common problems Flashcards
1
Q
Workup of patient w/new onset migraines?
A
-BMP, CBC, -VDRL (r/o syphilis) -ESR -*CT head
2
Q
Clinical presentation of basal cell carcinoma
A
waxy “pearly” appearance central depression or rolled edge
3
Q
Second degree burn
A
** partial thickness -moist, BLISTERS, extends beyond epidermis
4
Q
Pupil changes seen in narcotic toxicity
A
MIOSIS **cocaine causes Mydriasis
5
Q
First degree burn
A
-dry, red, NO blisters, involves epidermis only
6
Q
Management of hypercalcemia
A
Calcitonin (inc Ca reabsorption) if impaired CV or renal fxn *if >12, start NS infusion w/loop diuretics
7
Q
Treatment of narcotic overdose
A
-gastric lavage/activated charcoal -Naloxone (narcan) -Butorphanol (stradol)
8
Q
Tylenol OD equivalent medications?
A
Anacin-3 Panadol
9
Q
Actinic keratoses
A
PREMALIGNANT to squamous cell carcinoma -asymptomatic
10
Q
Which type of HA is a/w “cold-like” sxs?
A
cluster HA
11
Q
which drugs may be causes of non-infectious post op fever?
A
-ampho B -Bactrim -beta lactam abx -isoniazid -alpha-methyldopa -quinidine
12
Q
most common organisms causing cellulits- outpatients
A
strep pyogenes (Gp A strep) -usual cause S.aureus -less common
13
Q
Treatment for antidepressant toxicity
A
*admit to ICU if CNS/cardiac toxicity
- gastric lavage/activated charcoal
- sodium bicarb
- Benzos to treat seizures
- Serotonin syndrome: dantrolene
14
Q
Emergent treatment of Burns
A
**maintain normothermia (37-37.5)
Use sterile NS as initial tx & wrap burns w/sterile gauze
pain meds Silver Sulfadiazine (silvadene)-antifungal for 2nd &3rd degree burns
15
Q
When evaluating a HA, what component is most important?
A
chronology
16
Q
Clinical manifestations of severe hypokalemia (2.5)
A
flaccid paralysis tetany hyporeflexia rhabdo
17
Q
Causes of normal anion gap metabolic acidosis
A
*diarrhea (CDIFF) -ileostomy -RTA -recovery from DKA
18
Q
Causes of hypokalemia
A
-chronic use of diuretics -GI loss -excess renal loss & alkalosis -elevated serum epineprhine in trauma pts
19
Q
If a patient with hypotonic, hypovolemic hyponatremia is symptomatic, what is the treatment?
A
NS & Loop diuretic **if CNS sxs–> 3%NS w/loop diuretic
20
Q
S&S of narcotic toxicity
A
- drowsiness
- *hypothermia
- resp depression, shallow resp
- coma
21
Q
First 3 steps in evaluating hyponatremia?
A
- determine urine Na 2. determine Serum Osmo 3. clinical status
22
Q
Causes of hyperkalemia
A
Excess intake -renal failure -drugs (NSAIDS) -hypoaldosteronism -cell death
23
Q
Drug of choice in treatment of organophosphate poisoning
A
*Atropine
activated charcoal if ingested
24
Q
S&S of benzo overdose
A
drowsiness
confusion
slurred speech
resp depression
hyporeflexia
25
Causes of Hypocalcemia
hypoparathyroidism
hypomagnesemia
pancreatitis
renal failure
severe trauma
\*multiple blood transfusions
26
Common causes of hypervolemic, hypotonic hyponatremia
-edematous states -CHF -liver dz -advanced renal failure
27
Limitations of gastric lavage?
limited use for ingestions \>30 min use of 28-38F
28
somatic pain
non-localized, muscle, bones nerves, blood vessels, Soft tissues/Supporting tissues (ex: sprained ankle)
29
most common organisms causing cellulits- inpatients
-GN organisms: E coli, klebsiella, pseudomonas, enterobacter -S.aureus (MRSA, CA-MRSA)
30
Dose of narcan
0.04-2mg
31
Management of cluster HA?
PO drugs usu don't work
- \*\*inhalation w/100% O2
- Imitrex 6mg SQ may my effective
- Ergotamine tartrate (Ergostat) aerosol INH may be effective
32
Treatment for hyperkalemia
Exchange resins (I.e Kayexalate) If \>6.5: Reg Insulin 10 U IV--\> D5W calcium cl or calcium gluconate B2 agonist (albuterol) sodium bicarb
33
Treatment for salicylate OD?
gastric lavage/activated charcoal sodium Bicarb in severe acidosis (pH \<7.1)
\*monitor ABGs
34
What level of albumin indicates protein malnutrition?
\<3.5
35
initial treatment of post op fever?
\*\*hydration and measures to expand lung inflation
36
Two types of migraines?
class=migraine w/aura common=migraine wo/aura
37
Management of hypokalemia
\>2.5--\> PO replacement if unable to take PO--\> 10meq/hr
\*if \<2.5 severe S&S--\> can give 40meQ /hr---\> check q3hr & continuous ECG monitoring
\*ensure Mg WNL
38
Migraine HA involve which artery and which CN?
d/t excessive pulsations of branches of EXTERNAL CAROTID -CN IV (trigeminal)
39
When is prophylactic intubation needed in burn patients?
-burns to face -singed nares or eyebrows -dark soot/mucous from nares and/or mouth
40
3 types of hypotonic hyponatremia?
need to assess if patient is hypovolemic or hypervolemic --\> if hypovolemic, need to determine if due to extrarenal salt losses or renal salt wasting hypovolemic hyponatremia w/Na \<10 hypovolemic hyponatremia w/Na \>20 hypervolemic, hypotonic hyponatremia
41
Examples of antimetabolites
Azathioprine (Imuran) Mycophenolate mofetil (cellcept)
42
S&S of salicylate (ASA) OD
N/V
\*hyperthermia
\*tinnitus
dizziness,
HA
dehydration
metabolic acidosis
inc LFTS
43
What serum osmo is indicative of hypertonic hyponatremia?
\>290
44
Presence of an aura is only associated with which type of HA?
migraines
45
Fluid resuscitation management for burn patients
Give 1/2 of all fluid needed in 1st 8hr, w/remaining fluid over the next 16hr
46
SeBorrheic Keratoses
benign, not painful lesions "stuck on" appearance beige, brown/black in appearance
47
Cluster HA most commonly affect?
middle aged men
48
S&S organophosphate poisoning
N/V/D, cramping
\*excessive salivation
\*HA, \*blurred vision
\*MIOSIS
\*bradycardia
mental confusion, slurred speech, coma
49
Normal Ionized Ca
1.1-1.4 mmol/L OR 4.5-5.5 mg/dl \*\*ionized Ca NOT bound to albumin, thus doesn't vary w/albumin level
50
visceral pain
poorly localized such as w/internal organs
51
Common causes of hypovolemic, hypotonic hyponatremia w/ Na \<10
-dehydration -N -D
52
Treatment for basal cell carcinoma
shave/pumch bx & surgical excision
53
Fluid resuscitation calculation in burns
4ml/kg x TBSA
54
S&S of Herpes Zoster
\*\*pain along dermatomal distribution, usu on trunk \*grouped vesicle eruption of erythema & exudate along dermatomal pathway \*lymphadenopathy may be present
55
most common type of HA?
tension
56
Shortcut to calculate serum osmo?
Na x 2
57
Corrected Ca calculation
0.8 x (4 - patients albumin) + Serum Ca
58
what 3 categories of meds are considered standard tx in immunosuppression for transplanted organs?
calcineurin inhibitor antimetabolite steroid
59
Complications of parenteral nutrition support
-PTX -Hemothorax -\*\*hyperglycemia -\*\*HHNK -arterial lac -air emboli -catheter thrombosis -catheter sepsis
60
If enteral nutrition is needed for \> 6wk, which type of tube should be used?
enterostomal tube (gastrostomy, PEG, J tube)
61
What Hgb level for W & M can indicate lack of iron or protein resulting in inadequate O2 perfusion?
W \<12 M \<13.5
62
Normal osmolality
275-285, \*\*280
63
Management for acute migraine?
rest in dark, quiet room
simple ASA taken right away may provide some relief
Sumatriptan (Imitrex) 6mg SQ at onset, may repeat in 1 hr (up to 3x/d)
Imitrex 25mg PO at onset of HA
64
S&S of antidepressant toxicity
confusion, hallucinations,
blurred vision
urinary retention
hypotension, tachycardia, dysrhythmias
hypothermia
\*seizures
"can't see, can't pee, can't spit, can't shit"
65
Bites to which locations should be left open?
hands & lower extremities \*wounds older than 6hrs
66
S&S of hyperkalemia
-weakness, flaccid paralysis -abd distension -diarrhea
67
Complications w/enteral nutrition support
- aspiration
- diarrhea
- \*hypernatremia
- dehydration
- emesis
- GI bleeding
- mechanical obstruction of tube
68
Median age at diagnosis of malignant melanoma
40
69
If parenteral nutrition is needed for \< 2weeks, which method should be used?
PPN
70
Highest mortality of all skin CA
malignant melanoma
71
Examples of steroids used in immunosuppression
Prednisone Deltasone orasone Meticorten
72
Which burn patients need to be referred to burn center?
- partial thickness \>10% TBSA
- burns that involve face, hands, feet, genitaliza/perineum,
major joints
- 3rd degree burns
- electrical burns, chemical burns
- inhalation injury
- burns + TRAUMA
- \*children
73
Clinical presentation of cluster HA
severe, UNILATERAL, periorbital pain occurring daily for several weeks
- pain occurs at night, awakening pt
- pain usu last \<2hr
- pain free mon or wks b/t attacks
- ipsilateral nasal congestion, eye redness, rhinorrhea
74
ECG findings w/hypokalemia
decreased amplitude broad T waves prominent U waves PVCs--\> VT/Vfib
75
What is the usually the duration of the following types of HA's? 1. tension 2. migraines 3. cluster
1. usu last several hours 2. 2-72hr 3. usu \<2hr
76
S&S of hypokalemia
- muscular weakness, fatigue, muscle cramps
- constipation/ileus
77
most common skin cancer
basal cell carcinoma
78
Causes of hypercalcemia
hyperparathyroidism
hyperthyroidism
Vit D intoxication
prolonged immobilization
79
What serum Osmo is indicative of Hypotonic hyponatremia?
\<280
80
What acid base disturbance and electrolyte derangements should be monitored in burn patients?
metabolic acidosis (expected during early resus) hyperkalemia (early: first 24-48hr)--\> hypokalemia (later, ~3d post burn)
81
Rule of Nines in Calculating Burn Injury 1. Each arm= 2. Each leg= 3. Thorax= 4. Head= 5. Perineum/genitalia
1. 9% 2. 18% 3. 18% front & 18% back 4. 9% 5. 1%
82
Causes of anion gap metabolic acidosis
-DKA -alcoholic KA -LA -drug/chemical anion
83
Treatment regimens for CA-MRSA cellulitis
Bactrim (95-100%) Doxy/Minocycline (90-95%) Clindamycin (85-95%)
84
Which drug is recommended as agent of choice for induced emesis in OD?
Ipecac
85
Common meds for migraine prophylaxis
Amitryptyline (Elavil) Gabapentin (neurontin) Propanolol (inderal) Divalproex (Depakote) Imipramine (Tofranil) Clonidine (Catapres) Verapamil (Calan) Topiramate (Topamax) Methysergide (Sansert)
86
The type of HA a/w focal neuro disturbances?
migraines
87
This onset of this type of HA commonly occurs in adolescence and is more common in females than males. A family is history is often present
migraines
88
Treatment of hypotonic, hypovolemic hyponatremia?
\*given NS IV \* if Na\>20, treat cause
89
Management of BB overdose
\*\*glucagon atropine as needed stabilize airway
90
Acidemia \_\_\_\_\_\_\_the ionized Ca level.
Increases
91
Third degree burn
\*\* full thickness dry, leathery, black, pearly, waxy -extends from epidermis to dermis to underlying tissues, fat, muscle, and/or bone
92
which type of HA is often generalized, vise-like/tight in quality and is not associated with neuro sxs?
tension
93
Anion gap calculation
[Na +K] - [HCO3+Cl]
94
causes of post op fever
-post op atelectasis -increased BMR -dehydration -drugs reactions
95
Clinical manifestations of malignant melanoma
A: asymmetry B: border irregularity C: color variation D: diameter \>6cm E: enlargement
96
Normal urine Na
10-20
97
What treatment is indicated for a tar burn injury?
use petroleum based product to remove burning tar -bacitracin -petroleum jelly -mayo
98
Alkalosis \_\_\_\_\_\_\_the ionized Ca level.
decreases
99
What are the pupil changes seen in organophosphate toxicity?
MIOSIS (constriction)
100
Normal anion gap
7-17
101
What vaccine is needed for dog, cat & human bites?
Rabies
102
S&S of hypercalcemia
fatiguability muscle weakness depression anxiety N/V constipation \*\*\>12=medical emergency (severe hypercalcemia--\> coma & death)
103
When is prophylaxis for migraines indicated?
if attacks occur more than 2-3 times per month
104
S&S of Beta blocker Overdose
\*bronchospasm
hypotension, brady
delirium,
coma
105
S&S of acute rejection fo a transplanted organ
immediate failure of that organ \*\*flu-like sxs
106
What is the first step if acute rejection is suspected of a transplanted organ?
BIOPSY
107
If needing group A strep coverage in treatment of cellulitis, what are possible tx regimens?
add Beta lactam (PCN, Amoxi, or 1st gen cephalosporin-Keflex) to either Bactrim or Doxy
108
Symptoms of migraines
- UNILATERAL
- dull/throbbing -build up gradually & last for several hours or longer
- focal neuro sxs may precede/accompany migraines
- visual disturbances common
- photophobia/phonophobia
- N/V
109
Antibiotic prophylaxis for human and animal bites?
PO abx for both staph & anaerobes x 3-7d (e.g Augmentin)
110
S&S of hypocalcemia
(hyper S&S)
- \*prolonged QTc
- inc DTRs
- muscle/abd cramps
- Carpopedal spasm (Troussaus sign) /Chovosteks sign
- convulsions
111
Normal total Ca
2.2-2.6 mmol/L OR 8.5-10.5mg/dl
112
Common causes of hypovolemic, hypotonic hyponatremia w/Na \>20
(low volume & kidneys can't conserve Na) -\*\*diuretics -ACEIs -Mineralcorticoid deficiency
113
Examples of drugs seen in organophosphate (insecticide) poisoning?
Malathion Parathion
114
At what albumin level would you expect to see edema?
\<2.7
115
Examples of calcineurin inhibitor
Tacrolimus (prograft), cyclosporine
116
what labs should be monitored in refeeding syndrome?
Phos & K+
117
What kind of dsg should be put on a decubitus ulcer w/necrotic tissue?
hydrocolloid
118
What does the leg/foot look like in a hip fracture?
externally rotated
119
what electrolyte should be monitored in ASA overdose?
K+ (if low, will prevent alkalinzation of urine, which is mainstay of treatment)
120
what electrolyte should be monitored before administering Succinylcholine?
K+
