Misc (combined from lectures) Flashcards

Question

How to treat eclampsia

Answer 1

Mg and deliver Mg - halves rate of progression from pre -> eclampsia Eclamptic seizures – more effective than phenytoin or benzodiazepines Dose: 4g over 5min -> 1g/hr (aim for a level of 2-4mmol/L) Adverse effects of high levels = muscle weakness, respiratory muscle fatigue, slowed cardiac conduction (>7.5mmol/L) -> arrest (>12.5mmol/L) toxicity unlikely if tendon reflexes are present

Answer 2

Sedative/hypnotic for RSI. RSI Dose: 1-2 mg/kg - give around 100-150 mg Use for asthmatics, hypotensives. Contraindications: extreme HTN, cocaine, tachycardia, increased IOP or ICP

Answer 3

Sedative/hypnotic for RSI. No analgesic effects, mild increase in airway resistance. Can cause myoclonus. RSI Dose: 0.3 mg/kg - give around 20-30 mg Drug of choice for HTN or tachycardic pts!!! (no hemodynamic instability) Contraindications: adrenal insufficiency, (causes adrenocortical suppression).

Answer 4

Competitive inhibitor of ACh receptors, prevents all muscle action. No fasciculations (non-depolarizing) 1 mg/kg (~70-100 for adults), effect in 45-60 secs, duration of action 45 min. USE IN KIDS!!!

Answer 5

Ach analog that stimulates all receptors and then wear them out, transient fasciculations, then paralysis. Increases K. Dose: 1.5 mg/kg (~100 for adults) 45 sec to effect Duration: 6-10 min DONT USE IN KIDS ``` Contraindications: Causes HYPERKALEMIA (beware in renal pts, Crush or burn injury over 48h old, rhabdo, Malignant hypothermia) ``` Denervating diseases/injuries (MS, ALS, old strokes, old cord injury, prolonged immobilization)

Answer 6

Listen to chest End tidal CO2 (waveform capnog) CXR

Answer 7

DOPES ``` D - Displacement of tube O - Obstruction of the ETT P - PTX (also: PE, pulmonary edema, collapse, bronchospasm, mucus plugging) E - equipment — ventilator problems S - ‘Stacked breaths’ ```

Answer 8

Versed/Midazolam (0.2 mg/kg --> ~15 mg) | Propofol (1.5-3 mg/kg --> ~100 mg)

Answer 9

Nature Bones, stones, groans and psychic moans Causes>90% from Malignancy and Hyperparathyroidism Basically: Tumour, increased PTH and increased Vit D

Answer 10

1. Chemical burn(alkali-worst, acid, solvents, detergents) 2. Acute central retinal artery occlusion (CRAO) 3. Elevated IOP from - Retrobulbar hematoma - Acute angle closure glaucoma - Ocular compartment syndrome

Answer 11

Can cause keratitis with prolonged use! Don't send patients home with this!

Answer 12

Box cars and cherry red spot (macula)

Answer 13

1. retrobulbar hemorrhage (recent ocular trauma or surg) 2. AA closure glaucoma 3. Ocular compartment syndrome (congestion/sinusitis --> orbital cellulitis

Answer 14

GO CART MTV ``` Glaucoma Optic neuritis CRAO, CRVO Amaurosis fugal Retinal detachment Trauma Migraine**** Temporal arteritis (GCA) Vasculitis ```

Answer 15

retinal detachment ischemic optic disease or retinal disease severe glaucoma causing trauma to optic nerve optic neuritis direct optic nerve damage (trauma, radiation, tumor) very severe macular degeneration retinal infection (CMV, herpes)

Answer 16

acetazolamide, beta blocker timolol, alpha agonist ilodipine, Mannitol, steroid

Answer 17

Sickle cell disease

Answer 18

blood and thunder (retinal bleeds everywhere)

Answer 19

GCA + polymyalgia rheumatica. They are at risk for monocular vision loss 2/2 inflammation of the ocular arteries Rx: Corticosteroids are the mainstay of therapy.

Answer 20

Perilimbal involvement: Iritis Uveitis Perilimbal sparing: Kawasaki Dz Conjunctivitis

Answer 21

Vesicles on the tip of the nose that precedes the development of ophthalmic herpes zoster. Means nasociliary branch of the trigeminal nerve involved, which innervates cornea too, and can lead to painful vesicles on cornea & blindness,

Answer 22

``` CN I – Olfactory CN II – Optic CN III – Oculomotor CN IV – Trochlear CN V – Trigeminal CN VI – Abducens CN VII – Facial CN VIII – Vestibulocochlear CN IX – Glossopharyngeal CN X – Vagus CN XI – Accessory CN XII – Hypoglossal ```

Answer 23

Strep, treat with Polytrim or moxifloxacin Polytrim is similar to bactrim, which covers GP skin flora and MRSA Moxifloxacin is a fluoroquinolone that covers strep, enterics, and atypicals

Answer 24

inflammatory response to bright light (welding, snowboarders, tanners, etc.) death of small groups of cells on the surface of the cornea Eye, watery, and sensitive to light, and vision may decrease somewhat. Most recover fully.

Answer 25

Compressions 100-120/minute Depth: 2 inches in adults, allow full recoil Minimize time off chest (interruptions less than 10 sec) Ventilate ~1 breath every 6-10 secs – do not hyperventilate.

Answer 26

dantrolene

Answer 27

Most commonly for medical patients: fentanyl & propofol 1. Bolus fentanyl 100 mcg/IV (1-2 mcg/kg bolus) 2. Start fentanyl drip at 50 mcg/hour 3. Start propofol drip at 20 mcg/kg/min Titration: - fentanyl, increase 25 mcg/hour - propofol, increase 10 mcg/kg/min Post intubation sedation for trauma patients: Fentanyl and Midazolam/versed + Vec (0.1 mg/kg)

Answer 28

Trauma: Fentanyl and Midazolam/versed + Vec (0.1 mg/kg)

Answer 29

LEMON ``` Look externally Eval the 3-3-2 rule Mallampati Obstruction (ex. Subglottic stenosis) Neck mobility ```

Answer 30

Premature tube size 0.1X gest age in weeks and then downsize to next smaller tube Ex. 34 weeks --> 3.4 --> 3.0 Depth: 3X size of tube (ex tube size 3.0 x 3 = 9 cm)

Answer 31

MTP → 1:1:1 (PRBC’s, platelets and plasma) has better survival Blood is then sent every 20-25 minutes

Answer 32

ceftriaxone + azithromycin | plus zosyn or levaquin if pseudomonas

Answer 33

(for mycoplasma, chlamydia, legionella) azithromycin, doxy, or levaquin

Answer 34

1. hospitalized for 2+ days in the 90 days preceding the infection 2. reside in a nursing home or long-term care facility 3. IV abx, chemotherapy, chronic dialysis, or wound care in the 30 days preceding the pneumonia 4. pneumonia that developed at least 48 hours after hospitalization

Answer 35

Typical combination would be zosyn, levaquin, vanc. Two antipseudomonal Choose from: zosyn, levaquin, Gent, imi/meropenem, 3rd gen ceph → cefepime or ceftazidime MRSA coverage → vanc.

Answer 36

within 12h of sx onset, within 90 min of entering hospital (or 120 if a transfer)

Answer 37

S. aureus, Klebsiella, enteric orgs (Aspiration)

Answer 38

Histoplasma

Answer 39

chlamydia psittaci, histoplasma

Answer 40

mycoplasma pneumoniae

Answer 41

Pseudomonas (Rx: zosyn or levaquin)

Answer 42

coccidioides spp.

Answer 43

TB | Staph aureus

Answer 44

Mycoplasma pneumoniae

Answer 45

Mycoplasma pneumoniae | Chlamydia spp

Answer 46

legionella

Answer 47

H. flu, Moraxella cat.

Answer 48

klebsiella

Answer 49

Pseudomonas or S. aureus

Answer 50

Pseudomonas or S. aureus

Answer 51

Legionella

Answer 52

same orgs as rest of pop, +TB, PCP

Answer 53

Staph aureus

Answer 54

anaerobes, polymicrobial

Answer 55

staph aureus

Answer 56

strep pneumoniae

Answer 57

Q fever (Coxiella burnetti)

Answer 58

strep pneumo (encapsulated

Answer 59

strep pneumo (encapsulated)

Answer 60

``` Streptococcus pneumoniae Neisseria meningitidis Klebsiella pnemoniae Haemophilus influenzae Salmonella typhi Cryptococcus neoformans Pseudomanas aeruginosa ```

Answer 61

Usually in 3rd trimester. Complete or incomplete. 1. Hemolysis (LDH >600) 2. Elevated Liver enzymes (AST >70) 3. Low Platelets <1002/2 plt aggregation) Sx: tender RUQ, edema, polyuria from nephrogenic DI Complications: hemorrhage, infarction, preterm delivery Tx: resuscitation (for hemorrhage), deliver, antiHTN, Mg for eclampsia prophylaxis, steroids for lung maturity

Answer 62

1. Magnesium 4g IV bolus over 30 minutes 2. Terbutaline 2.5 mg PO or 0.25 mg subQ (old) 3. Nifedipine (CCB)

Answer 63

Oxytocin (Pitocin) – 40 units in 1L NS, run at 20ml/min or 600/hr. Can give 10 Units IM if no IV access. Beware of cramping, nausea, hypotension. Methergine (methylergonovine) – 0.2mg IM. Can cause serious hypertension. Beware of nausea and cramping. Hemabate (carboprost tromethamine, prostaglandin F2a) – 0.25mg IM q15 min.

Answer 64

LOTS OF magnesium Start at 6g IV bolus then 4g/hr and keep going until they lose their reflexes Seizure control: - Versed (midaz) - Keppra, Dilantin (phenytoin) - phenobarbital BP control - Mg or Labetalol, hydralazine Definitive management is immediate delivery. Can still occur up to 4 weeks post-partum.

Answer 65

b2 agonist used in asthma and preterm labor (tocolytic), but has a lot of side effects

Answer 66

4 ml/kg x %TBSA = LR volume 1st 8 hours since injury = give 50% of the volume Then for 16 hrs = give 50% of the volume Don’t forget tetanus in burn patients

Answer 67

Recently started new med. Fever, malaise. Rash over trunk, starting as scattered bumps, spreading. Rash can change over time. Swollen face with painful cervical lymph nodes, Abd pain. Anticonvulsants, Sulfa, NSAIDs, Allopurinol. Delayed reaction: 3-8 weeks after initiation.

Answer 68

Descending Rash - starts at head and go down. Unvaccinated population. Highly contagious. Cough, Conjunctivitis, Coryza + Fever. Koplik spots.

Answer 69

In children, palpable purpura in LEs, vasulitis, JARS (joints, abd pain, renal, skin rash). Could lead to intussusception. Supportive care.

Answer 70

fever, HA, cough → lethargy, AMS. IMMEDIATE antibiotics, rifampin or cipro prophylaxis for contacts

Answer 71

Spread through ticks. Non blanching, on palms & soles. Viral prodrome, fever, HA, myalgias. Starts out and works was into trunk. Treat with doxy.

Answer 72

<5 yo, fever x5 days, Rash (perineum, torso) Skin changes on hands/feet (erythema, edema or later finding of desquamation), vasculitis, cervical lymphadenopathy, limbic sparing conjunctivitis, strawberry tongue. Later, coronary artery dilation.

Answer 73

Children <5 yo | Staph exotoxin, breaks down desmosomes. Fever + diffuse erythema → desquamatino, bullae

Answer 74

Rapidly progressive, SEVERE pain out of proportion, erythema that is growing fast (mark skin!). Posibly crepitus. Can develop bullae later. XR: Gas in tissues Lab risk indicator: high CRP, WBCs, Hgb, Na (low), creat (high), glucose (high) Types Polymicrobial (most common type) Monomicrobial (GaS) Vibrio (marine exposure, GNR) MRSA Antibiotics: Broad spectrum, need to cover for all 4! Vanc+Zosyn+Clinda (stop toxin formation from GAStrep) CT scan

Answer 75

sunburn like rash, mucous membrane involvement. Etiology: Toxin superantigen causes massive T cell activation. 2-3d after inciting factor begins. Viral prodrome → rapid prog to shock. Supportive care- fluid, pressors. Staph - associated w tampons Strep - local tissue invasion of Group A strep Rx: supportive care Abx don’t help as much (toxin mediated) Side note: Clinda ↓ toxin formation in nec fasc., but don’t need it here

Answer 76

Older people, no mucous membrane involvement, auto-ab hemidesmosomes. Subepidermal/deep blisters that are tense and firm (-Nikolski’s sign). Favorable prognosis.

Answer 77

Younger people, +mucous membrane involvement, auto-ab desmoglein 3. SUperficial blisters that are flaccid and rupture easily (+Nikolski’s sign). Poor prognosis. Can look like SJS

Answer 78

Immune complex mediated hypersensitivity, Toxic appearing with viral-type prodrome and sudden onset of painful rash, Mucous membrane involvement (Eyes, Mouth, Genitals). Etiology: DRUGS (allopurinol, psych meds, many), infection, malignancy, idiopathic. <10% BSA of epidermal detachment → SJS, TEN is >30% Admit to burn

Answer 79

posterolateral humeral head compression fracture, seen with anterior dislocation of shoulder

Answer 80

may be seen as a fracture of the anteroinferior aspect of the glenoid, seen with anterior dislocation of shoulder

Answer 81

Some lovers try positions that they can't handle: ``` scaphoid lunate triquetrum pisiform trapezium trapezoid capitate hamate ```

Answer 82

Perilunate dislocation - Lunate remains in position relative to the distal radius 3 c’s on lateral view: distal radius, lunate, capitate If capitate not in line, called a perilunate dislocation Lunate dislocation is when the middle of the 3 (the lunate) is out, “Spilled teacup”

Answer 83

Galeazzi fracture Distal/midshaft radial fracture + Ulnar dislocation (+ styloid fracture 60%) Ulnar nerve injury + compartment syndrome

Answer 84

Monteggia fracture Proximal ulnar fracture + radial head dislocation Radial nerve injury + compartment syndrome “GRUM” - Galeazzi radius broken, Monteggia, ulnar broken

Answer 85

Avulsion fracture of the lateral tibial plateau Associated with ACL injury (75-100%) Associated with meniscal injury (70%)

Answer 86

Maisonneuve fracture is the combination of a spiral fracture of the proximal fibula and unstable ankle injury which could manifest radiographically by widening of the ankle joint due to distal tibiofibular syndesmosis and/or deltoid ligament disruption, or fracture of the medial malleolus.

Answer 87

Ankle X-ray is only required if - There is any pain in the malleolar zone; and, Any one of the following: Bone tenderness at distal posterior edge of the tibia or tip of the medial malleolus, OR Bone tenderness at distal posterior edge of the fibula or tip of the lateral malleolus An inability to bear weight both immediately and in the emergency department for four steps.

Answer 88

Levophed (norepinephrine) Start drip at 5 mcg/min Titrate up to 50 mcg/min Could also use phenylephrine for septic shock Maintain MAP >65 mmHg

Answer 89

Alpha-1 Adrenergic - Located in: Vascular wall → Vasoconstriction Heart→ Increase contractility Beta Adrenergic Beta-1 → Heart → ↑Inotropy and chronotropy Beta-2 → Blood vessels → Vasodilation (and bronchodilation) Dopamine Renal, Splanchnic(mesenteric), coronary, cerebral → Vasodilation Subtype → Vasoconstriction

Answer 90

``` zosyn levaquin Gentamycin imi/meropenem, 3rd gen ceph → cefepime or ceftazidime ```

Answer 91

Gram positive (Strep, MSSA) Gram negatives Anaerobes Pseudomonas

Answer 92

Gram positives (including MRSA)

Answer 93

Azithro (cover legionella, mycobacteria) and resp fluoroquinolone --> levaquin

Answer 94

Rocephin/ceftriaxone and and resp fluoroquinolone --> levaquin

Answer 95

clindamycin to decrease anti toxin

Answer 96

Ampicillin (listeria) Acyclovir (HSV) & Cefepime (GP, GN, anaerobes)

Answer 97

ampicillin, gentamycin, acyclovir

Answer 98

ceftriaxone(rocephin) + vanc

Answer 99

treat after 4h with NAC (look at nomogram) test synthetic fxn: coags, tibili (not enzymes as much) can give metabolic acidosis die from cerebral edema 2/2 liver failure

Answer 100

Antimuscarinic (anticholinergic) Signs and symptoms: Mydriasis (wide pupils), loss of accommodation, tachycardia, bronchodilation, decreased gastric motility, urinary retention, depressed salivary and sweat gland activity, and CNS effects Causes: Belladonna alkaloids (atropine, hyoscyamine), diphenhydramine/Benadryl, cyclobenzaprine, TCAs, phenothiazines, Tx: Physostigmine (reversible acetylcholinesterase inhibitor) , but can cause seizures, bradycardia, Bronchoconstriction. Beware in epileptics, evidence of AV block or Na channel blocking effects on ECG, asthma Treatment: Supportive care, benzodiazepines

Answer 101

Treatment: Supportive, benzodiazepines (GIVE ENOUGH!), hydration, cooling (wet and windy) if hyperthermic COMPLICATION: rhabdo (get temp!!!), start cooling early!, All can result in DIC Note: Cocaine is a sodium channel blocking drug and may cause a widened QRS. Treat a wide QRS from cocaine with iIV sodium bicarbonate. Note: Do not treat hypertension in cocaine or sympathomimetic crisis with beta blockers. Beta blockers may cause unopposed alpha stimulation, worsening the hypertension and coronary vasospasm.

Answer 102

Does not show up on drug screen: fentanyl, oxycodone, methadone Mimics: alpha 2 agonists Tx: naloxone → Give just enough! If you give too much → opioid withdrawal Supportive care

Answer 103

Signs and symptoms: Piloerection, yawning, abdominal cramping, N/V/D, rhinorrhea No fever or altered mental status Treatment: Supportive care, clonidine, antiemetics, antidiarrheals

Answer 104

Cholinergic overdose Wet, “slimed”, Seizures, AMS Rx: atropine → GIVE ENOUGH!! Causes: Organophosphates (phos, fos, thion in name), nerve agents, carbamate insecticide, medicinal Ach-esterase inhibitors (physostigmine, pyridostigmine, neostigmine), etc. 3 Treatment: Decontamination, airway, atropine, pralidoxime (organophosphates), benzodiazepines

Answer 105

EKG: VTach, wide complex tachycardia, look at aVR to look for Na channel blocking effects (terminal R wave changes) Rx: bicarb Mechanisms of toxicity: sodium channel blocking effects, antimuscarinic effects, alpha1 blocking effects The more acidemic the patient, the more binding of the TCA to the sodium channel. Wide QRS = sodium bicarbonate IVP Seizures-treat aggressively with benzos and then watch the monitor for QRS widening. Seizure → acidemia → increased risk of QRS widening

Answer 106

Age <20, >55 (less likely to be benign pain) Severe systemic disease Non-MSK complaints (fevers, rashes, etc.) Non-MSK pain (i.e. moving around for kidney stones) ANY new Neurologic symptoms (like urinary retention, new numbness/saddle anesthesia, leg weakness)

Answer 107

testicular Ca

Answer 108

Common orgs: staph, strep, TB Route: hematologic, LP/epidural (super rare) RFs: IVDU, immunocompromised pts, ANY RECENT INFECTION Sx: infx sx, back pain

Answer 109

``` CBC, BMP, UA ECG Creatinine (renal function) Chest x-ray Urine drug screen Pregnancy test Head CT to rule out SAH Consider TSH/T4 ``` - decrease MAP by 20% - Nicardipine 10 mg bolus then drip (don't use in HF) - Nitro drip (use for HF) - Labetalol or Esmolol Clonidine takes 4h :(

Answer 110

Out pt meds Amlodipine (causes swelling, not in pregnancy) Lisinopril (great for remodeling, angioedema) HCTZ (makes pee, orthostatic, kidney stones)

Answer 111

HTN, 30% of americans have HTN HTN increases MI risk 3X

Answer 112

Already have a Low pretest probability <15%, yes or no for do you work up PE or not? PERC is for YOUNG HEALTHY people, no one under age 50, no one with comorbidities, no one on OCP use.

Answer 113

Already committed to PE w/u, What tests do I order? Wells score Modified Geneva Score

Answer 114

``` anaphylaxis airway stenosis FB CHF (most common) tumor laryngeal dysmotility ```

Answer 115

Maintain, optimize oxygen and ventilation Treat hypotension (IVF bolus, vasopressor-levophed) EKG!!!! To determine if pt goes to cath Is pt following commands? If not → therapeutic hypothermia

Answer 116

If you correct too quickly → Central pontine myelinolysis/Osmotic demyelination syndrome If they were hypoNa for >2 days, 8 mEq Na/day is the MAX!

Answer 117

When is it acute in onset (<1-2d) and have AMS, Sz, focal neuro findings. Use hypertonic 3% saline → 100 cc’s to acutely bump Na 2-3 mEq. (Only use if <120 and have acute sx.)

Answer 118

Cancer Hyperparathyroid Treat with lots of saline! 1. ABC/NGT 2. NSS (150-200 ccs/hour) - slow bc might develop pulm edema 3. Lasix - use it only for fluid balance, allows the saline and Ca to leave 4. Follow K, follow Mg 5. Get a Bisphosphonate??? Level (with oncologist/internist)