@PROFDOCDIGITALLIBRARIES
2025 Family Medicine
PR
EOR Exam Study Guide
Summary
O
FD
Iparts Books
REGISTERED NURSE
2025
O
C
,@PROFDOCDIGITALLIBRARIES
URGENT CARE
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) o Acute: 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
PR
§ 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
O
structural cause of AMS o
Asymmetrical deficits
o Unequal
pupils o
FD
Afebrile
o History of trauma, structural
abnormality o Often a rapid onset
• Signs/symptoms of a metabolic cause of AMS
o Symmetrical deficits
o Equal pupils (? altered
function) o ? Fever
O
o History of metabolic disorder or
illness o Rapid 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
C
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
,@PROFDOCDIGITALLIBRARIES
o Tx: refer if > 4 cm; surgical repair if >5.5 cm or
expands >0.6 cm per year o Monitor every 2 years if <4cm.
Monitor every 6 months if >4 cm
o Screen males 65-74 yo w/ hx of smoking
1
PR
O
FD
O
C
, @PROFDOCDIGITALLIBRARIES
• Mesenter
ic Ischemia o
Acute
§ Sudden decrease of mesenterial blood supply à inadequate
perfusion esp @ splenic flexure à ischemic bowel disease
§ MC d/t occlusion (embolus from A fib or MI, thrombus from
atherosclerosis)
§ Sxs: severe abd pain out of proportion to physical exam, poorly
localized, N/V/D
§ Dx: angiogram definitive
§ Tx: surgical revascularization
o Chronic
§ Mesenteric atherosclerosis of GI tract à inadequate perfusion esp@
splenic flexure during post-prandial states à ischemic bowel disease
§ There is usually some collateral flow
§ Sxs: chronic, dull abd pain worse after meals, weight loss
§ Dx: colonoscopy, angiogram confirms diagnosis
§ Tx: NPO, surgical revascularization
• Colonic Ischemia
o MC d/t systemic hypotension or atherosclerosis involving superior & mesentericarteries
PR
o MC at watershed areas w/ decreased collaterals (splenic flexure & rectosigmoid
junction)
o Sxs: LLQ pain w/ tenderness, bloody diarrhea
o Dx: colonoscopy
o Tx: restore perfusion, observe for signs of perf
• Toxic Megacolon
o
O
Nonobstructive, extreme colon dilation > 6cm + signs of systemic toxicity
o Etiologies: ulcerative colitis (MC), Crohn’s, Hirschsprung’s,
pseudomembranous colitis, enteritis o Sxs: fever, abd pain, N/V/D, rectal
bleeding, tenesmus, electrolyte disorders
FD
o PE: abd tenderness, rigidity, distention, tachycardia
o Dx: KUB shows dilated colon > 6 cm
o Tx: bowel decompression, NPO, broad spectrum abx, electrolyte repletion
Burns
• Rule of 9s (Head 9%, Each arm 9%, Chest 9%, Abdomen 9%, Each anterior leg 9%, Eachposterior
leg 9%, Upper back 9%, Lower back 9%, Genitals 1%)
O
• 1st degree (sunburn): erythema of involved tissue, skin blanches with pressure, skin maybe
tender
• 2nd degree (partial thickness): skin is red and blistered, very tender
• 3rd degree (full thickness): burned skin is tough and leathery, skin non-tender
C
• 4th degree: into the bone and muscle
• Minor burns:
o < 10% TBSA in adults
o < 5% TBSA in young/old
o < 2% full thickness burn
o Must not involve face, hands, perineum, feet, cross major joints, or be
circumferential
• Major burns:
o > 25% TBSA in adults
o > 20% TBSA in young/old
o >10% full thickness burn
o Burns involving face, hands, perineum, feet, crossing major joints, or
circumferential
• Tx: monitor ABCs, fluid replacement, sulfadiazine
o Children w/ > 10% and adults w/ > 15% total body area surface burns need fluid
resuscitation
§ Lactated Ringers - IV x 24 hours - 1/2 in 1st 8 hours the other in 1/2 in the
remaining 16
2025 Family Medicine
PR
EOR Exam Study Guide
Summary
O
FD
Iparts Books
REGISTERED NURSE
2025
O
C
,@PROFDOCDIGITALLIBRARIES
URGENT CARE
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) o Acute: 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
PR
§ 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
O
structural cause of AMS o
Asymmetrical deficits
o Unequal
pupils o
FD
Afebrile
o History of trauma, structural
abnormality o Often a rapid onset
• Signs/symptoms of a metabolic cause of AMS
o Symmetrical deficits
o Equal pupils (? altered
function) o ? Fever
O
o History of metabolic disorder or
illness o Rapid 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
C
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
,@PROFDOCDIGITALLIBRARIES
o Tx: refer if > 4 cm; surgical repair if >5.5 cm or
expands >0.6 cm per year o Monitor every 2 years if <4cm.
Monitor every 6 months if >4 cm
o Screen males 65-74 yo w/ hx of smoking
1
PR
O
FD
O
C
, @PROFDOCDIGITALLIBRARIES
• Mesenter
ic Ischemia o
Acute
§ Sudden decrease of mesenterial blood supply à inadequate
perfusion esp @ splenic flexure à ischemic bowel disease
§ MC d/t occlusion (embolus from A fib or MI, thrombus from
atherosclerosis)
§ Sxs: severe abd pain out of proportion to physical exam, poorly
localized, N/V/D
§ Dx: angiogram definitive
§ Tx: surgical revascularization
o Chronic
§ Mesenteric atherosclerosis of GI tract à inadequate perfusion esp@
splenic flexure during post-prandial states à ischemic bowel disease
§ There is usually some collateral flow
§ Sxs: chronic, dull abd pain worse after meals, weight loss
§ Dx: colonoscopy, angiogram confirms diagnosis
§ Tx: NPO, surgical revascularization
• Colonic Ischemia
o MC d/t systemic hypotension or atherosclerosis involving superior & mesentericarteries
PR
o MC at watershed areas w/ decreased collaterals (splenic flexure & rectosigmoid
junction)
o Sxs: LLQ pain w/ tenderness, bloody diarrhea
o Dx: colonoscopy
o Tx: restore perfusion, observe for signs of perf
• Toxic Megacolon
o
O
Nonobstructive, extreme colon dilation > 6cm + signs of systemic toxicity
o Etiologies: ulcerative colitis (MC), Crohn’s, Hirschsprung’s,
pseudomembranous colitis, enteritis o Sxs: fever, abd pain, N/V/D, rectal
bleeding, tenesmus, electrolyte disorders
FD
o PE: abd tenderness, rigidity, distention, tachycardia
o Dx: KUB shows dilated colon > 6 cm
o Tx: bowel decompression, NPO, broad spectrum abx, electrolyte repletion
Burns
• Rule of 9s (Head 9%, Each arm 9%, Chest 9%, Abdomen 9%, Each anterior leg 9%, Eachposterior
leg 9%, Upper back 9%, Lower back 9%, Genitals 1%)
O
• 1st degree (sunburn): erythema of involved tissue, skin blanches with pressure, skin maybe
tender
• 2nd degree (partial thickness): skin is red and blistered, very tender
• 3rd degree (full thickness): burned skin is tough and leathery, skin non-tender
C
• 4th degree: into the bone and muscle
• Minor burns:
o < 10% TBSA in adults
o < 5% TBSA in young/old
o < 2% full thickness burn
o Must not involve face, hands, perineum, feet, cross major joints, or be
circumferential
• Major burns:
o > 25% TBSA in adults
o > 20% TBSA in young/old
o >10% full thickness burn
o Burns involving face, hands, perineum, feet, crossing major joints, or
circumferential
• Tx: monitor ABCs, fluid replacement, sulfadiazine
o Children w/ > 10% and adults w/ > 15% total body area surface burns need fluid
resuscitation
§ Lactated Ringers - IV x 24 hours - 1/2 in 1st 8 hours the other in 1/2 in the
remaining 16
