2. spinal tumor

4. cauda equina syndrome

5. spinal stenosis

6. disc herniation

7. muscular strain

What nerve is at risk of injury with the following fractures?

1. shaft of humerus

2. surgical neck of humerus

3. supracondyle of humerus

4. medial epicondyle

5. anterior shoulder dislocation

6. injury to carpel tunnel

1. radial

2. axillary

3. median

4. ulnar

5. axillary

6. median