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Oral Boards > Differential Diagnosis > Flashcards

Differential Diagnosis Flashcards

1
Q

Delayed Awakening

A
  1. Pharmacologic
    - residual drugs, increased sensitivity to drugs (elderly, renal/hepatic disease, hypothermia)
  2. Metabolic
    - hypoxemia, hypercapnia, hypoglycemia, hyponatremia, hypothyroid/myxedema coma, hypothermia
  3. Neurologic
    - encephalopathy, hypoperfusion (CVA), ICH, increased ICP, cerebral edema
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2
Q

High Airway Pressure

A

High peak pressure = airway resistance

  • ETT kink or tip occlusion, bronchospasm, secretions or mucous plus
  • Total BS Plug

High plateau pressure = airway compliance
*pneumothorax, pulmonary edema, ARDS, pneumonia
“Master PP”

Decreased chest compliance
*obesity, surgical retraction, ascites or increased IAP, MH, opiates, inadequate muscle relaxation

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3
Q

Hypoxia

A
  1. Hypoventilation
    * Increased PaCO2
  2. Shunt
    * pneuomothorax, atelectasis, mainstem intubation, pulmonary edema, ARDS, pneumonia
  3. V/Q Mismatch (normal V/Q = 0.8)
    *hypotension, embolus, asthma/COPD
    “COPE w/hypotension”
  4. Diffusion Impairment
    * Emphysema, ILD (pulmonary fibrosis)
  • Shunt, V/Q Mismatch, and Diffusion impairment have increased A-a gradients (nl <10 mmHg) and normal PaC02
  • Only shunt does not improve with oxygen supplementation
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4
Q

Hypercarbia

A
  1. Increased production of CO2
    - fever, sepsis, MH, thyrotoxicosis, TPN w/high carbs
  2. Decreased elimination of CO2
    - hypoventilation (CNS depression, neuromuscular disease), decreased CO, decreased lung/chest wall compliance
  3. Exogenous addition of CO2
    - CO2 pneumoperitoneum
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5
Q

Hyperkalemia

A
  1. Release of potassium into extracellular space
    - rhabdo, hemolysis, burns
  2. Transmembrane shifts
    - acidosis, meds (beta blockers, sux)
  3. Decreased elimination of potassium
    - acute/chronic renal failure, potassium-sparing diuretics, adrenal insufficiency
  4. Pseudohyperkalemia
    - lysis of RBCs in specimen
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6
Q

Hypertension

A
  1. CNS: pain, anxiety, light anesthesia
  2. CV: essential, ischemia, atherosclerosis
  3. Pulmonary: hypoxia, hypercarbia
  4. Renal: renal failure/volume overload, renovascular dz
  5. Endo: pheo, thyrotoxicosis, Cushing syndrome
  6. Drugs: catecholamines, vasopressors, anticholinergics, withdrawal of antihypertensives
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7
Q

Hypotension

A
  1. Decreased Preload: hypovolemia, bleeding, venous pooling, pneumothorax, tamponade
  2. Decreased Afterload: vasodilation from anesthetics/drugs, sympathetic blockade (regional), hypocalcemia, sepsis, anaphylaxis
  3. Decreased Contractility/CO: MI, arrhythmia, valvular dz, negative inotropes (BB, CCB)
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8
Q

Hyperthermia

A
  1. External Heating
  2. Infection
  3. Noninfectious: MH, NMS, thyroid storm
  4. Malignancy (leukemia, lymphoma)
  5. Autoimmune (SLE, RA, vasculitis)
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9
Q

Hypokalemia

A
  1. Intracellular Shift: meds (B2 agonists, insulin), hyperthyroidism
  2. Renal loss: meds (diuretics), hyperaldosertonism
  3. GI loss: diarrhea, NG losses
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10
Q

Hyponatremia

A
  1. Hypotonic hyponatremia (most common): excess free water
    * Hypovolemic: cerebral salt wasting, diuretics
    * Euvolemic: SIADH
    * Hypervolemic: heart failure, liver cirrhosis, nephrotic syndrome
  2. Hypertonic hyponatremia
    * dilutional (non-sodium solute: glucose, mannitol, ethanol)
  3. Normotonic hyponatremia
    * TURP syndrome
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11
Q

Oliguria

A

<0.5 ml/kg/h or less than 400 ml/day

Prerenal: hypoperfusion

  • FENa <1%
  • BUN/Cr >20:1
  • Urine Na < 20 mEq/L
  • hyaline casts

Renal:

  • FENa > 2%
  • BUN/Cr <10:1
  • Urine Na >40 mEq/L
  • tubular epithelial or granular casts
  • Most common cause is ATN (ischemia)
  • Other causes of ATN: nephrotoxins (amino glycoside antibiotics (gentamicin) and contrast dye
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12
Q

Pacemaker Failure To Capture

A
  1. Pacemaker malfunction
  2. Lead dislodgement
  3. Insufficient energy to achieve depolarization
  4. MI (can significantly increase energy required for capture)
  5. Acid-base disturbance
  6. electrolyte abnormality
  7. Antiarrhythmic drug levels
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13
Q

Coagulopathy After CPB

A
  1. abnormal platelet function (most common)
  2. thrombocytopenia
  3. fibrinolysis
  4. hemodilution of clotting factors
  5. DIC
  6. hypothermia
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14
Q

Child with fever, drooling, stridor and respiratory distress

A
  • ACUTE EPIGLOTTITIS
  • laryngotracheobronchitis (croup, viral usually, steeple sign)
  • foreign body aspiration
  • severe tonsillitis
  • pharyngitis
  • pharyngeal abscess
  • Inspiratory stridor = supraglottic obstruction (epiglottitis)
  • Expiratory stridor = intrathoracic process
  • Biphasic stridor = both larynx and subglottic structures (croup)
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15
Q

Postoperative Stridor

A
  1. Laryngospasm
  2. Airway edema or subglottic stenosis from instrumentation or intubation
  3. Nerve injury or neurologic disorder (bulbar palsy, myasthenia gravis)
  4. Allergic reaction
  5. Asthma
  6. Foreign body
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16
Q

Bradycardia

A
  1. CNS: increased ICP, vagal stimulation, spinal shock
  2. CV: MI, AV block, SSS
  3. Pulmonary: hypoxia, hypercarbia
  4. Metabolic: acidosis, hypothermia
  5. Endocrine: hypothyroidism, adrenal insufficiency

6 Drugs: anesthetics, BB, CCB, digoxin

17
Q

Causes of Atrial Fibrillation

A 
Heart failure
Cardiomyopathy
Acute MI
Longstanding HTN
Valvular heart disease
Hyper/hypothyroidism
PE
Hypoxemia
Sick Sinus Syndrome
Drugs (cocaine, sympathomimetics)
18
Q

Postoperative Polyuria

A
  • diabetes insipidus (central most likely after neurosurgery)
  • mobilization of third-spaced fluid
  • diuretic use
  • osmotic diuresis (ie. hyperglycemia)

Oral Boards (6 decks)

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