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Step 2 DIT 😱 > Treatments 3 > Flashcards

Treatments 3 Flashcards

1
Q

Trauma assessment, primary

A

ABCDE
Airway (ET/cricothyroid)
Breathing (O2, pulse ox, ventilation, pneumothorax)
Circulation (pulse, vitals, IVF x2 PIVs or central line, bleeding)
Disability (GCS, glucose)
Exposure (remove clothes, DRE/Foley, blanket)

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2
Q

Trauma assessment, secondary

A 
Reassess ABCs
DRE/Foley (not if high riding prostate/blood at urethral meatus)
NGT placement
Hx
Head-to-toe exam
Examine back, remove backboard
X-rays, FAST, CT, labs, fx management
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3
Q

Lower ICP

A

Head of bed at 30 degrees
Mannitol IV (q6 hrs Na and osmolarity)
Intubate and hyperventilate (temp relief)
Decompressive craniectomy
Ventriculostomy, barbiturate coma, paralysis

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4
Q

Neck trauma, zone I

A

Clavicles to cricoid

CT angiogram, EGD, bronchoscopy, laryngoscopy

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5
Q

Neck trauma, zone II

A

Cricoid to angle of mandible

Surgical exploration

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6
Q

Neck trauma, zone III

A

Angle of mandible to base of skull

CT angiogram, EGD, bronchoscopy, laryngoscopy

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7
Q

Abdominal trauma, penetrating injury

A

(Emergent) exploratory laparotomy

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8
Q

Pelvic fx + DPL shows blood in pelvis

A

Emergent laparotomy

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9
Q

Pelvix fx + DPL shows urine in pelvis

A

Urgent laparotomy (bladder repair)

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10
Q

Pelvic fx + DPL shows nothing + hemodynamically unstable

A

Angiography + possible embolization

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11
Q

BAT + unstable vital signs + FAST shows fluid in pelvis

A

Emergent laparotomy

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12
Q

BAT + unstable vital signs + FAST shows no fluid in pelvis

A

Angiography + possible embolization

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13
Q

BAT + unstable vital signs + FAST inconclusive

A

DPL

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14
Q

BAT + stable vital signs

A

CT abdomen/pelvis, observation

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15
Q

Tension pneumothorax

A

Immediate chest tube placement

Needle decompression if CT delayed (2/3rd IC space mid-clavicular or 5th IC midaxillary)

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16
Q

Flail chest

A

O2
BiPAP or ET
Analgesia

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17
Q

Gonorrhea prophylaxis

A

Ceftriaxone 125 mg IM

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18
Q

Chlamydia prophylaxis

A

Azithromycin 1 g PO or

Doxycycline 100 mg PO bid x7 days

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19
Q

Trichomonas prophylaxis

A

Metronidazole 2 mg PO

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20
Q

Post-op to improve pulmonary fxn

A

Incentive spirometry
Deep breathing exercises
PT
Analgesia

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21
Q

Pre-op labs concerning for liver disease

A

Increased PT/PTT
Decreased platelets
Decreased albumin
Increased bilirubin

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22
Q

Obstruction (abdominal)

A

Surgical lysis of adhesions

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23
Q

Diverticulitis

A

Metronidazole and fluoroquinolone (PO outpatient or IV inpatient)

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24
Q

Massive GI hemorrhage (perforation)

A

Angiography w/ embolization, surgical repair of detectable site of bleeding

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25
Q

Appendicitis

A

Appendectomy

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26
Q

Acute mesenteric ischemia

A

NPO
NG tube
Antibiotics
Resection of necrotic bowel

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27
Q

Malignant hyperthermia

A

Evaporative cooling
Dantrolene
Cold inhaled O2, GI lavage, IV fluids

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28
Q

Chronic mesenteric ischemia

A

Bypass, endarectomy, or angioplasty and stenting

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29
Q

Graft vs. host disease

A

Corticosteroids

Tacrolimus, mycophenolate

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30
Q

Hyperacute transplant rejection

A

(First 24 hrs)

Untreatable

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31
Q

Acute transplant rejection

A

(6 days - 1 year)

Immunosuppressive agents

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32
Q

Chronic transplant rejection

A

(>1 year)
Usu untreatable
Immunosuppressive agents may help a bit

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33
Q

Common cold

A

Rest, analgesia, symptomatic treatment

NO Abx

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34
Q

Pharyngitis

A

Self-limited

Abx reduce infection time, reduce acute rheumatic fever (B-lactams)

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35
Q

Peritonsillar abscess

A

Needle aspiration or I&D

Pain meds + abx (amoxicillin/clavulanate or clindamycin)

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36
Q

Sinusitis

A

Symptomatic (nasal irrigation, analgesics, oral decongestants, intranasal steroids)
Amoxicillin-clavulanata, doxycycline or levofloxacin

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37
Q

PNA in neonates

A

Amp + gent +/- vancomycin

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38
Q

PNA in 1-4 months

A

Macrolides (-mycin) +/- cefotaxime

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39
Q

PNA in 4 months - 4 years

A

Amoxicillin, Ampicillin

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40
Q

PNA in 5-15 years

A

Amoxicillin + clarithromycin
Azithromycin
Amoxicillin + doxycycline

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41
Q

Acute bronchitis

A

Azithromycin, erythromycin, tetracycline, fluoroquinolone

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42
Q

Viral PNA

A

Self-limited

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43
Q

Strep pneumo PNA

A

B-lactam, macrolide (-mycin)

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44
Q

H. influenzae PNA

A

B-lactam, TMP-SMX

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45
Q

S. aureus PNA

A

B-lactam, MRSA coverage (vancomycin, etc)

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46
Q

Klebsiella PNA

A

Cephalosporin + aminoglycoside (gentamicin, tobramycin)

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47
Q

Pseudomonas PNA

A

Antipseudomonal B-lactam (piperacillin-tazobactam, cefepime, imipenem, meropenem, aztreonam) + one or two of following:
Antipseudomonal quinolone (cipro or levofloxacin)
Aminoglycoside (tobramycin, gentamicin or amikacin)
Azithromycin

48
Q

GBS PNA

A

B-lactam (+ gentamicin in neonates)

49
Q

Enterobacter PNA

A

TMP-SMX

50
Q

Mycoplasma PNA

A

Macrolides (-mycin)

51
Q

Legionella PNA

A

Macrolides (-mycin), fluoroquinolones (-floxacin)

52
Q

Chlamydophila PNA

A

Doxycycline, macrolides (-mycin)

53
Q

Coccidiomycosis PNA

A

Amphotericin B or Ketoconazole (systemic)

Fluconazole

54
Q

Histoplasmosis PNA

A

Amphotericin B or Ketoconazole (systemic)

Itraconazole

55
Q

Blastomycosis PNA

A

Amphotericin B or Ketoconazole (systemic)

Itraconazole

56
Q

Latent TB (asymptomatic +PPD)

A

INH x 9 months

57
Q

Primary or secondary active TB

A

Rifampin, Isoniazid Pyrazinamide, Ethambutol x 4 months
THEN Rifampin and Isoniazid x 2 months
Vitamin B6 w/ INH to prevent peripheral neuritis

58
Q

ARDS

A

ICU, treat underlying cause
Mechanical ventilation w/ low tidal volume, adequate PEEP
Conservative fluid management

59
Q

Mild intermittent asthma

A

Inhaled short acting B2 agonist

60
Q

Mild persistent asthma

A

Inhaled short acting B2 agonist +

Low dose inhaled corticosteroid

61
Q

Moderate persistent asthma

A

Inhaled short acting B2 agonist +
Low-medium dose inhaled corticosteroid +
Long acting B2 agonist
Consider LT inhibitor, ipratropium

62
Q

Severe asthma

A 
Inhaled short acting B2 agonist +
High dose inhaled corticosteroid +
Long acting B2 agonist
Consider LT inhibitor, ipratropium
Consider systemic steroids, theophylline
63
Q

Asthma + persistent allergic rhinitis

A

LT inhibitor (montelukast, zafirlukast, zileuton)

64
Q

COPD A (Gold 1-2, mild sx)

A

Short acting bronchodilator (albuterol)

65
Q

COPD B (Gold 1-2, mod-severe sx)

A

Short acting bronchodilator (albuterol) +

Long acting bronchodilator (ipratropium, maybe long acting B2 agonist)

66
Q

COPD C (Gold 3-4, mild sx)

A

Short acting bronchodilator (albuterol) +
Long acting bronchodilator (ipratropium, maybe long acting B2 agonist) +
Inhaled corticosteroids

67
Q

COPD D (Gold 3-4, mod-severe sx)

A

Short acting bronchodilator (albuterol) +
Long acting bronchodilator (ipratropium, maybe long acting B2 agonist) +
Inhaled corticosteroids +/-
Theophylline, home O2 if indicated, PDE4 inhibitor (roflumilast)

68
Q

Bronchiectasis

A

Pulmonary hygiene including chest PT
Antibiotics for increased sputum
B2 agonists/corticosteroids for symptoms
Resection of diseased lung segments

69
Q

Superior vena cava syndrome

A

Steroids, stent

Tumor removal

70
Q

Non-small cell lung cancer w/o metastasis

A

Surgical resection

Adjuvant chemo, radiation

71
Q

Non-small cell lung cancer w/ LN

A

Radiation

Consider surgery, chemo

72
Q

Non-small cell lung cancer w/ metastasis

A

Palliative

73
Q

Small cell lung cancer

A

Chemo

Radiation (adjuvant)

74
Q

Laryngeal cancer

A

Laryngectomy

Radiation, chemo

75
Q

Idiopathic pulmonary fibrosis

A

Steroids
Azathioprine or cyclophosphamide
N-acetylcysteine
Lung transplant

76
Q

Sarcoidosis

A

Occasionally self-resolving

Steroids, cytotoxic drugs, rarely transplant

77
Q

Pneumoconioses

A

Usu no successful treatment (steroids may help)

78
Q

Goodpasture syndrome

A

Plasmapheresis

Corticosteroids and immunosuppressants

79
Q

Granulomatosis w/ polyangiitis (Wegener)

A

Cytotoxic (cyclophosphamide) and steroids

80
Q

Pulmonary embolism

A 
Supplemental O2
IVF or pressors if needed for hypotension
AC w/ LMWH or warfarin 3-6 months
IVC if AC C/I
Possible thrombolysis
81
Q

Pulmonary HTN

A

Supplemental O2
Vasodilators to decrease pulm vascular resistance (prostanoids, endothelin receptor antagonists/-sentans, PDE inhibitors/sildenafil, DHP CCB/nifedipine)
AC to decrease risk of pulm thrombus formation
Diuretics for pulm congestion

82
Q

Pulm edema

A

Treat like CHF (NO LIP)

Nitrates, O2 if hypoxic, Loop diuretics, Inotropes (last ditch), Positioning

83
Q

Pleural effusion

A

Treat underlying condition
Thoracocentesis and CT relieve pressure
CT required for empyema
Pleurodesis if recurrent malignant

84
Q

Closed pneumothorax, <15%

A

Supplemental O2, observe

85
Q

Closed pneumothorax, >15%

A

CT

86
Q

Open PTX, small wound

A

CT + occlusive dressing

87
Q

Open PTX, larger wound

A

Attempted closure, low threshold for intubation

88
Q

Tension pneumothorax

A

Immediate needle decompression and CT

89
Q

Recurrent PTX

A

Maybe pleurodesis

90
Q

Hemothorax

A

O2, CT, treat underlying cause

91
Q

Malignant mesothelioma

A

Surgery, chemo, radiation -> all have poor prognosis

92
Q

Sleep apnea

A

Weight loss
No sedatives (including alcohol)
CPAP
Surgery

93
Q

Atelectasis

A

IS, early ambulation, PT
Upper airway suctioning
Lower airway suctioning w/ bronchoscopy

94
Q

Croup

A 
Supportive care (humidified/cool air)
Inhaled steroids, epinephrine (if stridor)
95
Q

Epiglottitis

A

Intubation

IV abx 7-14 days

96
Q

Bronchiolitis

A

Supportive care

Inhaled albuterol, epinephrine

97
Q

Respiratory distress syndrome of the newborn

A

Corticosteroids before labor if <37 wks)

Surfactant replacement therapy

98
Q

Meconium aspiration syndrome

A

Suction nose, mouth, upper airway
Supplemental O2, intubate if needed
Surfactant therapy may help
Empiric abx if concerned about PNA

99
Q

Cystic fibrosis

A

B2 agonists, DNAse I, chest PT
Antibiotics PRN (Azithromycin, fluoros)
Pancreatic enzymes and vitamins A, D, E, K

100
Q

Hepatitis A

A

Self limited, supportive care

Vaccine before travel

101
Q

Hepatitis B

A

HBV immediately after exposure in unvaccinated pt
IFN-a
Antivirals (lamivudine, adefovir, entacavir)

102
Q

Hepatitis C

A

IFN-a

Consider ribavirin

103
Q

Hepatitis D

A

IFN-a

104
Q

Hepatitis E

A

Self-limited, supportive care

105
Q

Salivary gland disorders

A

Warm compresses, massage, lemon drops (ductal stones)
Abx and hydration (infx)
Surgery (refractory)

106
Q

Achalasia

A

Nitrates and DHP CCB (rarely used)
Pneumatic dilation
Botulinum injections
Myotomy

107
Q

Diffuse esophageal spasm

A

CCP, nitrates, TCAs

108
Q

Zenker diverticulum

A

Cricopharyngeal myotomy or diverticulectomy

109
Q

GERD

A

Elevate HOB, weight loss, dietary modification
Antacids
H2 blockers or PPIs
Nissen fundoplication or hiatal hernia repair (refractory)

110
Q

Esophageal cancer

A

Surgical resection (early)
Radiation/chemo (nonoperative or adjuvant)
Poor prognosis

111
Q

Hiatal hernia

A

Sliding - reflux control

Paraesophageal - surgery (gastropexy, Nissen fundoplication)

112
Q

Gastritis

A

Stop alcohol/medications
H2 blockers/PPIs
Type A - vitamin B12
Type B - PPI + clarithromycin + amoxicillin or metronidazole 10-14 days

113
Q

PUD

A

R/o active bleeding (CBC, EGD, stool guiaic)
PPI/H2 antagonist to decrease gastric acid
Sucralfate, bismuth subsalicylate, misoprostol (NSAID use) to protect mucosa
Surgery for acute perforation, refractory

114
Q

Zollinger-Ellison syndrome

A

Surgical resection if localized
PPI/H2 blockers
Octreotide in metastatic

115
Q

Gastric cancer

A 
Subtotal gastrectomy (distal third of stomach)
Total gastrectomy (upper/middle stomach, invasive)
Radiation/chemo as adjuvants

Step 2 DIT 😱 (23 decks)

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