chapter 36 shock

Question 1

patients who are hypotensive – what fluids should you give?

Answer 1

fluid bolus of LR

Question 2

if fluids don’t raise BP

Answer 2

intravascular monitoring

Question 3

if laryngeal edema?

Answer 3

teach or cricket

IM epinephrine + fluids if anaphylactic

Question 4

dopamine dosages

Answer 4

low = renal dilation, vasodilation
higher = contractility = beta1
highest - vasoconstriction = alpha1

Question 5

what do you give patients w/ hypotension to increase peripheral resistance?

Answer 5

norepinephrine (mostly alpha 1 effects)

Question 6

what do you give patients w/ hypotension w/ bradycardia?

Answer 6

isoproterenol == both inotrope and chronotope (beta1/2 effects)

Question 7

what do you give patients w/ cardiac arrest and anaphylaxis?

Answer 7

epinephrine (alpha = beta)

Question 8

second hand smoke increases risk of

Answer 8

asthma and URI, otitis media in children

Question 9

smoking slows the healing of peptic ulcer disease, and cessation stops the development in

Answer 9

burger disease

Question 10

what is the best way to decrease the risk of post op pulmonary complications?

Answer 10

cessation of smoking preoperatively

Question 11

if a woman is over the age of 35 or is younger than 35 and smokes 15+ cigarettes?

Answer 11

no OCP but could take estrogen if postMP

Question 12

TESTICULAR TORSION VERSUS EPIDIDYMITIS

Answer 12

pain decreases w/ testicular elevation + may be urethral discharge w/ epididymitis

Question 13

diagnostic test of choice in testicular pain

Answer 13

ultrasound!

Question 14

bph tx

Answer 14

terazosin/dozasoin, tamsulosin

finasteride

TURP = if repeated UTIs, urosepsis , urinary retention, hydronephrosis

Question 15

signs of urethral injury

Answer 15

absent or abnormally positioned prostate on exam

Question 16

hydrocele versus varicose

Answer 16

hydrocele = remnant of vaginalis, no tx needed
varicocele = no transillumination, prominent when standing

Question 17

noncontrast helical CT scan

Answer 17

diagnostic test of choice

Question 18

tx of nephrolithiasis

Answer 18

tamsulosin
stones<= 4 mm pass spontaneously
4-10 mm doesn’t mass
if no pass, tx w/ lithotripsy, uteroscopy w/ stone retrieval, open surgery

Question 19

after 1 year, do surgical intervention to preserve fertility and facilitate future testicular exams

Answer 19

cryptorchidism

Question 20

oligohydramnios

Answer 20

pull hypoplasia
renal defects
twisted face/extremities

Question 21

most common cause of death during vascular surgery>

Answer 21

MI

Question 22

AAA

Answer 22

pulsatile abdominal mass causing abdominal or back pain’
<5 cm = SERIAL ULTRASOUND EXAMS (RF reduction) >5 cm = surgical correction
if pain is present, rupture or leak should be suspected

Question 23

leriche syndrome

Answer 23

claudication in buttocks, atrophy, impotence

Question 24

claudication

Answer 24

cessation of smoking
exercise
aspirin is preferred
clopidogrel for its who can’t use aspirin

if progresses to rest pain: arterial duplex for dx

Question 25

tearing ripping pain in chest or back w/ FND

Answer 25

``` aortic dissection >20mmg upper extremities aortic regurgitation widened mediastinum smoking CT angiogram type A = surgery type B = med management ```

Question 26

acute mesenteric ischemia versus chronic versus colonic

Answer 26

``` acute = red currant jelly, POOP chronic = intestinal angina = atherosclerosis in IMA, SMA = postprandial epigastric pain colonic = reduction in intestinal blood flow causing ischemia acutely at watershed areas angiodysplasia = tortuous dilation ```

Question 27

necrotizing enterocolitis

Answer 27

premature, formula-fed infants w/ immature immune systems

Question 28

``` abdominal bruit fear of eating food extensive atherosclerosis negative CT scan + selective angiogram of the SMA ```

Answer 28

chronic mesenteric ischemia

Question 29

thickened bowel walls resembling thumb prints + afib, bloody diarrhea

Answer 29

acute bowel ischemia

Question 30

varicose veins w/ palpable cord

Answer 30

superficial thrombophlebitis

Question 31

left subclavian artery obstruction proximal to vertebral artery origin

Answer 31

to perfuse an exercising arm, blood is stolen from vertebrobasilar system and flows backward into distal subclavian artery CNS sx + UE claudication during exercise

Question 32

most common cause of B12 deficiency

Answer 32

pernicious anemia in which anti parietal cell antibodies destroy IF

Question 33

phenytoin | tmp mtx

Answer 33

``` folate deficiency (normal MMA, high homo) unlike B12 where both are high ```

Question 34

how to treat vitamin K def due to severe liver disease

Answer 34

FFP

Question 35

sudden sensorineural hearing loss

Answer 35

idiopathic | steroids are first line therapy

Question 36

common cause of a neck mass

Answer 36

children == thyroglossal duct cysts = midline location + elevation w/ tongue protrusion branchial = lateral infected cystic hygroma = lymphangioma = Turner syndrome = surgical resection

Question 37

cervical lymphadenitis

Answer 37

strep ebb in teens cat scratch leukemia

Question 38

otitis externa

Answer 38

*** pseudomonas aeruginosa *** | manipulation of auricle + erytematous swollen skin in auditory canal

Question 39

otitis media

Answer 39

spneumo hflu moraxella no pain w/ manipulation earache, fever, erythematous + bulging tympanic membranes + N/V

Question 40

recurrent otitis media

Answer 40

ppx abx + tympanovstomy

Question 41

infectious myringitis = vesicles on the tympanic membrane due to inflammation and infection

Answer 41

inflamed tympanic membranes (mycoplasma) erythromycin or clarithromycin to cover mycoplasma and stir pneumonia

Question 42

sinusitis is due to?

Answer 42

spneumo flu for 6 weeks tx if chronic

Question 43

otic bones come fixed together = progressive conductive hearing loss

Answer 43

otosclerosis

Question 44

parotid gland swelling

Answer 44

``` bulimia sarcoid sialolithiasis sjogre pleomorphic adenoma sjogren syndrome ```

Question 45

burns related to a fire

Answer 45

give 100% O2

Question 46

ELECTRICAL BURN

Answer 46

- EKG, seizures | - posterior shoulder dislocation

Question 47

hypothermia management <95F

Answer 47

conscious - rewarm unconscious - gastric lavage warm sinus Brady tsh - myxedema coma

Question 48

high CK, autonomic instability, rigidity in pt taking antipsychotics

Answer 48

NMS stop med fluids admin dantrolene admin

Question 49

how to deal with near drowning episodes

Answer 49

intubate pt if unconscious | monitor ABG

Question 50

causes of hyperthyroidism

Answer 50

graves TMN Goiter = hot nodules adenoma subacute thyroiditis = tender, painful thyroid gland factious hyperthyroidism = patient takes thyroid hormone

Question 51

hypothyroidism ass w/

Answer 51

vitiligo pernicious anemia DM coma | CTS

Question 52

hypothyroidism lab findings

Answer 52

``` high TSH low T3/T4 antithyroid + antimicrosomal antibodies hypercholesterolemia anemia ```

Question 53

sick euthyroid syndrome

Answer 53

a pt w/ illness has mild derangements in TSH == hypothyroidism like

Question 54

ACTH = high cortisol = inappropriately low post-operative pt crashes = hypotension, shock, hyperkalemeia

Answer 54

GIVE STEROIDS to prevent adrenal crisis

Question 55

most common primary cause of hypoadrenalism

Answer 55

autoimmune disease