Form 2 Block 4 - Created Aug 7 Flashcards
ARDS goal is to keep partial pressure of arterial oxygen at 55-80 mm Hg (or oxygen sat. at 88-95%). How is this maintained?
- low TV’s at 6-8 mL/kg predicted wt
- RR < 35/min
- plateau pressure < 3 cm H2O
- FiO2 < 60%
ARDS pt is at goal with minimal level of PEEP. (5 cm H2O). What is next step?
Decrease FiO2 to < 40% to prepare for spontaneous breathing trial in the near future
pt has exercise-induced hypothalamic amenorrhea. What should be done next?
Check DEXA to assess risk for stress fracture.
with elderly pt who has TSH above normal on exam, what to do with it?
If it’s < 7 and no overt/bad signs of hypothyroidism, it’s subclinical. Leave them alone.
when should grief counseling be suggested
when the person who lost a loved one has poor family and/or social support
Pt had success with SSRI before with depression, but pt has bipolar disorder and hates Lithium. Next step?
Educate pt about the risks of mania with antidepressant therapy and give other options to stabilize mood. (lamotrigine, valproate, quetiapine, lurasidone)
HIT type 1 vs. 2 presentation
- plt’s at 100k w/in 2 days of starting heparin
- plt’s go down 30-50%, occurs 5-10d after heparin or <1d if they’ve had heparin recently, see new thrombosis or skin necrosis
HIT type 1 vs. 2 treatment
- requires NO change in therapy
2. check plt factor 4 Ab, stop heparin, and start argatroban
people at risk to get rhino-orbital-cerebral mucormycosis
diabetes, blood cancer, solid organ or stem cell transplant
tx of rhino-orbital-cerebral mucormycosis
surgical debridement, Amp.B, and eliminate risk factors if possible
presentation of splenic sequestration in SCD child
L sided abd. pain, palpable splenomegaly, severe anema
tx of splenic sequestration in SCD child
IVF -> RBC transfusion -> possibly splenectomy
tx of Lyme disease
doxy if skin/mild dz
ceftriaxone (hosp) if neuro or cardiac dz
presentation of acalculous cholecystitis
critically ill pt, unexplained fever, jaundice, leukocytosis, GB wall thickening w/o choleliths
tx of of acalculous cholecystitis
percutaneous cholecystostomy and Abx
cholecystectomy if perf or necrosis
on nonstress test, if mom has a uterine contraction and baby has no acceleration in HR, next step?
do biophysical profile to assess fetus (NST, AFI, breathing, movements, tone)
what is associated with a more aggressive course in RA?
anti-cyclic citrullinated peptide Ab’s
what labs to monitor with neonatal polycythemia (Hct >65% or Hgb >22% in term babies)
glucose and bilirubin
treatment of neonatal polycythemia
IVF, G, partial exchange transfusion
presentation of postop ileus
no return of bowel function >72h after intraabdominal surgery -> V, lack of gas, can’t eat p.o.
xray findings of SBO vs ileus
SBO - air fluid levels, dilated proximal bowel but collapsed distal bowel, no air in colon/rectum
ileus - dilated loops of bowel, air in colon and rectum
mgt of postop ileus
IVF, antiemetics, bowel rest w/ ng tube placement, avoiding opiates
part of the presentation of hydatidiform mole that’s not ob/gyn related per se
hyperthyroidism
presentation of pt with heavy alcohol use and severe hypophosphatemia
sxs start 12-36h after admission to hospital; generalized weakness, diminished reflexes, paresthesias, ileus, and/or metabolic encephalopathy; do IV phosphate if having sxs; do p.o. if Asx
risk with retaining a dead fetus
DIC
possible causes of otitis externa
water, cotton swabs, headphones, hearing aids, derm conditions
presentation of otitis externa
ear pain, discharge, pruritis, pain with auricle manipulation; red, edematous ext. auditory canal
bugs that cause otitis externa
pseudomonas and staph aureus
tx of otitis externa
topical FQN +/- topical glucocorticoid
what can happen in pt with COPD who is started on NPPV
pulmonary barotrauma (Ptx, pneumoperitoneum, pneumomediastinum, subcut. emphysema)
presentation of subcutaneous emphysema
rapid-onset, painless swelling of upper chest, neck, and/or face as well as crepitus; get a CXR to look
