Random Topics from Fitzgerald Flashcards
Mammography at age
40 annually
Hypocalcemia correction with low albumin
add 0.8 md/dL calcium for every 1 gram albumin below 4
Medications that cause hyperkalemia
ACE-I
Heparin
NSAIDs
Opioid antagonists
Butorphanol
Naloxone
Naltrexone
Pentazocine
Complications of Acute Rhinosinusits
Orbital cellulitis
Osteomyelitis
Sinus Thrombosis
Treatment duration for ARS
No risk for resistance and 1st line therapy works= 5-7 days
Resistance7-10 days
Causes of chronic glaucoma
ethnicity, age, near-sightedness, DM
S/S of acute closed narrow angle glaucoma
ipsilateral HA blurry vision severe periorbital pain Halos around objects pain with eye movement
Normal variant in eye exam for contact wearers
absence of corneal reflex
Assessment of Asthma
Classify severity
Asthma control
Two medications that help with allergies in asthma
Leukotriene receptor antagonists (LTRA) -lukast
Omalizumab
When to consider and when to consult asthma specialist
Consider at stage 3
Consult at stage 4
both if required
Intubation criteria for asthma exacerbation
after 1 hour of treatment PEF/FEV1 42 absence of wheezing drowsiness confusion bradycardia
Assessment of COPD
Exacerbation risk
Symptom assessment
Spirometric assessment
Steroid dose and duration for COPD exacerbation
40 mg/day for 5 days
Mild-Moderate COPD exacerbation requiring abx
Amoxicillin
Doxycycline
Bactrim
Severe COPD exacerbation requiring abx
Augmentin Cephalosporin Azithromycin Clarithromycin Fluoroquinolone
Booster phenomenon in TB
elders; infected long ago have initial negative mantoux but a positive mantoux when retested up to 1 year later due to first test boosting immune response
Two-step testing in TB
strategy to distinguish a boost reaction
Person with negative mantoux is retested 1-3 weeks later
Positive with second test= boosted reaction, not recent infection
PPD for TB
tests for exposure
can produce false positives
IGRA for TB
used for people who received BCG vaccine
useful in people who do not follow-up with skin tests
Pt should have either TST (mantoux) or IGRA not both
Most common cause of fatal CAP
Strep. pneumoniae
Pneumonia associated with close proximity to crowded areas
M. pneumoniae
C. pneumoniae
CURB-65
Confusion
Urea (BUN >19)
RR >30
BP 65
Admission for ICU with pneumonia
Shock or Respiratory failure
Or three minor criteria:
RR greater than 30, PaO2/FiO2 less than 250, Multilobar infiltrates, Confusion, BUN above 20, WBC under 4000, Platelets under 1000
Temp under 36.3, Hypotension requiring fluid resusc
Diagnostic criteria and management of ARDS
bilateral infiltrates
PA wedge pressure less than 19
PaO2/FiO2 under 200
TV 6ml/kg
Rate 10
PEEP 5-10
Sedation and paralyzing for compliance
LAMA mechanism of action (tiotropium)
anti-inflammatory
mucolytic activity
Highest risk for PE
stasis
Biggest lifestyle modification to reduce HTN
weight loss (5-20 mmHg per 10 kg weight loss)
HTN medication class not to be used with heart failure
CCB
Aldosterone risk with prolonged use
gynecomastia
abrupt withdrawal of clonidine can lead to
rebound HTN
Goal BP reduction in HTN urgency and emergency
Urgency: hours
Emergency: reduce MAP no more than 25% within 2 hours then toward 160/100 within 2-6 hours
High risk unstable angina
worsening mitral regurg hemodynamic instability sustained VT PCI within 6 months high TIMI/GRACE score Reduce LV EF
Treatment in Chronic HF
Ace-I
Beta-blockers
Control comorbidities
Diuresis
Treatment of Acute HF
- Vasodilator
MSO4
Diuresis 1-2x daily amount
Inotropes
Acute HF S/S
dyspnea at rest coarse rales S3 no peripheral S/S Kerley lines
Chronic HF S/S
dyspnea with exertion redistribution of flow on X-ray JVD abdominal discomfort peripheral edema
Staging of HF (A-D)
A: high risk without structural disease or symptoms
B: Structural disease without symptoms
C: Structural and symptoms
D: Refractory HF
Treatment of pericarditis
pain meds
NSAIDs (not in renal failure)
Steroids
Phases of cardiac rehab
1: inpatient at hospital
2: medically supervised
3: daily life
target HR for patients with ischemic changes
10 bpm below level of ischemia
must be above resting HR
Most important risk factor in CAD
family history
HgbA1C percents with correlating glucose
5%- 97 6%- 126 7%- 154 8%- 183 9%- 212 10%- 240 11%-269 12%- 298
First line treatment in untreated hyperthyroidism
non-selective BB
Nadolol
Propranolol
Treatment
PTU
RAI
Signs of addisons disease
fatigue hypotension hyperpigmentation arthralgias uncontrolled inflammation
T score for osteoporosis
+1 to -1 Normal
-1 to -2.5 prevention to osteoporosis 1500 mg Ca 800units Vit D
Urinary incontinence testing
provocative stress testing
PVR
voiding records
Short term memory loss in elderly
normal age related change
medication for depression and appetite stimulation
remeron
Majority of elderly falls happen
in patient’s home
Intra-renal failure can lead to ischemia when
MAP 30 minutes
Lupus like drug reaction (joint pain) in what meds
Procainimide hydralazine INH quinidine minocycline diltiazem
Pain relief with BM
IBD
Tension/cramping pain indicates
obstruction
gastroenteritis
food-related
Inflammatory pain in abd
generalized to localized; worse with movement
appendicitis
cholecystitis
pancreatitis
Ischemic abd pain
deep acute pain, smokers at risk
ischemic bowel
Mesenteric artery infarct
Surgical abdomen diagnoses
dissecting aneurysm
ectopic pregnancy
appendicitis
perforated organ
Non-surgical abdomen diagnoses
cholelithiasis
PID
Gastroenteritis
Warning signs of surgical abdomen
intractable vomiting Pain before vomiting acute steady pain for hours pain causing syncope pain that disturbs sleep pain >6 hours well localized pain unrelieved by analgesics old abdominal scars
Wedge pressure in Cardiogenic shock
increased
Wedge pressure in Obstructive shock
decreased