Other DSA Stuff Flashcards
stage 1 radiographic findings sarcoidosis
hilar adenopathy alone
stage 2 radiographic findings sarcoidosis
hilar adenopathy w/ parechymal involvement
stage 3 radiographic findings sarcoidosis
parenchymal involvement alone
stage 4 radiographic findings sarcoidosis
advanced fibrotic changes principally in the upper lobes
most prominent sx of IPF
progressive dyspnea
hallmark features on lung biopsy of IPF
heterogenous distribution of parenchymal fibrosis against background of mild inflammation
first tx in pts with UA/NSTEMI
aspirin
- clopidogrel if aspirin intolerant
initial conservative tx in pts with UA/NSTEMI
anticoag therapy
- enoxaparin
- fondaparinux (less common)
after initiating enoxaparin, what tx for pts w/ UA/STEMI in conservative tx
clopidogrel
initial invasive strategy in pts with UA/NSTEMI
anticoag thearpy
- enoxaparin
- bivalirudin
after initiating enoxaparin, what tx for pts w/ UA/STEMI in invasive tx
add second anticoag for precatheterization
- clopidogrel
- GP IIb/IIIa inhibitor (eptifibatide or tirofiban)
3 P2Y12 inhibitor antiplatelet therapies
clopidogrel
prasugrel
ticagrelor
3 GP IIB/IIIA inhibitors
tirofiban
epitifibatide
abciximab
MOA fondaparinus
Xa inhibitor
MOA bivalirudin
direct thrombin inhibitor
do you treat unstable angina with CCB
NO, third line therapy only
Killip classification 1-4 (part of GRACE score)
1: absence of rales and S3
2: rales that do not clear w/ coughing over 1/3 or less lung fields, or presence of S3
3: rales that do not clear w/ coughing more than 2/3 lung fields
4: cardiogenic shock (rales, hypotension, signs of hypoperfusion)
GRACE risk score
measure risk stratification for coronary angiography in pts w/ or w/o ST elevation
TIMI risk score is based on what factors
- age 65 or older
- 3 or more cardiac risk factors
- prior coronary stenosis 50% or more
- ST segment deviation
- 2 anginal events in prior 24 hours
- aspirin in prior 7 days
- elevated cardiac markers
what type of shock is associated w/ pulmonary edema
cardiogenic
tension pneumothorax, cardiac tamponade, PE, and severe pulmonary HTN cause what type of shock
obstructive
elevated serum lactate is associated with what type of shock
septic shock
GI effects of hypotension
splanchnic vasoconstriction –>
- oliguria
- bowel ischemia
- hepatic dysfunction
- multiorgan failure
CNS effects hypotension
- restlessness
- agitation
- confusion
- lethargy
- coma
what to do with shock patients who become unresponsive
check glucose and if levels are low give 50% dextrose IV
central venous pressure < 5 mmHg indicates
CVP > 18 mmHg indicates
hypovolemia
volume overload, cardiac failure, tamponade, pulm HTN
PACs measure what
- pulmonary artery pressure
- left sided filling pressure
- PCWP
what can you use to distinguish b/w cardiogenic and septic shock
pulmonary artery catheters
what does POCUS look at
inferior vena cava (intravascular volume status)
cardiac index < 2L/min/m2 means
cardiac index > 4L/min/m2 in hypotensive pt means
<2: needs inotropic support
>4: early septic shock
systemic vascular resistance low (<800): SVR high (>1500):
low: sepsis and neurogenic shock
high: hypovolemic and cardiogenic shock
what fluid is used for volume replacement in shock
crystalloid solution
compare fluid replacement in cardiogenic and septic shock
cardiogenic: smaller fluid challenges in increments of 250 mL
septic: large volumes of fluid (usually more than 2L)
compare vasoactive therapy in:
pt w/ hypotension and high CO after volume resuscitation
pt with low CO w/ high filling pressure
pt 1: vasopressor support to improve vasomotor tone
pt 2: inotropic support to improve contractility
what vasoactive therapy to give in pts with vasodilatory shock
NE and E
vasopressor of choice in septic shock
NE
- phenylephrine can also be used
1st line vasopressor agents in cardiogenic shock
NE or dopamine
tx of choice for pts with shock secondary to adrenal insufficiency
corticoteroids
what endogenous pyrogens mediate fever
IL-1, TNF, interferon a
elevation of temperature related to inability of body to dissipate heat
hyperthermia
5 categories of fever
hypersensitivity rxns altered thermoregulatory mechanisms related to administration of drug direct extensions of pharmacologic action of drug idiosyncratic (we don't know)
near universal agreement that core body temp of ___ represents a fever
38.3 (100.9)
most common causes of fever of unknown origin
tuberculosis and intra-abdominal abscesses
malignancies associated with fever of unknown origin
hodgkin’s dz, non-hodgkin’s lymphoma
inflammatory conditions associated w/ fever of unknown origin
SLE
giant cell arteritis
IBD
very high fever, consider —>
CNS infections
NMS
heat stroke
fever w/ rash, consider –>
meningitis
bacteremia w/ septic shock
rickettsial dz
bacterial endocarditis
fever w/ change in mental status, consider –>
meningitis encaphlitis NMS heat stroke bacterial infections w/ septic shock
fever w/ dizziness or light-headedness, consider –>
bacterial infection w/ septic shock
adrenal insufficiency
PE
fever w/ recent chemotherapy, consider –>
nosocomial infection w/ neutropenia
fever w/ SOB and CP, consider –>
PE, pneumonia, empyema
tertian fever and quartan fever are associated w/:
tertian: malaria due to plasmodium vivas or ovale
quartan: malaria due to plasmodium malariae
DUKE criteria for infectious endocarditis
- positive blood culture
- persistent positive blood culture
- echo positive for IE
minor criteria: - fever
criteria for fever of unknown origin:
fever >101 on at least two occasions
illness duration of > 3 weeks
maculopapular rash in a sparse distribution over the anterior trunk in the groin and upper legs
- intermittent fever
rickettsial infection
sx of human monocytotropic erlichiosis (HME)
- fever
- headache
- myalgia
- malaise
- 8 day illness
- thrombocytopenia, leukopenia, elevated serum aminotransferases
sx rocky mountain spotted fever
- fever, rash, hx of tick exposure
- rash characterized by macules appearing on wrists and ankles and then spreading to rest of extremities and trunk
sx lyme dz
erythema marginatum, fever, chills, myalgia
