Internal Med 3 Flashcards
Initial med choices for treatment of HTN
- Thiazide diuretics
- CCB
- ACEi
- ARBs
What are the components of CHADSVASc and what is it used for
o C = CHF or LVEF = 40% o H = HTN o A = Age >/= 75 o D = DM o S = Stroke/TIA/Thromboembolism o V = Vascular disease o A = Age 65-74 o S = Sex (female)
Risk of stroke for patients with A-fib / used to determine need for anticoagulation
What is Trousseu syndrome - presentation and association?
• Trousseau syndrome is a hypercoagulable disorder that usually presents with unexplained, recurrent, and migratory superficial venous thrombosis at unusual sites (e.g. arm, chest ares)
Describe sx of Lupus
♣ R – Rash (malar or discoid)
♣ A – Arthritis (non-erosive, 2 joints)
♣ S – Serositis (e.g. pleuritic, pericarditis)
♣ H – Hematologic disorders (hemolytic anemia, leukopenia, lymphopenia, thrombocytopenia)
♣ O – Oral/nasopharyngeal ulcers (painless)
♣ R – Renal disease (diffuse proliferative glomerulonephritis or membranous glomerulonephritis)
♣ P – Photosensitivity
♣ A – Antinuclear antibodies (+ANA)
♣ I – Immunologic disorder (anti-dsDNA, anti-Smith, anti-histone, or anti-phospholipid/anti-cardiolipin)
♣ N – Neurologic disorders (seizures, psychosis)
Mechanism of SLE
o Damage due to antibody-antigen complex deposition = Type III HSR
Describe aortic stenosis murmur
Crescendo/decrescendo systolic murmur
Ejection click may be present - when aortic valve opens, slightly later that mitral valve closing
Radiates to carotids
Describe murmur of mitral regurg
Holosystolic, “blowing” murmur
Radiates to L axilla
Describe murmur of aortic regurg
Early diastolic decrescendo murmur
Describe murmur of mitral stenosis
Opening snap, followed by rumbling mid-to-late diastolic murmur
Describe murmur of mitral valve prolapse
Mid-systolic click, followed by systolic murmur
Maximum dose of acetaminophen for a day
4 g
Why are beta-blockers used in the treatment of acute myocardial infarction
♣ Slows down the heart, thus reducing oxygen demand and increasing diastolic filling time to improve coronary blood flow
♣ Will reduce infarct size and decrease mortality
What is the MOA of beta blockers in treating HTN
- Decrease cardiac output – due to ionotropic and chronotropic effects
- Depression of RAAS system (recall the rain open umbrella) – antagonize beta-1 receptors at JGA
What is Ludwig angina
o Rapidly progressive cellulitis of the submandibular space
o Clinical manifestations
♣ Fever, chills, malaise
♣ Mouth/neck pain, swollen area on floor of mouth
♣ Drooling, dysphagia, muffled voice, airway compromise
What is the pathogenesis of systemic sclerosis
♣ Progressive tissue fibrosis
♣ Vascular dysfunction
Clinical features of systemic sclerosis
♣ Systemic: fatigue, weakness
♣ Skin: Telangiectasia, sclerodactyly, digital ulcers, calcinosis cutis
♣ Extremities: Arthralgias, contractures, myalgias
♣ GI: Esophageal dysmotility, dysphagia, dyspepsia
• Esophageal manometry typically shows hypomotility and incompetence of lower esophageal sphincter
♣ Vascular: Raynoud phenomenon
What should you be careful of when treating a pt with ARDS
Do not want to over-distend alveoli, so want to use LOW TIDAL VOLUME ventilation
What are some causes of acute increase in LFT’s to the 1000’s (e.g. AST = 6,000)
- Shock liver
- Infectious causes
- Toxicity (e.g. drugs)
- Portal venous thrombosis
Treatment of aspiration pneumonitis
- Lung parenchyma inflammation (not infection)
- Aspiration of gastric acid with direct tissue injury
Tx = supportive (no abx)
Signs and sx of spinal cord compression
♣ Gradually worsening, severe local back pain
♣ Pain worse in recumbent position/at night
♣ Early signs: symmetric lower extremity weakness, hypoactive/absent DTR
♣ Late signs: bilateral babinksi reflex, decreased rectal sphincter tone, parapesis/paraplegia with increased DTR, sensory loss
Management of spinal cord compression
♣ Emergency MRI
♣ IV glucocorticoids
♣ Radiation-oncology & neurosurgery consultation
Describe Factor V Leiden
♣ Mutation that makes Factor Va resistant to inactivation by protein C
♣ Increased coagulation
What are the clinical features of hemophilia
• Delayed/prolonged bleeding after mild trauma
o Hemarthrosis, intramuscular hematomas
o GI or GU tract bleeing
o Intracranial hemorrhage
Abnormal lab values in hemophilia
- Deficiency of factor VIII
* Increases PTT (no effect on PT or INR)
