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STEP2 > ER/ICU/Critical Care > Flashcards

ER/ICU/Critical Care Flashcards

1
Q

antidote for arsenic

A

dimercaprol, succimer, or penicillamine

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2
Q

antidote for methanol, ethylene glycol (antifreeze)

A

fomepizole, ethanol

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3
Q

vasopressors

A 
phenylephrine
NE
EPI
Dobutamine
Dopamine
Isoproterenol
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4
Q

Phenylephrine

A

alpha 1 agonist

use in septic shock

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5
Q

Epinephrine

A

A1, A2, B1, B2 agonist that vasoconstricts at high doses

use:anaphylaxis, septic shock

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6
Q

dopamine

A

b1 agonist at low doses, a1 agonist at high doses

use: cardiogenic shock, not renal -protective

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7
Q

dobutamine

A

beta-1 agonist

use in cardiogenic shock

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8
Q

isoproterenol

A

beta 1 agonist, beta 2 agonist

use in cardiac arrest

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9
Q

Packed RBCs

A

RBCs that have been separated from other blood components

this is suitable for a patient who has lost a lot of blood (trauma, surgery, etc)

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10
Q

vasopressin

A

ADH analog with weak pressor effect
uses: resistant septic shock

ACLS: VF, PEA

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11
Q

Platelets

A

active bleeding due to thrombocytopenia

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12
Q

Fresh frozen plasma

A

plasma from which cellular components have been removed

Use in warfarin overdose, clotting factor deficiency, DIC, TTP

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13
Q

Cryoprecipitate

A

precipitate rich in clotting factors and von Willebrand factor, collected while FFP is thawing

smaller volume than FFP

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14
Q

Specific clotting factors

A

pooled from multiple donors

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15
Q

Albumin

A

given after large- volume paracentesis (>5L of ascites from abd)
to prevent hypotension and maximize colloid pressure

given in cases of hypoalbuminemia

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16
Q

Transfusion reactions

A

nonhemolytic febrile reaction caused by cytokines generated by cells in the blood while in the blood is in storage

onset 1-6 hours after transfusion
fever, chills, malaise
no hemolysis

treat with acetaminophen

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17
Q

acute hemolytic reaction

A

1/250,000 transfusions
Due to ABO incompatibility
main reason is clerical error

onset during transfusion
antibody- mediated hemolysis
fever, chills, nausea, flushing, tachycardia, tachypnea, hypotension

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18
Q

AB+

A

universal recipients

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19
Q

O-

A

universal donors, but can only receive blood from other O-

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20
Q

delayed hemolytic reaction

A

caused by antibodies to Kidd of Rh (D) antigens
Occurs 2-10 days after transfusion
slight fever, less- severe hemolysis, mild increase in unconjugated bilirubin

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21
Q

anaphylactic reaction

A 
1/150,000 transfusions
shock
hypotension
angioedema
respiratory distress

maybe 2/2 anti IgA IgG as that IgA- deficient patients have but maybe don’t know about

Treatment iV fluids, airway maintenance

for these patients, provide extra-washed RBCs when possible

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22
Q

Minor allergic reactions

A

caused by plasma present in donor blood, leads to urticaria

treat with diphenhydramine

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23
Q

Post- transfusion purpura

A

thrombocytopenia developing 5-10 days after transfusion, primarily in women who are sensitized by pregnancy

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24
Q

how to treat severe anemia due to autoimmune hemolytic anemia

A

pRBC

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25
Q

treat hemophilia

A

give specific clotting factor (8 or 9)

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26
Q

treat DIC

A

FFP, platelets

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27
Q

treat shock due to trauma or postpartum hemorrhage

A

pRBCs, IV fluids

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28
Q

to maintain blood pressure during large volume paracentesis

A

albumin

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29
Q

for hemorrhage due to warfarin overdose

A

FFP

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30
Q

need for vWF-rich blood product

A

cryoprecipitate

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31
Q

give for thrombocytopenia

A

platelets

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32
Q

high doses optimize the alpha-1 vasoconstriction

A

epinephrine

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33
Q

ADH analog

A

vasopressin

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34
Q

best choice for anaphylactic shock

A

epinephrine

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35
Q

best choice for septic shock

A

NE

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36
Q

best choice for cardiogenic shock

A

dobutamine

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37
Q

causes vasoconstriction but with bradycardia

A

phenylephrine

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38
Q

What physiologic pressure does PCWP approximate

A

LAP

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39
Q

What are the preferred vessels to target in the placement of a Swan- Ganz catheter

A

R. IJ

L. subclavian

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40
Q

what 2 cardiovascular diseases are the biggest risk factors for CHF

A

hypertension and ischemic heart disease

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41
Q

Polyarteritis nodosa

A

necrotizing inflammation of small or medium arteries, leading to ischemia of the affected tissue

PAN can affect any tissue, but it often affects the kidneys, heart, GI tract, muscles, nerves, and joints

SPARES THE LUNGS

Risk factors: Hepatitis B, hepatitis C

Labs: increased WBC, increase ESR

proteinuria, hematuria if there is kidney disease

negative for ANCA

Renal angiography may show aneurysms

42
Q

Temporal (giant cell) arteritis

A

subacute granulomatous inflammation of external carotid and vertebral arteries

granulomas where macrophages cluster around

more common in older women
associated with polymyalgia rheumatica

unilateral or bilateral headache,
scalp pain, temple tenderness, jaw claudication, and transient or permanent blindness in one eye

Labs: ESR, if elevated get a temporal artery biopsy
multinucleated biopsy

Start treatment- prednisone, continue until biopsy results are available,
If positive, keep going on high-dose prednisone, then taper off

Aspirin
calcium, vitamin D to prevent osteoporosis 2/2 steroids (this goes for anyone on steroids for more than 3 months)

43
Q

Takayasu arteritis

A

arteritis in one of the 3 main branches of the aorta

inflammation of the arch of the aorta
Cerebrovascular ischemia
Myocardial ischemia

Asian heritage, women ages 10-40 (young)

Can cause vertigo, syncope, fever, decreased pulses in the limbs (“pulseless disease:)

If you find poor pulses in the upper extremities think about takayasu arteritis

CTA to look for stenosis and defects in vascular walls

Treat with steroids, immunosuppressive agents,
or surgically bypass obstructed

44
Q

Eosinophilic granulomatosis with polyangiitis (Churg- Strauss)

A

inflammation of small and medium arteries

associated with asthma, nasal polyps, sinusoidal obstruction

H and P: fatigue, malaise, mono or polyneuropathy, tender skin nodules, palpable purpura, papular rash

labs: eosinophilia, p-ANCA

45
Q

Eosinophilia DDx (CANADA-P)

A

Collagen vascular disease (PAN, dermatomyositis)

Atopic diseases (allergies, asthma, Churg-Strauss, allergic bronchopulmonary aspergillosis)

Neoplasm

Adrenal insufficiency (Addison disease)

Drugs (NSAIDs, penicillins, cephalosporins)

Acute interstitial nephritis

Parasites (strongyloides, ascaris > Loffler eosinophilic pneumonitis)

Other causes: HIV, hyper-IgE syndrome, coccidiomycosis, etc).

Tx: steroids and immunosuppressive agents

46
Q

Henoch- Schonlein Purpura

A

IgA immune complex- mediated vasculitis, affecting arterioles, venules, and capillaries

CHildren> adults

recent URI
LE palpable purpura
arthritis
arthralgias
abdominal pain
renal disease from IgA deposition in the kidney

often self- limited but we can use steroids in patients who have GI symptoms

47
Q

Granulomatosis with polyangiitis (Wegener’s)

A

focal necrotizing vasculitis
granulomas in the lung and upper airway
glomerulonephritis

c-ANCA positive

48
Q

Thromboangiitis obliterans (Buerger disease)

A

vasculitis of small and medium- sized peripheral arteries and veins

affects young male smokers (30s-40s)

Clinical presentation:
intermittent claudication
superficial nodular phlebitis
Raynaud phenomenon
Gangrene, auto-amputation of the digits

Treatment: stop smoking and it will go away

49
Q

Kawasaki disease

A

necrotizing vasculitis
infants and young children
Asian descent

diagnostic criteria (mucocutaneous lymph node syndrome)"
Fever (>40 C or 104F), lasting at least five days in addition to 4 of the following 5 symptoms (CRASH)

Conjunctivitis (bilateral, non-exudative, painless)
Rash on the trunk
Adenopathy of the cervical lymph nodes
Strawberry tongue and diffuse erythema of mucous membranes
Hands and feet have edema with induration, erythema, or desquamation

Coronary artery aneurysms can occur within weeks of the illness but are not included in the diagnostic criteria (these can rupture and extend within the aneurysm leading to MI). Since they don’t show up for weeks, you don’t need to them to make the diagnosis

Treatment: IVIG (ideally within the first 10 days of illness)

High- dose aspirin, continued until 49 hours after fever resolution, followed by low- dose aspirin until inflammatory markers (platelets, ESR) return to normal (usually 6 weeks)

Steroids are not indicated and are of no proven benefit

Echocardiogram in the acute phase and 6-8 weeks later

50
Q

20 year-old Asian female

A

Takayasu arteritis

51
Q

2 year-old Asian female

A

Kawasaki disease

52
Q

Associated with asthma

A

Eosinophilic granulomatosis with polyangiitis

53
Q

young male smoker

A

Thromboangiitis obliterans

54
Q

associated with PMR

A

Temporal arteritis

55
Q

Associated with IgA nephropathy

A

Henoch Schonlein purpura

56
Q

Associated with hepatitis B

A

polyarteritis nodosa

57
Q

elderly woman with jaw claudication and vision loss

A

temporal arteritis

58
Q

strawberry tongue

A

Kawasaki disease

59
Q

desquamation on hands/feet

A

Kawasaki disease

60
Q

Poor pulses in the arms

A

Takayasu

61
Q

Palpable purpura on the legs

A

HSP

62
Q

vasculitis of the kidney and GI tract, spares the lungs

A

PAN

63
Q

Vasculitis of the kidney, upper airway, and lungs

A

GPA

64
Q

necrotizing immune complex inflammation of visceral and renal vessels

A

PAN

65
Q

infants and young children: involves coronary arteries

A

Kawasaki disease

66
Q

most common vasculitis

A

temporal arteritis

67
Q

Cushing’s triad and other signs of increased intracranial pressure

A

hypertension
bradycardia
bradypnea

papilledema
altered mental status
pupil asymmetry

68
Q

classic findings in a basilar skull fracture

A

bruising around the eyes (raccon eyes)
bruising over the mastoid process (Battle sign)

Blood behind the tympanic membrane

CSF rhinorrhea or otorrhea

69
Q

Next step: possible fracture and +DPL

A

emergent laparotomy

70
Q

pelvis fracture + DPL shows urine in the pelvis

A

urgent, non-emergent laparotomy

71
Q

pelvis fracture + nothing on DPL + pelvic instability

A

angiography with possible embolization (you suspect a retroperitoneal hemorrhage)

72
Q

Blunt abdominal trauma + unstable vital signs + FAST positive

A

exploratory laparotomy, emergent

73
Q

blunt abdominal trauma + unstable vital signs + FAST shows no fluid in pelvis

A

angiography with possible embolization

74
Q

blunt abdominal trauma +unstable vital signs + FAST inconclusive

A

DPL

75
Q

Blunt abdominal trauma + stable vital signs

A

CT abd/pelvis

76
Q

abdominal stab wound + hypotensive or signs of peritonitis

A

emergent laparotomy

77
Q

Antibiotic prophylaxis for a rape victim:
Gonorrhea
Chlamydia
Trichomoniasis
HepB if not yet vaccinated or if perpetrator is known carrier
HIV
Pregnancy

A

Ceftriaxone 125 mg IM (gonorrhea)

Azithromycin 1g PO or doxycycline 100mg PO BID for 7 days (chlamydia)

Metronidazole 2g PO (trichomoniasis)

Hepatitis B !1 of 3 if not yet vaccinated +/- hepatitis B immune globulin (not standard of care)

HIV prophylaxis for 3-7 days with follow-up for further counseling

Other prophylaxis:
Antiemetic (promethazine) for nausea caused by HIV meds and pregnancy prophylaxis

Levanorgestrel (Plan B) 0.75 mg PO- repeat dose in 12 hours (alternatively, both doses can be taken at once for improved compliance). Other options exist

78
Q

How do we evaluate for extremity trauma?

A

sensory, motor, vascular exam in addition to `imaging

79
Q

What antidepressants are associated with hypertensive crisis?

A

MAOIs, exacerbated by tyramine

80
Q

When is post-op MI most likely

A

within the first 48 hours after surgery

Telemetry in the postop period helps check for this

81
Q

What are signs of hepatic disease in a pre-operative workup

A

increased PT/PTT
low platelets
increased bilirubin
decreased albumin

82
Q

what interventions help optimize lung function in a patient with pre-existing pulmonary disease

A 
incentive spirometry
pain control
deep breathing
physical therapy
bronchodilators
inhaled steroids
83
Q

What do you order in your evaluation of post-op fever?

A 
CXR
urinalysis with urine culture
blood culture
sputum culture
examine surgical wound
wound culture
84
Q

What are 2 indicators of how severe hypotension is in a shock patient?

A

urine output

mental status

85
Q

Hyperacute transplant rejection

A

Seen within initial 24 hours after transplantation
Cause: anti-donor antibodies in recipient
Treatment: untreatable, avoided by proper crossmatching

86
Q

Acute rejection

A

seen 6 days to 1 year later
Cause- anti-donor T-cell proliferation in recipient
Treatment: immunosuppressive agents (reversible)

87
Q

chronic rejection

A

seen >1 year after transplant

Treatment- untreatable, but immunosuppressants can delay onset

88
Q

which cytokine is most important for T cell differentiation

A

IL2

89
Q

Adverse effects of cyclosporine

A

nephrotoxic, mannitol can help prevent nephrotoxicity

90
Q

Azathioprine adverse effects

A

bone marrow suppression, leukopenia

metabolized by xanthine oxidase (don’t combine with allopurinol)

91
Q

Tacrolimus adverse effects

A

nephrotoxicity

92
Q

corticosteroids adverse effects

A

Cushingoid features
osteoporosis
diabetes

93
Q

Muromonab side effects

A

leukopenia

94
Q

Rapamycin side effects

A

thrombocytopenia, hyperlipidemia

95
Q

Mycophenolate adverse effects

This drug is often used to treat lupus

A

leukopenia
lymphoma
teratogenic

96
Q

Anti-thymocyte glubulin side effecs

A

depletes T cells

97
Q

Hydroxychloroquine adverse effects

lupus, transplant, RA

A

visual disturbances

98
Q

Thalidomide adverse effects

A

phocomelia

99
Q

Graft versus host disease

A

grafted bone marrow is now attacking the patient’s entire body

H&P: maculopapular rash, abdominal pain, n/v, diarrhea, recurrent bleeding, easy bleeding

Labs: elevated LFT, decreased immunoglobulin levels, decreased platelets

Biopsy of the skin and liver will detect inflammatory reaction with significant cell death

Treatment: steroids, tacrolimus, mycophenolate

100
Q

AXR findings consistent with ruptured viscus

A

free aid under the diaphragm

101
Q

Labs to get in a patient presenting with generalized abdominal pain

A

CBC with differential, basic metabolic profile, LFTs, beta hCG, stool guaiac, amylase and lipase, EKG and cardiac enzymes if >45yo especially if women, diabetics, elderly

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