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LUNG + RENAL STEP 2 > dif to remebmer > Flashcards

dif to remebmer Flashcards

1
Q

tumors of the mediastinum - location

A

anterior: thymoma, thyroid, teratoma, lymphoma
middle: bronchogenic cysts
posterior: neurogenic, esoph leiomyomas

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2
Q

Modified Wells criteria

A
  • 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
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3
Q

COPD - factors that decrease mortality

A
  1. smoking cessation
  2. 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)
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4
Q

COPD indications for O2 at home

A
  1. resting PaO2 55 or lower
  2. SaO2: under 89%
  3. Those with RHF or HCT higher than 55 should be started if Pao2 lower than 60 or Sao2 lower than 90
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5
Q

causes of hypoxemia - A-a gradient, corects with O2

A
  1. hypoventilation: normal, yes
  2. dead-space ventilation (V/Q=infinity), increased , yes
  3. diffusion limitation: increased, yes
  4. intrapulmonary shunt (V/Q=0): increased, no
  5. intracradiac shunt (R-L): increased, no
  6. Reduced PiO2: normal, yes
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6
Q

asthma severity for patients not on controller medication (steps)

A 
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
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7
Q

asthma treatment

A

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

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8
Q

there are 2 types of abnormal ventilation during sleeping

A
  1. apnea: cessation of breathing for 10 or more sec)
  2. 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)
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9
Q

COPD - seizures after 02 supplementation

A

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
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10
Q

normal pleural fluid ph / trandudate fluid ph / edudate

A
  • 7.6
  • 7.4-7.55
  • exudate: 7.3-7.45 (may be lower)
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11
Q

1st generation H1 blockers - drugs

A
  1. diphenhydramine
  2. dimenhydrinate
  3. chlorpheniramine
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12
Q

2nd generation H1 blockers - drugs

A
  • ADINE + cetirizine
    1. loratadine
    2. fexofenadine
    3. desloratadine
    4. cetirizine
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13
Q

PEAK airway pressure

A

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

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14
Q

Curb 65 - interpretation

A

0 –> outpatient
1-2 –> likely inpatinet
3-4 –> urgent inpatinet
ICU if more than 4

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15
Q

repeated pneumonia at the same location - next step

A

CT (not bronchoscopy)

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16
Q

pulmonary nodule - female vs male / location?

A

in females the possibility to be cancer is higher

- upper lobe location is more likely to be cancer

17
Q

Wegener - nasal biopsy?

A

very FN

18
Q

acute hyponatremic encephalopathy - treatment

A

3% saline and observatiom

increase sodium 6-8 the first 24 hours

19
Q

MCC of hyponatremia

A

Hypovolemia
if mild –> 5% dextrose in 0.45 water
severe –> 0.9%
no ore than 1meg/L/h

20
Q

management of ureteral stones

A

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

21
Q

hyperkalemia - ECG

A
  • tall peaked T waves with short QT
  • PR prolongation + QRS widening
  • No P waves
  • conduction block, ectopy, or sine wave pattern
22
Q

evaluation of met alkalosis

A

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)

23
Q

evaluation of hyponatremia

A

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

24
Q

recommendations for blood tranfusion

A

under 7: always
7-8: if cardiac surgery, HF, oncology patients in treatment
8-10: symptomatic anemia, noncardiac surgery, ongoing bleeding, ACS

25
Q

indications for urgent dialysis

A
  1. refractory acidosis with ph under 7.1
  2. volume overload refractory to diuretics
  3. symptomatic uremia (bleeding, encephalopathy, pericarditis
  4. ingestion: toxic alcohols, salicylate, lithium, sodium valproate, carbamazepine
  5. elect abnormalities: severe or symptomatic hyperkalemia refractory to medications
26
Q

pyelonephritis treatment

A
  • outpatient: fluoroquinolones
  • inpatient: IV antibiotics (fluoroquinolone, aminoglycoside +/- ampicillin)
  • urine culture prior to treatment
27
Q

uncomplicated cystitis - treatment

A
  • 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
28
Q

complicated cystitis - treatment

A
  • fluoroquinolones (5-14d),
  • extended spectrum antibiotics (ampicillin/gentamycin) for for severe
  • culture before
29
Q

interstitial cystitis (bladder pain syndrome) - clinical presentation

A
  1. bladder pain with filling, releif with voiding
  2. urinary frequency + urgency
  3. Dyspareunia
30
Q

interstitial cystitis (bladder pain syndrome) - diagnosis

A
  • bladder pain with no other cause for 6 or more weeks

- normal urinalysis

31
Q

hyperakalemia - acute therapy if

A
  1. more than 7
  2. ECG changes
  3. rapid rising
32
Q

casts in urine - types

A
  1. RBCs
  2. WBCs
  3. Fatty casts
  4. granular (muddy brown casts)
  5. waxy casts
  6. hyaline casts

LUNG + RENAL STEP 2 (5 decks)

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