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0 BOARDS > immunologic + shock + etc > Flashcards

immunologic + shock + etc Flashcards

1
Q

receptor and reservoir for HIV

A

T4 (CD4) cells

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2
Q

HIV modes of transmission x4

A
  • blood
  • semen
  • vaginal secretions
  • breast milk
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3
Q

HIV sero conversion: defn, s/s, & time frame

A
  • conversion HIV - to +
  • flu-like sx (early: fever, night sweats, weight loss)
  • 3 wk to 6 mo
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4
Q

AIDS defn

A

CD4

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5
Q

HIV: initial screening tool

A

ELISA (sens > 99.9%)

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6
Q

HIV: confirmatory test

A

Western Blot

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7
Q

absolute CD4 lymphocyte count: normal

A

> 800 cells/uL

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8
Q

high risk of progression to AIDS @ ? CD4 lymphocyte %

A

20%

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9
Q

HIV: viral load what + how

A
  • correlates closely with progression of HIV (ideally undetectable)
  • PCR
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10
Q

pneumocystis jirovecii (opportunistic infection) prophylactic tx in HIV+

A

bactrim

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11
Q

AART - what + when

A

active antiretroviral therapy

- controversial: some experts = start @ time of dx / CDC rec = all pts on AART by CD4 = 350/uL

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12
Q

osteoarthritis is…

A

degenerative joint disease

- slow destruction of articular cartilage

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13
Q

OA: damage type

A

articular cartilage destruction

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14
Q

rheumatoid arthritis is…

A

systemic autoimmune disease

- inflammation of connective tissue

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15
Q

RA: damage type

A

inflammation of connective tissue

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16
Q

inflammation OA vs RA

A

OA: asymmetrical
RA: symmetrical

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17
Q

OA vs RA gender impacted

A

OA: equal
RA: women 3:1

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18
Q

OA: joints involved

A
  • weight-bearing (knees/hips) + fingers, hands, wrists

- heberden’s & bouchard’s nodes

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19
Q

RA: joints involved

A 
proximal interphalangeal joints (PIPs)
metacarpophalangeal joints (MCPs)
wrists
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20
Q

OA: joint sx

A

swelling, edema W/O erythema/heat

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21
Q

RA: joint sx

A

swelling, edema, erythema, “heat”

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22
Q

heberden’s nodes

A

OA: distal interphalangeal joints (DIPs)

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23
Q

bouchard’s nodes

A

OA: proximal interphalangeal joints (DIPs)

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24
Q

metacarpophalangeal joints are

A

knuckles

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25
Q

OA: pain progression

A

AM: better - worsens as day progresses

- aggravated by activity & relieved by rest

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26
Q

RA: pain progression

A

AM: worse - improves as day progresses

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27
Q

OA or RA: aggravated by activity / relieved by rest

A

OA

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28
Q

OA or RA: angular deformities of affected joints

A

OA

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29
Q

OA or RA: autoimmune w multifactorial etiology

A

RA

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30
Q

OA or RA: fatigue, weakness, malaise, anorexia, wt loss

A

RA

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31
Q

OA or RA: obesity as exacerbating factor

A

OA

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32
Q

OA or RA: limited ROM

A

OA

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33
Q

OA + RA diagnostics

A

OA: synovial aspirate normal (clear/yellow)
RA: synovial aspirate = inflammatory changes, WBCs

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34
Q

OA: XRay findings x4

A
  • narrowing of joint space
  • osteophytes
  • juxta-articular sclerosis
  • subchondral bone
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35
Q

osteophyte is…

A

bony outgrowth assoc with degeneration of joint cartilage

- OA

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36
Q

juxta-articular sclerosis is…

A

increased density of bone directly adjacent to joint

- OA

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37
Q

OA or RA: joint swelling

A

RA

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38
Q

OA or RA: joint space narrowing

A

both!

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39
Q

OA or RA: osteophytes

A

OA

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40
Q

OA or RA: osteopenia

A

RA

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41
Q

bone cortex is

A

outer “shell” of bone

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42
Q

OA or RA: progressive cortical thinning

A

RA

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43
Q

OA or RA: involvement of subchondral bone

A

OA

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44
Q

osteopenia is…

A

decreased bone mass (normal 833 mg/cm^2, osteopenia 833-648)

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45
Q

osteopenia vs osteoporosis

A
  • penia: decreased bone mass
  • porosis: porous bone; bone tissue normally mineralized but bone density is decreased resulting in impaired structural integrity of trabecular bone
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46
Q

OA or RA: juxta-articular sclerosis

A

OA

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47
Q

RA: XRay findings x4

A
  • joint swelling
  • progressive cortical thinning
  • osteopenia
  • joint space narrowing
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48
Q

OA: mgmt x4

A
  • ASA
  • APAP
  • NSAIDs (ibuprofen, naproxen)
  • COX-2 inhibitors (celecoxib/Celebrex)
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49
Q

RA: mgmt x4

A
  • DMARDS ***
    • corticosteroids, methotrexate, antimalarials (hydrochloroquine), gold salts injections
  • high-dose salicylates
  • NSAIDs
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50
Q

methotrexate: important monitoring consideration

A

monitor LFTs + CBCs (monthly)

  • dose-related hepatotoxicity
  • bone marrow suppression
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51
Q

OA or RA: methotrexate

A

RA (DMARD!)

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52
Q

OA or RA: celecoxib/Celebrex

A

OA (COX-2 inhibitor!)

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53
Q

OA: supportive care x6

A
  • wt loss
  • cane use opposite side
  • ice (improves ROM)
  • moist heat ( ↓ muscle spasms, relieves stiffness)
  • PT
  • refer: joint replacement
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54
Q

RA: supportive care x4

A
  • early rheumatology referral
  • rest
  • PT
  • surgery
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55
Q

OA: typical age range

A

53 - 64 years (85%)

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56
Q

RA: typical age range

A

35 - 50 years (80%)

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57
Q

closed fracture is…

A

broken/crushed bone evident on x-ray where skin is NOT broken

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58
Q

open fracture is…

A

broken/crushed bone evident on x-ray where skin IS broken + underlying tissue = open to air

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59
Q

avulsion is…

A

fracture; bone fragments pulled off by attached ligaments/tendons

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60
Q

dislocation is…

A

disruption between normal relationships of joint surfaces

- X-Ray confirms dx

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61
Q

subluxation is…

A

incomplete dislocation

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62
Q

what confirms a dislocated bone?

A

X-Ray

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63
Q

fractures & dislocations: tx x4

A
  • ortho consult
  • splinting, traction if appropriate
  • IV analgesia
  • if open fracture: IV abx, sterile dressing, tetanus prophylaxis, surgical debridement
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64
Q

open fracture specific tx x4

A
  • IV abx
  • sterile dressing
  • tetanus prophylaxis
  • surgical debridement
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65
Q

compartment syndrome is…

A

↑ interstitial pressure w/in closed fascial compartment

- r/t: hemorrhage, edema, sustained external pressure on limb, constrictive casts/dressings

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66
Q

compartment syndrome causes x4

A

hemorrhage
edema
sustained external pressure on limb
constrictive casts/dressings

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67
Q

? should be suspected in unconscious pt with a swollen limb

A

compartment syndrome

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68
Q

compartment syndrome s/s x6

A
  • severe ischemic pain
  • tensely swollen
  • skin perfusion & art pulses normal
  • paresthesia
  • passive muscle stretch painful
  • progressive loss sensory & motor fxn
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69
Q

exam considerations re: compartment syndrome development

A

repeat examinations required!

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70
Q

compartment syndrome mgmt x2

A
  • release constricting appliances

- fasciotomy (only effective w/in a few hours)

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71
Q

fasciotomy considerations re: compartment syndrome

A

only effective if performed within a few hours

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72
Q

systemic lupus erythematosus (SLE) is…

A

multi-system, inflammatory autoimmune disorder

- primarily impacts women of childbearing age

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73
Q

SLE primarily impacts who?

A

women of childbearing age

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74
Q

SLE s/s x18

A
  • butterfly rash (
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75
Q

periungual erythema is

A

nailfold (cuticle) redness

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76
Q

splinter hemorrhage is

A

small streaks of bleeding areas under finger/toe nails

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77
Q

SLE: labs/diagnostics x3

A

ANA+ (95%)
anti-phospholipid abx
anemia, leukopenia, thrombocytopenia (often)

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78
Q

SLE: mgmt

A
  • mild sx: bedrest, midafternoon nap, avoid fatigue
  • sun protection
  • topical glucocorticoid (isolated skin lesions)
  • NSAIDs, hydroxychloroquine, glucocorticoids, etc
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79
Q

top 5 drugs implicated in lupus-like syndrome (per Barkley)

A
  • amiodarone (Cordarone)
  • atenolol (Tenormin)
  • lovastatin (Mevacor)
  • oral contraceptives
  • simvastatin (Zocor)

see pg 136 for full list - there are 30

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80
Q

definite causative drugs implicated in lupus-like syndrome (per UpToDate)

A 
procainamide
hydralazine
penicilliamine
diltiazem
isoniazid
quinidine
minocycline
methyldopa
chlorpromazine
practolol
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81
Q

giant cell arteritis is…

A
  • aka temporal arteritis
  • inflammatory condition
  • typically 50+
  • can lead to permanent blindness
  • 15% of all FUO in 65+
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82
Q

giant cell arteritis s/s x7

A 
temporal artery: nodular, enlarged/tender
HA, scalp tenderness, jaw claudication
jaw claudication
visual complaints
fever (as high as 104F)
chills/rigors
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83
Q

giant cell arteritis labs/diagnostics

A

ESR: very high
WBC: normal
temporal artery bx: + in 85-95%

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84
Q

giant cell arteritis mgmt x2

A

predisone & referral

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85
Q

optic disc description x3

A

donut-shaped
orange/pink neuroretinal rim - surrounds:
central white depression (physiologic cup)

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86
Q

neuroretinal rim is…

A

part of the optic disc of the eye
carries retinal ganglion cells
surrounds physiologic cup (central white depression)

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87
Q

cup/disc (optic disc) ratio

A

cup should not be > 1/2 size of disc diameter

- larger: consider glaucoma

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88
Q

artery:vein ratio in eye

A

2:3 or 4:5

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89
Q

macula (of the retina) is

A

oval-shaped pigmented area near center of retina
- contains structures involved in high-acuity vision
- ~2 to 2.5 disc diameters temporal side of the optic disc
avascular

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90
Q

fovea centralis is…

A

one of several portions of the retinal macula

  • slightly darker
  • lies in center of macular region
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91
Q

what should you do if patient’s macula is difficult to visualize?

A

ask patient to look directly into light

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92
Q

earliest detectable sign of diabetic retinopathy

A

microaneurysms

per AAO, also cotton wool spots

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93
Q

what can result from rupture of microaneurysms (r/t diabetic retinopathy?)

A

retinal hemorrhages
- superficial (flame-shaped)
OR
- in deeper retinal layers (blot and dot hemorrhages)

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94
Q

cotton wool spots are associated with what common eye problem?

A

diabetic retinopathy

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95
Q

what are cotton wool spots?

A

infarction of the nerve fiber layer of retina; tends to result from the resolution of fluid deposition in the macula. (PATHOPHYS: microaneurysm = compromised vasculature = fluid seeping = fluid pooling = resolution leaves behind sediment = eventual vascular obstruction = infarction)

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96
Q

what are cotton wool spots?

A

infarction of the nerve fiber layer of retina; tends to result from the resolution of fluid deposition in the macula. (PATHOPHYS: microaneurysm = compromised vasculature = fluid seeping = fluid pooling = resolution leaves behind sediment = eventual vascular obstruction = infarction)

associated with diabetic retinopathy

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97
Q

what is AV nicking?

A

arteriovenous nicking - sign of chronic hypertension
- d/t continued htn, arterial walls thicken; at areas where arteries cross over veins, veins are compressed and a tapering of the vein on either side of the artery can be seen)

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98
Q

arcus senilis is…

A

cloudy appearance of cornea + gray/white arc/circle around limbus

  • d/t deposition of lipid material (high cholesterol)
  • no effect on vision
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99
Q

most common eye disorder

A

conjunctivitis

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100
Q

conjunctivitis is…

A

inflammation/infection of conjunctiva d/t allergies, bacteria, viruses, or STIs
- aka pink-eye

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101
Q

conjunctivitis s/s x7

A 
itching/burning
redness
increased tears
blurred vision
sensation of foreign body 
eyelid swelling
eyelid crust (sticky, mucopurulent discharge)
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102
Q

conjunctivitis mgmt: bacterial

discharge + tx

A

discharge: purulent
tx: self-limiting, use abx drops (fluoroquinolones & aminoglycosides)
- levofloxacin, cirprofloxacin, ofloxacin
- tobramycin, gentamycin

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103
Q

conjunctivitis mgmt: allergic

discharge + tx

A

discharge: stringy, increased tearing
tx: PO antihistamines

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104
Q

conjunctivitis mgmt: gonococcal/chlamydial

discharge + tx

A

discharge: copiously purulent
tx:
G: ceftriaxone 250mg IM
C:
- erythromycin (ophalmic ointment) or
- PO route: tetracycline, doxycycline, clarithromycin (less used: erythromycin, azithromycin)

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105
Q

conjunctivitis mgmt: viral

discharge + tx

A

discharge: watery
tx: symptomatic care

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106
Q

corneal abrasion is…

A

trauma to eye resulting in interruption of epithelial surface

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107
Q

corneal abrasion s/s x3

A
  • intense pain in affected eye that worsens
  • tearing
  • redness
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108
Q

corneal abrasion labs/diagnostics x2

A
  • recent hx trauma to eye

- sodium fluorescein stain (detects abrasion)

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109
Q

corneal abrasion mgmt x5

A
  • anaesthetize eye for thorough exam (ensure no foreign body)
  • topical abx or sulfonamide drops
  • pressure patch (24 hours)
  • CONTRAINDICATED steroid drops, also anaesthetic drops after initial exam
  • if not healed in 24 hours, refer
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110
Q

glaucoma is…

A
  • increased IOP
  • open-angle: chronic
  • closed-angle: acute
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Perfectly
111
Q

which type of glaucoma is acute?

A

closed-angle

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112
Q

cataract is…

A

clouding/opacification of normally clear lens

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113
Q

major cause of treatable blindness

A

cataract

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114
Q

most common surgical procedure in 65+

A

senile cataracts

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115
Q

open-angle glaucoma: s/s x4

A

asymptomatic
elevated IOP
cupping of disc (looks like ice-cream scoop)
constriction of visual fields

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116
Q

closed-angle glaucoma: s/s x4

A

extreme pain
blurred vision
halos around lights
pupil dilated or fixed

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117
Q

which type of glaucoma can be asymptomatic?

A

open-angle (the chronic one)

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118
Q

which type of glaucoma typically involves extreme pain?

A

closed-angle (the acute one)

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119
Q

causes of cataracts x7

A 
aging, heredity, congenital
trauma
possibly toxins/drugs/tobacco/alcohol
diabetes
AV sunlight exposure
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120
Q

cataracts: s/s

A

CLASSIC SX: painless, diplopia in one eye, halos around lights
also: clouded/blurred/dim vision, difficulty with night vision, sensitivity to light/glare, fading/yellowing of colors, need brighter light for reading/activities, no red reflex, lens opacity

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121
Q

glaucoma vs cataract: which is painless?

A

cataracts

- closed-angle glaucoma is extremely painful

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122
Q

patient presentation: diplopia in one eye, halos around lights, no pain
- this is classic for ?

A

cataracts

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123
Q

glaucoma: labs/diagnostics

A

tonometry: IOP screening

recommended by age 40

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124
Q

tonometry: normal values for IOP

A

10 - 20

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125
Q

cataracts: labs/diagnostics

A

none!

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126
Q

open-angle glaucoma: mgmt x2

A
  • alpha-2 adrenergic agonists (brimonidine, alphagan)

- beta-adrenergic blockers (timolol)

127
Q

closed-angle glaucoma: mgmt x3

A
  • carbonic anhydrase inhibitors (acetazolamide/Diamox)
  • osmotic diuretics (mannitol)
  • surgery
128
Q

open or closed-angle glaucoma: surgery may be needed

129
Q

open or closed-angle glaucoma: timolol used

130
Q

open or closed-angle glaucoma: acetazolamide (Diamox) used

131
Q

cataracts: mgmt x2

A
  • change glasses as cataracts develop

- ophthalmology referral for surgery (do promptly)

132
Q

most common musculoskeletal change found in older adults

A

sarcopenia (decreased muscle ma

133
Q

what is sarcopenia?

A

decreased muscle mass/strength

- most common musculoskeletal change found in older adults

134
Q

what changes in lean body mass & fat in older adults?

x4

A

loss of lean body mass, which is replaced by fat
fat redistribution
increased adipose tissue %age UNTIL 60, then decreases

135
Q

skeletal changes in older adults?

x5

A 
low bone mass
intervertebral disc degeneration
stature changes w/ kyphosis, height reduction
cartilaginous tissue degeneration
fibrosis (decreased joint elasticity)
136
Q

total body water in older adults?

137
Q

sarcopenia in older adults: findings

A

increased risk: disability, falls, unstable gait

138
Q

typical musculoskeletal findings in older adults x7

A 
sarcopenia
increased body fat %age
height reduction d/t intervertebral disc degeneration
osteoporosis
osteroarthritis
limited ROM
joint instability
139
Q

immunosenescence is…

A

diminished fxn of immune system with age, leads to declined infection response

140
Q

changes in innate immunity in older adults? x3

A

macrophages, natural killer cells, neutrophils decline

141
Q

changes in adaptive immunity in older adults?

A

diminished response

142
Q

change in thymic hormone in older adults?

A

decreased production leading to decreased # fxning T-cells

143
Q

changes in antibodies & antigen response in older adults?

A

decreased ab production/response

diminished antigen response

144
Q

typical immune findings in older adults x4

A

increased infection susceptibility
poor wound healing
exacerbation of chronic disease
waning vaccine-induced antibody reponse

145
Q

What are the modes of transmission of HIV/AIDS?

A

Blood
Semen
Vaginal secretions
Breast milk

146
Q

What are the early s/s of HIV/AIDS?

A

Flu-like symptoms - think seroconversion.
Fever
night sweats
weight loss

147
Q

What is the definition of AIDS?

A

T4 (CD4) count

148
Q

What is the initial screening diagnostic for HIV/AIDS?

A

ELISA test

149
Q

What is the confirmatory diagnostic for HIV/AIDS?

A

Western Blot

150
Q

What is the therapy for opportunistic infections in patients with HIV/AIDS?

A

Bactrim for Pneumocystis jirovecii PNA ppx

151
Q

What is the CDC recommendation for starting HAART combination tx in patients with HIV/AIDS?

A

When the T4/CD4 count is

152
Q

What is the leading cause of death in AIDS patients?

A

Pneumocystis jirovecii PNA

153
Q

Explain the pathology of osteoarthritis.

A

Degenerative joint disease with slow destruction of the articular cartilage

154
Q

What is the characteristic of inflammation in osteoarthritis?

A

Asymmetrical inflammation with no redness or heat.
Pain is worse as the day goes on and increase with activity
decrease with rest

155
Q

What joints are most affected in osteoarthritis?

A

Weight-bearing joints (knees/ hips) + fingers/hands/ wrists

156
Q

What are Heberden’s nodes and which disease are the associated with?

A

Distal interphalangeal joints (DIPs) and osteoarthritis

157
Q

Explain Bouchard’s Nodes and what disease they are associated with.

A

Proximal interphalangeal joints (PIPs) and OA

158
Q

What is the diagnostic for osteoarthritis?

A

Synovial aspirate. Clear + yellow + normal.

159
Q

What do you expect to find on xray in patient with suspected osteoarthritis?

A

Narrowing of joint space
Osteophytes
Articular sclerosis
Subchondral bone

160
Q

What is the pharmacological management for osteoarthritis?

A

ASA
Acetaminophen
NSAIDS
COX-2 Inhibitors - celecoxib (Celebrex)

161
Q

What are the supportive care measures for osteoarthritis?

A

Cane - opposite side
Ice
Moist heat
Joint replacement

162
Q

Explain the pathology of rheumatoid arthritis.

A

Systemic autoimmune disease

Inflammation of CONNECTIVE tissue

163
Q

What is the characteristic inflammation of RA?

A

Symmetrical edema with heat and redness that is worse in the morning
DIPs
Metainterphalangeal joints (MCPs)
Wrists

164
Q

What are the diagnostics of RA?

A

Synovial aspirate - elevated WBCs
Elevated ESR
ANA positive

165
Q

What are the characteristic xray findings in RA?

A

Osteopenia
Joint swelling
Cortical thinning
Narrowing of joint space

166
Q

What is the pharmacological management of RA?

A

High-dose salicylates
NSAIDS
DMARDS

167
Q

What is the most cost-effective medication for RA?

A

DMARDs - methotrexate

168
Q

When do you administer antibiotics to a patient presenting with a fracture?

A

OPEN fracture - skin is broken and underlying tissues are open to the air

169
Q

What is the management of an open fracture?

A 
IV abx
IV analgesia
Sterile dressing
Tetanus ppx
Surgical debridement
170
Q

Define avulsion.

A

Bone fragments pulled off by attached ligaments and tendons

171
Q

Define subluxation.

A

Incomplete dislocation. (disruption between normal relationship of joint surfaces)

172
Q

Explain the patho of Compartment Syndrome.

A

Increased interstitial pressure within a closed FASCIAL compartment.
Hemorrhage; edema; constriction of cast; dressings.

173
Q

What are the main signs and symptoms of compartment syndrome?

A

Pain disproportional to injury
Tensely swollen
Skin perfusion/arterial pulses = NORMAL
Loss of sensory/motor control

174
Q

Explain the management of compartment syndrome.

A

Remove restricting appliances (cast, dressing).

Fasciotomy: Only effective if performed within a few hours.

175
Q

Explain the pathology of systemic lupus erythematosus (SLE).

A

Multisystem inflammatory autoimmune disorder. F of child bearing age.

176
Q

What are the cardinal signs and symptoms of SLE?

A

Butterfly rash
Photosensitivity
Flu-like symptoms

177
Q

What is the diagnostic for SLE?

178
Q

What is the management for mild SLE?

A 
Bed rest
Avoidance of fatigue
Sun protection 
Topical glucocorticoids - skin lesions
NSAIDS
Enteral glucocorticoids
179
Q

55 yo. M presents to ED with complaints of fever for past 3 weeks; headache; scalp tenderness; and jaw claudication. Most likely diagnosis?

A

Giant Cell Arteritis

180
Q

What is the pathology of Giant Cell Arteritis?

A

Inflammation that can lead to permanent blindess related to occlusion of opthalmic artery.

181
Q

Explain the cardinal signs and symptoms of Giant Cell Arteritis.

A 
Scalp tenderness
FUO
Headache
Jaw claudication
Temporal artery - enlarged
182
Q

What is the confirmatory diagnostic for Giant Cell Arteritis?

A

Temporal biopsy - positive in 85-95% of cases

183
Q

What is the management of Giant Cell Arteritis?

A

Prednisone taper for antiinflammatory

184
Q

What is a sign of chronic uncontrolled hypertension?

A

AV nicking

185
Q

What is the earliest detectable sign of diabetic retinopathy?

A

Microaneurysms.

186
Q

27 yo. F presents to clinic with complaints of itchy red watery right eye with a thick crust of mucopurulent discharge. She denies any pain. What is most likely diagnosis?

A

Conjunctivitis. Pink Eye

187
Q

Patient diagnosed with conjunctivitis and has purulent discharge. What etiology is suspected? What is the appropriate treatment?

A

Bacterial conjunctivitis.

Antibiotic drops - levofloxacin, ciprofloxacin

188
Q

32 yo. F status post surgery POD 2 now presents with new complaints of red intense progressing painful left eye and leaving contact in since before surgery. What is most likely diagnosis?

A

Corneal abrasion.

189
Q

What is the management of a corneal abrasion?

A

Topical abx - sulfonamide eye drops
24 hr. pressure patch on affected eye
Refer if not healed

190
Q

Explain pathology of glaucoma.

A

Increased intraocular pressure that results in loss of vision due to pressure and damage of ocular nerve

191
Q

Which type of glaucoma is a medical emergency?

A

Acute closed-angle glaucoma.

192
Q

What is normal intraocular pressure and how is it measured?

A

10-20 mmHg.

Tonometry.

193
Q

What are the signs and symptoms of open angle glaucoma?

A

Chronic onset
Cupping of the eye disc
Constriction of visual fields - center stays clear, outside is blurry.

194
Q

What are the signs and symptoms of closed angle glaucoma?

A

Extreme pain
Dilated or fixed pupil
Nausea, vomiting
Halos around lights

195
Q

What is the management of open angle glaucoma?

A

Alpha-2 adrenergic agonists
- Brimonidine
Beta Blockers - Timolol
Miotic agents - PILOCARPINE

196
Q

What is the management of acute closed angle glaucoma?

A

Carbonic anyhdrase inhibitors - Acetaxolamide (Diamox)
Mannitol
Surgery

197
Q

Explain the pathology of cataracts.

A

Clouding or opacification of the clear lens of the eye.

198
Q

What are the classic symptoms of cataracts?

A

Diplopia (double vision) in one eye.
No red reflex
Opacity of the lens

199
Q

Define sarcopenia.

A

Decreased muscle mass and strength. Normal physiological finding in the older adult.

200
Q

30 yo. F recently diagnosed with SLE and started on Coumadin. Patient fears she will not be able to complain with anticoagulant therapy. What should the ACNP do?

A

Set up coumadin clinic visits and PCP visits for the patient.

201
Q

If a patient with AIDS has a decreasing CD4 count and an increasing viral load count what does this indicate?

A

meds are not working

202
Q

What is the most common reason why HIV/AIDS patients are non-compliant?

A

access to care

203
Q

Top differentials for pain inside the eye

A

retinal detachment

corneal abrasion

204
Q

What is the major difference between glaucoma and cataracts?

A

glaucoma is painful and cataracts are not painful

205
Q

Why do vaccines not work as well in the elderly patient?

A

decreased antibody production

decreased response to antigens

206
Q

How do veins present on a fundascopic exam?

A

veins are bigger than arteries

207
Q

AV nicking is a sign of what

A

chronic HTN not DM

208
Q

True or False: Abdominal pain is a sign of AIDS.

209
Q

When is seroconversion in a patient with HIV?

A

3 weeks - 6 months

210
Q

Where are Bouchard’s nodes found?

A

PIP proximal

211
Q

How often should a 55 yo. F with Type II DM be screened for glaucoma?

212
Q

MOA of acetazolamide (Diamox) and indication

A

acute closed-angle glaucoma

decrease the production of aqueous humor and lower intraocular pressure

213
Q

Bony enlargement in the proximal interphalangeal joints is called

A

bouchards nodes

214
Q

75 yo. F is suspected of having osteoarthritis of the hip. Which radiographic finding supports this diagnosis?

a. compression fx of femoral head
b. joint space narrowing at the hip
c. subluxation of the vertebral body
d. increased bone density

A

joint narrowing at the hip

215
Q

What is the earliest sign of compartment syndrome?,pain
The most frequent symptom in women with early HIV infection is:
a. candidal vaginitis
b. dysphagia
c. weight loss
d. anorexia

A

candidal vaginitis

metrondiazole (Flagyl) is most effective against,anaerobic bacteria

216
Q

Strep pneumo: 5 major associated diseases

A 
meningitis
sinusitis (also common, H flu)
otitis media
bronchitis
CAP
217
Q

sinusitis: 2 common causative agents

A

Strep pneumo

H flu

218
Q

central venous pressure

A

measure of the pressure exerted by fluid in RIGHT ATRIUM

indicative of RIGHT HEART FXN

normal: 0 - 6 mmHg

219
Q

CVP: normal

A

0 - 6 mmHg

220
Q

What hemodynamic measurement is indicative of right-sided heart function?

A

central venous pressure (CVP)

221
Q

what happens to CVP in cardiogenic shock?

222
Q

what happens to CVP in fluid overload?

223
Q

what happens to CVP in distributive shock?

224
Q

what happens to CVP in severe dehydration?

225
Q

mean arterial pressure: definition and equation

A

indicates avg driving force in arterial system throughout cardiac cycle

SBP + 2/3DBP

226
Q

pulmonary artery pressure

A

a measure of systolic and diastolic pressures in the pulmonary artery

normal: 15 - 25 / 5 - 15

227
Q

pulmonary artery pressure: normal

A

15 - 25 / 5 - 15

228
Q

what happens to pulmonary artery pressure in pulmonary hypertension?

229
Q

what happens to pulmonary artery pressure in fluid overload?

230
Q

what happens to pulmonary artery pressure in untreated diabetes insipidus?

231
Q

pulmonary capillary wedge pressure is also known as these 2 terms

A

pulmonary artery wedge pressure

pulmonary artery occlusion pressure

232
Q

pulmonary capillary wedge pressure

A

measure of the pressure in the LEFT VENTRICLE at END-DIASTOLE (ie, maximal stretch)

indicative of LEFT HEART FXN

also a reflection of tendency to develop PULMONARY EDEMA

normal: 6 - 12 mmHg

233
Q

pulmonary capillary wedge pressure: normal

A

6 - 12 mmHg

234
Q

what happens to pulmonary capillary wedge pressure in hypervolemia?

235
Q

what happens to pulmonary capillary wedge pressure in left ventricular hypertrophy?

236
Q

what happens to pulmonary capillary wedge pressure in severe dehydration?

237
Q

what hemodynamic measure is important in optimizing cardiac performance and minimizing tendency for pulmonary edema? what should you do with it?

A

pulmonary capillary wedge pressure

keep it at the lowest point at which cardiac performance is acceptable

238
Q

cardiac output: definition and equation

A

amount of fluid in L/min that the heart pumps into systemic circulation

SV x HR = CO
normal: 4 - 8 L/min

239
Q

cardiac output: normal

A

4 - 8 L/min

240
Q

what happens to cardiac output after administration of inotropic agents?

A

inotropic agent causes ↑ HR, ∴ ↑ CO

HR x SV = CO

241
Q

what happens to cardiac output in SIADH?

A

SIADH = body retains water = excess fluid for heart to pump = ↑ SV ∴ ↑ CO
HR x SV = CO

242
Q

what happens to cardiac output in hypovolemia?

243
Q

cardiac index: definition and equation

A

CO adjusted for body surface area; it is more accurate because it takes BSA into account

normal: 2.5 - 4 L/min

244
Q

cardiac index: normal

A

2.5 - 4 L/min

245
Q

systemic vascular resistance: definition and equation

A

resistance provided by the systemic circulation AGAINST which the LEFT VENTRICLE must pump blood

( MAP - RAP / CO ) x 80

normal: 800 - 1200 (but remember Joan’s tip: 1000)
psst RAP = CVP

246
Q

CVP is essentially a measure of what?

A

right atrial pressure (RAP)

247
Q

systemic vascular resistance: normal

A

800 - 1200, but remember Joan’s tip: 1000

248
Q

mixed venous O2 saturation

A

used to assess effectiveness of peripheral O2 delivery (it is measured in the venous blood that returns to the heart)
continuously displayed by pulmonary artery catheter
normal: 60 - 80%

249
Q

what hemodynamic line can display SVO2?

A

pulmonary artery catheter

250
Q

mixed venous O2 saturation

251
Q

how do you interpret an SVO2 of less than 60%?

A

your toes ate more O2 than normal (body tapped into venous reserve of O2)

causes typically ↓ O2 supply + ↑ O2 demand

252
Q

what are 2 causes of SVO2 less than 60%?

A

↓ O2 supply

↑ O2 demand

253
Q

what abnormal value of SVO2 might you expect to see in anemia?

A

anemia ↓ O2 supply so SVO2 could drop below 60% (toes are eating from a supply that is already low)

254
Q

what abnormal value of SVO2 might you expect to see in malignant hyperthermia?

A

hyperthermia is essentially a hypermetabolic state with ↑ O2 demand so SVO2 could drop below 60%

255
Q

what abnormal value of SVO2 might you expect to see in administration of FiO2 exceeding the patient’s needs?

A

an SVO2 over 80% - the body has much more O2 than it really needs

256
Q

what abnormal value of SVO2 might you expect to see in hypothermia?

A

an SVO2 over 80% - the body is in a hypometabolic state and is conserving energy and therefore not using all of the O2 it has available to it

257
Q

how do you interpret an SVO2 of over 80%?

A

this is a high return of O2 indicating decreased tissue extraction of O2 (your toes didn’t eat very much)

  • often early indicator of patient status change
  • causes often ↑ O2 supply + ↓ O2 demand
258
Q

what abnormal value of SVO2 might you expect to see in septic shock?

A

an SVO2 over 80% - the body’s cells are stressed and cells are having difficulty with O2 uptake;

additionally, O2 delivery is less effective because the body is in shock and less blood volume is circulating

259
Q

what is shock?

A

clinical syndrome of systemic hypotension, acidemia, and impairment of vital organ function resulting from tissue hypoperfusion

260
Q

why does shock result in organ dysfunction?

A

tissue hypoperfusion

261
Q

CO/CI in hypovolemic shock?

262
Q

CVP in hypovolemic shock?

263
Q

PCWP in hypovolemic shock?

264
Q

SVR in hypovolemic shock?

265
Q

SVO2 in hypovolemic shock?

266
Q

CO/CI in cardiogenic shock?

267
Q

CVP in cardiogenic shock?

268
Q

PCWP in cardiogenic shock?

269
Q

SVR in cardiogenic shock?

270
Q

SVO2 in cardiogenic shock?

271
Q

CO/CI in septic shock?

A

↑ then ↓

272
Q

CVP in septic shock?

A

↓ then ↑

273
Q

PCWP in septic shock?

A

↓ then ↑

274
Q

SVR in septic shock?

275
Q

SVO2 in septic shock?

A

↓ then ↑

276
Q

CO/CI in anaphylactic shock?

277
Q

CVP in anaphylactic shock?

278
Q

PCWP in anaphylactic shock?

279
Q

SVR in anaphylactic shock?

280
Q

SVO2 in anaphylactic shock?

281
Q

CO/CI in neurogenic shock?

282
Q

CVP in neurogenic shock?

283
Q

PCWP in neurogenic shock?

284
Q

SVR in neurogenic shock?

285
Q

SVO2 in neurogenic shock?

286
Q

CO/CI in obstructive shock?

287
Q

CVP in obstructive shock?

288
Q

PCWP in obstructive shock?

289
Q

SVR in obstructive shock?

290
Q

SVO2 in obstructive shock?

291
Q

what is the difference between PAP and PAWP?

A

pulmonary artery pressure is essentially the “blood pressure” in the pulm art

pulmonary artery wedge pressure is a measurement using a swan ganz catheter and the inflation of a balloon in the pulm art to measure the pressure in front of it - a proxy for left ventricular pressure (and therefore function)

292
Q

How soon should you order antibiotics in newly diagnosed septic shock?

A

Within 1 hour of diagnosis

293
Q

SVR is high for which shocks and low for which shocks?

A

high for cardiogenic, hypovolemic, and obstructive

low for the distributives (septic, anaphylactic, neurogenic)

294
Q

what is hypovolemic shock?

A

results from a loss of greater than 20% circulating blood volume

d/t ex: internal/external bleeding, burns, DKA/HHNK, severe dehydration

295
Q

what are 5 potential causes of hypovolemic shock?

A

internal/external bleeding, burns, DKA/HHNK, severe dehydration

296
Q

hypovolemic shock: mgmt

A
  • fluid resuscitation - MAINSTAY! I mean, duh

- PRBCs when indicated by hgb/hct

297
Q

what is the mainstay of treatment for hypovolemic shock?

A

fluid resuscitation duh

298
Q

what is cardiogenic shock?

A

a loss of effective contractile function resulting in impaired CO, impaired O2 delivery, and reduced tissue perfusion

d/t ex: MI (most common), dysrhythmia, pericardial tamponade, pulmonary edema, acute valvular regurg

299
Q

what are 5 potential causes of cardiogenic shock?

A

MI (most common), dysrhythmia, pericardial tamponade, pulmonary edema, acute valvular regurg

300
Q

what is the most common cause of cardiogenic shock?

301
Q

cardiogenic shock: mgmt

A
  • initial, careful admin of IVF
  • vasopressor support
  • nitroglycerin IV PRN ischemia
302
Q

what is distributive shock?

A

3 types - all characterized by vasodilation, decreased intravascular volume, reduced peripheral vascular resistance, and loss of capillary integrity

septic, anaphylactic, neurogenic

303
Q

what is septic shock?

A

distributive shock caused by infective organisms which invade the bloodstream and alter vascular tone

hypovolemia develops as a result of blood pooling in the microcirculation

304
Q

what is an important diagnostic to order for septic shock in addition to hemodynamic monitoring?

A

BLOOD CULTURES!!!

305
Q

septic shock: mgmt

A
  • crystalloid fluid resus (mainstay)
  • vasopressors
  • upon diagnosis of sepsis, abx WITHIN 1 HOUR !!
306
Q

what is the mainstay of treatment for septic shock?

A

crystalloid fluid resuscitation

307
Q

what is anaphylactic shock?

A

IgE mediated reaction that occurs shortly after exposure to an allergen

308
Q

anaphylactic shock: mgmt

A
  • maintain airway
  • diphenhydramine 25 - 75 mg IV or IM (depends on severity)
  • epinephrine 0.3 - 0.5 mg (1:1000 sol) SQ or IM for respiratory distress, stridor, wheezing, etc.
  • crystalloid IVF
  • IV glucocorticosteroids
  • consider H2 antagonist (ranitidine/Zantac)
  • inhaled beta agonist for bronchospasm
309
Q

what is the indication for epinephrine in anaphylactic shock management?

A

respiratory distress, stridor, wheezing, etc

310
Q

what is obstructive shock?

A

inadequate CO d/t impaired ventricular filling

causes ex: massive PE (most common), tension pneumothorax, cardiac tamponade, obstructive valve disease

311
Q

what are 4 causes of obstructive shock?

A

massive PE (most common), tension pneumothorax, cardiac tamponade, obstructive valve disease

312
Q

what is the most common cause of obstructive shock?

A

massive PE

313
Q

obstructive shock: mgmt

A
  • maintain BP while initiating tx of underlying cause

- fluid admin + vasopressors

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