22nd June Flashcards
When is NPPV contraindicated in COPD patients
pH < 7.1, indication is to then intubate
When do you give abx to COPD patients
2 or more of the cardinal signs: increased cough, sputum production or increased dyspnea
Tx of malignant hyperthermia
Dantrolene
Explain the process of management if a newborn starts emesis within 24 hours of life
Feeds should be discontinued, nasogastric tubes should be placed for decompression and the neonate stabilized. After that the first step to do is abdominal x ray to look for air under the diaphragm, if that is there then next step is surgery. If not then x ray shows air or no air in the bowel. If there is no air in the bowel then the differential is hirschsprung or meconium ileus, gastrogragin enema is performed as it is diagnostic and therapeutic for meconium ileus.
If NG tube is misplaced then its malrotation, if double bubble sign then dudenal atresia
What is duodenal atresia associated with?
Down syndrome
First step when beckewith wideman syndrome is suspected in a newborn
Look out for hypoglycemia
First step if gallstone pancreatitis is suspected? Second step?
First is to do RUQ US, if no glasstones are seen then do ERCP
What are the causes of protraction of active phase of labor
Passage, passenger, power, so cephalopelvic disproportion, macrosomia, inadequate strength of contraction, fetal malposition
Which phase of the labor is affected by epidural anesthesia usually?
Second stage of labor, first stage is not affected
Acamprosate
Used for alcohol cravings, second line, avoid in renal impariment
What is the next step in emphysematous cholecystitis
Emergent cholecystectomy, broad spectrum IV antibiotics
In utero fetal bradycardia is defined by? Tachycardia
HR < 110, tach is above 160
Basic medical workup of new onset psychosis first step
UDS
Hemodynamically stable patient with abdominal pain presents to clinic, positive urine pregnancy test but US does not show anything in the uterus, best next step?
Transvaginal US, have to have a diagnosis of ectopic before she can be sent for surgery
Interval between starting MAOI and stopping SSRI, waht does it cause?
2 weeks, serotonin syndrome
Hallmark difference between primary ciliary diskinesia and CF in pediatric patients
Normal growth in primary ciliary dyskinesia
Know the exact definition of preeclampsia
Systolic <140, diastolic <90, proteinuria and/or end organ damage, so proteinuria is not necessary
3 medication of preeclampsia HTN tx and which one is PO
Hydralazine, labetalol, nifedipine, with the last one being PO
The first step for gastric cancer is always
Endoscopy
Next step if pancreas is not seen on US
CT scan, NEVER DO ERCP for pancreas alone, it is done for choldeocholithiasis
Area posterior to the testis is swollen and tender, next step in management
Abx, acute epididmyitis
Most common organism causing acute epididmyitis
Below 35, nisseria and gonorrhea, above 35, E coli and other coliform bacteria
Cut off for renal stone management
10 mm, if less than that tamsulosin and medical management, if more then surgery
Risk factors for placenta previa
Prior placenta previa, c section and multiple gestations, smoking
What symptoms are common in dysuria in post menopausal woman with estrogen deficiency
They can have recurrent UTIs, this does not necessarily mean they have a fistula even if they have a history of surgery
Risk factors for placental abruption
Smoking, cocaine use, HTN, preeclampsia, prior hx of abruption
Most common cause of sepsis in burn patients
Immediately after are gram positive such as Staph and after 5 days it is gram negatives like Pseudomonas
What is a complication of coronary catheterization and what is the best management for it
Retroperitoneal hematoma, non contrast CT scan of the abdomen and pelvis
How to differentiate viral myocarditis from acute rheumatic fever
Viral myocarditis presents with rhinorrhea and congestion, strep throat does not causes fever and arthritis preceding the myocarditis episode
Contraindications to dTaP vaccine
anaphylaxis or encephalopathy after receiving the vaccination, seizure is not a contraindication
When is Bordetella pertussis prophylaxis indicated?
Within 21 days of close contacts
What is preverteberal calcifications specific for?
Abdominal Aortic aneurysm
What has to be present to diagnose Bipolar II
Hypomanic episode/hx of depression, bipolar 1 can still be NOT functionally impairing
What is necessary for depression to be present in? Bipolar I or II?
Bipolar II, since it has to have a hypomanic episode
Tx of pyelo in a pregnant pt?
Hospitalization + ceftriaxone
Illiotibial band syndrome
Overuse injury, tenderness at the lateral femoral condyle during flexion and extension
Pes anserinus pain syndrome
Overuse injury, pain and tenderness over the anteromedial tibia, just below the joint line
How do we differentiate extra renal and renal sodium losses for hyponatremia
If urine Na is more than 20 then it is renal loss, otherwise it is extra renal loss such as from diarrhea, vomiting etc
What murmurs prolong with Valsalva
MVP and HOCM
Upper abdominal series is the best diagnostic test for?
Volvulus
Feboxustat
Probenecid
Colchicine
Xanithinine oxidas inhibitor, same as allopurinaol, used for gout, probenecid increases uric acid secretion by blocking its reabsorption in the renal tubules, colchicine is a short term treatment for acute gout, inhibits chemotaxis
When are alpha adrenergic antagonist used for urinary incontinence
When there is uretheral outflow obstruction like ib BPH, alpha adrenergic antagonist reduce uretheral sphincter tone so it can exacerbate stress and urge incontinence
Beta blockers that improve long term mortality
Metoprolol, carvedilol and bisoprolol
What are the recommendation for HTN control
Age less than 60, chronic kidney disease, diabetes, goal blood pressure is <140/90, for age > 60, goal blood pressure is <150/90
OCPs reduce risk of
Ovarian and endometrial cancer
What is given to shrink uteirne fibroids?
Leuprolide since it decreases estrogen and causes them to shrink
Next step in hemodynamically stable patients with penetrating injuries to the neck?
CT angio, injuries to the trachea, larynx, esophagus and blood vessels has to be evaluated
