Obj. 15 PART TWO f-k Flashcards
Name 3 neurogenic causes of acute urinary retention.
~MS
~metastatic or any kind of spinal cord lesion
~diabetes mellitus
~cauda equina syndrome
What age group gets testicular torsion?
under 30
Describe the presentation of testicular torsion.
~Sudden onset of severe unilateral testicle pain often associated with nausea and vomiting
~on exam, elevated testicle with horizontal lie
What is the best imaging for diagnosis of testicular torsion?
Dopper U/S which shows decreased blood flow to affected testicle
What is the definition of coma?
total absence of awareness and arousal (no eye opening, speech, or spontaneous movements) that lasts for at least 1 hour
What is the empiric therapy D.O.N.T. and when is it used?
~for coma: Dextrose Oxygen Naloxone Thiamine
What 3 things do you give in status epilepticus?
~glucose
~lorazepam
~phenytoin
Complaints of back/neck pain are more sensitive than spinal tenderness for spinal cord injury.
T/F
True
What are the NEXUS criteria used for?
Clears patients from cervical spine fracture clinically, without imaging.
What are the NEXUS criteria?
- no midline tenderness
- normal LOC
- no intoxication
- no focal neurological deficit
- no painful distracting injury
Injury at __ or above should have airway secured with endotracheal intubation.
C5
Your patient has hemotympanum, Battle sign, raccoon eyes, and CSF leaking from nose. What do you suspect?
basilar skull fracture
Name one thing you will do and one thing you won’t do for your basilar skull fracture patient.
~DO elevate HOB to 30 degrees
~Do NOT place NG tube
On non-contrast head CT you see:
~A crescent-ish shaped bleed whose inside edge conforms to the contours of the cerebral cortex
~bleed crosses suture lines
Is it epidural, subdural, or subarachnoid?
subdural
On non-contrast head CT you see:
~football-shaped density along skull, with both inside and outside edges smooth
~density does not cross suture lines
Is it epidural, subdural, or subarachnoid?
epidural
On non-contrast head CT you see:
~no space-occupying lesion, but blood in sulci and fissures
Is it epidural, subdural, or subarachnoid?
subarachnoid
What are the 6 P’s of compartment syndrome?
PAin PAllor PAresthesia PAralysis Poikilothermia (short version - skin will be cool) Pulselessness
What’s the most common presentation of acute adrenal crisis?
shock, with hypotension refractory to fluids and vasopressors
What’s the diagnostic study of choice to confirm adrenal crisis?
ACTH stimulation test aka dexamethasone challenge test
What is the drug of choice to treat adrenal crisis?
IV hydrocortisone
What is the most common acute, life-threatening complication of DM?
DKA
Name 3 signs and 3 lab results in DKA.
~Signs: ...Kussmaul respirations with fruity breath ...tachycardia ...altered mental status ~Labs: ...arterial pH < 7.3 with anion gap ...glucose > 250 ...serum bicarb < 15
Your patient is an elderly diabetic complaining of weakness, polyuria, and polydipsia. Your lab findings are as follows: ~blood glucose 601 ~serum osmolality elevated ~no acidosis, blood pH > 7.3 ~serum bicarb > 15 ~normal anion gap What is it?
non-ketotic hyperosmolar “coma”, better known as
Hyperosmolar Hyperglycemic State
~severe dehydration + high blood sugar
~probably no Kussmaul respirations
What are the 5 steps of the emergent management of thyroid storm?
- supportive care, e.g. volume repletion
- inhibit thyroid hormone release
- inhibit production of new hormone
- block peripheral beta adrenergic receptors
- block peripheral conversion of T4 to T3
It’s winter. Your patient is a 61 yo female who skis into your office from the snow with dry skin, hung up DTRs, weakness, and a transverse scar across her lower neck. She makes some inappropriate jokes with slow speech and is disoriented.
What is it? What do you give her?
myxedema crisis (severe hypothyroidism); levothyroxine
Your patient on warfarin has an INR result of 9.2 and develops a life-threatening bleed. What do you do?
Admit. Stop warfarin, give vitamin K, give prothrombin complex concentrate or fresh frozen plasma.
Allergic transfusion reaction usually doesn’t require the transfusion to be stopped - just give antihistamine
T/F
True
What causes tumor lysis syndrome? What is the treatment?
Iatrogenic - chemotherapy causes it.
Prevention is best, but allopurinol
Short-term and long-term treatments for panic disorder/acute anxiety attack:
acute: benzos
long-term: SSRIs, CBT
Your patient is on antipsychotics and calls you, concerned that he has neuroleptic malignant syndrome. What is the tetrad of s/s of this syndrome?
~fever
~muscular rigidity
~autonomic dysfunction
~altered mental status
For MILD traumatic brain injury:
~LOC for how long?
~initial GCS?
~posttraumatic amnesia for how long?
~LOC < 30 min
~initial GCS 13-15
~amnesia < 24 hrs
For MODERATE traumatic brain injury:
~LOC for how long?
~initial GCS?
~posttraumatic amnesia for how long?
~LOC 30 min - 24 hrs
~initial GCS 9-12
~amnesia 24 hrs - 7 days
For SEVERE traumatic brain injury:
~LOC for how long?
~initial GCS?
~posttraumatic amnesia for how long?
~LOC > 24 hrs
~initial GCS 3-8
~amnesia > 7 days
If you suspect that your patient’s rhinorrhea and otorrhea contain CSF (e.g. in a basilar skull fracture), what will you test for?
beta-2 transferrin
