Spring Midterm Flashcards

1
Q

ARDS classification

A
P/F ratio: Normal > 400
< 300= mild ARDS
< 200= moderate ARDS 
< 100= severe ARDS 
Higher risk, severe ARDS with decreased compliance (20 mL or less) and increased minute ventilation ( 13 L/min or more)
C= stiffness
R= diameter of airways
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2
Q

BiPAP

A

Can help decrease CO2 in a hypercapnia patient by augmenting minute ventilation

Contraindications: do not use in pts who are unable to protect their airway or have large secretion burden, caution in patients who are at high aspiration risk

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3
Q

WHO Approach to Pain Management

A
  1. +/- Non Opioid (Tylenol) & +/- Adjuvant (NSAID)
  2. Opioid for mild to moderate pain (Oxycodone, Tramadol, Vicodin)
    +/- Non Opioid & +/- Adjuvant
  3. Opioid for moderate to severe pain (IV Opioid)
    +/- Non Opioid & +/- Adjuvant
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4
Q

Types of Pain

A

Acute < 6 months, d/t tissue damage; subsides with interventions and healing of tissue damage

Chronic > 6 months continued/episodic, negative changes in life, treatment to improve functionality of life, frequent re-evals and combination therapy

Cancer: caused by direct tumor involvement of sensory receptors, decreases if responsive to chemo and radiation

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5
Q

Pain location

A

Nociceptive pain: stimuli from somatic and visceral structures (transduction, transmission, perception, modulation)

Cutaneous: skin

Visceral: poorly localized, from internal organs

Somatic: non localized in muscle, bones, nerves, blood vessels

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6
Q

Tylenol Overdose Treatment

A

N-Acetylcysteine, administer if any of the following:

  • APAP level >200 mg/L at 4 hours
  • If unknown time of ingestion and APAP level > 10 mcg/ml
  • Serum APAP won’t return in 8 hours and ingestion suspected
  • Any evidence of hepatotoxicity
  • Repeated excessive APAP ingestions
    Serum APAP

Dose: (oral) 140 mg/kg then 70 mg/kg q4h x 17 doses (72 hours)
(IV) 150 mg/kg over 1 hour, then 50 mg/kg over 4 hours, then 100 mg/kg over 16 hours

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7
Q

Indications for transplant after tylenol overdose

A

Kings Criteria:

  • arterial pH < 7.3 after fluid resuscitation
  • Creatinine > 3.4
  • PT > 1.8 above normal or INR > 6.5
  • Grade III or IV encephalopathy
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8
Q

Organisms of Infective Endocarditis

A
Strep Viridans group (mutans, sanguine)
Staph. Aureus
Enterococcus
HACEK organisms (slow growing gram negative, oral flora)
- Haemophilus organisms
- Actinobacillus, Actinomycetemcomitans
- Cardiobacterium
- Eikenella
- Kingella

If culture returns quickly, likely not HACEK organism

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9
Q

Vegetation Risk of Emboli

A

Mitral Valve 25%
Mitral valve, anterior leaflet 40%
Mitral valve, ant. leaflet, size >10mm 50-60%
MV, ant. leaflet, > 10 mm, mobile 60-80%

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10
Q

Inflammatory phase of wound healing

A
  • Platelets release control blood loss, start clotting process;
  • recruitment of leukocytes & macrophages;
  • Leukocyte infiltrate wound, clean/remove debris and foreign particles;
  • Macrophages release growth factor initiating granulation tissue formation
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11
Q

Zones of Carotid Injury

A
  • Zone 1: Sternal notch to cricoid (highest mortality)
  • Zone 2: cricoid to angle of mandible (most common, carotid, jugular, vertebral)
  • Zone 3: angle of mandible to base of skull (most difficult to expose)
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12
Q

Carotid Artery Endartectomy (CEA) indications

A

Asymptomatic (plaque >70%) or symptomatic pts
No previous h/o radiation therapy to neck
No previous h/o of CEA to same side

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13
Q

Carotid Artery Stenting (CAS) indications

A

Plaque not approachable by CEA, high risk of CV complications, < 70 year old, h/o radiation on affected side

> risk of stroke

***symptomatic pts NOT a candidate

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14
Q

Shapes of aneurysm

A

Fusiform: symmetric bulge, most common
Saccular: Asymmetric, likely d/t trauma or aortic ulcer
Psuedoaneurysm: “false” aneurysm, actual disruption of one or more of wall layers

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15
Q

Calculating Ideal Body Weight (IBW) or Estimate Lean Weight (ELW)

A

Men: 106 lbs for first 5 feet, add 6 pounds per inch above
Women: 100 lbs for first 5 feet, and 5 lbs per inch above

Add 10% for obese pts.
Subtract 10% for petite pts.

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16
Q

Causes of skin changes with nutritional deficiencies

A
Pallor: iron, folate, B12
Dermatitis: EFA, Zn, B2, B3
Poor wound healing: Zn, Vit C, protein
Scaly texture: Vit A, EFA
Skin turgor: poor fluid status
17
Q

Quick physical exam for evaluating for CVA

A
FAST exam
Facial droop
Arm weakness
Speech difficulty
Time to call

*Gait disturbances, sudden HA

18
Q

Management of Cerebral Aneurysms

A
CT, if negative, LP, CTA
TXA prevent further bleeding
Liberal SBP 
Nimodipine for treatment of vasospasm
Saccular treatment= clipping or OR
19
Q

Definition of Neutropenic Fever

A

Single oral fever >38.3 (101 F)
Sustained > 38 (100.4 F) for > 1 hour
Neutropenia: ANC < 500 or ANC expected to decrease to < 500 in next 48 hours

ANC= [(Neutrophil % + Band cells %) x total WBC] / 100

20
Q

Differentials of positive Anion Gap (Na-(HCO3 + Cl)

Normal < 12

A
AT MUDPILES
Alcohol
Toluene
Methanol
Uremia
DKA/Drugs
Praldehyde
INH/Iron
Lactic Acidosis
Ethanol/ Ethylene glycol
Salicylate/Starvation ketosis
21
Q

Differentials of positive Osmolar Gap
measure serum osmolality - predicted serum osmolality
Predicted value found online

A
ME DIE
Methanol
Ethanol
Diuretic
Isopropyl
Ethylene glycol
22
Q

Dialyzable Drugs

A
I STUMBLE
Isopropanol
Salicylates
Theophylline
Urea
Methanol
Barbiturates
Lithium
Ethylene glycol
23
Q

Toxidromes

A
sympathomimetic
cholinergic
anticholinergic
serotonin syndrome
opioid intoxification/withdrawal
sedative hypnotics
24
Q

Sympathomimetic toxidrome agents, presentation, treatment

A

Agents: cocaine, LSD, caffeine, ephendrine, pseudoephedrine

Presentation: dilated pupils, tachy, HTN, hyperthermia, DIAPHORETIC, seizure, CNS excitation, normal bowel sounds

Treatment: Benzos, fluid resuscitation, treat hyperthermia

25
Q

Cholinergic toxidrome agents, presentation, treatment

A

Agents: organophosphates, insecticides, mushrooms, acetylcholine, carbachole

Presentation: DUMBBELS- diarrhea, urination, miosis, bronchorrhea, brady, emesis, lacrimation, salivation
SLUDGE- salivation, lacrimation, urination, defecation, GI distress, emesis

Treatment: Atropine, pralidozime, Benzos

26
Q

Anticholinergic toxidrome agents, presentation, treatment

A

Agents: antihistamines, scopolamine, TCA, atropine, compazine, phenergan, Jimson weed

Presentation: flushed, no diaphoresis, urinary retention, mydriosis, altered mental status, hyperthermia,

Treatment: NaHCO3 for prolong QTc, Benzo, treat hyperthermia

27
Q

Serotonin Syndrome toxidrome agents, presentation, treatment

A

Agents: SSRI, SNRI, MAOIs, Dextromorphan, Tramadol

Presentation: increased muscle tone, hyperreflexia, HTN, hyperthermia, clonus, tremor, ANS

Treatment: Benzo, Nitro, paralyze for hyperthermia
Antidote: Cyproheptadine

28
Q

Opioid Intox/Withdrawal toxidrome agents, presentation, treatment

A

Agents: heroin, MSO4, fentanyl, oxy, methadone, meperidine, lomotil, prpoxyphene

Presentation: CNS depression, miosis, hypotension, brady, DIMINISHED BOWEL SOUNDS, HYPOTHERMIA, abdominal cramping, N/V, anxiety

Treatment: Naloxone (chronic), Clonidine (acute), Benzo

29
Q

Sedative/Hypnotic toxidrome agents, presentation, treatment

A

Agents: benzos, barbiturate, GHB, ketamine, propofol, ambien, soma, flexiril

Presentation: sedation, confusion, delirium, diplopia, blurred vision, nystagmus, slurred speech, ataxia, paresthesia

Treatment: Flumazenil

30
Q

Contraindications to thrombolytics

A
History of hemorrhagic stroke
Active intracranial neoplasm
Recent (200 or DBP >110)
Nonhemorrhagic stroke within prior 2 months
Surgery within last 10 days
Thrombocytopenia (<100,000 platelets)
31
Q

Light’s Criteria

A

Pleural fluid protein/serum protein ratio >0.5
Pleural fluid LDH/serum LDH ratio >0.6
Pleural fluid LDH greater than 2/3 the upper limits of laboratory normal serum LDH (>200)

1 criteria= 70% sensitive for exudate, #1 & #3= 97% sensitive, all= 99% sensitive

32
Q

Indications for emergent dialysis

A

A- acid abnormalities (metabolic acidosis)
E- electrolyte imbalances (hyperkalemia, hypermagnesia)
I- Intoxication (I STUMBLE)
O- Overload (
U- Uremia (pericarditis)