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Common problems in acute care > common problems > Flashcards

common problems Flashcards

1
Q

Workup of patient w/new onset migraines?

A

-BMP, CBC, -VDRL (r/o syphilis) -ESR -*CT head

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2
Q

Clinical presentation of basal cell carcinoma

A

waxy “pearly” appearance central depression or rolled edge

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3
Q

Second degree burn

A

** partial thickness -moist, BLISTERS, extends beyond epidermis

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4
Q

Pupil changes seen in narcotic toxicity

A

MIOSIS **cocaine causes Mydriasis

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5
Q

First degree burn

A

-dry, red, NO blisters, involves epidermis only

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6
Q

Management of hypercalcemia

A

Calcitonin (inc Ca reabsorption) if impaired CV or renal fxn *if >12, start NS infusion w/loop diuretics

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7
Q

Treatment of narcotic overdose

A

-gastric lavage/activated charcoal -Naloxone (narcan) -Butorphanol (stradol)

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8
Q

Tylenol OD equivalent medications?

A

Anacin-3 Panadol

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9
Q

Actinic keratoses

A

PREMALIGNANT to squamous cell carcinoma -asymptomatic

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10
Q

Which type of HA is a/w “cold-like” sxs?

A

cluster HA

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11
Q

which drugs may be causes of non-infectious post op fever?

A

-ampho B -Bactrim -beta lactam abx -isoniazid -alpha-methyldopa -quinidine

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12
Q

most common organisms causing cellulits- outpatients

A

strep pyogenes (Gp A strep) -usual cause S.aureus -less common

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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
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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

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15
Q

When evaluating a HA, what component is most important?

A

chronology

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16
Q

Clinical manifestations of severe hypokalemia (2.5)

A

flaccid paralysis tetany hyporeflexia rhabdo

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17
Q

Causes of normal anion gap metabolic acidosis

A

*diarrhea (CDIFF) -ileostomy -RTA -recovery from DKA

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18
Q

Causes of hypokalemia

A

-chronic use of diuretics -GI loss -excess renal loss & alkalosis -elevated serum epineprhine in trauma pts

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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

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20
Q

S&S of narcotic toxicity

A
  • drowsiness
  • *hypothermia
  • resp depression, shallow resp
  • coma
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21
Q

First 3 steps in evaluating hyponatremia?

A
  1. determine urine Na 2. determine Serum Osmo 3. clinical status
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22
Q

Causes of hyperkalemia

A

Excess intake -renal failure -drugs (NSAIDS) -hypoaldosteronism -cell death

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23
Q

Drug of choice in treatment of organophosphate poisoning

A

*Atropine

activated charcoal if ingested

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24
Q

S&S of benzo overdose

A

drowsiness

confusion

slurred speech

resp depression

hyporeflexia

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25
Q

Causes of Hypocalcemia

A

hypoparathyroidism

hypomagnesemia

pancreatitis

renal failure

severe trauma

*multiple blood transfusions

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26
Q

Common causes of hypervolemic, hypotonic hyponatremia

A

-edematous states -CHF -liver dz -advanced renal failure

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27
Q

Limitations of gastric lavage?

A

limited use for ingestions >30 min use of 28-38F

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28
Q

somatic pain

A

non-localized, muscle, bones nerves, blood vessels, Soft tissues/Supporting tissues (ex: sprained ankle)

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29
Q

most common organisms causing cellulits- inpatients

A

-GN organisms: E coli, klebsiella, pseudomonas, enterobacter -S.aureus (MRSA, CA-MRSA)

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30
Q

Dose of narcan

A

0.04-2mg

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31
Q

Management of cluster HA?

A

PO drugs usu don’t work

  • **inhalation w/100% O2
  • Imitrex 6mg SQ may my effective
  • Ergotamine tartrate (Ergostat) aerosol INH may be effective
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32
Q

Treatment for hyperkalemia

A

Exchange resins (I.e Kayexalate) If >6.5: Reg Insulin 10 U IV–> D5W calcium cl or calcium gluconate B2 agonist (albuterol) sodium bicarb

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33
Q

Treatment for salicylate OD?

A

gastric lavage/activated charcoal sodium Bicarb in severe acidosis (pH <7.1)

*monitor ABGs

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34
Q

What level of albumin indicates protein malnutrition?

A

<3.5

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35
Q

initial treatment of post op fever?

A

**hydration and measures to expand lung inflation

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36
Q

Two types of migraines?

A

class=migraine w/aura common=migraine wo/aura

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37
Q

Management of hypokalemia

A

>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

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38
Q

Migraine HA involve which artery and which CN?

A

d/t excessive pulsations of branches of EXTERNAL CAROTID -CN IV (trigeminal)

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39
Q

When is prophylactic intubation needed in burn patients?

A

-burns to face -singed nares or eyebrows -dark soot/mucous from nares and/or mouth

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40
Q

3 types of hypotonic hyponatremia?

A

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

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41
Q

Examples of antimetabolites

A

Azathioprine (Imuran) Mycophenolate mofetil (cellcept)

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42
Q

S&S of salicylate (ASA) OD

A

N/V

*hyperthermia

*tinnitus

dizziness,

HA

dehydration

metabolic acidosis

inc LFTS

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43
Q

What serum osmo is indicative of hypertonic hyponatremia?

A

>290

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44
Q

Presence of an aura is only associated with which type of HA?

A

migraines

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45
Q

Fluid resuscitation management for burn patients

A

Give 1/2 of all fluid needed in 1st 8hr, w/remaining fluid over the next 16hr

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46
Q

SeBorrheic Keratoses

A

benign, not painful lesions “stuck on” appearance beige, brown/black in appearance

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47
Q

Cluster HA most commonly affect?

A

middle aged men

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48
Q

S&S organophosphate poisoning

A

N/V/D, cramping

*excessive salivation

*HA, *blurred vision

*MIOSIS

*bradycardia

mental confusion, slurred speech, coma

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49
Q

Normal Ionized Ca

A

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
Q

visceral pain

A

poorly localized such as w/internal organs

51
Q

Common causes of hypovolemic, hypotonic hyponatremia w/ Na <10

A

-dehydration -N -D

52
Q

Treatment for basal cell carcinoma

A

shave/pumch bx & surgical excision

53
Q

Fluid resuscitation calculation in burns

A

4ml/kg x TBSA

54
Q

S&S of Herpes Zoster

A

**pain along dermatomal distribution, usu on trunk *grouped vesicle eruption of erythema & exudate along dermatomal pathway *lymphadenopathy may be present

55
Q

most common type of HA?

A

tension

56
Q

Shortcut to calculate serum osmo?

A

Na x 2

57
Q

Corrected Ca calculation

A

0.8 x (4 - patients albumin) + Serum Ca

58
Q

what 3 categories of meds are considered standard tx in immunosuppression for transplanted organs?

A

calcineurin inhibitor antimetabolite steroid

59
Q

Complications of parenteral nutrition support

A

-PTX -Hemothorax -**hyperglycemia -**HHNK -arterial lac -air emboli -catheter thrombosis -catheter sepsis

60
Q

If enteral nutrition is needed for > 6wk, which type of tube should be used?

A

enterostomal tube (gastrostomy, PEG, J tube)

61
Q

What Hgb level for W & M can indicate lack of iron or protein resulting in inadequate O2 perfusion?

A

W <12 M <13.5

62
Q

Normal osmolality

A

275-285, **280

63
Q

Management for acute migraine?

A

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
Q

S&S of antidepressant toxicity

A

confusion, hallucinations,

blurred vision

urinary retention

hypotension, tachycardia, dysrhythmias

hypothermia

*seizures

“can’t see, can’t pee, can’t spit, can’t shit”

65
Q

Bites to which locations should be left open?

A

hands & lower extremities *wounds older than 6hrs

66
Q

S&S of hyperkalemia

A

-weakness, flaccid paralysis -abd distension -diarrhea

67
Q

Complications w/enteral nutrition support

A
  • aspiration
  • diarrhea
  • *hypernatremia
  • dehydration
  • emesis
  • GI bleeding
  • mechanical obstruction of tube
68
Q

Median age at diagnosis of malignant melanoma

A

40

69
Q

If parenteral nutrition is needed for < 2weeks, which method should be used?

A

PPN

70
Q

Highest mortality of all skin CA

A

malignant melanoma

71
Q

Examples of steroids used in immunosuppression

A

Prednisone Deltasone orasone Meticorten

72
Q

Which burn patients need to be referred to burn center?

A
  • 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
Q

Clinical presentation of cluster HA

A

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
Q

ECG findings w/hypokalemia

A

decreased amplitude broad T waves prominent U waves PVCs–> VT/Vfib

75
Q

What is the usually the duration of the following types of HA’s? 1. tension 2. migraines 3. cluster

A
  1. usu last several hours 2. 2-72hr 3. usu <2hr
76
Q

S&S of hypokalemia

A
  • muscular weakness, fatigue, muscle cramps
  • constipation/ileus
77
Q

most common skin cancer

A

basal cell carcinoma

78
Q

Causes of hypercalcemia

A

hyperparathyroidism

hyperthyroidism

Vit D intoxication

prolonged immobilization

79
Q

What serum Osmo is indicative of Hypotonic hyponatremia?

A

<280

80
Q

What acid base disturbance and electrolyte derangements should be monitored in burn patients?

A

metabolic acidosis (expected during early resus) hyperkalemia (early: first 24-48hr)–> hypokalemia (later, ~3d post burn)

81
Q

Rule of Nines in Calculating Burn Injury 1. Each arm= 2. Each leg= 3. Thorax= 4. Head= 5. Perineum/genitalia

A
  1. 9% 2. 18% 3. 18% front & 18% back 4. 9% 5. 1%
82
Q

Causes of anion gap metabolic acidosis

A

-DKA -alcoholic KA -LA -drug/chemical anion

83
Q

Treatment regimens for CA-MRSA cellulitis

A

Bactrim (95-100%) Doxy/Minocycline (90-95%) Clindamycin (85-95%)

84
Q

Which drug is recommended as agent of choice for induced emesis in OD?

A

Ipecac

85
Q

Common meds for migraine prophylaxis

A

Amitryptyline (Elavil) Gabapentin (neurontin) Propanolol (inderal) Divalproex (Depakote) Imipramine (Tofranil) Clonidine (Catapres) Verapamil (Calan) Topiramate (Topamax) Methysergide (Sansert)

86
Q

The type of HA a/w focal neuro disturbances?

A

migraines

87
Q

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

A

migraines

88
Q

Treatment of hypotonic, hypovolemic hyponatremia?

A

*given NS IV * if Na>20, treat cause

89
Q

Management of BB overdose

A

**glucagon atropine as needed stabilize airway

90
Q

Acidemia _______the ionized Ca level.

A

Increases

91
Q

Third degree burn

A

** full thickness dry, leathery, black, pearly, waxy -extends from epidermis to dermis to underlying tissues, fat, muscle, and/or bone

92
Q

which type of HA is often generalized, vise-like/tight in quality and is not associated with neuro sxs?

A

tension

93
Q

Anion gap calculation

A

[Na +K] - [HCO3+Cl]

94
Q

causes of post op fever

A

-post op atelectasis -increased BMR -dehydration -drugs reactions

95
Q

Clinical manifestations of malignant melanoma

A

A: asymmetry B: border irregularity C: color variation D: diameter >6cm E: enlargement

96
Q

Normal urine Na

A

10-20

97
Q

What treatment is indicated for a tar burn injury?

A

use petroleum based product to remove burning tar -bacitracin -petroleum jelly -mayo

98
Q

Alkalosis _______the ionized Ca level.

A

decreases

99
Q

What are the pupil changes seen in organophosphate toxicity?

A

MIOSIS (constriction)

100
Q

Normal anion gap

A

7-17

101
Q

What vaccine is needed for dog, cat & human bites?

A

Rabies

102
Q

S&S of hypercalcemia

A

fatiguability muscle weakness depression anxiety N/V constipation **>12=medical emergency (severe hypercalcemia–> coma & death)

103
Q

When is prophylaxis for migraines indicated?

A

if attacks occur more than 2-3 times per month

104
Q

S&S of Beta blocker Overdose

A

*bronchospasm

hypotension, brady

delirium,

coma

105
Q

S&S of acute rejection fo a transplanted organ

A

immediate failure of that organ **flu-like sxs

106
Q

What is the first step if acute rejection is suspected of a transplanted organ?

A

BIOPSY

107
Q

If needing group A strep coverage in treatment of cellulitis, what are possible tx regimens?

A

add Beta lactam (PCN, Amoxi, or 1st gen cephalosporin-Keflex) to either Bactrim or Doxy

108
Q

Symptoms of migraines

A
  • 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
Q

Antibiotic prophylaxis for human and animal bites?

A

PO abx for both staph & anaerobes x 3-7d (e.g Augmentin)

110
Q

S&S of hypocalcemia

A

(hyper S&S)

  • *prolonged QTc
  • inc DTRs
  • muscle/abd cramps
  • Carpopedal spasm (Troussaus sign) /Chovosteks sign
  • convulsions
111
Q

Normal total Ca

A

2.2-2.6 mmol/L OR 8.5-10.5mg/dl

112
Q

Common causes of hypovolemic, hypotonic hyponatremia w/Na >20

A

(low volume & kidneys can’t conserve Na) -**diuretics -ACEIs -Mineralcorticoid deficiency

113
Q

Examples of drugs seen in organophosphate (insecticide) poisoning?

A

Malathion Parathion

114
Q

At what albumin level would you expect to see edema?

A

<2.7

115
Q

Examples of calcineurin inhibitor

A

Tacrolimus (prograft), cyclosporine

116
Q

what labs should be monitored in refeeding syndrome?

A

Phos & K+

117
Q

What kind of dsg should be put on a decubitus ulcer w/necrotic tissue?

A

hydrocolloid

118
Q

What does the leg/foot look like in a hip fracture?

A

externally rotated

119
Q

what electrolyte should be monitored in ASA overdose?

A

K+ (if low, will prevent alkalinzation of urine, which is mainstay of treatment)

120
Q

what electrolyte should be monitored before administering Succinylcholine?

A

K+

Common problems in acute care (1 decks)

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