Medicine Flashcards
Differentiate transudate vs exudate
Light’s Criteria
≥ one of following for exudate:
1) pleural fluid protein: serum protein ratio > 0.5
2) Pleural fluid LDH:serum LDH > 0.6
3) Pleural fluid LDH > 2/3rds of upper limit normal
S&S, Management,Rx HSV Encephalitis
S&S: high fever, gustatory hallucinations, confusion
Do lumbar puncture (look for RBCs)
order PCR for HSV protein of CSF and commence IV acyclovir immediately before results come back.
S/E Thiazides
- Mnemonic (HyperGLUC)
hyperglycemia
hyperlipidemia
hyperuricemia
hypercalcemia
hypokalemia (due to compensatory aldoseterone release from drop blood volume)
hypotension
Statin Follow-Up
Lipids and Liver enzymes q 4-6 months or if pts complains of jaundice, RUQ pain,dark urine
CK at baseline and if pt complains of myalgia
D/C statin if CK > 10x upper limit of normal
Define Hemochromatosis
excess iron storage, which causes multiorgan system dysfunction with total body stores of iron increased to 20-40 g (normal 1g)
Tetrad Hemochromatosis
The classic tetrad of manifestations resulting from hemochromatosis consists of (1) cirrhosis, (2) diabetes mellitus, (3) hyperpigmentation of the skin, and (4) cardiac failure
New York Heart Assocation Classification HR Failure
Class 1 - No limitation during ordinary activity
Class 2 - slight limitation during ordinary activity
Class 3 - marked limitation of normal activities without symptoms at rest
Class 4 - unable to undertake physical activity without symptoms; symptoms may be present at rest
S/E of CCB
Dizziness, nausea, hypotension, cough, pulmonary edema
(all due to vasodilatory effects)
Treatment of acute pulmonary edema
LMNOP
first treat underlying ppting factors (e.g. ischemia, arrhythmia)
L - Lasix (furosemide) 40-500 mg IV
M -morphine 2-4 mg IV- decreases anxiety and preload (venodilation)
N- nitroglycerin- topical/IV/SL (decreases preload)
0-oxygen
P- positive airway pressure (CPAP/BiPAP)- decreases preload and need for ventilation
P - position - sit patient up with legs hanging down unless patient is hypotensive
5 Most Common Causes of CHF
- Coronary Hrt Disease (60-70%)
- HTN
- Idiopathic (often dilated cardiomyopathy)
- Valvular (AS, MR, AR)
- Alcohol (dilated cardiomyopathy)
What is Metabolic Syndrome
obesity, lipid abnormalities, hypertenion, hyperglycemia
Rx: exercise, weight loss, dietary changes
Orthostatic proteinuria
Benign condition in adolescents and young adults characterized by proteinuria < 2 g in the upright postion and not supine position and normal creatinine clearance.
Viral Meninigits - CSF characteristics
Pressure normal
Glucose normal (low in Bacterial)
Protein elevated
Cell count < 300 (high in bacterial)
Chloride normal (low in tuberculous meningitis)
Best diagnostic test for Vitamin D deficiency
Measure levels of 25 hydroxyvitamin D
3 commonly used analgesics for pain control in the ICU
Fentanyk
Morphine sulphate
Hydromorphone
Antibiotic of choice for bacterial meningitis
Ceftriazone - thrid generation cephalosporin has good penetrance into the CSF and is most likely to hit the offending agent
Analgesic to avoid in geriatric patients
Propoxyphene is to be avoided in geriatric patients as efficacy is similar to aspirin or acetominophen but drug accumulation, ataxia, dizziness, neurotoxic effects result in morbidity
Oxycodone, hydrocodone, hydromorphone and acetominophen are acceptable for use in geriatric patients
Wernicke encephalopathy vs Korsakoff syndrome
Wernicke - psychomotor slowing or pathy, ataxia, impaired consciousness (confusion), opthalmoplegia (horizontal nystagmus, bilateral abducens palsy) - traid in bold
Korsakoff - mental confusion, dysphonia, confabulation and impaired memory of recent events. Can develop after repeated episodes of Wernicke
Treatment - 50-100 mg IM or IV thiamine for several days followed by 10-20 mg once/day until therapeutic dose reached
Best starting dose for Parkinsons
Carbidopa : levodopa
25mg/100mg 3 x/day
DDx of T wave Inversion
myocardial infarction, myocarditis, old pericarditis, myocardial contusion, digoxin toxicity
S&S Celiac disease
- Characteristic bulky, fowl smelling stools
- loss of muscle mass or subcutaneous fat
- Pallor - due to iron deficiency anemia
- bone pain - due to osteomalacia
- easy bruising - due to vitamin K deficiency
- hyperkeratosis - due to vitamin A deficiency
DDx of Erythema Nodosum
NODOSUM
No - no cause - idiopathic (40%)
Drugs (sulfonamides, OCP, etc)
O - Other infections (GAS+)
Sarcoidiosis
Ulcercerative COlitis and Crohn’s (C>UC)
Malignancy (leukemia, Hodgkin’s, lymphoma)
Morphine S/Es and Uses
Uses:
1) Analgesia
2) Treatment of Diarrhea
3) Relief of Cought
4) Treatment of acute pulmonary edema: possibily due to vasodilatory effect
S/E
Miosis
Respiratory Depression (most common acute overdose S/E)
Histamine Release (bronchoconstriction, rash - never give morphine to asthmatic!)
Constipation
Vomiting and Nausea (40% patients)
Of all S/E: tolerance to constipation and meiosis does not develop
Causes Interstitial Nephritis
70% drugs - cephalosporins, penicillins, sulfonamides, sulfomamide containing diuretics, NSAIDs, rifampin, phenytoin, allopurinol
