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MS3 > Internal Med 2 > Flashcards

Internal Med 2 Flashcards

1
Q

What are components of qSOFA

A

Positive screen is associated with poor outcomes

Criteria (positive if >/=2)

  • RR >/= 22
  • AMS
  • Systolic BP = 100
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2
Q

What are SIRS criteria

A
  • T >38 or <36
  • RR >20
  • HR >90
  • WBC >12,000 or <4,000
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3
Q

Definition of septic shock

A

Sepsis (SIRS + confirmed/presumed infectious source) + refractory hypotension despite adequate fluid resuscitation (30 cc/kg)

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4
Q

What bugs / empiric drugs should you use in sepsis before you have cultures

A
  • MRSA = Vancomycin
  • Gram neg rods (E. Coli) = Cefepime (CTX doesn’t cover psuedomonas)
  • Psuedomonas = Cefepime
  • Anaerobes = Metronidazole
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5
Q

What is your goal in a day for increasing Na in hyponatremic patients?

A

8-10 increase in sodium level in a day

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6
Q

What should be your initial questions/evaluation of a patient with upper GI bleed

A
  • Liver disease
  • ETOH
  • NSAIDs
  • h/o bleeding
  • PMH
  • Coagulopathy
  • Past endoscopy
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7
Q

What meds should you give initially for an upper GI bleed

A
  • PPI
  • Octreotide
  • Abx (Ceftriaxone for infection prophylaxis in ANY cirrhotic patient)
  • Transfuse only when Hgb <7
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8
Q

How should you treat someone with persistent tachycardia

A

If hemodynamically unstable, will probably need electricity

If hemodynamically stable, need to slow heart rate to see underlying rhythm
- Valsalva, carotid massage
- Adenosine
Then assess underlying rhythm

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9
Q

Triggers of Afib

A
  • Stress
  • Structural abnormalities
  • Hyperthyroidism
  • Heart failure
  • Alcohol
  • PE (may be due to catecholamine surge)
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10
Q

Treatment of Afib

A

Per Dr. Soesilo

  • Usually okay to control just the rate
  • If symptomatic, then also want to control the rhythm
  • Anticoagulation
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11
Q

What is CHADVASC score

A

Calculates the risk of stroke for patients with A-fib/A-flutter

Age, gender, DM, HTN, h/o prior embolic event, h/o CHF

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12
Q

What are the 4 components you must treat in CHF

A
  • Preload = Volume status/Diuretics (e.g. Furosemide)
  • Afterload = (decrease vasoconstriction)
  • — ACEI
  • — ARBs
  • — Hydralazine (+ nitro)
  • Beta blockers (remodelling)
  • Aldosterone receptor antagonists (remodelling)
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13
Q

How do you determine anion gap?

A

Na - (Cl + HCO3)

>12 = anion gap
8-12 = non-anion gap
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14
Q

What are the causes of anion gap metabolic acidosis

A 
Anion gap = adding acid to the blood
o	MUDPILES:
♣	M – Methanol
♣	U – Uremia (renal failure) 
♣	D – Diabetic ketoacidosis
♣	P –  Propylene glycol/Paraldehyde
♣	I – Isoniazid/Iron
♣	L – Lactic acidosis
♣	E – Ethylene glycol (antifreeze)
♣	S – Salicylates (aspirin)
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15
Q

What are the causes of non-anion gap metabolic acidosis

A

Non-anion gap = Losing excessive HCO3-

o Diarrhea, Renal tubular acidosis, Spironolactone, Acetazolamide

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16
Q

Acronym for uses of acute dialysis

A

AEIOU

Acid, electrolytes, intoxication, overload, uremia

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17
Q

Describe cause and findings of immune thrombocytopenia (ITP)

A

o IgG autoantibodies to GP2b3a
o Antibodies produced by plasma cells of spleen and antibody-bound platelets consumed by macrophages of spleen
o Often associated with HIV

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18
Q

Treatment of ITP

A

♣ Steroids and IVIG (autoimmune treatment)

♣ Splenectomy

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19
Q

Describe cause and findings of thrombotic thrombocytopenic purpura (TTP)

A

o Platelets used up in pathologic formation of microthrombi in small vessels
o Due to decreased ADAMTS13, enzyme that normally cleaves vWF for degradation
♣ No vWF degradation = abnormal platelet adhesion = microthrombi

o Findings (Pentad):
♣ Thrombocytopenia = platelets being used up
♣ Microangiopathic hemolytic anemia = RBCs sheared by microthrombi
♣ Renal insufficiency (thrombi involve vessels of the kidney)
♣ Neurological symptoms (confusion, HA, seizures, coma) – thrombi involve vessels of CNS
♣ Fever

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20
Q

What are common causes of thrombocytopenia due to decreased platelet production

A

o Viral infections (e.g. EBV, Hep C, HIV)
o Chemotherapy
o Myelodysplasia
o Alcohol use
o Congenital (e.g. Fanconi)
o Vitamin B12 or folate deficiency (causes pancytopenia)

21
Q

What are common causes of thrombocytopenia due to increased platelet destruction

A 
o	SLE
o	Medications (e.g. Heparin)
o	Idiopathic thrombocytopenic purpura
o	Disseminated intravascular coagulation 
o	Thrombotic thrombocytopenic purpura
o	Hemolytic Uremic Syndrome
o	Anti-phospholipid syndrome
22
Q

Risk factors for aortic dissection. Which is the most common

A

♣ HTN (most common)
♣ Marfan syndrome
♣ Cocaine use

23
Q

Complications of aortic dissection

A

♣ Stroke (carotid arteries)
♣ Acute aortic regurgitation (aortic valves)
♣ Horner syndrome (superior cervical sympathetic ganglion)
♣ Acute myocardial ischemia/infarction (coronary artery)
♣ Pericardial effusion/cardiac tamponade (pericardial cavity)
♣ Hemothorax (pleural cavity)
♣ Lower extremity weakness or ischemia (spinal or common iliac arteries)
♣ Abdominal pain (mesenteric artery)

24
Q

How does thyrotoxicosis cause HTN

A

T3 acts as a positive ionotrope and chronotrope, leading to tachycardia, high BP

25
Q

Acronym to think about Altered mental status

A

MIST:

  • M = metabolic (electrolytes, glucose, liver, TSH)
  • I = infection/inflammatory
  • S = structural (stroke, seizure, bleeds, tumor)
  • T = toxins (intoxication, withdrawal

AEIOU

  • A = alcohol
  • E = electrolytes
  • I = iatrogenic
  • O = oxygen
  • U = uremia
26
Q

When do you get a CT prior to LP in a patient with suspected meningitis

A

If pt has a focal neuro deficit

27
Q

What is the next thing you should look at in an EKG of a patient with tachycardia

A

Narrow vs. Wide QRS

28
Q

How can you further divide narrow QRS tachycardia

A

Regular vs. Irregular rhythm

29
Q

Ddx for Narrow QRS tachycardia with regular rhythm

A 
o	1. Sinus tachycardia
o	2. Atrial tachycardia (due to ectopic nodes that fire quicker than SA node)
o	3. AVRT
o	4. AVnRT
o	5. Atrial flutter
30
Q

Ddx for widened QRS tachycardia with irregular rhythm

A

o 1. Atrial fibrillation
o 2. Flutter with variable block
o 3. Multifocal atrial tachycardia (MAT)

31
Q

Go through the steps of reading an EKG . . . no seriously . . . DO IT

A
  • Rate
  • Rhythm
  • Axis
  • Intervals
  • Chambers
  • Ischemia/infarct
32
Q

What are the 3 criteria to diagnose BBB

A
  • Wide QRS
  • Inverted T-waves in precordial leads
  • No q-waves in V5 or V6
33
Q

What will you see on EKG in PE

A

• S1Q3T3
o S waves in lead I
o Q waves in lead III
o Inverted T waves in lead III

34
Q

What is Cushing triad in brain injury

A
  • Triad of hypertension, bradycardia, and respiratory depression in response to increased intracranial pressure
  • Increased ICP =pressure constricts arterioles in brain = cerebral ischemia = sympathetic response = increases peripheral vasoconstriction, thus increasing BP = aortic baroreceptors sense increased BP = respond with reflex bradycardia and respiratory depression
35
Q

What will you see with (1) Protein, (2) glucose, (3) cells,, (4) culture in:
Bacterial meningitis

A

♣ Cells = polymorphs
♣ Protein = high
♣ Glucose = low
♣ Other = culture and gram stain may be positive

36
Q

What will you see with (1) Protein, (2) glucose, (3) cells,, (4) culture in:
Viral meningitis

A

♣ Cells = lymphocytes
♣ Protein = high
♣ Glucose = Normal
♣ Other = Viral PCR may be positive

37
Q

What will you see with (1) Protein, (2) glucose, (3) cells,, (4) culture in:
TB meningitis

A

♣ Cells = lymphocytes
♣ Protein = high
♣ Glucose = very low
♣ Other = positive for acid-fast bacilli

38
Q

What med must you include in suspected aspiration pneumonia

A

Clindamycin

39
Q

Empiric tx of community acquired pneumonia for a previously healthy OUTpatient

A

♣ Macrolide (e.g. Azithromycin) or doxycycline

40
Q

Empiric tx of CAP for outpatient with comorbidities

A

Fluoroquinolone or beta-lactam + macrolide

• Beta-lactam does not work against atypicals (Chlamydia, Legionalla, Mycoplasma) so need to add macrolide

41
Q

Empiric tx of CAP in non-ICU inpatient

A

♣ Fluoroquinolone (IV) – respiratory fluoroquinolones = Levofloxacin, Moxifloxacin
♣ Beta-lactam (e.g. Ceftriaxone) + macrolide (IV)

42
Q

Empiric tx of CAP in ICU inpatient

A

♣ Beta-lactam + macrolide (IV)

♣ Beta-lactam + fluoroquinoloe (IV)

43
Q

Empiric tx of bacterial meningitis in pt age 2-50

Include bugs you are trying to treat

A

♣ Bugs
• Strep pneumo, Neisseria meningitides

♣ Abx
• Vancomycin + 3rd generation cephalosporin

44
Q

Empiric tx of bacterial meningitis in pt age >50

Include bugs

A

♣ Bugs:
• S. pneumo, N. meningitides, Listeria
♣ Abx:
• Vancomycin + Ampicillin + 3rd generation cephalosporin

45
Q

Empiric tx of bacterial meningitis in immunocompromised pt

Include bugs

A

♣ Bugs:
• S. pneumo, N. meningitides, Listeria, gram negative rods
♣ Abx:
• Vancomycin + Ampicillin + Cefepime

46
Q

Empiric tx of bacterial meningitis in pt with recent neurosurgery/penetrating skull trauma

A

♣ Bugs:
• Gram-negative rods, MRSA, coagulase negative staph
♣ Abx:
• Vancomycin + Cefepime

47
Q

Ddx for tachycardia with wide QRS with regular rhythm

A

o 1. Ventricular tachycardia

o 2. SVT with aberrancy (BBB)

48
Q

Ddx for tachycardia with wide QRS and irregular rhythm

A

o 1. SVT with aberrancy

o 2. Ventricular fibrillation

49
Q

What does HR of 150 clue you in to?

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