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
The 4 drugs you give a patient with TB are ____
____ can turn body fluids red/orange
____ can cause peripheral neuropathy and you must therefore give ____ to help
___ can cause OPTIC problems
Use these 4 for ___ months of continuous therapy
RIPE = Rifampin, Isoniazid (INH), Pyrazinamide, and Ethambutol
Rifampin
INH, Vitamin B6 (aka Pyridoxine)
^** Injures NEURONS and HEPATOCYTES
Ethambutol (EYEthambutol)
6 months
If you have a + PPD, no history of BCG vaccine, check CXR and see no signs of ACTIVE TB -> Then you can be confident you have a case of LATENT TB and start a ____ month therapy of ____ to treat
+ PPD with history of BCG and check CXR and IGRA and CXR for active comes back - and IGRA comes back + that means you also have a latent TB patient so use same treatment
If CXR comes back negative for active TB and IGRA comes back -, then you do NOT have active or latent TB and NO TREATMENT is needed
9 months of INH
Gallstones are either Cholesterol or Pigmented (brown or black)
Crohns disease often presents with ___ stones and if a bacterial infection in an Asian is the presentation, think _____ stones
If a patient develops ASCENDING CHOLANGITIS (Charcots triad) the most common causes are
_____ for gram -
____ for gram +
____ for anaerobes
Pigmented, brown pigmented
E. Coli
Enterococcus
Bacteroides fragilis
For a patient with ascending Cholangitis, one would want to order AST/ALTs, Alk Phos, fractionated bilirubin, Amylase/Lipase, pre-procedure INR, and blood cultures and bile cultures
After ERCP, one can develop ____ which would show elevated lipase and amylase levels, ascending cholangitis, and less commonly perforation, bile leaks, or hemobilia
Pancreatitis
Mirizzi syndrome occurs when a stone gets stuck in the ____ duct, which causes an EXTRINSIC compression on the _____ duct leading to obstruction and this can lead to a _____ to provide an exit for the gallstones
Cystic, common hepatic, cholecystenteric fistula
The antibiotic choices for treating cholangitis include monotherapy with a _____ and _____
Beta-lactam and Beta-lactamase inhibitor
_____ are good to use for inflammatory conditions like Rheumatoid Arthritis or IBD but some side effects are you have increased chances of developing _____ or TB along with various dermatological conditions or even skin cancers
TNF-Alpha, bacterial infections
Diaphragmatic excursion is the distance between the level of _____ on full EXPIRATION and the level of dullness on full INSPIRATION via percussion down from the lung parenchyma (which is a resonant sound) to structures below the diaphragm (which becomes a dull sound)
^** Normal distance is ___ to ____ cm
If one performs egophony there is a strong chance they have ____
If you hear bronchophony or whispered pectoriloquy then think pneumonia, consolidations, or effusions
Dullness
3-5.5cm
Pneumonia
Grey turners sign and cullens sign present if ____ is present
Rebound tenderness tests for periotneal inflammation
Rovsings = \_\_\_\_\_ Mcburneys = \_\_\_\_\_ or periotneal irritation Murpheys = \_\_\_\_\_ Courvoisiers = \_\_\_\_\_
Bleeding
Appendicitis
Appendicitis
Cholelithiasis or cholecystitis
Pancreatic disease or cancer
Sympathetic levels
1) Gallbladder
2) Stomach
3) Liver
4) Small intestine
5) Large intestine
6) Appendix
Parasympathetics
1) Up to transverse colon
2) Descending colon and beyond
1) T6-T9
2) T5-T9
3) T6-T9
4) T9-T11
5) T10-L2
6) T12
1) Vagus n (OA and AA)
2) PSN (S2-S4)
+ Iliopsoas muscle test = ____
+ Obturator muscle test = ____
Heel strike = _____
Appendicitis
Appendicitis
Appendicitis
Choledocholithiasis will have the _____ duct larger than _____ cm
Common bile duct, 6cm
If a patient has pain you should give them ____ but if those are contraindicated you can consider ____ but the problem with this is that they raise the pressure for the _____ which can worsen the underlying problem and it also _____ the activity of the digestive tract leading to possible constipation or ileus
NSAIDS, Opiods, sphincter of oddi, slows
If a patient ends up with a temp above 38C or 100.4F, heart rate ABOVE 90, respiration above 20, PaCO2 below 32mm hg and WBC above 12,000 then you should consider ______ which can develop into sepsis and eventually septic shock
SIRS (Systemic inflammatory response syndrome)
Hematochezia
1) ____ is painless bleeding that coats the stool at end of defecation
2) ____ is tearing pain with small amount of blood on toilet paper
3) IBD = UC
4) Infectious colitis
5) Ischemic colitis
6) ____ is intermittent rectal bleeding, passage of mucus, mild diarrhea associated with fewer than 4 loose stools per day (mild UC)
1) Hemorrhoids
2) Anal fissues
3) Proctitis
Patients with bleeding can end up with hypovolemia
1) Mild to moderate hypovolemia presents with ____
2) Orthostatic hypotension occurs when blood volume loss is ___ percent or more, DECREASED systolic BP more than ___ mmhG and INCREASED heart rate of more than ____
3) If blood volume loss is 40% or more = _____
1) resting tachy
2) 15%, 20, 20
3) Supine hypotension
If a patient were to STOP ____, they have an increased risk for UC
Upper GI bleeds have a BUN:Cr ratio of ____:____
AST:ALT is 2:1 for alcoholids
_______ is the anatomical division between an UPPER GIB and LOWER GIB
If you stop a Beta Blocker it can cause _____
Smoking
30:1
Ligament of Treitz
Rebound Tachycardia
Erythema nodosum is present in patients with ____
Evaluating lower GI bleeds can be done via Radionuclide imaging, CT angiography, Angiography, or Colonoscopy
If an Upper GI bleed is occur and you have a HIGH index of suscpicion you should perform an _____
If moderate suspicion perform a ____ with ____
IBD
EGD (Upper endoscopy)
Nasogastric tube with lavage
If a patient is experiencing an ACUTE LOWER GIB, you should start supportive treatment which includes IV access, O2, IVF, blood products, etc
If bleeding is ongoing, perform a _____ after an adequate bowel preparation has been done (4-6Ls of Polyethylene glycol)
If you are considering a blood tranfsusion with packed RBCs, first type and screen if Hg is stable and no acute bleeding is occurring
^** If patient is YOUNG and NO comorbid illness, only transfuse if Hg is LESS than ____
If OLDER patient WITH comorbid illness like CAD, the require MORE THAN ____ g/dl
If the patients are actively bleeding and have hypovolemia, they might require a blood transfusion despite normal hemoglobin levels and also make sure you get IRON studies BEFORE transfusions
Giving 1 unit of PRBCs increases the Hgb levels by ____ g/dl
Colonoscopy
7
9
1
Both UC and CD are at increased risk for COLON CANCER and ____
KCL (Potassium Chloride) can be given through a peripheral IV at ____ mEq per hour MAXIMUM or else it will irritate the vein
During an acute IBD flare, treat via ____ IV or PO
DVTs
10
Corticosteroids
Patients at risk for CRC
If your’e risk is AVERAGE, only screen if patient is ____ or older and perform the colonoscopy every ___ years, or CTC every ___ years, or FIT every ____ year
If patient is at INCREASED risk due to personal or family history then….
If due to personal history perform a _____
If due to family history:
1) Genetics like FAP or HNPCC perform early, intense screening, genetic counseling and testing
2) CRC or adenomas in a first degree relative LESS than 60 or CRC/adenomas in TWO or MORE first degree relatives = COLONOSCOPY beginning at age ____ or ____ years earlier than age of youngest diagnosis aka if your brother had CRC at 40 years old, the perform one when you turn 30
3) CRC or adenomas in a FDR OVER 60 or CRC in TWO or MORE second degree relatives perform AVERAGE risk screening starting at age ____
50, 10, 5, 1
Surveillance colonoscopy
2) 40, 10
3) 50
Room O2 is ____%
If PO2 is less than ____ mmHg or spO2 is less than ____ mmHg you should give O2
Nasal canula = ___-___L and +___% for the first L added and then +___% for everyone after
^** Measure with ____
Rebreather masks allows ___-___L and goes up to ____% max and same concept as nasal canulas where you add +4% for each extra liter so starting at 6L = 44% -> 48% -> 52% etc…
^** These have open ports on BOTH sides of the mask for ambient air flow
Non-rebreather masks with reservoirs allows ___-___L starting at ____% for the first 6 liters and then adding _____% for each liter up to 10
^** These have ONE open port (R side) for ambient air flow and on the L side it has a 1-way valve to prevent rebreathing
21
60, 90
1-6L, 3, 4
Pulse Ox
6-10, 60%
6-10, 60%, 10%
____ masks are used for patient with hypercapnia and moderate hypoxemia
BWOYRG
Venturi masks
For chest CXRs remember -> ____
D = Details (DOB, Patients name, date of CXR) R = RIPE = Radiation, Integration, Pictures (angle/approach), Exposure S = Soft tissue and bones (is trachea over SPs?) A = Airways (heart should NOT be more than 1/2 mediastinum) B = Breathing C = Circulation (heart borders), position, shape, size, etc D = Diaphragm (\_\_\_-\_\_\_\_ rib spaces is normal) and if you see shallow angles it can indicate \_\_\_\_ E = Extras
DRS.ABCDEs
6-7, pleural effusions
Pulmonary function tests measures your ____
In patients with ____ disease, the curve is NARROW and its due to LOSS of _____
In patients with ___ disease the curve is SCOOPED and due to LOSS of ____ and air trapping
In patients with COPD you can perform an ____ test and if you see PFTs improved by ___% or ___CC its a POSITIVE test for COPD
Use methacholine challenge for asthma
FVC
Restrictive, elasticity
Obstructive, recoil
Albuterol, 12% or 200cc
If PR interval is prolonged (more than 0.2 seconds) and NO beats dropped = ____
PR prolonged increases and then beat dropped = _____
PR prolonged but not increasing and then beat dropped
Atria and ventricles beat independently = ____
1st degree AV block
2nd degree Mobitz type 1 aka Wenckebach
2nd degree Mobitz type 2
3rd degree block
QT interval should be less than 0.44 and prolonged QT leads to an increased risk of _____ and can be due to electrolyte abnormalities, congenital disease, or acute MIs
Torsades de pointes
Lateral leads = ____ and ____ a.
Inferior leads = ____ and ____ a.
Anterior leads = ____ and ____a.
Mobitz type 1 is usually due to an _____ MI and Mobitz type 2 is usually due to an ____ MI
Bradycardia is usually ___ MI and Tachycardia is usually ____ MI
1 and avL, LCX
II, III, and avF, RCA
V1-V6, LAD
Inferior, Anterior
Inferior, Anterior
Peaked T waves seen in _____ and ST elevation = MI
Treatment for an MI = ____
Hyperkalemia
MONA-B
