GENERAL MEDICAL Flashcards by Kelly Linskey

What is deficient in ITP? What is first line treatment? What other treatments might be used if autoimmune?

-Low platelets

-Platelets first line tx

-May tx with steroids/IG

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Treatment for DIC?

-PRBCs
-Platelets
-FFP
-Heparin

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What hemophilia factor may have prescription for home use to terminate early bleeding episode?

Facotr VIII

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2 major complications of sickle cell?

Acute chest and acute abdomen

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What is Hydroxyurea used for?

Impede sickling and to stimulate fetal hemoglobin F production in sickle cell patients

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Characteristics of rash associated with measles/rubeola

-Rash to face first, then spreads to truck and extremities
-Rash looks all the same
- Overlaps

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Characteristics of rash associated with chicken pox/varicella

-Rash starts on truck/chest/torso
-No sores overlap
-Sores in various stages

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Patches inside cheek unique for measles only

Koplik’s Spots

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What kind of transmission is measles/rubeola?
What kind of transmission is chicken pox/varicella?

-Measles = droplet

-Chicken Pox = contact + airborne

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Swelling and tenderness of the salivary/parotid glands, usually unilateral, may lead to orchitis, will not cause airway problem

Mumps

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When do we hear the whooping cough associated with pertussis?

Day 4-7

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When are chicken pox/varicella no longer contagious?

When all lesions are crusted over

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Fluid replacement for adults? Peds?

Adults = 1-2 L of NS
Peds = 20ml/kg

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What do we initially treat both hypo and hypernatremia with?

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How do we treat hyponatremia?

Hypernatremia?

Hypo = hypertonic solution (initially NS)

Hyper = hypotonic solution (initially NS)

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Why does hypernatremia have a high mortality?

Because brain cells shrink leading to ICH

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What are the 2 mandatory treatments for hyperK?

insulin and D50

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What EKG findings are seen with hyperkalemia?

Hypokalemia?

Hyper = tall, peaked T-waves

Hypo = sagging ST

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What is the max IV potassium/hr?

40 mEq/hr

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This leads to fluid retention and causes dilutional hyponatremia; first line treatment sodium then lasix. Usually idiopathic, may be pituitary problem

SIADH

Cortisol insufficiency, crisis may be fatal, leads to hypotension, hypoglycemia, dehydration; treat daily with steroids and crisis with hydrocortisone (Solu-Cortef)

Addison’s Disease

What is the pH in HHNK? Ketones?

What is the pH in DKA? Ketones?

HHNK pH = normal, ketones = usually negative, may be trace positive

DKA pH = low pH, acetone high

Why is the potassium high in DKA? How do we treat this?

High in DKA because no insulin to keep the potassium in the cell. Start potassium replacement when level is ~5.5.

How do we treat DKA? When do we treat until?

Treat with IVF and insulin until ketosis resolves

TSH low, T3/T4 high; s&s: nervous, sweating, heat intolerance, palpitations, dyspnea, fatigue, weight loss, EXOPTHALMOUS, possible goiter

Graves Disease

How do we treat a high HR associated with thyroid crisis?

Beta Blockers

This causes confusion, swelling in the brain, and liver damage; usually occurs in child with recent viral illness who was given aspirin

Reye's Syndrome

Hepatitis: fecal-oral, travelers/immigrants, IG if given within 2 weeks of exposure, can get 2 doses pre-vaccination

How do we test for/treat hepatitis B after exposure?

-after exposure, draw HBsAG. If you are negative the surface antigen will be negative and you can stop here. -If HBsAG positive, check Hep B antibodies. If positive, stop here because you are protected - this is likely from a prior vaccine. -If Hep B antibody negative, give Hep B IG + vaccine.

If we see what on an otherwise healthy person should we r/o HIV?

Thrush

What are 3 opportunistic infections seen in HIV --> AIDS

-Pneumocystitis (PCP) pneumonia -CMV -Kaposi's Sarcoma

Meningitis sign: Kernig's sign

Bend/extend (K)NEE, pt brings head forward

Meningitis sign: Brudzinski's sign

Hand on head/ (B)RAIN, bend neck - knees will flex

Glucose on CSF for bacterial meningitis? Viral?

Bacterial = low glucose Viral = normal glucose

How do we treat bacterial meningitis?

Rocephin

How do we treat tinea/ringworm?

Treat with topical antifungal for a minimum of 2 weeks or if rash lasts longer than 2 weeks treat until rash gone + 1 week

Transmitted by personal skin-to-skin contact, itching worse at night, common on flexor surfaces and between fingers

Scabies

How do we treat scabies?

Treat all household family members on same day and re-treat 1 week later, wash all clothing/linens/etc in normal wash cycle

What are symptoms of syphilis? Herpes?

Syphilis = painless, 1 chancre/ulcer, no discharge Herpes = painful, multiple sores, raised/pustules

When is TB contagious? When do we isloate?

Contagious when symptomatic; must be isolated for 2 weeks.

What 2 meds treat TB? What is a side effect?

Meds = INH and Rifampin Rifampin discolors body fluids and stains contacts

What is the most common type of chronic anemia? Most common acutely seen in the ER?

Chronic = iron deficiency Acute = blood loss

Mainstays of treatment for sickle cell (3)

-Fluids -Pain meds -Oxygen (only helpful early)

What is a risk factor for febrile seizures?

Sibling had febrile seizure

What are 3 types of dehydration?

-isotonic -Hypertonic -Hypotonic

Pruritic rash with red, scaly borders expanding and centrally clearing

Tinea

Classic finding associated with SIADH?

Dilutional hyponatremia

Hemophilia A Factor? B? C?

A = VIII B = IX C = XI