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usmle step 2 secrets > chapter 36 shock > Flashcards

chapter 36 shock Flashcards

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USMLE® Step 1 flashcards
1
Q

patients who are hypotensive – what fluids should you give?

A

fluid bolus of LR

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2
Q

if fluids don’t raise BP

A

intravascular monitoring

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3
Q

if laryngeal edema?

A

teach or cricket

IM epinephrine + fluids if anaphylactic

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4
Q

dopamine dosages

A

low = renal dilation, vasodilation
higher = contractility = beta1
highest - vasoconstriction = alpha1

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5
Q

what do you give patients w/ hypotension to increase peripheral resistance?

A

norepinephrine (mostly alpha 1 effects)

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6
Q

what do you give patients w/ hypotension w/ bradycardia?

A

isoproterenol == both inotrope and chronotope (beta1/2 effects)

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7
Q

what do you give patients w/ cardiac arrest and anaphylaxis?

A

epinephrine (alpha = beta)

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8
Q

second hand smoke increases risk of

A

asthma and URI, otitis media in children

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9
Q

smoking slows the healing of peptic ulcer disease, and cessation stops the development in

A

burger disease

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10
Q

what is the best way to decrease the risk of post op pulmonary complications?

A

cessation of smoking preoperatively

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11
Q

if a woman is over the age of 35 or is younger than 35 and smokes 15+ cigarettes?

A

no OCP but could take estrogen if postMP

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12
Q

TESTICULAR TORSION VERSUS EPIDIDYMITIS

A

pain decreases w/ testicular elevation + may be urethral discharge w/ epididymitis

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13
Q

diagnostic test of choice in testicular pain

A

ultrasound!

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14
Q

bph tx

A

terazosin/dozasoin, tamsulosin

finasteride

TURP = if repeated UTIs, urosepsis , urinary retention, hydronephrosis

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15
Q

signs of urethral injury

A

absent or abnormally positioned prostate on exam

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16
Q

hydrocele versus varicose

A 
hydrocele = remnant of vaginalis, no tx needed
varicocele = no transillumination, prominent when standing
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17
Q

noncontrast helical CT scan

A

diagnostic test of choice

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18
Q

tx of nephrolithiasis

A

tamsulosin
stones<= 4 mm pass spontaneously
4-10 mm doesn’t mass
if no pass, tx w/ lithotripsy, uteroscopy w/ stone retrieval, open surgery

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19
Q

after 1 year, do surgical intervention to preserve fertility and facilitate future testicular exams

A

cryptorchidism

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20
Q

oligohydramnios

A

pull hypoplasia
renal defects
twisted face/extremities

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21
Q

most common cause of death during vascular surgery>

A

MI

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22
Q

AAA

A

pulsatile abdominal mass causing abdominal or back pain’
<5 cm = SERIAL ULTRASOUND EXAMS (RF reduction) >5 cm = surgical correction
if pain is present, rupture or leak should be suspected

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23
Q

leriche syndrome

A

claudication in buttocks, atrophy, impotence

24
Q

claudication

A

cessation of smoking
exercise
aspirin is preferred
clopidogrel for its who can’t use aspirin

if progresses to rest pain: arterial duplex for dx

25
Q

tearing ripping pain in chest or back w/ FND

A 
aortic dissection
>20mmg upper extremities
aortic regurgitation
widened mediastinum
smoking
CT angiogram
type A = surgery
type B = med management
26
Q

acute mesenteric ischemia versus chronic versus colonic

A 
acute = red currant jelly, POOP
chronic = intestinal angina = atherosclerosis in IMA, SMA = postprandial epigastric pain
colonic = reduction in intestinal blood flow causing ischemia  acutely at watershed areas
angiodysplasia = tortuous dilation
27
Q

necrotizing enterocolitis

A

premature, formula-fed infants w/ immature immune systems

28
Q 
abdominal bruit
fear of eating food
extensive atherosclerosis
negative CT scan
\+ selective angiogram of the SMA
A

chronic mesenteric ischemia

29
Q

thickened bowel walls resembling thumb prints + afib, bloody diarrhea

A

acute bowel ischemia

30
Q

varicose veins w/ palpable cord

A

superficial thrombophlebitis

31
Q

left subclavian artery obstruction proximal to vertebral artery origin

A

to perfuse an exercising arm, blood is stolen from vertebrobasilar system and flows backward into distal subclavian artery

CNS sx + UE claudication during exercise

32
Q

most common cause of B12 deficiency

A

pernicious anemia in which anti parietal cell antibodies destroy IF

33
Q

phenytoin

tmp mtx

A 
folate deficiency 
(normal MMA, high homo) unlike B12 where both are high
34
Q

how to treat vitamin K def due to severe liver disease

A

FFP

35
Q

sudden sensorineural hearing loss

A

idiopathic

steroids are first line therapy

36
Q

common cause of a neck mass

A

children == thyroglossal duct cysts = midline location + elevation w/ tongue protrusion

branchial = lateral infected

cystic hygroma = lymphangioma = Turner syndrome = surgical resection

37
Q

cervical lymphadenitis

A

strep
ebb in teens
cat scratch
leukemia

38
Q

otitis externa

A

** pseudomonas aeruginosa **

manipulation of auricle + erytematous swollen skin in auditory canal

39
Q

otitis media

A

spneumo
hflu moraxella

no pain w/ manipulation
earache, fever, erythematous + bulging tympanic membranes + N/V

40
Q

recurrent otitis media

A

ppx abx + tympanovstomy

41
Q

infectious myringitis = vesicles on the tympanic membrane due to inflammation and infection

A

inflamed tympanic membranes (mycoplasma)

erythromycin or clarithromycin to cover mycoplasma and stir pneumonia

42
Q

sinusitis is due to?

A

spneumo flu for 6 weeks tx if chronic

43
Q

otic bones come fixed together = progressive conductive hearing loss

A

otosclerosis

44
Q

parotid gland swelling

A 
bulimia
sarcoid
sialolithiasis
sjogre
pleomorphic adenoma
sjogren syndrome
45
Q

burns related to a fire

A

give 100% O2

46
Q

ELECTRICAL BURN

A
  • EKG, seizures

- posterior shoulder dislocation

47
Q

hypothermia management <95F

A

conscious - rewarm
unconscious - gastric lavage warm
sinus Brady
tsh - myxedema coma

48
Q

high CK, autonomic instability, rigidity in pt taking antipsychotics

A

NMS
stop med
fluids admin
dantrolene admin

49
Q

how to deal with near drowning episodes

A

intubate pt if unconscious

monitor ABG

50
Q

causes of hyperthyroidism

A

graves
TMN Goiter = hot nodules
adenoma
subacute thyroiditis = tender, painful thyroid gland
factious hyperthyroidism = patient takes thyroid hormone

51
Q

hypothyroidism ass w/

A

vitiligo pernicious anemia DM coma

CTS

52
Q

hypothyroidism lab findings

A 
high TSH
low T3/T4
antithyroid + antimicrosomal antibodies
hypercholesterolemia
anemia
53
Q

sick euthyroid syndrome

A

a pt w/ illness has mild derangements in TSH == hypothyroidism like

54
Q

ACTH = high
cortisol = inappropriately low
post-operative pt crashes = hypotension, shock, hyperkalemeia

A

GIVE STEROIDS to prevent adrenal crisis

55
Q

most common primary cause of hypoadrenalism

A

autoimmune disease

usmle step 2 secrets (9 decks)

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