Internal Med Critical Care Flashcards
(72 cards)
1
Q
etiology of acute adrenal crisis
A
stressor with insufficient cortisol
2
Q
presentation of adrenal crisis
A
- high fever
- severe abd pain
- n/v
- confusion
- hypotensive shock
3
Q
diagnosis of adrenal crisis
A
order serum cortisol and ACTH but do not wait on results to start treatment
4
Q
treatment of adrenal crisis
A
- IV hydrocortisone
- fix electrolytes
- broad spectrum antibiotics
5
Q
defining location of upper GI bleed vs lower GI bleed
A
ligament of treitz
6
Q
presentation of upper GI bleed
A
- hematemesis
- coffee ground emesis
- melena
- hyperactive bowel sounds
7
Q
presentation of lower GI bleed
A
hematochezia
8
Q
diagnosis of upper GI bleed
A
NG tube with lavage
9
Q
diagnosis of lower GI bleed
A
- rectal exam
- colonoscopy
10
Q
management of GI bleed
A
- hemodynamically stable: consult GI or surgery for endoscopy
- hemodynamically unstable: NPO, fluids, blood transfusion
11
Q
indications for transfusion of GI bleed
A
- failure of perfusion after 2L of fluids
- hbg <7
- hbg<9 and comorbidities
12
Q
etiology of acute glaucoma
A
sudden increase of IOP causing damage to optic nerve
13
Q
s/s of acute glaucoma
A
- halos around lights
- dilated pupils
- headache
- severe eye pain
- steamy, red cornea
14
Q
diagnosis of acute glaucoma
A
gonioscopy
15
Q
treatment of acute glaucoma
A
- acetazolamide
- pilocarpine
- recheck IOP every 30-60 minutes
- definite: laser iridotomy
16
Q
ARDS
A
acute respiratory failure following a systemic or pulmonary insult without evidence of heart failure
17
Q
etiologies of ARDS
A
- sepsis
- aspiration pneumonia
18
Q
pathophys of ARDS
A
lung injury causes excess fluid to accumulate in both the interstitium and alveoli which causes impaired gas exchange
19
Q
diagnosis of ARDS
A
- acute onset within 1 weeks of clinical insult
- bilateral pulmonary infiltrates
- PaO2/FIO2 <300mg
20
Q
s/s of ARDS
A
- SOB
- tachypnea
- intercostal retractions
- crackles
- multiple organ failure
- does not respond to supplemental O2
21
Q
treatment of ARDS
A
- treat underlying cause
- PEEP
- low tidal volume ventilation
22
Q
s/s of cardiac tamponade
A
- distant heart sounds
- JVD
- hypotension
- kussmauls sign
- pulsus paradoxus
- electrical alternans
- water bottle heart
23
Q
diagnosis of cardiac tamponade
A
echo
24
Q
Management of cardiac tamponade
A
pericardiocentesis
25
coma
state of unresponsiveness, even to stimuli, and may lack a gag reflex or pupillary response that lasts for >1hour
26
confirmatory test for coma
cold caloric testing with normal response
27
cold caloric testing normal response
eyes moving to irrigated side followed by brisk horizontal nystagmus back to contralateral ear
28
locked in syndrome
patients are awake and alert but are mute and quadriplegic
29
brain death
irreversible cessation of all brain function with a known cause
30
diagnosis of brain death
* 6 hours of flat EEG
* 12 hours without EEG
* 24 hours for anoxic brain injury without EEG
31
etiology of DKA
insulin deficiency triggered by stress
32
presentation of DKA
* n/v
* fruity breath
* hypotension and tachycardia
* kussmaul respirations
33
diagnosis of DKA
* elevated glucose
* b-hydroxybutyrate
34
management of DKA
fluids then insulin
35
hypertensive urgency
BP 220/125 with no sx
36
hypertensive emergency
BP 220/130 with end organ damage
37
treatment of hypertensive urgency
* clonidine
* captopril
* nifedipine
38
treatment of hypertensive emergency
* BB and CCB used first
* lower 25% in the first 2 hours, then 160/100 the next 2-6 hours
39
s/s of pneumothorax
* pleuritic CP
* tachypnea
* SOB
* diminished breath sounds
* tension: tracheal deviation and lateral PMI
40
diagnosis of pneumothroax
CXR
41
treatment of pneumothorax
* small primary: supplemental o2 and observe
* large primary: aspiration and possible chest tube
* secondary: tube and admit
* tension: needle decompression
42
s/s of PE
* pleuritic CP
* dyspnea
* tachypnea
43
diagnosis of PE
* first do PERC rules, then Wells score
* low risk and no perc: observation
* low risk with positive perc or moderate risk: D-dimer
* high risk: CTA
44
wells score interpretation
* high risk: >6
* moderate risk: 2-6
* low risk: <2
45
gold standard for diagnosis of PE
pulmonary angiography
46
treatment of PE
* supplemental O2
* anticoagulation
* TPA for high risk pts
* embolectomy for high risk patients that cant have TPA
47
Choice of anticoagulation for PE
* unstable and renal insufficiency: heparin
* cannot take oral anticoags: lovenox
* anyone else: DOAC
48
seizure disorder (epilepsy)
2 or more unprovoked seizures
49
pre-ictal phase of seizure
* sx that occur before the seizure
* numbness/tingling
* hallucinations
* HA
* nausea
50
post-ictal phase of seizure
weakness and fatigue that occurs after the seizure
51
focal seizure
* abnormal activity that affects only one area of the brain
* can have retained or impaired awareness
52
absence seizure
staring off into space with impaired consciousness
53
myoclonic seizure
sudden, irregular, brief jerks or twitches
54
atonic seizures
* drop attacks
* usually associated with intellectual impairment
55
tonic seizures
muscle stiffening and rigidity
56
clonic seizures
* convulsive movements
* rhythmic jerking
57
tonic-clonic seizures
* LOC
* violent shaking
* body stiffening
* loss of bowel and bladder incontinence
58
treatment of seizures
* focal: lamictal
* generalized: valproate
* pregnanct: keppra
59
Etiology of cardiogenic shock
Acute MI
60
S/S of cardiogenic shock
* hypoperfusion
* tachycardia
61
treatment of cardiogenic shock
* if due to ischemia, PCI
* NE or dopamine
62
s/s septic shock
* hypotensive
* hypo or hyper thermia
* tachycardia
* no response to at least 3L of fluids
63
treatment of septic shock
* vanc+zosyn
* fluids
* high flow o2
64
neurogenic shock
caused by lesion or injury to the cervical spine that causes loss of vascular tone
65
s/s of neurogenic shock
* warm skin
* hypotension
* no reflex tachy
66
treatment of neurogenic shock
* fluids
* vasopressors
67
etiology of obstructive shock
* pneumothorax
* pericardial tamponade
* massive PE
68
status epilepticus
seizure activity lasting longer than 5-10 minutes or several seizures occurring during a 30 minute time frame
69
treatment of status epilepticus
IV benzo
70
thyroid storm
severe, life treatening thyrotoxicosis triggered by stress
71
s/s of thyroid storm
* delirium
* tachycardia
* vomiting
* diarrhea
* dehydration
72
treatment of thyroid storm
* methimazole
* PTU
* beta blocker
