Intern 101 Flashcards
Discharging patients
- Med recs (must be printed out at nurses station and placed in physical chart, give patient’s 7 days of medications)
- D/C instructions
- D/C order
- SW placement
SSI adjustment rule
total amount of SSI used in one day
- Total SSI given for 1 day/2 = X
- X added to original long acting insulin (Lantus)
- X added to total short acting (humalog) / 3 for meals
Fever > 105.2
- Uncover, undress patient
- Ice packs
- IVF bolusses with pressure bags
- Tylenol 650 mg PO, or 1 gm IV
- Ibuprofen 600 mg IV
- Cooling blankets (usually only in ICU)
Best way to tell if someone is faking weakness on neurologic exam
pronator drift
Ulcers occurring in the sac of hiatal hernia
Cameron ulcers/lesions
Indications for aldosterone antagonists (aldactone) in CHF
- Consider if HF severe or post-MI
- 30% reduced mortality in NYHA class 2-4 and EF < 35%
- 15% reduced mortality in HF post-MI, EF < 40%
BRCA associated cancers in men
- prostate
- male breast
Lee’s Revised Cardiac Risk Index (RCRI)
- High risk surgical procedure (intaperiotoneal, intrathoracic, suprainguinal vascular)
- History of CAD
- History of CHF
- History of CVA
- DM or preop treatment with insulin
- Renal insufficiency (Cr. > 2)
Each risk factor is assigned 1 point
0 > Class I > 0.4% risk
1 > Class II > 0.9%
2 > Class III > 6.6%
3+ > Class IV > 11%
First sign of hepatic encephalopathy
sleep reversal/disturbance
indications for erythropoiten stimulating agents (ESA’s) in CKD
Hg < 10 (target Hg 10-11)
but other causes of anemia, including iron deficiency, hemoglobinopathies, vitamin B12 deficiency, and gastrointestinal blood loss, should be considered before beginning this therapy.
hyponatremia correction guidelines with 3% saline in first 24 hours
4-6 meq/L
interferon beta 1b side effects
- flulike symptoms after injections
- elevated serum aminotransferase levels
- lymphopenia, and worsening of underlying spasticity
- depression
- migraines
Antimitochondrial antibodies
autoimmune hepatitis
Antineutrophil cytoplasmic antibodies
vasculitis
-granulomatosis with polyangiitis (Wegener
granulomatosis)
-microscopic polyangiitis
-Churg-Strauss syndrome
anti–glomerular basement membrane disease
drug-induced vasculitis
ANA
SLE
painless jaundice + diffusely enlarged pancreas with a narrowed pancreatic duct + IgG4 positive
Autoimmune pancreatitis
Autoimmune pancreatitis treatment
- trial of corticosteroids
- re-imaging to differentiate pancreatic cancer from AIP
- relapse when steroids withdrawn > immunomodulatory therapy (azathioprine)
Dermatitis Herpetiformis treatment
Dapsone
Chronic draining organisms/treatment pnemonic
SNAP Sulfa (TMP/SMX) Nocardia Mycobacteria Actinomyces
Leukoplenia + PANCA
Levamizole
Statin contraindicated in HIV
Simvastatin (Zocor)
Crestor (rosuvastatin) reduction in LDL with starting dose (5 mg)
37-45%
Aldactone indications in CHF
Class 2-4 CHF
BRCA association in males
prostate cancer
male breast cancer
Differentiating sign in smokers
elevated carboxyhemoglobin
HgA1c - blood glucose equation
average blood glucose = (35.6*HgA1c)-77.3
HgA1c - blood glucose correlations
HgA1c + 1 --> BG + 35 -------------------------------- 6 > 135 7 > 170 8 > 205 9 > 240 10 > 275 11 > 310 12 > 345
Prometheus panel
- IBD diagnostic test that combines serologic, genetic, and inflammation markers
- differentiate IBD vs. non-IBD and CD vs. UC in one comprehensive blood test.
-ASCA, OmpC, CBir1, Anti-A4-Fla2, Anti-FlaX
Role of surrogate decision maker
make sure living will is carried out
Heyde’s syndrome
syndrome of aortic valve stenosis with gastrointestinal bleeding from colonic angiodysplasia
differentiating COPD from alpha-1 AT
COPD > bullae in upper lobes
alpha-1 AT > bullae in lower lobes
Asthma response to bronchodilators
-> 12% increased in FEV1
and
-200 cc increase
Paracentesis criteria for supplemental albumin
> 5 L removed, then add albumin 25g
Therapeutic Lovenox renal adjustment
-if Cr. clearance < 30 will decrease from q12 > q24
Elective PCI without stent placement anticoagulation therapy
First month: ASA 81-325 + clopidogrel 75
After 1st month: single antiplatelet
Bare metal stent anticoagulation therapy
First month: ASA 81-325 + clopidogrel 75
Months 2-11: low dose ASA 81 and clopidogrel 75
> 12 months: single anti platelet therapy
*Cilostazol 100mg twice daily as a substitute in dual antiplatelet therapy only in patients with allergies or intolerances to ASA or clopidogrel
Drug eluting stent (DES)
- First 3-6 months: ASA 81-325 + Clopidogrel 75
- After 3-6 months to 12 months: low dose ASA 81 and clopidogrel 75
> 12 months: single antiplatelet therapy
*Cilostazol 100 mg twice daily as a substitute in dual antiplatelet therapy only in patients with allergies or intolerances to ASA or clopidogrel
Lone AF antiarrythmic
class IC drugs (flecainide, propafenone) or sotalol
CAD + AF antiarrythmic
class III drugs (amiodarone, dronedarone, sotalol, dofetilide)
CHF + AF antiarrythmic
dofetilide or amiodarone
