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Flashcards in Interventions Deck (25):
1

Posterior vs anterior urethral injury

Posterior = membranous (pelvic fracture), surgery
Anterior = bulbar (straddle injury), may temporize with catheterization

2

Cholecystectomy

No symptoms - no tx needed
Bilary colic - elective lap chole, may ursodeoxycholic acid to temporize
Complicated dz with cholecystitis, choledocholithiasis, or pancreatitis - cholecystectomy within 72 hrs

3

Vascular surgery side effects

Cholesterol emboli (livedo reticularis, eosinophilia)
Toe ischemias, watershed areas of colon such as:
rectosigmoid junction with rectal sparing
splenic flexure
presents with leukocytosis, hematochezia, lactic acidosis
Endoscopy shows hemorrhagic, friable mucosa
CT scan wall edema and fat stranding

4

SBO

Empiric abx with 3rd gen ceph such as cefotaxime
Fluoroquinolones for ppx
GNRs, SAAG > 1.1, protein <1, PMNs elevated

5

Contraindications to hormonal contraception

Hypertension
migraines with aura
Smoking and over 35
DM with end organ damage
APL syndrome
hx of dvt, PE, stroke
breast cancer
heart or liver disease
major surgery
post-partum (< 3 weeks)

6

Blunt abdominal trauma

FAST assessment
Hepatic, splenic laceration
Irritation of phrenic nerve may cause referred shoulder pain

7

Emergency contraception

1 - Copper IUD
2 - Ulipristal pill
3 - Levonorgestrel pill
4 - OCPs

8

Primary vs secondary Raynaud's

Primary - treat symptomatically with CCBs
(young women, neg ANA)
Secondary - find etiology e.g. connective tissue dz, nicotine, vascular dz, sympathomimetics
(men > 40, digital ulcers)

9

Torsades (polymorphic ventricular tachycardia)

Defibrillation if unstable
IV magnesium if stable
(due to prolonged QT, from meds or genetic causes)

Adenosine is reserved for SVTs
Avoid atropine, BBs

10

MDD with psychotic features

ECT, esp if suicidal, elderly, or NPO
may add antipsychotic first otherwise

11

Rhogam

to Rh - mothers at 28-32 weeks first, then:
within 72 hrs of Rh + infant delivery
after abortion, trauma, amniocentesis, or bleeds

12

ADHD tx

Methylphenidate - if aversion to stimulants, atomoxetine (NE reuptake inhibitor)

13

Lactose intolerance

Dx with positive hydrogen breath test
bloating, flatulence, cramps, diarrhea

14

Cryptococcus meningitis

Dx with CSF labs (low gluc, high prot, crypto antigen)
Amphotericin B with flucytosine
maintenance with fluconazole
seen when CD4 < 100

15

Variable vs late decelerations

Variable - oligohydramnios, cord prolapse, cord compression
Late - uteroplacental insufficiency

16

HIT

Thrombocytopenia (>50% reduction) within 5 days of heparin exposure
Dx with serotonin release assay
replace heparin products with direct thrombin inhibitor or fondaparinux

17

Bowel perforation

Air under diaphragm, pneumoperitoneum
Dx with x ray of chest/abdomen
Tx with surgery

18

Tourette's

Tx with 2nd gen antipsychotics, clonidine (alpha 2 adrenergic), behavioral therapy

19

Psychotherapy

Supportive - low functioning, pts in crisis, psychosis
Cognitive behavioral - maladaptive behaviors
Interpersonal - depression
psychodynamic - high functioning, personality disorders
MIs - substance use
dialectical - Borderline personality disorder
Biofeedback - somatic or pain disorders

20

Neonatal conjunctivitis

Chemical (following silver nitrate) - eye lubricant
Gonococcal (dx with cx) - IM cefotaxime single dose
Chlamydial (dx with PCR) - PO macrolide

21

Vaginitis

Bacterial vaginosis - metronidazole or clindamycin
Trichomoniasis - metronidazole, treat partner
Candidiasis - fluconazole

22

Labor protraction vs arrest

Protraction (cervical change +/- contractions) - oxytocyn
Arrest (no change > 4 hrs with contractions, > 6 hrs w/o contractions) - c section

23

Pseudogout

Calcium pyrophosphate crystals deposits in joints and chondrocalcinosis
Send iron studies to r/o hemochromatosis
Also send TSH, PTH

24

Hypertension in young patient

Send lipid panel, U/A, BMP, EKG first
Then rule out secondary causes:
Renal stenosis, coarctation of aorta, adrenal tumor

25

Painless jaundice

Abdominal U/S or CT scan to r/o cancer in head of pancreas
Double duct sign - compression of pancreatic duct and common bile duct
Courvoisier sign - distended nontender gallbladder with intra and extrahepatic biliary duct dilation
Trousseau syndrome - migratory thrombophlebitis