04 APR 2017 1258 MIX Flashcards
what is the pathophysiology of ARDS? what are the implications for lung physiology?
- fluid / cytokine leakage into alveoli
- impaired gas exchange, decreased lung compliance, PHTN
bilateral lung opacities (pulmonary edema) NOT due to CHF / fluid overload?
ARDS
in ARDS there is hypoxemia with a PaO2/FiO2 ratio equal to or less than ______ mm Hg - why?
- 300 mm Hg
- decreasing PaO2 leads to higher FiO2 requirement
what should you consider in hypoxemia with a PaO2/FiO2 ratio equal to or less than 300 mm Hg?
ARDS
why is lung compliance decreased in ARDS?
- loss of surfactant
- increased elastic recoil of edematous lungs
ARDS causes shunting with an ______________ (decreased / increased) A-a gradient
increased
_________________ (sympathetic / parasympathetic) fibers are located on the periphery of the oculomotor nerve, which means that compression would cause __________________
- parasympathetic
- mydriasis
when do you do a workup for neonatal hydration / dehydration?
if infant has lost more than 7% of body weight
when can formula supplementation be recommended for infants?
infants who have lost over 7% of birth weight despite optimization of breastfeeding
why should water never be given to infants under 6 months?
due to the immature kidneys of infants, it can dilute the blood, resulting in hyponatremia and seizures
what are the first and second line medications for bipolar disorder?
- first line: lithium, valproate
- second line: quetiapine, lamotrigine
how does digoxin toxicity present?
- nausea
- vomiting
- decreased appetite
- confusion
- weakness
- scotoma
- blurry vision / color changes
elevation of peak and plateau pressures indicates a process causing ____________ (decreased / increased) pulmonary compliance, such as pulmonary edema, atelectasis, pneumonia, or right mainstem bronchus
decreased
what type of drug is raloxifene? what is the MOA? what is the indication?
- SERM
- estrogen agonist activity on BONE
- decrease post-menopausal osteoporosis in patients who cannot tolerate bisphosphonates or are at high risk for invasive breast cancer
SERMs have estrogen _____________ (agonist / antagonist) activity in the breast, estrogen ______________ (agonist / antagonist) activity in the bone, and estrogen _________________ in the uterus
- breast: antagonist
- bone: agonist
- uterus: antagonist
what is the treatment for acute bronchitis?
SYMPTOMATIC TREATMENT
in a suspected ectopic pregnancy in a hemodynamically stable patient, what is the course of action after an equivocal transvaginal US?
- serum BhCG
- if over 1500 repeat BhCG level and transvaginal US in 2 days
- if under 1500 repeat BhCG level in 2 days
BhCG should increase every 2 days in viable pregnancies but rise at a slower rate in ectopic and nonviable pregnancies
in a woman over 35, infertility is considered when there is lack of conception after ____ months due to _____________
- 6
- diminished ovarian reserve
wide complex tachycardia with 2 fusion beats is diagnostic for:
sustained monomorphic ventricular tachycardia
enterococci are a common etiology of bacterial endocarditis following what type of infection?
nosocomial infections (e.g. UTI)
what are the 3 first line abx for asymptomatic bacteriuria?
- cephalexin
- amoxicillin-clavulanate
- nitrofurantoin
TMP-SMX is safe to use during which trimester? why cant it be used during the other trimesters?
- 2nd trimester
- 1st trimester: interferes with folate metabolism
- 3rd trimester: neonatal kernicterus
what is the explanation for the large oxygen saturation gap seen in methemoglobinemia?
- metHb absorbs light at distinct wavelengths, so pulse oximetry is commonly around 85% regardless of the true oxygen saturation
- in parallel, blood gas analysis frequently returns a falsely elevated result for oxygen saturation as it provides an estimate based on only the PaO2 and not on effective Hb-oxygen binding
