Final Flashcards
A common cause of wheezing in kids is a _____
Asthma often is worse at 3am
Risk factors for asthma = RSV infection before 6 months of age, or patient/family history of atopy
Triggers are viruses, allergies, exercise, cold air, cigarette smoke
Common findings on a CXR for asthma or RAD = ______ aka partial collapse of a lung, _____ of both lungs, or PERIHILAR ____
Viral infection
Atelectasis, Hyperinflation, Thickening
Cap refill of more than ___ seconds in kids is NOT good
If the pediatric patient is having asthma exacerbation, admit them to ____
_____ gases are the easiest to obtain in kids but the downside is you cant use the PaO2 (oxygen) from them, instead you can ONLY use pH and CO2
For IVF of kids, if you’re YOUNGER than 1 you get ____ NS and if your’e OLDER than 1 you get ____
^** NS is reserved for blousing and in peds patients add _____ to the IVF
2
PICU
Capillary blood
1/4, 1/2, K
You should do EVERYTHING you can to not intubate an asthmatic pediatric patient because they can NOT ____ so they can die from b/l pneumothorax or acute RHF
Terbutaline drip, Mg2+, Theophylline, subcutaneous epinephrine, heliox or BiPAP
You CAN intubate a child if they are between an ____ and ___ state
Which population has the highest mortality from asthma?
Exhale
Irritable and obtunded
Adolescents (since they dont carrytheir rescue inhaler with them)
If you see a patient with wheezing, nasal flaring and tachypnea, subcostal/intercostal/suprasternal reactions, stridor, and sniffing or tripod positioning they are in ____
Treat via ____ nebulizer or “rescue inhaler” which is a _____ bronchodilator, ICS, Oral corticosteroids, or O2
^** Note that if you see SUDDEN stridor in a child, think _____
_____ is the most accurate measurements for oxygen saturation and one must first perform an ____ test to determine sufficient collateral flow through the radial and ulnar arteries and ABGs below ____ can not be measured on PulseOx
Respiratory distress
Albuterol, SABA
FBA (Foreign body aspiration)
ABGs, Allen, 91
If a patient is in respiratory distress you might want to include ____ in the diff dx if they are also presenting with Clubbing, FOULD-SMELLING stools, recurrent pneumonia, edema, poor height and weight, or failure to thrive
Test via ____
CF
Cl- sweat test
If a patient has these symptoms, what is the suggested disease?
1) Wheezing and atopy
2) Clearing throat, allergic salute, worse when recumbent
3) New symptoms with onset after choking
4) Wet or productive cough
5) Dry cough, breathlessness****
^** Testing includes spirometry, HRCT scan, autoimmune markers, and lung biopsy
1) Asthma
2) Allergic rhinitis
3) FBA
4) Bronchiectasis, CF, etc
5) ILD
The asthma plan ZONES
Name them for each zone
1) GREEN A) Daytime \_\_\_\_ B) Nighttime \_\_\_\_ C) Reliever \_\_\_\_ D) Physical activity \_\_\_\_\_ E) Can they go to school? F) Peak expiratory flow
^** Staye controlled and avoid triggers
2) Yellow
^** Adjust
3) Red
^** Call for help
A) 3 or LESS per week B) None C) 3 or LESS per week D) Normal E) Yes F) 85-100
A) 3 or MORE per week B) Some C) 3 or MORE per week D) Limited E) Maybe F)60-85
A) CONTINUOUS and worsening B) CONTINUOUS and worsening C) Relief less than 3-4 hours D) Very limited E) No F) Less than 60
GTPAL = _____
When you remove the uterus, ovaries, and cervix it’s called a _____
G = Gravidity aka # of total pregnancies T = Term births aka number of full 38 week term births P = Preterm births aka 37 week or before A = Abortions L = Living children
Total hysterectomy
Persistent splitting of S2 during inspiration and expiration can be due to _____ from heart disease in adults or massive _____ due to ___ ventricle pressure overload
^** If you hear ____, think PE
In patients with SHOCK, the best way to measure blood pressure constantly is an _____
Most common EKG findings of a patient with PE is nonspecific ____-___ wave abnormalities and ____
^** ____ will be indicative of PE on EKG
Best imaging for a PE is _____
RBBB, PE, Right
Rales
Arterial line
ST-T, sinus tachycardia
S1Q3T3
If a patient has HYPOTENSION due to a PE, you can give them _____
Tissue plasminogen activator (tPA) is a CLOT BUSTER used for systemic thrombolysis since it can act widespread and can be given rapidly and acts by ACTIVATING plasminogen
If someone is taking HRT (hormone replacement therapy) or estrogen (premarin) that is actually a PRO-thrombotic risk factor
Do NOT use fibrinolytic therapy for DVTs or acute PE if the patient has had PRIOR intracranial hemorrhage, aortic dissection, active bleeding, etc
_____ mutations put one at an INCREASED risk for developing VTEs (Venous thromboembolisms) due to the fact that its associated with the ______ aspect of virchows triad
^** All 3 components of the triad are ____, _____, and _____
tPA
FVL (Factor V Leiden)
Hypercoagulability
Stasis, hypercoagulability, and endothelial damage
Wells criteria and modified wells criteria are used to score and assess the probability of developing a PE
For the normal Wells, if its ABOVE ____ you have a HIGH chance, if its between ___-____ you have a MODERATE chance and if it’s below ____ you have a LOW chance
For the modified wells criteria if its ABOVE ____ you have a LIKELY chance and if it’s BELOW or EQUAL to ____ you have an UNLIKELY chance
6, 2-6, 2
4, 4
PEs can lead to _____ shock which will present as a ___ and ____ skin feeling, ____ Preload, ____ CO, ______ afterload and tissue perfusion will be ______ than 65
Obstructive, Cold and Clammy, Decreased, Decreased, Increased, greater
An abnormality of blood coagulation that increases the risk of thrombosis is called _____ and inherited thrombophilia can be due to FVL mutations, protein C/S. Homocystine levels, assays for antithrombin 3, and Antiphospholipid Abs
If a patient has an inherited thrombophilia disorder and develops an ACUTE VTE (Venous thromboembolism) give them ____ therapy for at LEAST ___-___ months
If the patient has ONLY a family history of VTEs and don’t meet the other desired criteria, simply give them routine care and education. If they do meet the criteria provide PROPHYLACTIC anticoagulation therapy POSTOPERATIVELY during ____ and _____
If they have NO family history but have an ____ deficiency then also give them the prophylactic treatment
Thrombophilia,
Anticoagulation, 3-6
Pregnancy and postpartum
ANTITHROMBIN
Mean arterial pressure MAP =
OVER 65 all tissues are perfused normally
UNDER 65 hypoperfusion or hypotension
Diastolic BP + ((Systolic - diastolic) /3)
are INCREASED risk for TB. Also IV drug abusers, HIV/AIDS, endemic area immigrants, or someone in close contact with an active TB patient are also all at risk
Know the PPD scale (also realize its a ____ hypersensitivity reaction)
Name the PPD size that would consider it +
1) HIV patients
2) Patients in jails, nursing homes, homeless shleters, healthcare facilities, etc
3) Healthy patients older than 4 with low chance of TB infection\
4) DM, Chronic renal failure, malignant, malnourished, IV DRUG ABUSERS
5) Close contact with an infected person
6) Immunosuppressed
7) No reaction secondary to immune unresponsiveness
8) Child LESS THAN 4 years old
9) CXR with fibrotic changes consistent with TB
10) From country of high prevalence
Type 4
1) 5
2) 10
3) 15
4) 10
5) 5
6) 5
7) Anergy
8) 10
9) 5
10) 10
Patients with _____ have fever, night sweats, weight loss, cough, and hemoptysis
^** The cough is generally LONGER than ____ weeks
TB is a MICROBIOLOGICAL diagnosis and the current gold standard to diagnosing TB is ____ taken at 3 separate mornings on liquid and solid media
^** Since it’s so slow growing it can take 6-8 weeks to get back results
On the sputum staining you need to SPECIFICALLY ASK for ____ staining
If a + smear for AFB is seen but the cultures are still pending, you can perform a ____ to detect TB genetic material or ___ to detect INH and Rifampin resistance
Active TB
2
Sputum culture (SCx)
Acid fast bacillus
NAAT-TB, NAAT-R
Your initial screening stain for TB is _____ stain and your confirmatory AFB stain is either ____ or ____ stain which looks for PINK rods
Realize that the PPD test CAN BE + in patients that received a ____ vaccine so if a patient gets a PPD that comes back +, but they had the BCG vaccine when they were younger, and you still suspect LATENT TB, you would conduct the _____ because this doesnt give a false + due to BCG
Rhodamine-auramine stain; Ziehl-neelsen or Kinyun stain
BCG, IGRA (Interferon gamma release assay)
The CLASSIC presentation of secondary Tb aka REACTIVATED latent TB would be ___ lesions in the ____ lobes of the lungs on a ____ imaging
Cavitary, apicical, CXR
