Quiz #4 Flashcards
(45 cards)
1
Q
____ - _____% of patients with sepsis die.
A
28-50%
2
Q
Risk Factors for Sepsis (4)
A
- 65+ years old
- Pts with chronic medical conditions (DM, lung dz, CA, kidney dz)
- People with weakened immune systems
- Neonates
3
Q
SIRS Criteria
A
- Body Temperature (>38 or < 36)
- Heart Rate (> 90 bpm)
- Tachypnea (> 20 breaths)
- WBC Count (> 12,000, < 4,000, or > 10% immature neutrophils)
4
Q
Sepsis Steps
A
- Sepsis: presumed source of infxn + 2 or more SIRS criteria
- Severe sepsis: sepsis + organ dysfunction
- Septic shock: sepsis refractory to IV fluid (refractory hypotension) OR lactate > 4
5
Q
Severe Sepsis Bundle
A
Within 3 hrs of presentation: 1. measure serum lactate 2. obtain blood cx prior to abx 3. administer abx 4. start IV fluids (LR/NS) 2.5 L/hr Within 6 hours of presentation: 1. repeat serum lactate if initial lactate > 2
6
Q
IV fluid rate for peds in severe sepsis
A
40 ml/kg when septic
7
Q
Septic Shock Bundle
A
Within 3 hours of presentation: 1. measure serum lactate 2. obtain blood cx prior to abx 3. administer abx 4. resuscitate with 30 ml/kg fluids Within 6 hours of presentation: 1. repeat volume status and tissue perfusion assessment 2. give vasopressors (if hypotension persists)
8
Q
Top sources of sepsis infections
A
Lungs
Urinary tract
Skin
GI tract
9
Q
Types of Headaches
A
Tension (most common - 40%)
Migraine
Cluster
10
Q
DDX for headache
A
- Primary (tension, migraine, cluster)
- Vascular (hemorrhage, hematoma, aneurysm)
- Infectious (meningitis, abscess, encephalitis)
- Cancer
- Medical D/O (hypothyroidism, OCPs, fever, CO exposure)
11
Q
Characteristics of Migraines (POUND)
A
Pulsatile Onset/Duration 4-72 hours Unilateral Nausea Disabling
12
Q
Red Flags for Headaches
A
"Worst HA of my life" Thunderclap HA FND (atypical aura) Fever, nuchal rigidity, kernig's, papilledema > 50 y/o New onset in pregnancy Worsening pattern HA triggered by cough or exertion Recent trauma
13
Q
Classifications for Migraines
A
At least 2 of the following:
- Unilateral
- Moderate to severe
- Pulsatile
- Aggravated by movement
1 of the following:
- Nausea
- Photo and phonophobia
At least 5 episodes
14
Q
Auras of migraines
A
Visual - scintillating scotoma, photophobia
Sensory - paresthesia, numbness
Other - weakness, aphasia
15
Q
Tx for migraines (acute)
A
NSAIDs Tylenol Triptans OTC Excedrin Fioricet Cafergot Goody's Powder Opiates Antiemetics
16
Q
Tx for migraines (preventative)
A
Consider if 2+/month CCB (Verapamil) BB (Propranolol) TCA (Amitriptyline) Valproate Sodium Botox
17
Q
Tx for tension HA (acute)
A
Aspirin Acetaminophen Ibuprofen Naproxen Excedrin
18
Q
Tx for tension HA (chronic)
A
Amitriptyline
Fluoxetine
Tizanidine
Stop smoking
19
Q
Tx for cluster HA
A
O2, ergotamines at first signs of sx Corticosteroids Verapamil Topiramate Valproic Acid
20
Q
Associated symptoms with migraines
A
Nausea Vomiting Photophobia Phonophobia Aura
21
Q
Associated symptoms with cluster HA
A
Ipsilateral lacrimation Ipsilateral redness of the eye Stuff nose Rhinorrhea Pallor Sweating Restlessness or agitation
22
Q
Presentation of CVA
A
Sudden speech difficulty Weakness Paralysis Vision loss Dizziness Severe HA FAST (face, arm, speech, time)
23
Q
DDX of stroke
A
Seizures Hypoglycemia Migraine with aura HTN encephalopathy Drug toxicity CNA abscess or tumor Wernicke's encephalopathy
24
Q
Time since “last known normal” timeframes
A
< 4.5 hrs for tPA
< 6 hrs for endovascular thrombectomy
25
Physical Exam for stroke
Skin: purpura, ecchymoses
Head: signs of trauma, papilledema, tongue laceration (seizure)
CV: pulses in neck, arms, legs, auscultate for murmurs, check for bruits
Extremities: cellulitis, DVT
Lungs: abnormal breath sounds, fluid overload, stridor, rales
26
Dx for CVA
```
Non contrast CT or MRI
Glucose
O2 sat
Electrolytes
BUN
sCr
CBC
Cardiac enzymes
PT/INR,PTT
EKG
```
27
Tx for CVA
```
tPA
Antipyretic
IV labetalol
PT, OT, mental health support
speech therapy
```
28
Exclusion criteria for tPA
```
evidence of hemorrhage
glucose < 50
current anticoagulant
active internal bleeding
systolic > 185 or diastolic > 110
significant head trauma
< 18 y/o
```
29
Relative exclusion criteria for tPA
```
Pregnancy
Seizure at onset
Major surgery w/n 14 days
Recent acute mI
Recent GI or urinary tract hemorrahge
```
30
Labs/tests for gout
CBC
Uric acid
Arthrocentesis
Xray
31
Categories in arthrocentesis results
```
Color
Clarity
Crystals
Cell Count
Culture
```
32
Gout arhrocentesis
Negative birefringence, needle-shaped crystals
| Elevated white count
33
Tx for gout
```
Colchicine (rarely used)
NSAIDs (naproxen, celecoxib, indomethacin)
Oral steroids (prednisone)
Allopurinol
Febuxostat
```
34
Symptoms of osteoarthritis
- Morning stiffness < 30 min
- Evening joint stiffness
- Stiffness decreases with rest and worsens throughout day
- Primary affects hands (PIP, DIP)
- Tenderness and crepitus or grating sensations develop
35
PE for OA
Skin: rash, warmth, swelling
GI: r/o crohn's
MSK: inspect joint above, below, and bilaterally. Deformities, swelling, ROM, Heberden's nodes (DIP), bouchard's nodes (PIP)
36
Imaging/Labs for OA
XR (osteophytes, narrowing of joint space, sclerosis)
CBC (infection)
Rheumatic factor
37
Tx for OA
```
Acetaminophen
NSAIDs
Stretching
Orthotics
Weight reduction
Referral to PT
```
38
Sx for RA
- Morning stiffness > 30 min after initiating movement
- Improves later in the day
- Small joint stiffness (MCP, PIP, wrist, knee, MTP, shoulder, ankle)
- Constitutional sx (fever, fatigue, anorexia, weight loss)
- Symmetric arthritis (swollen, tender, boggy joint)
39
PE for RA
General: fatigue, weight loss, anorexia, fever
MSK: boutonniere deformity (flexion at PIP, hyperextension of DIP)
Ulnar deviation at MCP joint
Rheumatoid nodules
40
Dx for RA
Rheumatoid factor
CRP and ESR
Anti-citrullinated peptide antibodies (most specific)
41
Tx for RA
methotrexate
If they have an ectopic pregnancy it'll fix that too
42
Emergent back pain dx
```
Spondylolysis
Spondylolisthesis
Degenerative Disk Dz
Herniated disc
Compression fx
Cauda Equina Syndrome
Spinal stenosis
Epidural abscess
Shingles
Aortic aneurysm
```
43
Red flags for back pain
```
> 50 y/o
Acute sudden tearing back pain
Duration > 6 weeks
IV drug use
Unexplained weight loss
Chronic steroid use
Saddle numbness
Fever
Bowel/bladder dysfunction
```
44
PE for back pain
```
Sensation
Motor
DTR
+/- SLR
Pain with hip flexion
Heel walk
Toe walk
Rectal exam
```
45
Tx for back pain w/ no red flags
```
Acetaminophen
NSAIDs
Skeletal muscle relaxants
Heat therapy
PT
Staying active (but avoid heavy lifting, bending, twisting, and prolonged sitting)
```
