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Rosh > Third Year Saveables > Flashcards

Third Year Saveables Flashcards

1
Q

TRALI

A

More common in FFP and platelets
Mortality rate 5-8%!
Supportive and maybe Intubate
Hypoxia fever ARDS CXR

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2
Q

How do you decide inpatient vs outpatient CAP tx?

A

PSI score!

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3
Q

CAP outpatient therapy healthy and comorbids

A

Healthy Doxy

Co morbids: Augmentin + doxy OR Levo

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4
Q

Sudden onset

A
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5
Q

2 labs to order in a septic mimic?

A

VBg and sailicylate. ASA toxicity
Acidosis with CO2 lower than it should be (resp alk. + met acidosis) co2 should match pH levels

They can intislly be alkalemic with vomiting and resp. Alk

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6
Q

Always get what test in Preg VB

A

Type and screen for Rhogam

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7
Q

ASA tox treatment

A 
Avoid HypoG
Put oxygen on with good sats
Replenish K
Hydrate
sodium bicarbonate in D5w 7.4-7.5 pH
Dialysis

What kills is pulm edema and cerebral edema and renal failure

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8
Q

4 causes hypoxia

A 
VQ mismatch (the common lung diseases): PNA, Asthma, COPD, Atalectasis, PE, pulmonary edema, ARDS. Corrects with supplemental O2.
Shunt: deadspace (alveoli filled with pus, fluid, or blood); or cardiac defect with RL shunt. Will NOT improve with supplemental O2.
Diffusion defect: interstitial lung disease or interstitial edema.
Hypoventilation: resp depression, CNS injury, peripheral neuromuscular dz, chest wall rigidity
Low Fi02: altitude, SCUBA system malfunction
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9
Q

Absolutely lymphocyte count less than 1600 should make you think about…

A

HIV

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10
Q

Saline load vs CT

A

CT is 100/100% ,vs 92/92% for knee saline load good p but lower power
ppx abx
rosh says ct scan is best vs saline load

40 cc is needed for elbow- not sure of CT here.

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11
Q

Codes things you actually shoudlnt do:

A
  1. Calcium (harmful, worse outocmes- JAMA 2021 articles)
  2. bicarb (harmful, worse outcomes)
  3. Intubate (really just need oxygenation)
  4. atropine
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12
Q

when do you shock asystole

A

US shows a quivering heart (asystole is dead heart) and it is fine v fib - shock it

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13
Q

tourniquet on finger which is too tight?

A

Digital block

use a cutting needle (look to see if conventional or reverse cutting)

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14
Q

Food impaction tx

A

Don’t use glucagon for vomiting against a closed tube
Nitro paste works!
Secretions a lot of them is a sign, if it stops then there is partial passage. Then GI scope maybe

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15
Q

CHF risk factors for poor prognosis

A

hyponatremia, poor renal function, hypoalbuminemia, and congestive hepatopathy or elevated liver enzymes.

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16
Q

why low plt in liver disease?

A

Portal hypertension leads to splenomegaly, which causes platelet sequestration and is the largest contributor to thrombocytopenia.

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17
Q

ptosis ddx

A 
bells
stroke
MG
brain aneyrusm
horners
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18
Q

thyroid dz with eye pain

A

watch out for conreal ulcer

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19
Q

dacroadenitis is

A

inflammation of lacrimal gland above the eye- usually viral

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20
Q

2 month old with purpleish outpouching above eye

A

think a deep hemangioma (treat with BB)

21
Q

BP necessary for pre-E PP

A

150-160 or 110 DBP
usually with headache
then get labs and urine and think mag and admit

22
Q

What clinical tool should you use for liver stuff?

A

Meld for chronic

Kings college for transfer in acute liver failure for transplant eval

23
Q

Headache, CTA neg within 6 hours, small aneurysm tho…

A

Have to do LP

24
Q

Do do eacharatoty unless you have electrocautery

A

Unless on the chest and HD unstable - transfer for it or only do if loss Doppler pulses

25
Q

Bowel Obstructions 3 6 9 rule (Small, larhe, cecal on CT)
SBO usually resolve on own, valvuale (stair step and pearls on a string)
LBO (diverticuli can cause it)- surgery usually, half way haustra on KUB
Cant miss volvulus, closed loop obstructions
Admit, hydtae (not all routine NG and abx, case by case for bad casses)

A
26
Q

isolated elevated AST and abd pain, net CT…

A

Think cardiac, AST also released in cardiac damage

27
Q

Lactate sensitivity in mesenteric ishcmeia

A

48% of Mes Ischemia normal - does not rule out

28
Q

CT findings: thickened/edema bowel wall, new ascites

A

Think possible mesenteric ischemia, early findings (reg CT w/ contrast sensitivity is 70-90%)
Now htink Surgery consult or CTA

29
Q

Smart trial/salted, LR vs NS

A

Basic balanced crystallioids nnt 94, 5 percent mortality ARR for 90 day mortality especially beneficial in sepsis, much better than NS

Remember: LR more hypotonic than plasmalyte- don’t give it in head injuries but otherwise pretty equal. No trial looking at the two of them

30
Q

Valvular emergency

A

Don’t expect to hear a murmur, pressure between LV aorta the same - keep on ddx for SOB CP-
From dissection, endocarditis, trauma
Don’t use BB
Reduce aftelad nitropussy
Hypotensive= dobutamine
Surgery consult *
Avoid intubation, bipap (increased Intra thoracic pressure)
Avoid levo (up after road) avoid nitro (decrease preload)
More ways to screw it up than go right

31
Q

Kids sedations adjuncts to decrease slaivation

A

atropine, glucorpyrralte

can sedate for an exam if needed

32
Q

Refractory migraine/headache in Female <40 yo, some neck pain, partial hroner, HA

A

Cartoid artery dissection - repeat imaging if not imrpovong - it is more common than you think

33
Q

Post T&A bleed

A

TXA, epi soaked gauze, sedate the kid if needed, once you stabilize, intubate (secondary hemorrhage adter herald dbleed), mcgill foreceps with gauze and hold pressure and leave tail outside the mouth. be prepared for needle cric

34
Q

BRB in diaper for kid…

A

Think omnicef, looks like tomato sauce, if neg bedside test can go home

35
Q

What do you do if you want a cath and cardiologist doesn’t?

A

Heparinize them, admit for serial ekgs/trop

36
Q

5 deadly withdrawals

A 
Alcohol
Bacolfen
Benzo
Barb
Clonidine
37
Q

UAs

A
  1. look at Antibiogram
  2. In order E coli, Enterobacter, Proteus,
  3. MAcrobid good for E coli, bad for everything else, Keflex good, Augmentin good
  4. Cefdinir For outpatient pyelo
  5. Realize what rules in and rules out on UA (Nitrite IN, if no WBC helps rule out, 8 squames cut off (a urine culture still good)
38
Q

evidence behind bicarp for renal dysfunction acidosis

A

No mrotlaity benefit but does help (ICU septic patient mostly) - Good to go for it

39
Q

AKI + edema

A

Pulm inovlvement: 1 mg/kg lasix

if not, think albumin possibly vs Give fluids fo rkidneys

40
Q

Who do you scan with AKI?

A 
UA normal
PVR normal
AKI doesnt get better with fluids
Hydronephrosis b/l
=badness within belly
41
Q

Do you need to wake up nephrologist voernight for AKI patient needing CRRT?

A

STARRT - AKI trial:
Ealry vs late CRRT no difference in outcomes (6 hours vs 18 or so hours)
*you can wait

42
Q

AEIOU for dilausis

What is the dilayzable ingestion?

A 
I STUMBLED
INZD, iso alcohol
salicyaltes
theophylliine
URea
Methaniol
BArbs
lithium
Ethylene glycil
Depakote, dabitgratran
43
Q

bleeding fistual steps

A

direct pressure 5-10 mins>
Surgicell, combat gause with it
Protamine 10-20 mg or DDAVP

Last line is figure of 8

If life threatening: toruiquet and vascular consult- graft is done tho

DASS or steal syndrome is poor flow and inschemic limb- vasc consult

44
Q

Fisutla problems

A

thinks thrombosis or stneosis needs fisutlagram and vasc surgery consult

45
Q

Type 4 rash DDX

usually days to weeks later

A

Morbilliform drug eruoptions (95%) (many diff presentations)
SJS
AGEP (single drug, 24 hours later, can have mucous membranes)
DRESS
Photosensitivity allergic reaction after a drug (PMLE is similar but unknown trigger after light exposure)

46
Q

rash emergencies DDX

A 
Morbilliform drug eruoptions 
SJS
AGEP 
DRESS
Photosensitivity allergic reaction
HIV
MONO
RMSF
2nd syphilis 
SCAR
Subacute cutaenous Lupus Erythema (upperchest/arms and up)
acute cutaneous lupus (systmic lupus flares)
47
Q

rash red flags

A 
pain
mcuousa
hgih fever
blisters
ertyehderma
immunosuppressed
purpura

Infection, drugs, autoimmune stuff

48
Q

AKA

A

Does not need ketones in urine (measures acetoen not beta hydoybtyrate)
order beta hyroxybutyrate to confirm if needed
if not gettign better think toxic alcohols

Think in an older person, hihg ethnaol [ ] , and HIGH anion

49
Q

osmol gap and anion gap graph

A 
know the graph, understand the time frame and that you may not see the osmol gap if they ave had tiem to metabolize and turn it into an anion gap
ongoing acidosis (lactate will continue to rise too!) and you cant explain thin ktoxic alcohol SI attempt and call tox and think fomepizole

Rosh (14 decks)

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