Last Ocm Flashcards
Newman
Ok
When using IV fluids what think about
Water
Normal physiologic needs for water
Depend on kidney, antidioretic hormone, how much drink
Drink, save, and put out
100mL for every 100 kcal of energy expended
Daily caloric expenditure
<10 kgL 100kcal.kg
>10kg to 20kg: 1000 kcal for first 10 kg plus 50kcal/kg for any increment of weight about 10 kg
>20 kg-80 kgL 1500 kcal for first 20 kg of body weight plus 30 kcal.kg for any increment of weight above 20 kg
Weight >80kgL 2700kcal.day with adjustments made as clinically pertinent for either increase r decrease
Insensible water loss
Respiration and skin
Sensible
Urine and stool
Water you know you are losing
Regular condition sensible+insensible
Sensible and insensible=100cc/kcal of energy oexpended
Just sitting
Losing insensible
Diarrhea
Sensible loss increase and this is fluid you must replace
Burns
Fluid loss, always need more fluid
Holliday segar methof
Most common to calculate fluids
Maintenance fluid requirements
Assume 100 mL neede to replace sensible and insensible under regular circumstances for ever 100 kcal.kg of energy
Fluid requirement is related to caloric means!!!!!!!!
Holliday segar assumes what
Everything is Normal
Normal conditions
Uses weight alone
4-2-1
4 cc per kg per hour x5=20cc an hour
10-20 40mL+2mL/kg
> 20=60+1 ml/kg
Everyone needs what per day
100ml/kg/day is less than 10kg
1000mL+50 ml/kg/day for >10
1500 ml+20 ml/kg/day for over 20kg
An and cl requirements
3mEq per 100 cc water
K
1-2 mEq per 100 cc
Need dextrose in fluid?
Yes almost always added D5 usually by get hypoglycemic
If chance fasting for a bit
Pre op always make sure there’s sugar in it
Calculate hourly maintenance IV fluid rate for a normal 25 kg child
65 cc per hour
57 cc/hour
Rehydration use what
ISOTONIC
LR and NS
Isotonic
Maintenance fluid
First line is 1/3 or 1/4 normal saline
Or NS
AAP recommends that patients 28 days to 18 years needing maintenance VIFs should receive __ solutions. Why
Isotonic
Sig decrease risk of developing hyponatremia
QUALITY A EVIDENCE
What is NS
.9% back
Half NS
4.5 NaCL
1/4 NS
2.25%
Mild dehydration
3-5%
Well appearing, normal to inc HR, normal breathing, normal cap refill
Warm , instant skinrecoil
Moderate dehydration
6-9% body weight loss
Ill appearing, tachycardia, increased breathing, pulses normal, normal capillary refill,
Cool perfusion, delayed 2 s skin turtle
Severe dehydration
> 10% loss of body weight due to water loss
Sick
Lethargic, tachycardia, increased deep breathing, poor pulses, prolonged capillary refill
Cold, very prolonged cap refill >2 sec
Hydration most important cap refill over 2, dry mucous membrane, absent tears, general appearance
DEHYDRATION
Tends to be as diagnostic as the rest
Gold standard asses hydration
Weight
If dehydrated remember replace deficit with
10 kg child 5% dehydrated
.5 kg
1000 , 500cc of fluid when replace replace deficit along with giving them their maintenance
Acute vomiting and diarrhea in 2 year old boy and has low grade fever
Skin turf or, mucous membranes, e perfusion, general appearance
Oral hydration, come back in ew days if not better
Viral gastritis
Wheeze and cold three days ago runny nose cough first days and now trouble breathing afebrile
Not all asthma Foreign object Allergies Toxin Pneumonia
Complemtary alternative medicine
Ok
Difference between integrative and functional medicine
Functional-connected with or being a function: the functional differences between the departments
Affecting physiological or psychological functions but not organic strucureL functional heart disease
Systems biology based , genes env lifestyle, timelines, in depth interviews
ROOT CAUSE,
Similarities integrative and functional medicine
Create health
Combines alternative medicine practice with conventional practice
Together complementary and alternative medicines
Philosophy that neither rejects conventional medicine nor accepts alternative therapies uncritically
Basics of acupuncture
Expensive, safe,
Who qualified to do accupuncture
Ok
Natural therapeutic interventions for common problems
Compare and contrast regenerative medicine
Back pain
Glucosamine+chondroitin sulfate
Pain
Yoga
Sores
Relaxation techniques like diaphragmatic breathing
Balance
Tai chi
Detoxify
Essential oils.purify air by removing toxins increasing oxygen, prevent illness
Topical, aromatically, internally
Upset stomach cramping, gas, bloating, heart, big
Peppermint
Anti infections cold sores, fevers, soar through, ear infection, infections
Lemon
Calming relaxing, wound healing, burns, cuts
Lavender
Regenerative medicine
Mask.ortho injuries
Prolotherapy, platelet rich plasma, stem cell therapy
Prolotherapy
Injection, repairs weak/painful joint/ligamentous areas, long term solution
Raising growth factors
Tissue repair/growth
Indication prolotherapy
MSK pain>8 weeks
Low back pain ……..
Try before surgery
History prolotherapy
Chronic MSK pain from inadequate repair of CT. Mainly ligaments and tendons poor blood supple so get chronic pain
Sclerotherapy
Inaccurate term for prolotherapy
Ssclerotherpy basis
Scar formation was treatment mechanism
When biopsy have not shown scar formation
How sclerotherapy work
Stimulate cascade inflammation activated fibroblasts
Raises GF levels_fibrosis-new CT repair
Efffectiveness has been evidenced with double blind placebo controlled studies
MRI misleading/.
Correlate results of imaging to ther patient
MRI can show abnormal results in pain freee patients
Pain is a liar
Ligament injury can cause severe pain due to density of nerve endings
NSAIDS and corticosteroids have not been shown to improve health
Sclerotherapy
Tendonsis intentionally turned to tendinitis to stimulate repair
Low back pain
Prolotherapy
Prolotherapy and spinal disc disease
Stabilize and strengthen the ligaments around weakened joints and reduce or eliminate pain
Sciatica an dprolotherp
Usually from ligamentous laxity in SI joint
SI ligament pain referral
Overlap sciatic nerve pathways
Piriformis
Piriformis inflammation leading to welling and pressure on sciatic nerve causing pain and referral
Merriments study
Prolotherapy fewer side effects than fusion for SCIATICA
Wolfs law prolotherapy OA
Bones respond to stress by making new bone
Meniscus tear prolotherapy
Treats when supporting ligaments
Cartilage regeneration
May help by raise GF levels
Neck pain and MSK HA
Very successful
Appearance and behavior, eye contact, eye movement
Important when walk in for mental status
Mood and affect
Mood-subjective report of emotional state by patient
Affect: objective observation of patients emotional state by the physician
Akathisia
Excessive motor activity
Agitation
Wringing hands, rocking, picking at skin or clothing
Bradykinesia
Psychomotor retardation
Catatonia
Immobility with muscular rigidity waxy flexibility
Gait
Shuffling, broad based, limping, stumbling, hesitation
Tardive dyskinesia
Involuntary facial grimaces, choreathetotic moments
The ordering and implementation of cognitive function necessary to engage in appropriate behaviors
Biotin to focus based on internal or external priorities
Judgement
Choose appropriate behaviors
Insight
Awareness and understanding of illness and need for treatment
Gnosis
Ability to Naem objects and their function
Praxis
Ability to carry out intentional motor acts
Visuospatial profiency
Ability to perceive and manipulate objects and shapes in space
Verbal or written communication
> 100 words per min normal
M50 words per min not normal
Verbal or written communication
Volume and tone: loud , soft, monotone, weak, strong, mumbles
Fluency and rhythm
Coherent
Echolalia
Echolalia
Immediate and involuntary repetition of words or phrases just sponge by others
Prosody
Recognize the emotional aspects of language
Recall of past events
Declarative
Procedural: complete them without. Conscious thought
Sensorium
Level and stability of consciousness
Deepest on Glasgow coma score
Active vs passive thought
Ok
Auditory hallucinations
Compelling
Jamais vu
Sense of eeriness and the observers impression of seeing the situation for the first time, despite rationally knowing that he or she has been nit he situation before
Associated with certain types of aphasia, amnesia, and epilepsy
Circumferential
Patient goes through multiple thoughts before arriving at the answer to a question
Disorganized thought
Moves from one topic to another without organization or coherence
Tangential
Listens to question and begins discussion related thoughts ,but never arrives at the answer
Circumlocution
Use of many words where fewer would do, as when having difficulty finding a word
Where are most BCC
Head neck
Modular BCC
Most common
Pearl white or pink dome shaped pale resembling mollusculm contagious
Extends
Pearly border
Center ulcerated
Telangiectasia
SCC
Risk metastasis unlike BCC
From epithelium and is common int he Middle Ages and elderly population
Separated into prior radiation and from actinically damaged skin
Most common SCC spoil
Sun exposed like scalp back of hands
Bcc rarely found
Presentation SCC
Red, inflamed, scaly lesion from actinic keratosis
Melanoma
High metastic potential
IV light, tanning bed, fair complexion, family history, dysplastic and congenital nevi
Superficial spreading melanoma
Most common initial radial growth phase before invasion
Lentils maligna melanoma
Long growth phase before invasion
Elderly and sun exposed
A real lentiginous
Black ppl
Palms and soles, mucosal surfaces, in nail beds, and mucocutaneous junctions
Modular
Poor prognosis invasive growth from onset
Clinical melanoma
Pigmented colorless caries
>6 mm asymmetric, irregular, variation in color
Melanoma diagnosis
Biopsy excisions
Depth of invasion is the most important prognostic factor
Actinic
Scaly erythematous macula or patch of skin
Develop to SCC
In situation or intra epidermal squamous cell carcinoma Bowen’s disease
Localized neoplasticism cells that are confined to epidermis flat erythematous and scaly plaque that si well demarcated but irregularly shaped.
Sun exposed spots legs
Slow growing
SCC
In situation SCC affecting glans panic or vulva
Erythroplasia of queyrat and is associated with HPV infection
X ray
Scatter radiation that is not absorbed
Can affect team
Greater depth penetration lighter grey
Fluoroscopy
X rays imaging to create a real time look into internal structures
Dynamic procedures such as injections, biopsies,, angiograms and GI
CT
2d image with pain radiograph
ST
Measure and display varying x rays attenuation of the tissues in a section fo the body by passing x rays through the section from many different angles then using computers to reconstruct the image you see
Ct good
Fast, good resolution of bony lesions, less expensive than MRI
Weakness CT
Ionizing radiation, expensive, poor soft tissue
T1 MRI
Fat bright, water dark, detect anatomy
T2
Water bright, fat dark , detect pathology
MRI good
No ionizing radiation, entire cross sections without interference , superior soft tissue contrast
Weak MRI
Subject to motion artifact, inferior to CT in detecting acute hemorrhage, inferior to CT in detection of bony injury, requires prolonged acquisition time for many images
How do MRI/CT
Contrast medium injected into joint under fluoroscopy contrast used depends on type of imaging CT or MRI
Used to elucidate tears in labrum or cartilage
US
No ionizing radiation
Send waves through transducer
Turn off transducer allows time to receive echos and electrical impulses generated and image recreated
Due a
Radiography tube generates photon beams of two different energy levels thus dual energy
The difference in attenuation of two photon beams as they pass through body of variable composition distinguished bone from soft tiers and allows quantification of BMD
T score the value used for diagnosis of osteoporosis
Z score used to compare patients BMD to population
Open x ray
Thick open to air has penetrated skin
Closed fracture
Bone has been fractured yet has not penetrated the skin
Displacement
Extent to which axial bones are not aligned
Can be described in terms of percentages distal segment displaced relative to proximal one
Angulation
Fracture segments are not anatomically aligned but rather at an angle
Apex relative to anatomical long axis
Rotation
Extent to which the fracture segments are rotated distal segment rotated relative to proximal segment
Osteomyelitis
Bone and arrow inflammation
Most common bone infection
S aureus
Osteomyelitis presentation
Acute osteomyelitis gradual onset of symptoms over several days
Dull pain at involved site
Tender, warm swollen
Imaging modality of choice for osteomyelitis
2 weeks of symptoms+ suggestive clinical history-x ray-looked like osteomyelitis or symptoms>2 weeks-MRI
Or x ray doesn’t look like osteomyelitis no MRI
Annular
Ring like
Nummular
Coin like
Acrochordons
Fibroepithelial polyps; benign cutaneous growths. Commonly found in areas of frequent friction. Small skin colored or brown, soft Papuans
Atopic dermatitis
Chronic, relapsing. Prurience conditions often associate with allergic rhinitis. More common in kids, usually involves the flexural aspects of the extremities, but can be widespread. Intense pruritus
Allergic contact dermatitis
Type IV reaction poison ivy, oak, sumac
Urticaria
Wheals
Erythematous no do sum
Bright red elevated. Pretibial sarcoidosis
Folliculitis
Inflammation of superficial hair follicles resulting in follicularly centered papules and pustules.
Lipodermatosclerosis
Inflammation fo the adipose below the skin secondary to chronic venous insuffiency. LE. Initially is tender with erythema and hyperpigmentation progresses to sclerosis and hyperpigmentation
Pityriasis rosea
Scaly pink or flesh colored herald lesion followed by eruption of discrete oval, erythematous and scaly plaques and patches oriented along skin cleavage lines, trunk
Spares palm and soles
Vitiligo
Acquired leukoderma characterized by well circumscribed chalk white depigmented maulers of patches. Hypothesized to either be autoimmune or an intrinsic melanocytes defect
Herpes zoster
1-3 day prod Rome of burning pain and parenthesis. Dermatologic. Crust over and resolve 7-14 days
