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Internal Med PAEA > Critical care > Flashcards

Critical care Flashcards

1
Q

What is Addisonian crisis?

A

worsening of diagnosed or undiagnosed chronic adrenal insufficiency precipitated by a stressful even

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2
Q

What is the MC cause of Addison crisis?

A

abrupt withdrawal of steriods

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3
Q

What lab values are seen in adrenal crisis?

A

hyponatremia
hypoglycemia
hyperkalemia

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4
Q

What is the tx for adrenal crisis?

A

Normal saline/D5N5 + IV hydrocortisone (Dexamethasone)

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5
Q

Cloudy “steamy” cornea, mid-dilated fixed pupil?

A

acute narrow angle closure glaucoma

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6
Q

What is the txt for acute angle glaucoma?

A

Topical (Timolol, Pilocarpine) + systemic lower intraocular pressure (PO or IV Acetazolamide or IV mannitol)

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7
Q

What is the definitive txt for acute angle glaucoma?

A

Iridotomy

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8
Q

What is the consequence of untreated glaucoma?

A

optic nerve damage

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9
Q

What is seen on chest xray for ARDS?

A

bilateral diffuse pulmonary infiltrates

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10
Q

What is the difference between findings in CHF and ARDS?

A

ARDS spares the costophrenic angles

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11
Q

What is the pulmonary capillary wedge pressure in ARDS?

A

< 18 mmHg

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12
Q

What is the txt for ARDS?

A

Mechanical ventilation + txt underlying cause (low tidal vlm and CPAP)

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13
Q

What causes 75% of cardiac arrest?

A

V-tach

V-fib

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14
Q

What is the txt for cardiac arrest?

A

CPR and defibrillation

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15
Q

What is the definitive txt for cardiac arrest?

A

implantable cardiac defibrillator

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16
Q

What intervention may improve outcomes in cardiac arrest?

A

temperature management

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17
Q

T/F the rate of accumulation of fluid in cardiac tamponade is less critical than the volume?

A

False

more critical

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18
Q

What is Beck’s triad seen in?

A

cardiac tamponade

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19
Q

Beck’s triad?

A

decreased heart sounds
increased JVP
hypotension

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20
Q

What pulse phenomenon is seen in Beck’s triad?

A

pulsus paradoxus

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21
Q

What is seen on echo for cardiac tamponade?

A

pericardial effusion + diastolic collapse of cardiac chamber

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22
Q

TOC of cardiac tamponade?

A

pericardiocentesis immediate

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23
Q

MC cause of diabetic ketoacidosis?

A

infection

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24
Q

What 2 things are seen on PE for DKA?

A

fruity acetone breath, Kussmaul signs

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25
Q

What anion gap is seen in DKA?

A

metabolic acidosis

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26
Q

What is the txt for DKA?

A 
SIPS
Normal saline (0.9%)
Insulin
Potassium 
Search for underlying cause
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27
Q

What is the most important level to measure to determine the severity of DKA?

A

Bicarb

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28
Q

What electrolyte should be consistently checked in DKA?

A

K+ (due to hypokalemia)

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29
Q

Who is Hyperosmolar hyperglycemic usually seen in?

A

Type II DM

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30
Q

T/F HHS is usually associated w/ severe ketosis or acidosis?

A

False

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31
Q

Txt for HHS?

A

Saline
Insulin
Potassium
Search for underlying cause

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32
Q

What is the most important txt for HHS?

A

Saline

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33
Q

Serum glucose is usually over ?? in HHS?

A

> 600

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34
Q

What glucose level is consider hypoglycemic?

A

<70mg/dl

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35
Q

Txt for mild/moderate hypoglycemia?

A

15-20g of fast acting carb, fruit juice, hard candy

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36
Q

Txt for severe hypoglycemia?

A

IV bolus of D50 or IV glucagon

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37
Q

Txt for hypertensive urgency?

A

Oral meds (Clonidine, Captopril, Labetalol, Nicardipine, Furosemide)

38
Q

What is the blood pressure txt goal in hypertensive urgency?

A

160/100

39
Q

Txt for hypertensive emergency?

A

IV Sodium Nitroprusside

40
Q

What is Malignant hypertension?

A

Diastolic reading > 140 associated with papilledema and either encephalopathy or nephropathy

41
Q

Txt for malignant hypertension?

A

Hydralazine

42
Q

What is the targeted door to PCI time in MI?

A

<90 mins

43
Q

What is the targeted door to thromboloytic time in MI?

A

<30mins

44
Q

What thrombolytic is used in a MI?

A

Clopidogrel

45
Q

What is the MC cause of pericardial effusion?

A

lung cancer

46
Q

TOC for pericardial effusion?

A

echocardiogram

47
Q

What is seen on ECG for pericardial effusion?

A

electrical alternans and low voltage QRS complexes

48
Q

Txt for pericardial effusion?

A

txt underlying cause (pericarditis)

pericardiocentesis

49
Q

What is seen on PE for pneumothroax?

A

hyperresonance to percussion
decreased fremitus
decreased breath sounds

50
Q

What might be seen on Chest xray in a pneumothorax?

A

companion lines

51
Q

What is the txt for small spontaneous pneumothorax?

A

observation + oxygen

52
Q

What is the txt for large spontaneous pneumothorax?

A

needle or catheter aspiration

53
Q

What is txt for stable secondary pneumothorax?

A

chest tube or catheter thoracostomy

54
Q

What is txt for tension pneumothorax?

A

needle aspiration followed by chest tube thoracostomy

55
Q

Patient education for pneumothorax?

A

avoid pressure changes for 2 weeks

56
Q

Tall thin man with Marfan is at risk for what?

A

spontaneous pneumothorax

57
Q

What is Virchow’s triad?

A

Intimal damage
Stasis
Hypercoagulability

58
Q

What is the MC symptom of PE?

A

dyspnea

59
Q

What are symptoms of PE?

A

Dyspnea, pleuritic chest pain, hemoptysis (rare)

60
Q

What is the MC abnormal finding in PE?

A

Atelectasis

61
Q

What EKG change is most specific for PE?

A

S1Q3T3

62
Q

What is the best initial test to confirm PE?

A

helical spiral CT angiography

63
Q

What is the gold standard test for PE?

A

pulmonary angiography

64
Q

Which test is used in pts with a PE when CT can’t be preformed?

A

V/Q scan

65
Q

In a hemodynamic stable PE what is 1st line therapy?

A

anticoagulation (heparin bride plus warfarin)

66
Q

Who recieves IVC filter in PE?

A
  • anticoag is contraindicated
  • anticoag is unsuccessful
  • RV dysfunction is seen on echocardio
67
Q

Txt for unstable PE pts?

A

Thrombolysis or thrombectomy or embolectomy

68
Q

What is hampton’s hump?

A

wedge shaped infiltrate due to infarction

69
Q

What is westermark’s sign?

A

avascular markings distal to PE

70
Q

What is PE prophylaxis?

A

early ambulation
elastic stockings/ compression
LMWH

71
Q

What is the difference between a focal simple or complex seizure?

A

consciousness

72
Q

What type of seizure is repetitive behaviors such as lip smacking, facial grimacing seen in?

A

focal partial seizures

73
Q

What is the most common seizure seen in childhood?

A

absence petit mal

74
Q

What is seen on EEG for absence seizures?

A

bilateral symmetric 3 Hertz spike and wave activity

75
Q

Txt for absence seizures?

A

Ethosuximide

76
Q

2nd line txt for absence seizures?

A

Valproic acid

77
Q

Long term txt of Grand mal seizures?

A

Levetiracetam and Lamotrigine (preggo)

78
Q

What classifies as a status epilepticus?

A

seizures > 5 mins or >1 seizure within 5 min w/o recovery

79
Q

Initial TOC for status epilepticus?

A

Benzo (Lorazepam)

80
Q

2nd line TOC for status epiplepticus?

A

Phenytoin

81
Q

3rd line TOC for status epilepticus?

A

Phenobarbital

82
Q

What if all 3 txt failure in status epilepticus?

A

use sedation (Midazolam and Propofol)

83
Q

1st line txt for generalized seizures?

A

Lorazepam

84
Q

A “drop attack” is seen in which type of seizure?

A

Atonic seizure

85
Q

Symptoms of thyroid storm?

A

palpitations, tachycardia, atrial fib, fever, tremors, delirium

86
Q

Txt for thyroid storm?

A

IV fluids + Propranolol + antithyroid med (PTU) + IV glucocorticoids

87
Q

What med should be avoided in thyroid storm?

A

Aspirin

88
Q

What txt comes after the initial txt in thyroid storm?

A

oral or IV sodium iodide

89
Q

Gold standard for dx acute angle glaucoma?

A

Gonioscopy

90
Q

Honeycombing of the lung parenchyma?

A

Idiopathic pulmonary fibrosis

Internal Med PAEA (9 decks)

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