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Family Medicine EOR > Urgent Care > Flashcards

Urgent Care Flashcards

1
Q

What are the causes of RUQ pain?

A

biliary or hepatic

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2
Q

What are the clinical features of biliary colic?

A

intense, dull discomfort located in the RUQ or epigastrium

  • associated with nausea, vomiting, and diaphoresis
  • generally lasts at least 30 minutes, plateauing within one hour
  • benign abdmoinal examination
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3
Q

What are the clinical features of acute cholecystitis?

A

prolonged (>4 to 6 hours) RUQ or epigastric pain, fever

-patients will have abdominal guarding and murphy’s sign

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4
Q

What are the clinical features of acute cholangitis?

A

fever, jaundice, RUQ pain

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5
Q

What are the clinical features of sphincter of Oddi dysfucntion?

A

RUQ pain is similar to other biliary pain

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6
Q

What are the clinical features of acute hepatitis?

A

RUQ pain with fatigue, malaise, nausea, vomiting, and anorexia
-patients may also have jaundice, dark urine, and light-colored stools

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7
Q

What are the clinical features of Periphepatitis (Fitz-Hugh-Curtis syndrome)?

A

RUQ pain with a pleuritic component, pain is sometimes referred to the right shoulder

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8
Q

What are the clinical features of liver abscess?

A

fever and abdmoninal pain are the most common symptoms

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9
Q

What are the clinical features of Budd-Chiari syndrome?

A

symptoms include fever, abdominal pain, abdominal distention (from ascites), lower extremity edema, jaundice, gastrointestinal bleeding, and/ore hepatic encephalopathy

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10
Q

What are the clinical features of portal vein thrombosis?

A

symptoms include abdominal pain, dyspepsia, or gastrointestional bleeding

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11
Q

What are the clinical features of acute myocardial?

A

may be associated with shortness of breath and exertional symptoms

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12
Q

What are the clinical features of acute pancreatitis?

A

acute-onset, persistent upper abdominal pain radiating to the back

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13
Q

What are the clinical features of chronic pancreatitis?

A

epigastric pain radiating to the back

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14
Q

What are the clinical features of peptic ulcer disease?

A

epigastric pain or discomfort is the most promient symptom

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15
Q

What are the clinical features of gastroesophagel reflux disease?

A

associated with heartburn, regurgitation, and dysphagia

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16
Q

What are the clinical features of gastritis/gastropathy?

A

abdominal discomfort/pain, heartburn, nausea, vomiting, and hematemesis

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17
Q

What are the clinical features of functional dyspepsia?

A

the presence of one or more of the following: postprandial fullness, early satiation, epigastric pain, or burning

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18
Q

What are the clinical features of gastroparesis?

A

nausea, vomiting, abdominal pain, early satiety, postprandial fullness, and bloating

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19
Q

What are the clinical features of splenomegaly?

A

pain or discomfort in the LUQ, left shoulder pain, and/or early satiety

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20
Q

What are the clinical features of splenic infarct?

A

severe LUQ pain

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21
Q

What are the clinical features of splenic abscess?

A

associated with fever and LUQ tenderness

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22
Q

What are the clinical features of splenic rupture?

A

may complain of LUQ, left chest wall, or left shoulder pain that is worse with inspiration

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23
Q

Where does the pain from an appendicitis localize to?

A

generarlly right lower quadrant

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24
Q

What are the clinical features of appendicitis?

A

periumbicial pain initially that radiates to the right lower quadrant
-associated with anorexia, nausea, and vomiting

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25
Q

Where does the pain of diverticulitis localize to?

A

generally left lower quadrant; right lower quadrant more common in Asiant patients

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26
Q

What are the clinical features of diverticulitis?

A

the pain is usually constant and present for several days prior to presentation
-may have associated nausea and vomiting

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27
Q

Where does the pain of nephrolithiasis localize to?

A

either lower quadrant

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28
Q

What are the clinical features of nephrolithiasis?

A

pain most common symptom varies from mild to severe

-generally, flank pain, but may have back or abdominal pain

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29
Q

Where does the pain from pyelonehritis localize to?

A

either lower quandant

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30
Q

What are the clinical features of pyelonephritis?

A

associated with dysuria, frequency, uregency, hematuria, fever, chills, flank pain, and costovertebral angle tenderness

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31
Q

Where does the pain from acute urinary retention localize?

A

suprapubic

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32
Q

What are the clinical features of acute urinary retention?

A

present with lower abdominal pain and discomfort; inability to urinate

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33
Q

Where does the pain from cystitis localize to?

A

suprapubic

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34
Q

What are the clinical features of cystitis?

A

associated with dysuria, frequency, uregency, and hematuria

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35
Q

Where does the pain from infectious colitis localize to?

A

either lower quadrant

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36
Q

What are the clinical features of infectious colitis?

A

diarrhea is the promident symptom, but may also have assciated abdominal pain, which may be severe

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37
Q

What is an allergic reaction/anaphylaxis?

A

an adverse cutaneous reaction in response to the administration of a drug

  • skin reactions are the most common adverse drug reactions
  • severity can range from mild eruprtions that resolve after the removal of the inciting agent to severe skin damage with multiogran involvment
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38
Q

How is anaphylaxis treated?

A

with epinephrine 1:1000 0.5 - 1 mL given IM or subQ

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39
Q

What are the characteristics of brown recluse spider bites?

A
  • brown violin on the abdomen
  • necrotic wound - local tissue reaction causes local burning at the site for 3-4 hours - blanched area (due to vasoconstriction) - central necrosis erythematous margin around an ischemic center “red halo” - 24/7 hours after hemorrhagic bullae that undergoes Eschar formation - necrosis
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40
Q

What is the tx for brown recluse?

A

for brown spider bites, use wound care, local symptomatic measures, and sometimes delayed excision

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41
Q

What are the characteristics of black widow spider bites?

A
  • red hourglass on the abdomen
  • neurologic manifestations - you may not see much at bite site: toxic reaction: nausea, vomiting, HA, fever, syncope, and convulsions
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42
Q

What is the tx of black widow spider bites?

A

anti-venom available for elderly and kids

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43
Q

What are the venomous insects (stingers)?

A

bee, wasp, hornet, yellow jacket, and fire ant

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44
Q

What is the main treatment to prevent itching of insect bites?

A
  • cool the affected area
  • apply topical calamine lotion or local anesthetic agent
  • oral antihistamine reduces itch and weals
  • use moderate potency topical steroids for papular urticaria or persistent reactions

-bites from insects carrying disease require specific antimicrobial therapy to treat the disease

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45
Q

What is the body percentage for burns?

A
  • rule of 9’s: Head 9%, each arm 9&, chest 9%, abdomen 9%, each anterior leg 9%, each posterior leg 9%, upper back 9%, lower back 9%, genitals 1%
  • palmer method: patient’s palm equates to 1%
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46
Q

What is a first degree burn?

A

sunburn

-erythema of involved tissue, skin blanches with pressure, the skin may be tender

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47
Q

What is a second degree burn?

A

partial thickness

-skin is red and blistered, the skin is very tender

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48
Q

What is a third degree burn?

A

full thickness

-burned skin is tough and leathery, skin non-tender

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49
Q

What is a fourth degree burn?

A

into the bone and muscle

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50
Q

What is a minor burn?

A

<10 TBSA adults, <5 TBSA young/old, <2% full thickness, must not involve face, hands, perineum, feet, cross major joints or be circumferential

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51
Q

What is a major burn?

A

> 25% TBSA adults, >20% TBSA young/old, >10% full thickness burn, burns involving the face, hands, perineum, feet, cross major joints/circumferential

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52
Q

What is the tx of burns?

A

monitor ABCs, fluid repletion, topical antibiotic

  • cleans with mild soap and water, don’t apply ice directly, irrigate chemical burns with running water x 20 min, topical antibiotic cream to superficial burns, fingers and toes wrapped individually to prevent maceration and gauze placed between them
  • children with >10% total body surface area and adults with >15% need fluid resuscitation = LR IV x 24 hrs (1/2 in first 8 hours, 1/2 in remaining 16)
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53
Q

What is heart failure?

A

a syndrome of ventricular dysfunction

  • left ventricular failure causes shortness of breath and fatigue
  • right ventricular failure causes peripheral and abdominal fluid accumulation
  • the ventricles can be involved together or separately
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54
Q

What are the characteristics of heart failure?

A
  • either diastolic or systolic dysfunction can precede CHF
  • ACEI needs to be used ASAP to decrease comorbidity and mortality
  • three specific beta-blockers are used in reducing mortality from heart failure: bisoprolol, carvedilol, metoprolol succinate
  • labs = BNP - released by ventricular tissue in response to elevated ventricular pressure, low levels are seen in obese individuals
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55
Q

What are the characteristics of systolic left heart failure?

A
  • systolic - S3 (rapid ventricular filling during early diastole in the mechanism responsible for the S3)
  • dilated thin-walled weak left ventricle: often due to CAD or heart attack which causes the muscle to die
  • dyspnea, PND, orthopnea, rales, crackles, displaced downward and to the left apical impulse
  • dilated left ventricle and a low ejection fraction <40%
  • treat with Ace inhibitor + beta-blocker + loop diuretic
  • systolic left heart failure is diagnosed and treated based on class: Class I, II, III and IV and patients can go from controlled class I to poorly controlled and worsening class II, III, or IV and back
  • acute worsening of heart failure: O2 + Ace + stop beta-blocker + start nitroglycerine and a double dose of diuretic IV (once stable go back on beta-blocker and PO loop diuretics
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56
Q

What are the characteristics of diastolic left heart failure?

A
  • diastolic - S4
  • hypertrophic thick-walled left ventricle with impaired relaxation
  • increases over 55 years of age, commonly in patients with hypertension
  • patients will have problems when blood pressure increase, often when patients forget to take their medications
  • dyspnea and rales with an apical heave or lift
  • ejection fraction is usually normal
  • treat with Ace inhibitor + beta blocker or CCB (do not use diuretics in stable chronic diastolic failure)
  • never use digoxin for diastolic heart failure
  • acute = same as systolic heart failure = Ace inhibitor + loop diuretic IV + NTG + O2
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57
Q

What are the characteristics of right heart failure (right ventricle)?

A
  • causes: pulmonary HTN - the right heart is unable to easily pump blood into the lungs, the most common cause of right heart failure is left heart failure
  • no rales, JVD, and leg edema
  • diagnose with echo and doppler, gold standard is high heart cardiac catheterization
  • treat the underlying condition
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58
Q

What are the characteristics of high output cardiac failure?

A
  • caused by increased metabolic demand - metabolic demand is higher than the heart can pump at maximum
  • hyperthroidism
  • severe anemia
  • beriberi or thiamine deficiency
  • will have tachycardia at first but once the heart tires it will look like systolic failure because the heart will dilate and weaken
  • treat like heart failure and acute CHF, treat the underlying condition
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59
Q

What are the characteristics of deteriorating mental status/unconscious patient?

A

level of consciousness is evaluated by attempting to wake patients first with verbal commands, then with non-noxious stimuli, and finally with noxious stimuli (eg, pressure to the supraorbital ridge, nail bed, or sternum)

  • the Glasgow Coma Scale was developed to asses s patients with head trauma
  • for head trauma, the score assigned by the scale is valuable prognostically
  • for coma or impaired consciousness of any cause, the scale is used because it is a relatively reliable, objective measure of the severity of unresponsiveness and can be used serially for monitoring
  • asymmetric motor responses to pain or deep tendon reflexes may indicate a focal hemispheric lesion
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60
Q

How does the scale assign points?

A

based on responses to stimuli

  • eye-opening
  • facial grimacing
  • purposeful withdrawal of limbs from a noxious stimulus indicate that consciousness is not greatly impaired
  • E + V + M = score
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61
Q

What is confusion?

A

a behavioral state of reduced mental clarity, coherence, comprehension, and reasoning

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62
Q

What is drowsiness?

A

the patient cannot be easily aroused by touch or noise and cannot maintain alertness for some time

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63
Q

What is lethargy?

A

depressed mental status in which the patient may appear wakeful but has depressed awareness of self and environment globally; cannot be aroused to full function

64
Q

What is stupor?

A

the patient can be awakened only by vigorous stimuli, and an effort to avoid uncomfortable or aggravating stimulation is displayed

65
Q

What is coma?

A

the patient cannot be aroused by stimulation and no purposeful attempt is made to avoid painful stimuli

66
Q

What is delirium?

A

acute onset of fluctuating cognition with impaired attention and consciousness, ranging from confusion to stupor

67
Q

What are the causes of altered level of consciousness?

A

AEIOU TIPS

  • alcohol or AAA
  • electrolytes, endocrine
  • insulin
  • opiates
  • uremia
  • trauma, temperature, or toxemia
  • infections - sepsis, meningitis
  • psychogenic or pulmonary embolus
  • space occupying lesions, strokes, shock, seizure
68
Q

What are the reversible causes of unconscious patient?

A
  • hypoglycemia (check glucose, give dextrose)
  • opiate overdose (trial of naloxone)
  • thiamine deficiency (trial of thiamine)
  • consider head CT for any patient with unclear etiology or neurologic abnormality
  • consider empiric antibiotics in patients with fever of unclear etiology
69
Q

What is a foreign body aspiration?

A

presentation (depends on the location of obstruction)

  • inspiratory stridor if high in the airway
  • wheezing and decreased breath sounds if low in the airway
70
Q

What are the complications of foreign body aspiration?

A

pneumonia, acute respiratory distress syndrome, asphyxia

71
Q

What is the treatment of foreign body aspiration?

A

remove foreign body with a bronchoscope

72
Q

What are upper extremity disorders?

A
  • shoulder fractures/dislocations

- fractures and dislocations of the forearm, wrist, and hand

73
Q

What are disorders of the hip?

A

fractures and dislocations of the hip

74
Q

What are disorders of the knee?

A

fractures and dislocations of the knee

75
Q

What are disorders of the ankle and foot?

A

fractures and dislocations of the ankle and foot

76
Q

What is hypertensive urgency?

A

persisten asymptomatic SBP > 220 and/or diastolic > 125

77
Q

What are the characteristics of hypertensive urgency?

A
  • plus optic disc edema, progressive target organ complications, and severe perioperative hypertension
  • mut be reduced within a few hours
  • parenteral drug therapy is not required and the goal is a partial reduciton of blood presssure with a relief of symptoms
  • TX with Clonidine
78
Q

What is hypertensive emergency?

A

increase BP + target organ damage DBP >130

79
Q

What are the characteritics of hypertensive emergency?

A
  • BP must be reduced in 1 hour to avoid morbidity or death
  • TX with Nicardipine IV - most potent and longest acting calcium channel blocker with potential to precipitate reflex tachycardia and should be used with a beta-blocker such as Labetalol (labetalol used in pregnancy)
  • reduce pressure by no more than 25% within 1-2 hours and then towards 160/100 within 2-6 hours
  • if reduced too fast may precipitate coronary, renal or cerebral ischemia
  • avoid the use of sublingual or oral fast-acting nifedipine
80
Q

What is malignant hypertension?

A

sustained elevated arterial blood pressure

81
Q

What are the characteristics of malignant hypertension?

A
  • DBP >130
  • SBP >200
  • characterized by encephalopathy or nephrophathy with papilledema
  • treatment is identical to that of hypertensive emergencies
82
Q

What are the pearls of Hydrocarbons (benzene, petroleum distillates, gasoline) ingestion?

A
  • mucosal irritation
  • vomiting, bloody diarrhea
  • cyanosis, respiratoy distress, fever, tachycardia
83
Q

How is ingestion of Hydrocarbons (benzene, petroleum distillates, gasoline) dx?

A
  • CXR
  • Urinalysis
  • EKG
84
Q

What is the tx for ingestion of Hydrocarbons (benzene, petroleum distillates, gasoline)?

A
  • avoid emetics and lavage
  • oxygen with mist
  • antibiotics if pneumonia develops
85
Q

What are the pearls of Bases (Clorox, Drano) ingestion?

A
  • irritated mucous membranes
  • stomach perforation, hepatotoxicity
  • respiratory distress secondary to edematous epiglottis
86
Q

What is the dx for ingestions of Bases (Clorox, Drano)?

A

EGD to determine the degree of damage to larynx, esophagus, stomach

87
Q

What is the tx for ingestion of Bases (Clorox, Drano)?

A
  • small amounts of water (diluent)
  • avoid vomiting
  • supportive care
88
Q

What are the pearls of ingestion of Acetaminophen (Tylenol)?

A
  • especially in depressed patients, acetaminophen converted to free radicals - liver necrosis (occurs in the hypoxic area around central veins, called zone III)
  • hepatic failure: elevated LFTS
89
Q

How is ingestion of Acetaminophen (Tylenol) dx?

A
  • monitor APA plasma concentration (nomogram)

- LFTs - nonemergent

90
Q

What is the tx for ingestion of Acetaminophen (Tylenol)?

A
  • gastriv lavage - only works in the first hour
  • charcoal - prevents enteophepatic recirculation, but only works <2 h of ingestion
  • N-acetylcysteine (antidote): increases glutathione levels, which acts as a neutralized or free radicals 4-h APAP levels to determine respone to therapy
91
Q

What are the pearls of ingestion of Aspirin (salicylates)?

A
  • vomiting
  • hyperpnea, pulmonary edema
  • fever
  • encephalopathy, convulsions, coma
  • renal failure
92
Q

How is the ingestion of Aspirin (salicylates) dx?

A
  • check serum salicylate level
  • look for metabolic acidosis and hypokalemia
  • high or reduced serum glucose
93
Q

What is the tx for ingestion of Aspirin (salicylates)?

A
  • induce emesis
  • charcoal to bind the drug
  • correct dehydration with IVF
  • hemodialysis
94
Q

What are the pearls of ingestion of Organophosphates (chlorthion, diazinon)?

A
  • salvation, lacrimation
  • sweating
  • urination, diarrhea
  • pulmonary congestion
  • twitching, convulsions, coma
  • miosis
95
Q

How is ingestion of Organophosphates (chlorthion, diazinon) dx?

A
  • measure red cell cholinesterase levels

- blood glucose levels

96
Q

What is the tx of ingestion of Organophosphates (chlorthion, diazinon)?

A
  • ABCs
  • Decontamination of skin
  • Atropien + pralidoxime
97
Q

What are the pearls of ingestion of iron?

A
  • intestinal bleeding
  • impaired coagulatino
  • shock, coma
  • red urine
98
Q

How is iron ingestion dx?

A
  • blood indices
  • metabolic panel: acidosis
  • UOP
  • type and screen
  • LFTs
99
Q

What is the tx of iron ingestion?

A
  • evoke emesis
  • gastic lavage
  • whole-bowel irrigation
  • deferozamine
  • dialysis
100
Q

What are the pearls of ingetion of mercury?

A
  • overconsumption of fish
  • diarrhea, constricted visual fields, peripheral neuropathy, hyperhidrosis (sweating)
  • renal failure
  • tachycardia, hypertension,
101
Q

What is the tx for ingestion of mercury?

A

chelating agents (succimer, dimercaprol, penicillamine)

102
Q

What are the pearls of ingestion of lead?

A
  • ingestion of lead-based paint, working with batteries or working with lead-based casting material
  • neuropathy and renal failure
103
Q

How is ingetion of lead dx?

A
  • blood indices
  • all childen should be screened with a blood lead test at ages 12 and 24 months or at ages 36-72 months if they have not previously been screened
104
Q

What is the tx for ingestion of lead?

A

chelating agents (succimer, dimercaprol)

105
Q

What are the pearls for ingestion of arsenic?

A
  • pesticides or containated groundwater

- severe headahces, abdominal pain, diarrhea, delirium, convulstions, and breath that smells like garlic

106
Q

How is ingestion of arsenic dx?

A
  • the urine test is the most reliable test for arsenic exposure withtin the last few days
  • urine testing needs to be done within 24-48 hours for accurate analysis of acute exposure
  • tests on hair and fingernails can measure exposure to high levels of arsenic over the past 6-12 months
107
Q

What is the tx for ingestion of arsenic?

A

chelating agents (succimer, dimercaprol)

108
Q

What are the pearls of carbon monoxide ingestion?

A
  • house fires and automobile exhause ingestion
  • headache, cherry-red skin
  • lactic acidosis due to hypoxia
109
Q

How is ingestion of carbon monoxide dx?

A

serum for carbon monoxide

110
Q

What is the tx of carbon monoxide ingestion?

A
  • 100% O2

- hyperbaric oxygen

111
Q

What are the pearls of cyanide ingestion?

A
  • house fires
  • cyanide - produced form the combustion of furnitue materials
  • coma, seziure
  • heart dysfunction
  • metabolic acidosis and breath that smeels like bitter almonds
112
Q

How is ingestion of cyanide dx?

A
  • blood gasses - cyandie toxicity is characterized by normal arterial oxygen tension and an abnormally high venous oxygen tension, resulting in a decreased arteriovenous oxygen difference (<10%)
  • a high anion-gap metabolic acidosis is a hallmark of significnat cyanide toxicity
  • serum study for cyanide
113
Q

What is the tx for ingetsion of cyanide?

A
  • nitrited to oxidize Hb to Met-Hb which has a higher affinity for CN - (protecting cytochrome oxidase)
  • thiosulfate to bind cyanide for renal excretion as thiocyanate
114
Q

What is a non-ST-segment elevation (NSTEMI)?

A

a myocardial necrosis (evidenced by cardiac markers in the blood; troponin I or troponin T and CK will be elevated) WITHOUT acute ST-segment elevation or Q waves

115
Q

What are the characteristics of NSTEMI?

A
  • ECG changes such as ST-segment depression, T-wave inversion or both may be present
  • coronary artery not completely blocked
  • subendocardial infarct
  • cardiac markers will be elevated
116
Q

What are the cardiac markers for NSTEMI?

A
  • troponin is most sensitivity and specific appears at 2-4 hours, peaks 12-24 hours and lasts for 7-10 days
  • CK/CK-MB appears at 4-6 hours, peaks at 12-24 hours and returns to normal within 48-72 hours
  • Myoglobin (Mb) is used less than the other markers and appears at 1-4 hours, the peak is 12 hours, and returns to baseline levels within 24 hours
117
Q

What is the tx for a NSTEMI?

A

Beta blocker + NTG + aspirin and clopidogrel + heparin + ACEI + statins + reperfusion

  • reperfusion via percutaneous coronary intervention (not thrombolysis)
  • less time-senstiive than in STEMI
118
Q

What is a ST-segment elevation myocardial infarction (STEMI)?

A

is myocardial necrosis (evidenced by cardiac markers in the blood; troponin I or troponin T and CK will be elevated) WITH acute ST-segment elevation or Q waves

119
Q

What are the characteristics of a STEMI?

A
  • coronary artery completely blocked; full thickness of myocardial wall involved
  • ECG shows ST elevation, possible Q waves
120
Q

What are the EKG findings for anterior wall infarcation?

A

Q waves and ST elevation in lead I AVL, and V2 to V6

121
Q

What are the EKG findings for inferior wall infarcation?

A

Q waves and ST elevation in leads II, III, and AVF

122
Q

What are the EKG findings for lateral wall infarction?

A

ST elevation in the lateral leads (I, aVL< V5-6), reciprocal ST depression in the inferior leads (III and aVF)

123
Q

What are the EKG findings for posterior wall infarction?

A

ST depressions in V1 to V3

124
Q

What is the tx for a STEMI?

A

beta blockers + NTG + aspirin and clopidogrel + heparin + ACEI + statins + reprofusion

  • aspirin and clopidogrel are given at once
  • very time sensitive - immediate (within 90 minutes) coronary angiography and primary PCI
  • thrombolytic therapy within the first 3 hours if PCI not available
125
Q

What are the absolute contraindications for fibrinolytic used in STEMI?

A
  • prior intracranial hemorrhage (ICH)
  • known structural cerebral vascular lesion
  • known malignant intracranial neoplasm
  • ischemic stroke within 3 months
  • suspected aortic dissection
  • active bleeding or bleedign diathesis (excluding menses)
126
Q

What is orbital cellulitis?

A

decrease extraocular movement, pain with movement of the eye and proptosis, signs of infection

  • often assocaited with sinusitis
  • occurs more often in children than adults - ages 7-12 y/o
  • decreased vision is a rare manifestation of orbital cellulitis
  • CT scan of orbits (confirmatory)
127
Q

What is the tx of orbital cellulitis?

A

hospitalization and IV broad-spectrum antibiotics (vancomycin)

128
Q

What is a pneumothorax?

A

absence of breath sounds and hyperresonance to percussion wth tracheal deviation

129
Q

What is a primary spontaneous pneumothorax?

A

occurs in the absence of underlying disease - tall, thin males between 10 and 30 years of age are at the greatest risk of primary pneumothorax

130
Q

What is a secondary spontaneous pneumothorax?

A

occurs in presence of underlying disease - asthma, COPD, cystic fibrosis, interstitial lung disease

131
Q

What is a tension pneumothorax?

A
  • etiology: penetrating injury
  • physical exam: hyperresonance to percussion and trachel shift to the contralateral side
  • small pneumothoraces <15% of the diameter of the hemithroax will resolve spontaneously without the need for chest tube placement
  • for large, >15% of the diatmeter of hemithorax, and symptomatic pneumothoraces, chest tube placement is performed
  • patients should be followed with serial CXR every 24 hours until resolved
132
Q

What are the symptoms of a pulomary embolus?

A

dyspnea (most common) and pleuritic chest pain

133
Q

What is virchow’s triad for pulmonary embolus?

A

hypercoagulable states, venous stasis, vascular injury

134
Q

What are the risk factors for a pulmonary embolus?

A

cancer, surgery, oral contracpetive pills, pregnancy, long bone fracture (fat emboli)

135
Q

What is Homan’s sign for pulmonary embolus?

A

dorsiflexion of the foot causes pain in calf - indicative of deep vein thrombosis

136
Q

What are the EKG findings for a pulmonary embolus?

A

tachycardia (most common), ST changes, S1Q3T3 (indicates cor pulmonale)

137
Q

What imaging is done for pulmonary embolus?

A
  • spiral CT: best initial test
  • gold standard is pulmonary arteriography
  • chest radiograph: Westermark’s sign and Hampton’s Hump - triangular infiltrate secondary to intraparenchymal hemorrhage
  • treatment: heparin to coumadin bridge, 3-6 mo treatment
138
Q

What is acute respiratory distress syndrome (ARDS)?

A
  • Etiology: sepsis, severe trauma, aspiration of gastic contents, near-drowing
  • Presentation: rapid onset of profound dyspnea occurign 12-24 hours after the precipitating event and tachypnea, pink frothy sputum, crackles
139
Q

What are the diagnsotic studies for ARDS?

A
  • chest readiograph: air bronchograms and bilaterally fluffy infiltrate
  • normal BNP, pulomary wedge pressure, left ventricle function and echocardiogram
140
Q

What is the tx for ARDS?

A

underlying cause and intubation positive pressure oxygen

141
Q

What is the difference between a sprian and a strain?

A

a sprain involved ligaments and a strain involves muscles and tendons

  • the symptoms of a sprain and a strain are very similar
  • that’s because the injuries themselves are very similar
142
Q

What is a sprain?

A

a joint sprain is the overstretching or tearing of ligaments

  • ligaments connect two bones together
  • the most common location for a sprain is the ankle joint
  • symptoms include pain, bruising, swelling, limited flexibility, decrease ROM
143
Q

What is a strain?

A

a joint strain is the overstretching or tearing of muscle sor tendons

  • tendons connect bones to muscles
  • the most common locations for a muscle strain are teh hamstring muscles and the lower back
  • symptoms include pain, muscle spasms, swelling, limited flexibility, decrease ROM
144
Q

How is a sprain/strain dx?

A

often clinical = X-ray or MRI

145
Q

What is the tx for a sprain/strain?

A

RICE, NSAIDs

-more severe strains and sprains may require surgery to repair damaged or torn ligaments, tendons or muscles

146
Q

What is abruptio placentae?

A

premature separtion of the placenta from the uterine wall

-presents as heavy painful vaginal bleeding in teh 3rd trimester

147
Q

What is the tx of abruptio placentae?

A

delivery of the fetus and placenta is the definitive treatment, blood type, crossmatch, and coag studies as well as placement of large-bore IV line
-cesarean section most often is the preferred route for delivery

148
Q

What is placenta previa?

A

a condition in which the placenta lies very low in the uterus and covers all or part of the cervix
-placenta previa happens in about 1 in 200 pregnancies

149
Q

What is complete previa?

A

placenta completely covers the internal os

150
Q

What is partial previa?

A

placenta covers a portion of the internal os

151
Q

What is marginal previa?

A

the edge of placenta reaches the margin of the os

152
Q

What is low-lying placenta?

A

implanted in the lower uterine segment in close proximity but not extending to the internal os

153
Q

What is vasa previa?

A

fetal vessel may lie over the cervix

154
Q

What is the presenation of placenta previa?

A

painless vaginal bleeding - usually occurs after 28 weesk of gestation (third trimester bleeding)

  • bleeding from placenta previa results from small disruptions in placental attachment during normal development and thinning of the lower uterine segment during third-trimester = may stimulate further uterien contractions = further placental separation and bleeding
  • fetal complications assocaited with Previa: preterm delivery and its complications, preterm PROM, intrauterine growth restriction, malpresentation, vasa previa, congenital abnormalities
155
Q

What are the RF for placenta previa?

A

prior c-section, multiple gestations, multiple induced abortions, advanced maternal age

156
Q

How is placental previa dx?

A

ultrasound (transvaginal) - vaginal exam contraindicated - a digital exam can cause further separation

157
Q

What is the tx of placenta previa?

A

strict pelvic rest (no intercourse) and modified bed rest, no vigorous exercise

  • a blood transfusion may be necessary so get a type and screen if you discover previa vis U/S
  • C-section is preferred delivery
  • Give Rhogam if Rh-
  • Some stuides show that delivery between 34-37 weeks may be optimal

Family Medicine EOR (14 decks)

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