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Internal Med > Firecracker/Step Up Cirrhosis, Dyspnea > Flashcards

Firecracker/Step Up Cirrhosis, Dyspnea Flashcards

1
Q

Cirrhosis pathology

A

diffuse, irreversible

firbosis, necrosis, nodules

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2
Q

Cirrhosis - most common causes

A

Hep C > Alcohol > NAFLD > Hep B

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3
Q

Cirrhosis - less common causes

A

Autoimmune, PBC, PSC, Wilson’s Disease, Hematochromatosis, alpha 1 antitrypsin def, drugs

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4
Q

Findings in Cirrhosis

A

Jaundice, Ascites, Hepatic Encephalopathy, Asterixis
Palmary erythema, spider angiomatas, gynecomastia
caput medua

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5
Q

Compensated cirrhosis

A

fatigue, wt loss, weakness

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6
Q

Decompensated cirrhosis

A

ascites, edema
confusion, pruritis
hematemesis, melena

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7
Q

liver biopsy for cirrhosis

A

presence of fibrosis
regenerating hepatic nodules
decreased number of septa

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8
Q

ultrasound in cirrhosis

A

assess countour of liver
impedeance of blood flow
amount of ascites

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9
Q

Severe Complications of cirrhosis

A

SBP, varices
hepatorenal/hepatopulmonary syndrome
portal vein thrombosis, cardiomyopathy, hepatic encephalopathy

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10
Q

Treatments for Cirrhosis

A

beta blockers
lactulose
TIPS

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11
Q

hepatic congestion can occur secondary to

A

right sided heart failure

constrictive pericarditis

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12
Q

treatment of varices

A

IV antibiotics
IV octreotide for 3-5 d
beta blockers
endoscopic treatment

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13
Q

albumin in cirrhosis

A

hypoalbuminemia = reduced oncotic pressure

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14
Q

SAAG > 1.1

A

portal HTN likely

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15
Q

fetor hepaticus

A

musty odor of breath

associated with hepatic encephalopathy

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16
Q

SBP most common causes

A

e coli
klebsiella
s. pneumonia

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17
Q

how to treat coagulopathy in cirrhosis

A

FFP (not vit k)

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18
Q

ascites usually found in

A

portal htn/increased hydrostatic pressure
hypoalbuminemia
malignacies - ovarian
infections - tb

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19
Q

clinical presentation of ascites

A

abdominal swelling and wt gain

SOB

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20
Q

physical exam for ascites

A

bulging flanks
fluid waves
shifting dullness

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21
Q

evaluation of ascitic fluid

A

apperance
albumin, total protein
cell count, cell culture

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22
Q

causes of portal htn with SAAG > 1.1

A

Budd-Chiari
CHF
constrictive pericarditis

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23
Q

SAAG < 1.1

A

nephrotic syndrome

cancer

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24
Q

complications of ascites

A

SBP

hepatic hydrothorax

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25
Q

treatment of ascites

A

sodium restriction
diurectics - furosemide, spironolactone
beta blocker

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26
Q

alcoholic progression of liver disease

A

fatty steatosis –>
alcoholic hepatitis –>
liver cirrhosis/fibrosis

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27
Q

alcoholic liver disease liver biopsy shows

A

Mallory bodies
steatosis
fibrosis

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28
Q

Mallory bodies

A

eosinophilic hyaline inclusion bodies

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29
Q

steatosis

A

fatty deposion

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30
Q

LFTs in alcoholic liver disease

A

AST:ALT 2:1

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31
Q

lab tests for alcoholic liver disease

A

bilirubin, alk phos, GGT
PT/INR
MCV

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32
Q

alcoholic liver dz complications

A

cirrhotic complications
liver failure
HCC
death

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33
Q

Disulfiram/Antabuse

A

inhibits acetaldehyde dehydrogenase

flushing, vomiting, nausea

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34
Q

drug induced liver injury

A

tylenol, statins, Atbs(amox-clauv, isoniazid), amiodarone, antifungals, valproic acid

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35
Q

pre-renal azotemia

A

decreased renal blood flow
decrease in glomerular hydrostatic pressure –> –>
decrease in amount of nitrogenous waste products filtered

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36
Q

Causes of pre renal azotemia

A

hypovolemia, hypotension
decreased CO
RAS/fibromuscular dysplasia
meds: ACEIs, NSAIDs

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37
Q

pre renal azotemia that leads to renal damage

A

has progressed to intrinsic renal dz

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38
Q

Intrinsic Renal Disease

A

damage to renal parenchyma

depends on location: glomerular dz, tubular-interstitial dz, vascular dz

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39
Q

Type I RPGN

A

Good pasture syndrome

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40
Q

Type II RPGN

A

poststreptococcal glumerolonephritis
lupus nephritis
iga nepropathy

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41
Q

Type III RPGN

A

wegner granulomatosis

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42
Q

tubular-interstitial dz

A

ATN or AIN

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43
Q

ATN

A

ischemic (more common)or nephrotoxic insult

epithelial casts, muddy-brown renal tubular casts

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44
Q

Vascular diseases

A

intrarenal vascular occlusion

intrarenal vasculitis

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45
Q

intrarenal vasculitis

A

wegener granulomatosis

46
Q

intrarenal vascular occlusion

A

renal artery/vein thrombosis

thrombotic microangiopathies: HUS, TTP

47
Q

Post renal azotemia

A

obstruction or urine outflow

48
Q

causes of post renal azotemia

A 
obstruction of urethra by BPH
neprholithiasis
neoplastic obstruction
retroperitoneal fibrosis
bilateral staghorn stones
49
Q

retroperitoneal fibrosis

A

bilateral obstruction of ureters

50
Q

bilateral staghorn stones

A

bilateral obstruction of kidneys

51
Q

ARF symptoms

A

fatigue, anorexia, nausea, AMS
oliguria, hematuria, flank pain
weight gain + edema!!!

52
Q

pre renal azotemia labs

A

minimal-> no proteinuria
hyaline casts
osm > 500
FeNa<1

53
Q

intrinsic: tubular dz labs

A

mild-mod proteinuria
pigmented granular casts
1 FeNa

54
Q

AIN labs

A

mild-mod proteinuria, leukocytes
white cells and casts, eosinophils, RBCs
1 FeNA

55
Q

acute glomerulonephritis labs

A

mod to severe proteinuria
RBCs and RBC casts
>500 osm
<1 FeNa

56
Q

postrenal azotemia labs

A

minimal/no proteinuria
crystals, rbcs, white cell
1 FeNa

57
Q

imaging for ARF

A

ultrasound
ct
renal arteriography
renal biopsy

58
Q

AKI complications

A 
uremia
volume expanison --> pulm edema
hyperkalemia
hyponatremia
hypernatremia
metabolic acidosis
hypocalecemia
hyperphosphatemia
anemia
infections
59
Q

AKI treatment

A

prevention
correct underlying fluid and electrolyte imbalances
dialysis

60
Q

pre-renal AKI treatment

A

maintenace of euvolemia, underlying disorder treatment

swan-ganz catheter

61
Q

intra-renal AKI treatment

A

supportive

possible immunosupp meds

62
Q

postrenal AKi treatment

A

bladder catherization or surgical removemnt

63
Q

prognosis of AKI

A

decreases with increasing age and severity

64
Q

mortality in AKI

A

infection

cardiorespiratory complications

65
Q

dyspnea - broad causes

A

cardiac, pulmn, cirrhosis, kidney, hematological (anemia)

66
Q

dyspnea - cardiac

A

ACS, CHF, pericarditis

67
Q

dyspnea - pulm

A

bronchitis, pneumonia, COPD, pulmonary embolism, pulmonary fibrois, pulmonary htn

68
Q

HAP organisms

A

GNR
S auerus
ventilator associated

69
Q

Aspiration pneumonia

A

right lower lobes

GN, anaerobes

70
Q

HAP - acquire up to…

A

90 days after d/c (stay 2 nights)

30 days after nursing home/rehab

71
Q

risk factors for aspiration

A

seizures
oropharyngeal muscle fatigue
cns depression

72
Q

alcoholics - common organism for pneumonia

A

Klebsiella

73
Q

pneumonia diagnosis

A

PA and lateral CXR

sputum gram culture

74
Q

methanamine silver stain

A

PCP

75
Q

severe complications of pneumonia

A

acute respiratory failure
pleural effusion
empyema
sepsis

76
Q

CAP treatment

A

azithromycin for 5 days

77
Q

Pneumonia treatment - inpatient, non ICU

A

respiratory fluroquinolone (moxi/gemi/levofloxacin)
or
B lactam + macrolide

78
Q

Pneumonia treatment - inpatient, ICU

A

blactum + azithromycin OR resp fluroquinolone
or
azetronam + fluroquinolone (peniclllin allergic)

79
Q

pneumonia - pseudomonas

A

pipercillin-tazobactam, cefepime or imipenem
+
cipro or levofloxacin or aminoglycoside+erythromycin

80
Q

CA MRSA pneumonia

A

add vanc or linezolid

81
Q

CURB-65

A

predicts 30 day mortality
confusion, BUN >19, RR >30, bp: systolic <60
65 or older

82
Q

SIRS diagnosis

A 
2 or more of
HR>90
Temp  100.4
WBC 12000
RR > 20 or PaCo2<32
83
Q

Sepsis diagnosis

A

2 or more SIRS criteria

plus positive blood cultures or source of active infection

84
Q

sepsis can progress to

A

septic shock
DIC
multiple organ dysunfction
death

85
Q

risk factors for sepsis

A 
bacteremia
advanced age
diabetes
cancer
immunosuppresion
86
Q

severe sepsis

A

meet criteria for sepsis and evidence of organ dysfunction, hypotension, or hypoperferusion

87
Q

Septic shock

A

sepsis and hypotension refractory to fluid resuscitation

88
Q

septic shock caused by

A

peripehral vasodilation leading to severe drop in systemic vascular resistance

89
Q

skin of individual in septic shock

A

flushed, warm

90
Q

other lab values in patients with sepsis

A

elevated lactic acid
increased bun/cr
elevated liver enzymes

91
Q

septic shock - lab values to differentiate from other types of shock

A

CO normal or elevated
MVO2 increased
SVR decreased
PCWP normal or decreased

92
Q

symptoms of sepsis/septic shock

A

fever, hypothermia, tachycardia, tachypnea, AMS, oliguria, abd pain

93
Q

Cause of sepsis

A

1) Gram Positive –> S. aureua
2) GN: E coli
3) fungal: Candida

94
Q

if you acquire sepsis in hospital, coverage must include

A

MRSA, pseudomonas, e coli

95
Q

treatment of sepsis

A

broad spectrum antibiotics
IV fluids
pressors

96
Q

first line vasopressor in sepsis

A

norephinephrine/levophed

97
Q

most common cause of cryptogenic organizing pneumonia

A

idiopathic
viral infections
drugs
CTD

98
Q

saddle embolusm

A

occludes bifurcation of R and left main pulmonary arteries

99
Q

most common cause of PE

A

DVTs

100
Q

PE symtpoms

A

sudden onset of dyspnea, pleuritic chest pain, tachypnea, tachycardia

101
Q

PE later findings

A

resp alkalosis with hypoxia and hypocarbia
loud P2
right heart failure

102
Q

PE imaging

A

CT angiogram

103
Q

V/Q scan

A

not used

104
Q

gradient in PE

A

increased A-a gradient
areas of unused ventilation
low Pco2

105
Q

PE CXR

A

normal

may show Hamptom’s hump or westermark’s sign

106
Q

hamptom’s hump

A

wedge shaped infarct

107
Q

westermark’s sign

A

oligemia in affected zone

108
Q

PE EKG classic finding

A

S1 s wave in 1
Q3 q wave in 3
T3 inverted t wave in III
but has to be large enough to cause cor pulmonale and new RBBB

109
Q

PE most common EKG finding

A

nonspecifict St and t wave changes

110
Q

PE treatment

A

thrombolytics

6 months of warfari (with heparin bridge)

111
Q

PE treatment if anticoagulation can’t be used

A

IVC filter

Internal Med (23 decks)

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