UWSA 1= 262 Flashcards
What is the greatest risk to parenteral nutrition?
Central Line Associated blood stream infections
Reactive fetal NSt
- BL FHR: 110-160
- Mod Variable: 6-25/min
- > =2 accelerations lasting >= 15 seconds, >=15 beats above normal
Pt with loss of palpable radial pulse during inspiration. Had recent syncope following 2 weeks ago having URI and vague retrosternal chest pain that radiated to left arm shoulder.
Cardiac Tamponade, pulsus paroxodus. Virus –> Viral pericardidis –> Cardiac Tamponade
Viral Encephalitis, what does the LP show?
increased protein (90), increased RBC (700), NL glucose, 125 WBC with only 5% neutrophils
Neurogenic claudication (Psuedocladication), pain with extension of spine, walking down hill, relieved by flexing spine, waling uphill. What is it, how to diagnose?
Lumbar spinal stenosis, 2/2 degenerative OA, dx with MRI. Narrowing of lumbar canal and compression of lumbar nerve roots.
Paraneoplastics ACTH production, what is it?
A polypeptide hormone (ACTH). How? By Small cell lung carcinoma, have severe hypercortisolism, also hyperpigmentation bcus of MSH receptors being bound by ACTH and MSH
Most common cause of labor protraction? (cervical change slower than expected +/- inadequate contractions). Arrest = no cervical change >= 4 hours with adequate contractions or >=6 hours with inadequate contractions.
Contraction inadequacy. Should be forceful q2-3min. Tx with oxytocin.
Effective measures to prevent aspiration PNA?
Oral care, diet modification for patients with dysphagia, elevating bed to 30-45 degrees. Only J tube, post pyloric feeding has been shown to reduce the risk or aspration. (NG tube/G tube/trachial tube all predispose to ASA PNA) Tx. With Clinda.
Adult stares blankly for several minutes and engages in automatisms such as lip smaking or chewing, then confusions, and leg dragging for 30 minutes (transient post seizure state)
Partial Complex Seizure 2/2 temporal lobe epilepsy DX RMi or RRG (absense no post ictal confusion)
Tx of wide complex Vtach
Amiodarone
Tx SVT
Adenosine
Ca 14, severe neuro sxs, low phos
Malignancy, 2/2 PTHrP
Hypocalcemia, hyperphosphatemia w/CKD
Secondary hyperparathyroidsm. Increased PTH, renal osteodystrophy, pain, increased risk of fracture. Can lead to autonomous adenomas, tertiary hyperparathyroidsm, high CA and PTH.
Precipitating factors for hepatic encephalopathy
Drugs, Hypovolemia, electrolyte changes (low K), increased Nitrogen (GI bleed), infection, TIPS
Young Pt with recent viral illness presents with heart failure, chest pain, arrhythmias
Dilated CM 2/2 viral myocarditis (Cox B)
Back pain, fevers, night sweats, immunosuppressed, back pain, Xray shows cavity infiltrate in left upper lung
Active TV (spread hematogenously)
Twist knee, impaired extension of the knee, instability, and exacerbation of pain with squatting. Joint line tenderness, effusion, locking or catching when extended while under load.
Meniscal tear
Most important prognostic factors for astrocytomas
patient age, functional status, tumor grade (degree of anaplasia)
Chronic Lymphocytic Leukemia
LAD
HSM
Mild Thrombocytopenia, anemia
Severe lymphcytosis and smudge cells, dx with flow cytometry
Tx with monoclonal antiboty against CD20 antigen expressed on B lymphocytes 1st line. Also at high risk infections, #cause M&M.
High risk cardiac procedures that need abx prophylaxis for specific invasive procedures
Prosthetic heart valve, previous hx IE, structurally abnormal valve in transplated heart, certain CHD
Most common underlying condition that increases risk of IE from transient bacteremia
MVP
Tx acute dystonia
Anticholinergic (Benztropine/trihexyphenidyl) or diphenhydramine
6 year old delayed milestones, autistic behavior, ID, elongated face, large testes, macrocephaly, hypotonia
Fragile X, CDD FMRI gene X chromosome
3-5 days after MI, hypotension, tachycardia, holosystolic murmur LLB, oxygen gradient between RA (65%) and RV (79%), and increased right sided heart pressures
VSD
Metastatic BC, thrombocytopenia, decreased fibrinogen, increased INR
DIC, most common coagulopathy in pts with malignancies (microangiopathi hemolytic anemia)
Murmur or mitral stenosis
Mid diastolic murmur at cardiac apex (low pitched, openin snap)
Hemothorax after thoracentesis of L PE, then SOB, MOA
Decreased Left Ventricular preload tx with chest tube
Loss of cremasteric reflex with testicular pain
testicular torsion
Cisplatin tox
Renal tox, electrolyte abnormalities, tinnitus, hearing loss, N/V, neurotox
Quickest way to relieve pain with MI
reduce preload with nitrates
First line medicine with spinal epidural abscess
Abx (vanc + ceftriazone), ASA or surgical decompression (glucorticoids better for reducing compression with epidural mets)
CLL
Smudge cells
Pregnant patio with high Pre test probability for PE has a low or mod prob PE on V/Q
CTA, only normal V/Q scan can r/o PE
HIV tx that causes anxiety, dizziness, impaired concentration, and vivid dreams, depression
Efavirnez
1st line tx for urge incontinence
bladder training, then antimuscarinic oxybutnin
Blunt trauma, CXR shows widened mediastinum, what next? HDS.
CT with contrast (Or TEE)
Ergot + triptan
severe elevation in BP 2/2 prolonged vasospasm due to over-activation 5HT receptors
painless blurring of vision, glare, halos, worsening distance vision (myopic shift), red flex lost
CATARACT
Splenectomy
thrombocytosis for months years
Sterile pyuria (WBC w/out bacteria in clean urine sample) and urethritis in sexually active pt in non monogamous relationship 2/2
Chlamydia
Very high TG and pancreatitis bouts tx with
fenofibrate
Tx torsades with
magnesium
