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76 Cards in this Set

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Ranson's Criteria
Acute Pancreatitis
1. Age >55
2. WBC> 16,000 mg/dL
3. Glucose> 200
4. AST >250
5. LDH>350
Jones Criteria
Rheumatic Heart disease

Major: Carditis, arthritis,syndeham's chorea, erythema marginatum, subsutaneous nodules

Minor: Previous history of RF/ RHD, Arthralgias, Elevated ESR, Prolonged PR, and Fever

(2 Major or 1 Major/2 Minor)
Phimosis
Unable to retract foreskin (rarely emergent)
Paraphimosis
Retracted foreskin -necrosis of glans

Emergent

"Call the paramedics"
Osler- Weber-Rendu Syndrome
Hereditary hemorrhagic telangiectasia; Telangiectasias of the skin, mucous membranes, GI tract

recurrent GI episodes of bleeding
Hepatitis Markers
1. HBsAg
2. HBsAb
3. HBeAg
4. HBcAb
1. sAg: (+) early infections
2. sAb: (+) immunity after vaccine
3. eAg: (+) super infection
4. cAb: (+) immunity after previous infection
Ulcerative Colitis
1. Rectum and colon (small bowel not affected)
2. Blood diarrhea
3. Risk of cancer > 30x's
Crohn's Disease
1. Mouth to anus
2. Skip lesions: gross blood is uncomin
3. Increased oxalate absorption leads to calcium oxalate kidney stones
Behcet's syndrome
1. Painful oral/ genital ulcers
2. Arthritis, vasculitis, neurolgic, uveitis/ retinal vasculitis
3. Prednisone for flair ups
Guillan Barre Syndrome
Progressive ascending motor weakness with sensory component (loss of DTRs)
Causes: campylobacter/flu vaccine
Respiratory support, plasmapheresis/ immunoglobulin
Multiple Sclerosis
Demylenating in the central nervous system.
1. Optic neuritis (painful visual loss)
2. Bilateral internuclear opthalmoplegia (eyes can't look at nose)
3. Mutiple areas of sensory/ motor issues that make no sense
Myasthenia Gravis
Autoimmune AB's to AcH receptors- muscles weaken with repeative use

Limb weakness proximal> distal

Muscle weakness and fatiguability with diplopia and ptosis
Dressler's Syndrome
Pericarditis 2-8 weeks post-MI

Fever, leukocytosis, friction rub, pericardial and pleural effusions

Treat: NSAIDs adn steroids
Kleihauer-Betke Test
Test in pregnancy for women who sustained abdominal trauma to detect/quantify the amount of fetomaternal hemorrhage that has occured
Transient global amnesia
sudden, transient amnesia - where patient is unable to form new memories (short: hours - a day)
leptomeningeal cyst
(skull fx): 'growing fracture' in pediatrics that enlarges overtime aand associated tear of underlying dura - initially have >4mm fragment separation.
-re xray in 2 months for signs of growing fracture
Hamman's crunch
Mediastinal friction rub with heart beat (associated with tracheobronchial injury and diving injuries)
Low Sodium (3) [Hyponatremia]
1. Rocky mountain spotted fever
2. Necrotizing fasciitis
3. SIADH
Ramsey Hunt Syndrome
Herpes zoster oticus causes deafness, vertigo, facial palsy; grouped vesicles on an erythematous base inside the ear canal.
Carbon Monoxide
a. measure it
b. symptoms
c. treatment
a. Pulse OX ABG = normal; carboxyhemoglobin
b. family that presents with headache, nausea, confusion, coma, seizures, and not cyanotic - get a delayed neuropsychiatric syndrome
c. 100% oxygen and HBO
Hydrogen sulfide
rotten eggs - don't go in you will die

treat: cyanide antidote kit
What two drugs are contraindicated in MAOI?
Meperidine and dextromethorphan - can cause severe hypertermia
Opisthotonus
back muscle spasms, body arched (occurs in stychnine toxicity and NMS)
Neuroleptic Malignant Syndrome
AMS, severe hyperthermia (106F), rigidity, opisthotonos, hypertension, tachycardia

Treatment: fever control, dantrolene, paralysis, bromocriptine
Serotonin Syndrome
Lower extremity rigidity >> UE rigidity
Rapid onset, myoclonus/hyperkinesia, ⇑BP/TEMP/HR

Distinguished from NMS [slow in onset, associated with bradykinesia and lead pipe rigidity]

Treatment: cypoheptadine
Strychnine Toxicity
CNS hyperstimulation -muscle twitching, facial grimacing, extensor spasm, opisthtonos

rx: airway, benzodiazepines, may require paralytics
Acute Periodic Paralysis
Rapidly progressive extremity weakness in young males - after exercise

Associated with hypokalemia, thyrotoxicosis
Tensilon test
Increases ACH by blocking break down of AcH by cholinesterase = increases muscle strength (EMG= rapid fatigue)

can cause: AV block and cardiac arrest - atropin at bed side
ALS
degeneration of upper and lower motor neurons

NO SENSORY defects

UMN: spasticity, no sensory defects
LMN: atrophy and fasciculations
Normal pressure hydrocephalus
Wet Wild Wacky

dementia, ataxia, urinary incontinence

Treatment: shunt
Jefferson Fracture
Burst fracture of atlas (C1) Unstable fracture due to axial compression such as diving
Brown-Sequard Syndrome
Ipsilateral weakness, loss of position/vibration sense

Contralateral loss of pain and temperature sensation
Diagnostic criteria for Kawasaki disease?
Fever for last 5 days plus at least 4 of the following:
- Bilateral non-exudative conjunctivitis
- Changes of lips/oral mucosa (fissured lips; strawberry tongue)
- Changes in extremities (erythema of palms/soles, edema, periungal desquamation)
- Polymorphous rash
-Cervical lymphadenopathy (at least one node >1.5 cm)
Treatment of Kawasaki's?
ASA (80-100mg/kg/day)
Single infusion of IVIG (2g/kg)

DO NOT GIVE STEROIDS
Henoch-Schonlein Purpura
The most common acute vasculitis in children

ARENA
A= Abdominal pain (bloody stool/intussusception)
R= Rash, purpuric in dependant areas (legs and butt)
E= Edema
N= Nephritis (microscopic hematuria)
A= Arthralgias
Severe's Disease
Norweigian Scabeies that is seen in immunocompromised patients
Rocky Mountain Spotted Fever
Rickettsia rickettsii; Dermacentor tick

Rash starts on ankle/wrists/palms/soles and then moves centrally becomes palpable and non-blanching

Treatment: doxycycline
Diptheria
Cornybacterium diphtheria (Gram + bacillus)

Thick grayish membrane with sharply defined borders; sore throat, dysphagia; can cause myocarditis and airway obstruction

Treatment: Respiratory isolation and erythromycin for 14 days
Pertussis
Bordetalla pertussis (Gram neg coccobacilli)

Three phases with barking cough; whoop and post tussive emesis
Babesiosis
Tick (Ioxedis)

Hemolytic anemia (elevated bilirubin and LDH)
Ehrlichiosis
obligate intracellular rickettsia-like coccobacilli

Thrombocytopenis and leukopenia
Dengue Fever
Viral infection in the tropics and subtropics (Aedes mosquito)

Acute, self-limiting fever, myalgias, headaches, rash, lymphadenopathy, leukopenia
Rabies
Acquire from bats, raccoon, fox skunk

Post exposure: 5 doses of vaccination and HRIG 20 IU/kg
Tichinosis
Trichinella spiralis - ingestion of infected pork

Eosinophilia

Treatment: mebendazole
Tetanus Prophylaxis
1. Clean wounds
a. primary series completed w/ last booster >10 years ago: Td
b. Unknown status: Td

2. All other wounds
a. Primary series completed >5 yr: Td
b. Unknown: Td and TIG
Rubella
German Measles

Rash spreads from head to feet

Prominent lymphadnopathy: posterior auricular, cervical, and occipital
Rubeola
(Measles)
Fever, cough, conjuctivitis, coryza

Koplik spots

Maculopapular red-brown morbiliform rash spreads from head to feet
Roseola Infantum
HHV 6/7

High fever => rash with defervescence
Febrile seizures common
Pink macules on trunk that can spread to neck, face, extremities
Erythema Nodosum
Painful, non-ulcerative, violacesous nodules loncate on anterior tibia, arms, and trunk;

Often a marker for systemic disease (drug reaction, infection, sarcoid, IBD, Malignancy)
Carcinoid tumor
circumscribed tumors occuring in small intestines, appendix, stomach,, colon

secretes serotonin: skin flushing, watery stools, hypotension, vasodilation, edema, ascites, and bronchoconstricution
Pheochromocytoma
Tumor of adrenal medulla cells that secrete NE causing elevated HTN

Diagnosis w/ catecholamines and VMA in 24 hr urine
Acoustic Neuroma
Benign tumor of CN VIII

Atacia, deafness, and ipsilateral facial weakness
TTP
⇓⇓platelets, severe microangiopathic hemolytic anemia; transient neuro defects; renal failure; fever

release of vWF and consumption thrombocytopenia

Treatment: steroids, plasmapheresis, FFP

NO PLATELETS
ITP
Generally no other findings than thrombocytopenia (low platelets) and petechia/purpura

Treatmet: platelets; IVIG
Tumor Lysis Syndrome
Massive lysis of cancer cells from chemotherapy 12-72 hr post treatment

Treatment
a elevated PO4/K - hydration/forced diresis
b. Decrease uric acid build up by alkalinzation of urine
Calcium supplimentation if cv instability
Central Retinal Artery Occlusion
Sudden, painless visual loss (embolic) causing monocular blindness

Pale retina, fixed dilated pupil with cherry-red spot on macula and box-car look to retinal artery
Temporal Arteritis
3 of the 5 criteria
a. age >50
b. New onset headache or localized cephalgia
c. Temporal artery tenderness
d. Decreased pulsation not related to carotid disease
e. ESR>50 mm

Ischemic of muscles of mastication cause painful chewing
Treatment for temporal arteritis
Opthalmology consult, high-dose prednisone or IV prednisolone
Treatment for acute angle glaucoma
1. Decrease aqueous humor production (topical β-blocker, alpha agonist acetazolamide)
2. Mannitol
4. Topical miotic (pilocarpine) - facilitates aqueous humor drainage
Horner's syndrome
Loss of sympathetic chain

ptosis, miosis (constriction) and anhydrosis
CREST syndrome
Scleroderma
Calcinosis: subcuaneous calcifications (fingers)
Raynauds phenomenon
Esophagitis (due to LES sclerosis-> reflux)
Sclerodactyly (fibrosed skin causes immobile digits and rigid facies
Telangiectasis
vWF deficiency
Most common inherited bleeding dz

⇑ bleeding time and ecchymoses, normal PT/PT

Treatment DDAVP
HELLP syndrome
Hemolysis
Elevated LFTs
Low Platelets
Sarcoidosis
bilateral hilar adenopathy; uveitis (can be bilateral) noncaseating granulomas on biopsy of lungs

Rx: steroids
Marfan's
Genetic collegen defect

Increased risk for aortic dissection, MVP, joint laxity, optic lens dislocation and blue sclera
Osteogenesis Imprefecta
"brittle bone disease" and blue sclera

mutation in defective collegen synthesis
Paget's disease
Increased activity of both osteoblasts and osteoclasts - diffuse fractures and bone pain

HIGH OUTPUT CARDIAC failure (increased alkaline phosphatase)
G6PD
AR X-linked; causing hemolytic anemia with administration of certain drugs (antimalerias, sulfonamides, and nitrofuratoin)

RBCs are unable to produce gluthione that protects hemoglobin from oxidative denaturation
Botulism
Acute DESCENDING flaccid paralysis cause by Clostridium botulinum 0 ingestion of spores in honey
Lambert Eaton Syndrome
similar to MG + Cancer

Weakness and fatigue of proximal muscles especially thigh/hips but IMPROVES with use

Treatment: remove tumor and plasmaphoresis
Subacute Cerebellar Degeneration
deterioration of the area of the brain concerned with muscle coordination and balance
Wernicke's encephalopathy
occulomotor crisis, CN VI palsy (lateral rectus), nystagmus, ataxia, global confusion
Korsakoff's syndrome
retrograde amnesia and confabulation
Trimetaphan
drug that counteracts cholinergic tranmission bloking both SNS and PNS acting as a non-depolizing antagonis at the nicotinic receptor

use; hypertensive crises, dissecting aortic aneurysm, and treat pulmonary edema
Phentolamine
alpha adrenergic antagonis causes vasodilation

Used in cocaine induced hypertension; hypertensive emergencies and pheochromocytoma
Pyridostigmine
parasympathomimetic and a reversible cholinesterase inhibitor - used to treat MG