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Urgent Care Guide > MS 2 > Flashcards

MS 2 Flashcards

1
Q

compartment syndrome

A

elevated tissue pressure causing decreased tissue perfusion, which can lead to necrosis of tissue and nerves

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2
Q

elevated tissue pressure causing decreased tissue perfusion, which can lead to necrosis of tissue and nerves

A

compartment syndrome

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3
Q

compartment syndrome - more common in what part of body

A

lower extremities and long bone fractures, especially tibial fractures

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4
Q

compartment syndrome - acute

A

life threatening emergency

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5
Q

compartment syndrome - hx and clinical presentation
5

A
  1. pain out of proportion to injury
  2. trauma
  3. burns
  4. prolonged compression of extremity
  5. snake bite
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6
Q

compartment syndrome - what are the 5 P’s

A
  1. pain
  2. pallor
  3. paresthesia
  4. paralysis
  5. pulselessness
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7
Q

compartment syndrome - the five P’s are considered what type of finding

A

late finding

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8
Q

compartment syndrome - physical exam
5

A
  1. perform motor and sensory exam
  2. discoloration
  3. assess compartment - may have tense “woody” feel on palpation, but not all compartments are directly palpable
  4. pain with passive stretch
  5. assess pulses
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9
Q

compartment syndrome - img/testing
3

A
  1. x ray if concerned for fx/foreign body
  2. measure compartment pressures if available - refer to ER if not
  3. consider urine myoglobin - but don’t delay ER transfer
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10
Q

compartment syndrome - tx
3

A
  1. keep NPO
  2. establish IV access if available
  3. analgesics
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11
Q

gout

A

uric acid in the blood causes monosodium urate (MSU) crystals to deposit into joints causing pain and inflammation

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12
Q

uric acid in the blood causes monosodium urate (MSU) crystals to deposit into joints causing pain and inflammation

A

gout

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13
Q

gout risk factors
4

A
  1. obesity
  2. alcoholism
  3. HTN
  4. certain meds i.e. diuretics
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14
Q

gout - sudden onset of
4

A
  1. severe pain
  2. swelling
  3. warmth
  4. redness of joint
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15
Q

gout - occurs more often, but not limited to what area

A

lower extremities

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16
Q

gout - percentage of location
2

A

75% monoarticular
50% involve MTP joint of great toe

17
Q

gout - on physical exam you’ll find what of affect joint
5

A

inflammation
tenderness
erythema
swelling
warmth

18
Q

gout - img/testing

A
  1. consider x ray if suspicion for trauma, osteomyelitis, or foreign body
  2. fluid aspiration if available to assess for crystals under light
19
Q

gout - uric acid levels

A

not sensitive or specific in acute gout - don’t need to order

20
Q

gout - DD
6

A
  1. OM
  2. septic arthritis
  3. cellulitis
  4. RA
  5. OA
  6. bursitis
21
Q

gout - tx (none rx)
4

A
  1. rest
  2. ice
  3. elevate joint
  4. lifestyle changes
22
Q

gout - diet modifications
6

A

avoid foods high in purines
red meats
organ meats
seafood
asparagus
spinach

23
Q

gout - lifestyle changes
2

A
  1. limit alcohol
  2. weight reduction
24
Q

gout - rx
3

A
  1. NSAIDs (naproxen, 500 mg BID PO, max 1500 mg day; script only for this higher dose)
  2. oral colchicine (adjust dose for those taking P-gp inhibitors)
  3. oral corticosteroids (prednisone 30 mg/day x 5 days)

*NSAIDs and prednisone have been shown to be equally as effective. Consider pt preference and tolerance. NSAIDs contraindicated in kidney disease eGFR <40, uncontrolled HTN, GI ulcers.

25
Q

gout - NSAID use, caution w/
3

A
  1. hx of GI bleed
  2. ulcers
  3. kidney disease eGFR <60
26
Q

gout - after starting meds, when do symptoms start to improve

A

within days

27
Q

gout - how long to continue NSAIDs

A

can be taken a few months - but consult with PCP if needing this long term

28
Q

gout - colchicine duration, continue to take for how long after the flareup stops

A

24-48 hours after flare up stops

29
Q

gout - steroid choice

A

PO prednisone 0.5 mg/kg per day for 2-5 days then taper for 7-10 days; some can use tapered packs; tapering of steroids is most often only needed if taking 40 mg a day and for taking longer than one week

30
Q

gout - refer to
3

A

PCP
rheumatologist
ortho

31
Q

gout - when to send to ER
3

A

suspected OM
septic joint
trauma involving joint space

Urgent Care Guide (38 decks)

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