Medicine (Diseases) Flashcards
When is viral hepatitis considered acute?
Inflammation that lasts less than 6 months
What are symptoms of hepatitis?
malaise, myalgias, arthralgia, anorexia, nausea, vomiting, diarrhea, low grade fevers, jaundice
What is the treatment for hepatitis A?
Supportive care
Besides supportive care, what else can be used to treat hepatitis B?
nucleoside or nucleotide analogs
What can be used to treat hepatitis C?
peginterferon, ribavirin. Also, Harvoni and Mavyret. Liver transplant
What is the MELD score?
90 day mortality without liver transplant. Based on sodium, INR, bilirubin, creatinine. Range from 6-40
What is the Child Turcotte Pugh score?
Predicts survival rate at 2 years. Based on bilirubin, albumin, INR, ascites, hepatic encephalopathy. Categories A, B, C
For patients with active liver disease what pre-op tests would you order?
ECG- cirrhotic cardiomyopathy. Increased QT
stress test, echo
CBC to assess for anemia, leukopenia, thrombocytopenia
LFTs-albumin, INR
CMP
What is patypnea-orthodeoxia syndrome
Shortness of breath when changing from lying down to sitting up
What simple medication can be used preop to aid in hemostasis for moderate coagulopathy?
Intranasal desmopressin
What is desmopressin?
Synthetic analog of antidiuretic hormone. Increases plasma levels of Von Willebrand factor, factor VIII, and t-PA
Would you avoid propofol, ketamine and versed?
No, as long as blood pressure and cardiac output are maintained they are safe. Versed will have a longer half life so titration to effect is key
Which local anesthetic would you avoid in liver disease?
I would avoid amide local anesthetics, such as bupivacaine (marcaine)
Define hypertension
Persistently elevated arterial blood pressure of 130/80 or higher
What is the JNC 7 classification for hypertension
Normotensive- <120, <80
Elevated blood pressure- 120-129, <80
Hypertensive stage 1- 130-139, 80-89
Hypertensive stage 2- >140, >90
List a few causes of secondary hypertension
Cushing syndrome
Pheochromocytoma
Pregnancy
Renal artery stenosis
Polycythemia vera
How would you determine end organ damage of a hypertensive patient?
Mycocardial ischemia, chest pain
bradycardia
encephalopathy, confusion
dyspnea
nausea, vomiting
headache
seizure
What is atherosclerosis?
Hardening of the arteries due to lipid accumulation within the arterial wall
What are risk factors for atherosclerosis
Genetics
Dyslipidemia- total cholesterol over 240
Tobacco- oxidation of LDL, increased platelet adhesion
HTN- damages endothelium
DM- glycosylation of LDL
Metabolic syndrome- abdominal obesity, insulin resistance, HTN, HLD
Sedentary lifestyle
Menopausal women
What is the pathophysiology of atherosclerosis?
- Damage to endothelium
- Macrophages imbibe LDL to form foam cells
- Smooth muscle cells secrete extracellular matrix
- Fibrous cap forms, then thins and ruptures and has a thrombotic lipid core
What is ischemic heart disease or coronary artery disease?
Stenosis of the coronary arteries leading to a mismatch of oxygen supply and demand of the myocardium
How much time from symptoms to treatment has the best outcomes for ACS patients?
90 minutes
What is a MET?
metabolic equivalents. amount of energy expended during activity
What level of METs do you consider for clinical treatment or hospital?
Above 4 METs patients can power walk and bike
<4 METs is poor functional capacity- hospital setting
How much time after ACS until treatment in clinic?
MI or bare metal stent- 6 weeks
Drug eluting stent- 6 months
consult with cardiology team
What is congestive heart failure
The inability of the heart to meet the metabolic demands of the body
Do you know of a classification for congestive heart failure?
The New York Heart association classification
Class 1- no symptoms or limitation of physical activity
Class 2- no symptoms at rest. Slight limitation in activity
Class 3- Limitation of activity with minimal exertion
Class 4- Symptoms at rest. Severe limitation in activity
What is done for CHF workup?
EKG, echo
chest radiograph
exam
BNP lab
BMP
LFTs
Fasting lipid and gluose (metabolic syndrome and DM)
CBC and Thyroid levels
Your CHF is prescribed digoxin. What might you look for?
Digitalis toxicity- xanthopsia (yellow vision)
nausea, vomiting
confusion
paresthesias
v-tach, PVCs
heart block, bigeminy, trigeminy
Where is the mitral valve?
Between the left atrium and left ventrical
A patient has aortic valve stenosis. What might you hear on auscultation?
Crescendo-decrescendo systolic murmur
What is your valvular disease work-up?
Exam
Chest radiograph
EKG
Echo
What is asthma
chronic, obstructive disease with bronchiolar inflammation and hyeprresponsiveness. Reversible and recurrent
What is the classification of asthma?
Intermittent, mild persistent, moderate persistent, severe persistent
When does FEV1 change in asthma?
Moderate persistent and severe persistent
Patient has expiratory wheezing and oxygen saturations are dropping
Stop procedure. Suction, maintain open airway and add supplemental oxygen. beta2 agonist, IV dexamethasone, IV mag sulfate, 0.3 mg 1:1000 epi intramuscular. Intubate for PaCO2 >50
What is Samter’s triad?
Nasal polyps, asthma, aspirin sensitivity
What is cystic fibrosis
Altered chloride and water transport at epithelial cells
How is cystic fibrosis diagnosed?
Sweat chloride concentration above 60 mEq/L and at least one of the following:
chronic airway disease, exocrine pancreatic insufficiency, cystic fibrosis in a first degree relative
A cystic fibrosis patient has issues absorbing which fat soluble vitamins?
Vitamin A,E,D,K
If a patient cannot absorb vitamin A what might you expect?
Impaired vision and dry skin
If a patient cannot absorb vitamin E what might you expect?
Peripheral neuropathy and hemolytic anemia
If a patient cannot absorb vitamin D what might you expect?
reduced bone density
If a patient cannot absorb vitamin K what might you expect?
Coagulopathy with vitamin K dependent factors
What is COPD
Irreversible airway obstruction caused by either chronic bronchitis or emphysema
What are risk factors for COPD?
Smoking, occupational exposure, alpha 1 antitrypsin deficiency, respiratory infection
What are signs and symptoms of COPD?
wheezing, chronic cough, productive cough, hyperinflation of chest, weight loss, fatigue, dyspnea on exertion, pursed lips, pulmonary hypertension
How is bronchitis diagnosed in COPD?
Chronic productive cough for at least 2 years
What are the classifications of COPD?
Mild, Moderate, Severe and very Severe
All have an FEV1/FVC <70%
Mild- FEV1 >80%
Moderate- FEV1 50-79%
Severe- FEV1 30-49%
Very Severe- FEV1 30%
What is a pulmonary emoblism?
Obstruction of the pulmonary arteries leading to a ventilation perfusion mismatch
What are sources of a pulmonary emboli?
Thrombus from the lower extremity
Mural thrombus from a-fib
Fat embolism from long bones
What are signs and symptoms of a pulmonary emoblism?
Pleuritic chest pain
Dyspnea
Tachypnea
Hemoptysis
Coughing
JVD
Cyanosis
Rales and rhonchi
Diminished breath sounds
What is Virchow’s triad?
Stasis, damage to endothelium, hypercoagulable state
How would you diagnosis a suspected pulmonary embolism in the PACU?
Signs and symptoms of a PE
D-Dimer
Chest x-ray
CT angiography
Ultra sound of the lower extremities
arterial blood gas
Wells criteria >4
How would you treat a PE?
Anticoagulation (low molecular weight heparin, bridging to warfarin)
(inferior vena cava filter if cannot tolerate anticoagulation)
What is your dose for lovenox?
1 mg/kg every 12 hours
What is the Wells criteria?
Helps determine the likelihood of a pulmonary embolism. >4 high suspicion
Signs/symptoms of DVT (3)
High suspicion of PE (3)
Heart rate >100 BPM (1.5)
Surgery within a month or immobility >3 days (1.5)
History of PE or DVT (1.5)
Malignancy (1)
Hemoptysis (1)
What is a typical GFR for a male?
130 mL/min
What is a typical GFR for a female?
120 mL/min
How is an acute kidney injury diagnosed?
Creatinine increase by more than 0.5 mg/dL
Your infection patient needs a CT with contrast but has a acute renal failure due to dehydration. How would you manage this patient?
Pre-treatment with sodium bicarbonate and post CT hydration
At what GFR is chronic kidney disease diagnosed?
60 mL/min for 3 or more months
What GFR is end stage renal disease diagnosed?
GFR <15 mL/min
What are indications for dialysis?
AEIOU
Acidosis
Electrolyte disturbance (hyperkalemia)
Intoxications (methylene glycol, lithium)
Overload (volume)
Uremia
What would be your workup for a chronic kidney disease patient?
CMP
EKG
Echo
HbA1c
What labs would you order for anemia work up?
Ferritin, transferritin, MCV, reticulocyte count, CBC, PTT, PT, INR
What is a normal MCV value?
80-100
Can you explain Glasgow coma scale?
Movement, voice and eyes
Movement is scored 6-1
Voice is scored 5-1
Eyes are scored 4-1
Total score of 15-13 is mild, 12-9 is moderate, 8-3 is severe
What is acute myelogenous leukemia?
Increased production of immature myeloid cells leading to bone marrow failure
Marked by thrombocytopenia, granulocytopenia and anemia
There are genetic, environmental and medication causes
Down syndrome, neurofibromatosis
Benzenes, radiation
Alkylating agents
What is chronic myelogenous leukemia?
Chronic increase in myeloid cells. Caused by Philadelphia chromosome translocation
Indolent disease found on routine blood work
> 60 years old, leukocytosis
Radiation and benzenes are risk factors
Treated with tyrosine kinase inhibitors
How is rheumatoid arthritis diagnosed?
6 weeks of at least 4/7 of the following:
Morning stiffness >1 hr
Symmetrical joint involvement
Positive serum rheumatoid factor
Swelling hand joints
Swelling 3+ joints
Subcutaneous nodules
Radiographic erosive arthritis
What is myelodysplastic syndrome
Hematologic malignancy with anemia neutropenia and/or thrombocytopenia. Severe cases treated with stem cell transplant.
What is systemic lupus erythematosis?
Chronic Autoimmune disease that can affect any organ
What is denosumab?
Used to treat osteoporosis. RANK-L inhibitor
