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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
If Abd X Ray shows signs of FREE AIR/ DEAD BOWEL when assessing for Acute Mesenteric Ischemia, what is next?
Laparotomy (embolectomy vs colon resection)
26
If Abx X Ray does NOT show Free air/Dead bowel when assessing for Acute Mesenteric Ischemia, what is next?
Abdominal CT angiography
27
Abx for Acute Mesenteric Ischemia
Ceftriaxone + Metronidazole
28
Retrocecal appendicitis
Psoas sign | pull leg back
29
Pelvic appendix
Obturator sign | flex knee forward
30
No imaging needed for Clinical appendicitis
If you do, CT WITH contrast is most specific | MRI if prego
31
Peri-operative abx for Appendicitis
Cefoxitin or Cefazolin + Metronidazole
32
Abx for Diverticulitis
Cipro + Metronidazole
33
Dx of Toxic Megacolon: Enlarged colon on X Ray >6 cm +
+ 3 of following: Fever, Tachy, Leukocytosis, Anemia + 1 of following: dehydration, AMS, electrolyte dist, hypotension
34
Abx for Toxic Megacoln
Ampicillin Gentamycin Metronidzaole AND Steroids
35
Perianal abscess abx
Augmentin or Cipro + Metronidazole
36
Ectopic pregnancy imaging
FAST US for intraperitoneal hemorrhage
37
Tx for Ectopic pregnancy (if no fetal heartbeat)
Methotrexate
38
Fitz Hugh curtis synd
Complication of PID Liver capsule inflammation
39
PID tx inpatient
Cefoxitin + Doxy
40
PID tx outpatient
Ceftriaxone + Doxy
41
Most common Gyn emergency
Ovarian torsion
42
Ovarian torsion imaging
Duplex US
43
Abx for Endometritis
Clinda + Genta
44
Lab alert definition for low glucose
<70
45
A-sx hypoglycemia
"defensive actions" repeat measure, avoid critical tasks, eat snack, adjust tx
46
Symptomatic hypoglycemia "with it" awake
Eat 15-20 g oral carb (glucose tablet, hard candy) Followed by long acting carb
47
Severe hypo, AMS
SubQ or IM Glucagon (0.5-1 mg) CAUSE N/V
48
Quicker way to correct hypoglycemia
25 g of 5% glucose (dextrose) IV followed by ongoing glucose infusion
49
Hypoglycemia sx
look like "stroke like"!!!! focal neuro deficits
50
If hypoglycemia was d/t Sulfa
must ADMIT pt | hypo is likely to recur bc Sulfa is long acting
51
Values w DKA
LOW BICARB (metabolic acidosis) High ketones High BUN/Cr
52
Anion gap associated with
Metabolic acidosis
53
Normal anion gap
<10
54
Increased ion gap
MUDPILES ("D standing for DKA")_
55
What things are LOW with DKA?
Low Na Low K Low Bicarb
56
What things are HIGH with DKA?
``` Glucose, obvi Ketones Creatine BUN Anion gap ```
57
HHS | hyperosmolar hyperglycemia state
Non-ketotic
58
Both DKA and HHS are precipitate by
insulin omission | infection
59
Sx of DKA onset
hours-days | QUICk
60
No known hx of Diabetes
can STILL BE DKA | often the first sign of their diabetes dx
61
DKA diagnosis must have
KETONES (urine and serum +)
62
Sodium is often ____ in DKA
falsely low
63
Biggest priority in treatment for DKA
Serum KETONES
64
Tx DKA
SALINE- AGRESSIVE FLUIDS correct electrolytes Continuous Insulin Reverse Acidosis and Ketogenesis
65
Tx DKA
AGRESSIVE saline fluids Electrolytes Insulin Add dextrose (goal is to reverse ketogenesis)
66
DO NOT GIVE BICARB to treat DKA
Risk of Intra-cerebral ACIDOSIS and Can accelerate Ketogenesis
67
When do you give bicarb?
If Significant HYPERkalemia High K+
68
Mainstay of reversing ketogenesis
Fluids | Insulin
69
HHS
reaaaally high glucose DEHYDRATED No ketosis or acidosis bc they still have SOME insulin left
70
HHS tx
Fluid (not as aggressive as DKA) Electrolytes Insulin
71
Thyroid storm
Hyperpyrexia Cardiovascular dysfx (A-FIB) AMS
72
Thyroid storm tx
Beta blocker- Propranolol Methimazole 1 hour later: Iodine
73
Other tx for Thyroid storm
(PTU if pregnant) Iodine solution- 1 HOUR AFTER METHIMAZOLE/PTU Steroid Bile acid seq
74
PTU
works stronger, may be good at first BUT does not last as long as Methimazole
75
Methimazole
longer half life
76
Myxedema Coma can lead to
Encephalopathy
77
Hallmark of Myxedema Coma
Hypothermia | CNS depression
78
Highest risk for low thyroid Myxedema Coma
Elderly women
79
Tx for myxedema coma T4 T4 T4 T4 T4 IV
Thyroid hormone (give T4 IV) Steroid fluids Rewarm underlying cause
80
Adrenal insuff
lack of Cortisol Tx: Glucocort, Mineralocorticoids
81
Secondary adreno insuff
Inhibit release of ACTH
82
Tertiary adreno insuff
Suppression of HPA axis
83
most common cause of Tertiary adreno insuff | suppression of HPA axis
Abrupt stopping of chronic Steroids!!!
84
Sepsis, surgical stress
Primary adrenal insufficiency Usually have PROFOUND HYPOTENSION Tx: Give Hydrocortisone****, and Mineralocorticoid
85
Waterhouse Friderichsen syndrome FEVER AMS PURPURA + profound hypotension
Adrenal infarct d/t Meningococcemia
86
Adrenal crisis
give HYDROCORTISONE asap

Quarter 4 (10 decks)

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