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85 Cards in this Set
- Front
- Back
Best test to evaluate head trauma
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Noncontrast CT (better than MRI in emergent situations)
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Management of blunt abdominal trauma where pt is awake and stable and initial exam is benign
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Admit and observe with serial abdominal exams
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Management of blunt abdominal trauma where pt is hemodynamically unstable and does not respond to fluid challenge
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Proceed directly to laparotomy
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Management of pt with blunt abdominal trauma where pt had AMS and abd is unexaminable or tender or there is no obvious source for blood
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CT scan of abdomen and pelvis with oral or IV contrast
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Mgmt of GSW to the abdomen
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laparotomy
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Mgmt of sharp instrument to abdomen and pt is unstable
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laparotomy
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Mgmt of sharp instrument to the abdomen and pt is stable
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CT scan and if results are positive then laparotomy; if negative, observe and repeat exam later
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Si/Sx of tension pneumothorax
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1. Trachea and mediastinum are shifted to OPPOSITE side of chest
2. absent breath sounds 3. hypertympanic or hyperresonant to percussion on AFFECTED side 4. hypotension or distended neck veins |
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Mgmt of tension pneumothorax
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Needle thoracentesis to anterior 2nd ICS followed by insertion of a chest (thoracostomy) tube
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DX: penetrating trauma to left chest resulting in hypotension, distended neck veins, muffled heart sounds, pulsus paradoxus and normal breath sounds
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Cardiac tamponade
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Mgmt of cardiac tamponade
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If stable, Echocardiogram to confirm dx; If unstable then catheter insertion in pericardial sac via subxiphoid approachto aspirate blood or fluid
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Initial mgmt of massive hemothorax
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IVF &/or blood BEFORE chest tube placement. If bleed stops then CXR &/or CT and treat supportively. If bleeding does not stop then emergent thoracotomy.
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The most common (MC) cause of immediate death after an automobile accident or fall from a great height
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Thoracic aortic rupture usu at the aortic isthmus
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Classic CXR finding with aortic dissection
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widened mediastinum
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Most immediate life-threatening risk with electricity exposure and burns
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cardiac arrhythmias; order an EKG
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Mgmt of 1st degree burns--epidermis only; painful, dry red areas WITHOUT blisters
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keep clean
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Mgmt of 2nd degree burns involving epidermis and some dermis; swollen with blisters and open weeping surfaces
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Remove blisters and apply abx ointment (silver nitrate, silver sulfadiazine, neomycin) and dressing
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Mgmt of 3rd degree burns involving all layers of the skin incl nerve endings; skin is dry and PAINLESS
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Surgical excision of eschar and skin grafting is required. Watch for compartment syndrome which is treated with escharotomy.
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What vaccine should burn victims receive?
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Tetanus
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The most impt thing to monitor in pts with hypothermia
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EKG for arrhythmias; Classic but rare finding on EKG is J wave, small positive deflection following QRS complex.
Also monitor electrolytes, renal function and acid-base status |
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Immediate threats to life in pts with hyperthermia
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Convulsions (Rx: Diazepam) and cardiovascular collapse
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Classic culprits for pts with malignant hyperthermia? Treatment?
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Succinylcholine and halothane exposure
Tx with Dantrolene |
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Mgmt of near drowning pts
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If pt unconscious--intubate; If pt conscious--monitor ABGs
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Acute abdomen localized to RUQ you should think:
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GB (cholecystitis), bile ducts (cholangitis) or liver (abscess)
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Acute abdomen localized to LUQ you should think:
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slpeen (rupture w/blunt abd trauma and rarely abscess)
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Acute abdomen localized to RLQ you should think:
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appendix (appendicitis) or OB/Gyn problem
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Acute abdomen localized to LLQ you should think:
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sigmoid colon (diverticulitis) or OB/Gyn problem
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Findings assoc with cholangitis?
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RUQ pain, fever, or shaking chills and jaundice
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Mgmt of cholangitis?
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Blood cultures 1st then prophylactic abx and cholecystectomy once the pt is stable
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Best 1st test for suspected GB disease
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Ultrasound; HIDA scan clinches a difficult dx
(+) scan==>nonvisualization of the GB |
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DX: Pt with blunt abd trauma with hypotension or tachycardia, shock and Kerr sign (pain referred to left shoulder)
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Splenic rupture
Needs splenectomy; Don't forget immunizations against encapsulated organisms |
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MC Dx in pt >50YO with localized LLQ pain?
Mgmt? |
Diverticulitis; confirm with CT scan abdomen with oral and IV contrast
Tx: broad-spectrum abx and NPO |
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Complications of acute pancreatitis
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pseudocyst and pancreatic abscess
Dx by CT scan and may require surgical intervention |
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Which narcotic should be avoided in pts with pancreatitis
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Morphine which causes sphincter of Oddi spasm and can worsen ssx. Use opiates instead, usu. meperidine
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Most likely dx and mgmt for pt with mildly elevated amylase & normal lipase with small amt of free air under the diaphragm on Xray
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Perforated peptic ulcer
Laparotomy |
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MCC od SBO in adults is
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adhesions from previous abdominal surgeries
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Si/Sx SBO
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bilious vomiting (early)
abd distention constipation hyperactive bowel sounds (high-pitched, rushing sounds) poorly localized abd pain multiple air-fluid levels in small bowel loops |
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In a child with SBO what is MC etiology?
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Think incarcerated inguinal hernia or Meckle's Diverticulum
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Mgmt of SBO
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NPO
NG tube IVF If ssx do not resolve or if pt develops peritoneal ssx then laparotomy is needed to relieve the obstruction |
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In a child with LBO consider
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Hirschsprung's disease
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Common causes of LBO in older adults and mgmt
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Diverticulitis, volvulus, colon cancer
Tx: NPO, NGT; Sigmoid volvulus can be decompressed with endoscope; If refractory may require surgery |
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MC hernia in both sexes and all age groups
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INDIRECT
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Protrusion of this hernia begins lateral to the inferior epigastric vessels due to a patent processus vaginalis
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INDIRECT
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This hernia is more common in women
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Femoral
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This hernia is due to defect in abdominal wall, Hasselbach's triangle
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DIRECT
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This hernia is most susceptible to incarceration and strangulation
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Femoral
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Protrusion of this hernia is MEDIAL to the inferior epigastric vessels and NOT into the labia or scrotum
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DIRECT
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Best preoperative test to assess pulmonary function
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Spirometry
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MCC of post-op fever in the 1st 24hrs
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Atelectasis
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Fascial/wound dehiscence typically occurs ________ days post-op
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5-10 dd post-op
Look for leakage of serosanguinous fluid w/Valsalva Tx: Abx (if 2/2 infxn) and reclosure of incision |
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Cause of acquired hearing loss in children
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Meningitis or recurrent OM
Screen for hearing loss after meningitis |
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Classical physical findings and bacterial cause for infectious myringitis?
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Otoscopy reveals vesicles on TM and classic cause is Mycoplasma spp. Also Strep pneumo and viruses
Rx: abx |
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MCC of sensorineural hearing loss in adults
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presbyacusis---nml part of aging
Tx: hearing aid if needed |
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MCC of progressive conductive hearing loss in adults
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Otosclerosis
Tx: hearing aid or surgery |
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What is Beck's triad?
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--decr systemic arterial pressure
--incr CVP --small quiet heart **signifies acute cardiac tamponade |
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Post-op hypotension, hypoglycemia, and change in mental status---you should suspect____
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Adrenal insufficiency
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Lung white out 2 days after flail chest or rib fractures---dx and mgmt?
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pulmonary contusion--fluid restriction, diuretics, respiratory support
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Blood in meatus and high riding prostate after trauma--dx & mgmt?
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Posterior urethral injury
Do posterior urethrogram, suprapubic catheter, repair delayed 6 months |
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Blood in meatus and scrotal hematoma--dx & mgmt?
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Anterior urethral injury
Do retrograde urethrogram and immediate surgical repair |
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What tumor classically affects both the 7th and 8th CNs?
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Acoustic schwannoma which is located in the cerebellopontine angle. If present consider---neurofibromatosis
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MCC of BILATERAL facial nerve palsy
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Lyme disease
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Most likely dx in pt with hx of head trauma w/LOC followed by lucid interval of minutes to hours then neurological deterioration. Tx?
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Epidural hematoma--biconvex on xray
Tx: surgical evacuation |
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Worst HA of pt's life with si/sx of meningitis except NO fever
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Subarachnoid hemorrhage (SAH)
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SAH is usually 2/2
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Rupture of aneurysm (usu berry)--blood in ventricles but NOT in brainstem or brain
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Treatment for SAH
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Support, anticonvulsants and observation; once pt is stable, do a cerebral angiogram to look for aneurysms or AVMs which are usu treated w/surgical clipping or ligation
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Causes of bleed in brain parenchyma
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MCC is HTN; AVMs, coagulopathies, tumor and trauma are other causes
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Classic and MC location of HTN-related bleeds
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Basal ganglia (2/3)
Pt often presents in coma. If awake, may have contralateral hemiplegia and hemisensory deficits |
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4 classic signs of basilar fracture
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1. periorbital ecchymosis (raccoon eyes)
2. postauricular ecchymosis (battle sign) 3. hemotympanum (bld behind TM) 4. CSF otorrhea/rhinorrhea |
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After trauma pt has unilat dilated unreactive pupil---pt most likely has
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epidural bleed causing impingement of ipsilat CN III and impending uncal herniation due to incr ICP
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Normal ICP range
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5-15mmHg
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What is Cushing's triad and what does it's presence suggest?
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Incr BP
bradycardia resp irregularity **suggests very high ICP |
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How to treat HTN in setting of incr ICP?
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Do NOT treat
Cerebral perfusion pressure = BP-ICP |
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Si/sx of spinal cord (SC) trauma
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spinal shock--loss of reflexes and motor fxn and hypotension
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Mgmt of SC trauma
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Immediate IV corticosteroids and surgery for incomplete neurologic injury
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Pt with local spinal pain and neuro deficits below the lesion (e.g. hyperreflexia, +Babinski, weakness or sensory loss) likely has____?
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Subacute SC compression---can be due to metastatic CA, primary neoplasm, subdural or epidural abscess or hematoma (esp after spinal tap)
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In what condition of the elderly is the classic triad of ataxia, dementia, and urinary incontinence seen?
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Normal pressure hydrocephalus
Tx: ventricular shunt |
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Bilat loss of pain and temp sensation below lesion in SC in the distribution of a cape--dx?
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Syringomyelia---central cavitation of the SC
Dx w/MRI Tx: Surgery--create shunt |
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Type of glaucoma that is a painless gradual progressive visual field loss
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Open-angle glaucoma---accts for 90% of cases
Usu 2/2 HTN |
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Medications for open-angle glaucoma
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beta blockers
prostaglandins (latanoprost) acetazolamide pilocarpine |
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Si/sx of closed-angle glaucoma
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sudden ocular pain
halos around lights red eye very high intraocular pressure (>30mmHg) N/V sudden decr in vision fixed, mid-dilated pupil |
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Treatment for closed angle glaucoma
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Immediately with pilocarpine drops, and oral glycerine and acetazolamide to break the attack then surgery to prevent other attacks (peripheral iridectomy)
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6 Causes of sudden unilateral, painless vision loss
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1. Central retinal artery occlusion
2. Central retinal vein occlusion 3. Retinal detachment 4. Vitreous hemorrhage 5. Optic neuritis/papillitis 6. Stroke or TIA |
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MC Dx in pt with branching ulcer over his cornea with terminal bulbs that stain green with fluorescein. Usu starts with vesicular eruption on lid and conjunctivitis.
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Ocular herpes keratitis
Refer to ophthalmologist promptly for antiviral tx (idoxuridine) |
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Mgmt for a pt with CC of floaters and flashes of light and "veil or curtain coming down in front of eye"
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Dx---likely retinal detachment
Immediate referral to ophthalmologist, as prompt surgery (reattachment) may save pt's vision |
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4 causes of sudden, unilateral painful vision loss
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Trauma
Closed-angle glaucoma optic neuritis migraine HA (rare) |