UWorld D Flashcards
78 y/oF p/w acute hypoxic RF requiring intubation, PNA treated and she’s extubated but then develops stridor and increased WOB
Cause of stridor?
Laryngeal edema, presents w/ post-extubation stridor
-occurs in up to 30% of intubated pts
We give magnesium sulfate to asthmatics?
In severe asthma exacerbation (peak expiratory flow under 40% of baseline): mag sulfate can be used as a parenteral bronchodilator if pt has already failed 1 hour of SABA and glucocorticoids
So pt w/ bad asthma comes in- you give SABA and IV steroids, 1 hr later worse, w/ PEF under 40, consider mg sulfate
Lung CA associated with
(a) SIADH
(b) PTHrP
(a) SIADH- small cell carcinoma
(b) PTHrP- squamous cell carcinoma
20 month old girl p/w cough and fever
Harsh, brassy coughing followed by mild inspiratory stridor
(a) Diagnosis
(b) CXR sign
(c) Tx
(a) Croup = laryngotracheitis = parainfluenza infxn of larynx and trachea
(b) CXR- steepe sign due to subglottic narrowing
(c) Single dose of corticosteroids can treat mild croup
Radiographic findings c/w benign pulmonary nodule
Popcorn calcification (hamartoma), concentric, diffuse homogeneous, laminated, central Basically popcorn calcification = hamartoma and is benign
While eccentric, asymmetric, reticular, punctate raise suspicion for malignancy
Aside from pressors, what other support may brain-dead pt need to manage organs for donation
Maintain euvolemia- may require IV fluids and desmopressin to combat central diabetes insipidus that can increase UOP to 1L/hr and cause volume depletion
Goals for managing brain-dead organ donor: maintain euvolemia, normotensive, normothermic
Large PE
(a) Possible conduction disturbance
(b) Valvular abnormality
(a) RBBB due to RV strain
(b) Tricuspid regurg due to dilation of RV that stretches the tricuspid valve annulus
Chance that pt has lung cancer if CT chest if read as positive (noncalcified nodule over 4mm)
Chance of cancer is under 10%, super high false positive rate of 96% but study showed 20% relative mortality reduction in group that got screened
So counsel that screening is helpful but any positive finding needs to be confirmed by further workup
When to give Rhogam
Rh+ father, Rh- mother, baby has a chance of being Rh+
Prevent mother from making anti-Rh+ antibodies when maternal and fetal blood mix (through placenta and through maternal hemorrhage) for the next baby
So give
- 28 weeks
- within 72 hours post-partum
Standard dose (300 ug) given at 28 weeks, then have to do Rosette test to qualitatively test for fetomaternal hemorrhage.
negative: give standard dose anti-D immune globulin
positive: determine amount of hemorrhage by Kleihaur-Betke test and increase dose of anti-D immune globulin based on percentage of fetal RBC in maternal circulation
Gastroschisis vs. omphalocele
Gastroschisis = eviscerated bowel w/ no covering membrane
Omphalocele = sac containing multiple organs at umbilicus
3 indications for GBS prophylaxis for mothers w/ unknown GBS status
GBS ppx in mothers w/ unknown status if (not just everyone w/ unknown status)
- preterm labor (under 37 weeks)
- intrapartum fever
- rupture of membranes for 18+ hours
Neonatal jaundice- when do tbilis peak?
(b) When to stop phototherapy
(c) What is the danger to the baby?
Tbilis peak at day 5-7
(b) Continue phototherapy until bilis normalize (don’t just expect them to plateau then resolve)
(c) Kernicterus = bilirubin-induced encephalopathy
When is exchange transfusion indicated for neonatal physiologic jaundice?
When tbilis are severe, above 20-25 = toxic, too high risk of kernicterus (bili encephlopathy) => exchange transfusion
3 causes of elevated maternal serum AFP
Elevated AFP
- multiple gestation (twins)
- open neural tube = anencephaly, open spina bifida
- ventral wall defect = omphalocele, gastrochisis
Association w/ reduced plasma maternal serum AFP
Trisomy- 18 and 21
