Interventions Flashcards
lern da tx
Posterior vs anterior urethral injury
Posterior = membranous (pelvic fracture), surgery Anterior = bulbar (straddle injury), may temporize with catheterization
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
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
SBO
Empiric abx with 3rd gen ceph such as cefotaxime
Fluoroquinolones for ppx
GNRs, SAAG > 1.1, protein <1, PMNs elevated
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)
Blunt abdominal trauma
FAST assessment
Hepatic, splenic laceration
Irritation of phrenic nerve may cause referred shoulder pain
Emergency contraception
1 - Copper IUD
2 - Ulipristal pill
3 - Levonorgestrel pill
4 - OCPs
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)
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
MDD with psychotic features
ECT, esp if suicidal, elderly, or NPO
may add antipsychotic first otherwise
Rhogam
to Rh - mothers at 28-32 weeks first, then:
within 72 hrs of Rh + infant delivery
after abortion, trauma, amniocentesis, or bleeds
ADHD tx
Methylphenidate - if aversion to stimulants, atomoxetine (NE reuptake inhibitor)
Lactose intolerance
Dx with positive hydrogen breath test
bloating, flatulence, cramps, diarrhea
Cryptococcus meningitis
Dx with CSF labs (low gluc, high prot, crypto antigen)
Amphotericin B with flucytosine
maintenance with fluconazole
seen when CD4 < 100
Variable vs late decelerations
Variable - oligohydramnios, cord prolapse, cord compression
Late - uteroplacental insufficiency
HIT
Thrombocytopenia (>50% reduction) within 5 days of heparin exposure
Dx with serotonin release assay
replace heparin products with direct thrombin inhibitor or fondaparinux
Bowel perforation
Air under diaphragm, pneumoperitoneum
Dx with x ray of chest/abdomen
Tx with surgery
Tourette’s
Tx with 2nd gen antipsychotics, clonidine (alpha 2 adrenergic), behavioral therapy
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
Neonatal conjunctivitis
Chemical (following silver nitrate) - eye lubricant
Gonococcal (dx with cx) - IM cefotaxime single dose
Chlamydial (dx with PCR) - PO macrolide
Vaginitis
Bacterial vaginosis - metronidazole or clindamycin
Trichomoniasis - metronidazole, treat partner
Candidiasis - fluconazole
Labor protraction vs arrest
Protraction (cervical change +/- contractions) - oxytocyn
Arrest (no change > 4 hrs with contractions, > 6 hrs w/o contractions) - c section
Pseudogout
Calcium pyrophosphate crystals deposits in joints and chondrocalcinosis
Send iron studies to r/o hemochromatosis
Also send TSH, PTH
Hypertension in young patient
Send lipid panel, U/A, BMP, EKG first
Then rule out secondary causes:
Renal stenosis, coarctation of aorta, adrenal tumor
