Murmurs
Most common congenital heart defect and type of murmur+location
VSD. Holosystolic murmur at L-Lower Sternal Border
Foul smelling diarrhea after recent Abx Tx. What organism?
Prevention?
Tx:
C.diff
Hand washing
Oral vanc/fidaxomicin. Last resort is fecal transplant.
Test for primary adrenal insufficiency.
What clinical features?
Tx?
Cosyntropin testing
Fatigue, weakness, anorexia, n/v/abd pain, postural hypotension,hyperpigmentation
Tx w/ glucocorticoids, mineralocorticoids
What electrolyte is elevated with rhabdo/tumor lysis syndrome?
EKG findings?
Potassium
Peaked T waves, wide QRS
Outpatient?
Inpatient?
If aspiration PNA?
HAP?
Outpatient: Amoxicillin/Augmentin and Azithro for atypical
Inpatient: MC Fluoroquinolones (-floxacins)
If aspiration PNA: clindamycin to cover anaerobes and if HAP = Zosyn/Cefipime
You hear split S2 on inspiration and expiration, what murmur is it?
IF U SEE SPLIT S2 ON EXPIRATION, ALWAYS THINK ASD
Pork consumption leading to diarrhea, what organism?
Dx for diabetes insipidus
How to differentiate b/w Central vs. nephrogenic?
Dx with water deprivation test. Remeasure serum osmolality and urine osmolality after a couple hours. If urine osmolality doesn't increase, suspect DI.
Give desmopressin. If urine osmolality increases a lot, central. If it stays the same, nephrogenic DI. Tx of nephrogenic is HCTZ
Tx for hypermagnesemia?
IV calcium gloconate
CSF findings in viral infections?
WBC, protein, glucose?
Increased WBC, protein
Normal Glucose
Pt with URI 30 years ago, having palpitations, EKG shows A-fib. Dx of murmur, location and #1 RF of this?
Mitral stenosis. Diastolic murmur with opening snap at apex.
#1 RF: Rheumatic Fever
#1 RF for A-Fib = Mitral Stenosis
Potato salad + water diarrhea?
S. aureus
Pt with neck mass, seizures, hypocalcemic with ECG showing QT prolongation.
Dx?
Tumor markers?
Dx: Men 2A or 2B leading to medullary thyroid cancer
Calcitonin
Tx for hypovolemic hypernatremia?
NS until euvolemic then correct free water deficit
MC causative organism of septic arthritis in:
Normal person
Sickle cell
IVDU
Norma: S. aureus
Sickle: Salmonella
IVDU: Pseudomonas
Aortic Regurgitation:
Where do you hear it, what type of murmur is it, what do you see to diagnose?
What do you see clinically?
Heard best at L-lower sternal border. Can be at R-sternal border if reallllly bad. Diastolic decrescendo murmur
Dx: with widened pulse pressure (Inc SBP + dec DBP),
Water-hammer pulsation with head bobbing and hyperdynamic pulse
Pt with bloody diarrhea + thrombocytopenia + unconjugated hyperbilirubinemia + acute renal failure
Organism?
E.coli O157:H7 or Shigella
Pt with Hx of Graves, decompensating in ED, very hypertension, tachy, AMS
Dx?
1st LOT:
2nd step:
Dx: Thyroid Storm
1. Beta blocker (propranolol)
2. PTU
What is the next best step for hypokalemia after giving potassium?
GIVE MAG
Pt presents with erythematous lines on arms with tender lymphadenopathy.
Dx?
Tx?
Dx: Catscratch dz (Bartonella)
Tx: Macrolide/Doxy
Old male with syncopal episodes and DOE/SOB with physical activity.
What murmur, where do you hear it, what findings do you see?
Aortic Stenosis.
Heard over 2nd R-ICS, crescendo-decrescendo murmur.
HY: Soft and single S2 during inspiration in severe AS.
Pathophys: Obstruction of LV outflow decreases pulse pressure and weakens systemic pulsation. Higher LV pressure needed to open = higher murmur intensity later in systole. C
Findings: Pulsus parvus atardis- long time to feel carotid pulse (carotid pulses slow rising and delayed)
Fever+ abd pain + Mucoid/Bloody diarrhea with ascending paralysis?
Transmitted via?
Campylobacter jejuni. GBS 2/2 to infxn.
Undercooked poultry.
Dx?
DDx and how to differentiate?
Subacute thyroiditis/De Quervains thyroiditis/granulomatous thyroiditis
DDx of exogenous thyroid use. Will also show cold RAIU. Use thyroglobulin (subacute is +, exogenous -)
Electrolyte abnormality seen in refeeding syndrome?
Phosphate (hypo)
HIV prophylaxis for what organism and diarrhea.
CD4 < 200?
CDV < 50?
Watery diarrhea + HIV?
Bloody diarrhea + HIV?
< 200: Bactrim --> PCP PNA
< 50: Azithromycin --> MAC (Mycobacterium Avium Complex)
Watery: Cryptosporidium parvum
Bloody: CMV
MAC: Fever+diarrhea