Deck 5 Flashcards
pharmacotherapy for COPD exacerbation
inhaled bronchodilators (albuterol/ipratropium), IV methylprednisolone (solumedrol), ABX
signs of beta blocker toxicity
hypotension, bradycardia, bronchospasm, altered mental status, seizures, hypoglycemia
FEV1/FVC ratio in restricted lung disease
normal
decreased FEV1/FVC ratio
obstructive
estrogen effect on thyroid hormone metabolism
it increases Thyroglobulin productin which causes decreased T4/T3 and therefore an increased TSH
calcium and phosphate level in pagets disease
normal only alk phos is elevated
what else can give you asterixis
hyperuricemia
indications for urgent dialysis
AEIOU: A: acidosis <7.1, E: electrolyte abnormalities I: ingestion of toxins O: volume overload U: uremia
when do papillary muscles rupture after acute MI
within 3 days
when does the IV septum rupture after acute MI
within 3-5 days
when do pts. get free wall rupture after acute MI
within 5 days or up to 2 weeks
when do pts. get ventricular aneurysms after MI
up to several months later
what is the cause of aKI after itiation of loop diuretics for COPD/CHF
they lower CO via decreased preload therefore decreased renal hypoperfusion so its a prerenal AKI
adverse effect of beta blockers on weight
weight gain and worsening glucose tolerance
platelet levels in antiphospholipid syndrome
lower because the antipholpholipid ab
what is superior vena cava syndrome
this is when you have venous congestion of the head neck and upper extremities due to obstruction of the SVC to the RA
signs of superior vena cava syndrome
edema of the upper extremities and face, prominant veins on chest and face, JVD
what are the most common causes of SVC syndrome
malignancy
intial eval of acromegaly
IGF-1 level
first line eval for patients with chronic insomnia
sleep diary
what type of thyroid disorder do patients when they have an acute illness
euthyroid sick syndrome
what is urine sodium like in a patient who is hyponatremic
it will be low so <20mEq/L
how do you dx entamoeba histolytica
stool pcr or serology
when do you need to do a proctocolectomy for FAP
late teens or early 20s
diagnosis of chronic pancreatitis
CT scan and MRCP
what do patients do to decrease pain levels in chronic pancreatitis
lean forward
CSF analysis of a patient with guillain barre
elevated protein but normal everything else
tuberculous meningitis CSF
low glucose, high protein moderate WBCs
bacterial meningitis CSF
low glucose, high protein, High WBCs
what is dobutamine
beta 1 agonist
dobutamine effect on the heart
positive inotropic effect and positive chronotropic effect
dobutamine effect on end systolic volume
decrease LV End systolic volume
what is the dx of a patient with a cough so bad they throw up or get a rib fracture
this is pertussis
what is the first thing you should do if a patient has a likely stroke
ABCs and then noncontrast CT
most common signs of post concussive syndrome
headache, sleep disturbance, mood changes
signs of DIC
low platelets, elevated PT/PTT,
how many ring enhancing lesions are in toxo
there are multiple
how any ring enhancing lesions in CNS lymphoma
1
what does the plateau pressure reflect in
elastic pressure which reflects the compliance
what do you use to treat nocardia
TMP-SMX
why do patients with sepsis get hypoglycemia
increased tissue glucose use
what type of murmur do you hear in acute aortic dissection
acute aortic regurg which is an early diastolic murmur
why do patients with sarcoid get hypercalcemia
this is because the granulomas produce 1-alpha hydroxylase which converts vitD to active calcitriol which in turn increases renal Ca absroption
PTH level in sarcoid
PTH is low which causes more Ca get excreted from the urine
lab abnormalities in CMV
they are elevated
clinical manifestations of paroxysmal nocturnal hemoglobinuria
hemolysis, cytopenias, venous thrombosis
echo findings of a patient with cadiomyopathy due to viral myocarditis
dilated ventricles with diffuse hypokinesis
pain onset for varicella zoster
can occur before the rash
what is associated with contact use for keratitis infection
pseudomonas
what is pulmonary arterial pressure like in ARDS
it is increased because of hypoxic vasocontriction to pooly airated lung parenchyma
what does ECG show in Hypertrophic cardiomyopathy
it shows t wave inversions
medication triggers for patients with asthma
aspirin, beta blockers, ACEs
initial test for likely DVT
compression ultrasound
what is bicarb like in compensated respiratory alkalosis
it should be low
clinical signs of hemophilia
hemarthroses, IM hematomas, GI/GU bleeding, intracranial hemorrhage
physical exam findings in severe AS
pulsus parvus et tardus (delayed carotids), late peaking systolic murmur, soft and single S2
beta agonits effect on potassium
they cause low potassium because there is an intracellular shift
CMV colitis diarrhea blood or no blood
bloody diarrhea
signs of cholesterol emboli
blue toe syndrome, livedo reticularis, intenstinal ischemia, AKI etc.
does a fib have p waves
NO
signs of multifocal atrial tachycardia on EKG
> 3 different P wave forms, and atrial rate >100
does COPD cause clubbing
NO
what are the most common causes of clubbing
occult malignancy, restrictive lung disease, CF, R-L cardiac shunt
what do pericardial calcifications represent on xray
contrictive pericarditis
sharp x and y descents on central venous tracing
constrictive pericarditis
what is cor pulmonale
this is right heart failure due to a pulmonary issue
what prophylaxis do all HIV patients need to be on
TMP-SMX
what is electrical alternans
this is when there are varying heights of the QRS complex most notable on V1
what does electrical alternans indicate
cardiac tampenode
why do people with CF get diabetes
because of pancreatic destruction
adverse effect of erythropoietin stimulating agents
hypertension
what drugs are used for rhythm control in afib
flecainide and propafenone
what are the 4 main infectious causes of bloody diarrheas
entemeba histolytica, shigella, EHEC, campylobactor
signs of gabapentin overdose
encephalopathy, myoclonus
creatine kinase in polymyalgia rheumatica
normal!
leukocytes in leukemia
they can be normal or elevated or decreased
can gonorrhea cause pharyngitis
yes, from oral sex
which myopathies are painful
statin induced and hypothyroid
CK and ESR in glucocorticoid myopathy
normal!
what kind of hypertrophy happens in severe aortic regurgitation
eccentric hypertrophy
what is the compliance like in eccentric hypertrophy
it is increased compliance due to dilation of the chamber
treatment of hypercalcemia
saline plus calcitonin and then bisphosphonates
what is a retrospective cohort study
this is where you have a group and look at people who have the risk factor vs. those who dont and then compare disease occurance
what is a case control study
this is where you compare diseased cases vs. non disease cases and see what risk factors there are
what autoantibodies are present in autoimmune hepatitis
anti-smooth muscle
treatment of chest pain due to cocaine use
benzos, cath if STEMI, nitro, CCB
what does it usually mean if a patient has unintentional weight gain
hypothyroid
what drugs can cause hypothyroidism
amiodarone, lithium
what is amiloride
this is a potassium sparing diuretic that blocks ENaC
what are the main causes of nephrotic syndrome
membranous nephropathy, minimal change disease
what results from spinal stenosis
compression of lumbar nerve roots
what is pseudoclaudication
this is from compressed nerve roots due to spinal stenosis causes pain when walking because of lumbar extension
what is the pathophysiology of acute chest syndrome
vasoocclusion in pulmonary microvasculature
what is the post exposure prophylaxis for neisseria meningitidis
rifampin or ceftiraxone
signs of bronchiectasis
chronic daily production of voluminous thick mucus with exacerbations +/- hemoptysis
how do you dx bronchiectasis
high res CT
manifestations of leprosy in the skin
macular anesthetic skin lesions and painful nerves with sensory loss
dx of leprosy
full thickness biopsy
CLL lab values
dramatic lymphocytosis, thrombocytopenia, anemia
how do you dx CLL
flow cytometry
G6PD signs of hemolytic anemia
hyperbilirubinemia, hemoglobinuria (positive urine dip for blood but no RBCs
what is the cause of hemolytic anemia in G6PD
oxidative injury
in secondary adrenal insufficiency what is the aldosterone level like
normal because this is primarily controlled by RAAS
what arrythmia is most common for digoxin toxicity
atrial tachycardia with AV block
what age do pts get splenic sequestration crises with sickle cell disease
young children
what is a delayed hemolytic transfusion reaction
this is when a patient has a reaction days later due to antibody production from memory b cells
urine sodium in SIADH
it is high because there is decreased aldosterone due to there being less RAAS activated?
volume status of SIADH patients
euvolumic
cause of repeat chlamydia infections
reinfection from an untreated parner
what parasite goes to the muscles
trichinella
what other organ does ascariasis harm
the lungs
what is melanosis coli
this is dark brown pigmentation of the colon
what causes melanosis coli
laxative overuse (senna
what is seen on xray of a patient with alpha1 antitrypsin deficiency
emphysematous changes ( like large air spaces)
what is prophyria cutanea tarda
this is blistering of sun exposed skin (back of hands, forearms face)
lab abnormalities of porphyria cutanea tarda
iron overload (bc not being used), mildly elevated liver enzymes
what is associated with acquired prophyria cutanea tarda
hepatitis C, HVI, excess alc, estrogen use, smoking
how to dx lumbar spinal stenosis
mri
treatment of ethylene glycol
fomepizole
symptoms of milk-alkali syndrome
constipation, polyuria, polydipsia, neuropsych sx
describe the ECG of supraventricular tachy
buried P waves, constant RR interval
treatment of supraventricular tachycardias
vagal maneuvers or adenosine to help unmask the P waves and ID what type of arrythmia is going on
why do patients with multiple myeloma get recurrent infections
because they have infiltration into the bone marrow so normal lymphocytes cant make the normal amount of abs
treatment of bacterial meningitis in immunocompromised patients
cefepime, vanc, amp
