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EOR - Internal Med > Critical Care > Flashcards

Critical Care Flashcards

1
Q

4 renal causes of acute abdomen

A

stones
RCC
pyelo
glomerulonephritis

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2
Q

pancreatic causes of acute abdomen

A

pancreatitis
pancreatic ca

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3
Q

3 gallbladder causes of acute abdomen

A

cholecystitis
choledocholithiasis
ascending cholangitis

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4
Q

2 hepatic causes of acute abdomen

A

hepatitis
cirrhosis

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5
Q

2 splenic causes of acute abdomen

A

rupture
infarct

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6
Q

3 gastric causes of acute abdomen

A

PUD/perforated ulcer
gastritis
GERD

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7
Q

intestinal causes of acute abdomen

A

obstruction
cancer
volvulus
appendicitis
gastroenteritis
ileus
hernia
mesenteric ischemia
diverticulitis
IBD
IBS
celiac

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8
Q

pelvic causes of acute abdomen

A

ovarian torsion
ectopic
ruptured ovarian cyst
PID
endometriosis
vaginitis
cystitis

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9
Q

tx for primary adrenal insufficiency (addisons)

A
  1. hydrocortisone
  2. fludrocortisone
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10
Q

t/f: fludrocortisone should be used for secondary adrenal insufficiency

A

f!

only for primary

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11
Q

tx for secondary adrenal insufficiency

A

pituitary adenoma resection
iatrogenic: wean steroids

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12
Q

presentation of upper GIB

A

hematemesis/coffee ground emesis
melena: black tarry stool

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13
Q

upper GIB’s originate proximal to the

A

ligament of treitz

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14
Q

6 causes of upper GIB

A

peptic ulcer
esophageal ulcer
mallory weiss tear
esophageal varices
malignancy
erosive esophagitis

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15
Q

odynophagia
GERD
dysphagia

A

esophageal ulcer

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16
Q

emesis, retching, or coughing -> hematemesis

A

mallory-weiss tear

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17
Q

odynophagia, dysphagia
retrosternal chest pain

A

erosive esophagitis

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18
Q

indications for blood transfusion

A

high risk pt: hgb < 9
low risk pt: hgb < 7

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19
Q

empiric tx for uppper GIB

A

IV PPI

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20
Q

hallmark presentation of lower GIB

A

hematochezia/BRBPR

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21
Q

6 causes of lower GIB

A

hemorrhoids
anal fissure
proctitis
polyps
colorectal ca
diverticulitis

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22
Q

painless bleeding w. wiping

A

hemorrhoids

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23
Q

severe rectal pain w. defecation

A

anal fissure

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24
Q

painless rectal bleeding
no red flag signs

A

polyps

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25
Q

increased IOP -> optic n damage decreased flow of aqueous humor thru trabecula -> increased pressure in anterior chamber

A

acute glaucoma

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26
Q

2 types of glaucoma

A

open angle - mc
angle closure - emergency

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27
Q

acute glaucoma triad

A

injected conjunctiva
steamy cornea
fixed, dilated pupil

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28
Q

sx of acute angle closure glaucoma

A

painful vision loss
tearing
n/v
diaphoresis

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29
Q

tx for acute angle closure glaucoma (4)

A

emergent ophto referral
IV acetazolamide
topical timolol
iridotomy

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30
Q

moa for acetazolamide

A

carbonic anhydrase inhibitor

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31
Q

med contraindicated in acute angle closure glaucoma

A

mydriatics

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32
Q

2 sx of open angle glaucoma

A

loss of peripheral vision
increased cup to disc ratio

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33
Q

management of angle closure glaucoma

A

ophto referral
1st line: latanoprost
timolol
acetazolamide
laser vs surgery

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34
Q

moa for latonoprost

A

prostaglandin analog

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35
Q

respiratory failure characterized by fluid collecting in the lungs and depriving organs of O2

A

ARDS

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36
Q

5 rf for ARDS

A

critically ill
sepsis - mcc
trauma
aspiration
near-drowning

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37
Q

hallmark presentation of ARDS (4)

A

-rapid onset of profound dyspnea 12-24 hr after precipitating event
-tachypnea
-pink frothy sputum
-crackles

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38
Q

CXR findings of ARDS

A

air bronchograms
bilat fluffy infiltrate

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39
Q

75% of episodes of cardiac arrest are caused by (2)

A

v tach
v fib

40
Q

5 h’s of cardiac arrest

A

hypoxia
hypovolemia
hyperkalemia/hypokalemia
H+ (acidosis)
hypothermia

41
Q

causes of cardiac arrest (5 t’s)

A

tamponade
tension ptx
toxins
thromboembolism
thrombosis

42
Q

patient’s who are able to be resuscitated after cardiac arrest may have improved outcomes w. what treatment (2)

A

targeted temperature management
implantable defibrillator

43
Q

what medication is contraindicated in stable, chronic diastolic HF

A

diuretics

decrease preload -> may further impair filling

44
Q

how does morphine function in diastolic heart failure

A

reduces preload

45
Q

how do nitrates work in diastolic heart failure

A

reduce preload O2

46
Q

poor prognostic factors w. CHF

A

CKD
DM
lower LVEF
severe sx
old age

47
Q

build up of fluid btw the pericardial sac and the heart that constricts the heart

A

cardiac tamponade

48
Q

2 types of tamponade

A

-acute onset: trauma, MI, aortic dissection, pericardial effusion
-slow onset: cancer, chronic inflammation, uremic pericarditis, hypothyroidism, connective tissue dz

49
Q

beck’s triad for cardiac tamponade

A

muffled heart sounds
JVD
hypotn

50
Q

what is this showing

A

electrical alternans -> cardiac tamponade

51
Q

hallmark PE finding of cardiac tamponade

A

pulsus paradoxus: 10 mmHg drop in SBP on inspiration
narrow pulse pressure

52
Q

what is this showing

A

water bottle heart -> cardiac tamponade

53
Q

tx for cardiac tamponade

A

pericardiocentesis

54
Q

2 brainstem reflexes

A

pupillary light
eye movements

55
Q

pathology behind pupillary light reflex defects

A

-anisocoria (asymmetric pupils): uncal herniation
-pinpoint pupils: narcotics, ICH
-bilat fixed, dilated pupils: severe anoxia
-unilateral fixed, dilated pupil: CN3 compression

56
Q

what is the oculocephalic test

A

when head is turned to one side, eyes should move conjugately to the opposite direction if brainstem is intact

57
Q

sure way to know brainstem is intact

A

pt can breathe on their own

58
Q

how does DKA cause hypokalemia

A

insulin deficiency -> hyperglycemia -> dehydration -> ketonemia -> anion gap metabolic acidosis -> potassium deficit

59
Q

hallmark labs of DKA

A

BG > 250
pH < 7.3
bicarb < 18

60
Q

healthy pt w. fasting hypoglycemia

A

insulinoma
mc: adenoma of islet of langerhans

61
Q

-sx of hypoglycemia usually occur at what BG level
-impaired brain fxn usually occrus at what BG leve

A

sx: <60
impaired brain fxn: <50

62
Q

5 meds that cause hypoglycemia

A

FQ
quinine
ACEI
salicylates
bb

63
Q

what is factitious hypoglycemia

A

self induced

64
Q

mcc of postprandial hypoglycemia

A

gastric surgery

65
Q

lifestyle management of postprandial hypoglycemia

A

small meals
increase complex carbs/fiber
reduce simple carbs

66
Q

pharm for post prandial hypoglycemia

A

octreotide 30 min prior to meals

67
Q

classifications of hypertensive crisis

A

urgency: >180/120 w.o organ damage
emergency: >180/120 w. organ damage
malignant: DBP > 140

68
Q

malignant htn is associated w. (3)

A

papilledema
encephalopathy
nephropathy

69
Q

tx for htn urgency vs emergency vs malignant

A

urgency: clonidine
emergency: sodium nitroprusside
malignant: hydralazine

70
Q

in MI, troponin
appears at:
peaks at:
lasts:

A

appears: 2-4 hr
peaks: 12-24 hr
lasts: 7-10 days

71
Q

in MI, CK/CK-MB
appears:
peaks:
lasts:

A

appears at: 4-6 hr
peaks at: 12-24 hr
lasts for: 48-72 hr

72
Q

in MI, myoglobin
appears:
peaks:
lasts:

A

appears: 1-4 hr
peaks: 12 hr
lasts: 24 hr

73
Q

management of MI

A

bb
NTG
asa + clopidogrel
heparin
ACEI
statins
PCI

74
Q

management of MI

A

bb
NTG
asa + clopidogrel
heparin
ACEI
statins
PCI

75
Q

timeline for 2 types of reperfusion in STEMI

A
  1. PCI w.in 90 min
  2. thrombolytics w.in 3 hr if PCI not available
76
Q

causes of pleural effusion (lots!)

A

aortic dissection
heart failure
hypoalbuminemia
lymphatic obstruction
malignancy
radiation
renal failure
trauma
AI dz
acute pericarditis
myxedema
drugs
iatrogenic
idiopathic

77
Q

ekg findings of pericardial effusion

A

low voltage QRS
electrical alternans

78
Q

3 PE findings of PTX

A

decreased tactile fremitus
hyperresonance to percussion
diminished breath sounds

79
Q

3 causes of secondary PTX

A

asthma
CF
ILD

80
Q

management of PTX based on size

A

<15% diameter of hemithorax: resolve spontaneously
>15% diameter of hemithorax: chest tube
serial CXR q 24 hr

81
Q

management of tension PTX

A

large bore needle decompression

82
Q

pharm management of PE

A

acute: heparin
post acute: Xa inhibitors, DOACs

83
Q

duration of anticoagulation with PE

A

reversible rf: 3 mos
unprovoked: 6 mos
2 episodes unprovoked: indefinite

84
Q

s/sx of shock

A

weakness
hypotn
tachycardia
tachypnea
sweating
anxiety
increased thirst
anuria/oliguria
AMS
lactic acidosis

85
Q

initial management of shock

A

fluid bolus (500-1,000 L NS vs LR)
pressors if hypotn persists depite fluids

86
Q

4 types of shock

A

cardiogenic
hypovolemic
neurogenic
septic

87
Q

2 types of hypovolemic shock

A

hemorrhagic
nonhemorrhagic

88
Q

5 causes of non hemorrhagic hypovolemic shock

A

vomiting
diarrhea
dehydrtation
burns
third spacing

89
Q

4 causes of neurogenic shock

A

SCI
head injury
spinal anesthesia
vascular tone

90
Q

sz lasting > _ may result in permanent brain damage

91
Q

thyroid storm is caused by (2)

A

graves dz
toxic multinodular goiter

92
Q

5 precipitating factors for thyroid storm

A

infxn
trauma
embolism
DKA
preeclampsia

93
Q

6 s/sx of thyroid storm

A

heat intolerance
palpitations
wt loss
tachycardia
anxiety
jaundice

94
Q

why does jaundice occur w. thyroid storm

A

increased peripheral consumption of O2 -> hepatic tissue hypoxia

95
Q

management of thyroid storm

A

bb
PTU vs methimazole
iodine
hydrocortisone
bile acid sequestrants (cholestyramine)

96
Q

moa for PTU

A

inhibits conversion of thyroxine to triiodothyronine

EOR - Internal Med (13 decks)

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