AAC 1 Flashcards
What is Well’s criteria
Used to determine pretest probability of PE:
♣ Wells Scoring Criteria:
• Clinical symptoms of DVT (leg swelling, pain with palpation) = 3
• Other diagnosis less likely than PE = 3
• Heart rate > 100 = 1.5
• Immobilization (>/= 3 days) or surgery in the previous 4 weeks = 1.5
• Previous DVT/PE = 1.5
• Hemoptysis = 1
• Malignancy = 1
Describe what to do for different scoring of Well’s
• Wells <2 = low probability
o Get D-dimer
♣ If low = likely not PE
♣ If elevated = continue with further testing
• Wells >4-6 = high probability o CTA with IV contrast ♣ Best test ♣ Must have normal kidney o V/Q scan ♣ Can perform with abnormal kidneys ♣ Must have a normal CXR
Describe CURB 65
PNEUMONIA SEVERITY SCORE:
• Criteria:
o C = Confusion (based upon a specific mental test or new disorientation to person, place, or time)
o U = Urea (BUN >7)
o R = Respiratory Rate >/= 30
o B = Blood Pressure (systolic <90 or diastolic <60)
o 65 = Age >65
Describe pneumococcal vaccine PPSV23 and who it is used for
♣ Contains capular material from 23 serotypes that have historically been responsible for the majority of pneumonoccal infections
♣ Because polysaccharides alone cannot be presented to T-cells, the vaccine induces a relatively T-cell-independent B-cell response that is less effective in young children and the elderly
Describe pneumococcal vaccine PCV13 and who it is used for
♣ Consists of capsular polysaccharides from 13 of the most common serotypes that have been covalently attached to the inactivated diphtheria toxin protein
♣ This polysaccharide-protein conjugate induces a T-cell-depended B-cell response, resulting in improved immunogenicity due to the formation of higher-affinity antibodies and memory cells
How will Leydig tumors present in terms of
- Testosterone
- Estrogen
- LH
- FSH
Elevated testosterone and estrogen (gynecomastia) with secondary inhibition of LH and FSH
Diagnose:
- Hypotension
- Increased venous pressure, JVD
- Clear lung sounds
Cardiac tamponade
What physical exam finding is often found in pericardial effusion
Inability to palpate PMI
Describe defect in Factor V Leiden
Most common hereditary thrombophilia
♣ Mutation that makes Factor Va resistant to inactivation by protein C
♣ Increased coagulation
Imaging for osteonecrosis of the femoral head
MRI
Describe hereditary hemorrhagic telangiectasia
♣ Aka Osler-Weber-Rendu syndrome
♣ Inherited disorder of blood vessels
♣ Presentation:
• Telangiectasias, recurrent epistaxis, skin discoloration, arteriovenous malformations, Gi bleeding, hematuria
o AVMs in the lungs can shunt blood from the right to the left side of the heart, causing chronic hypoxemia, digital clubbing, and reactive polycythemia
Describe CBC in polycythemia vera
♣ CBC will show an increase in all 3 cell lines (RBC, Leukocytes, and platelets)
Describe mutation in polycythemia vera
o JAK2 kinase mutation
♣ Normally, RBC production is depended on EPO released by the kidney and liver in response to tissue hypoxia
♣ EPO activates JAK2 tyrosine kinase, which differentiates late myelid cells into erythrocytes
♣ In PV, RBC production is driven by a constitutively active JAK2 gene rather than by tissue hypoxia; therefore, EPO levels tend to be low
What is the defect in Hashimotos
- Most common cause of hypothyroidism
* Autoimmune destruction (antithyroid peroxidase and antithyroglobulin antibodies)
What is the defect in Graves disease
• Thyroid stimulating immunoglobulin (TSI) stimulates TSH receptor
Describe CHADSVASC
• CHADSVASC Score risk of stroke for patients with A-fib/A-flutter o CHA(2)DS(2)VASc o Components: ♣ C = CHF or LVEF = 40% ♣ H = HTN ♣ A = Age >/= 75 ♣ D = DM ♣ S = Stroke/TIA/Thromboembolism ♣ V = Vascular disease ♣ A = Age 65-74 ♣ S = Sex (female)
Describe order of method for reading EKGs
- Rate
- Rhythm
- Axis
- Chambers
- Intervals
- Ischemia/Infarct
