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IPAP > EMED Block 4 > Flashcards

EMED Block 4 Flashcards

1
Q

What type of underlying issues cause visceral pain?

What do PTs present complaining of?

Where will they locate their pain to?

A

Obstruction Ischemia Inflammation
Stretched unmyelinated fibers innervating organs

Cramp Dull Ache
Steady/Colicky

Localized to spinal cord level

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2
Q

What types of underlying issues cause parietal pain?

PTs will localize pain to?

What happens as this pain develops?

A

Irritated myelinated fibers innervating peritoneum (anterior wall)

Dermatome above origin

Rigidity/rebound tenderness, still PT

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3
Q

Define Referred Pain

What is an example and why does this happen?

A

Pain felt distant from origin but on same side

Ureter obstruction w/ ipsilateral testicle pain d/t shared innervation

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4
Q

What two facts are used to determine urgency and approach to PTs w/ abdominal pain?

What type of fluid support is requested for critically ill PTs needing stabilization?

A

PT acuity, RFs

Emergency release blood

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5
Q

How long does it take for SBP to reflect a loss of blood volume?

? is used to assess volume depletion

This assessment tool is invalid in ? PTs

A

30-40%

Tachy

Peds- compensated shock

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6
Q

If PTs pulse and BP are WNL but suspected volume depletion is present, what is the next step?

Tachypnea can indicate ? issues may be present

A

Orthostatic VS

Cardiopulmonary
Axiety
Metabolic acidosis
Panic

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7
Q

What labs are ordered for critically ill PTs w abdominal pain?

What type of blood is ordered if hemorrhage is suspected or transfusions are anticipated

A

Chem panel- E+ BUN/Cr
CBC w/ platelet
PT/PTT/INR
Type, Ag Screen

Cross-matched

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8
Q

What are the high risk groups of PTs to present w/ abdominal pain?

A

Cognitive impairment
Lack of communication
Asplenic
Minimal/obscured lab results

Transplant/ImmSupp/Mod
Impaired immune system
Neutropenic

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9
Q

Mild-Mod immune dysfunctions have ? presentations of common dzs

Severe immune dysfunction PTs are more likely to present w/ ?

A

Delayed/atypical

Opportunistic infections

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10
Q

? is the most important measure of immune competency in AIDS PTs

What level in these PTs are less likely to present w/ opportunistic infections

A

CD4

> 200

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11
Q

When PTs present w/ acute abdominal pain, what is the abdomen inspected for?

A 
Distension
Obvious masses
Ecchymoses
Scars
Stigmata of liver dz
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12
Q

Although non-specific for Dx, what do different bowel sounds mean?

Liver size can be estimated w/ percussion except for when ? is present

What does tympanic sounds indicate?

A

Dec: Narcotic Infarction Peritonitis Ileus
Inc: Small bowel obstruction

Bowel distension

Dilated loops of bowel

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13
Q

Define Sine qua Non

Peritoneal signs, CMT, uni/bilateral abdominal/pelvic tenderness can suggest ? issues are present

If these S/Sxs are present in males PTs, what exams are needed?

A

Necessary rebound tenderness for Dx of peritonitis

Pelvic infection
Ectopic pregnancy

Hernia
Testicular
Prostate

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14
Q

What abdominal issues present w/ pain, vomiting and/or rigidity

What abdominal issues present w/ pain, vomiting and distension?

A

Diabetic gastric paresis
Incarcerated hernia
DKA
Acute pancreatitis

Bowel obstruction
Cecal volvulus

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15
Q

What abdominal issues present w/ pain and/or vomiting?

What abdominal conditions present w/ pain, shock and rigidity

A 
MI
Acute diverticulitis
Mesenteric ischemia
Adnexal torsion
Testicular torsion

Perforated appendix, diverticula, ulcer
Ruptured esophagus, spleen

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16
Q

What abdominal issues present w/ distension and/or pain?

When giving opioids for pain to these PTs what is coupled with it?

A

Bowel obstruction/volvulus

Anti-emetics

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17
Q

What lab result is used to Dx pancreatitis if lipase is unavailable?

What are lactate results used for identifying?

A

Amylase

Mesenteric ischemia

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18
Q

What are the atypical PTs that need EKGs when presenting w/ abdominal pain?

Radiological evidence of SBO may be present as early as ? before Sxs present

A

Female Elderly Diabetic

6-12hrs

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19
Q

Plain films have limited benefit for abdominal pain PTs when screening for ?

? is the preferred imaging modality for biliary tracts?

A

Constipation
Obstructions
Perforation
Sigmoid volvulus

US

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20
Q

What is the next step for suspected cholecystitis/biliary dyskinesia but normal US?

How much radiation exposure comes w/ each abdominal CT?

How does that compare to x-ray images?

A

Cholescintegraphy

10msV, 10x higher than x-ray

Skull x-ray= 5 CXRs
Lumbar x-ray= 75 CXRs
Head CT= 100 CXR
Abd CT= 400 CXRs

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21
Q

What are two examples of underlying issues that non-contrast CT would be used to image?

? is the preferred imaging modality when searching for kidney/ureteral stones?

A

Ureteral calculi
Retroperitoneal hematoma

Non-contrast CT

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22
Q

When is PO contrast CT the preferred imaging modality?

When is IV contrast CT procedures preferred?

A

Perforation
Fistula
GI abscess

Bowel mucosa
Visceral organs
Vascular structures
Sm/Lg bowel obstruction and transition points

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23
Q

? is the initial ToC for suspected AAA rupture or mesenteric ischemia

How are suspected abdominal sepsis and peritonitis Tx

A

IV contrast CT

Zosyns

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24
Q

How are PID cases Tx

What are high risk PTs that may need to be held overnight for observation prior to surgical Tx

What PTs are not high risk but candidates for admission/observation?

A

Ceftriaxone Metronidazole Doxy

Non-communicative
ImmComp
Cognitively impaired
Elderly

Non compliant (d/c, f/u)
Ill-appearing
Lack of social support
Intractable pain/vomit

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25
Q

PTs w/ abdominal pain, negative CT and are being d/c have ? f/u orders?

When/why would they need to return to the ER sooner?

A

Return <12hrs

Inc/different pain
Vomit
Bleeding Fever Syncope

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26
Q

What type of surgical complications are higher in elderly PTs?

? lab result has a low predictive value for surgical dzs

A 
Perforated viscus
Strangulated hernia
Infarcted bowel
Necrotizing pancreatitis
Gangrenous gallbladder

WBC

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27
Q

? is the MC surgical entity in elderly PTs w/ abdominal pain

What other entities follow this MC?

What Dx is rare among the elderly and ? presentation of diarrhea may indicate ? Dx

A

Cholecystitis

SBO
Perferated viscus
Appendicitis
LBO

VGE, Messenteric ischemia

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28
Q

What is the difference in presentation between a proximal and distal obstruction

What type of PE finding suggests a mechanic obstruction

A

Prox: early emesis, less distension
Dist: later emesis, more distension (feculent emesis)

High pitched sounds

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29
Q

MC cause of mechanical SBO?

What PT populations are more likely to present w/ appendicitis?

A

Adhesion from prior surgery

F>M 10-19y/o

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30
Q

? is the MC cause of atraumatic abdominal pain in Peds >1y/o

? is the MC non-OB surgical emergency in pregnant PTs

A

Appendicitis

Appendicitis

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31
Q

Why does appendicitis pain start w/ umbilical pain?

What is the classic location?

A

Visceral innervation

McBurneys- 1/3 distance between ASIC-umbilicus

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32
Q

What are the causes for atypical appendicitis presentations?

A

Retrocecal- R flank/pelvic pain

Colo malrotation- LUQ pain

RUQ pain- pregnant, but RLQ still MC

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33
Q

? is a common early sign of appendicitis

What is the next Sx to present after non-specific Sxs

A

Anorexia

Periumbilical pain (pain then nausea)

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34
Q

What type of urinary tract manifestation indicates appendicitis?

What aggravating/alleviating PE findings can help w/ Dx

A

Sterile pyuria

Worse w/ deep inspiration
Painful trip w/ bumps

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35
Q

What type of appendicitis will not have TTP in RLQ?

How is this type tested for on PE?

A

Retrocecal, doesn’t touch anterior parietal peritoneum

DRE

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36
Q

Define Rovsing Sign

Define Psoas Sign

Define Oburator test

A

Pain at McBurneys w/ palpation w/ palpation of LLQ

Pain w/ extension of R leg at hip w/ PT lays on L side

Pain w/ in/external rotation of flexed R hip

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37
Q

? lab result may be the earliest marker of appendicitis inflammation?

What are the 4 goals of imaging suspected cases?

A

Inc WBC

Establish Dx
Avoid - appendectomy
ID perforation
Exclude other causes

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38
Q

What type of US findings in pregnant/Peds PTs suggest appendicitis

? PTs are more likely to have unclear US results and what is the next step?

A

Thick/non-compressible >6mm in diameter
Possible hyperemia

Adult male/non-preg female
Ab/pelvic CT w/out contrast

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39
Q

What CT findings suggest an appendicitis

When would the preferred MRI imaging of pregnant PTs be removed

A

Dilated >6mm w/ thick wall
Periappendiceal inflammation
Visualizing fecolith/abscess

2nd/3rd trimester

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40
Q

Alcohol associated pancreatitis is morecommon in ? while gallstone induced is more common in?

What are the RFs for this condition

A

Alcohol- men
Gall- women

Smoking Obese DM

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41
Q

PTs tend to develop pancreatitis <30 days after having ? procedure

How do PTs w/ pancreatitis present

A

ERCP

Severe persistent pain in epigastrium w/ N/V anorexia and dec PO intake
Worse laying, inhale
Better sitting/knee flexed

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42
Q

Define Cullen’s Sign

Define Grey-Turner Sign

A

Blue discolor around umbilicus, indicates hemoperitoneum

Red-brown discolor along flanks, indicates retroperitoneal blood/extravasation

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43
Q

Pancreatitis Dx requires two of what three criteria

Lipase is the key for Dx but what other non-pancreatis issues can cause inc lipase?

A

Consistent presentation
Inc lipase/amylase x3
Images (contrast CT/MRI/US)

DM
Renal Dz
Appendicitis
Cholecystitis

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44
Q

Lipase levels during pacreatitis is more sensitive in ? PTs/presentations

What labs are drawn w/ lipase during work ups?

A

HyperTG
Alcohol induced
Delayed

CHEM w/ LFT Glucose CBC- Belly Labs

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45
Q

? criteria is used for predicting severity/outcome of pancreatitis

If PTs meet clinical presentation Dx criteria, what is not needed?

A

Ransons criteria

CT
If doubtful- CT w/ contrast= inflammation, necrosis, fluids or pseudocyst seen

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46
Q

How is pancreatitis Tx

What is avoided

A

Fluid resuscitation: 2.5-4L total w/ 1/3 given in first 24hrs
IV opioids

ABX/anti-fungals

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47
Q

What defines mod-sev pancreatitis?

What defines a severe dz?

A

Transient organ failure <48hrs
Local/systemic complications

One or more complications
Organ failure >48hrs

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48
Q

Besides SIRS, what other clinical findings are associated w/ severe pancreatitis at initial assessment?

A

> 55y/o Comorbid Obese AMS

BUN >20
Hct >44%
Inc Creatinine

Extrapancreatic fluid collection
Pleural effusion
Pulmonary infiltrates

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49
Q

When do PTs w/ pancreatitis need to be considered for admission?

A 
First pancreatitis
Biliary- surg consult, cholecystectomy
Pain meds IV
Inc pain
Abnormal VS
NPO d/t vomit
Organ insufficiency
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50
Q

? is MC cause of progression from acute to chronic pancreatitis

How are these PTs care for upon presentation

A

Alcohol

Hydrate
Pain/nausea control

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51
Q

? has lower mortality risk, chronic or acute pancreatitis

Why?

? is the MC complication of gallstone dz

A

Acute>chronic

Acute can progress to necrosis/gangrenous

Biliary colic x few hrs, self resolves when stone moves from obstructing

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52
Q

Define emphysematous cholecystitis

Define Choledocholithiasis and the two types

A

Inflammed gallbladder infected w/ gas producing organisms (Clostridium, E Coli, Klebsiella)

Gallstone in CBD-
Primary- arises w/in bile duct
Secondary- MC, forms in gallbladder then moves to CBD

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53
Q

Define Cholangitis

This complication can further complicate ? issues

A

Infection of biliary tree

Choledocholithiasis
Stricture/tumor obstruction

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54
Q

? causes chronic cholecystitis

? is a rare but life threatening sequelae that can develop?

Define Biliary sludge

A

Prolonged gallbladder inflammation from recurrent cystic duct obstructions

Gallbladder perf

Microlithiasis composed of cholesterol crystals, Ca bilirubinate/salts

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55
Q

Define Acute Acalculous cholecystitis

What are RFs

A

No gallstones, from Sepsis Burns Trauma Surgery

DM ImmSupp Age

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56
Q

When/how does cholecystitis induced colic present

What tradition is not reliable for this Dx

A

Epigastric/RUQ pain at midnight from circadian rhythm

Fatty food intake induced pain

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57
Q

How does cholecystitis biliary colic and acute cholecystitis pain differ?

What are the classic presentations of biliary cholic and acute cholecystitis?

A

BC- Sxs last few hrs
AC- loca RUQ pain, inc w/ peritoneal irritation

BC: Mild RUQ tenderness, afebrile, no peritoneal signs
AC: severe tenderness, possible fever, rare jaundice

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58
Q

What PE maneuver is done during acute cholecystitis

What does jaundice on PE suggest?

A

Murphys- cessation of inspiration from fingers touching inflamed gallbladder

Choledocholithiasis obstruction in CBD
Mirizzis Syndrome- compressed duct from impacted cystic duct/gallstone

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59
Q

Define Charcot’s Triad

What S/Sxs are added for it to become Reynolds Pentad

A

Cholangitis presentation:
Jaundice RUQ pain Fever

AMS Shock

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60
Q

What lab results will be seen in acute cholecystitis results?

What lab result is most sensitive and specific for choledocholithiasis?

A

Leukocytosis
Inc CRP
Normal LFTs

Abnormal y-glutamyl transpeptidase

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61
Q

? is imaging modality of choice for acute cholecystitis

W/ this image, ? Dx test can be done

A

Abdominal/RUQ US

Sonographic Murphys

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62
Q

? combo of results is indirect evidence of choledocholithiasis?

When is an elective cholecystectomy recommended?

A

Gallstone + CBD dilation

Sickle cell
Planned organ transplant
Ethnic groups w/ high risk for GB Ca

63
Q

What is first line therapy for cholecystitis biliary colic?

How are these PTs managed?

A

NSAIDs

Anti-emetics Analgesic Volume/E+ ABX NPO
GenSurg- laparascopic cholecystectomy

64
Q

When can cholecystitis PTs be d/c from ED?

Define Post-Cholecystectomy Syndrome

A

Colic Sx control

Persistent Sxs after GB removal
Early- concern for bile leak

65
Q

? is a common cause of post-cholecystectomy pain

? is the landmark separating upper from lower GI bleeds

A

Choledocholithiasis

Ligament of Treitz

66
Q

MC cause of UGI bleeds

What are common predisposing factors?

A

Peptic ulcer dz, H Pylori

Alcohol Salicylates Anticoags NSAIDs Glucocorticoids

67
Q

Stress related mucosal Dzs occur in PTs w/ ?

What causes esophageal and gastric varices?

A

Sepsis
Trauma
Respiratory failure requiring mechanical ventilation

PHTN
Most often- alcoholic liver dz

68
Q

Define Mallory Weiss Syndrome

What is the classic history leading to this condition?

What predisposing factors can it also be associated with?

A

Bleeding secondary to longitudinal tear a GE junction

Repeat vomit leading to bright read hematemesis

Binge drinking
DKA
Chemo

69
Q

Why are NSAIDs so hard on the stomach?

Ingestion of what two things can present/mimic melena?

A

Inhibit prostaglandin formation for protective barrier of stomach

Fe/Bismuth

70
Q

? is the most reliable method to Dx UGI bleeds in ED

What is the most important test to order if significant bleeding is present?

A

Visual inspection of vomit

Type and Cross match

71
Q

What effect does UGIB have on BUN levels?

? lab result is a sentinel sign of severe illness?

A

Increases

Elevated lactate

72
Q

? Dx/image study is c/i for suspected GI bleeds?

What tests can be ordered if endoscopic methods are unavailable?

A

Barium contrast

Tagged red-cell scintigraphy
Visceral angiography

73
Q

? procedure is Dx and Thx for GI bleeds?

What does this result mean if there is not Hx of hematemesis?

A

NG intubation and aspiration w/ visual inspection

Strong evidence for UGI source of bleeding

74
Q

If bright red blood or clots are seen on NG aspirate, what is the next step?

What resuscitative step is done w/ caution in these PTs?

A

Gatric lavage w/ room temp water

Intubate

75
Q

What is the Hgb threshold used for deciding to blood transfuse a PT or not

What are two c/i to reversing anticoagulation in PTs on therapy w/ GI bleeds

A

Hgb <7, <9 if older PT w/ comorbidities

Cardiac/vascular stents

76
Q

INR of ? is significant predictor of mortality in UGIB PTs on anticoagulants

What are PPIs important for non-variceal bleeds

A

> 1.5 or more

Clots from platelet aggregation require pH >6

Omeprazole 80mg IV bolus w/ infusion 8mg/h

77
Q

What is the trifecta benefit of using PPIs in peptic ulcer bleeds

What is Octerotide and its benefits

A

Reduce need for surgery
Dec hospital stays
Reduce signs of bleeding

Long acting somatostatin analog
Inhibits gastric acid secretion
Reduced blood flow to mucosa
Induces spanchnic constriction

78
Q

? drug is preferred over Octreotide, why?

PTs w/ ? liver Dz are ImmComp and have inc risk for bacterial infections?

A

Terlipressin- only drug Tx associated w/ reduced mortality

Cirrhosis- Tx w/ Cipro/Ceftriax

79
Q

What are two pro-motility agents used for GI bleeds that can aid visualization during procedures

? is the Dx study of choice for UGI bleeds and why is this preferred and w/in ? time frame?

A

Erythromycin
Metroclopramide

Endoscopy- visualization and administration of hemostatic therapy, <24hrs

80
Q

What procedure is done during endoscopy for Tx of visceral bleeds

What procedure is done during endoscopy for Tx of ulcerative lesions

A

Variceal ligation and sclerotherapy

Clips
Thermocoagulation
Sclerosant injections w/ Epi

81
Q

What drugs are used for endoscopy prep?

What drugs are used if PT is unstable?

A

Fentanyl
Versed/Propofol

Ketamine Etomidate

82
Q

What is an effective short term solution for GI bleed Tx

What is the MC source for all bleeds detect in LGI system

A

Balloon tamponade after intubation

Upper GI bleeds

83
Q

? is the MC cause of LGI bleeds

How does this MC present

A

Diverticular Dz
Colitis Adenomatous polyps Malignancy (apple core lesion)

Painless gross bleeding from L sided lesion but lesions on R side more likely to bleed

84
Q

? is a RF for developing bleeding vascular ectasis

? is the MC cause of intestinal ischemia and a common RF

A

Valvular heart dz

Ischemic colitis
Prolonged strenuous exercise

85
Q

? causes messenteric ischemia

What is a presenting clue of this condition?

A

Clot in SMA

Pain OOP on exam

86
Q

? is the Dx study of choice for ischemic and mesenteric ischemia

Why is this Dx dangerous

A

Angiography

50% survival if Dx <24hrs

87
Q

Where are Meckels MC found

More than half will contain ?

A

Terminal ileum

Ectopic gastric tissue

88
Q

What are the initial Dx procedures of choice for lower GI bleeds

What image has the highest sens/spec for detection?

A

Angiography Scintography
Endoscopy

Multi-detector CT angiography

89
Q

Define Diverticula

What is the criteria for a true diverticula

Define false diverticula

A

Herniation where vasculature penetrate muscular layer of colon

All layers of colon wall involved

Only sub/mucosal layers

90
Q

What microbes can cause diverticulitis

A 
Fusobacterium
Gram neg rods- E coli
Bacteroides
Clostridium
Peptostreptococcus
91
Q

What are two major RFs for diverticuli

What is a protective fact

A

Smoking
Obesity

Active life style

92
Q

Where is diverticular dz almost exclusively found in the US

What is the classic presentation for this dz

A

L sided dz in descending/sigmoid colon

LLQ pain w/ change in bowel type/habits
Fever
Leukocytosis

93
Q

Why do PTs presenting w/ diverticuli dz have urinary Sxs

What is the next step for presenting PTs that have Hx and Dx of diverticulitis and an acute presentation?

A

Inflammation effect

Do not scan, no further evaluation required

94
Q

What type of image is ordered for PTs presenting w/ first acute flare of diverticulitis

What findings are indicative of Dx

A

Abd/Pelvis CT w/ IV and PO contrast

Thickening >4mm
Phlegmon- inflammation of soft tissue spreading under skin/in body

95
Q

What are the two severity categories for diverticulitis

A

Uncomplicated: isolated to inflammation of diverticula w/ or w/out phlegmon

Complicated: diverticula inflammation w/ abscess, stricture, obstruction, fistula or perforation

96
Q

How is uncomplicated diverticulitis Tx

? are the MC complications from this dz process

A

Bowel rest, liquid diet
PO ABX

Abscess
Phlegmon

97
Q

Diverticulitis PTs w/ abscess that measure ? size and ? are admitted

How are these PTs Tx

A

<4cm and phlegmon

IV ABX, no percutaneous drainage

98
Q

? PT populations w/ diverticulitis have inc risk for morbidity and mortality

What is the criteria for failed OutPT therapy

A

ImmComp
Chronic steroids

Sxs/worsening radiographic images w/in 6wks of initial episode

99
Q

Define Apiploic Appendagitis

How is it Dx

How is it Tx

A

Fat filled sacs near lining of colon that inflame due to torsion/thrombosis

CT

Benign/self limiting
Pain management w/ f/u in 7 days

100
Q

What causes kidney stones to hurt so much?

What type of lab results will be seen indicating a stone is likely?

A

Pressure against Gerota’s fascia

SrCr increase

101
Q

What are the 3 most likely sites for kidney stones to become obstructed

Stones smaller than ? will almost always pass alone

A

Ureteropelvic junction
Pelvic brim
Ureterovesical junction- most constricted site of ureter

<5mm w/in 4wks

102
Q

How do PTs w/ stones present?

What body compensation mechanism will have PTs presenting w/ additional Sxs

A

Sudden onset flank pain w/out peritoneal Sxs

Adrenergic response= Tachy HTN Diaphoresis

103
Q

What are 3 important Hx questions asked during kidney stone interviews?

What are two DDx/risks that have to be r/o?

A

RFs for stone development
Prior stone related outcomes
Important mimickers

AAA
Renal artery infarction

104
Q

? is the MC mis-Dx given to PTs w/ ruptured AAA

How is this mis-Dx differentiated

A

Nephrolithiasis

Absent in men >60y/o
No HOTN, ever

105
Q

Why/how do renal artery stenosis present w/ hematuria similar to stones?

? test has to be ordered on all renal stone PTs that are female and reproductive age?

A

Infarcted kidney swells

hCG

106
Q

Why do PTs w/ kidney stones have an elevated WBC w/out fever/systemic illnesses?

When are scans recommended for these PTs?

A

Stress demargination

All first time stones

107
Q

What IV pain meds can be used for kidney stones if NSAIDs are not working?

What med is the only antiemetic proven in Tx of renal colic

A

Ketorolac

Metoclopramide

108
Q

What ABX are given for PTs w/ kidney stones and signs of fever, renal insufficiency or systemic signs?

What drugs can be used for expulsion therapy?

What Tx class is avoided?

A

Cipro*
Piper-Tazo
Genta/Tobra +Amp
Ticarcillin-Clavulanic acid

A-blockers: Alfu/Tamsulosin

Steroids

109
Q

What are the absolute indications to admit PTs w/ kidney stones?

What are the relative indications?

A 
Intractable pain/vomit
Urosepsis
Single/transplant kidney w/ obstruction
Acute RF
HyperCa crisis
Comorbidities/inc age
Fever
Single/transplant kidney w/out obstruction
Obstructing stones w/ signs of infection
Urinary extravasation
Comorbidities
Large stone above pelvic brim
110
Q

When can kidney stone PTs be discharged?

Give these PTs a strainer and they’ll probably catch stones that are ? size w/in ? days

A

Smaller stones
No infection
Pain controlled w/ PO meds

5-6mm in 7-3 days

111
Q

What are the d/c orders for PTs w/ kidney stones

When/why would no further Tx be needed in these PTs

A

Return if fever, vomit, uncontrolled pain
F/u w/ urologist <7days

Stone passes in ED

112
Q

How are pregnant PTs w/ kidney stones Tx

How are kidney stones in Peds Tx

A

No NSAIDs, use opioids
A-blockers

Pain/nausea control
US eval
No expulsive therapy

113
Q

? is the leading cause of maternal death during the first trimester

What hormone imbalances can increase risks for this?

A

Ectopic pregnancy leading to maternal exsanguination after tubal rupture

Inc estradiol/progesterone, inhibit tubal migration

114
Q

PTs w/ ? SurgHx have ectopic pregnancy until proven other wise?

? PT population are at high risk for ectopic pregnancy after procedures?

A

Tubal surgery for sterilization

Laparoscopic partial salpingectomy
Electrodestruction tubal ligation
Either <28y/o

115
Q

Woman of child bearing age w/ ? SurgHx is excluded from ectopic pregnancy

? is the MC presenting Sx of ectopic pregnancy

A

Hysterectomy w/ oophorectomy

Abdominal pain from tubal distension

116
Q

How do PTs present if they’ve had ruptured ectopic pregnancy

What PE finding should not be seen in ectopic PTs?

A

Shoulder pain from diaphragm irritation

Fever

117
Q

How is a definitive Dx of ectopic pregnancy made?

What is the primary goal of US during early pregnancy

A

US
Laparoscopic visualization
Surgery

Viable IUP determination
Exclude ectopic pregnancy

118
Q

How is GI decontamination accomplished

How is blood/tissue decon accomplished

A

NG lavage w/ charcoal and Cathartic

Urine alkalinization
Hemodialysis

119
Q

How do surgical Tx for ectopic pregnancy differ if PTs is hemodynamic un/stable?

MC route of poisoning/over dose?

A

Un: laparotomy
Stable: laparoscopy

Ingestion

120
Q

What does the AEIOU TIPS for poisonings stand for

A 
A: alcohol acid/alkalosis
E: endocrine E+ encephalopathy
I: insulin
O: opiates
U: uremia
T: trauma
I: ICP  infection
P: poison psych
S: seizure syncope
121
Q

Define Toxicologist Handshake

What drugs are not detected by toxicology screens?

A

No axillary sweat- anti-cholinergic
Presence- sympathomimetic, cholinergic

Rohypnol
Methadone/Meperidine
MDMA

122
Q

How do anti-cholinergic ODs present

How are cholinergic ODs going to present

A

Mad as a hatter-
Atropine Anti-histamine/psychotics
Rhabdo AMS Dry/Hot

Oganophosphate/Carbamate insecticides:
SLUDGE

123
Q

How are hypoglycemic ODs going to present

How are opioid ODs going to present

A

Suflonylureas, Insulin:
AMS Diphoretic Tachy HTN

Codeine Morphine Heroine-
Hypothermia Brady Miosis

124
Q

What is the goal pH range when utilizing urine alkalinization

What must be monitored for in these PTs

A

pH 7.5-8.5 but not w/out raising serum pH >7.55

HypoK
Volume overload

125
Q

When is hemoperfusion an effective Tx?

How long are poisoning PTs monitored for after Tx

A

Large molecular weight toxin
Protein binding

6hrs

126
Q

What fluid is used for HOTN during poisoning/ODs

How is hypoglycemia Tx

What med is given for Na channel blocker toxicity w/ CV complications (wide QRS, tachy)

A

IV crystalloids

IV Dextrose

Na Bicarb

127
Q

How are drug induced seizures Tx

What drug is not sued

A

Benzos

Phenytoin

128
Q

How are agitated poisoning PTs Tx

How are opioid induced hypoventilation Tx

How is cardiac arrest from Bupivacaine toxicity Tx

A

Titrated Benzo

Naloxone

IV Lipid emulsion

129
Q

Antidote for CCBs

Antidote for HyperMg/CCBs

A

Ca chloride 10%

Ca gluconate 10%

130
Q

Antidote for Cyanide/Hydrogen sulfide

Antidote for Digoxin or cardioactive steroid

A

Sodium nitrate

Digoxin fab

131
Q

Antidote for Benzos

Antidote for CCB/BBs

A

Flumazenil

Glucagon

132
Q

Antidote for Cyanide/Nitroprusside

Antidote for lipophilic cardiotoxins

A

Hydroxycobalamin

IV Lipid emulsion 20%

133
Q

? US findings indicate ectopic pregnancy is highly likely

How are these cases Tx

A

Pelvic mass/free fluid
Empty uterus

Unruptured: laparoscopic salpingostomy
Methotrexate medical Tx

134
Q

How are sedative/hypnotic ODs going to present

What is the first priority for any PT presenting w/ poisoning/OD

A

Benzo/Barbituate-
Brady, depression, ataxis

ABCs

135
Q

What is the only poisoning case where antidotes take precedence over primary survey?

How is this exception Tx

A

Cyanide

O2
Amyl nitrate
IV sodium nitrate
IV sodiu thiosulfate

136
Q

Antidote for oxidating toxins like nitrites, benzocaine or sulfonamide

Antidote for Chlonidine

A

Methylene blue

Naloxone

137
Q

Antidote for Na channel blockers or urinary alkalinization

Antidote for Wernickes syndrome or Wet BeriBeri

A

Na Bicarb

Thiamine

138
Q

What drug is used for local anesthetic during eye decontamination

How long is irrigation initiated

All alkali injuries get ?

A

0.5% tetracaine

pH 7.2-7.4

Ophthalmologic consult

139
Q

Decontamination of ? is rarely done during poisoning management

Do not give PTs ?

A

GI

Ipecac syrup

140
Q

What are the benefits of giving activated charcoal to poisoning PTs?

What toxins are not affected?

A

Less toxin for uptake
Enhanced elimination

Fe Hydrocarbon Lithium Lead Toxic alcohols

141
Q

When would multi-dose activated charcoal Tx regimes be used?

What is given for whole bowel irrigation

When would this Tx be needed

A 
Theophylline
Carbamazepine
Phenobarbital
Quinine
Dapsone

Polyethylene glycol

Sustained/delay release pills
Fe Lithium Lead
Stuffer/packers

142
Q

When is whole bowel irrigation c/i

How is urine alkalization accomplished

When is this Tx commonly considered

A

Diarrhea substance
Bowel obstruction

Sodium Bicarb

Salicylate poisoning

143
Q

What happens to abdominal pain due to peritoneal origins during palpation?

If need to know if PT is pregnant and what image to do, ? test is ordered

Pain in pelvic area, what test is ordered?

A

Refers from adjacent quadrant being palpated to point of max tenderness

Qualitative

Quant for US

144
Q

How are PTs w/ obstructions managed

How is post-op urinary retention Dx and Tx

A

No complications- floor admit
High grade obstruction/peritonitis- Surgery

US, drainage

145
Q

What are the less common causes of appendicitis obstructions

A 
Fecalith*
Lymph tissue
Gallstone
Tumor 
Parasite
146
Q

Ranson Criteria

A 
At admission:
Glucose >10mmol
Age >55y/o
LDH >350
AST >250
WBC >16K
At 48Hrs:
Ca 10%
Hct 
O2
BUN
Base deficit
Sequestration of fluid >6L
147
Q

What 3 groups of medication classes can cause acute pancreatitis?

? chest Dzs can present as RUQ pain mimicking cholecystitis

A

Antiretrovirals
Chemo
ImmSuppressants

Pneumonia
Pleurisy
PE

148
Q

? US technique has a higher NPV for cholecystitis Dx

Normal CBD diameter is ? but can be enlarged in ? PTs

A

No Gallstone, + sonographic Murphys sign= 95%

<5mm
Prior cholecystectomy
Elderly

149
Q

What ABX may be added on to PTs for cholecystitis prior to admission for surgery

What is the disposition for PTs w/ acute cholecystitis or cholangitis

A

2nd 3rd Gen Cephalosporin
B-lactams
Metronidazole/FQN
Carbapenems

Admit
Severe- admit to ICU

150
Q

If needed, what is the more reliable method for imaging emphysematous cholecystitis

Define Gallstone Ileus

A

CT w/ contrast

Mechanical SBO from ectopic gallstone in small intestine via biliary enteric fistula
Dx w/ CT
Tx w/ surgery

151
Q

PE finding seen in Boerhaave’s Syndrome

Cirrhosis + UGIB need ? ABX

A

Hamman sign- crunching during chest auscultation

Cipro

152
Q

When are PPIs used for GI bleeds?

What diverticulosis PTs have inc M/M?

A

Non-variceal from PUD

NSAIDs
Anticoag use
Transfusion needs
Elderly w/ medical illness

153
Q

Define Vascular Ectasia

How is ischemic colitis Dx

A

Arteriovenous malformations and angiodysplasia of colon

Endoscopy

IPAP (212 decks)

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