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Advanced Clinical Reasoning > Quiz #4 > Flashcards

Quiz #4 Flashcards

1
Q

____ - _____% of patients with sepsis die.

A

28-50%

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2
Q

Risk Factors for Sepsis (4)

A
  • 65+ years old
  • Pts with chronic medical conditions (DM, lung dz, CA, kidney dz)
  • People with weakened immune systems
  • Neonates
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3
Q

SIRS Criteria

A
  1. Body Temperature (>38 or < 36)
  2. Heart Rate (> 90 bpm)
  3. Tachypnea (> 20 breaths)
  4. WBC Count (> 12,000, < 4,000, or > 10% immature neutrophils)
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4
Q

Sepsis Steps

A
  1. Sepsis: presumed source of infxn + 2 or more SIRS criteria
  2. Severe sepsis: sepsis + organ dysfunction
  3. Septic shock: sepsis refractory to IV fluid (refractory hypotension) OR lactate > 4
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5
Q

Severe Sepsis Bundle

A 
Within 3 hrs of presentation:
1. measure serum lactate
2. obtain blood cx prior to abx
3. administer abx
4. start IV fluids (LR/NS) 2.5 L/hr
Within 6 hours of presentation:
1. repeat serum lactate if initial lactate > 2
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6
Q

IV fluid rate for peds in severe sepsis

A

40 ml/kg when septic

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7
Q

Septic Shock Bundle

A 
Within 3 hours of presentation:
1. measure serum lactate
2. obtain blood cx prior to abx
3. administer abx
4. resuscitate with 30 ml/kg fluids
Within 6 hours of presentation:
1. repeat volume status and tissue perfusion assessment
2. give vasopressors (if hypotension persists)
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8
Q

Top sources of sepsis infections

A

Lungs
Urinary tract
Skin
GI tract

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9
Q

Types of Headaches

A

Tension (most common - 40%)
Migraine
Cluster

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10
Q

DDX for headache

A
  1. Primary (tension, migraine, cluster)
  2. Vascular (hemorrhage, hematoma, aneurysm)
  3. Infectious (meningitis, abscess, encephalitis)
  4. Cancer
  5. Medical D/O (hypothyroidism, OCPs, fever, CO exposure)
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11
Q

Characteristics of Migraines (POUND)

A 
Pulsatile
Onset/Duration 4-72 hours
Unilateral
Nausea
Disabling
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12
Q

Red Flags for Headaches

A 
"Worst HA of my life"
Thunderclap HA
FND (atypical aura)
Fever, nuchal rigidity, kernig's, papilledema
> 50 y/o
New onset in pregnancy
Worsening pattern
HA triggered by cough or exertion
Recent trauma
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13
Q

Classifications for Migraines

A

At least 2 of the following:

  1. Unilateral
  2. Moderate to severe
  3. Pulsatile
  4. Aggravated by movement

1 of the following:

  1. Nausea
  2. Photo and phonophobia

At least 5 episodes

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14
Q

Auras of migraines

A

Visual - scintillating scotoma, photophobia
Sensory - paresthesia, numbness
Other - weakness, aphasia

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15
Q

Tx for migraines (acute)

A 
NSAIDs
Tylenol
Triptans
OTC Excedrin
Fioricet
Cafergot
Goody's Powder
Opiates
Antiemetics
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16
Q

Tx for migraines (preventative)

A 
Consider if 2+/month
CCB (Verapamil)
BB (Propranolol)
TCA (Amitriptyline)
Valproate Sodium
Botox
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17
Q

Tx for tension HA (acute)

A 
Aspirin
Acetaminophen
Ibuprofen
Naproxen
Excedrin
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18
Q

Tx for tension HA (chronic)

A

Amitriptyline
Fluoxetine
Tizanidine
Stop smoking

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19
Q

Tx for cluster HA

A 
O2, ergotamines at first signs of sx
Corticosteroids
Verapamil
Topiramate
Valproic Acid
20
Q

Associated symptoms with migraines

A 
Nausea
Vomiting
Photophobia
Phonophobia
Aura
21
Q

Associated symptoms with cluster HA

A 
Ipsilateral lacrimation
Ipsilateral redness of the eye
Stuff nose
Rhinorrhea
Pallor
Sweating
Restlessness or agitation
22
Q

Presentation of CVA

A 
Sudden speech difficulty
Weakness
Paralysis
Vision loss
Dizziness
Severe HA
FAST (face, arm, speech, time)
23
Q

DDX of stroke

A 
Seizures
Hypoglycemia
Migraine with aura
HTN encephalopathy
Drug toxicity
CNA abscess or tumor
Wernicke's encephalopathy
24
Q

Time since “last known normal” timeframes

A

< 4.5 hrs for tPA

< 6 hrs for endovascular thrombectomy

25
Q

Physical Exam for stroke

A

Skin: purpura, ecchymoses
Head: signs of trauma, papilledema, tongue laceration (seizure)
CV: pulses in neck, arms, legs, auscultate for murmurs, check for bruits
Extremities: cellulitis, DVT
Lungs: abnormal breath sounds, fluid overload, stridor, rales

26
Q

Dx for CVA

A 
Non contrast CT or MRI
Glucose
O2 sat
Electrolytes
BUN
sCr
CBC
Cardiac enzymes
PT/INR,PTT
EKG
27
Q

Tx for CVA

A 
tPA
Antipyretic
IV labetalol
PT, OT, mental health support
speech therapy
28
Q

Exclusion criteria for tPA

A 
evidence of hemorrhage
glucose < 50
current anticoagulant
active internal bleeding
systolic > 185 or diastolic > 110
significant head trauma
< 18 y/o
29
Q

Relative exclusion criteria for tPA

A 
Pregnancy
Seizure at onset 
Major surgery w/n 14 days
Recent acute mI
Recent GI or urinary tract hemorrahge
30
Q

Labs/tests for gout

A

CBC
Uric acid
Arthrocentesis
Xray

31
Q

Categories in arthrocentesis results

A 
Color
Clarity
Crystals
Cell Count
Culture
32
Q

Gout arhrocentesis

A

Negative birefringence, needle-shaped crystals

Elevated white count

33
Q

Tx for gout

A 
Colchicine (rarely used)
NSAIDs (naproxen, celecoxib, indomethacin)
Oral steroids (prednisone)
Allopurinol
Febuxostat
34
Q

Symptoms of osteoarthritis

A
  • Morning stiffness < 30 min
  • Evening joint stiffness
  • Stiffness decreases with rest and worsens throughout day
  • Primary affects hands (PIP, DIP)
  • Tenderness and crepitus or grating sensations develop
35
Q

PE for OA

A

Skin: rash, warmth, swelling
GI: r/o crohn’s
MSK: inspect joint above, below, and bilaterally. Deformities, swelling, ROM, Heberden’s nodes (DIP), bouchard’s nodes (PIP)

36
Q

Imaging/Labs for OA

A

XR (osteophytes, narrowing of joint space, sclerosis)
CBC (infection)
Rheumatic factor

37
Q

Tx for OA

A 
Acetaminophen
NSAIDs
Stretching
Orthotics
Weight reduction
Referral to PT
38
Q

Sx for RA

A
  • Morning stiffness > 30 min after initiating movement
  • Improves later in the day
  • Small joint stiffness (MCP, PIP, wrist, knee, MTP, shoulder, ankle)
  • Constitutional sx (fever, fatigue, anorexia, weight loss)
  • Symmetric arthritis (swollen, tender, boggy joint)
39
Q

PE for RA

A

General: fatigue, weight loss, anorexia, fever
MSK: boutonniere deformity (flexion at PIP, hyperextension of DIP)
Ulnar deviation at MCP joint
Rheumatoid nodules

40
Q

Dx for RA

A

Rheumatoid factor
CRP and ESR
Anti-citrullinated peptide antibodies (most specific)

41
Q

Tx for RA

A

methotrexate

If they have an ectopic pregnancy it’ll fix that too

42
Q

Emergent back pain dx

A 
Spondylolysis
Spondylolisthesis
Degenerative Disk Dz
Herniated disc
Compression fx
Cauda Equina Syndrome
Spinal stenosis
Epidural abscess
Shingles
Aortic aneurysm
43
Q

Red flags for back pain

A 
> 50 y/o
Acute sudden tearing back pain
Duration > 6 weeks
IV drug use
Unexplained weight loss
Chronic steroid use
Saddle numbness
Fever
Bowel/bladder dysfunction
44
Q

PE for back pain

A 
Sensation 
Motor
DTR
\+/- SLR
Pain with hip flexion
Heel walk
Toe walk
Rectal exam
45
Q

Tx for back pain w/ no red flags

A 
Acetaminophen
NSAIDs
Skeletal muscle relaxants
Heat therapy
PT
Staying active (but avoid heavy lifting, bending, twisting, and prolonged sitting)

Advanced Clinical Reasoning (8 decks)

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