Term
| when should you notify authorities about a possible bioterrorism event? |
|
Definition
| as soon as you have the suspicion, don't wait until you have confirmation or ALL of the information |
|
|
Term
| complications of gallbladder disease |
|
Definition
| gallstone pancreatitis, gallstone ileus, biliary cirrhosis, and gallbladder cancer |
|
|
Term
| presence of gallstones in the gallbladder |
|
Definition
|
|
Term
| pain caused by a stone temporarily obstructing the cystic duct |
|
Definition
|
|
Term
| inflammation of the gallbladder from obstruction of the cystic duct |
|
Definition
|
|
Term
| the presence of a stone in the common bile duct |
|
Definition
|
|
Term
| episodic pain in the RUQ, that may radiate to the right shoulder or back |
|
Definition
|
|
Term
| when does the pain of cholelithiasis begin? end? |
|
Definition
begins within 1 hr of eating
may last from 1-5 hrs |
|
|
Term
| tx of gallstones that were found incidentally |
|
Definition
| may be followed until they become symptomatic |
|
|
Term
| what does a calcified or porcelain GB increase your risk of? |
|
Definition
|
|
Term
|
Definition
Eyes - 4
Verbal - 5
Motor - 6 |
|
|
Term
|
Definition
1 = none
2 = pain
3 = voice
4 = spontaneous |
|
|
Term
|
Definition
1 = none
2 = incomprehensible
3 = inappropriate
4 = confused
5 = appropriate |
|
|
Term
|
Definition
1 = none
2 = extension (decerebrate)
3 = flexion (decorticate)
4 = withdraws
5 = localizes
6 = obeys commands |
|
|
Term
| sxs of gestational trophoblastic disease (6) |
|
Definition
vaginal bleeding, hyperemesis, eclampsia, overly enlarged uterus
grape cluster apperance on US
abnormally high b-hCG |
|
|
Term
| tx of gestational trophoblastic disease |
|
Definition
suction curettage in the hospital setting.
if b-hCG levels fail to decrease = evidence of persistent/invasive disease and requires chemotherapy |
|
|
Term
| where can invasive trophoblastic disease mets to? |
|
Definition
|
|
Term
| pt with gestational trophoblastic disease, presents with rapid onset of respiratory distress resembling an amniotic fluid emobolus, dx? |
|
Definition
| trophoblastic emobloization |
|
|
Term
| diagnostic study of choice for ovarian torsion |
|
Definition
| pelvic/vaginal ultrasound |
|
|
Term
| loss of pregnancy < 20 wks |
|
Definition
|
|
Term
| pregnancy related blood discharge or frank bleeding (first 1/2 of pregnancy) without cervical dilation |
|
Definition
|
|
Term
| vaginal bleeding and cervical dilation |
|
Definition
|
|
Term
| passage of only parts of the products of conception (6-14wks) |
|
Definition
|
|
Term
| passage of all fetal tissue, including trophoblast and all products of conception, before 20 wks of conception |
|
Definition
|
|
Term
| fetal death < 20 wks without passage of any fetal tissue for 4 wks after |
|
Definition
|
|
Term
| infection at any stage of abortion |
|
Definition
|
|
Term
|
Definition
chromosomal abnormalities
other risks: advanced maternal age, prior poor obstetric history, concurrent medical disorders, previous abortion, certain infections, anatomic abnormalities, exposure to certain agents |
|
|
Term
| tx of a threatened abotion |
|
Definition
| discharge with close follow up, avoid intercourse and tampons |
|
|
Term
| tx of an incomplete abortion |
|
Definition
|
|
Term
| tx of a complete abortion |
|
Definition
| discharged safely with follow up |
|
|
Term
| tx of a pt with a non-viable fetus |
|
Definition
| admit or D&C and follow up within a week. Return immediately if there is heavy bleeding, pain, or fever |
|
|
Term
| if unsensitized, all pregnant women who are Rh-negative and have vaginal bleeding should get |
|
Definition
| RhoGam prior to discharge or within 72 hrs |
|
|
Term
| COPD is most common secondary to what? |
|
Definition
|
|
Term
| excessive mucous production with airway obstruction and notable hyperplasia of mucus-producing glands |
|
Definition
|
|
Term
| destruction of the airways distal to the terminal bronchiole |
|
Definition
|
|
Term
| obese, productive cough with progression over time to intermittent dyspnea, frequent and recurrent pulmonary infections, progressive cardiac/respiratory failure over time, edema, wt gain |
|
Definition
|
|
Term
|
Definition
|
|
Term
| think with barrel chest, long hx of progressive dyspnea with late onset nonproductive cough, occasional mucopurulent relapses, eventual cachexia and respiratory failure |
|
Definition
|
|
Term
|
Definition
|
|
Term
| what provides the best clue as to the acuteness and severity of a COPD attack? |
|
Definition
|
|
Term
| what can be used to differentiate COPD and CHF? |
|
Definition
|
|
Term
| what PEFR and FEV1 indicate a severe COPD exacerbation? |
|
Definition
FEFR < 100L/min
FEV1 < 1.00 L |
|
|
Term
| CXR = increased bronchovascular markings and cardiomegaly |
|
Definition
|
|
Term
| CXR = small heart, hyperinflation, flat hemidiaphragms, and possible bullous changes |
|
Definition
|
|
Term
| first line therapy for COPD |
|
Definition
| beta 2 agonist via nebulizer or MDI |
|
|
Term
| what can improve the FEV1 in acute exacerbations of COPD? |
|
Definition
|
|
Term
| MCC of bacterial pneumonia |
|
Definition
|
|
Term
| pneumonia from H influenzae commonly arises when? |
|
Definition
|
|
Term
| risk factors for H influenzae pneumonia |
|
Definition
| astham, COPD, smoking, and a compromised immune system |
|
|
Term
| pneumonia that results in an aggressive necrotizing lobar pneumonia |
|
Definition
|
|
Term
| what increases your risk for klebsiella pneumonia? |
|
Definition
|
|
Term
| type of pneumonia observed in IV drug users |
|
Definition
|
|
Term
| infection that results from contaminated water condensed from air conditioning systems |
|
Definition
|
|
Term
| causative agents of gram negative pneumonia? usually found in who? |
|
Definition
ecoli, pseudomonas, enterobacter, and serratia.
usually found in pts who are debilitated, immunocompromised, or recently hospitalized |
|
|
Term
| causative agents of aspiration pneumonia |
|
Definition
| moraxella, bacteroides, peptostreptococcus, and fusobacterium |
|
|
Term
| bloody/rust colored sputum |
|
Definition
|
|
Term
|
Definition
| pseudomonas, haemophilus, or pneumococcal |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| rigors or shaking chills suggests ________ pneumonia |
|
Definition
|
|
Term
| HA, malaise, nausea, vomiting, diarrhea suggests ________________ |
|
Definition
|
|
Term
| sudden onset of sxs and rapid illness progression are associated with ____________ pneumonia |
|
Definition
|
|
Term
| hyponatremia and microhematuria may be associated with ___________ |
|
Definition
|
|
Term
| CXR = air bronchograms is suggestive of _____________ |
|
Definition
|
|
Term
| CXR of cavitary lesions and bulging lung fissurse suggests __________ |
|
Definition
|
|
Term
| CXR of cavitation and associated pleural effusions suggests ___________ |
|
Definition
| Staph aureus, anaerobic infections, gram negative infections, TB |
|
|
Term
| ___________ had prediliction for lower fields, while __________ has a tendency to occur in the upper fields. |
|
Definition
lower = legionella
upper = klebsiella |
|
|
Term
| what may aid in the dx of pneumonia if the xray is unclear? |
|
Definition
|
|
Term
| MCC pneumonia in alcoholics |
|
Definition
| strep pneumoniae, klebsiella, haemophilus |
|
|
Term
|
Definition
| staph aureus, gram negative bacteria |
|
|
Term
| what are the risks of CAP in pregnancy? |
|
Definition
| preterm labor and delivery |
|
|
Term
| MC pneumonia in the elderly |
|
Definition
| pneumococcal, legionella (atypical), and influenza (viral) |
|
|
Term
| what might be the presenting sx of an elderly pt with pneumonia? |
|
Definition
|
|
Term
| MC pneumonia in nursing home pts |
|
Definition
| strep pneumoniae, gram - bacilli, H. Influenzae |
|
|
Term
| MC pneumonia in HIV pts based on CD4 counts |
|
Definition
CD4 > 800 = s pneumoniae, pseudomonas
CD4 = 250-500 = mycobacterium, cryptococcus, histoplasma
CD4 < 200 = PCP |
|
|
Term
| bacterial pneumonias are more common with what transplants? |
|
Definition
|
|
Term
| MC pneumonas based on time frame after transplant |
|
Definition
0-3m = pseudomonas, staph aureus, legionella
0-6m = PCP, fungal infections (aspergillus)
> 6m = s pneumoniae, H influenzae |
|
|
Term
| best initial abx of choice for CAP |
|
Definition
| macrolide: erythromycin, clarithromycin, azithromycin (once daily dosing) |
|
|
Term
| tx of a pt with CAP and a hx of COPD or smoking |
|
Definition
| trimethoprim and sulfamethoxazole |
|
|
Term
| tx of a severely ill CAP pt with sepsis or respiratory failure or when neutropneia is presents |
|
Definition
| IV macrolide + third generation cephalosporin |
|
|
Term
|
Definition
|
|
Term
| risk factors for a pleural empyema |
|
Definition
aspiration pneumonia
immunocompromised status
fungal infections or TB
malignancy
chronic alcoholism |
|
|
Term
| confirmatory test for a pleural empyema |
|
Definition
|
|
Term
|
Definition
| drainage, re-expansion of the lugn, eradication of inection based on pts general condition |
|
|
Term
| inflammatory chemical injury of the tracheobronchial tree from the inhalation of regurgitated gastric contents |
|
Definition
|
|
Term
| nonproductive cough and tachypnea or tracheobroncitis wth bloody/frothy sputum and respiratory distress |
|
Definition
|
|
Term
| fever, dyspnea, and productive cough, possible change in mental status or fucntion, lethargy, nasuea/vomiting |
|
Definition
|
|
Term
|
Definition
|
|
Term
| most accurate test for pancreatitis |
|
Definition
|
|
Term
| most reliable imaging modality for the dx of pancreatitis |
|
Definition
|
|
Term
|
Definition
A = normal pancreas
B = focal/diffuse gland enlargement
C = intrinsic gland abnormality
D - single ill defined collection
E = 2+ ill defined collections or teh presence of gas in or nearby the pancreas |
|
|
Term
| Ranson's criteria on admission (5) |
|
Definition
age greater than 55
WBC > 16,000
BGL > 200
serum LDH > 350
SGOT (AST) > 250 |
|
|
Term
| Ransons criteria in the first 48 hrs (6) |
|
Definition
Hct fall of > 10%
BUN increase > 8
serum calcium < 8
arterial O2 < 60 mm Hg
base deficit > 4 meq
estimated fluid sequestration greater than 6000mL |
|
|
Term
| complications of pancreatitis (2) |
|
Definition
| hyperglycemia, hypocalcemia |
|
|
Term
| mainstay in the tx of pancreatitis |
|
Definition
| fluid resuscitation followed by parenteral narcotics and antiemetics |
|
|
Term
| tx of biliary pancreatitis |
|
Definition
| urgent decompression for persistent biliary obstruction via sphincterotomy |
|
|
Term
|
Definition
1 (1-24 hrs) = subclinical
1 (24-72 hrs) = RUQ pain, anorexia, n/v, increased transaminase, hypotension, tachycardia
3 (72-96) = sequelae of hepatic necrosis |
|
|
Term
| how is tylenol toxicity assessed? |
|
Definition
| possible vs probable toxicity via the Rumack-Matthews nomogram at 4 hrs post ingestion |
|
|
Term
| how should a tylenol OD be treated withn the first hr? |
|
Definition
|
|
Term
| what is the antidote for tylenol OD? |
|
Definition
|
|
Term
| when is IV administration of n-acetylcysteine warranted? (4) |
|
Definition
fulminant hepatic failure
high serum levels 8 hrs after ingestion
pt unable to take PO
pregnant pt |
|
|
Term
| when should sutures be removed: face, scalp, trunk, arms/legs, joint |
|
Definition
face = 3-5 days
scalp = 7-10 days
trunk = 7-10 days
arms/legs = 10-14 days
joints = 14 days |
|
|
Term
| wound is closed immediately by approximating it's edges |
|
Definition
|
|
Term
| wound is left open and allowed to close on its own. Particularly well suited for highly contaminated wounds |
|
Definition
|
|
Term
| wound is left open for a period of 4-5 days, after which it may be closed if no infection supervenes |
|
Definition
| tertiary (delayed primary) closure |
|
|
Term
| overall goal of wound care |
|
Definition
| restore the skin's integrity to reduce the risk of infection, scarring, and impaired function |
|
|
Term
| inability to retract the foreskin proximally and posterior to the glans penis |
|
Definition
|
|
Term
|
Definition
| infection, poor hygiene, previous injury with scarring |
|
|
Term
| inability to reduce the proximal edematous foreskin distally over the glans penis |
|
Definition
|
|
Term
|
Definition
compression of glans for severel minutes
several puncture wounds with small needle
superficial dorsal incision of the band |
|
|
Term
| persistnet painful, pathologic erection, both corpora cavernosa are engorged with blood |
|
Definition
|
|
Term
|
Definition
substances for impotence
oral agents for HTN
sickle cell disease |
|
|
Term
| complications of priapism |
|
Definition
| urinary retention, impotence |
|
|
Term
|
Definition
adequate analgesia
terbutaline (most effective)
corporal aspiration followed by irrigation (normal saline or alpha-adrenergic agents) = primary tx |
|
|
Term
| inflammation of the glans and foreskin, appears purulent, excoriated, malodorous, and tender |
|
Definition
|
|
Term
| what can be the sole presenting sign of DM |
|
Definition
| recurrent balanoposthitis |
|
|
Term
|
Definition
cleansing with mild soap and drying
antifungal creams
oral azole
possibly circumcision |
|
|
Term
| what temperature is defined as hypothermia? |
|
Definition
|
|
Term
| pathognomonic finding of hypothermia |
|
Definition
| J waves of Osborn = prominent in lead 2 |
|
|
Term
| common EKG readings in hypothermia |
|
Definition
early = brady or slow a-fib
late = v-fib or asystole |
|
|
Term
| when does shivering cease? |
|
Definition
|
|
Term
| how should the dx of hypothermia be made? |
|
Definition
| rectal temp, electronic thermometers are preferred |
|
|
Term
| 1st priority in the tx of hypothermia |
|
Definition
| prevent further heat loss: remove wet clothes, wrap in blankets, cover head |
|
|
Term
| 4 types of rewarming for hypothermia |
|
Definition
passive (pts rewarm on their own)
active external (warm stimulus is applied)
active core (lavage)
inhalation (warm, humidified O2) |
|
|
Term
| reflex of vasoconstriction in visceral muscles, shunts blood to the core |
|
Definition
diving reflex
most pronounced in small children |
|
|
Term
| grave prognosis markers in a pt with hypothermia |
|
Definition
cell lysis (hyperkalemia >10)
intravascular thrombosis (fibrinogen < 50) |
|
|
Term
| fever, sinus/supraventricular tachycardia, changes in normal mental status, GI symptoms |
|
Definition
|
|
Term
|
Definition
stabilization, ABCs, IV
BB for severe adrenergic sxs
PTU or methimazole
electrolyte replacement PRN
no iodine until the synthetic pathway has been blocked |
|
|
Term
| pt presents after a day at the beach with multiple, linear, very painful, urticarial lesions. dx? |
|
Definition
| portuguese man of war injury |
|
|
Term
| tx of portuguese man of war envenomation |
|
Definition
immediately rinse with sea water (dont use fresh or hot water)
5% acetic acid (vinegar) will inactivate the venom
shave the area
topical lidocaine, benadryl, or steroids
oral benadryl & narcotics
muscle spasms = valium |
|
|
Term
| vesicular morbiliform pruritic dermatitis after saltwater immersion, erupts on the covered areas |
|
Definition
|
|
Term
| HA, chills, night pruritis, malaise, conjunctivitis, urethritis |
|
Definition
|
|
Term
| tx of seabather's eruption |
|
Definition
pepain (proteolytic enzyme in Accent) > 30 min or until no pain
benadryl PO
calamine lotion
topical steroids |
|
|
Term
| inflammation and infection of the eyelid and portions of the skin around the eye, no effect on vision or EOMs |
|
Definition
|
|
Term
| pathognomonic for digitalis OD |
|
Definition
|
|
Term
| hallmarks of opiod OD (3) |
|
Definition
coma
respiratory depression
miosis |
|
|
Term
|
Definition
airway!
charcoal/supportive
naloxone - pure opiod antagonist |
|
|
Term
| reversal agent for benzos |
|
Definition
|
|
Term
| orthostatic hypotension, light headedness, syncope, tachycardia, diaphoresis |
|
Definition
|
|
Term
|
Definition
lavage/charcoal
airway, O2, fluids, Trendelenberg position, vasopressors
methylene blue for methemoglobin level > 40% |
|
|
Term
| child presents with hemorrhagic diarrhea, likely cause? |
|
Definition
|
|
Term
| one of the leading causes of death due to toxicological agents in children < 6 yo |
|
Definition
|
|
Term
|
Definition
GI = 20mg/kg
moderate = 40mg/kg
severe = 60mg/kg (potentially lethal) |
|
|
Term
| 5 stages of iron poisoning |
|
Definition
1 = GI
2 = latent (tricky to healthcare providers)
3 = metabolic/CV
4 = hepatic
5 = delayed (scarring) |
|
|
Term
| most pts die in what stage of iron OD? |
|
Definition
|
|
Term
|
Definition
whole bowel irrigation
charcoal is NOT helpful
deferoxamine chelation = mainstay |
|
|
Term
initial stinging sensation is replaced over 6-8 hrs by severe pain and pruritis, edema at bite site produces an erythematous halo around the lesion.
at 24-72 hrs a hemorrhagic vesicle develops at the site, later forms a dark eschar |
|
Definition
| brown recluse spider bite |
|
|
Term
| systemic sxs of brown recluse spider bite |
|
Definition
appear after 1-2 days
rash, fever, chills, n/v
arthralgias, myalgias, petechiae, hemolysis
renal failure, seizures, DIC, coma
occasionally death |
|
|
Term
| tx of brown recluse spider bites |
|
Definition
monitor fluids and electrolytes
elevation and immobilization
cool compress, local wound care
TD prophylaxis
analgesics, antipruretics, antihistamines
dapsone to reduce tissue necrosis |
|
|
Term
| gold standard for intra-abdominal injuries |
|
Definition
|
|
