Emma Holiday Cards Flashcards
Right ventricular infarct
V4-V6; may show ST segment depression
S/s: Hypotension, tachycardia, clear lungs, JVD
Tx: Fluid resuscitation to improve preload; DO NOT GIVE NITRO
Coronary angiography indications for CABG
Left main disease
> 3 vessel disease
> 70% occlusion
Pain despite maximum medical tx
Post-infarction angina
Work-up for unstable angina (no toponins and negative EKG after chest pain)
Exercise EKG
-Exercise echo if the pt. is on Digoxin, has baseline ST elevation, or old LBBB
-If pt. has chest pain reproduced, ST depression, or hypotension, test is positive
=»Coronary angiography
Post-MI pt. who has “step up” in O2 conc. from RA to RV
IV septal rupture
Post-MI pt. who has persistent ST elevation and systolic MR one month later
Ventricular aneurysm
Canon A-waves
Pt. with bounding jugular veins
-Indicates AV dissociation in post-MI pts.; could be 3rd degree block as well
Pt. with canon a-waves on exam and has a regular P-P and R-R interval
EKG shows irregular PR intervals
Multifocal atrial tachycardia
Patient with a regular rhythm but HR between 150-220 bpm
Pt. has palpitations and dizziness
EKG shows rapid HR with barely any Repolarization time
SVT
DOC: Carotid massage THEN adenosine
Holosystolic murmur that radiates to the left axilla w/ LAE
Mitral regurgitation
Rumbling diastolic murmur with an opening snap, LAE, and possible A-fib
Mitral stenosis
Young pt. who has a history of viral infxn and now presents with signs of CHF
Consider myocarditis
CXR with “thickened peritracheal stripe and splayed carina bifurcation”
Possible mediastinal tumor
or
LAE
Light’s Criteria
Transudative if:
LDH <200
LDH eff/LDH serum <0.6
Protein eff/Protein serum <0.5
Best prognostic indicator for COPD
FEV1 value
Goal for SpO2 in COPD
94-95
Hypercapnea keeps their respiratory drive going
CXR showing nodules with eggshell calcifications
Silicosis
***Pts. need yearly TB testing
Patchy lower lobe infiltrates with thermophilic actinomycetes
Hypersensitivity pneumonitis
“Farmer’s lung”
Sarcoidosis findings that are sometimes thrown out there (3 things)
Increased ACE
Pts. haver hypercalcemia due to increased Vit D from pulmonary macrophages
25% have anterior uveitis =» GET OPTHO REFERRAL
Lung nodule with “popcorn calcification”
Hamartoma
Lung nodule with eccentric calcification or spiculated calcifications
Signs of malignancy; get biopsy
Effusion in adenocarcinoma
High in hyaluronidase and exudative
Lung cancer that has a tendency for distant mets and peripheral calcification
Large cell carcinoma
Patient who has an AST or ALT in the 1000s after surgery or trauma
Suspect shock liver
Pneumonia in a farmer who has vomiting and diarrhea
Coxiella
Tx: Doxycycline
Pt with pneumonia who is a gardener
Don’t rule out Fransicella
Tx: Gentamicin or streptomycin (AGCs from Sketchy)
Kid under 4 exposed to TB
Isoniazid prophylaxis for 9 months
1 cause of death during endocarditis
2 is septic emboli
CHF
Indications for prophylaxis for endocarditis
Prosthetic valve
Hx of EC
Uncorrected congenital lesion
Ziovudine ADRs
GI
Leukopenia
Macrocytic anemia
Pt who develops asymptomatic hyperuricemia after being treated for TB
Due to pyrazinimide
Abacavir ADRs
Rash, fever, muscle aches
IF HIV pt states they had this rxn after treatment, NEVER USE THIS DRUG AGAIN
HIV pt who has a seizure with deja-vu beforehand and CSF shows RBCs
HSV encephalitis
Give acyclovir AS SOON as you suspect
HIV pt. w/ hemisensory loss, visual impairment, loss of Babinski
PML
MRI shows demyelination at the gray-white jnxn
HIV pt. with memory and gait problems
AIDS-dementia complex
Check blood, CSF, and MRI to be sure it’s nothing else tho
Neutropenic pt. in the ER; what should you not do?
DRE
Pt. with neutropenic fever and does not improve after 5 days of cefepime and Vanc but there has been no cause found
Add antifungal treatment
Erlichiosis tx in kids
Doxycycline!
Test to check if metabolic alkalosis
Urine chloride
If Cl>20 and pt. has HTN =» Hyperaldosteronism
if nomotensive =>> Barter's or Gittelman's
If Cl <20 =» Vomiting, diuretics, antacids
Type I RTA
Distal; due to the kidney being unable to excrete H+
Causes: Lithium, Ampho B, analgesics
Findings: Urine pH >5.4, hypokalemia, kidney stones
Tx: Replete K+, oral bicarb
Type II RTA
Proximal; due to the kidney not reabsorbing HCO3-
Causes: Fanconi’s syndrome, myeloma
Findings: Hypokalemia, ostemalacia
Tx: Replete K+; replacing bicarb DOESNT HELP
Type IV RTA
Hyperrenin, hypoaldost
Cause: Diabetes
Findings: Hyperkalemia, hypchlorremia, high urine Na+ even with salt restriction
Tx: Fludrocortisone
Pt with rhabodmyolysis and kidney failure treatment
Get serum K+ and EKG to rule out cardiac probs
HCO3- to alkalinize urine to prevent precipitation
Kid who recently had a viral syndrome and now has arthralgia, palpable purpura (Especially on the butt), and renal failure
Henoch-Schonlein
Tx: Supportive; steroids if severe
Pt. with renal failure, asthma, eosinophilia, and + p-ANCA
Churg-Strauss
Tx: Cyclophosphamide
Cardiac pt. with renal failure, hemolytic anemia, decreased platelets, fever, AMS
TTP
Tx: Plasmapheresis
Polyarteritis nodosa tx
Cyclophosphamide
Tx for stones 5mm-2cm
Shockwave lithotripsy
Sideroblastic anemia lab findings
Iron: Increased
Ferritin: Increased
TIBC: Decreased
MCV: Decreased
Thalassemia CBC
Iron: Very low, like 60
RDW: Decreased
Liver disease CBC
MVC: Increased
Acanthocytes present on peripheral smear
Rosacea Tx
Avoid triggers
️Topical metronidazole if refractory
Tx of Keratocanthoma
Observation
Tx of Seborrheic dermatitis
Sunlight exposure
Dandruff shampoo
️Topical ketoconazole
️Topical steroids
