UW 1 Flashcards
What exam should be done w/Clavicular Fx and why?
Neurovascular to R/O damage to vessels
- Close proximity of Subclavian artery and brachial plexux
Pt with clavicular fx and bruit heard by clavicle?
Do angiogram to check vessel damage
How does shoulder appear in clavicular fx?
Shoulder is displaced inferiorly and posteriorly
Post op cardiac surgical pt w/fever, tachycardia, chest pain, leukocytosis, sternal would drainage?
Acute Mediastinitis
How does Acute mediastinitis occur?
Complication of cardiac surgery due to intraoperative wound contamination
- w/in 14 days post op
How does CXR look for acute mediastinitis?
Widened mediastinum
Tx for acute mediastinitis?
Surgical debridement
Drainage
Abx
What murmur is common post CABG?
A-fib
Tx w/rate control
Anticoagulate if > 24 hrs
Septal Perforation
Self-inflicted (nose picking) rhinoplasty Syphillis TB Cocaine Sarcoidosis Wegener's
Whistling noise heard during respiration?
Nasal septum perforation b/c of sepal hematoma thru septal abscess (post op)
When do we surgically treat Aortic stenosis?
SAD
Syncope
Angina
Dyspnea (CHF)
What is surgery for Aortic stenosis?
Aortic valve replacement
Indications for Aortic valve replacement?
Symptomatic pts
Pts w/severe AS undergoing CABG/valvular surgery
Asymptomatic pt with severe AS - poor LV fnc, LVH >15mmHg, valve area < 0.6 cm or abnormal response to exercise
Placenta previa?
Painless 3rd trimeter bleeding, bleeding w/out ctx
Risk factors: C-section (previous), prior PP, multiparity, advanced age
Dx for placenta previa?
Transabdominal sonography
Sudden onset abdominal pain and bleeding, hyperventilation, agitation, tachycardia?
Uterine Rupture - most common during labor
Painless antepartum hemorrhage + rapid deterioration of fetal heart tracing?
Vasa previa
What thyroid cancer ass’d with Hashimoto’s?
Lymphoma
What characteristics ass’d with benign cardiac murmur in child?
If no ass’n with structural heart dz:
- Grade II/VI or less - intensity
- early or mid-systolic
- decrease w/standing or Valsalva
- normal S2
- no sx’s
What sx’s are seen in a pathologic cardiac murmur in child?
Sx’s:
Infants -Diaphoresis or tiring w/feeds, poor weight gain
Children - chest pain, dizziness, syncope, SOB, fatigue
What PE findings are seen in pathologic cardiac murmur in child?
Harsh or Holosystolic Diastolic Grade III/VI intensity or higher Increased w/standing or Valsalva Abnormal S2 Decreased absent femoral pulses
What is the workup for child w/pathologic cardiac murmur?
CXR for cardiomegaly
EKG for hypertrophy
Echo - structural
Cardiac referral
What liver changes seen in HELLP?
Centrilobar necrosis Hematoma formation Thrombi in portal capillary system - Cause liver swelling w/distension of hepatic (Glisson's capsule) RUQ pain Epigastric pain N/V
Schisotocytes on PS, high BR, low haptoglobin,
Microangiopathic Hemolytic Anemia
When does amniotic fluid embolism usually occur?
Labor
Delivery
What puts pregnant women at risk for CAP?
Decreased cell mediated immunity
What puts pregnant women at risk for Aspiration pneumonia?
Increased intra abdominal pressure
Relaxed LES
Choriamnionitis (intramniotic infxn) Risk factors?
PROM >24 Hours
Prolonged labor
Internal fetal/uterine monitoring devices
Genital tract pathogens
Choriamnionitis Dx?
Maternal fever >100.4 + One of these: - Maternal Tachycardia (>100) - Uterine tenderness - Malodorous/purulent amniotic fluid/vaginal d/c - WBCs > 15,000 OR Fetal Tachycardia >160
When does PROM occur?
Can happen anytime throughout pregnancy
When is PROM a problem?
When it becomes PPROM - Prolonged
What can occur as a result of PROM?
Preterm labor
Cord Prolapse
Placental Abruption
Chorioamnionitis
What is the management for chorioamnionitis?
Get cervical cultures
Start IV Abx
Deliver immediately -schedule
TX for preterm fetus w/out chorioamnionitis?
Tx w/betamethasone
Tocolytics = decrease ctx
Amp/gent - decrease risk of chorioamnionitis
What is uterine indicative of?
Upper genital tract infxn
How does acute cervicitis present?
Purulent vaginal discharge
MCC Trichomonas, Chlamidya, Gonorrhea
What is the MC risk factor for PROM?
Ascending infxn from lower genital tract
What is seen on US with PROM?
Oligohydramnios
Maternal complications w/choriamnionitis?
Uterine atony
Postpartum Hemorrhage
Endometritis
Fetal complications with chorioamnionitis?
Preterm birth Serious bacterial Infxn Perinatal asphyxia Cerebral Palsy Death
Indications for C-section?
Breech
Fetal distress
Multiple previous c-sections
Defensive mechanism where IVDA contracts HCV and blames community lack of control of HCV?
Distortion
Tx of choice OCD?
SSRI
Tx of choice Tourette disorder?
Dopamine Antagonists - AP’s like Risperidone (2nd G)
Defense mechanism where woman is angry at husband and throws his baseball card collection away?
Displacement
Defense mechanism where woman agrees with abuse husband that she is worthless
Introjection
Defense mechanism where person was rescued from burning building and now denies any memory of event?
Dissociation
Defense mechanism where person expression aggression with person by repeated passive failures to meet their needs
Passive aggressive
Eye conditions where patients see halos around lights?
Acute angle-closure glaucoma
Painful loss of vision
Acute angle-closure glaucoma
Optic neuritis
What is blood and thunder fundoscopy changes?
When do we see it?
Optic disc swelling Retinal hemorrhages Cotton wool spots Dilated veins Central Vein Occlusion
