2023 Family Medicine EOR Exam Study Guide Summary

Respiratory Failure/Arrest • ARDS o Life threatening acute hypoxemic respiratory failure WITHOUT signs of heart failure o Pao2/FIo2 ≤200 mm Hg o MC develops in critically ill pts (MC while in hospital) oAcute: hours-days afterinciting event (sepsis MCC) o Pro-inflammatory cytokines à inflammatory lung injury à diffuse alveolar damage à permeability of alveolar capillary barrier à pulm edema, loss of surfactant, vasculardamage à ¯ blood oxygenation o Sxs: rapid onset of profound dyspnea & hypoxemia o PE: tachypnea, frothy pink or red sputum and diffuse crackles o Dx: § 3 main components: (1) severe refractory hypoxemia HALLMARK (2)b/l pulm infiltrates on CXR (3) absence of cardiogenic pulm edema/CHF § ABG: • Pa02:FI02 /= 200 mmHg that is NOT responsive to 100% 02 § CXR: air bronchograms and bilaterally fluffy infiltrate à white out pattern § Characteristically spares the costophrenic angle § Cardiac cath of pulm artery: pulmonary capillary wedge pressure 18mmHg (normal) o Tx: tracheal intubation with lowest level of PEEP Deteriorating Mental Status/Unconscious Patient • Signs/symptoms of a structural cause of AMS o Asymmetrical deficits o Unequal pupils o Afebrile o History of trauma, structural abnormality oOften a rapid onset • Signs/symptoms of a metabolic cause of AMS o Symmetrical deficits o Equal pupils (? altered function) o ? Fever o History of metabolic disorder or illness oRapid onset less likely • Critical Considerations for Altered Mental Status: gas exchange issue (hypoxic or hypercapnia), problem w/ blood flow to brain, metabolic problem (w/ glucose à can’t breakdown, etc) or traumatic issue Allergic Reaction/Anaphylaxis • Common causes: drugs (penicillin), insect stings, venom, foods (MC eggs, seafood, nuts),latex • Anaphylactic reactions typically begin within 15 mins – 1 hour of exposure to the allergen • Symptoms may recur 4 to 8 hours after the initial exposure or later • Tx: ABCs most important, epi, antihistamines, corticosteroids Acute Abdomen • Abdominal Aortic Aneurysm o Dilation of aorta 3cm; rupture occurs @ 5cm o MC below renal arteries (@ aortic bifurcation or common iliac MC) o Flank pain radiating to back, hypotension, pulsatile abdominal mass o Cullen (periumbilical ecchymosis) or grey turner (flank ecchymosis) signs o Dx: US study of choice if unruptured; CT if ruptured