PA Family Medicine EOR CORRECTRY ANSWERED REVISED 2023//2024

PA Family Medicine EOR CORRECTRY ANSWERED REVISED 2023//2024 Deteriorating mental status/unconscious patient ABC's IOM's - ANSWER *A*irway security *B*reathing *C*irculation *I*V access *O*2 saturation *M*onitor vitals Acute Respiratory Distress Syndrome - ANSWER ↓ PaO2 and ↑ PaCO2 from fluid collapsing the *alveoli* MCC: 6-72 hrs s/p *Sepsis* Associated w/ Renal & Hepatic failure ↓ BP or shock w/ crackles, rales, wheezing Tx: Mechanical Vent w/ *PEEP* Anaphylaxis (Type 1 Hypersensitivity) - ANSWER Upper airway obstruction Urticaria Bronchospasm Hypotension Cardiovascular Collapse Tx: Epinephrine + O2 + IVF Cardiac failure/arrest - ANSWER CPR: 100-120bpm Bag-Valve: 10 respirations/min, Consider advanced airway Rx: EPI 1mg Q 3-5min, Amiodarone 300mg then 150mg Reversible causes of cardiac arrest *H's & T's* - ANSWER *H*ypovolemia *H*ypoxia *H*ydrogen ion (acidosis) *H*ypo-hyperkalemia *H*ypothermia *T*ension pneumo *T*amponade (cardio) *T*oxins *T*hrombosis (pulm) *T*hrombosis (cardio) Hypertensive Crisis v. Urgency v. Emergency - ANSWER Crisis: Systolic BP 180mmHg or Diastolic BP 130mmHg Urgency: Severely elevated BP w/o evidence of end-organ damage Emergency: HTN w/ acute end-organ damage Encephalopathy, Stroke, Aortic dissection, MI, Acute renal failure Hypertensive Emergency - ANSWER BP 180/130 with evidence of organ damage Tx: IV *Labetalol or Nicardipine* to ↓ MAP by 25% in 1st hour then normalize BP over next 8-24hrs CAUTION: Organ Ischemia w/ ↓ in MAP Placentae previa - ANSWER *Painless vaginal bleeding* 30 weeks = ↑ risk of transfusion need, ↑ risk of preterm/perinatal mortality Tx: C-sec 30 weeks = good prognosis Foreign body aspiration - ANSWER MC: Rt main bronchus Dx: CXR - unilateral emphysema if in trachea Tx: Rigid bronchoscopy Myocardial infarction - ANSWER Chest pressure & *dyspnea* at rest and worsening over 30min Confusion, syncope, vertigo, diaphoresis ST- segment Elevation on EKG Elevated troponin Tx of MI - ANSWER Morphine O2 Nitrates Aspirin & Clopidigrel - ↓ morbidity/mortality BBs ACEI CCBs Statins Heparin Appendicitis - ANSWER Periumbilical, colicky pain → RLQ *McBurney's point* Rebound Tenderness, Psoas, Rovsing Loss of appetite Nauea/Vomiting/Fever MCC: Fecolith Dx: US or CT Tx: Appendectomy + Abx Jefferson (C1) Fracture - ANSWER Burst fracture of C1 via axial load (football player/diver) Unstable: immobilize c spine C-spine Xrays: AP, Lateral, Oblique, Odontoid Pulmonary embolus - ANSWER Sudden onset of SOB, CP, *Tachycardia* EKG: Nonspecific ST changes, Right heart strain, S1Q3T3 CKR: Westermark's sign Dx: CT Pulmonary Angiogram Tx: Anticoags thrombolytics embolectom