acute renal failure, cardiac, liver dz, pneumonia, DVT/PE Flashcards
cut offs for pre-renal vs intrarenal for FeNa, FeUrea, and BUN:Cr
pre-renal:
FeNa<1
FeUrea <35
BUN: Cr >20
intrarenal:
FeNa>2
FeUrea >35
BUN: Cr <10
uremia sxs
encephalopathy lethargy nausea bleeding complication pericarditis
manage hyperkalemia
calcium gluconate insulin plus dextrose albuterol lasix, fluids kayexelate
do you get repeat CXR in pneumonia patients after treatment?
most dont
only if- immunocompromised, atypicals, smokers (post-obstructive cancer?)
what can you have hemoptysis from?
Infection (TB, etc) PE pneumonia trauma lung cancer Good pastures Wegners CF- bronchiectasis
what can you get calf tenderness from
DVT cellulitis muscle spasm trauma baker cyst
acute vs chronic resp alkalosis
for every change in 10 pCO2
- acute: change in pH by 0.08
- chronic: change in pH by .03
normal Aa gradient
age/4 + 4
Well’s criteria measures probability of
probability of having PE
Well’s criteria components
DVT signs/sxs HR>100 previous VTE Immobile >3 days or surgery Malignancy Hemoptysis
what PE workup should be done if low, intermediate, high probability or if sxs
low: PERC tool, CXR, other workup
intermediate: D-dimer
High: CT-PE
if sxs of DVT: DVT US–> treat
CT PE contra
allergy
pregnancy
renal failure
what test should you do if you cant do CT PE?
VQ scan
is pleural effusion from PE transudative or exudative?
exudative
anticoagulation duration for provoked vs unprovoked PE vs VTE in setting of cancer?
provoked: 3-6 months
unprovoked/cancer: life long if no bleeding risk
what should you do if bleeding on anti-coagulation?
retrievable IVC filter for 6 months
test for esophageal varices
UGI endoscopy
treat esophageal varices
volume replete, PPI, abx for SBP
beta blockers
if active: octreotide, TIPS, ligatio
Melt score
to determine liver transplant need
based on Cr, bili, INR
non cirrhotic causes of portal HTN
cardiac dz- right heart failure
venous flow obstruction- budd-chiari, thrombosis
acute liver sz- alcoholic hepatitis
malignancy of liver
portal vein thrombosis
ascites treatment
primary: less sodium intake, spirincolactone + lasix, paracentesis
secondary: TIPS
ascites complications
tense ascites- CV compromise
hepatic hydrothorax- resp compromise
ubilical hernia- bowel incarceration or spontaneous rupture
portosystemiatic enceophalopathy vs fulminant hepatic failure
both forms of hepatic-induced encephalopahty due to increased ammonia
PSE: cirrhosis cause, gradual onset
FHFL acute liver failure cause, rapid onset
hepatic encepahlopathy treatment
lactulose
abx
restrict protein
