PA Family Medicine EOR Exam With Correct Accurate Solutions Graded A 2024

Deteriorating mental status/unconscious patient ABC's IOM's - *A*irway security *B*reathing *C*irculation *I*V access *O*2 saturation *M*onitor vitals Acute Respiratory Distress Syndrome - ↓ 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) - Upper airway obstruction Urticaria Bronchospasm Hypotension Cardiovascular Collapse Tx: Epinephrine + O2 + IVF Cardiac failure/arrest - 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* - *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 - 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 - 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 - *Painless vaginal bleeding* 30 weeks = ↑ risk of transfusion need, ↑ risk of preterm/perinatal mortality Tx: C-sec 30 weeks = good prognosis Foreign body aspiration - MC: Rt main bronchus Dx: CXR - unilateral emphysema if in trachea Tx: Rigid bronchoscopy Myocardial infarction - Chest pressure & *dyspnea* at rest and worsening over 30min Confusion, syncope, vertigo, diaphoresis ST- segment Elevation on EKG Elevated troponin Tx of MI - Morphine O2 Nitrates Aspirin & Clopidigrel - ↓ morbidity/mortality BBs ACEI CCBs Statins Heparin Appendicitis - 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 - Burst fracture of C1 via axial load (football player/diver) Unstable: immobilize c spine C-spine Xrays: AP, Lateral, Oblique, Odontoid Pulmonary embolus - 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 embolectomy Pneumothorax - Decreased breath sounds- unilateral Sharp chest pain, worse w/ deep breaths or coughs Xray shows air outside lung Tx: *1st line*: 14ga. Needle decompression 2nd ICS MCL 2nd line: Chest tube ICS MCL Types of Pneumothoraces A. Tall thin men 20-40 B. Complication of underlying lung disease C. Stab wound, Gun Shot, or MVA w/ direct blow to chest D. Pleural Edema or Anascara and ↑ thoracic pressure - A. Spontaneous Pneumo B. Secondary Spontaneous Pneumo C. Traumatic Pneumo D. Tension Pneumo Black Widow Spider bite - Pinprick spider-bite Acetylcholine-Induced Myalgias Severe cramping of chest & abdomen Tx: Opioids + *Benzo's* Latrodectus Antivenom Brown Recluse Spider Bite - Cytotoxin Local tissue destruction & necrosis Tx: wound care Hydrocarbon Pneumonitis - Ingestion of furniture polish Mild CNS depression Aspiration = coughing Dx: *CXR* & pulmonology consult = diffuse b/l inflitrates May lead to ARDS Ethylene glycol ingestion (antifreeze) - Osmolal gap Anion-Gap Metabolic Acidosis Acute renal failure (ATN) *Calcium Oxalate* in urine Hypocalcemia Tx: Fomepizole or Ethanol Salicylate toxicity - ASA, Wintergreen, Pepto-Bismol Respiratory Alkalosis (early) GAP metabolic acidosis (late) Hypoglycemia *Tinnitus* Tx: Activated Charcoal (if 1hr from ingestion) Urinary alkalinization w/ *Sodium Bicarb* IV K+ Hemodialysis Carbon Monoxide Poisoning - HA, Nausea, Dizziness Cherry-red skin ↑ Carboxyhemoglobin levels Tx: 100% O2, Hyperbaric Mild Intermittent Asthma - Symptoms: 2x/wk Night Sxs: 2x/mo FEV: 80% prediciton Tx: No daily meds Mild Persistent Asthma - Symptoms: 2x/wk but 1x/d Night Sxs: 2x/mo FEV: 80% prediction Tx: *Low-dose ICS* Cromolyn, leukotriene (S/E: ↑ mucous production) Moderate Persisitent Asthma - Symptoms: Daily Sxs + Daily use of B2-agonist Night Sxs: 1x/wk FEV: 60-80% prediction Tx: *Low-Med dose ICS + Long-acting B2-agonist* Severe Persistent Asthma - Symptoms: Continuous w/ impaired physical activity Night Sxs: Frequent FEV: 60% Tx: High-dose ICS + Long-acting B2-agonist + oral steroid (60mg/d) Community Acquired Pneumoniae - 40 y/o Sudden onset of rigors, rusty colored sputum PE: Dullness to percussion