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IPAP > SmPcEMED Manual > Flashcards

SmPcEMED Manual Flashcards

1
Q

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

A

Otalgia Otorrhea

2% lidocaine/mineral oil w/ suction/forcep removal

Benzocaine anti-pyrene

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2
Q

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

A

Unilateral purulent, foul smelling nasal d/c w/out other respiratory complaints

Non-visual/posterior location
Impacted
Unsuccessful removals

Oxymetazoline drops

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3
Q

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

A

Slit lamp
Flouroscein stain

Topical anesthetic
Irrigation

Ophthalmoligist removal via surgery

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4
Q

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?

A

Bacillus cereus

Systemic and Topicals

Rust ring

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5
Q

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

A

Corneal abrasions

Acute: Staph A:
Chronic: Candidia
Manipulation, trauma, manicure

Abscess: InD
No abscess: topical ABX and chlorhexidine/povidone soaks
Dicloxacillin
Cephalexin

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6
Q

Define Felon

What is the MC microbe

How are these Tx

A

Finger pulp infection usually thumb/index

Staph A

Incision w/ block and Tqt:
Central volar longitudinal
Dorsal mid-axial

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7
Q

Define NSTEMI

What type of EKG changes may be seen

What type of infarct can cause this presentation

A

Myocardial necrosis w/: +troponin/CK
But w/out:
ST elevation, Q-waves

ST depression
T-wave inversion

Subendocardial infarct

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8
Q

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

A

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

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9
Q

How are NSTEMIs Tx

A 
BBs 
ASA 
Reperfusion- PCI   
Clop 
Heparin 
ACEI 
NTG
Statin
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10
Q

Define STEMI

How are these worked up

A

Myocardial necrosis w/: +troponin/CK AND
ST elevation/Q-wave

CXR CBC/CMP
BNP EKG Troponin I

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11
Q

What EKG findings indicated the location of an MI

A

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

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12
Q

How are STEMIs Tx

A

ASA/Clop at once
PCI <90min
Thrombolytics <180min if PCI unavailable

BBs 
ASA 
Reperfusion- PCI   
Clop 
Heparin 
ACEI 
NTG
Statin
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13
Q

What are the absolute c/i for performing fibrolytic therapy for STEMI Tx

What absolutes don’t include ? ongoing issue

A 
Prior intracranial hemorrhage
Cerebral vascular lesion
Malignant intracranial neoplasm
Ischemic stroke <3mon
Suspected aortic dissection
Active bleeding/diathesis

Menses

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14
Q

Primary HTN is defined as ?

A

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 >

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15
Q

What does the ACC/AHA define as a target blood pressure regardless of w/ or w/out comorbidity

What are the JNC8 Tx targets

A

<130/80

<60y/o, even w/ DM/Kidney D/o: <140/90
>60y/o: <150/90

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16
Q

How is Primary HTN Tx

A

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

17
Q

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

A

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

18
Q

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

A

Angina pectoris

Proteinuria

Pregnancy

DMs

19
Q

S/e of using Spironolactone for antihypertensive therapy

S/e of CCBs

What two CCBs are rate controling

A

HyperK

Edema

Verapamil/Diltiazem

20
Q

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

A

BPH

Lupus-like syndrome
Pericarditis

SBP >180 and/or DBP 120 or>
End organ damage
New/Worse/Progressive

21
Q

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

A

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

22
Q

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

A

> 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

23
Q

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

A

HTN Retinopathy; diastolic >140 w/ papilledema and either encephalopathy or nephropathy

Clonidine- RxoC

Sodium nitroprusside

Clevidipine/Sodium nitroprusside

24
Q

Define Secondary HTN

What are the red flags for secondary HTN

This Dx needs to be suspected in ? presentation

A

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

25
Q

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

A

Primary aldosteronism

UA
Spot albumin/Cr ratio
EKG
Cr K Na Fasting glucose Lipids TSH

Underlying condition Tx w/ aim for BP treatment targets

26
Q

What class drug can accidentally cause HTn Urgency

How does occur

A

MAOI

Eating wrong at Holiday buffets: cheese sausage wine

27
Q

How do Aortic Dissections present

When/how are these screened for

When is surgical repair indicated

A

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

28
Q

When is US monitoring preferred for Aortic Dissections

What medication is used during monitoring phases

What CXR finding aids w/ Dx

A

No further: <3cm
Annual: 3cm-4cm
q6mon: 4.5-5cm w/ referral to VascSurg
q3mon: 5-5.4cm

BBs

Wide mediastinum

29
Q

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

A

Ascending: surgical emergency
Descending: medical therapy w/ BBs unless +complications

HTN; intima

MRI angiography

IPAP (212 decks)

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