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)
Treatment of Hemophilia A
Factor 8 replacement or Desmopressin:
♣ Increases circulating factor VIII
♣ Stimulates vWF secretion from endothelial cells
Inheritance pattern of Hemophilia A
X-linked recessive
More likely in males
Inheritance pattern of VonWillbrand disease
Autosomal dominant
Presentation of vWB disease
Prolonged mucosal bleeding (oropharyngeal, GI, uterine)
Less likely to see bleeding into deep tissues
Abnormal lab values in vWB disease
♣ Increased bleeding time – decreased platelet adhesion
♣ Increased PTT – vWF normally stabilizes Factor VIII
Treatment of vWB disease
♣ Desmopressin – increases vWF release from Weibel-Palade bodies of endothelial cells
What androgen is produced by adrenal glands but not testes/ovaries
DHEAS (dihydroepiandrosterone sulfate)
Major side effect of erectile dysfunction drugs
E.g. Sildenafil (phosphodiesterase-5 inhibitor, PDE-5 inhibitor)
Hypotension due to vasodilatory effect
Name penicillins that cover:
- Gram + cocci
- Gram neg
- Anaerobes
- Resistant gram neg / pseudomonas
- Gram pos = Pen G and C
- Gram neg = Amox/Amp
- Anaerobes = Amox/Clav (Augmentin), or Amp/Sul (Unasyn)
- Resistant GNR/pseudomonas = Piperacillin/Tazobactam
Name Cephalosporins that cover:
- Gram + cocci
- Gram neg
- Anaerobes
- Resistant gram neg / pseudomonas
- Gram + cocci = 1st gen (Cefelexin/Cefazdin)
- Gram neg = 3rd gen (Cefdinir/CTX)
- Anaerobes = none
- Resistant gram neg / pseudomonas = 4th gen (Cefepime)
Name penems that cover:
- Gram + cocci
- Gram neg
- Anaerobes
- Resistant gram neg / pseudomonas
- GPC, GNR, and Anaerobes = all of them (Ertapenem, Imipenem, and Meropenem)
- Pseudomonas / resistant GNR = Imi and Mero (not Erta)
Name fluoroquionolones that cover:
- Gram + cocci
- Gram neg
- Anaerobes
- Resistant gram neg / pseudomonas
- GPC and GNR = Levofloxacin, Ciprofloxacin, and Moxifloxacin
- Anaerobes = none of them
- Resistant gram neg / pseudomonas = Levofloxacin
What would be good drug choices to treat anaerobes
- Amox/Clav
- Amp/Sul
- Pip/Tazo
- Metronidazole
- Clindamyacin
What would be good drug choices to treat resistant GNR/Pseudomonas
- Pip/tazo
- Cefepime
- Imipenem
- Meropenem
- Levofloxacin
What would be good drug choices to treat Resistant GPC (MRSA)
- Vancomycin
- Linezolid
- Daptomycin
- TMP/SMX
- Doxycyline
- Clindamycin
What would be good drug choices to treat atypicals
- Azithromycin
- Doxy
