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Things I always forget Flashcards

1
Q

High Frequency oscillatory ventilation

A

HFOV - very high RR, very small tidal volumes

*helps lower risk of distention in ARDS

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2
Q

Extracorpeal membrane oxygenation

A

ECMO - supports hypoxemia without the potentially injurious ventilator setting sometimes needed in severe ARDS

“a treatment that uses a pump to circulate blood through an artificial lung back into the bloodstream… provides heart-lung bypass support outside of the body”

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3
Q

Viruses that are most associated with acute cough

A

influenza A and B, rhinovirus, adenovirus, echovirus, RSV, parainfluenza, coronavirus

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4
Q

Side effects of antitussives

A

confusion, nausea, constipation

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5
Q

Three main causes of chronic cough in non smokers, normal CXR, with no ACE I

A
  • GERD
  • Asthma
  • Upper Airway Cough Syndrome (UACS)
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6
Q

Massive hemoptysis causes death via

A

asphyxiation

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7
Q

MRC Dyspnea Scale

A
  1. no trouble except with strenuous exercise
  2. SOB when hurrying at level or walking up slight hill
  3. walks slower than most on level, stops 1 mile, or 15 min
  4. stops for breath after walking 100 yards or few min
  5. too breathless to leave house or SOB when undressing
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8
Q

How do patients describe dyspnea with:

a. Asthma
b. HF

A

a. chest tightness

b. air hunger/suffocating

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9
Q

Risk factors of head/neck cancers

A
  • alcohol
  • tobacco
  • EBV
  • HPV
  • marijuana
  • pollutant exposure
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10
Q

Sx of cancer of nasopharynx

A

epistaxis, otis media

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11
Q

Tumor stagins

A

T1 - less then or equal to 2cm
T2 - greater then 2cm but less then 4cm
T3 - greater than 4cm
T4A - invasion of skin, mandible, ear canal, fascial n.
T4B - invasion of skull, pterygoid plates, encases carotid a.

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12
Q

When should you use sputum cytology to check for lung cancer?

A

pts with poor pulmonary function who cannot tolerate invasive procedures

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13
Q

If there is malignancy in non small cell lung cancer, what can’t you do?

A

surgery

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14
Q

What two features characterize benign pulmonary nodules?

A
  1. no growth in 2 years
  2. calcification in a diffuse, central, or laminar pattern

*malignant nodules are greater then 2 cm, have speculated edges, located in upper lobes

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15
Q

Gold Criteria for COPD

A
  • I Mild: FEV1/FVC < 70%; FEV1 > 80%
  • II Moderate: FEV1/FVC <70%; 50 < FEV1 < 80%
  • III Severe: FEV1/FVC <70%; 30% < FEV1 < 50%
  • IV Very severe: FEV1/FVC <70%; FEV1 < 30% or FEV1 < 50% with chronic respiratory failure
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16
Q

When do you give oxygen therapy to someone with COPD?

A

arterial PO2 = 55 mmHG

or

oxygen saturation = 88% with or without hypercapnia

or

arterial PO2 = 59 mmHG or oxygen saturation = 89% if they have pulmonary HTN, cor pulmonale, edema due to RHF, or hematocrit >55%

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17
Q

Drugs that cause Parenchymal lung disease

A
  • amiodarone
  • methotrexate
  • nitrofurantoin
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18
Q

many patients with severe or chronic DPLD develop what?

A

pulmonary HTN

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19
Q

What is needed to diagnosis of OSA?

A

polysomnography (PSG)

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20
Q

Leading causes of pleural effusions

A

HF, pneumonia, cancer

  • transudative: suggests HF
  • exudative: suggests cancer
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21
Q

CURB-65

A

Confusion
Urea nitrogen >19.6 mg/dL
Respiration rate >/= 30
BP <90 mmHG or <60 mmHg and 65 or older

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22
Q

PH can only be confirmed via

A

right heart catheterization or direct measurement of mean pulmonary artery pressure

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23
Q

When is IGRA preferred?

A

when pts have gotten the BCG vaccination or those that are unlikely to return for TST interpretation

  • for kids 5 and younger, use TST over IGRA
  • neither test can distinguish b/t latent or active TB
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24
Q

Triad of fat embolism

A

hypoxemia, neuro changes, petechial rash

*onset 24-48 hrs after event

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25
Q

How long should you overlap warfarin with heparin? how long should DVT pts be treated?

A

5 days

3 months

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26
Q

Only a normal what can exclude PE?

A

V/Q

*tests for PE dx: contrast enhanced CT or ventilation - perfusion (V/Q) scanning

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27
Q

What HF sx can venous insufficiency of legs/varicose veins provide?

A

edema (not JVD or other HF sx)

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28
Q

HFrEF vs. HFpEF

A

a. systolic, S3, PND, DOE, orthopnea, EF < 40%
b. diastolic, stiff ventricles, SOB, DOE, pulmonary edema ; associated with myocardial fibrosis, amyloidosis, acute ischemia, constrictive pericarditis, restrictive cardiomyopathy

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29
Q

High output vs. Low output HF

A

a. EFr but CO inc (prego, hyperthyroid, anemia…)

b. ischemic HD, dilated cardiomyopathy, pericardial dx

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30
Q

What causes MCD?

A

idiopathic

2 to Hodgkin’s lymphoma

31
Q

What causes FSGS?

A

idiopathic

2 to HIV, sickle cell dx, heroin, obesity, interferon tx, congenital malformations

IF can have IgM, C3, C1

32
Q

What causes membranous nephropathy?

A

1 with ABs to phospholipase A2 Receptor

2 to infections, SLE, Drugs (NSAIDs), solid tumors

33
Q

What HS rxn is APSGN?

A

III

*has dec C3 due to consumption

34
Q
  1. Subepi deposits

2. sub endo deposits

A
  1. acute GN

2. lupus nephritis, MPGN

35
Q

What pattern describes APSGN?

A

diffuse proliferative GN

36
Q

Type II RPGN

A

IgA, lupus, hence schonlein Purpura

37
Q

What does HLA DRB1 mean? HLA DQA1?

A

a. might get good pasture syndrome

b. might get membranous nephropathy

38
Q

normal urinary protein levels

A

less then 150mg in 24 hrs

39
Q

do corticosteroids and immunosuppressive treatment help with MGN?

40
Q

What do you see on IF in the following:

a. APSGN
b. Goodpasture
c. MGN
d. MCD
e. MPGN Type I
f. MPGN Type II
g. IgA neuropathy
h. FSGS

A

a. granular IgG, C3 in GBM and mesangium
b. linear IgG, C3
c. granular IgG, C3
d. negative
e. IgG, C3 (C1q, C4)
f. IgG, C3 (C1q, C4)
g. IgA (IgG, IgM, C3 in mesangium)
h. IgM, C3

41
Q

What can progress to chronic GN?

A 
Crescentic GN (90)
FSGS (50-80) 
MPGN (50)
MGN (30-50) 
IgAN (30-50)
Poststrep GN (1-2)
42
Q

What is Acute Tubular Injury?

A
  • damage from toxins or ischemia

- 3 stages (initiation, maintenance, recovery)

43
Q

diffuse cortical necrosis

A

coagulative necrosis and both glomerulus and tubules (cortex is pale due to ischemic necrosis)

*obstetric crisis, septic shock, surgery

44
Q

What causes thickened GBM and increased mesangial matrix in DM nephropathy?

A

metabolic defect linked to hyperglycemia

45
Q

Papillary Necrosis:

a. DM
b. Analgesics

A

a. pale, gray

b. red-brown

46
Q

Xanthogranulomatous pyelonephritis is associated with what often?

A

proteus infection

47
Q

Tubulointerstitial nephropathy

A
  • azotemia + inability to concentrate urine
  • due to drug toxins
  • eosinophilia, fever, interstitial renal parenchymal infiltrates
  • one type is analgesic nephropathy (can show pap nec)
48
Q

Benign nephrosclerosis is not usually associated with renal insufficiency except:

A
  • AAs
  • superimposition of severe HTN
  • diabetic nephroapthy
49
Q

Hemolytic Uremic Syndrome vs. Thrombotic Thrombocytopenia Purpura

A

HUS - normal ADAM, endo injury and activation, intravascular thrombosis; shiva like toxin

TTP - abnormal ADAM, platelet activation and aggregation; NEURO INVOLVEMENT, fever, thrombocytopenia, renal failure, microangiopathic hemolytic anemia

50
Q

Atypical HUS

A
  1. inherited mutations of proteins that regular complement
  2. multiple acquired cause of endo injury
  3. antiphospholipid syndrome, pregnancy, sclerosis, malignant HTN, chemo…
51
Q

TTP is more common in?

A

females; over 40

52
Q

Most common source of embolus that causes renal infarction

A

mural emboli from LV

53
Q

Sickle cell nephropathy

A
  • patchy papillary necrosis
  • hematuria, hyposthenuria (general)
  • proteinuria (some)
54
Q

Killip Classification of MI

A

I - absence of rales and S3
II - rales that don’t clear with coughing over 1/3 or less of lung fields; S3
III - rales that don’t clear with cough over more than 1/3
IV - cariogenic shock

55
Q

Whens should pts. with an MI be given aspirin?

A

right away; even if fibrinolytic meds have already been given

*if aspirin allergy –> P2Y12 inhibitor (-grel)

though both should be give for preferably 1 year

56
Q

What pts can be harmed by thrombolysis?

57
Q

Pts undergoing primary PCI should get what two drugs

A

glycoprotein IIb/IIIa inhibitors (abciximab) and heparin

58
Q

Absolute CIs to Fibrinolytic Therapy

A
  1. previous hemorrhagic stroke (or other strokes within 1 yr)
  2. Intracranial neoplasm
  3. Recent heard trauma (even minor trauma)
  4. Active internal bleeding
  5. Suspected Aortic Dissection
59
Q

Nitrates should be avoided in pts who received PDE5 inhibitors in past ___ hours?

60
Q

What meds do you discharge your pt on?

A
  • aspirin

- P2Y12 inhibitor (if they received coronary stent)

61
Q

Post infarction ischemia is more common following what MI?

62
Q

If sinus tachycardia is due to hemodynamic compromise, what is a CI?

A

beta blockers

63
Q

Most pts with cariogenic shock have what dysfunction?

A

Moderate tos evere LV systolic dysfunction

64
Q

What is the most appropriate vasopressor for cardiogenic hypotension?

65
Q

What is used for pts with symptomatic post infarction supra ventricular arrhythmias?

A

amiodarone

66
Q

If you want a CABG, but you’re on clopidogrel or ticagrelor, how long do you need to be off them before the surgery? prasurgrel?

A

a. 5 days

b. 7 days

67
Q

What type of shock do burns cause?

A

hypovolemic shock

68
Q

What qualifies SIRS?

A
  1. temp above 100.4F or lower than 96.8
  2. HR > 90
  3. RR > 20 or PaCO2 less than 32 mmHG
  4. abnormal WBC

*when source of infection is found, it gets labeled as sepsis

69
Q

Hypovolemic shock vs. Cardiogenic shock

a. Contractility
b. Ventricle size

A

a. H - preserved
C - decreased
b. H - small
C - dilated/full

70
Q

In shock, vasopressors or inotropic agents are administered only after what?

A

adequate fluid resuscitation

71
Q

What are non osmotic stimuli for ADH release?

A

nausea, hypoxia, pain, medications

72
Q

Drugs associated with SIADH

A
  • antidepressants
  • anticonvulsants
  • anipsychotics
  • anti cancer (Cyclophosphamide)
  • opiates
  • MDMA (ecstasy)
73
Q

What is Transtubular potassium gradient?

A

an invalid test you should not order

*doesn’t actually dx hyper K

74
Q

What does sustained handgrip do to MVP? HCM?

A

a. increases intensity
b. decreases intensity

*both are intensified by valsalva and standing

CPR (22 decks)

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