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Quarter 4 > Emed exam II > Flashcards

Emed exam II Flashcards

1
Q

Tx for Priapism (erection for >4 HOURS)

A

Sudafed

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2
Q

most common Risk factor for Fourniers gangrene

A

Diabetes Mellitus

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3
Q

Tx of SBP

Spontaneous Bacterial Peritonitis

A

do NOT do an exploratory lap

Empirical Abx (Cefotaxime, Albumin, Stop b-blockers)

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4
Q

Secondary Bacterial Peritonitis

A

MUST DO Exploratory lap

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5
Q

Abx for Acute cholecystitis

A

Ceftriaxone, Cefuroxime

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6
Q

Courviesers sign can be a sign of

A

CholeDocholithiasis

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7
Q

Can do Percutaneous drainage for Acute cholecystitis in what type of pt?

A

Unstable

save surgery until pt is more stable

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8
Q

Tx for HIGH risk pt with Choledocholithiasis

A

ERCP remove stone,

followed by cholecystectomy

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9
Q

Tx for LOW risk pt with Choledocholithiasis

A

Cholecystectomy

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10
Q

Acute Cholangitis Empiric Abx

A

Ceftriaxone + Metronidazole

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11
Q

Elevated Lipase and Amylase 3x normal

A

Pancreatitis

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12
Q

What imaging is sensitive in early dz for Pancreatitis?

A

MRI

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13
Q 
Pancreatitis dx (must meet 2 of 3. 
If top 2 met, don't need the 3rd.)
A

Typical pain
Lipase/Amylase
Imaging

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14
Q

Two most common risk factors for PUD

A

H. Pylori

NSAID use

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15
Q

Imaging for PUD

A

KUB X Ray
CXR- check for free air

worried about Perforation

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16
Q

Splenic abscess etiology

A

typically from Endocarditis or Seeding from another site

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17
Q

Imaging for Splenic Abscess

A

CT WITH Contrast

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18
Q

Splenic infarct (lack of BF)

A

Occluded by embolus (thrown from elsewhere), clot, or infection

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19
Q

Labs for Splenic infarct

A 
Elevated Lactate (LDH)
Leukocytosis
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20
Q

Imaging for Splenic infarct

A

CT WITH contrast

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21
Q

Most Splenic infarct cases are uncomplicated, in which the tx is

A

Pain meds and monitor

if complicated: consult for Surgery

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22
Q

Gold standard imaging for Splenic RUPTURE

A

US

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23
Q

Tx for Splenic Rupture

A

Immediate surgery: splenectomy (huge risk for bleeding out)

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24
Q

Which type of Mesenteric ischemia has more rapid onset sx?

Embolus or Thrombus

A

Embolus (when thrown from elsewhere)

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25
Q

If Abd X Ray shows signs of FREE AIR/ DEAD BOWEL when assessing for Acute Mesenteric Ischemia, what is next?

A

Laparotomy (embolectomy vs colon resection)

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26
Q

If Abx X Ray does NOT show Free air/Dead bowel when assessing for Acute Mesenteric Ischemia, what is next?

A

Abdominal CT angiography

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27
Q

Abx for Acute Mesenteric Ischemia

A

Ceftriaxone + Metronidazole

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28
Q

Retrocecal appendicitis

A

Psoas sign

pull leg back

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29
Q

Pelvic appendix

A

Obturator sign

flex knee forward

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30
Q

No imaging needed for Clinical appendicitis

A

If you do, CT WITH contrast is most specific

MRI if prego

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31
Q

Peri-operative abx for Appendicitis

A

Cefoxitin or Cefazolin + Metronidazole

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32
Q

Abx for Diverticulitis

A

Cipro + Metronidazole

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33
Q

Dx of Toxic Megacolon:

Enlarged colon on X Ray >6 cm +

A

+ 3 of following: Fever, Tachy, Leukocytosis, Anemia

+ 1 of following: dehydration, AMS, electrolyte dist, hypotension

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34
Q

Abx for Toxic Megacoln

A

Ampicillin
Gentamycin
Metronidzaole

AND

Steroids

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35
Q

Perianal abscess abx

A

Augmentin or Cipro
+
Metronidazole

36
Q

Ectopic pregnancy imaging

A

FAST US for intraperitoneal hemorrhage

37
Q

Tx for Ectopic pregnancy (if no fetal heartbeat)

A

Methotrexate

38
Q

Fitz Hugh curtis synd

A

Complication of PID

Liver capsule inflammation

39
Q

PID tx inpatient

A

Cefoxitin + Doxy

40
Q

PID tx outpatient

A

Ceftriaxone + Doxy

41
Q

Most common Gyn emergency

A

Ovarian torsion

42
Q

Ovarian torsion imaging

A

Duplex US

43
Q

Abx for Endometritis

A

Clinda + Genta

44
Q

Lab alert definition for low glucose

A

<70

45
Q

A-sx hypoglycemia

A

“defensive actions”

repeat measure, avoid critical tasks, eat snack, adjust tx

46
Q

Symptomatic hypoglycemia

“with it” awake

A

Eat 15-20 g oral carb
(glucose tablet, hard candy)

Followed by long acting carb

47
Q

Severe hypo, AMS

A

SubQ or IM Glucagon (0.5-1 mg)

CAUSE N/V

48
Q

Quicker way to correct hypoglycemia

A

25 g of 5% glucose (dextrose) IV

followed by ongoing glucose infusion

49
Q

Hypoglycemia sx

A

look like “stroke like”!!!!

focal neuro deficits

50
Q

If hypoglycemia was d/t Sulfa

A

must ADMIT pt

hypo is likely to recur bc Sulfa is long acting

51
Q

Values w DKA

A

LOW BICARB (metabolic acidosis)

High ketones
High BUN/Cr

52
Q

Anion gap associated with

A

Metabolic acidosis

53
Q

Normal anion gap

A

<10

54
Q

Increased ion gap

A

MUDPILES

(“D standing for DKA”)_

55
Q

What things are LOW with DKA?

A

Low Na
Low K
Low Bicarb

56
Q

What things are HIGH with DKA?

A 
Glucose, obvi
Ketones
Creatine
BUN
Anion gap
57
Q

HHS

hyperosmolar hyperglycemia state

A

Non-ketotic

58
Q

Both DKA and HHS are precipitate by

A

insulin omission

infection

59
Q

Sx of DKA onset

A

hours-days

QUICk

60
Q

No known hx of Diabetes

A

can STILL BE DKA

often the first sign of their diabetes dx

61
Q

DKA diagnosis must have

A

KETONES (urine and serum +)

62
Q

Sodium is often ____ in DKA

A

falsely low

63
Q

Biggest priority in treatment for DKA

A

Serum KETONES

64
Q

Tx DKA

A

SALINE- AGRESSIVE FLUIDS
correct electrolytes
Continuous Insulin

Reverse Acidosis and Ketogenesis

65
Q

Tx DKA

A

AGRESSIVE saline fluids
Electrolytes
Insulin
Add dextrose (goal is to reverse ketogenesis)

66
Q

DO NOT GIVE BICARB to treat DKA

A

Risk of Intra-cerebral ACIDOSIS

and Can accelerate Ketogenesis

67
Q

When do you give bicarb?

A

If Significant HYPERkalemia

High K+

68
Q

Mainstay of reversing ketogenesis

A

Fluids

Insulin

69
Q

HHS

A

reaaaally high glucose
DEHYDRATED

No ketosis or acidosis bc they still have SOME insulin left

70
Q

HHS tx

A

Fluid (not as aggressive as DKA)
Electrolytes
Insulin

71
Q

Thyroid storm

A

Hyperpyrexia
Cardiovascular dysfx (A-FIB)
AMS

72
Q

Thyroid storm tx

A

Beta blocker- Propranolol
Methimazole
1 hour later: Iodine

73
Q

Other tx for Thyroid storm

A

(PTU if pregnant)
Iodine solution- 1 HOUR AFTER METHIMAZOLE/PTU
Steroid
Bile acid seq

74
Q

PTU

A

works stronger, may be good at first BUT does not last as long as Methimazole

75
Q

Methimazole

A

longer half life

76
Q

Myxedema Coma can lead to

A

Encephalopathy

77
Q

Hallmark of Myxedema Coma

A

Hypothermia

CNS depression

78
Q

Highest risk for low thyroid Myxedema Coma

A

Elderly women

79
Q

Tx for myxedema coma

T4 T4 T4 T4 T4 IV

A

Thyroid hormone (give T4 IV)

Steroid
fluids
Rewarm
underlying cause

80
Q

Adrenal insuff

A

lack of Cortisol

Tx: Glucocort, Mineralocorticoids

81
Q

Secondary adreno insuff

A

Inhibit release of ACTH

82
Q

Tertiary adreno insuff

A

Suppression of HPA axis

83
Q

most common cause of Tertiary adreno insuff

suppression of HPA axis

A

Abrupt stopping of chronic Steroids!!!

84
Q

Sepsis, surgical stress

A

Primary adrenal insufficiency

Usually have PROFOUND HYPOTENSION

Tx: Give Hydrocortisone**, and Mineralocorticoid

85
Q

Waterhouse Friderichsen syndrome

FEVER
AMS
PURPURA
+ profound hypotension

A

Adrenal infarct d/t Meningococcemia

86
Q

Adrenal crisis

A

give HYDROCORTISONE asap

Quarter 4 (10 decks)

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