SmPcEMED Manual Flashcards
Retained foreign bodies in ear canals can present w/ ?
What is the next step if visualization reveals alive insect w/out full view of TM
What is used for residual post-procedural pain
Otalgia Otorrhea
2% lidocaine/mineral oil w/ suction/forcep removal
Benzocaine anti-pyrene
Retained foreign body in nose will present w/ ?
What are the indications for a referral
What can be added prior to removal procedures to aid the process
Unilateral purulent, foul smelling nasal d/c w/out other respiratory complaints
Non-visual/posterior location
Impacted
Unsuccessful removals
Oxymetazoline drops
How are retained ocular foreign bodies ID’s on PE
Once visualized, how are they removed
What is the next step if foreign body is intraocular
Slit lamp
Flouroscein stain
Topical anesthetic
Irrigation
Ophthalmoligist removal via surgery
Retained intracoluar debris from vegetative sources carry ? microbe and risk for infections
What ABX is used to prevent this
What will be seen post-op if object was made of iron?
Bacillus cereus
Systemic and Topicals
Rust ring
If a rust ring is visualized after removal of an retained iron foreign body, these Pts are Tx like?
? is the MC microbe that causes Paronychias usually after ? events
How are Paronychias Tx
Corneal abrasions
Acute: Staph A:
Chronic: Candidia
Manipulation, trauma, manicure
Abscess: InD
No abscess: topical ABX and chlorhexidine/povidone soaks
Dicloxacillin
Cephalexin
Define Felon
What is the MC microbe
How are these Tx
Finger pulp infection usually thumb/index
Staph A
Incision w/ block and Tqt:
Central volar longitudinal
Dorsal mid-axial
Define NSTEMI
What type of EKG changes may be seen
What type of infarct can cause this presentation
Myocardial necrosis w/: +troponin/CK
But w/out:
ST elevation, Q-waves
ST depression
T-wave inversion
Subendocardial infarct
What does the typical workup for NSTEMI include
What cardiac marker is most sensitive and what time frames does it follow
What other two markers can be used, but less often, and what time lines do they follow
CXR CBC/CMP
BNP EKG Troponin I
Troponin:
Appears 2-4hrs
Peaks 12-24hrs
Lasts 7-10days
CK/MB:
Appear: 4-6hrs
Peak: 12-24hrs
Normal: 48-72hrs
Mb:
Appear: 1-4hrs
Peak: 12hrs
Baseline: 24hrs
How are NSTEMIs Tx
BBs ASA Reperfusion- PCI Clop Heparin ACEI NTG Statin
Define STEMI
How are these worked up
Myocardial necrosis w/: +troponin/CK AND
ST elevation/Q-wave
CXR CBC/CMP
BNP EKG Troponin I
What EKG findings indicated the location of an MI
Anterior:
1, aVL, V2-6
Inferior:
2,3,aVF
Lateral:
ST elevation 1, aVL, 5-6 w/ reciprocal changes in 3, aVF
Posterior:
ST depression V1-3
How are STEMIs Tx
ASA/Clop at once
PCI <90min
Thrombolytics <180min if PCI unavailable
BBs ASA Reperfusion- PCI Clop Heparin ACEI NTG Statin
What are the absolute c/i for performing fibrolytic therapy for STEMI Tx
What absolutes don’t include ? ongoing issue
Prior intracranial hemorrhage Cerebral vascular lesion Malignant intracranial neoplasm Ischemic stroke <3mon Suspected aortic dissection Active bleeding/diathesis
Menses
Primary HTN is defined as ?
SBP 130 or >
DBP 80 or >
On two readings during two different visits w/out obvious cause
Norm: <120/80 and <80
Elevate: 120-29 and <80
Stage 1: 130-39 or 80-89
Stage 2: 140or> or 90 or >
What does the ACC/AHA define as a target blood pressure regardless of w/ or w/out comorbidity
What are the JNC8 Tx targets
<130/80
<60y/o, even w/ DM/Kidney D/o: <140/90
>60y/o: <150/90
How is Primary HTN Tx
Normal: yearly eval
Elevated: lifestyle change, re-eval 3-6mon
Stage 1: assess ASCVD risk <10%: lifestyle mod, reassess 3-6mon >10%, CVD, DM, CKD: lifestyle mod, 1 medication, re-eval 1mon Met goal: reassess 3-6mon Not met: different med/titrate Monthly f/u until goal reached
Stage 2: lifestyle mod w/ 2 medications, reassess 1mon
Met goal: re-eval 3-6mon
Not met: change med/titrate
Monthly f/u until goal reached
How are Non-Black Pts, including those w/ DM Tx for Primary HTN
How is Tx changed if they’re at Stage 2 HTN
How are black adults Tx and w/ ? goal in mind
ACEI or ARB
CCB: Amlodipine
Thz: Chlorthalidone/Indapamide
2 BP meds from different classes
Two or more med (Thx and CCB) for target <130/80
When are CCBs c/i as an anti-hypertensive
Why are ACEI/ARB c/i in diabetic HTN control
When are ACEIs c/i
When are BBs c/i during anti-hypertensive therapy
Angina pectoris
Proteinuria
Pregnancy
DMs
S/e of using Spironolactone for antihypertensive therapy
S/e of CCBs
What two CCBs are rate controling
HyperK
Edema
Verapamil/Diltiazem
A-blockers can be used to Tx HTN and ? simultaneously
What are two possible s/e of using Hydralazine for antihypertensive therapy
Criteria for a HTN emergency and the next step that determines Tx
BPH
Lupus-like syndrome
Pericarditis
SBP >180 and/or DBP 120 or>
End organ damage
New/Worse/Progressive
Once an HTN emergency is admitted to ICU, what 3 conditions have to be r/o
What is the Tx plan if these condition are or are not present
Aortic dissection
Pre/Eclampsia
Pheo crisis
Are:
SBP <140 w/in first hr
Dec to <120 if dissecting
Not:
Max reduction 25% w/in first hour
Then to 160/110-100 w/in 2-6hrs,
Then to normal w/in 24hrs
Criteria for HTN urgency
How are these PTs managed
What Dx count as end organ damage for HTN Emergencies
What doesn’t count as an end organ damage
> 180/120 w/out end organ damage
Start on 2 PO drugs w/ close f/u
Encephalopathy Nephropathy ICH Aortic dissection Pulm Edema Unstable angina MI
Papilledema- HTN retinopathy
Define Malignant HTN
What is the drug of choice for Tx of HTN urgency
What is the drug of choice for HTN emergencies
What is the recommended drug combo for Tx of Malignant HTN
HTN Retinopathy; diastolic >140 w/ papilledema and either encephalopathy or nephropathy
Clonidine- RxoC
Sodium nitroprusside
Clevidipine/Sodium nitroprusside
Define Secondary HTN
What are the red flags for secondary HTN
This Dx needs to be suspected in ? presentation
SBP 130 or >
DBP 80 or >
Both w/ identifiable and correctable cause
HTN <25y/o w/out FamHx
HTN starting >50
Previously controlled, now refractory
Refractory to antihypertensives
What is believed to be the MC cause of Secondary HTN
If Pts HTN is newly Dx, what is the next step
How is Secondary HTN Tx
Primary aldosteronism
UA
Spot albumin/Cr ratio
EKG
Cr K Na Fasting glucose Lipids TSH
Underlying condition Tx w/ aim for BP treatment targets
What class drug can accidentally cause HTn Urgency
How does occur
MAOI
Eating wrong at Holiday buffets: cheese sausage wine
How do Aortic Dissections present
When/how are these screened for
When is surgical repair indicated
Knife-like ripping pain radiating to back
US in any male >65y/o w/ +smoking Hx
Expands >0.6cm/yr or >5.5cm; even if ASx
When is US monitoring preferred for Aortic Dissections
What medication is used during monitoring phases
What CXR finding aids w/ Dx
No further: <3cm
Annual: 3cm-4cm
q6mon: 4.5-5cm w/ referral to VascSurg
q3mon: 5-5.4cm
BBs
Wide mediastinum
How does the location of an Aortic Dissection change Tx plan
What causes the dissection to begin and in ? layer
What is the gold standard for emergency evaluation
Ascending: surgical emergency
Descending: medical therapy w/ BBs unless +complications
HTN; intima
MRI angiography
