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Clin Medicine > Last Ocm > Flashcards

Last Ocm Flashcards

1
Q

Newman

A

Ok

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2
Q

When using IV fluids what think about

A

Water

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3
Q

Normal physiologic needs for water

A

Depend on kidney, antidioretic hormone, how much drink

Drink, save, and put out

100mL for every 100 kcal of energy expended

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4
Q

Daily caloric expenditure

A

<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

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5
Q

Insensible water loss

A

Respiration and skin

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6
Q

Sensible

A

Urine and stool

Water you know you are losing

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7
Q

Regular condition sensible+insensible

A

Sensible and insensible=100cc/kcal of energy oexpended

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8
Q

Just sitting

A

Losing insensible

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9
Q

Diarrhea

A

Sensible loss increase and this is fluid you must replace

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10
Q

Burns

A

Fluid loss, always need more fluid

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11
Q

Holliday segar methof

A

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!!!!!!!!

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12
Q

Holliday segar assumes what

A

Everything is Normal
Normal conditions
Uses weight alone

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13
Q

4-2-1

A

4 cc per kg per hour x5=20cc an hour

10-20 40mL+2mL/kg

> 20=60+1 ml/kg

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14
Q

Everyone needs what per day

A

100ml/kg/day is less than 10kg

1000mL+50 ml/kg/day for >10

1500 ml+20 ml/kg/day for over 20kg

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15
Q

An and cl requirements

A

3mEq per 100 cc water

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16
Q

K

A

1-2 mEq per 100 cc

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17
Q

Need dextrose in fluid?

A

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

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18
Q

Calculate hourly maintenance IV fluid rate for a normal 25 kg child

A

65 cc per hour

57 cc/hour

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19
Q

Rehydration use what

A

ISOTONIC

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20
Q

LR and NS

A

Isotonic

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21
Q

Maintenance fluid

A

First line is 1/3 or 1/4 normal saline

Or NS

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22
Q

AAP recommends that patients 28 days to 18 years needing maintenance VIFs should receive __ solutions. Why

A

Isotonic

Sig decrease risk of developing hyponatremia

QUALITY A EVIDENCE

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23
Q

What is NS

A

.9% back

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24
Q

Half NS

A

4.5 NaCL

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25
Q

1/4 NS

A

2.25%

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26
Q

Mild dehydration

A

3-5%

Well appearing, normal to inc HR, normal breathing, normal cap refill
Warm , instant skinrecoil

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27
Q

Moderate dehydration

A

6-9% body weight loss

Ill appearing, tachycardia, increased breathing, pulses normal, normal capillary refill,

Cool perfusion, delayed 2 s skin turtle

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28
Q

Severe dehydration

A

> 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

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29
Q

Hydration most important cap refill over 2, dry mucous membrane, absent tears, general appearance

A

DEHYDRATION

Tends to be as diagnostic as the rest

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30
Q

Gold standard asses hydration

A

Weight

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31
Q

If dehydrated remember replace deficit with

A

10 kg child 5% dehydrated

.5 kg

1000 , 500cc of fluid when replace replace deficit along with giving them their maintenance

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32
Q

Acute vomiting and diarrhea in 2 year old boy and has low grade fever

A

Skin turf or, mucous membranes, e perfusion, general appearance

Oral hydration, come back in ew days if not better
Viral gastritis

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33
Q

Wheeze and cold three days ago runny nose cough first days and now trouble breathing afebrile

A 
Not all asthma 
Foreign object
Allergies
Toxin 
Pneumonia
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34
Q

Complemtary alternative medicine

A

Ok

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35
Q

Difference between integrative and functional medicine

A

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,

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36
Q

Similarities integrative and functional medicine

A

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

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37
Q

Basics of acupuncture

A

Expensive, safe,

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38
Q

Who qualified to do accupuncture

A

Ok

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39
Q

Natural therapeutic interventions for common problems

A

Compare and contrast regenerative medicine

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40
Q

Back pain

A

Glucosamine+chondroitin sulfate

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41
Q

Pain

A

Yoga

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42
Q

Sores

A

Relaxation techniques like diaphragmatic breathing

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43
Q

Balance

A

Tai chi

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44
Q

Detoxify

A

Essential oils.purify air by removing toxins increasing oxygen, prevent illness

Topical, aromatically, internally

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45
Q

Upset stomach cramping, gas, bloating, heart, big

A

Peppermint

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46
Q

Anti infections cold sores, fevers, soar through, ear infection, infections

A

Lemon

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47
Q

Calming relaxing, wound healing, burns, cuts

A

Lavender

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48
Q

Regenerative medicine

A

Mask.ortho injuries

Prolotherapy, platelet rich plasma, stem cell therapy

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49
Q

Prolotherapy

A

Injection, repairs weak/painful joint/ligamentous areas, long term solution

Raising growth factors

Tissue repair/growth

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50
Q

Indication prolotherapy

A

MSK pain>8 weeks
Low back pain ……..
Try before surgery

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51
Q

History prolotherapy

A

Chronic MSK pain from inadequate repair of CT. Mainly ligaments and tendons poor blood supple so get chronic pain

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52
Q

Sclerotherapy

A

Inaccurate term for prolotherapy

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53
Q

Ssclerotherpy basis

A

Scar formation was treatment mechanism

When biopsy have not shown scar formation

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54
Q

How sclerotherapy work

A

Stimulate cascade inflammation activated fibroblasts
Raises GF levels_fibrosis-new CT repair

Efffectiveness has been evidenced with double blind placebo controlled studies

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55
Q

MRI misleading/.

A

Correlate results of imaging to ther patient

MRI can show abnormal results in pain freee patients

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56
Q

Pain is a liar

A

Ligament injury can cause severe pain due to density of nerve endings
NSAIDS and corticosteroids have not been shown to improve health

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57
Q

Sclerotherapy

A

Tendonsis intentionally turned to tendinitis to stimulate repair

58
Q

Low back pain

A

Prolotherapy

59
Q

Prolotherapy and spinal disc disease

A

Stabilize and strengthen the ligaments around weakened joints and reduce or eliminate pain

60
Q

Sciatica an dprolotherp

A

Usually from ligamentous laxity in SI joint

61
Q

SI ligament pain referral

A

Overlap sciatic nerve pathways

62
Q

Piriformis

A

Piriformis inflammation leading to welling and pressure on sciatic nerve causing pain and referral

63
Q

Merriments study

A

Prolotherapy fewer side effects than fusion for SCIATICA

64
Q

Wolfs law prolotherapy OA

A

Bones respond to stress by making new bone

65
Q

Meniscus tear prolotherapy

A

Treats when supporting ligaments

66
Q

Cartilage regeneration

A

May help by raise GF levels

67
Q

Neck pain and MSK HA

A

Very successful

68
Q

Appearance and behavior, eye contact, eye movement

A

Important when walk in for mental status

69
Q

Mood and affect

A

Mood-subjective report of emotional state by patient

Affect: objective observation of patients emotional state by the physician

70
Q

Akathisia

A

Excessive motor activity

71
Q

Agitation

A

Wringing hands, rocking, picking at skin or clothing

72
Q

Bradykinesia

A

Psychomotor retardation

73
Q

Catatonia

A

Immobility with muscular rigidity waxy flexibility

74
Q

Gait

A

Shuffling, broad based, limping, stumbling, hesitation

75
Q

Tardive dyskinesia

A

Involuntary facial grimaces, choreathetotic moments

76
Q

The ordering and implementation of cognitive function necessary to engage in appropriate behaviors

A

Biotin to focus based on internal or external priorities

77
Q

Judgement

A

Choose appropriate behaviors

78
Q

Insight

A

Awareness and understanding of illness and need for treatment

79
Q

Gnosis

A

Ability to Naem objects and their function

80
Q

Praxis

A

Ability to carry out intentional motor acts

81
Q

Visuospatial profiency

A

Ability to perceive and manipulate objects and shapes in space

82
Q

Verbal or written communication

A

> 100 words per min normal

M50 words per min not normal

83
Q

Verbal or written communication

A

Volume and tone: loud , soft, monotone, weak, strong, mumbles

Fluency and rhythm

Coherent

Echolalia

84
Q

Echolalia

A

Immediate and involuntary repetition of words or phrases just sponge by others

85
Q

Prosody

A

Recognize the emotional aspects of language

86
Q

Recall of past events

A

Declarative

Procedural: complete them without. Conscious thought

87
Q

Sensorium

A

Level and stability of consciousness

Deepest on Glasgow coma score

88
Q

Active vs passive thought

A

Ok

89
Q

Auditory hallucinations

A

Compelling

90
Q

Jamais vu

A

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

91
Q

Circumferential

A

Patient goes through multiple thoughts before arriving at the answer to a question

92
Q

Disorganized thought

A

Moves from one topic to another without organization or coherence

93
Q

Tangential

A

Listens to question and begins discussion related thoughts ,but never arrives at the answer

94
Q

Circumlocution

A

Use of many words where fewer would do, as when having difficulty finding a word

95
Q

Where are most BCC

A

Head neck

96
Q

Modular BCC

A

Most common
Pearl white or pink dome shaped pale resembling mollusculm contagious

Extends
Pearly border
Center ulcerated
Telangiectasia

97
Q

SCC

A

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

98
Q

Most common SCC spoil

A

Sun exposed like scalp back of hands

Bcc rarely found

99
Q

Presentation SCC

A

Red, inflamed, scaly lesion from actinic keratosis

100
Q

Melanoma

A

High metastic potential

IV light, tanning bed, fair complexion, family history, dysplastic and congenital nevi

101
Q

Superficial spreading melanoma

A

Most common initial radial growth phase before invasion

102
Q

Lentils maligna melanoma

A

Long growth phase before invasion

Elderly and sun exposed

103
Q

A real lentiginous

A

Black ppl

Palms and soles, mucosal surfaces, in nail beds, and mucocutaneous junctions

104
Q

Modular

A

Poor prognosis invasive growth from onset

105
Q

Clinical melanoma

A

Pigmented colorless caries

>6 mm asymmetric, irregular, variation in color

106
Q

Melanoma diagnosis

A

Biopsy excisions

Depth of invasion is the most important prognostic factor

107
Q

Actinic

A

Scaly erythematous macula or patch of skin

Develop to SCC

108
Q

In situation or intra epidermal squamous cell carcinoma Bowen’s disease

A

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

109
Q

In situation SCC affecting glans panic or vulva

A

Erythroplasia of queyrat and is associated with HPV infection

110
Q

X ray

A

Scatter radiation that is not absorbed

Can affect team

Greater depth penetration lighter grey

111
Q

Fluoroscopy

A

X rays imaging to create a real time look into internal structures

Dynamic procedures such as injections, biopsies,, angiograms and GI

112
Q

CT

A

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

113
Q

Ct good

A

Fast, good resolution of bony lesions, less expensive than MRI

114
Q

Weakness CT

A

Ionizing radiation, expensive, poor soft tissue

115
Q

T1 MRI

A

Fat bright, water dark, detect anatomy

116
Q

T2

A

Water bright, fat dark , detect pathology

117
Q

MRI good

A

No ionizing radiation, entire cross sections without interference , superior soft tissue contrast

118
Q

Weak MRI

A

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

119
Q

How do MRI/CT

A

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

120
Q

US

A

No ionizing radiation

Send waves through transducer
Turn off transducer allows time to receive echos and electrical impulses generated and image recreated

121
Q

Due a

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

122
Q

Open x ray

A

Thick open to air has penetrated skin

123
Q

Closed fracture

A

Bone has been fractured yet has not penetrated the skin

124
Q

Displacement

A

Extent to which axial bones are not aligned

Can be described in terms of percentages distal segment displaced relative to proximal one

125
Q

Angulation

A

Fracture segments are not anatomically aligned but rather at an angle

Apex relative to anatomical long axis

126
Q

Rotation

A

Extent to which the fracture segments are rotated distal segment rotated relative to proximal segment

127
Q

Osteomyelitis

A

Bone and arrow inflammation

128
Q

Most common bone infection

A

S aureus

129
Q

Osteomyelitis presentation

A

Acute osteomyelitis gradual onset of symptoms over several days

Dull pain at involved site
Tender, warm swollen

130
Q

Imaging modality of choice for osteomyelitis

A

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

131
Q

Annular

A

Ring like

132
Q

Nummular

A

Coin like

133
Q

Acrochordons

A

Fibroepithelial polyps; benign cutaneous growths. Commonly found in areas of frequent friction. Small skin colored or brown, soft Papuans

134
Q

Atopic dermatitis

A

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

135
Q

Allergic contact dermatitis

A

Type IV reaction poison ivy, oak, sumac

136
Q

Urticaria

A

Wheals

137
Q

Erythematous no do sum

A

Bright red elevated. Pretibial sarcoidosis

138
Q

Folliculitis

A

Inflammation of superficial hair follicles resulting in follicularly centered papules and pustules.

139
Q

Lipodermatosclerosis

A

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

140
Q

Pityriasis rosea

A

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

141
Q

Vitiligo

A

Acquired leukoderma characterized by well circumscribed chalk white depigmented maulers of patches. Hypothesized to either be autoimmune or an intrinsic melanocytes defect

142
Q

Herpes zoster

A

1-3 day prod Rome of burning pain and parenthesis. Dermatologic. Crust over and resolve 7-14 days

Clin Medicine (28 decks)

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