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Oral Boards > Cardinal Signs > Flashcards

Cardinal Signs Flashcards

1
Q

Fever: considerations

A

Immunocompromised? Chemo? IV DU?

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2
Q

Cellulitis critical action

A

check for crepitus, consider US for abscess

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3
Q

Thyroid storm sx

A

Fever, tachy, agitated, confused, longer-standing sx than other causes of fever

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4
Q

Thyroid storm initial tx

A

Look for signs of high output heart failure. BB for tachycardia. Anti-thyroid meds.

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5
Q

UTI critical action

A

GU exam

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6
Q

UTI length of treatment

A

Uncomp cystitis: 3 days. Comp cystitis: 7 days. Uncomp pyelo: 7-10 days fluoroquinolone. Comp pyelo (male, preg, structural problems, neuro disease): hospitalize for IV abx

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7
Q

DM + ill appearing + UTI

A

Think about emphysematous pyelo or perinephric abscess

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8
Q

Endocarditis classic triad

A

Fever, anemia, cardiac murmur

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9
Q

Endocarditis mgmt

A

Blood cultures x3. Empiric abx: vanco + gent OR ceftriaxone + gent. Early cardiology consult for possible TEE/other intervention e.g. needs procedure if perivalvular leak –> HF

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10
Q

Definition of neutropenia

A

<500 PMNs/mm3

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11
Q

Neutropenic fever critical actions

A

BC x2, fluid resuscitation, empiric broad spectrum abx, ID consult. Admit with isolation precautions.

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12
Q

HIV/AIDS important history to obtain

A

Time since dx, any AIDS defining illnesses, therapy (HAART?), prophylactic abx use, CD4 counts/viral load

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13
Q

HIV/AIDS important places to look for opportunistic infection

A

Fundi (CMV retinitis), skin for Kaposi’s sarcoma, mucous membranes for thrush

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14
Q

Diagnostic studies (in addition to usual) for fever + HIV

A

quantiferon gold for TB, LFTs, sputum culture, ABG if SpO2 <95%, LP if any neuro signs

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15
Q

Hypoxia out of proportion to CXR in HIV/AIDS

A

PCP pna

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16
Q

HIV + hemoptysis critical action

A

respiratory precautions until TB ruled out

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17
Q

Cellulitis IV antibiotic regimen

A

Simple: ancef 1-2g q6h. Suspected MRSA vanco 20 mg/kg IV q12h. Diabetic foot infection: vanc 20 mg/kg + zosyn 3.375g. Deep infection/nec fasc: zosyn 3g q6h, clinda 600-900 mg q8h + vanco 20 mg/kg q12h

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18
Q

Triggers for thyroid storm (4)

A

infection, surgery, emotional stress, trauma. Contrast reaction, drug reaction, DKA

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19
Q

Thyroid storm critical actions

A

Palpate thyroid (usually toxic diffuse goiter), BG (DKA can precipitate thyroid storm, hyperglycemia in 55%). BB for signs of CHF. Consult endocrinology (and cards if cardiac complications)

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20
Q

Thyroid storm orders

A

basic labs, TSH, T4, LFTs, CXR (eval CHF), ECG

21
Q

Preferred beta blocker for thyroid storm

A

Propranolol: controls HR + inhibits peripheral conversion of T4 to T3. Propranolol 1-2 mg boluses q15 min until desired effect, then start oral.

22
Q

Treatment regimen for thyroid storm

A

BB if CHF/tachycardia –> methimazole or PTU (PTU if pregnant) to block new production –> iodine 1 hr after PTU. Decadron to decrease peripheral T4 to T3 conversion)

23
Q

Treatment of CHF caused by thyroid storm

A

BB, diuresis if needed, supplemental O2

24
Q

Avoid what analgesic in thyroid storm and why

A

aspirin. Displaces thyroid hormone from thyroid binding globulin –> worsens condition

25
Q

CP ddx top 4 “until proven otherwise”

A

ACS, dissection, PE, PTX (tension)

26
Q

Posterior MI ECG pattern

A

V1-V4 STD + tall R wave

27
Q

Chest pain critical actions (on ACS pathway)

A

Check for widened mediastinum on CXR before giving heparin/thrombolytics.

28
Q

Nitro gtt parameters

A

Start 20 ug/min, increase by 10 ug/min q10 min until pain free or BP drop.

29
Q

Ticagrelor / plavix loading doses for ACS

A

Ticagrelor: 180 mg. Plavix 300 mg.

30
Q

Heparin ACS loading and gtt dosing

A

60 U/kg load + 12u/kg/hr drip (adjust based on PTT at 6 hrs)

31
Q

LMWH dosing for ACS (heparin alternative)

A

1 mg/kg q12 hrs

32
Q

Thrombolytics for STEMI - give if no PCI in ___ min

A

90 min

33
Q

Thrombolytics for STEMI: absolute contraindications

A

H/o hemorrhagic stroke. Any stroke in past year. Active internal bleeding (menses excluded), known intracranial neoplasm, aortic dissection

34
Q

BP difference > x mmHg suggestive of aortic dissection

A

> 20 mm Hg, can be difference between arms or between left arm and left leg

35
Q

Aortic dissection critical actions for exam findings

A

Murmur (often aortic regurg), pulses in all 4 extremities, pressure in both arms. If murmur, ask if it is new.

36
Q

Suspect aortic dissection labs

A

CMP, CBC, trop, TYPE AND CROSS, coags

37
Q

Treatment aortic dissection

A

Call CT surgeon (type A), fluid resuscitate then pRBC if in shock (avoid hypotension). Control HR (titrate esmolol to goal 60 bpm) then control BP (add nicardipine if necessary, goal 100-120 systolic)

38
Q

Suspect dissection and hypotensive… next step

A

Do not go to radiology hypotensive. Perform ED TEE. If stable have MD or RN accompany pt to CT.

39
Q

Suspected PE phys exam critical actions

A

Leg asymmetry/palpable cord. Ask about melena.

40
Q

PE definitive management

A

Heparin 80 U/kg bolus then 18 U/kg/hr infusion (alternative Lovenox at 1 mg/kg BID). Make sure CXR is done first to look for signs of dissection

41
Q

Unstable, suspected PE: imaging evaluation, tx

A

echo + tpa 100 mg over 2 hrs. Consult CT/CV surg or IR for catheter directed therapy or thrombectomy

42
Q

Sudden pleuritic CP with dyspnea. First steps?

A

Assess JVD, tracheal deviation, and breath sounds

43
Q

Treatment of PTX (general, not necessarily tension)

A

100% oxygen by facemask for reabsorption. BMP, CBC, CXR, ECG.

44
Q

Syncope: things to look for on ECG

A

Brugada, WPW, hyperkalemia, LVH, ischemia, epsilon wave, abnormal intervals

45
Q

What is an epsilon wave

A

Positive “blip” at end of QRS complex in leads V1-V4. Indicative of arrhythmogenic right ventricular dysplasia; myocytes replaced by fatty non-conducting tissue creating islands of impaired conduction. Causes: MI, sarcoidosis, infiltrative disease

46
Q

Syncope key history questions

A

Cardiac hx, family h/o sudden death or arrhythmia

47
Q

Key syncope etiologies for boards

A

Reflex/vaso-vagal. Orthostatic. Cardiac: arrhythmia, AS, aortic dissection. Neuro: seizure, tia, migraine, subclavian steal.

48
Q

Long QTc ms

A

> 450 in men, >460 in women and children

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