Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
23 Cards in this Set
- Front
- Back
|
What 4 things happen when you palpate a trigger point in patients with myofascial pain syndrome?
|
1. reproduce their referred pain
2. local twitch response 3. autonomic phenom & neuro symptoms 4. Decreased ROM in that muscle |
|
|
What does it mean if a patient starts moving during a surgery?
Hint: it doesn't mean 2 things, and does mean 1 thing. |
Pt movement does NOT mean:
- inadequate paralysis - pt awareness Pt movement DOES mean: - inadequate analgesia |
|
|
What are the two forms of paralytics and how do they work?
(what kind is Succinulcholine?) How are these drugs reversed? |
1. Non-depolarizing: (most muscle relaxants)
compete with ACh for the NMJ and prevent an action potential 2. Depolarizing: (Succinylcholine) cause depolarization of the muscle and blocks subsequent depolarization REVERSAL: ACh-esterase inhibitor will prevent the breakdown of ACh --> more Ach to compete at the NMJ |
|
|
Malignant Hyperthermia is a genetic condition, what is the pattern of inheritance?
What triggers MH? What is the pathophys? (caused by ____; results in 3 hyper's & 3 msk-related problems) |
Autosomal dominant BUT with variable penetrance and variable severity.
Triggers: Succinylcholine, vapors (except NO) Pathophys: result from a loss of intracellular control of Ca+ - Hyper-thermia (1deg/5min), -carbia, -metabolic state - muscle rigidity, rhabdomyolysis, acute renal failure |
|
|
What are the 3 signs of Malignant Hyperthermia?
|
1. Resp & metabolic acidosis
2. Tachycardia (oftern first sign but very non-specific) +/-- arrythmias 3. HoTN ---> possible arrest |
|
|
What are the 3 principles/methods for treating Malignant Hyperthermia?
|
1. STOP the triggers (sux & vapors)
2. Give a muscle relaxant (Dantrolene) 3. Treat the symptoms (cool, fluids, kayexelate for high K+) |
|
|
Naloxene is an opioid antagonist that reverses the effects of opioid overdose for 30-45mins. How is it administered?
- dilution? (why is this necessary?) - dose? (time & amount) |
MUST be diluted
vial: 0.4mg/mL add to 9mL of saline to get 0.04mg/mL Dose: give 0.04 - 0.08mg (1-2mL) Q3-5mins. If no change after 5mL consider other causes of somnolence! |
|
|
How are hip fractures classified?
(i.e. what are the 4 types?) |
GARDEN Classification
Type I: impacted & displaced (best prognosis b/c it facilitates re-vascularization) Type II: crack across fem neck with minimal displacement Type III: complete # partially displaced Type IV: complete #, totally displaced |
|
|
What are the 5 indications for arthroplasty in hip fractures?
|
1. Old age (pt >70yrs)
2. Displaced sub-capital # 3. Pathological # d/t a tumor 4. Coexisting arthropathy 5. Head-splitting # |
|
|
What drugs should you in combination therapy for treatment of intra-abdominal infections?
Name the bugs & their drugs! |
DRUGS: BUGS:
Metronidazole -----> B. Fragilis Ceftriaxone & Cipro ----> E.Coli |
|
|
What three drugs can you use as single agent treatment for intra-abdominal infections?
When would you use each one? |
1. Pipracillin/Tazobactam: if critically ill & you suspect resistant E.Coli
2. Meropenem/Ertapenem: broadest spectrum; can be give OD 3. Moxifloxacin: ONLY fluoro that you can use in this setting and only use in mild-->mod (e.g. appendicitis in an otherwise well pt) |
|
|
What antibiotics are recommended for prophylaxis for the following surgical sites?
(3 sites only one drug; 2 sites require 2 drugs) |
Cefazolin:
biliary tract, stomach/duodenum, small bowel Cefazolin & metronidazole: Colon & appendectomy |
|
|
For effective antimicrobial prophylaxis, the drug must be present in the tissues in [effective]. How is this accomplished? (3ways)
|
1. Given IV
2. Given 30min prior to the procedure 3. Give a second dose if surgery is longer than 4hrs |
|
|
When approaching abnormal liver biochemistry you should look for what in the following parameters?
1. Pattern 2. Activity (levels) 3. Severity (i.e. is there cirrhosis?) |
1. Pattern: to distinguish Hepatitis from cholestasis
Hep = AST/ALT > ALP Chole = ALP > AST/ALT 2. Activity: Severe = > 10x upper limit of normal = urgent attention Mild = less urgent attention 3. Severity ( is cirrhosis present?) Look for W sign: low plts, high INR, low albumin, high bili \/\/ |
|
|
What are the types and shapes of crystals associated with each of the following:
1. Gout 2. Pseudogout 3. Hydroxiapetite *(location not shape of crystals) |
1. Gout --> Uric acid, needles
2. Pseudogout --> Ca+ pyroph, rhomboid & refractive 3. Hydroxiapetite --> crystals in soft tissue |
|
|
In degenerative arthiritis like OA, where would you find the following nodules:
- Herberden's? - Bouchards's? |
Herberdens = DIP
Bouchard's = PIP |
|
|
A very high ESR combined with severe morning stiffness dis diagnostic of what condidition?
|
++++ ESR
++++ morning stiffness = PMR!! |
|
|
What are the commonest infections by post-op days?
Hint: It's the 5 W's |
POD #1 - WIND: atelectasis
POD #2 - WATER: uti POD #3 - WOUND: look at surgical site POD #4 - WEGS: (legs) DVT or PE POD #5 - Wonder Drugs: hosptial acquired infection |
|
|
What are the 5 A's of anesthesia and what drugs go with each?
|
1. Amnesia - Benzo's antegrade amnesia prevents awareness
2. Anesthesia: Sleep/induction = propofol or Ketamine (dissociative) maintenance: vapors (NO, isoflurane, desflurane) 3. Analgesia: multimodal is best! 4. Areflexia (msk relaxant): Succinulcholine (depolarizes msks, others compete for ACh binding sites) 5. Autonomic blunting: intra-op stimuli cause significant sympathetic d/c (inc HR/bP) can be blunted by short-acting opiods & B-blockers |
|
|
What is the difference between Lidocaine & Bupivicaine?
|
Lido = fast onset, short duration
Bupivicaine = slow onset, long lasting |
|
|
What Xtic distinguishes chronic migraines/med-overuse headaches from tumors or mass lesions?
|
The frequency!
chronic migraine/Med-overuse = stable mass/tumor = increasing frequency |
|
|
What are the 4 criteria to Dx a migraine?
1. # of attacks 2. 2+ of the 4 symptoms 3. At lease 1 of 2 things 4. All other....... |
1. 5+ attacks
2. 2+ of the following: - unilateral - pulsating - moderate --> severe intensity - aggravated by causing avoidance of routine activity 3. At least one of: - Nx/Vx or Photo/Phono-phobia 4. ALL other causes excluded |
|
|
Triptans are given acutely for migraines. What are their 3 targets/mechanisms of action?
|
1. inhibit vasodilation
2. inhibit central Tmission of nocioceptive impulses 3. inhibit release of vasoactive neuropeptides *** AVOID with other SSRI's, any disease that causes Vcon or a setting where Vcon would be bad (stroke, PVasc disx, etc). Also avoid with MAOi's b/c tryptans are metabolized by MAO! |
