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Step 2 DIT > Treatments 3 > Flashcards

Treatments 3 Flashcards

(115 cards)

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1
Q

Trauma assessment, primary

A

ABCDE
Airway (ET/cricothyroid)
Breathing (O2, pulse ox, ventilation, pneumothorax)
Circulation (pulse, vitals, IVF x2 PIVs or central line, bleeding)
Disability (GCS, glucose)
Exposure (remove clothes, DRE/Foley, blanket)

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2
Q

Trauma assessment, secondary

A 
Reassess ABCs
DRE/Foley (not if high riding prostate/blood at urethral meatus)
NGT placement
Hx
Head-to-toe exam
Examine back, remove backboard
X-rays, FAST, CT, labs, fx management
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3
Q

Lower ICP

A

Head of bed at 30 degrees
Mannitol IV (q6 hrs Na and osmolarity)
Intubate and hyperventilate (temp relief)
Decompressive craniectomy
Ventriculostomy, barbiturate coma, paralysis

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4
Q

Neck trauma, zone I

A

Clavicles to cricoid

CT angiogram, EGD, bronchoscopy, laryngoscopy

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5
Q

Neck trauma, zone II

A

Cricoid to angle of mandible

Surgical exploration

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6
Q

Neck trauma, zone III

A

Angle of mandible to base of skull

CT angiogram, EGD, bronchoscopy, laryngoscopy

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7
Q

Abdominal trauma, penetrating injury

A

(Emergent) exploratory laparotomy

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8
Q

Pelvic fx + DPL shows blood in pelvis

A

Emergent laparotomy

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9
Q

Pelvix fx + DPL shows urine in pelvis

A

Urgent laparotomy (bladder repair)

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10
Q

Pelvic fx + DPL shows nothing + hemodynamically unstable

A

Angiography + possible embolization

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11
Q

BAT + unstable vital signs + FAST shows fluid in pelvis

A

Emergent laparotomy

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12
Q

BAT + unstable vital signs + FAST shows no fluid in pelvis

A

Angiography + possible embolization

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13
Q

BAT + unstable vital signs + FAST inconclusive

A

DPL

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14
Q

BAT + stable vital signs

A

CT abdomen/pelvis, observation

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15
Q

Tension pneumothorax

A

Immediate chest tube placement

Needle decompression if CT delayed (2/3rd IC space mid-clavicular or 5th IC midaxillary)

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16
Q

Flail chest

A

O2
BiPAP or ET
Analgesia

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17
Q

Gonorrhea prophylaxis

A

Ceftriaxone 125 mg IM

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18
Q

Chlamydia prophylaxis

A

Azithromycin 1 g PO or

Doxycycline 100 mg PO bid x7 days

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19
Q

Trichomonas prophylaxis

A

Metronidazole 2 mg PO

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20
Q

Post-op to improve pulmonary fxn

A

Incentive spirometry
Deep breathing exercises
PT
Analgesia

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21
Q

Pre-op labs concerning for liver disease

A

Increased PT/PTT
Decreased platelets
Decreased albumin
Increased bilirubin

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22
Q

Obstruction (abdominal)

A

Surgical lysis of adhesions

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23
Q

Diverticulitis

A

Metronidazole and fluoroquinolone (PO outpatient or IV inpatient)

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24
Q

Massive GI hemorrhage (perforation)

A

Angiography w/ embolization, surgical repair of detectable site of bleeding

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25
Appendicitis
Appendectomy
26
Acute mesenteric ischemia
NPO NG tube Antibiotics Resection of necrotic bowel
27
Malignant hyperthermia
Evaporative cooling Dantrolene Cold inhaled O2, GI lavage, IV fluids
28
Chronic mesenteric ischemia
Bypass, endarectomy, or angioplasty and stenting
29
Graft vs. host disease
Corticosteroids | Tacrolimus, mycophenolate
30
Hyperacute transplant rejection
(First 24 hrs) | Untreatable
31
Acute transplant rejection
(6 days - 1 year) | Immunosuppressive agents
32
Chronic transplant rejection
(>1 year) Usu untreatable Immunosuppressive agents may help a bit
33
Common cold
Rest, analgesia, symptomatic treatment | NO Abx
34
Pharyngitis
Self-limited | Abx reduce infection time, reduce acute rheumatic fever (B-lactams)
35
Peritonsillar abscess
Needle aspiration or I&D | Pain meds + abx (amoxicillin/clavulanate or clindamycin)
36
Sinusitis
Symptomatic (nasal irrigation, analgesics, oral decongestants, intranasal steroids) Amoxicillin-clavulanata, doxycycline or levofloxacin
37
PNA in neonates
Amp + gent +/- vancomycin
38
PNA in 1-4 months
Macrolides (-mycin) +/- cefotaxime
39
PNA in 4 months - 4 years
Amoxicillin, Ampicillin
40
PNA in 5-15 years
Amoxicillin + clarithromycin Azithromycin Amoxicillin + doxycycline
41
Acute bronchitis
Azithromycin, erythromycin, tetracycline, fluoroquinolone
42
Viral PNA
Self-limited
43
Strep pneumo PNA
B-lactam, macrolide (-mycin)
44
H. influenzae PNA
B-lactam, TMP-SMX
45
S. aureus PNA
B-lactam, MRSA coverage (vancomycin, etc)
46
Klebsiella PNA
Cephalosporin + aminoglycoside (gentamicin, tobramycin)
47
Pseudomonas PNA
Antipseudomonal B-lactam (piperacillin-tazobactam, cefepime, imipenem, meropenem, aztreonam) + one or two of following: Antipseudomonal quinolone (cipro or levofloxacin) Aminoglycoside (tobramycin, gentamicin or amikacin) Azithromycin
48
GBS PNA
B-lactam (+ gentamicin in neonates)
49
Enterobacter PNA
TMP-SMX
50
Mycoplasma PNA
Macrolides (-mycin)
51
Legionella PNA
Macrolides (-mycin), fluoroquinolones (-floxacin)
52
Chlamydophila PNA
Doxycycline, macrolides (-mycin)
53
Coccidiomycosis PNA
Amphotericin B or Ketoconazole (systemic) | Fluconazole
54
Histoplasmosis PNA
Amphotericin B or Ketoconazole (systemic) | Itraconazole
55
Blastomycosis PNA
Amphotericin B or Ketoconazole (systemic) | Itraconazole
56
Latent TB (asymptomatic +PPD)
INH x 9 months
57
Primary or secondary active TB
Rifampin, Isoniazid Pyrazinamide, Ethambutol x 4 months THEN Rifampin and Isoniazid x 2 months Vitamin B6 w/ INH to prevent peripheral neuritis
58
ARDS
ICU, treat underlying cause Mechanical ventilation w/ low tidal volume, adequate PEEP Conservative fluid management
59
Mild intermittent asthma
Inhaled short acting B2 agonist
60
Mild persistent asthma
Inhaled short acting B2 agonist + | Low dose inhaled corticosteroid
61
Moderate persistent asthma
Inhaled short acting B2 agonist + Low-medium dose inhaled corticosteroid + Long acting B2 agonist Consider LT inhibitor, ipratropium
62
Severe asthma
``` Inhaled short acting B2 agonist + High dose inhaled corticosteroid + Long acting B2 agonist Consider LT inhibitor, ipratropium Consider systemic steroids, theophylline ```
63
Asthma + persistent allergic rhinitis
LT inhibitor (montelukast, zafirlukast, zileuton)
64
COPD A (Gold 1-2, mild sx)
Short acting bronchodilator (albuterol)
65
COPD B (Gold 1-2, mod-severe sx)
Short acting bronchodilator (albuterol) + | Long acting bronchodilator (ipratropium, maybe long acting B2 agonist)
66
COPD C (Gold 3-4, mild sx)
Short acting bronchodilator (albuterol) + Long acting bronchodilator (ipratropium, maybe long acting B2 agonist) + Inhaled corticosteroids
67
COPD D (Gold 3-4, mod-severe sx)
Short acting bronchodilator (albuterol) + Long acting bronchodilator (ipratropium, maybe long acting B2 agonist) + Inhaled corticosteroids +/- Theophylline, home O2 if indicated, PDE4 inhibitor (roflumilast)
68
Bronchiectasis
Pulmonary hygiene including chest PT Antibiotics for increased sputum B2 agonists/corticosteroids for symptoms Resection of diseased lung segments
69
Superior vena cava syndrome
Steroids, stent | Tumor removal
70
Non-small cell lung cancer w/o metastasis
Surgical resection | Adjuvant chemo, radiation
71
Non-small cell lung cancer w/ LN
Radiation | Consider surgery, chemo
72
Non-small cell lung cancer w/ metastasis
Palliative
73
Small cell lung cancer
Chemo | Radiation (adjuvant)
74
Laryngeal cancer
Laryngectomy | Radiation, chemo
75
Idiopathic pulmonary fibrosis
Steroids Azathioprine or cyclophosphamide N-acetylcysteine Lung transplant
76
Sarcoidosis
Occasionally self-resolving | Steroids, cytotoxic drugs, rarely transplant
77
Pneumoconioses
Usu no successful treatment (steroids may help)
78
Goodpasture syndrome
Plasmapheresis | Corticosteroids and immunosuppressants
79
Granulomatosis w/ polyangiitis (Wegener)
Cytotoxic (cyclophosphamide) and steroids
80
Pulmonary embolism
``` Supplemental O2 IVF or pressors if needed for hypotension AC w/ LMWH or warfarin 3-6 months IVC if AC C/I Possible thrombolysis ```
81
Pulmonary HTN
Supplemental O2 Vasodilators to decrease pulm vascular resistance (prostanoids, endothelin receptor antagonists/-sentans, PDE inhibitors/sildenafil, DHP CCB/nifedipine) AC to decrease risk of pulm thrombus formation Diuretics for pulm congestion
82
Pulm edema
Treat like CHF (NO LIP) | Nitrates, O2 if hypoxic, Loop diuretics, Inotropes (last ditch), Positioning
83
Pleural effusion
Treat underlying condition Thoracocentesis and CT relieve pressure CT required for empyema Pleurodesis if recurrent malignant
84
Closed pneumothorax, <15%
Supplemental O2, observe
85
Closed pneumothorax, >15%
CT
86
Open PTX, small wound
CT + occlusive dressing
87
Open PTX, larger wound
Attempted closure, low threshold for intubation
88
Tension pneumothorax
Immediate needle decompression and CT
89
Recurrent PTX
Maybe pleurodesis
90
Hemothorax
O2, CT, treat underlying cause
91
Malignant mesothelioma
Surgery, chemo, radiation -> all have poor prognosis
92
Sleep apnea
Weight loss No sedatives (including alcohol) CPAP Surgery
93
Atelectasis
IS, early ambulation, PT Upper airway suctioning Lower airway suctioning w/ bronchoscopy
94
Croup
``` Supportive care (humidified/cool air) Inhaled steroids, epinephrine (if stridor) ```
95
Epiglottitis
Intubation | IV abx 7-14 days
96
Bronchiolitis
Supportive care | Inhaled albuterol, epinephrine
97
Respiratory distress syndrome of the newborn
Corticosteroids before labor if <37 wks) | Surfactant replacement therapy
98
Meconium aspiration syndrome
Suction nose, mouth, upper airway Supplemental O2, intubate if needed Surfactant therapy may help Empiric abx if concerned about PNA
99
Cystic fibrosis
B2 agonists, DNAse I, chest PT Antibiotics PRN (Azithromycin, fluoros) Pancreatic enzymes and vitamins A, D, E, K
100
Hepatitis A
Self limited, supportive care | Vaccine before travel
101
Hepatitis B
HBV immediately after exposure in unvaccinated pt IFN-a Antivirals (lamivudine, adefovir, entacavir)
102
Hepatitis C
IFN-a | Consider ribavirin
103
Hepatitis D
IFN-a
104
Hepatitis E
Self-limited, supportive care
105
Salivary gland disorders
Warm compresses, massage, lemon drops (ductal stones) Abx and hydration (infx) Surgery (refractory)
106
Achalasia
Nitrates and DHP CCB (rarely used) Pneumatic dilation Botulinum injections Myotomy
107
Diffuse esophageal spasm
CCP, nitrates, TCAs
108
Zenker diverticulum
Cricopharyngeal myotomy or diverticulectomy
109
GERD
Elevate HOB, weight loss, dietary modification Antacids H2 blockers or PPIs Nissen fundoplication or hiatal hernia repair (refractory)
110
Esophageal cancer
Surgical resection (early) Radiation/chemo (nonoperative or adjuvant) Poor prognosis
111
Hiatal hernia
Sliding - reflux control | Paraesophageal - surgery (gastropexy, Nissen fundoplication)
112
Gastritis
Stop alcohol/medications H2 blockers/PPIs Type A - vitamin B12 Type B - PPI + clarithromycin + amoxicillin or metronidazole 10-14 days
113
PUD
R/o active bleeding (CBC, EGD, stool guiaic) PPI/H2 antagonist to decrease gastric acid Sucralfate, bismuth subsalicylate, misoprostol (NSAID use) to protect mucosa Surgery for acute perforation, refractory
114
Zollinger-Ellison syndrome
Surgical resection if localized PPI/H2 blockers Octreotide in metastatic
115
Gastric cancer
``` Subtotal gastrectomy (distal third of stomach) Total gastrectomy (upper/middle stomach, invasive) Radiation/chemo as adjuvants ```

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