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Esquivel Flashcards

1
Q

Management for pt with Inferior wall ST elevations, JVD, parasternal lift, and clear lungs? Management?

A

MI with RV involvement

  1. Preload dependent - give fluid (lung crackling suggests too much)
  2. Give pressors if hypotensive
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2
Q

If pt with RV MI is fluid overloaded (crackles) but hypotensive - consider these causes?

A
  1. papillary muscle ischemia/rupture

2. Arrhythmia

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3
Q

Pylonephritis with hypotension - management?

A
  1. Goal-directed therapy - CVP 8-12; MAP>65
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4
Q

Septic shock pt with LV CHF - management?

A

Fluid until wedge pressure = 20

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5
Q

Treatment for CHF exacerbation?

A 
L-M-N-O-P
Loop diuretic (Lasix)
Morphine (venous vasodilator)
Nitroglycerin
O2
Position (sit up)
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6
Q

Lasix - MoA? How does it to site of action?

A

Blocks Na-K-2Cl transporter

Transporter through the Organic Ion transporter in PCT

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7
Q

CHF with BP 160/90, pulse 110, BUN 35, Cr 1.2 - management?

A

Lasix

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8
Q

CHF with BP 160/90, pulse 110, BUN 60, Cr 2.3 - management?

A
  1. Increasing doses of Lasix (Prerenal azotemia suggests low GFR - to get lasix into kidney, need to increase dose)
  2. Metolazone (thiazide to prevent distal Na resorption; should be given before lasix)
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9
Q

CHF with BP 160/90, pulse 110, BUN 80, Cr 6.0 - management?

A

Increase C.O. with dobutamine or milrinone

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10
Q

CHF with BP 85/40, pulse 110, BUN 80, Cr 6.0 - management?

A

Dialyze

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11
Q

Milrinone - MoA?

A

inotropic vasodilator - inhibits cAMP PDE in cardiac and vascular tissue

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12
Q

Hypovolemia with met acidosis - tx?

A

1) Lactate

2) NS with amps (50 mEq) of Bicarb

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13
Q

Lactate - why does it good for metabolic acidosis? Will not work if?

A

Lactate -> pyruvate -> Ox Phos -> increases CO2 produced -> CO2 made into more Bicarb

Liver failure

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14
Q

vomiting leading to Met Alk - why hypoK? tx?

A

Low volume increases ALDO - increased K excretion

Tx: NS

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15
Q

Urine Cl should be?

A

10

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16
Q

Met Alk - after NS, increased urine excretion of?

A

Na (gets dragged out with bicarb)

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17
Q

Saline Responsive Alkalosis

A

Loss of Cholride

  1. Vomiting
  2. Diuretics (Volume contraction)
  3. Posthypercapnia
  4. CF
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18
Q

Saline unresponsive alkalosis

A
  1. Primary Renin/ALDO
  2. Bartter/Liddle
  3. CHronic K depletion
  4. Milk-alkali
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19
Q

When is Urine Na a poor indicator of volume?

A
  1. Diuretics
  2. Met Alk
  3. Renal Salt Wasting
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20
Q

Low TSH, normal T4, normal T3?

A

Subclinical hyperthyroidism

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21
Q

Causes of hyperthyroidism (uptake seen on thyroid scan)?

A
  1. Graves’ disease (diffusely increased)
  2. Surreptitious thyroid intake (normal/low)
  3. Thyroiditis (decreased)
  4. Toxic multinodular goiter (focally increased)
  5. Non-thyroid illness
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22
Q

How to distinguish between surreptitious thyroid injection versus thyroiditis?

A

Increased thyroglobulin versus decreased thyroglobulin

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23
Q

Low TSH, low T3, low T4?

A

Hypothyroidism due to hypopituitarism

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24
Q

Pretibial myxedema seen with?

A

Hyperthyroidism

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25
Q

Why retain water with hypothyroidism?

A

Low T3/T4 stimulates pituitary increasing both TSH and ADH

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26
Q

Worst complication of hypothyroidism? Tx?

A

Myxedema coma

IV levothyroxine, IV hydrocortisone, empiric antibiotics

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27
Q

Low TSH, high T4, low T3?

A

Sick euthyroid

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28
Q

Normal TSH, low T3, normal T4

A

Version of sick euthyroid: low T3 syndrome

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29
Q

Patient with proptosis or tibial myxedema – treatment?

A

Steroids – neither will go away with anti-thyroid medications

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30
Q

Treatment for patients in thyroid storm?

A
  1. nonselective beta blocker (Propranolol)
  2. PTU
  3. Potassium iodine
  4. Dexamethasone/glucocorticoids
  5. Cholestyramine
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31
Q

Steroids decreasing order of mineralocorticoids?

A

Fludrocortisone (exclusively Mineralocorticoids) Hydrocortisone >prednisone >methylprednisolone > dexanethasone (purely glucocorticoids)

32
Q

Causes of refractory hypertension?

A
  1. Renal artery stenosis
  2. Conn’s disease
  3. Pheochromocytoma
  4. Fibromuscular dysplasia
33
Q

Patient with refractory hypertension – steps?

A
  1. Aldosterone: renin ratio
  2. If high aldosterone – CT scan
  3. If high renin – digital subtraction renal angiography
34
Q

Liddle syndrome? Aldosterone and renin levels?

A

Hyperactive ENaC channel. Low aldosterone and renin

35
Q

Glucocorticoid-remediable aldosteronism? ALDO/renin levels?

A

Disease where genes for glucocorticoids and mineralocorticoids are coupled

High aldosterone, low renin

36
Q

When to choose heparin over Lovenox?

A

High creatinine

37
Q

DVT – how to determine the length of coagulation?

A
  1. Provoked DVT: 3 to 6 months

2. Unprovoked DVT: 6 months than clotting workup

38
Q

Causes of unprovoked DVTs?

A
  1. Factor V Leiden
  2. Protein C/S deficiency
  3. Anti-phospholipid syndrome, lupus
39
Q

When to use an inferior vena cava filter?

A
  1. Contraindications to heparin (surgery, bleeding)

2. recurrent PEs despite heparin

40
Q

Multiphasic P waves with fast versus slow heart rate?

A

Multifocal atrial tachycardia versus wandering pacemaker

41
Q

COPD GOLD classes and treatment?

A

Class 1: FEV1 over 80% (PRN albuterol)
Class 2: FEV1 50-80. (Anti-cholinergic and long acting beta agonist = Tiotropium and salmeterol)
Class 3: FEV1 30-50(Inhaled steroids – fluticasone, budesonide)
Class 4: FEV1 <30 (theophylline, oral steroid)

42
Q

Treatments for patients admitted for acute COPD exacerbation?

A
  1. Beta-agonists
  2. Anticholinergics
  3. Steroids (5 days)
  4. Antibiotics
43
Q

Peak flow in different types of asthma?

A

Normal: 350-500 (females); 450-600 (male)
Mild >300
Moderate: 100 to 300
Severe <100

44
Q

Causes of decreased platelet production?

Causes of increased platelet destruction?

Causes of platelets splenic sequestration?

A

Parvovirus, CMV, EBV, HIV, hypothyroid, B12/folate deficiency

HIV, lupus

Hepatitis B/C

45
Q

When to get platelet transfusion? Why not give platelets more often?

A

If bleeding – 50,000
If not bleeding – 10,000

Risk of infection and risk of alloimmunization

46
Q

Treatment for ITP?

A
  1. Prednisone
  2. IVIg
  3. Rituximab, azathioprine, thrombopoetin
47
Q

Signs of cholesterol emboli?

A
  1. Livedo reticularis
  2. Blue toes
  3. Altered mental status
  4. Hollenhorst plaque
  5. Wedge shaped region kidney
  6. Sudden blindness
48
Q

Diagnosed HIT with? If positive?

A

Serotonin release assay.

Stop heparin, start agatroban

49
Q

Treatment options for DIC?

A
  1. Packed RBC’s
  2. Platelet transfusion
  3. FFP
  4. IV vitamin K
50
Q

Patient with uremic bleed – give?

51
Q

General causes of hypercalcemia?

A
  1. Hyperparathyroid (Primary, tertiary, immobilization)
  2. Vitamin D (Excess, sarcoid, lymphoma)
  3. IL-6/TNF (Multiple myeloma)
    4 Drugs (Thiazides/Li)
  4. Genetic (familial hypocalcinuric hypercalcemia)
  5. Igestions (milk alkali)
52
Q

Primary versus secondary versus. Tertiary hyperparathyroid?

A

Increased parathyroid hormone

chronic kidney disease (increased parathyroid hormone but decreased calcium)

Transplanted kidney but increased parathyroid production

53
Q

Patient with mass and positive technetium 99 sestamibi scan - next step?

A
  1. No Need to biopsy

2. Remove it if indicated

54
Q

Indications to remove parathyroid adenoma?

A

Osteoporosis, stones, renal disease, increased calcium excretion, age under 50, symptomatic

55
Q

Treatment for hypercalcemia?

A
  1. Normal saline (increases renal function and urine Na and Ca excretion)
  2. Calcitonin
  3. Bisphosphonates
  4. Denosumab (RANK ligand inhibitor)
  5. Dialysis
56
Q

Causes of renal failure from hypercalcemia?

A
  1. Prerenal
  2. Stones
  3. Renal artery vasoconstriction
  4. Nephrocalcinosis leading to acute interstitial nephritis
57
Q

Causes of hypercalcemia from malignancy?

A
  1. PTHrP - squamous cell lung cancer
  2. IL-6 and TNF - Multiple myeloma
  3. Vitamin D – lymphoma
  4. Local PTH/PTHrP – prostate cancer
58
Q

Patient with DKA – management?

A
  1. saline
  2. Bolus insulin (.1 units per kilogram)
  3. Insulin drip
  4. Potassium depletion
  5. EKG (it chest pain, measure troponins)
  6. Look for cause (chest x-ray, blood cultures, urine culture)
59
Q

Acid-base status for a patient with DKA?

A

Anion gap metabolic acidosis plus metabolic alkalosis (from vomiting)

60
Q

Causes of hyperkalemia in DKA?

A
  1. Acidosis
  2. Decreased insulin
  3. Hyperosmolarity
  4. Acute kidney injury (cannot excrete potassium)
61
Q

Of oral diabetes drugs - which do not cause hypoglycemia? Which do?

A

Metformin and pioglitazone

Sulfonylurea

62
Q

Imaging for pancreas? Liver? Biliary Stone? Biliary tree?

A

CT
Ultrasound
Ultrasound
CT

63
Q

Consider SBP if?

A
  1. White blood cells >500 or PMNs >250

2. Positive cultures

64
Q

In patient with liver disease, causes of hepatic encephalopathy?

A
  1. Medication noncompliance
  2. Infection
  3. Uremic bleeding
  4. Increased protein intake
  5. Too much Lasix
65
Q

Role of IV albumen in ascites?

A
  1. Prevents sudden hypotension if remove >5 L of fluid

2. Decreased risk of hepatorenal syndrome

66
Q

How to distinguish between prerenal azotemia versus a Hepatorenal syndrome?

A

Give 2 L normal saline and albumin – UA will reverse if it’s just prerenal

67
Q

In patients with recurrent pleural effusions – possible solution?

A

Talc and doxycycline – fuse pleura together

68
Q

Empyema if?

A

PH <60

LDH over 1000

69
Q

Causes of alternate mental status?

A 
AEIOU TIPPS
Alcohol
Electrolyte disturbances (sodium, calcium, bicarb, encephalopathy)
Insulin
Overdose
Uremia

Trauma
Infection
Pharmacology
Psychiatry
Stroke/shock/seizure
70
Q

Patient “acting crazy” – Give?

71
Q

Patient on EPO – goal hemoglobin?

72
Q

Myelofibrosis versus myelophthisis versus myelodysplasia?

A

Hypocellular marrow/CD 34 staining

versus
Marrow infiltrative process with immature forms

versus 
abnormal maturation (not noticeable in peripheral blood smear)
73
Q

Causes of B12 deficiency?

A
  1. Poor intake
  2. Poor absorption (pernicious anemia/Crohn’s/celiac)
  3. Metformin
74
Q

SVT - tx?

A

Adenosine to break tachycardia and determine if flutter or not

75
Q

Retrograde P wave means?

76
Q

If pt’s CHADS2 score is 0, when to anticoagulant?

A

Valvular dz (like MS)

Medicine (106 decks)

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