Patient w/ hyponatremia and extremely high glucose
Represents DKA
-Do not treat hyponatremia; it is dilutional
40 year old man has syncope during jog; what is diagnosis
Aortic stenosis
Expressive aphasia caused by what?
Stroke of Left MCA
Stroke keys:
- Do no harm
- Do not lower BP acutely
- Do not let pt drink
- Steroids dont help
- Do not start heparin
- Use pulse ox
Can you prevent a patient from faking?
No
Pt w/ stroke s/s; first thing to do?
Order non contrast CT
Most important first step w/ meningitis
Start abx
Should you give telephone advice?
No; will be held liable in court
Tx for acute glaucoma
Acetazolamide
Foreign pt w/ meningitis
Think TB meningitis or other exotic cause
Pt on coumadin presenting after fall with initially clear head CT
Will see subdural hematoma hours later
Sudden bursting headache
Subarachnoid hemorrhage; even if CT is negative still need to do lumbar puncture to completely r/o
If CT shows a stroke, is a pt a candidate for tPA
No; but always give aspirin
Child w/ febrile seizure and otitis media
Treat antibiotics and antipyretics
Elderly lady w/ AMS and foul-smelling urine
Delirium 2/2 to UTI
Young women w/ no known medical history collapses; what can you safely administer?
Glucose
Pt w/ spell where they talk in gibberish and stare w/ blank look, are unresponsive, and have facial twitching w/ post-ictal symptoms; what type of seizure?
Complex partial seizure
Football player w/ concussion that now has severe back pain and weakness in their arm; what is management?
Cervical spine stabilization and radiology
Pt w/ 12 week uterus and vaginal bleeding; management?
US and Rh type
-Do not get hCG quant
Woman w/ pelvic pain, vaginal bleeding, and left adnexal mass
Consider pregnancy (ectopic?)
Cocaine induced vasospasm tx
Aspirin + Benzos + nitrates
Pt w. red hot swollen foot and neuropathy but resolves w/ elevation
Charcot foot
Pt. w/ history of heart murmur that now presents w/ SOB; management?
TTE
First test for CP
EKG
V-fib managemnt?
Defibrillation
Pt w/ CP and ST segment depression and are on BBs and aspirin; what do they need prior to going to cath lab?
Heparin
Pt who is vomiting blood and is hypotensive; what fluid do you start?
NS
Pt w weakness in arms and legs that is on statin; management?
Check CPK
Pt. w/ inferior wall MI management
Do EKG w/ right sided leads
Abnormally large increase in pulse pressure (fall during inspiration >10)
Cardiac tamponade; you must have pulsus paradoxus to have cardiac tamponade
Pt. w/pleuritic CP after hip replacement; diagnosis?
PE
Sudden onset of ankle pain that awakens a woman from sleep; she has a temperature w/ a warm, swollen ankle that she cant bear weight on
Gout flare
get joint fluid
Pt. w/ PCP pneumonia and O2 of 65; tx?
Bactrim + Prednisone
Pt. w/ aortic dissection; tx?
Labetalol
Pt. w/ C. diff; tx?
Metronidazole
Pt. presents w/ supraventricular tachycardia; first thing to do and second thing to do
- Carotid massage
2. Give adenosine
Pt. w/ hypoglycemia who is a nurse
Self-injecting
Diagnosing Clostridium botulinum requires… and if they have SOB…
Serum toxin levels
Admit to ICU and monitor
Pt. w/ breast cancer who is hypotensive w/ pulsus parodoxus; management
Echocardiogram needed to help w/ fluid removal
Pt. on chronic benzos who has overdosed; what should you do?
Conservative management
Flumazenil only needed for acute cases
Elderly man w/ flank pain, fever, and chills w/ normal CXR; dx and managment?
Pyelonephritis; need admission and IV abx
Management for PCP
Sedation and low level stimulation
Pt. w/ DKA and pneumonia tx
IV abx + Hydration + insulin + ICU admission
Pt. w/ COPD who can communicate their wishes
Just fuckin talk to them
Alcoholic w/ several week history of fever, night sweats, cough, and pneumonia
Need isolation for TB
How else can you check for aortic dissection w/o CT?
Echo
Pt. who goes to part and has great time w/ later abdominal pain
Pancreatitis
Pt w/ known gallstones and elevated amylase/lipase; important drug to give
Pain relief
Pt. w/ thyroidectomy and involuntary contractions; what should you do?
Check calcium and other electrolytes as parathyroids probably removed
30 year old w/ sore throat, muffled voice, and difficulty swallowing; what should you think of?
Woodlut Titus
DO NOT MANIPULATE THROAT and call ENT
Pt. w/ hyperkalemia and EKG changes; what should you first give?
Calcium gluconate
Pt. w/ epigastric pain radiating to back w/ vomiting and elevated amylase/lipase/LFTs; first test to do?
US
Pt. w/ 2nd degree heart block type II; what will they need?
Permanent pacemaker
Pt. w/ plt count <20,000 and bleeding; what should you do?
Transfuse!
Fastest way to reverse Coumadin
FFP
Pt. w/ chemical in their eyes; what should you do?
Irrigate w/ water
Elderly man w/ hot, swollen knee and fever and effusion; what should you do?
Tap it
PT. w/ exercise induced astma has wheezing after playing bbal; what do they need?
Albuterol