Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ACEM fellowship prep > Medicine > Flashcards

Medicine Flashcards

1
Q

Delirium vs dementia

A

Onset: acute/insidious
Course: fluctuating/ gradual deterioration
Awareness: impaired/ often clear until advanced stages
Attention: disturbed/ often good until advanced stages
Memory: poor working memory and immediate recall/ poor short term memory
Delusions: short lived and changing /fixed
Sleep disturbances: fragmented sleep/sleep wake reversal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Chemical sedation

A

Benzodiazepenes:
Midazolam: 2.5-5mg IV or IM (short acting)
Diazepam: 5-10mg PO/IV
Lorazepam: 1-2mg PO (sedation for 4-6hrs)
Antipsychotics:
Olanzapine: 5-10mg PO/SL; 10mg IM (hypotension)
Haloperidol: 2.5-10mg IV/IM (QT prolongation/dystonia)
Droperidol: 2.5-10mg IV/IM (QT prolongation/dystonia)
Quetiapine: 25-200mg PO
Risperidone: 0.25-2mg PO/SL (orthostatic hypotension)
Chlorpromazine: 100-200mg IV infusion/24hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Complications of sedating and restraining patients

A
  1. Respiratory depression and pulmonary aspiration
  2. Sudden cardiac death/ excited delirium
  3. Hypotension
  4. Deep venous thrombosis and pulmonary embolus
  5. Rhabdomyolysis
  6. Dystonic reactions
  7. Neuroleptic malignant syndrome
  8. Anticholinergic effects
  9. Delirium
  10. Lactic acidosis
  11. Lowered seizure threshold
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Symptoms and signs of third cranial nerve palsy

A
  1. Down and out eye
  2. Ptosis- weakness of elevator palpebrae
  3. Diplopia and strabismus
  4. Dilated fixed pupil and blurred vision- parasympathetic fibres originate from Edinger Westphal subnucleus of 3rd nerve complex
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Causes of third nerve dysfunction

A

Nuclear portion- infarction, hemorrhage, neoplasm, abscess- either side of midbrain tegmentum
Midbrain portion- infarction, neoplasm, abscess or hemorrhage
Subarachnoid portion- posterior communicating artery aneurysm, meningitis/meningeal infiltration, ophthalmologic migraine, mass effect (uncle herniation)
Cavernous sinus portion (lateral wall)- tutor, pituitary infarction, vascular (aneurysm/cv thrombosis/AV fistula), ischemia, inflammatory (Tolosa Hunt syndrome)
Orbital portion- inflammatory (orbital inflammatory pseudotumor), endocrine (thyroid orbitopathy), tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Causes of SVC obstruction

A
  1. Indwelling SVC catheters- thrombosis, stricture formation, vessel injury and hepatoma
  2. Lung cancer
  3. Retrosternal goitre
  4. Retrosternal tumors: lymphoma, thymoma, dermoid, other malignancies
  5. Mediastinal lymphadenopathy: breast cancer, other malignancies, granulomatous diseases
  6. Aortic aneurysm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Management of SVC obstruction

A 
Specific therapy determined by aetiology:
Steroids
Chemotherapy
Radiotherapy
Thrombosis- stent, anticoagulation, thrombolytic
Surgical resection
IV access in the IVC territory
**Prepare for:
Cardiovascular collapse
Central airway obstruction
Laryngeal dysfunction
Associated respiratory failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Child Pugh scoring

A

Variable 1 point 2 points 3 points
Bilirubin
(μmol/L) <34 34-50 >50
Albumin
(g/L) >35 28-35 <28
INR <1.7 1.7-2.3 >2.3
Ascites None Mild Severe(refractory to diuretics)
Encephalopathy None Grade I-II Grade II-IV

CPS A: score 5-6; CPS B: score 7-9; CPS C: score 10-15 (decompensated)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Causes of serotonin syndrome

A 
Antidepressants- MAOIs, SSRIs, SNRIs, TCAs
Anticonvulsants- valproate, carbamazepine
Opioids- tramadol, buprenorphine
Amphetamines
Antibiotics- ciprofloxacin, erythromycin
Lithium
5HT3 antagonists- ondansetron
Metoclopromide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Serotonin syndrome

A

Triad of CNS dysfunction(altered mentation), autonomic disturbance and neuromuscular hyperactivity

  • Venlafaxine is associated with the highest mortality rate among serotonergic agents
  • onset usually within 24hours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Differences between serotonin syndrome and NMS

A
  1. NMS is a idiosyncratic reaction after prolonged exposure to neuroleptics or after withdrawal of a dopamine receptor agonist.
  2. NMS usually develops over days or weeks
  3. NMS usually accompanied by hyperthermia, severe muscle rigidity and rhabdomyolysis (not mydriasis, diarrhoea, hyperreflexia, myoclonus)
  4. NMS frequently associated with multi-organ failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

SAD-PERSONS score

A 
S- sex: male
A- age: <19 or >45years
D- depression or hopelessness
P- previous attempts/psychiatric care
E- excessive drug or alcohol use
R- rational thinking loss
S- separated/divorced/widowed
O- organised or serious attempt
N- no social supports
S- stated future intent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Causes of hepatic encephalopathy from acute decompensation of chronic liver disease

A
  • sepsis
  • spontaneous bacterial peritonitis
  • GI haemorrhage
  • alcohol (excess or withdrawal)
  • drugs (opiates, sedatives, diuretics)
  • electrolyte imbalances
  • hepatocellular carcinoma
  • portal vein thrombosis
  • dehydration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Spontaneous bacterial peritonitis - paracentesis finding

A

Cell count >250/mm3 is diagnostic for SBP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly

ACEM fellowship prep (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions