dif to remebmer Flashcards
tumors of the mediastinum - location
anterior: thymoma, thyroid, teratoma, lymphoma
middle: bronchogenic cysts
posterior: neurogenic, esoph leiomyomas
Modified Wells criteria
- 3 points: Clinical signs of DVT, alternate diagnosis is less likley
- 1.5 points: previous PE or DVT, herat rate more than 100, Recent surgery or immobilazation
- 1 point: hemoptyisis, cancer
MORE THAN 4 –> LIKELY
4 OR LESS –> UNLIKELY
COPD - factors that decrease mortality
- smoking cessation
- Long term supplemental 02 decreases mortality if:
- SpO2 under 89% or under 56
- SpO2 under 90% Or under 60 if RHF or erythrocytosis (HCT more than 55)
COPD indications for O2 at home
- resting PaO2 55 or lower
- SaO2: under 89%
- Those with RHF or HCT higher than 55 should be started if Pao2 lower than 60 or Sao2 lower than 90
causes of hypoxemia - A-a gradient, corects with O2
- hypoventilation: normal, yes
- dead-space ventilation (V/Q=infinity), increased , yes
- diffusion limitation: increased, yes
- intrapulmonary shunt (V/Q=0): increased, no
- intracradiac shunt (R-L): increased, no
- Reduced PiO2: normal, yes
asthma severity for patients not on controller medication (steps)
step 1 (intermittent): max 2 days a week symptoms, max 2 nighttime awakening per month step 2 (mild persistent): more than 2 days / wk, 3-4 awaakenings per month step 3 (moderate): daily symptoms, more than 1 awakening /wk step 4 or 5) (severe): throughout day, 4-7 awakening / wk
asthma treatment
step 1 –> SABA
step 2 –> Low dose inhaled cortic
step 3 –> low dose inhaled cosrticost + LABA or medium inhaled costic
step 4: medium dose inh cortic + LABA
step 5: High dose inh cosrtic + LABA + omalizumab if allegy
step 6: High dose inh cortic + LABA + Oral cortic + Omalizumab if allergy
there are 2 types of abnormal ventilation during sleeping
- apnea: cessation of breathing for 10 or more sec)
- hypopnea: reduced airflow causing SaO2 to decrease by 4%
in symptomatic paitnes, experiencing 5 or more obstructive resp events (apneas or hypopneas) per hour is diagnostic of obstructive sleep apnea)
COPD - seizures after 02 supplementation
increased CO2 retention due to
- loss of compensatory vasoconstriction in areas of ineffective gas exhange worsens V/Q mismatch
- increase on HbO2 reduces the uptake of CO2 from tissues
- Decreased resp drive and slowing of the resp rate causes reduced minute ventilation
- -> reflex cerebral vasodilation –> seizures
normal pleural fluid ph / trandudate fluid ph / edudate
- 7.6
- 7.4-7.55
- exudate: 7.3-7.45 (may be lower)
1st generation H1 blockers - drugs
- diphenhydramine
- dimenhydrinate
- chlorpheniramine
2nd generation H1 blockers - drugs
- ADINE + cetirizine
1. loratadine
2. fexofenadine
3. desloratadine
4. cetirizine
PEAK airway pressure
the maximum pressure measured as the TV is being delivered = the sum of the resistive pressure (flow x resistance) and the platue pressure
platue pressure: the P measured during an insiratory hold maneuver, when pulm airflow and thus resistive pressure are both 0 = elastic P + PEEP
PEEP is calculated with the end expir hold maneuver
Curb 65 - interpretation
0 –> outpatient
1-2 –> likely inpatinet
3-4 –> urgent inpatinet
ICU if more than 4
repeated pneumonia at the same location - next step
CT (not bronchoscopy)
pulmonary nodule - female vs male / location?
in females the possibility to be cancer is higher
- upper lobe location is more likely to be cancer
Wegener - nasal biopsy?
very FN
acute hyponatremic encephalopathy - treatment
3% saline and observatiom
increase sodium 6-8 the first 24 hours
MCC of hyponatremia
Hypovolemia
if mild –> 5% dextrose in 0.45 water
severe –> 0.9%
no ore than 1meg/L/h
management of ureteral stones
symptomatic relief –> urosepsis, acute renal failure or complete obstructiion?
yes –> urology consult
no –> stone siize:
less than 10 mm –> hydration pain control, a blocker
bigger than 10 –> urology consult
uncontrolled pain or no stone passage in 4-6 weeks –> urology consult
hyperkalemia - ECG
- tall peaked T waves with short QT
- PR prolongation + QRS widening
- No P waves
- conduction block, ectopy, or sine wave pattern
evaluation of met alkalosis
urine chloride
low –> vomiting / NG aspiration, prior diuretics (SALINE RESPONSIVE)
high –> hypervolemia (aldosterone) (SALINE UNRESPONSIVE)
hypovolemia/evolemia: current diuretics (SALINE RESPONSIVE) Barrter, gitelman (SALINE UNRESPONSIVE)
evaluation of hyponatremia
serum osm more than 290?
yes –> marked hypogl / advanced renal failure
no –> urine osm less than 100?:
- yes (polydipsia, malnutriotion)
- no –> check urine sodium
if if less than 25 –> SIADH, adrenal ins, hypoth
if it is more than 25 –> vloume depltion, cirrhosis, CHF
recommendations for blood tranfusion
under 7: always
7-8: if cardiac surgery, HF, oncology patients in treatment
8-10: symptomatic anemia, noncardiac surgery, ongoing bleeding, ACS
indications for urgent dialysis
- refractory acidosis with ph under 7.1
- volume overload refractory to diuretics
- symptomatic uremia (bleeding, encephalopathy, pericarditis
- ingestion: toxic alcohols, salicylate, lithium, sodium valproate, carbamazepine
- elect abnormalities: severe or symptomatic hyperkalemia refractory to medications
pyelonephritis treatment
- outpatient: fluoroquinolones
- inpatient: IV antibiotics (fluoroquinolone, aminoglycoside +/- ampicillin)
- urine culture prior to treatment
uncomplicated cystitis - treatment
- Nitrofurantoin for 5 fays (avoid if pyelonephritis or Cr clearance less than 60)
- TMP - sxm for 3 days
- fosfomycin (single dose)
- fluoroquinolones (2nd option)
- Culture only if initial treatment fails
complicated cystitis - treatment
- fluoroquinolones (5-14d),
- extended spectrum antibiotics (ampicillin/gentamycin) for for severe
- culture before
interstitial cystitis (bladder pain syndrome) - clinical presentation
- bladder pain with filling, releif with voiding
- urinary frequency + urgency
- Dyspareunia
interstitial cystitis (bladder pain syndrome) - diagnosis
- bladder pain with no other cause for 6 or more weeks
- normal urinalysis
hyperakalemia - acute therapy if
- more than 7
- ECG changes
- rapid rising
casts in urine - types
- RBCs
- WBCs
- Fatty casts
- granular (muddy brown casts)
- waxy casts
- hyaline casts
