Extra notes from slides Exam #1 Flashcards
if photophobia, pain or tearing interferes with exam, what should you add
topical ophthalmic anesthetics
If corrective lenses are unavailable, what should you do for VA?
pinhole testing
what does a slit lamp allow
3d view of ocular structure
what structures are infected with periorbital vs orbital cellulitis?
peri = anterior to orbital septum and benign
orbital = extends BEHIND orbital septum
difference in timing of hordeolum vs chalazion
both can infect the meibomian gland, but hordelolum is always an acute infection, while chalazion can be subacute and can be a progression of an internal hordeolum
if you are under this age and have HZV opthalmicus, you should get a work up
40 yo
what test can you use for a FB?
seidel test
what is the f/u for corneal foreign bodies if rust rings, central line, or deep? What if symptoms persist?
1st one = 24 hours
2nd one = 48 hours
what specifically is put over the eye for globe fracture?
Eye shield
when do you typically up date tetanus for eye?
If there is trauma
when do you f/o for chemical eye injury?
24 hours
for optic neuritits, what would some1 perceive a red object as?
Desaturated - almost pink
apart from veil going over eye, what do people with retinal detachment see?
floaters
what is bullous myringitis an extension of?
OM
just has a intact blood filled TM (shows red instead of purulent discharge)
how to make a hands-free tongue-depressor for pinching nose
tape 2/3 the way up
What is used to cauterize and when is it done?
silver nitrate, only after 2 attempts of direct pressure and bleeding is visualized (meaning it is anterior epistaxis)
Order of anterior epistaxis management
- pinch for 10-15 mintes two attempts
- silver nitrate
- thrombogenic foams/ gels
- nasal packing
when do you f/u for food impaction
12-24 hours
if passage does not occur w/in ____ days for a sharp object, consult surgery
3 days
if a battery passes through the esophagus, when is/are repeat exam(s) needed?
24 hours and 48 hours
When is hyperthermia common and what clues you into this?
Environmental exposure
Warm skin
Do not respond to antipyretics
What drugs can cause fever?
serotonin
New meds or dose changes
What is the length of FUO?
38.3 = 100.9 F for 3 weeks w/out diagnosis
What history question should you ask for all patients with fever?
Ill contacts
Travel
IV drug use (EVER)
endocarditis
spinal epidural abscess
once in the system, it can be there for ever
contitutional symptoms is worrying for
TB
what two things should you default to if a patient comes in with weird vitals but no symptoms?
PNA (CXR is sometimes normal - get a CT if not a clear)
UTI (UA is not always positive)
When do you use tylenol over ibruoprofen?
Tylenol is for younger
Ibuprofen for > 6 months (stronger)
If you have pain + fever, what is used?
Toradol IV/IM which is ibuprofen
Why are pediatric fever worrisome?
Lack of mature immune system leads to VAGUE symptoms + risk of spread of infection from system to system (from GU to another tract)
Hard to do a good PE in these patients
If there is a fever + rash, what likely is it?
MMR
unvaccinated
Roseala vs measels
rosealo starts at bottom and goes up (like a rose grows)
measles starts at top and goes down (like a weasle digs down)
Why is birth history important for infants?
if a patient is 1 week early, then they are considered minus 1 week to be their true age
for risk stratifying
what makes a seizure provoked (within this time window)?
A seizure within 7 days of an insult
what is refractory status epilepticus?
persistent seizure activity despite IV administration of 2 antiepileptic drugs
What can you use to verify psedoseizure?
Use a saline flush and if they move, then it is not a seizure
when would you get an LP for seizure?
Only if fever or worried of meningitis
If 1st and 2nd line methods do not work for seizure control what do you do?
Induce COMA
EEG
When can hyponatremia lead to seizure?
<120
give NaCl but titrate slow
discharge for a that patient is doing fine but has no history of seizure
normal imaging = discharge but NEED to have someone to drive them back. NO DRIVING!
How should you give antipyretics to adults? Should you stop after they do not have a fever?
Administer so that they always have a dose in their body instead of intermittently to avoid period chills/sweats
when specifically do you give AB for adults with fever?
ONLY if
neutropenia or soon to be
asplenia
immunocompromised
hemodynamically unstable
when do you order a CXR for a pediatric patient with fever?
tachypnea, cough, or hypoxemia
why do you only get a cath for UA in females < 24 m, uncircumcised boys < 12 m, circumcised boys < 6 m?
Low chance of UTI outside this window
girls are more likely to get UTI, which is why they get it later
why does chemo lead to neutropenic fever?
chemotherapy affects myelopoiesis and the integrity of GI mucosa allowing bacterial colonization and transposition across mucosa
is fosphenytoin or phenytoin preferred 2nd line for status epilepticus?
fosphenytoin d/t less SE
phenytoin can cause cardiac arrhythmia
what is hypocalcemia?
< 7
cause of seizures
calcium has 7 letters
what is hypomagnesemia?
< 1.5
cause of seizures
magnus has 150iq
syncope and presyncope
Syncope = LOC and tone for < 1min
Presyncope = prodomal symptom feeling like you are about to faint
BOTH WORKED UP THE SAME
syncope w/ multiple events with new onset should r/o
AV block
syncope w/ multiple events over years
vasovagal syncope
syncope w/ multiple events lasting multiple minutes
psychogenic
supine vs upright syncope
supine = cardiac
upright = reflex syncope (vasodilation +/- bradycardia)
how long does post event of syncope (N, pallor, diaphoresis) last and why?
when you pass out, you lie supine allowing blood to reprofuse the brain
DM are at risk for this type of syncope
Orthostatic hypotension d/t autonomic neuropathy and hypoglycemia
what typically causes vasovagal syncope?
emotions, vigorous exercise, etc followed by reflex parasympathetic response leading to drop in BP really fast
treatment of carotid sinus syncope in ER and disposition
ER = no treatment
Disposition = consider midodrine (vasoconstrictive drug)
worrying HINTS exam
bi-directional nystagmus
uni-directional (only to the right or left) is not concerning
management of HZV with ocular involvement
erythromycin ointment, cycloplegics, opioids, cool compresses
+ acyclovir of course
do you do ABX for UV keratitis?
yes
when do you use ketorolac drops?
corneal abrasions
also do prophylaxis ABX
what ABX do you use for lid laceration?
Keflex + erythromycin
think of erythro = blood and keflex = impetigo on eye
when do you get CT/US of abd w/ con if you have a fever?
abdominal pain
kinda common sense
what is the opening pressure for idiopathic hypotension?
< 6 H2O
what med should you avoid with idiopathic hypotension?
Opioids
instead use tylenol for pain!
what aortic stenosis LVEF do you need for surgery (if already severe)?
< 50 LVEF
eye finding to differentiate temporal arteritis from idiopathic intracranial hypertension
BOth have 6th CN palsy, but temporal arteritis also has Afferent pupillary defect (eye constricts with consensual but NOT direct light) and Flame hemorrhages from vasculature inflammation
ICH might have increased IOP
MC organism of spinal epidural abscess
Staph aureus
when do you use UFH vs LMWH?
BOTH for unstable angina and NSTEMI management
UFH if you choose to do sUrgery
LMWH if you choose to approach conservatively
aortic dissection detection risk score (ADD-RS) purpose and values
whether or not to order a d-dimer or CTA when sus of an aortic dissection
0-1 = Order D-dimer. If d-dimer >500, order CTA (if < 500, there is a 97% chance there is no dissection)
2-3 = SKIP d-dimer and straight to CTA
indications for admitting pericarditis
temperature >38°C (100.4°F)
subacute onset over weeks
immunosuppression
history of oral anticoagulant use
associated myocarditis (elevated cardiac biomarkers, symptoms of heart failure)
failure to respond to therapy with NSAIDs after 1 week of therapy,
a large pericardial effusion (an echo-free space >20 mm)
cardiac tamponade
uremic pericarditis (renal failure)
hemodynamic compromise
most are common sense, mainly know if there is still a fever, no response to treatment for 1+ week, or a large, 20+ mm effusion
two reasons to keep acyclovir after getting cultures back for CSF
herpes!
HSV HZV
which HA complaint is concerning of stroke if it is untreated?
temporal arteritis (giant cell), because the blood can back up and lodge
preferred cycloplegic
homatropine (hom on cycle)
