Zebra Conditions Flashcards
What is the presentation for a AAA?
Men over the age of 50, women over the age of 60
Pain in the back, flank, abdomen or groin that is unaffected by position.
A boring pain or piercing pain
A pulsatile abdominal mass
What is the ancillary study of choice for a AAA?
abdominal aorta ultrasound
CT is used to DDx a leaking or ruptured AAA
What is the cut off for dilation and aneurism?
3.8cm (normal is 2 cm)
What is the management for a AAA?
Emergent referral when there are symptoms
Urgent referral when >6cm seen on x-ray with only back pain
Semi-urgent referral when >6cm seen on x-ray with no symptoms
Nonurgent referral when <6cm with LBP and no red flags
What % of AAA lead to rupture?
1/3
What is the prognosis of AAA?
Long term prognosis is often effected by other health problems and comorbidities.
What is the risk of death if a 6cm AAA is untreated?
At 1 year 25%, at 5 years 50%
What is the risk for death of an untreated AAA greater than 6cm?
At 1 year 50%, at 2 years 75%, at 5 years 90%
What is the presentation for cauda equina syndrome?
Urinary retention, bladder dysfunction, loss of sexual function, saddle paresthesia
What are commonly the causes of CES?
Midline disc herniations, spinal stenosis, tumor or SOL
What is the ancillary study of choice to DX a CES?
MRI
What is the management for CES?
Urgent referral to a neurologist. Emergent is rapid onset of symptoms.
What is the prognosis for CES?
Heavily depends on how long they were symptomatic: hindrances to full recovery include delayed treatment, wide loss of sensation, rapid onset
What are the contraindications to giving nitroglycerin?
BP <90
What is the management for a suspected cardiac patient?
Monitor vitals,
calm and reassure the patient,
stay with the patient and instruct someone to get help/ aspirin/ AED/ call 911 as needed,
Give nitroglycerin unless contraindicated
Chew an aspirin
Apply oxygen if in shock
Apply AED/CPR as necessary
What is the correct dosage for aspirin in a suspected heart attack?
325 mg
What is the presentation of MI?
3Ds in the PNW
Diaphoresis, dyspnea, dizziness, syncope, palpitations, nausea, weakness
What removes the suspicion that chest pain is not due to cardiac?
if pain is modifiable or reproducible
What causes a VAD?
damage to the vertebral artery from turning the head, car accidents, or a vasospasm. a CTM may also cause the damage
What is Wallenberg syndrome
Occlusion of the posterior inferior cerebellar artery
What is locked in syndrome?
When the patient is paralyzed but conscious
What are the symptoms of a VAD?
5D and 3N
Dizziness, dysphasia, drop attacks, dysarthria, diplopia, ataxia, nausea, numbness (of one side of the body), nystagmus
What is the treatment for a VAD?
Call 911
What is the risk of an untreated DVT?
A pulmonary emboli
What is the risk of death in a DVT?
95% of pulmonary emboli are from DVT and 30% are fatal
Are distal or proximal DVTs more common?
Proximal, in the popliteal
What are risk factors for DVTs?
Recent surgery, immobilization
What is the classic presentation for a DVT?
Painful, swollen, red, tender leg
What is virchow’s triad?
Immobilization, damaged blood vessels, hypercoagulable state
What are wells criteria rules for DVT?
If less than 2, DVT is unlikely
If greater than 6 high probability
If less likely order a d-dimer to rule out pulmonary embolism
What does a positive d-dimer tell you?
That the patient needs to get a CT angiogram
What is the management for a DVT?
Urgent referral for anticoagulants- after it is under control-
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