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primary care > Urgent Care > Flashcards

Urgent Care Flashcards

1
Q

Systemic or Pulmonary insult that leads to pulmonary edema, alveolar collapse, and hypoxemia is known as _____.

A

ARDS

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2
Q

Sepsis, severe trauma, and aspiration of gastric contents are leading causes of ______ (hypoxemia refractory to O2 + organ failure).

A

ARDS

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3
Q

_____ (Prone/Supine) position helps to improve oxygenation in patients with ARDS.

A

Prone

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4
Q

The MC cause of cardiac failure is _____ (chronic condition).

A

CAD

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5
Q

Chronic causes of cardiac failure include:

A
  1. Dilated cardiomyopathy

2. Valvular dz

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6
Q

The most common rhythms seen in cardiac arrest are:

A
  1. V tach
  2. V fib

(also PEA and asystole)

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7
Q

Reversible causes of cardiac arrest include:

*Hint- H’s & T’s

A
  • Hypovolemia
  • Hypoxia
  • Hydrogen ion (acidosis)
  • Hypo-/hyperkalemia
  • Hypothermia
  • Tension PTX
  • Tamponade, cardiac
  • Toxins
  • Thrombosis, pulmonary
  • Thrombosis, coronary
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8
Q

____ is a normal GCS and ____ indicates severe TBI and the need for intubation.

A
  • 15–> normal

- < 8–> INTUBATE!

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9
Q

Give _____ then glucose when a patient is hypoglycemic with hx of EtOH abuse or malnutrition.

A

Thiamine

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10
Q

If you suspect an elevated ICP then elevate the head of bed 30 degrees and give _____ (drug).

A

Mannitol

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11
Q

Treatment of a local allergic reaction involves:

A

Ice, elevation, remove stinger, tylenol, ibuprofen

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12
Q

Treatment of urticaria involves:

A

Antihistamines, PO steroids (prednisone, medrol), consider EPI

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13
Q

Treatment of bronchospasm involves:

A
  1. Mild–> Moderate: Albuterol, parenteral steroids (methylprednisolone/solumedrol)
  2. Moderate–> Severe: Parenteral beta agonist (epinephrine), consider intubation
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14
Q

Treatment of Hypotension involves:

A
  • Etiology: histamine, PGE, and leukotrienes vasodilate peripheral vessels, inc capillary endothelial permeability and 3rd spacing
  • Treatment: IV NS or LR bolus, EPI or NE infusion; consider vasopressors (DA) for refractory hypotension
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15
Q

Treatment of Anaphylaxis involves:

A

-Etiology: IgE mediated

Treatment:
1. RSI, 2 large-bore IVs, continuous pulse ox, cardiac monitor

  1. Parenteral beta agonist (EPI), antihistamines, and glucocorticoids, IVF
  2. Obstructive Angioedema: Cricothyrotomy
    - Contraindicated if < 8 y/o
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16
Q

How is free air on CXR under the diaphragm and free fluid that is not ascites treated?

A

Urgent surgical referral!

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17
Q

What ABX are used for acute abdomen?

A
  • Levaquin-Flagyl combo
  • Zosyn
  • Also give aggressive IVF (1 L NS or LR per hr)
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18
Q

____ burns are the MC type.

A

Scald

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19
Q

_____ (treatment) is recommended for circumferential burns to prevent compartment syndrome.

A

Escharotomy

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20
Q

____ is used to treat superficial burns while _____ is used to treat 2nd-3rd degree burns (not including pregnant, <2mo, and face).

A
  1. Superficial- aloe vera and bacitracin

2. 2nd-3rd degree- Silvadene

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21
Q

What is the Parkland Formula?

A

Use to calculate IV Fluids for burns > 10%.

LR 4cc x Wt. (kg) x %BSA= amount given in 24hrs
-Half over first 8 hrs, half over subsequent 16 hrs

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22
Q

The treatment for chemical burns entails:

A

Continuous irrigation with H2O until pH= 7

*Ocular burns- Irrigate ASAP with NS or LR w/ morgan lens for at least 30 min. ABX- moxifloxacin and cycloplegics

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23
Q

Small surface injuries that may be associated with devastating internal injuries are related to which type of burn?

A

Electrical

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24
Q

Lichtenberg (fern like dendritic pattern on skin) is associated with what type of injury?

A

Lightning strike

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25
Q

____ is the MC cause of death in smoke inhalation pts

A

PNA

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26
Q

Injury ABOVE the glottis is MC caused by ____.

A

Heat

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27
Q

Injury BELOW the glottis is MC caused by _____.

A

Chemical injury

*Dx- fiberoptic bronchoscopy

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28
Q

How are inhalation injuries managed?

A

Mostly supportive: humidified O2, pulm physiotherapy, mucolytics, and bronchodilators

Consider intubation IF- copious secretions, laryngeal edema

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29
Q

Cherry red skin color, agitation, and AMS with a potentially normal PaO2 and SaO2 are signs of _____.

A

Carbon monoxide poisoning

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30
Q

How do you treat CO poisoning?

A

100% O2

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31
Q

What are common OB causes of 3rd trimester bleeding (after 28 weeks)?

A
  1. Abruptio placentae (MC)- premature separation of placenta–> abdominal pain and dark red blood
  2. Placenta previa- placenta covers opening of cervix–> profuse, painless, bright red bleeding
  3. Vasa previa- fetal blood vessels near opening of uterus–> painless vaginal bleeding w/ fetal distress
  4. Uterine rupture
  5. Premature labor
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32
Q

What are non-OB causes of 3rd trimester bleeding?

A

Genital tract lesions, infections, intercourse, friable cervix, cervical carcinoma

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33
Q

Rules for suturing areas of bites…

A
  1. YES if: clinically NOT infected, <12 hrs old (<24 hrs on face), NOT on hand or foot
  2. NO if: high risk for infection (crush injury, puncture wound, human/cat bite (unless on face), immunocompromised patient)
34
Q

What is the treatment of choice for foreign body aspiration?

A

Bronchoscopy- used for object removal

35
Q

What’s the study of choice for an occult hip fx?

A

MRI

36
Q

What’s the study of choice for a pelvic, facial, or intraarticular fx?

A

CT

37
Q

What IV abx are used for open fractures?

A

1st-2nd gen cephs and aminoglycosides

*Don’t forget tetanus shot!!

38
Q

Common sites of dislocations?

A

Anterior shoulder, posterior hip, posterior elbow

39
Q

Key features of Stable Angina are:

A
  1. Substernal CP (pressure, burning, tightness)
  2. Brought on by exertion
  3. Nonpleuritic
  4. Usually < 30 min, typically 1-5 min
40
Q

How is stable angina managed?

A

Rest or NTG

41
Q

Unstable angina, NSTEMI, and STEMI all fall under the umbrella of ______.

A

ACS- Acute Coronary Syndrome

42
Q

UA and NSTEMI can be distinguished from STEMI by:

A
  1. UA and NSTEMI- subtotal occlusion; STEMI- TOTAL OCCLUSION
  2. UA and NSTEMI- ST depressions and/or T wave inversions; STEMI- ST elevations
43
Q

Cardiac enzymes are _____ (positive/negative) in cases of UA and are ______ (positive/negative) in cases of NSTEMI.

A

UA= negative cardiac enzymes

NSTEMI= positive cardiac enzymes

44
Q

The MC cause of MI is:

A

Atherosclerosis- acute plaque rupture causing coronary thrombosis

45
Q

The S/s of ACS include:

A
  • Retrosternal “pressure” usually > 30 min!

- NOT RELIEVED WITH REST/NITRO

46
Q

Silent MIs….

A

About 25% of MIs

  • More common in women, elderly, DM, and obese
  • S/s= abdominal, jaw pain, or dyspnea w/o CP
47
Q

Natural STEMI progression on EKG=

A

Peaked T waves–> ST elevations–> Q waves–> T wave inversions

48
Q

The most sensitive and specific cardiac marker for NSTEMI/STEMI is _____.

A

Troponin

*Can also be elevated in cases of renal failure, advanced HF, acute PE, and CVA

49
Q

How are cases of UA and NSTEMI managed?

A
  1. Antithrombotic Therapy
  • Antiplatelet Meds
    a. ASA
    b. ADP Inhibitors (Clopidogrel)
    c. GP II/IIIa Inhibitors (Eptifibatide)
  • Anticoags
    a. Unfractioned Heparin
    b. LMWH (ADR: thrombocytopenia; renal dose)
  1. Adjunctive Therapy and Assess RFs (TIMI)a. BBs (see p. 10 for CIs)
    b. Nitrates
    c. Morphine
    d. CCBs (DOC for vasospastic disorders)
50
Q

How are STEMIs managed?

A
  1. Reperfusion treatment
    - Do w/in 12 hours; either with PCI or thrombolytics
    - PCI best within 3 hours of symptom onset- ideally 90 min.
    - Door to thrombolytics- 30 min.
  2. Antithrombotics
    - ASA- chew, dec. mortality by 20%
    - Heparin
  3. Adjunctive therapy
    - BBs
    - ACEI
    - Morphine
    - K+ and Mg+ repletion, Statin therapy, Monitor BP, glucose, reduce RFs
51
Q

What are the indications for CABG v. PCI?

A

CABG:

  • > 3 vessel dz.
  • L main coronary artery
  • Decreased LV EF
52
Q

____ is DOC in cocaine-induced MI and _____ (drug) should be avoided.

A

CCB= DOC

-AVOID BB b/c of vasospasm

53
Q

You want to avoid IV ____ and _____ in cases of R Ventricular (Inferior) MI because these drugs may drop preload.

A

Nitrates and Morphine

54
Q

If CP began 12+ hours ago you want to proceed with conservative management which entails:

A

ASA +/- Clopidogrel x 9 months, statin, BB, ACEI, Nitro PRN

55
Q

What is a TIMI score and what is considered a high risk?

A

Risk score to assess risk of death and ischemic events in pts with UA/NSTEMI to determine benefit of invasive angiography to reduce mortality

Score ≥ 3 = high risk!

56
Q

Absolute CIs for use of Thrombolytics in ACS are:

A
  • Intracranial hemorrhage
  • Non-hemorrhagic stroke w/in 6 months
  • Head/face trauma w/in 3 months
  • Intracranial neoplasm
  • Aneurysm
  • AVM

-p. 11 for relative CIs

57
Q

Transient ST segment elevations often seen in females > 50y/o and smokers and are associated with hyperventilation, emotional stress, and cold weather are known as ______.

A

Variant Angina

58
Q

Management of Variant Angina and Cocaine-induced MI include:

A

CCBs or Nitro

-ASA, heparin, and benzos (for cocaine-induced MI) may be given until atherosclerotic dz is ruled out

59
Q

Increased BP with NO acute end organ damage is known as a ______.

A

Hypertensive Urgency

60
Q

HTN Urgency is treated with:

A

Clonidine or Captopril to decrease BP by 25% over 24-48 hours

Goal= < 160/100mmHg

61
Q

Increased BP WITH acute end organ damage and BP > 180/120 is known as a ______.

A

HTN Emergency!

62
Q

HTN Emergency managed by:

A

Decreased BP by 25% w/in the 1st hours and additional 5-15% over next 23 hours with IV meds

63
Q

What medications do you want to use for an acute aortic dissection?

A

Esmolol, Labetalol

64
Q

What medications do you want to use for HTN encephalopathy?

A

Nicardipine, Clevidipine, Labetalol

65
Q

Classic triad for PE includes:

A

Dyspnea, Pleuritic CP, and Hemoptysis

66
Q

MC predisposing condition for PE is _____.

A

Factor V Leiden

67
Q

BREATHS acronym for suspected PE

A 
Blood in sputum
Room air sat < 95%
Estrogen or OCP use
Age > 50 y/o
Thrombotic event in past- PE or DVT, Trauma
HR > 100bpm
Surgery in last 4 weeks

*PERC Criteria- if all the above are negative you effectively r/o PE

68
Q

Workup for PE:

A

PE likely–> CT scan!

*If CT scan is indeterminate then Pulmonary Angiography is the GOLD STANDARD (can also do LE US–> 70% of patients will also have DVT)

PE UNlikely–> D-dimer
-If negative then VTE/PE excluded

69
Q

EKG findings associated with PE:

A
  • Sinus tach and nonspecific ST/T changes MC

- S1Q3T3 most specific–> wide deep S in lead I; isolated Q and T wave inversion in lead III

70
Q

Management of Stable PE:

A

IV UFH or SQ LMWH–> PO Warfarin or NOAC at least 3 months

*No PTT monitoring with LMWH (protamine sulfate is antidote to UFH and LMWH)

**If anticoag CI–> IVC filter

71
Q

Management of UNstable PE:

A

Thrombolytic treatment: tPA (CI if CVA or internal bleed within 2 months)

If Thrombolytics CI–> embolectomy

72
Q

When is PE prophylaxis warranted?

A

Preop patients w/ prolonged immobilization, pregnant, hx of prior DVT/PE

*LMWH: used if undergoing ortho, neuro sx, trauma

73
Q

What are the 3 types of PTX?

A
  1. Spontaneous- Due to bleb rupture
    a. Primary- NO underlying lung dz; tall and thin men
    that are 20-40, smokers, FHx of PTX
    b. Secondary- underlying lung disease w/o trauma
    (COPD, asthma)
  2. Traumatic- iatrogenic: CPR, thoracentesis, PEEP,
    subclavian line placement, trauma
  3. Tension- increased JVP, pulsus paradoxus, HYPOtension
74
Q

Management of PTX involves:

A
  • Observe at least 6 hours w/ repeat CXR to affirm no progression +24-48 hr f/u
  • If primary, spontaneous, and small then observation is okay. Usually resolves w/in 10 days.

*Chest tube placement if large or severe symptoms

**NEEDLE ASPIRATION for Tension PTX–> chest tube

75
Q

Ingesting harmful substances

A

p. 14-15!

76
Q

Orbital cellulitis…

A
  • Usually secondary to sinus infxn (ethmoid 90%)–> S. aureus, S. pneumo, GABHS, H. flu
  • May be caused by dental/facial infxns
  • MC in kids 7-12
  • S/s: decreased vision, pain with eye movement, proptosis, eyelid erythema, and edema
77
Q

How is orbital cellulitis diagnosed?

A

CT scan or MRI

78
Q

How is orbital cellulitis treated?

A

IV ABX- Vancomycin, clindamycin, cefotaxime

79
Q

What is preseptal cellulitis?

A

Infection of eyelid and periocular tissue. May have ocular pain and swelling but NO visual changes and NO pain with eye movement

80
Q

How is preseptal cellulitis treated?

A

Amoxicillin

primary care (12 decks)

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