Test 2 Flashcards
Ped Grief
Bereavement in children can present in different ways, depending on the child’s age. Preschool children tend to react with disbelief and may have magical thoughts that death is temporary or reversible. Older children understand the finality of death and may experience a range of emotional and behavioral reactions, including sadness, anxiety, anger, self-blame, regression, and avoidance.
Cardiogenic shock
Patients with significant left ventricular dysfunction and cardiogenic shock have reduced cardiac index and elevated pulmonary capillary wedge pressures. Systemic vascular resistance is typically increased to maintain adequate tissues perfusion pressure. See table
Adolescent mental health
Adolescent depression can present with irritability or somatic symptoms rather than depressed mood and may be mistaken for normal adolescent behavior. Associated symptoms, such as decline in educational and social functioning, should prompt assessment for depression.
Ob hypothyroidism
Newly pregnant patients with hypothyroidism should increase their levothyroxine dose at the time pregnancy is detected. TSH is then checked every 4 weeks with the levothyroxine dose adjusted to trimester-specific norms. See table
Child abuse
Child abuse should be suspected in children and adolescents with sudden behavioral problems. Risky sexual behavior, in particular, may be an indicator of possible sexual abuse.
ADHD sx before age 12 with duration of greater than or equal to 6 mo.
Surgery
Pulm & critical care
Postoperative pulmonary complications occur most often in those undergoing thoracic or upper abdominal surgery. Risk is greatest when patients have a history of COPD, cigarette smoking, CHF, or sleep apnea. Patients with a pre operative COPD or HF exacerbation should have surgery delayed until pulmonary or cardiac function is optimized.
Cushing syndrome
Cushing syndrome with an adrenal etiology is biochemically characterized by a nonsuppressible high-dose dexamethasone suppression test and low plasma ACTH plasma level.
Pituitary-dependent Cushing’s syndrome plasma acth levels are normal or elevated.
Ectopic acth = high acth levels
CI
Includes difference at center
Esophageal perforation
AKA boerhaave syndrome usually presents as acute retrosternal chest pain following episodes of repeated vomiting. Most tears occur in the distal third of the esophagus and are associated with left sided pleural effusion. Pneumomediastinum and/or pneumothorax can occur as well. A delay in surgical management is associated with mediastinitis and a high mortality rate.
See table
Dx: esophagogram with water-soluble contrast
Sinusitis
Acute rhinosinusitis is most commonly due to viral pathogens and usually resolves within 10 days. Patients with persistent symptoms greater than or equal to 10 days, severe sx, or deterioration after several days of improvement often have acute bacterial rhinosinusitis, which is usually treated empirically with 5-6 days of oral amoxicillin-clavulanate.
Incidentaloma
Before deciding to medically, surgically, or conservatively manage an incidentally detected unilateral adrenal mass, evaluation for hormone production should first be completed. All functional masses, masses with radiographing evidence of malignancy, or masses greater than 4 cm in size should be removed.
A fib
Beta blockers or nondihydropyridine calcium channel blockers are the preferred first-line agents for ventricular rate control in patients with rapid atrial fibrillation. These drugs are contraindicated or should be used with caution in patients with decompensated HF, hypotension, or bradyarrhythmias.
Digoxin rate control in AF in patients with hypotension or concomitant sys HF.
RRR
1 - RR
Risk in unexposed - risk in exposed/risk in unexposed
Has reduction in question
RR
Risk of dx in exposed / risk of dx in unexposed group
