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Internal Med EOR > Internal Med Critical Care > Flashcards

Internal Med Critical Care Flashcards

1
Q

etiology of acute adrenal crisis

A

stressor with insufficient cortisol

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2
Q

presentation of adrenal crisis

A
  • high fever
  • severe abd pain
  • n/v
  • confusion
  • hypotensive shock
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3
Q

diagnosis of adrenal crisis

A

order serum cortisol and ACTH but do not wait on results to start treatment

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4
Q

treatment of adrenal crisis

A
  • IV hydrocortisone
  • fix electrolytes
  • broad spectrum antibiotics
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5
Q

defining location of upper GI bleed vs lower GI bleed

A

ligament of treitz

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6
Q

presentation of upper GI bleed

A
  • hematemesis
  • coffee ground emesis
  • melena
  • hyperactive bowel sounds
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7
Q

presentation of lower GI bleed

A

hematochezia

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8
Q

diagnosis of upper GI bleed

A

NG tube with lavage

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9
Q

diagnosis of lower GI bleed

A
  • rectal exam
  • colonoscopy
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10
Q

management of GI bleed

A
  • hemodynamically stable: consult GI or surgery for endoscopy
  • hemodynamically unstable: NPO, fluids, blood transfusion
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11
Q

indications for transfusion of GI bleed

A
  • failure of perfusion after 2L of fluids
  • hbg <7
  • hbg<9 and comorbidities
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12
Q

etiology of acute glaucoma

A

sudden increase of IOP causing damage to optic nerve

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13
Q

s/s of acute glaucoma

A
  • halos around lights
  • dilated pupils
  • headache
  • severe eye pain
  • steamy, red cornea
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14
Q

diagnosis of acute glaucoma

A

gonioscopy

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15
Q

treatment of acute glaucoma

A
  • acetazolamide
  • pilocarpine
  • recheck IOP every 30-60 minutes
  • definite: laser iridotomy
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16
Q

ARDS

A

acute respiratory failure following a systemic or pulmonary insult without evidence of heart failure

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17
Q

etiologies of ARDS

A
  • sepsis
  • aspiration pneumonia
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18
Q

pathophys of ARDS

A

lung injury causes excess fluid to accumulate in both the interstitium and alveoli which causes impaired gas exchange

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19
Q

diagnosis of ARDS

A
  • acute onset within 1 weeks of clinical insult
  • bilateral pulmonary infiltrates
  • PaO2/FIO2 <300mg
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20
Q

s/s of ARDS

A
  • SOB
  • tachypnea
  • intercostal retractions
  • crackles
  • multiple organ failure
  • does not respond to supplemental O2
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21
Q

treatment of ARDS

A
  • treat underlying cause
  • PEEP
  • low tidal volume ventilation
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22
Q

s/s of cardiac tamponade

A
  • distant heart sounds
  • JVD
  • hypotension
  • kussmauls sign
  • pulsus paradoxus
  • electrical alternans
  • water bottle heart
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23
Q

diagnosis of cardiac tamponade

A

echo

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24
Q

Management of cardiac tamponade

A

pericardiocentesis

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25
Q

coma

A

state of unresponsiveness, even to stimuli, and may lack a gag reflex or pupillary response that lasts for >1hour

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26
Q

confirmatory test for coma

A

cold caloric testing with normal response

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27
Q

cold caloric testing normal response

A

eyes moving to irrigated side followed by brisk horizontal nystagmus back to contralateral ear

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28
Q

locked in syndrome

A

patients are awake and alert but are mute and quadriplegic

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29
Q

brain death

A

irreversible cessation of all brain function with a known cause

30
Q

diagnosis of brain death

A
  • 6 hours of flat EEG
  • 12 hours without EEG
  • 24 hours for anoxic brain injury without EEG
31
Q

etiology of DKA

A

insulin deficiency triggered by stress

32
Q

presentation of DKA

A
  • n/v
  • fruity breath
  • hypotension and tachycardia
  • kussmaul respirations
33
Q

diagnosis of DKA

A
  • elevated glucose
  • b-hydroxybutyrate
34
Q

management of DKA

A

fluids then insulin

35
Q

hypertensive urgency

A

BP 220/125 with no sx

36
Q

hypertensive emergency

A

BP 220/130 with end organ damage

37
Q

treatment of hypertensive urgency

A
  • clonidine
  • captopril
  • nifedipine
38
Q

treatment of hypertensive emergency

A
  • BB and CCB used first
  • lower 25% in the first 2 hours, then 160/100 the next 2-6 hours
39
Q

s/s of pneumothorax

A
  • pleuritic CP
  • tachypnea
  • SOB
  • diminished breath sounds
  • tension: tracheal deviation and lateral PMI
40
Q

diagnosis of pneumothroax

A

CXR

41
Q

treatment of pneumothorax

A
  • small primary: supplemental o2 and observe
  • large primary: aspiration and possible chest tube
  • secondary: tube and admit
  • tension: needle decompression
42
Q

s/s of PE

A
  • pleuritic CP
  • dyspnea
  • tachypnea
43
Q

diagnosis of PE

A
  • first do PERC rules, then Wells score
  • low risk and no perc: observation
  • low risk with positive perc or moderate risk: D-dimer
  • high risk: CTA
44
Q

wells score interpretation

A
  • high risk: >6
  • moderate risk: 2-6
  • low risk: <2
45
Q

gold standard for diagnosis of PE

A

pulmonary angiography

46
Q

treatment of PE

A
  • supplemental O2
  • anticoagulation
  • TPA for high risk pts
  • embolectomy for high risk patients that cant have TPA
47
Q

Choice of anticoagulation for PE

A
  • unstable and renal insufficiency: heparin
  • cannot take oral anticoags: lovenox
  • anyone else: DOAC
48
Q

seizure disorder (epilepsy)

A

2 or more unprovoked seizures

49
Q

pre-ictal phase of seizure

A
  • sx that occur before the seizure
  • numbness/tingling
  • hallucinations
  • HA
  • nausea
50
Q

post-ictal phase of seizure

A

weakness and fatigue that occurs after the seizure

51
Q

focal seizure

A
  • abnormal activity that affects only one area of the brain
  • can have retained or impaired awareness
52
Q

absence seizure

A

staring off into space with impaired consciousness

53
Q

myoclonic seizure

A

sudden, irregular, brief jerks or twitches

54
Q

atonic seizures

A
  • drop attacks
  • usually associated with intellectual impairment
55
Q

tonic seizures

A

muscle stiffening and rigidity

56
Q

clonic seizures

A
  • convulsive movements
  • rhythmic jerking
57
Q

tonic-clonic seizures

A
  • LOC
  • violent shaking
  • body stiffening
  • loss of bowel and bladder incontinence
58
Q

treatment of seizures

A
  • focal: lamictal
  • generalized: valproate
  • pregnanct: keppra
59
Q

Etiology of cardiogenic shock

A

Acute MI

60
Q

S/S of cardiogenic shock

A
  • hypoperfusion
  • tachycardia
61
Q

treatment of cardiogenic shock

A
  • if due to ischemia, PCI
  • NE or dopamine
62
Q

s/s septic shock

A
  • hypotensive
  • hypo or hyper thermia
  • tachycardia
  • no response to at least 3L of fluids
63
Q

treatment of septic shock

A
  • vanc+zosyn
  • fluids
  • high flow o2
64
Q

neurogenic shock

A

caused by lesion or injury to the cervical spine that causes loss of vascular tone

65
Q

s/s of neurogenic shock

A
  • warm skin
  • hypotension
  • no reflex tachy
66
Q

treatment of neurogenic shock

A
  • fluids
  • vasopressors
67
Q

etiology of obstructive shock

A
  • pneumothorax
  • pericardial tamponade
  • massive PE
68
Q

status epilepticus

A

seizure activity lasting longer than 5-10 minutes or several seizures occurring during a 30 minute time frame

69
Q

treatment of status epilepticus

A

IV benzo

70
Q

thyroid storm

A

severe, life treatening thyrotoxicosis triggered by stress

71
Q

s/s of thyroid storm

A
  • delirium
  • tachycardia
  • vomiting
  • diarrhea
  • dehydration
72
Q

treatment of thyroid storm

A
  • methimazole
  • PTU
  • beta blocker

Internal Med EOR (18 decks)

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