11.7 Flashcards
impaired cough and shallow breathing
hypoxia
increased RR
low pCO2
= atelactasis = loss of lung volume
ppx of atelectasis
pain control ICS direct coughing early mobilization
oozing from venipuncture sites sepsis trauma malignancy OB c/b
DIC long PT/PTT low fibrinogen high D-dimer schisotcytes
dilated fluid filled stomach
dilated proximal intestinal segment
no intraluminal fluid in rest of bowel
duodenal atresia
causes: polyhydramnios bc you can’t swallow
VACTERL
vertebral anal atresia cardiac TE fistula esophageal /duodenal atresia renal limb
if any defect, need to evaluate for the rest of these
associations of duodenal atresia
downs
VACTERL
COL1A1 defect
osteogenesis imperfect
frequ fractures blue sclera conductive hearing loss dental issues joints hypermobile
(only T2 is lethal)
chlamydia and gonorrhea in women
cervicities
urethrtisi perihepatitis
tx:
chlam: azithro
gono: both azithro + CTX
PID can be c/b
tubo ovarian abscess = fever + adnexal mass
degenerating subserosal uterine leiomycoma
abdominal pain
fever
irregularly enlarged focally tender uterus
ground glass ovary on U/S
endometriosis
adnexal mass w/ solid components + hyperechoic nodules
mature cystic teratomya
symmetric juvenile arthritis versus asymmetric juvenile arthritis?
symmetrical: JIA: tx w/ naproxen, will be worse in AM
asymmetric:
if vesiculopustual lesions: gonococcal arthritis = tx w/ CTX
if erythema migrains, lyme, tx w/ doxy
painful, fluctuant mass 4-5cm cephalad to anus w/ purulent blood drainage
pilonidal disease = infected hair follicle
perianal fistula vs abscess
fistula = drains purulent material
abscess = does not drain
sudden onset RDS, hypoxia, shock, or cardiac arrest s/p CVC placement, PPV, or neurosurgery
venous air embolism = can go to RV outflow tract and cause an obstruction
leads to dyspnea, RDS, obstructive shock causing cardiac arrest
discomfort, heaviness of scrotum, pampiniform plexus increases w valsalva
varicocele, increases infertility and testicular atrophy
if BL, c/f malignancy
GBS - ascending weakness + areflexia + high protein on CSF w/ abnormal EMG/NCS, ENHANCEMENTS OF ANTERIOR NERVE ROOTS ADN CAUDA EQUINA
TX?
1) SPIROMETRY TO DETERMINE MUSCLE STRENGTH
IF LOW fvc, THEN YOU NEED TO INTUBATE
2) if severe dysautonomia, widened pulse, RDS, or low FVC, then intubate
otherwise IVIG
In which settings can succinylcholine use cause hyperkalemia?
skeletal mm trauma
burn injury
stroke
GBS
postsynpatic ach receptors are upregulated in these conditions, so instead use vecuronium and recuronium
3 wk hx of weight loss abdominal pain nausea plus hypotension and lyte abnormaliites
addison’s disease
SIADH
hypotonic hyponatremia
serum osm<275 = LOW
urine osm>100 = HIGH
urine sodium >40 = HIGH
nitrates work by?
systemic vasodilation decreased cardiac preload decrease in LVEDV reduction in LV stress decreased in oxygen demand
pleural effusion w/ glucose<50 and high LDH could be
empyema
cancer
TB
RA
when do you not give a beta blocker in acute MI?
hypotension
bradycardia
acute HF
heart block
when do you give atropine in acute MI?
unstable sinus brady
when do you not give nitrates in acute MI
if hypotensive
right ventricular infarct
severe aortic stenosis
in metabolic acidosis, what is the urine pH
high, because the kidneys release extra bicarbb to alkalinize the urine and hold onto extra H+
what happens to aldosterone in contraction alkalosis
when volume contracts, aldosterone goes up to resolve intravsacular volume and results in H+ loss and Na+ retention
what drugs cause a false + PCP test?
dextromethorphan diphenhydramine ketamine tramadol venlafaxine
hypotension bradycardia bronchospasm altered mental status seizures
BB toxicity
tx w. fluids, atropine, and glucagon
TB tests ranges that you can do nothing about
<5 mm
<10
<15
<5 HIV+ patients, recent CONTACTS of known TB, NODULAR/FIBROTIC CHANGES on CXR c/w prior healed TB, ORGAN transplant recipients
<10: IMMIGRANTS, IV DRUGS, prisons, shelters, hospitals, lab workers, CHRONIC DISEASE (DM, LEUKEMIA, ESRD), KIDS<4
<15 everyone else
If TB test is positive but negative chest x ray how do you treat?
9 months of INH + pyridoxine or 4 mos of rifampin
how to treat active TB
RIPE for 8 weeks then I+R for 4 months
AUB management
<45 =OCP
>45 OR FAILED OCP OR OBESE or on tamoxifen = endometrial biopsy
if psychosis in PD, what do you do?
reduce carbidopa levodopa
unless resurgent motor symptoms, then treat w/ quetiapine
high testosterone
high estrogen
no LH surge = no follicle maturation
PCOS
FTT, diarrhea, LAD, PCP pneumonia in infant =
HIV in infant
tx w/ immediate ART
In pulmonary fibrosis what happens to A-A gradient?
increased, and decreased diffusion capacity for CO
stealing objects of low monetary value and not needed for personal use
kleptomania
blunt chest trauma w/ tension pneumo + crepitus –> despite CT, rapid reaccumulation OF PTX & rapid airleak of CT
bronchial rupture
intermittent abdominal pain after eating
decreased food consumption
weight loss
mesenteric ischemia
dx w/ mesenteric angiography
How to treat ischemic stroke in SCD?
exchange transfusion (or simple transfusion)
heparin is not given in stroke
how to manage primary amenorrhea
pelvic ultrasound to exclude anatomic abnmls
what is primary amenorrhea
no period at age>15 but breasts
no period at age>13 and no breasts
