Obj. 15 PART TWO f-k

Question 1

Name 3 neurogenic causes of acute urinary retention.

Answer 1

~MS
~metastatic or any kind of spinal cord lesion
~diabetes mellitus
~cauda equina syndrome

Question 2

What age group gets testicular torsion?

Answer 2

under 30

Question 3

Describe the presentation of testicular torsion.

Answer 3

~Sudden onset of severe unilateral testicle pain often associated with nausea and vomiting
~on exam, elevated testicle with horizontal lie

Question 4

What is the best imaging for diagnosis of testicular torsion?

Answer 4

Dopper U/S which shows decreased blood flow to affected testicle

Question 5

What is the definition of coma?

Answer 5

total absence of awareness and arousal (no eye opening, speech, or spontaneous movements) that lasts for at least 1 hour

Question 6

What is the empiric therapy D.O.N.T. and when is it used?

Answer 6

~for coma:
Dextrose
Oxygen
Naloxone
Thiamine

Question 7

What 3 things do you give in status epilepticus?

Answer 7

~glucose
~lorazepam
~phenytoin

Question 8

Complaints of back/neck pain are more sensitive than spinal tenderness for spinal cord injury.
T/F

Answer 8

True

Question 9

What are the NEXUS criteria used for?

Answer 9

Clears patients from cervical spine fracture clinically, without imaging.

Question 10

What are the NEXUS criteria?

Answer 10

1. no midline tenderness
2. normal LOC
3. no intoxication
4. no focal neurological deficit
5. no painful distracting injury

Question 11

Injury at __ or above should have airway secured with endotracheal intubation.

Answer 11

C5

Question 12

Your patient has hemotympanum, Battle sign, raccoon eyes, and CSF leaking from nose. What do you suspect?

Answer 12

basilar skull fracture

Question 13

Name one thing you will do and one thing you won’t do for your basilar skull fracture patient.

Answer 13

~DO elevate HOB to 30 degrees

~Do NOT place NG tube

Question 14

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?

Answer 14

subdural

Question 15

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?

Answer 15

epidural

Question 16

On non-contrast head CT you see:
~no space-occupying lesion, but blood in sulci and fissures
Is it epidural, subdural, or subarachnoid?

Answer 16

subarachnoid

Question 17

What are the 6 P’s of compartment syndrome?

Answer 17

PAin
PAllor
PAresthesia
PAralysis
Poikilothermia (short version - skin will be cool)
Pulselessness

Question 18

What’s the most common presentation of acute adrenal crisis?

Answer 18

shock, with hypotension refractory to fluids and vasopressors

Question 19

What’s the diagnostic study of choice to confirm adrenal crisis?

Answer 19

ACTH stimulation test aka dexamethasone challenge test

Question 20

What is the drug of choice to treat adrenal crisis?

Answer 20

IV hydrocortisone

Question 21

What is the most common acute, life-threatening complication of DM?

Answer 21

DKA

Question 22

Name 3 signs and 3 lab results in DKA.

Answer 22

~Signs: 
...Kussmaul respirations with fruity breath
...tachycardia
...altered mental status
~Labs: 
...arterial pH < 7.3 with anion gap
...glucose > 250
...serum bicarb < 15

Question 23

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?

Answer 23

non-ketotic hyperosmolar “coma”, better known as
Hyperosmolar Hyperglycemic State
~severe dehydration + high blood sugar
~probably no Kussmaul respirations

Question 24

What are the 5 steps of the emergent management of thyroid storm?

Answer 24

1. supportive care, e.g. volume repletion
2. inhibit thyroid hormone release
3. inhibit production of new hormone
4. block peripheral beta adrenergic receptors
5. block peripheral conversion of T4 to T3

Question 25

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?

Answer 25

myxedema crisis (severe hypothyroidism); levothyroxine

Question 26

Your patient on warfarin has an INR result of 9.2 and develops a life-threatening bleed. What do you do?

Answer 26

Admit. Stop warfarin, give vitamin K, give prothrombin complex concentrate or fresh frozen plasma.

Question 27

Allergic transfusion reaction usually doesn’t require the transfusion to be stopped - just give antihistamine
T/F

Answer 27

True

Question 28

What causes tumor lysis syndrome? What is the treatment?

Answer 28

Iatrogenic - chemotherapy causes it.

Prevention is best, but allopurinol

Question 29

Short-term and long-term treatments for panic disorder/acute anxiety attack:

Answer 29

acute: benzos

long-term: SSRIs, CBT

Question 30

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?

Answer 30

~fever
~muscular rigidity
~autonomic dysfunction
~altered mental status

Question 31

For MILD traumatic brain injury:
~LOC for how long?
~initial GCS?
~posttraumatic amnesia for how long?

Answer 31

~LOC < 30 min
~initial GCS 13-15
~amnesia < 24 hrs

Question 32

For MODERATE traumatic brain injury:
~LOC for how long?
~initial GCS?
~posttraumatic amnesia for how long?

Answer 32

~LOC 30 min - 24 hrs
~initial GCS 9-12
~amnesia 24 hrs - 7 days

Question 33

For SEVERE traumatic brain injury:
~LOC for how long?
~initial GCS?
~posttraumatic amnesia for how long?

Answer 33

~LOC > 24 hrs
~initial GCS 3-8
~amnesia > 7 days

Question 34

If you suspect that your patient’s rhinorrhea and otorrhea contain CSF (e.g. in a basilar skull fracture), what will you test for?

Answer 34

beta-2 transferrin