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EOR Family Medicine > Urgent Care > Flashcards

Urgent Care Flashcards

1
Q

Characteristics of second degree burn - superficial partial thickness

A

Erythematous, pink, moist, weeping
Blistering
Most painful!
Blanches with pressure

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2
Q

Characteristics of second degree burn - deep partial thickness

A 
Red, yellow, pale white, dry
Blistering
Not usually painful
Absent capillary refill
May need skin graft
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3
Q

Characteristics of third degree burn - full thickness

A

Waxy, white, leathery, dry
Painless
Absent cap refill

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4
Q

Characteristics of 4th degree burn

A

Black, charred, eschar, dry
Painless
Absent cap refill
Into underlying muscle, fat, bone

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5
Q

Risk factors for spontaneous pneumothorax

A

Family history
Smoking
Males

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6
Q

Diagnosis of pneumothorax

A

CXR

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7
Q

Treatment for small stable spontaneous pneumothorax

A

Oxygen and observation

If resolved after 6 hours on CXR can go home

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8
Q

Treatment for large stable spontaneous pneumothorax

A

Pleural aspiration, possible chest tube

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9
Q

Treatment for unstable spontaneous pneumothorax

A

Chest tube

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10
Q

Acute hypoxemic respiratory failure following a systemic or pulmonary insult without evidence of heart failure

A

ARDS

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11
Q

Most severe form of acute lung injury

A

ARDS

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12
Q

Three clinical settings that account for 75% of ARDS cases

A

Sepsis syndrome (MC)
Severe multiple trauma
Aspiration of gastric contents

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13
Q

Common Risk Factors for ARDS

A 
Sepsis
Aspiration of gastric contents 
Shock infection
Lung contusion
Non-thoracic trauma
Toxic inhalation
Near-drowning
Multiple blood transfusions
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14
Q

Rapid onset of profound dyspnea that occurs 12-48 hours after initiating event. Labored breathing, tachypnea, frothy pink or red sputum, intercostal retractions, diffuse crackles

A

ARDs / Respiratory Failure / Arrest

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15
Q

A quiet chest, agitation or confusion are ominous signs of impending:

A

Respiratory failure

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16
Q

Diagnosis of ARDS / acute respiratory failure

A

CXR - diffuse patchy bilateral infiltrates
Upper lung zone venous engorgement
Marked hypoxemia

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17
Q

Treatment for ARDS / acute respiratory failure

A

Identify and treat underlying cause

May require tracheal intubation and positive pressure mechanical ventilation

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18
Q

Unarousable unresponsiveness in which the subjects lie with eyes closed

A

Coma / deteriorating mental status

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19
Q

Characterized by lack of focal physical examination findings - pupils are typically small and reactive, but may be large in severe poisoning as from barbiturates

A

Toxic metabolic coma

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20
Q

Cornerstone of coma / deteriorating mental status assessment

A

Neurologic exam - descriptive, systematic, reference point for serial assessment

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21
Q

In hypoglycemic patients with a history of alcohol abuse or malnutrition, _________ should be administered before _________

A

Thiamine

Glucose

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22
Q

If elevated ICP is suspected in pts, elevated head to ___________ and keep at midline. _________ will help reduce ICP

A

30 degrees

Mannitol

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23
Q

Symptom complex associated with severe psychiatric disease with stupor, excitement mutism, posturing

A

Catatonia

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24
Q

Allergic reactions / anaphylaxis are _____ mediated

A

IgE mediated

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25
Q

DDX for allergic reaction / anaphylaxis

A 
Myocardial ischemia
Gastroenteritis
Asthma
Carcinoid
Epiglottitis
Hereditary angioedema 
Vasovagal reactions
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26
Q

Treatment for allergic reactions / anaphylaxis

A 
Control airway
Supplemental oxygen
Limit further exposure
Epinephrine IM for pts in shock
IV fluids for hypotension
Antihistamines
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27
Q

Special consideration for anaphylactic pts with bronchospasms

A

Albuterol

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28
Q

Non GI Factors for acute abdomen

A

Cardiorespiratory - cough, chest pain, dyspnea
Genitourinary - urgency, dysuria, vaginal discharge
Trauma - falls, MVAs

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29
Q

Important medications to ask about with acute abdomen

A

NSAIDs
Antibiotics
Steroids

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30
Q

More common causes of abdominal pain in pts > 50 y/o

A 
Biliary disease
Bowel obstruction
Diverticulitis
Cancer
Hernia
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31
Q

Reasons for urgent surgical referral with acute abdomen

A
  1. Systemic signs - tachycardia, hypotension, fever
  2. Free air on CXR under diaphragm
  3. Free fluid if not ascites
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32
Q

Acute management of acute abdomen

A

Aggressive fluid resuscitation
Analgesics
Antiemetics (Zofran)
ABX - broad spectrum

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33
Q

Most common cause of third trimester bleeding - premature separation of a normally implanted placenta after the 20th week of gestation but before birth

A

Abruptio placentae

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34
Q

Any bleeding that occurs after 28 weeks gestation. Complicates approximately 5% of all pregnancies

A

Third trimester bleeding

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35
Q

Bleeding with abdominal pain and/or uterine tenderness in third trimester is suggestive of

A

Abruptio placentae

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36
Q

Profuse, painless bleeding in third trimester is suggestive of

A

Placenta previa

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37
Q

Non obstetric causes of third trimester bleeding

A 
Genital tract lesions
Infections
Intercourse
Friable cervix
Cervical carcinoma
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38
Q

Workup for third trimester bleeding

A

CBC, PT/PTT
UA and cervical cultures to r/o infxn
If location of placenta is unknown, perform US to r/o placenta previa
Vaginal examination to r/o labor

39
Q

Fetal Well Being Test

A
  1. Check for fetal heart tones and conduct NST (non stress test)
  2. Amniocentesis considered for fetal lung maturity for the assessment of delivery options
  3. Administer RhoGAM if Rh- and send a Kleihauer-Betke test to assess for the extent of fetomaternal bleed
40
Q

Treatment for third trimester bleeding

A

Delivery for term pts

Bed rest and cautious tocolysis for stable preterm pts

41
Q

____ and ______ bites have higher rates of infection than dog bites

A

Cat and human

42
Q

Bites are usually polymicrobial, but __________ is the single most common isolate

A

Pasteurella

43
Q

________ bites are particularly concerning for the possibility of closed-space infections

A

Hand

44
Q

__________ prophylaxis indicated for non infected bites of the hand and ___________ required for infected hand bites

A

Antibiotic prophylaxis

Hospitalization

45
Q

Cat bites in any location should receive prophylaxis of:

A

Augmentin 500 mg TID x 5-7 days

If PEN allergic: clindamycin and doxy

46
Q

All infected bite wounds need to be __________ for direct therapy

A

Cultured

47
Q

Important evaluation for all bites: (2)

A

Rabies

Tetanus

48
Q

Treatment for scorpion stings

A

Antivenom

49
Q

Risk factors for foreign body aspiration

A

Altered mental status
Alcoholism
Impaired cough/swallowing reflex
Dementia

50
Q

Foreign body aspirations are more commonly on the:

A

Right side

51
Q

Coughing, choking, wheezing, or hemoptysis

A

Foreign body aspiration

52
Q

Complications of foreign body aspiration

A

Aspiration pneumonia

Gastric aspiration may cause ARDS

53
Q

Diagnosis of foreign body aspiration

A
  1. Bronchoscopy - provides direct visualization and removal

2. CXR

54
Q

Most common cause of cardiac failure / arrest

A

Ischemic heart disease

55
Q

Most common rhythms of cardiac arrest

A

Vtach

Vfib

56
Q

Fracture with right angle to the axis of the bone

A

Transverse

57
Q

Fracture where bone has twisted appearance - also called torsion

A

Spiral

58
Q

Fracture where fracture line is between horizontal and vertical direction

A

Oblique

59
Q

Fracture where bone is splintered or brushed

A

Comminuted

60
Q

Displacement of bone from a joint

A

Dislocation

61
Q

Imaging of fractures / dislocations

A

XR - ap and lateral
Radionuclide bone scanning - increased uptake at fracture site
CT
MRI - best for occult hip fracture

62
Q

Treatment for open fracture

A

Debride and irrigate in OR
ABX - cephalosporins and aminoglycosides
Tetanus status
Immobilize and fixate to preserve function

63
Q

There is significant potential for ___________ with fracture of the femur

A

Hemorrhage

64
Q

Any less serious loss of congruity or a less than complete dislocation

A

Subluxation

65
Q

Most common sites of dislocation

A

Anterior shoulder
Posterior hip
Posterior elbow

66
Q

Treatment of dislocations

A

Assess neurovascular status - closed reduction

Assess neurovascular post reduction as well

67
Q

Elevated blood pressure with no apparent acute end organ damage

A

Hypertensive urgency

68
Q

Management of hypertensive urgency

A

Decrease BP by 25% over 24-48 hours using ORAL agents

69
Q

Drugs used for hypertensive urgencies

A

Clonidine
Captopril
Labetalol
Nicardipine

70
Q

Elevated BP and acute end organ damage - usually systolic blood pressure > 180 and/or diastolic BP > 120

A

Hypertensive emergency

71
Q

Damage that can occur from hypertensive emergency

A

Neurological Damage
Cardiac Damage
Renal Damage
Retinal Damage

72
Q

Management of hypertensive emergency

A

Decrease BP by no more than 25% within the first hour and an additional 15-20% over the next 23 hours using IV agents

73
Q

Drugs used for hypertensive emergency

A

Nicardipine or Clevidipine
Labetalol, Esmolol
Nitroglycerin
Furosemide

74
Q

95% of pulmonary embolus’ arise from:

A

DVTs in the lower extremities above the knee or pelvis

75
Q

Most people who die from PE die from:

A

Subsequent PEs

Not the initial one

76
Q

Most common signs/symptoms of pulmonary embolus

A

Dyspnea, tachypnea

Pleuritic chest pain, hemoptysis

77
Q

Most common predisposing condition for PE

A

Factor V Leiden

78
Q

Physical exam with PE

A

Pulm exam - usually normal, may have rales or a pleural friction rub
+ Homan’s sign

79
Q

Diagnosis of PE

A
  1. Helical CT scan - best initial test
  2. V/Q scan
  3. Pulmonary angiography - gold standard
  4. Doppler ultrasound - lower extremity DVT
80
Q

A normal CXR in the setting of hypoxia is highly suspicious for

A

PE

81
Q

Avascular markings distal to the area of the embolus on CXR

A

Westermark’s Sign

PE

82
Q

Wedge-shaped infiltrate (represents infarction) on CXR

A

Hampton’s Hump

PE

83
Q

S1Q3T3

A

Most specific for PE

84
Q

Management of PE

A
  1. Anticoagulation - LMWH
  2. Warfarin for at least 3 months (apixaban, dabigatran)
  3. IVC filter
  4. Thrombectomy/Embolectomy
85
Q

Prophylaxis of PE

A
  1. Early ambulation in low risk, minor procedures
  2. Elastic stockings/SCD/venodyne boots
  3. LMWH
86
Q

Acetaminophen poisoning treatment

A

Acetylcysteine

Monitor APAP plasma concentration

87
Q

Aspirin poisoning treatment

A

Check serum salicylate level
Induce emesis
Charcoal to bind drug

88
Q

Harmful substance poisonings treatment

A
  1. Avoid emetics
  2. Small amounts of water as diluents
  3. May do activated charcoal
89
Q

General principles of management for substance poisonings

A

Induced vomiting and/or gastric lavage no longer recommended

Activated charcoal

90
Q

Orbital cellulitis is usually secondary to:

A

Sinus infections

91
Q

Orbital cellulitis most commonly occurs in

A

Children

92
Q

Decreased vision, pain with ocular movement, proptosis (bulging eye), eyelid erythema and edema

A

Orbital cellulitis

93
Q

Diagnosis of orbital cellulitis

A

High resolution CT scan

MRI

94
Q

Management of orbital cellulitis

A

IV abx - vancomycin, clindamycin, cefotaxime

EOR Family Medicine (14 decks)

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