Clin Med 3 Flashcards
NBTE form sterile thrombotic veg in undmged valves vs preexisting valve dz d/t?
PLT + fibrin, immune complexes, mononuclear cells vs blood flow turbulence
dx & tx for NBTE vs IE
TEE > TTE, blood cx to r/o infxn, distinguish NBTE from IE. systemic anticoag vs blood cx (3/6), TTE>TEE, Duke (def, possible, rejected), CXR if right sided. blood cx before empiric abx x/ CHF valve dysfxn, abx prophylaxis, valve replace, hyper/acute graft rejection doesn’t occur -> no immunosuppress
acute vs subacute IE bacteria & sxs
s. aureus, streptococcus, viridans; healthcare assoc; fever/chills, new murmurs, Jane way lesions vs s. epi, streptococcus, viridans, enterococci, H flu; community acquired; Osler, Roth, petechiae, splinter hem, mycotic aneurysm -> stroke
early vs intermed vs late prosthetic valve endocarditis. general & microorg causes of tricuspid valve?
<2mo -> s. aureus, epi vs 2-12mo -> epi, aureus, viridans vs >12mo -> aureus, viridans, epi, enterococci. IVDU; aureus > candida > pseudomonas
how can endocarditis show neg cx?
previous abx admin, inadeq micro technique, fastidious bacteria, intracell pathogens (Bartonella, brucella, coxiella, legionella)
general risk factors for resp infxns
young age (small short airways), old age (immunosenescence), immunocomp, H+ pump inhibitor (dec stomach acid), prior resp infxn (dmged resp mucosa & epithelia)
when do you start using SOFA score for sepsis?
if pt as <300 PaO2, <100 PLT, >2 bilirubin & Cr, GCS >10; resp 22, AMS, sbp <100mmHg
HACEK can cause subacute IE by infecting which valves?
mech aortic and prosthetic tricuspid
how to tx pts w/ chronic stable heart fail vs acute decomp heart fail vs refractory HTN vs cardiomyopathy w/ low EF?
loop, ACEI, BB vs loop, nitroprusside, NO BB; O2/assisted ventil by pos pressure vs inotropes, mech support vs transplant. GENERALLY AVOID NSAIDS & ALC
constrictive pericarditis. sxs vs dx vs tx
dense fibrocalcific scar -> diastolic dysfxn -> dip/plateau, square root sign. pulsus paradoxus, Kussmaul, Beck’s, pericardial knock (S3) vs echo for pericardial thickness or biatrial enlg, cardiac cath to chk diastolic pressures in chambers & LV tracing vs pericardiectomy
what does airway look like in peds? signs of resp distress in peds
larynx ant & higher, tongue = bigger, epiglottis flappy & bigger, airway smaller & shorter, more airway resistance. tachypnea, stridor, nasal flaring, grunting, drooling
upper airway dzs for <6mo vs >6mo
congen: laryngo/tracheomalacia, vocal cord paralysis; acquired: croup, foreign body vs acquired inflam: croup, tracheitis, epiglottitis, abscess, anaphylax/angioedema; acquired noninflam: foreign body
3 causes of pulm HTN & sequelae
inc venous pressure, flow, resistance –> R heart fail –> JVD, periph edema, ascites, S3, loud P2
diag tests for pulm HTN
R cardiac cath = gold standard; MAP >25mmHg at rest; CXR lg central vessels & R heart; EKG RBBB, high R V1, RAD; echo for ejection jet; PFT lung vol <50%; V/Q to chk for chronic venous thromboembol dz
tx meds for PAH
CCB x/ verapamil b/c neg ino; SGC like NO (CI = preg); prostanoids b/c prostacyclin = potent vasodil; endothelin receptor antag -sentan to block vasoconstrictor endothelin; PDE5I b/c prolong NO (sildenafil); end stage PH -> heart & lung transplant
pulm renal syndrome sx vs dx
rapid; systemic complaints for few wks vs nonspecific dx x/ known vasculitis or connective tissue dz; high Cr, anti GBM ab, ANCA
Goodpasture sx vs dx vs tx
rapid; glomerulonephritis from circ ab attacking type IV collagen in basement mem -> crescent formation, frothy sputum vs high Cr -> AKI, anti GBM ab, BAL, mild anemia, immunofluorescence igG vs plasmapheresis to remove ab, prednisone + cyclophosphamide to dec prod ab
clin pres for sepsis
QSOFA, warm shock & cold shock (mottled -> cool & varicose vv), skin (petechiae, no cap refill -> vasopressors), AKI, elderly & immunocompromised may show hypothermia/glycemia or leukopenia
how to dx sepsis? tx? tx goal?
clinical dx, 2 sets of blood cx, ABG, pulse ox, coag studies, PCR, inflam cytok. cx before abx if possible, broad spectrum abx w/in 1h, resusc crystalloids x30min for HoTN or lactatemia; vasopressors if fluids don’t work, PRBC if hgb<7, tidal vol 6mL/kg in ARDS. CVP 8-12, MAP >65
what are the key diff b/w nml and COPD/obstruction in spirometry? what about restrictive lung dz?
COPD/obstruction has dec FEV1 & FVC, inc RV; scooping expiratory loop. same as nml loop but smaller
when to do bronchoprovocation & how? what’s DLCO?
nml spirometry but sus variable obstruction/asthma -> exer or methacholine (bronchospasm; don’t give if sick). single breath diffusion & lung vol CO capacity for emphysema, pulm edema
diff b/w metab acidosis vs resp acidosis. acidosis w/ metab compensation? what does ABG measure?
nml CO2, low pH vs high CO2, low pH. lesser change in pH w/ metab compensation. PaC/O2, pH, SaO2, HCO3 in arterial blood
V/Q base < apex; why? how to fix V/Q mismatch? what happens in a shunt? can it be corrected by FiO2?
more blood flow & less air in base, vice versa in apex. inc FiO2. bypasses gas exchange. no
what happens if gas diffusion takes longer? tx?
impaired diffusion -> thickened alveoli. raise alveolar O2, FiO2
