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Flashcards in UW 1 Deck (51):
1

What exam should be done w/Clavicular Fx and why?

Neurovascular to R/O damage to vessels
- Close proximity of Subclavian artery and brachial plexux

2

Pt with clavicular fx and bruit heard by clavicle?

Do angiogram to check vessel damage

3

How does shoulder appear in clavicular fx?

Shoulder is displaced inferiorly and posteriorly

4

Post op cardiac surgical pt w/fever, tachycardia, chest pain, leukocytosis, sternal would drainage?

Acute Mediastinitis

5

How does Acute mediastinitis occur?

Complication of cardiac surgery due to intraoperative wound contamination
- w/in 14 days post op

6

How does CXR look for acute mediastinitis?

Widened mediastinum

7

Tx for acute mediastinitis?

Surgical debridement
Drainage
Abx

8

What murmur is common post CABG?

A-fib
Tx w/rate control
Anticoagulate if > 24 hrs

9

Septal Perforation

Self-inflicted (nose picking)
rhinoplasty
Syphillis
TB
Cocaine
Sarcoidosis
Wegener's

10

Whistling noise heard during respiration?

Nasal septum perforation b/c of sepal hematoma thru septal abscess (post op)

11

When do we surgically treat Aortic stenosis?

SAD
Syncope
Angina
Dyspnea (CHF)

12

What is surgery for Aortic stenosis?

Aortic valve replacement

13

Indications for Aortic valve replacement?

Symptomatic pts
Pts w/severe AS undergoing CABG/valvular surgery
Asymptomatic pt with severe AS - poor LV fnc, LVH >15mmHg, valve area < 0.6 cm or abnormal response to exercise

14

Placenta previa?

Painless 3rd trimeter bleeding, bleeding w/out ctx
Risk factors: C-section (previous), prior PP, multiparity, advanced age

15

Dx for placenta previa?

Transabdominal sonography

16

Sudden onset abdominal pain and bleeding, hyperventilation, agitation, tachycardia?

Uterine Rupture - most common during labor

17

Painless antepartum hemorrhage + rapid deterioration of fetal heart tracing?

Vasa previa

18

What thyroid cancer ass'd with Hashimoto's?

Lymphoma

19

What characteristics ass'd with benign cardiac murmur in child?

If no ass'n with structural heart dz:
- Grade II/VI or less - intensity
- early or mid-systolic
- decrease w/standing or Valsalva
- normal S2
- no sx's

20

What sx's are seen in a pathologic cardiac murmur in child?

Sx's:
Infants -Diaphoresis or tiring w/feeds, poor weight gain
Children - chest pain, dizziness, syncope, SOB, fatigue

21

What PE findings are seen in pathologic cardiac murmur in child?

Harsh or Holosystolic
Diastolic
Grade III/VI intensity or higher
Increased w/standing or Valsalva
Abnormal S2
Decreased absent femoral pulses

22

What is the workup for child w/pathologic cardiac murmur?

CXR for cardiomegaly
EKG for hypertrophy
Echo - structural
Cardiac referral

23

What liver changes seen in HELLP?

Centrilobar necrosis
Hematoma formation
Thrombi in portal capillary system
- Cause liver swelling w/distension of hepatic (Glisson's capsule)
RUQ pain
Epigastric pain
N/V

24

Schisotocytes on PS, high BR, low haptoglobin,

Microangiopathic Hemolytic Anemia

25

When does amniotic fluid embolism usually occur?

Labor
Delivery

26

What puts pregnant women at risk for CAP?

Decreased cell mediated immunity

27

What puts pregnant women at risk for Aspiration pneumonia?

Increased intra abdominal pressure
Relaxed LES

28

Choriamnionitis (intramniotic infxn) Risk factors?

PROM >24 Hours
Prolonged labor
Internal fetal/uterine monitoring devices
Genital tract pathogens

29

Choriamnionitis Dx?

Maternal fever >100.4 + One of these:
- Maternal Tachycardia (>100)
- Uterine tenderness
- Malodorous/purulent amniotic fluid/vaginal d/c
- WBCs > 15,000
OR
Fetal Tachycardia >160

30

When does PROM occur?

Can happen anytime throughout pregnancy

31

When is PROM a problem?

When it becomes PPROM - Prolonged

32

What can occur as a result of PROM?

Preterm labor
Cord Prolapse
Placental Abruption
Chorioamnionitis

33

What is the management for chorioamnionitis?

Get cervical cultures
Start IV Abx
Deliver immediately -schedule

34

TX for preterm fetus w/out chorioamnionitis?

Tx w/betamethasone
Tocolytics = decrease ctx
Amp/gent - decrease risk of chorioamnionitis

35

What is uterine indicative of?

Upper genital tract infxn

36

How does acute cervicitis present?

Purulent vaginal discharge
MCC Trichomonas, Chlamidya, Gonorrhea

37

What is the MC risk factor for PROM?

Ascending infxn from lower genital tract

38

What is seen on US with PROM?

Oligohydramnios

39

Maternal complications w/choriamnionitis?

Uterine atony
Postpartum Hemorrhage
Endometritis

40

Fetal complications with chorioamnionitis?

Preterm birth
Serious bacterial Infxn
Perinatal asphyxia
Cerebral Palsy
Death

41

Indications for C-section?

Breech
Fetal distress
Multiple previous c-sections

42

Defensive mechanism where IVDA contracts HCV and blames community lack of control of HCV?

Distortion

43

Tx of choice OCD?

SSRI

44

Tx of choice Tourette disorder?

Dopamine Antagonists - AP's like Risperidone (2nd G)

45

Defense mechanism where woman is angry at husband and throws his baseball card collection away?

Displacement

46

Defense mechanism where woman agrees with abuse husband that she is worthless

Introjection

47

Defense mechanism where person was rescued from burning building and now denies any memory of event?

Dissociation

48

Defense mechanism where person expression aggression with person by repeated passive failures to meet their needs

Passive aggressive

49

Eye conditions where patients see halos around lights?

Acute angle-closure glaucoma

50

Painful loss of vision

Acute angle-closure glaucoma
Optic neuritis

51

What is blood and thunder fundoscopy changes?
When do we see it?

Optic disc swelling
Retinal hemorrhages
Cotton wool spots
Dilated veins
Central Vein Occlusion