Last Ocm Flashcards
(142 cards)
1
Q
Newman
A
Ok
2
Q
When using IV fluids what think about
A
Water
3
Q
Normal physiologic needs for water
A
Depend on kidney, antidioretic hormone, how much drink
Drink, save, and put out
100mL for every 100 kcal of energy expended
4
Q
Daily caloric expenditure
A
<10 kgL 100kcal.kg
>10kg to 20kg: 1000 kcal for first 10 kg plus 50kcal/kg for any increment of weight about 10 kg
>20 kg-80 kgL 1500 kcal for first 20 kg of body weight plus 30 kcal.kg for any increment of weight above 20 kg
Weight >80kgL 2700kcal.day with adjustments made as clinically pertinent for either increase r decrease
5
Q
Insensible water loss
A
Respiration and skin
6
Q
Sensible
A
Urine and stool
Water you know you are losing
7
Q
Regular condition sensible+insensible
A
Sensible and insensible=100cc/kcal of energy oexpended
8
Q
Just sitting
A
Losing insensible
9
Q
Diarrhea
A
Sensible loss increase and this is fluid you must replace
10
Q
Burns
A
Fluid loss, always need more fluid
11
Q
Holliday segar methof
A
Most common to calculate fluids
Maintenance fluid requirements
Assume 100 mL neede to replace sensible and insensible under regular circumstances for ever 100 kcal.kg of energy
Fluid requirement is related to caloric means!!!!!!!!
12
Q
Holliday segar assumes what
A
Everything is Normal
Normal conditions
Uses weight alone
13
Q
4-2-1
A
4 cc per kg per hour x5=20cc an hour
10-20 40mL+2mL/kg
> 20=60+1 ml/kg
14
Q
Everyone needs what per day
A
100ml/kg/day is less than 10kg
1000mL+50 ml/kg/day for >10
1500 ml+20 ml/kg/day for over 20kg
15
Q
An and cl requirements
A
3mEq per 100 cc water
16
Q
K
A
1-2 mEq per 100 cc
17
Q
Need dextrose in fluid?
A
Yes almost always added D5 usually by get hypoglycemic
If chance fasting for a bit
Pre op always make sure there’s sugar in it
18
Q
Calculate hourly maintenance IV fluid rate for a normal 25 kg child
A
65 cc per hour
57 cc/hour
19
Q
Rehydration use what
A
ISOTONIC
20
Q
LR and NS
A
Isotonic
21
Q
Maintenance fluid
A
First line is 1/3 or 1/4 normal saline
Or NS
22
Q
AAP recommends that patients 28 days to 18 years needing maintenance VIFs should receive __ solutions. Why
A
Isotonic
Sig decrease risk of developing hyponatremia
QUALITY A EVIDENCE
23
Q
What is NS
A
.9% back
24
Q
Half NS
A
4.5 NaCL
25
1/4 NS
2.25%
26
Mild dehydration
3-5%
Well appearing, normal to inc HR, normal breathing, normal cap refill
Warm , instant skinrecoil
27
Moderate dehydration
6-9% body weight loss
Ill appearing, tachycardia, increased breathing, pulses normal, normal capillary refill,
Cool perfusion, delayed 2 s skin turtle
28
Severe dehydration
>10% loss of body weight due to water loss
Sick
Lethargic, tachycardia, increased deep breathing, poor pulses, prolonged capillary refill
Cold, very prolonged cap refill >2 sec
29
Hydration most important cap refill over 2, dry mucous membrane, absent tears, general appearance
DEHYDRATION
Tends to be as diagnostic as the rest
30
Gold standard asses hydration
Weight
31
If dehydrated remember replace deficit with
10 kg child 5% dehydrated
.5 kg
1000 , 500cc of fluid when replace replace deficit along with giving them their maintenance
32
Acute vomiting and diarrhea in 2 year old boy and has low grade fever
Skin turf or, mucous membranes, e perfusion, general appearance
Oral hydration, come back in ew days if not better
Viral gastritis
33
Wheeze and cold three days ago runny nose cough first days and now trouble breathing afebrile
```
Not all asthma
Foreign object
Allergies
Toxin
Pneumonia
```
34
Complemtary alternative medicine
Ok
35
Difference between integrative and functional medicine
Functional-connected with or being a function: the functional differences between the departments
Affecting physiological or psychological functions but not organic strucureL functional heart disease
Systems biology based , genes env lifestyle, timelines, in depth interviews
ROOT CAUSE,
36
Similarities integrative and functional medicine
Create health
Combines alternative medicine practice with conventional practice
Together complementary and alternative medicines
Philosophy that neither rejects conventional medicine nor accepts alternative therapies uncritically
37
Basics of acupuncture
Expensive, safe,
38
Who qualified to do accupuncture
Ok
39
Natural therapeutic interventions for common problems
Compare and contrast regenerative medicine
40
Back pain
Glucosamine+chondroitin sulfate
41
Pain
Yoga
42
Sores
Relaxation techniques like diaphragmatic breathing
43
Balance
Tai chi
44
Detoxify
Essential oils.purify air by removing toxins increasing oxygen, prevent illness
Topical, aromatically, internally
45
Upset stomach cramping, gas, bloating, heart, big
Peppermint
46
Anti infections cold sores, fevers, soar through, ear infection, infections
Lemon
47
Calming relaxing, wound healing, burns, cuts
Lavender
48
Regenerative medicine
Mask.ortho injuries
Prolotherapy, platelet rich plasma, stem cell therapy
49
Prolotherapy
Injection, repairs weak/painful joint/ligamentous areas, long term solution
Raising growth factors
Tissue repair/growth
50
Indication prolotherapy
MSK pain>8 weeks
Low back pain ........
Try before surgery
51
History prolotherapy
Chronic MSK pain from inadequate repair of CT. Mainly ligaments and tendons poor blood supple so get chronic pain
52
Sclerotherapy
Inaccurate term for prolotherapy
53
Ssclerotherpy basis
Scar formation was treatment mechanism
| When biopsy have not shown scar formation
54
How sclerotherapy work
Stimulate cascade inflammation activated fibroblasts
Raises GF levels_fibrosis-new CT repair
Efffectiveness has been evidenced with double blind placebo controlled studies
55
MRI misleading/.
Correlate results of imaging to ther patient
| MRI can show abnormal results in pain freee patients
56
Pain is a liar
Ligament injury can cause severe pain due to density of nerve endings
NSAIDS and corticosteroids have not been shown to improve health
57
Sclerotherapy
Tendonsis intentionally turned to tendinitis to stimulate repair
58
Low back pain
Prolotherapy
59
Prolotherapy and spinal disc disease
Stabilize and strengthen the ligaments around weakened joints and reduce or eliminate pain
60
Sciatica an dprolotherp
Usually from ligamentous laxity in SI joint
61
SI ligament pain referral
Overlap sciatic nerve pathways
62
Piriformis
Piriformis inflammation leading to welling and pressure on sciatic nerve causing pain and referral
63
Merriments study
Prolotherapy fewer side effects than fusion for SCIATICA
64
Wolfs law prolotherapy OA
Bones respond to stress by making new bone
65
Meniscus tear prolotherapy
Treats when supporting ligaments
66
Cartilage regeneration
May help by raise GF levels
67
Neck pain and MSK HA
Very successful
68
Appearance and behavior, eye contact, eye movement
Important when walk in for mental status
69
Mood and affect
Mood-subjective report of emotional state by patient
Affect: objective observation of patients emotional state by the physician
70
Akathisia
Excessive motor activity
71
Agitation
Wringing hands, rocking, picking at skin or clothing
72
Bradykinesia
Psychomotor retardation
73
Catatonia
Immobility with muscular rigidity waxy flexibility
74
Gait
Shuffling, broad based, limping, stumbling, hesitation
75
Tardive dyskinesia
Involuntary facial grimaces, choreathetotic moments
76
The ordering and implementation of cognitive function necessary to engage in appropriate behaviors
Biotin to focus based on internal or external priorities
77
Judgement
Choose appropriate behaviors
78
Insight
Awareness and understanding of illness and need for treatment
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Gnosis
Ability to Naem objects and their function
80
Praxis
Ability to carry out intentional motor acts
81
Visuospatial profiency
Ability to perceive and manipulate objects and shapes in space
82
Verbal or written communication
>100 words per min normal
| M50 words per min not normal
83
Verbal or written communication
Volume and tone: loud , soft, monotone, weak, strong, mumbles
Fluency and rhythm
Coherent
Echolalia
84
Echolalia
Immediate and involuntary repetition of words or phrases just sponge by others
85
Prosody
Recognize the emotional aspects of language
86
Recall of past events
Declarative
| Procedural: complete them without. Conscious thought
87
Sensorium
Level and stability of consciousness
| Deepest on Glasgow coma score
88
Active vs passive thought
Ok
89
Auditory hallucinations
Compelling
90
Jamais vu
Sense of eeriness and the observers impression of seeing the situation for the first time, despite rationally knowing that he or she has been nit he situation before
Associated with certain types of aphasia, amnesia, and epilepsy
91
Circumferential
Patient goes through multiple thoughts before arriving at the answer to a question
92
Disorganized thought
Moves from one topic to another without organization or coherence
93
Tangential
Listens to question and begins discussion related thoughts ,but never arrives at the answer
94
Circumlocution
Use of many words where fewer would do, as when having difficulty finding a word
95
Where are most BCC
Head neck
96
Modular BCC
Most common
Pearl white or pink dome shaped pale resembling mollusculm contagious
Extends
Pearly border
Center ulcerated
Telangiectasia
97
SCC
Risk metastasis unlike BCC
From epithelium and is common int he Middle Ages and elderly population
Separated into prior radiation and from actinically damaged skin
98
Most common SCC spoil
Sun exposed like scalp back of hands
| Bcc rarely found
99
Presentation SCC
Red, inflamed, scaly lesion from actinic keratosis
100
Melanoma
High metastic potential
IV light, tanning bed, fair complexion, family history, dysplastic and congenital nevi
101
Superficial spreading melanoma
Most common initial radial growth phase before invasion
102
Lentils maligna melanoma
Long growth phase before invasion
| Elderly and sun exposed
103
A real lentiginous
Black ppl
| Palms and soles, mucosal surfaces, in nail beds, and mucocutaneous junctions
104
Modular
Poor prognosis invasive growth from onset
105
Clinical melanoma
Pigmented colorless caries
| >6 mm asymmetric, irregular, variation in color
106
Melanoma diagnosis
Biopsy excisions
Depth of invasion is the most important prognostic factor
107
Actinic
Scaly erythematous macula or patch of skin
Develop to SCC
108
In situation or intra epidermal squamous cell carcinoma Bowen’s disease
Localized neoplasticism cells that are confined to epidermis flat erythematous and scaly plaque that si well demarcated but irregularly shaped.
Sun exposed spots legs
Slow growing
SCC
109
In situation SCC affecting glans panic or vulva
Erythroplasia of queyrat and is associated with HPV infection
110
X ray
Scatter radiation that is not absorbed
Can affect team
Greater depth penetration lighter grey
111
Fluoroscopy
X rays imaging to create a real time look into internal structures
Dynamic procedures such as injections, biopsies,, angiograms and GI
112
CT
2d image with pain radiograph
ST
Measure and display varying x rays attenuation of the tissues in a section fo the body by passing x rays through the section from many different angles then using computers to reconstruct the image you see
113
Ct good
Fast, good resolution of bony lesions, less expensive than MRI
114
Weakness CT
Ionizing radiation, expensive, poor soft tissue
115
T1 MRI
Fat bright, water dark, detect anatomy
116
T2
Water bright, fat dark , detect pathology
117
MRI good
No ionizing radiation, entire cross sections without interference , superior soft tissue contrast
118
Weak MRI
Subject to motion artifact, inferior to CT in detecting acute hemorrhage, inferior to CT in detection of bony injury, requires prolonged acquisition time for many images
119
How do MRI/CT
Contrast medium injected into joint under fluoroscopy contrast used depends on type of imaging CT or MRI
Used to elucidate tears in labrum or cartilage
120
US
No ionizing radiation
Send waves through transducer
Turn off transducer allows time to receive echos and electrical impulses generated and image recreated
121
Due a
Radiography tube generates photon beams of two different energy levels thus dual energy
The difference in attenuation of two photon beams as they pass through body of variable composition distinguished bone from soft tiers and allows quantification of BMD
T score the value used for diagnosis of osteoporosis
Z score used to compare patients BMD to population
122
Open x ray
Thick open to air has penetrated skin
123
Closed fracture
Bone has been fractured yet has not penetrated the skin
124
Displacement
Extent to which axial bones are not aligned
| Can be described in terms of percentages distal segment displaced relative to proximal one
125
Angulation
Fracture segments are not anatomically aligned but rather at an angle
Apex relative to anatomical long axis
126
Rotation
Extent to which the fracture segments are rotated distal segment rotated relative to proximal segment
127
Osteomyelitis
Bone and arrow inflammation
128
Most common bone infection
S aureus
129
Osteomyelitis presentation
Acute osteomyelitis gradual onset of symptoms over several days
Dull pain at involved site
Tender, warm swollen
130
Imaging modality of choice for osteomyelitis
2 weeks of symptoms+ suggestive clinical history-x ray-looked like osteomyelitis or symptoms>2 weeks-MRI
Or x ray doesn’t look like osteomyelitis no MRI
131
Annular
Ring like
132
Nummular
Coin like
133
Acrochordons
Fibroepithelial polyps; benign cutaneous growths. Commonly found in areas of frequent friction. Small skin colored or brown, soft Papuans
134
Atopic dermatitis
Chronic, relapsing. Prurience conditions often associate with allergic rhinitis. More common in kids, usually involves the flexural aspects of the extremities, but can be widespread. Intense pruritus
135
Allergic contact dermatitis
Type IV reaction poison ivy, oak, sumac
136
Urticaria
Wheals
137
Erythematous no do sum
Bright red elevated. Pretibial sarcoidosis
138
Folliculitis
Inflammation of superficial hair follicles resulting in follicularly centered papules and pustules.
139
Lipodermatosclerosis
Inflammation fo the adipose below the skin secondary to chronic venous insuffiency. LE. Initially is tender with erythema and hyperpigmentation progresses to sclerosis and hyperpigmentation
140
Pityriasis rosea
Scaly pink or flesh colored herald lesion followed by eruption of discrete oval, erythematous and scaly plaques and patches oriented along skin cleavage lines, trunk
Spares palm and soles
141
Vitiligo
Acquired leukoderma characterized by well circumscribed chalk white depigmented maulers of patches. Hypothesized to either be autoimmune or an intrinsic melanocytes defect
142
Herpes zoster
1-3 day prod Rome of burning pain and parenthesis. Dermatologic. Crust over and resolve 7-14 days
