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PMP > Week 4--even more > Flashcards

Week 4--even more Flashcards

1
Q

when is ipratropium useful for an asthma attack

A

first hour of an asthma attack –no evidence for use beyond this time

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2
Q

what is a blast

A

a malignant cell

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3
Q

what is CREST

A

variant of scleroderma

features include:
Calcinosis–calcium deposits in skin

Raynauds–spasm of blood vessels in response to cold or stress

Esophageal dysfunction–acid reflux and decrease in motility of esophagus

Sclerodactyly–thickening and tightening of the skin on the fingers and hands

Telangiectasias–dilation of the capillaries, causing red marks on the surface of the skin

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4
Q

what does the following antibody pattern suggest:

anti-sm AB

A

lupus (specific)

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5
Q

what does the following antibody pattern suggest:

RNP

A

ribonucleotide protein lupus/mixed connective tissue disease

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6
Q

what does the following antibody pattern suggest:

SSA (Ro)

A

sjogrens
lupus
risk for congenital heart block or neonatal lupus

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7
Q

what does the following antibody pattern suggest:

SSB (La)

A

same as Ro

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8
Q

what does the following antibody pattern suggest:

SCI-70/topoisimerase

A

diffuse scleroderma

systemic sclerosis

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9
Q

what does the following antibody pattern suggest:

DNA Ab

A

specific for lupus

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10
Q

what does the following antibody pattern suggest:

anti phospholipid ab

A

often + in lupus

assoc with fetal loss in lupus

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11
Q

what % of people returning of afghanistan have PTSD

A

8%

*trauma is common, PTSD is not

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12
Q

how do you manage ventricular tachycardia

A

SHOCK

then continue CPR for 2 minutes

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13
Q

causes of potentially reversible cardiac arrest (mnemonic)

A

Hs and Ts

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14
Q

what are the Hs of reversible cardiac arrest

A 
hyperkalemia
hypokalemia
hypovolemia
hypoxia
H+ excess (acidosis)
hypothermia
hypoglycemia
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15
Q

what are the Ts of reversible cardiac arrest

A 
Toxins
Tamponade
Thrombus (PE or MI)
trauma
tension pneumo
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16
Q

what are the non-shockable rhythms

A

asystole/PEA

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17
Q

what do you do in the event of cardiac arrest with asystole/PEA

A

CPR for 2 min
IV/IO access
EPINEPHRINE every 3-5 min
consider advanced airway

if rhythm becomes shockable, then shock. if not…

another 2 min CPR and treat reversible causes of cardiac arrest

if signs of return of spontaneous circulation, then go to post cardiac arrest care. if not, continue CPR as above

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18
Q

what do you do in the event of cardiac arrest with VF/VT

A

SHOCK

then CPR + IV/IO access established

if rhythm shockable again, SHOCK…if not, see if return of spontaneous circulation, otherwise do CPR and treat reversible causes

after second shock, continue CPR and give EPINEPHRINE every 3-5 min

rhythm shockable? if yes, shock again. then give amoidarone and continue to treat reversible causes.

continue as above

19
Q

what is the epinephrine dose for ACLS

A

1 mg every 3-5 min IV

20
Q

what is the amoidarone dose for ACLS

A

first dose 300 mg bolus

second dose 150 mg

21
Q

how do you initially manage a tachyarrhythmia in a stable patient

A

maintain patent airway, assist breathing as necessary

oxygen if hypoxemic

cardiac monitor to ID rhythm

monitor BP and oximetry

if patient continues stable and the complex is not wide, you can: 
establish IV access and 12 lead ECG
vagal maneuvers
adenosine if regular complex
Beta blocker or CCB
consider expert consult
22
Q

how do you manage a persistent tachyarrhythmia (usually above 150) causing hypotension, acutely altered mental status, signs of shock, ischemic chest discomfort, or acute heart failure?

A

synchronized cardioversion

  • if regular narrow complex tachy, consider adenosine
  • if wide irregular tachy, use defibrillation dose
23
Q

what is the dose of adenosine used to treat narrow complex tachyarrhythmias

A

first dose–6 mg rapid IV push followed with NS flush

second dose–12 mg if required

24
Q

how do you manage a persistent tachyarrhythmia (usually above 150) in a stable patient, but that has a wide QRS?

A

IV access and 12 lead ECG

consider adenosine only if regular and monomorphic

consider an antiarrhythmic infusion

consider expert consult

25
Q

what antiarrhythmic infusions should you consider for a stable wide-QRS tachycardia

A
  1. procainamide IV–20-50 mg/min until arrhythmia suppressed, hypotension ensues, QRS increases more than 50% or maximum dose given
    - -maintenance infusion is 1-4 mg/min
  2. amiodarone IV–first dose 150 mg over 10 min, then repeat as needed if VT recurs. Follow with maintenance infusion of 1 mg/min for 6 hours
  3. Sotalol IV–100 mg over 5 min
26
Q

how do you manage a symptomatic bradycardia

A

atropine

if ineffective try:
transcutaneous pacing
-or-
dopamine infusion
-or-
epinephrine infusion
27
Q

atropine dose for brady

A

first dose 0.5 mg bolus

repeat every 3-5 min

maximum 3 mg

28
Q

dopamine infusion dose for brady

A

2-20 mcg/kg per minute, titrate to patient response and taper slowly

29
Q

epinephrine infusion dose for brady

A

2-10 mcg per minute infusion

titrate to patient response

30
Q

what are you looking at on supine abdo xray

A

bowel gas pattern

31
Q

what are you looking at on upright abdo xray

A

air fluid levels

32
Q

what is a general approach to abdo xray

A

bones-stones-gas-mass

33
Q

what muscles should be a guiding point on abdo xray

A

psoas muscles–paired, running along posterior wall of abdo cavity

if not clearly seen this suggests pathology and should consider CT

34
Q

are there any normal intra abdo calcifications

A

no

but are not necessarily clinically significant

35
Q

what does pancreatic calcification suggest

A

chronic pancreatitis

36
Q

what are the normal bowel sizes on AXR

A

small bowel–less than 3 cm
large bowel–less than 6 cm
cecum–less than 9 cm

37
Q

what should you think if you see fecal matter in the small bowel

A

not normal–slow transit time

think obstruction

38
Q

how many air fluid levels are abnormal on AXR

A

more than 3

39
Q

is intra abdominal gas on AXR ever normal

A

always abnormal

this is a bowel perforation until proven otherwise

40
Q

what is the triad of symptoms in Wernicke’s encephaloptahy

A

confusion
ataxia
ophtho dysfunction (plegia or nystagmus)

secondary to thiamine deficiency
tx with PO thiamine or IV before glucose

complications can be korsakoffs syndrome

41
Q

what is korsakoff’s syndrome

A

anterograde and retrograde amnesia

confusion

personality changes

confabulation

lack of insight

*treat with prevention

42
Q

in a psychiatric presentation, what symptoms would make you really look for an organic cause

A

atypical sx i.e non-auditory hallucinations

atypical presentations–i.e elderly patient with new onset psychosis

acute onset

soft neuro signs or symptoms

abnormal blood work

43
Q

what are some medical causes of geriatric depression

A
  1. hypothyroid
  2. hyperthyroid
  3. hashimotos encephalopathy
    - -can respond to high dose corticosteroids
  4. B12 deficiency
    - -prevalence up to 40%, due to malabsorption
  5. hypercalcemia

PMP (9 decks)

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