Absite Review Flashcards
Subdural hematoma
crescent shape, conforms to brain; 50% mortality, elderly
Epidural hematoma
lens shape, goes into brain, 10% mortality, middle meningeal artery, ‘lucid interval’
Cerebral perfusion pressure
CPP = MAP - ICP, want to keep ~70
Cushing’s triad
increased ICP:
HTN, bradycardia, Kussmaul respiration
Brown Sequard
spinal cord transected 1/2 way, loss of
ipsilateral motor
contralateral pain and temp
Central Cord Syndrome
Bilateral loss of upper extremity motor, pain, temp;
Legs relatively spared.
Hyperflexed C-spine injury
GSC
GCS Motor:
6 commands, 5 localizes, 4 withdraw pain, 3 flexion pain (decorticate), 2 extension pain, 1 none
GCS Verbal: 5 oriented, 4 confused, 3 inappropriate, 2 incomprehensible, 1 none
GCS Eyes: 4 spontaneous, 3 to command, 2 to pain, 1 none
Anterior spinal artery syndrome:
lose bilateral motor, pain and temp; keep position sense, light touch
Spinal Shock
Cord injury above T5 can cause spinal shock; Rx with fluids, may need alpha-agonist. Recognize by hypotension with bradycardia, warm perfused extremities (vasodilated).
Spinal Shock
Cord injury above T5 can cause spinal shock; Rx with fluids, may need alpha-agonist (phenylephrine). Recognize by hypotension with bradycardia, warm perfused extremities (vasodilated).
EtOH and Head Injury ___ ADH release which causes
Inhibit ADH Diabetes Insipidus (high UOP, low urine glucose, high serum osmolarity/Na)
Closed Head Injury may cause SIADH
oliguric, high urine osmolarity, low serum osmo/Na
AVMs vs Aneurysms
AVM's: congenital, bleed age 40-60 aneurysms younger (age 20-59), are a/w HTN
Acoustic Neuromas
Arise from 8th CN at cerebellopontine angle,
hearing loss, vertigo, N/V
Krukenberg Tumor
Colon or stomach cancer met to ovary (signet cells on path)
Meig’s Syndrome
Pelvic tumor causing ascites and hydrothorax
Missed abortion
1st tri bleeding
Closed os
Sac on US
no heartbeat
Threatened abortion
1st tri bleeding
+heartbeat
Incomplete abortion
tissue @ os
PID
Risk of ectopic pregnancy
Ceftriaxone, Doxycycline
Appendicitis in pregnancy
50% premature delivery, fetal mortality 2-8%, maternal 1%
Ovarian Cancer Staging
stage I limited to ovary (5 yr survival only 66%); II in pelvis; III throughout abdomen; IV distant mets
infections can present w/in hours postop
ß-Strep and clostridial
Most common anaerobe in colon
b fragilis
Most common aerobic bacteria in colon
e. coli
Most common organism in the GI tract
Anaerobes
mechanism in gram negative sepsis
endotoxin (lipopolysaccharide A) release, triggers release of TNF-alpha, activates complement and coagualation cascade
early v. late gram negative sepsis
Early: decreased insulin, increased glucose (impaired utilization)
Late: increase insulin, increased glucose (insulin resistance)
First sign of sepsis
hyperglycemia
C. diff treatment
Oral vanco/flagyl
IV flagyl
C. diff in pregnancy
oral vanc
Tx for fulminant c. diff
total colectomy w/ ileostomy
When do abscesses occur
7-10 days post op
coagulase positive
staph aureus
Coagulase neagtive
staph epidermidis
Most common organism in SSI
s aureus
Most common organism in ICU pneumonia
S. aureus
pseudomonas
E. coli
Most common organism in line infections
s. epidermidis
s. aureus
yeast
Necrotizing soft tissue infections
beta-hemolytic strep
C. perfringens
*overlying skin can look normal as infection spreads along fascial planes
Tortuous abscesses in cervical, thoracic, abdominal areas
Actinomyces
CNS symptomsin AIDS patients
Cryptococcus (tx amphotericin)
Pulmonary symptoms in the Southwest
Coccidioidomycosis (tx amphotericin)
Pulmonary symptomsin Mississippi & Ohio River valley
Histoplasmosis (tx amphotericin)
Bacteria in primary SBP
monobacterial
50% E. coli
30% streptococcus
10% Klebsiella
Due to decreased host defenses not transmucosal migration
Dx of SBP
peritoneal fluid w/ PMNs>250 or positive cultures
Secondary SBP
intra abdominal source - polymicrobial (b. fragilis, E.coli, enterococcus
Potency
dose required for effect
ED50
drug level at which desired effect occurs in 50% of patients
LD50
drug level at which death occurs in 50% of patients
Gout TX
Colchicine: anti-inflammatory, binds tubulin
Indomethacin: NSAIDs, inhibits prostaglandin synthesis
Allopurinol: xanthine oxidase inhbitor
Probenecid: increases renal secretion of uric acid
ME of metoclopramide (Reglan)
inhibits dopamine receptors
ME of erythromycin
binds and activates motilin receptor
ME of zofran
central acting serotonin receptor inhibitor
ME of omeprazole
blocks H/K ATPase in stomach parietal cells
ME of ranitidine
H2 receptor blocker to decrease acid
ME of digoxin
Inhibits Na/K ATPase and increases myocardial calcium to slow AV conduction
*be cautious of hypokalemia, mesenteric ischemia
ME of amiodarone
Good for acute arrhythmia
**side effect is pulmonary fibrosis, thyroid problems
Best single agent shown to improve survival in patients w/ CHF
ACE inhibitors
Best single agent shown to improve survival in patients after MI
beta blockers
ASA poisoning
Respiratory alkalosis
Metabolic acidosis
Tx of AIDS
AZT - reverse transcriptase inhibitor
Ritonavir - protease inhibitor
Most common indication for laparotomy in HIV patients
CMV opportunistic infection (followed by lymphoma/neoplastic disease)
Abdominal pain, bleeding, perforation in AIDS
CMV colitis
MC neoplasm in AIDS
Kaposi sarcoma
Upper GI bleed in AIDS
Kaposi sarcoma
Lower GI bleed in AIDS
CMV
Most common indication for liver transplant
Hepatitis C
Most common infection in transplant patients
CMV (cellular inclusion bodies)
Test for osteomyelitis
MRI
Where does aspiration PNA occur
superior segment of right lower lobe
TX brown recluse bites
oral dapsone
bacteria in cat/dog bites
s. pyogenes, pasturella multocida (Tx w/ augmentin)
Peritoneal dialysis catheter infection bug
s. epidermidis
s. aureus
pseudomonas
