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Tidbits Flashcards

1
Q

Top 3 causes of acidosis

A

LA

Uremia

DKA

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2
Q

Fiorcet

A

Acetaminophen + butalbital + caffeine

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3
Q

Reynalds pentad

A 
RUQ tenderness 
Jaundice
Fever
Shock (hypotension or tachycardia)
AMS
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4
Q

Becks triad

A

Hypotension
Distended neck veins
Muffled heart sounds

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5
Q

Crohn’s disease

A

Presents with RUQ pain, diarrhea, weight loss, apthous ulcers in mouths and stomach, possible erythema nodosum, sacroiliitis, and fistulas

-Also ️Assoc. With calcium oxalate renal calculi, b12 deficiency, and malabsorption due to bile salt deficiency

Tx: Sulfasalazine of mesalamine; steroids for exacerbation

Azathioprine or cyclosporine for severe disease

Metronidaozle for colonic fistulas

TNF inhibitors for enterocutaneous fistulas

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6
Q

Immediate differential for syncope

A

Arrhythmia

Stroke

Anemia

GI bleed

Vasovagal

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7
Q

Risk of cardio verting AFib

A

Throwing a clot

Generally, do not acutely convert if the patient is stable and has been in the rhythm for >48 hours

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8
Q

️EMERGENCY dialysis indications

A

Overload

Electrolyte abnormalities

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9
Q

Increased qrs without electrical criteria for BBB

A

Interventricular conduction defect

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10
Q

Length of time it takes av fistulas to mature

A

6 weeks

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11
Q

EKG with inverse p waves in lead 1

A

Consider reversed leads

Consider Dextrocardia if you also see poor R wave progression in the R leads

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12
Q

When should you not screen for a Cancer if you suspect it

A

If their 10 yr survival rate is low

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13
Q

Scan to get on 30+ yr smoker aged 55-80 and if they did not stop smoking less than 15 yrs ago

A

Low dose CT

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14
Q

HPV screening ages

A

21-30: Pap q3yrs

30-65: HPV + pap q5yrs

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15
Q

Mammography screening

A

Digital q2yrs from 50-75

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16
Q

HCV ab screen

A

Everybody born between 1945-1965

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17
Q

Yamaguchi syndrome

A

Apical variant of HCM; has large qrs complexes and deep, spike like t wave inversions

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18
Q

Versed generic

A

Midazolam

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19
Q

Tx of thyroid storm

A
  1. Propanolol
  2. PTU/methimazole
  3. Iodide
  4. Cortisone
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20
Q

AMS causes

A 
Alcohol (intoxication or Withdrawl)
Epilepsy, electrolytes, encephalopathy
Insulin, intussusception 
Opioids, O2 
Urea
Trauma, temperature
Infxn, ingestion 
Psychiatric, porphyria 
Shock, SAH, stroke, seizure, space occupying lesion
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21
Q

Tiny PERC mnemonic

A 
Hormones
Age > 50
DVT or PE history 
Coughing blood
Leg swelling 
O2 sats <95%
Tachycardia, trauma
Surgery
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22
Q

Nausea med to use in acute gastritis

A

Raglan

Has anti gastroparesis qualities

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23
Q

Empiric treatment of endometritis

A

Rocephin and flagyl

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24
Q

Ehrlichia lab findings

A

Leukopenia

Increased LFTs

️Thrombocytopenia

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25
Q

Labs to order for sudden headache

A

CBC, BMP, coags, toxicology, EKG, ct head

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26
Q

HAV presentation

A

Abrupt N/V, anorexia, fever, malaise, abdominal pain

Few days later, patients develop bilirubinemia, acholic stools, jaundice, Pruritis

Labs show increased LFTs (ALT>AST), increased bilirubin, increased AP, and anti-IgM HAV antibodies present

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27
Q

EKG findings with pulmonary hTN

A

RAD
Sinus tachycardia
Right atrial overload (peaked p waves in V2)
️Decreased limb voltage

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28
Q

Mandela effect

A

Fake memories reinforced by social communities, false news, and misleading photographs

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29
Q

Labs to order in suspected stroke

A 
Ct head
Glucose
BMP, CBC 
Lipids
EKG
Trops
PT/INR 
O2 sat

Also consider b-hCG, UDS, blood alcohol, ABG, ️️CXR, and EEG

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30
Q

Exclusion criteria for tPA

A 
SX in past 3 weeks
Stroke or head trauma in past 3 months
Hx of intracerebral hemorrhage 
BP>185/>115
Evidence for SAH 
GI bleed in past 3 weeks
Pt>15
Plt<100,000
Gluc < 30 or >400
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31
Q

chronic bronchitis definition

A

Persistent cough and sputum for > 3 months a year in 2 consecutive years

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32
Q

Latuda

A

Lurasidone: atypical antipsychotic used for depressive symptoms in bipolar disorder

MOA: acts as a dopamine and serotonin antagonist

ADRs: drowsiness, Parkinsonism, nausea, increased glucose and triglycerides

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33
Q

Taivicay

A

Dolutegravir: ️Recommended in initial HAART therapy

MOA: binds to integrase active site in virus and ️Inhibits transfer step of HIV-1 iantegration into cell

ADRs: increased glucose, Transaminits,

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34
Q

Truvada

A

Emtricitabine + tenofovir:used to Tx hiv and for PEP

MOA: nucleoside and nucleoside reverse transcriptase inhibitors
Emtricitabine= cytosine analog
Tenofovir=adenosine analog

ADRs: lactic acidosis, renal toxicities, osteomalacia

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35
Q

Diuretic contraindicated in gout

A

Thiazides

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36
Q

RA diagnostic criteria

A
  1. Synovitis in at least one joint
  2. Need greater than six points
    - 1 large joint (0), 2-10 large joints (1), 1-3 small joints (2), 4-10 small (3), >10 (5),
    - Low positive RF or anti-CCP (2)
    - APR (1)

Sx greater than 6 weeks (1)

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37
Q

️Chronic treatment of gout

A

Probenecid

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38
Q

Pts who need a statin

A
  1. Known athersclerotic disease
  2. DM patients age 40-75 with ldl > 190
  3. 10 year ASCVD risk >7.5% and ldl 70-190
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39
Q

Best medicine to raise HDL

A

Nicotinic acid (15-30%)

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40
Q

Best medicines to lower TGLs

A

Fenofibrate/Gemfibrozil

25-40% lower

⭐️can cause gallstones, increased LFTs

⭐️increased risk of myalgia when used with statins

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41
Q

Medicine that prevents cholesterol absorption

A

Ezetimibe

Lowers ldl by 15%

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42
Q

Bentyl

A

Dicyclomine

Used for IBS

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43
Q

Empiric MRSA Tx

A
  1. Vanc
  2. Daptomycin
  3. Linezolid
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44
Q

Activity against GNR and anaerobes

A
  1. Unasyn
  2. Zosyn
  3. 3rd generation cephalosporin and flagyl
  4. FQN and flagyl
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45
Q

Unasyn

A

Ampicillin and Sulbactam

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46
Q

Medication to prescribe for patient on ️Chronic high dose prednisone

A

Bactrim

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47
Q

How long should sutures stay in

A

7-10 days

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48
Q

Cefodroxil

A

1st gen cephalosporin used to Tx UTI, joint infxn, skin and suture infxn

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49
Q

Lopressor

A

Metoprolol tartrate

Immediate release

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50
Q

Toprol

A

Metoprolol Succinate

XR

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51
Q

Imitrex

A

Sumatriptan

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52
Q

1st line prophylaxis for ️Chronic daily headache

A

Amitryptiline

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53
Q

Medication for AMS in geriatric Pts

A

Risperidal

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54
Q

Valium

A

Diazepam

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55
Q

Red flag back pain signs

A

Age > 70

Hx of malignancy

Hx of osteoporosis

Weight loss

LE weakness

Fever

Signs of RF

IVDA

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56
Q

Big R waves in V1-V6

A

Indicative of past MI

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57
Q

Pentad of TTP

A
  1. Fever
  2. Thrombocytopenia
  3. Schistocytes
  4. AMS
  5. Renal problems
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58
Q

Albumin needed for transfusion w/ hypoalbuminemia

A

25%

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59
Q

NSTEMI LOVENOX DOSING

A

1MG/KG Q 12H

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60
Q

Dyspepsia

A

Upper abdominal GI pain

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61
Q

Reasons to order endoscopy in pts with new-onset dyspepsia

A
  1. New onset dyspepsia at age >45
  2. Red flags (weight loss, recurrent vomiting, dysphagia, evidence of GI bleed, IDA)
  3. Sx that fail to respond to therapy
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62
Q

Treatment of peptic ulcer

A

Omeprazole + clarithromycin +metronidazole or amoxicillin

Penicillin allergy? =» Bismuth subsalicylate + metronidazole + tetracycline

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63
Q

Causes of digital clubbing

A
  1. Lung cancer (and by far the most common)
  2. Bronchiectasis
  3. Chronic lung abscess
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64
Q

Horner syndrome

A

Ptosis

Miosis (loss of pupillary dilatation)

Anhidrosis

*caused by compression of the superior cervical ganglion and resultant loss of sympathetic innervation; related to a superior sulcus tumor

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65
Q

Chest pain in lung cancer suggests what?

A

Pleural involvement or neoplastic invasion of the chest wall

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66
Q

Squamous cell carcinoma

A
  • Central lesion
  • Localized symptoms caused by bronchial obstruction (atelectasis, pneumonia)
  • Cavitary lesions
  • Produces PTHrP
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67
Q

Adenocarcinoma characteristics

A

Peripherally located

Mets early (CNS, bones, adrenals)

**LOWEST ASSOCIATION W SMOKING

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68
Q

Large Cell Carcinoma characteristics

A

Peripheral lesion

Mets to CNS, mediastinum

=» SVC SYNDROME AND/OR HOARSENESS W COMPRESSION OF LARYNGEAL NERVE

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69
Q

Monitoring of solitary pulmonary nodule

A

Lesion 8mm or less =» serial CT imaging; stability for 2yrs suggests benign etiology

1cm or larger =» PET scan, transthoracic needle biopsy, bronchoscopic evaluation if possible

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70
Q

Amount of insulin to administer w/ hypokalemia

A

10 units + 1amp glucose

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71
Q

Xanax dose in first time for pt

A

.25 TID

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72
Q

Treatment for pts w/o parathyroid glands

A

Ca2+ AND calcitriol

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73
Q

Midodrine

A

a-1 agonist =» increased arteriolor and venous tone

Uses: Orthostatic hypotension; also in ascites, hepatorenal syndrome, vasovagal syncope

ADRs: Supine HTN; paresthesia; pruritis; dysuria; reflexive bradycardia

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74
Q

Contraction alkalosis

A

Loss of relatively large volume of fluid that has high NaCl conc. and low HCO3

-Occurs due to loss of water from plasma volume due to loss of NaCl…overall, HCO3 is remaining relatively the same

***COMMON IN PTS RECEIVING HIGH DOSE LASIX OR OTHER LOOP DIURETIC

-Also occurs in CF, diarrhea, and possibly achlorhydia

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75
Q

Broca’s aphasia

A

Localized lesions affecting the frontal lobe; characterized by nonfluency w/ sparse output and agrammatis

Repetition and writing are also generally impaired

Can see r hemiparesis and oral apraxia as well if nearby structures affected

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76
Q

Agrammatism

A

Lack of full sentences; sometimes call “telegraphic speech”

“tree…children…run”- describing a park

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77
Q

Wernicke’s aphasia

A

Fluent aphasia w/ markedly impaired comprehension

Voluminous but meaningless speech (word salad) w/ neologisms

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78
Q

Conduction aphasia

A

Fluent aphasia w/ preserved comprehension BUT w/ impaired repetition

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79
Q

Transcortical motor aphasia

A

Nonfluent speech w/ good comprehension and repetition BUT HAVE DIFFICULTY INITIATING SPEECH AND COMPLETING THOUGHTS

  • Writing also affected; can occur during recovery from Broca’s as well as primary
  • Occurs w/ ACA infarcts or watershed infarction
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80
Q

Transcortical sensory aphasia

A

Fluent aphasia w/ frequent paraphrasic errors and impaired comprehension that seems similar to Wernicke’s but ECHOLALIA IS INTACT

-Pts can read aloud without error they just wont know wtf theyre talking about

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81
Q

Indications for chest tube drainage

A

Empyema

Positive Gram stain or cx of thoracentesis sample

Presence of loculations

pH < 7.2

Glucose <60

LDH >1000

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82
Q

Point at which to remove a chest tube draining fluid

A

Drainage rate <50mL/day

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83
Q

Treatment for multiloculated empyemas

A

4-6 weeks of abx

tPA, DNAase to help clear loculations

-Can use VATS if tPA and DNAase fail to clear them

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84
Q

Complications of cirrhosis

A

Portal HTN: Diagnosed clinically or can also eval blood flow w/ Doppler
=» ascites, splenomegaly, encephalopathy, varices
***W/ acute variceal bleeds, tx w/ IV octreotide (causes splanchnic vasoconstriction)

Ascites: tx w/ Na restriction, spironolactone, and loop diuretics

SBP: Ascitic fluid w/ >250neutrophils, commonly caused by E. coli, enterococci, Klebsiella

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85
Q

Ascites diagnosis w/ SAAG criteria

A

High gradient >1.1g/dL: Portal HTN

  • Cirrhosis
  • Portal vein thrombus
  • Budd-Chiari syndrome
  • CHF
  • Constrictive pericarditis

Low gradient <1.1g/dL: Nonportal HTN

  • Peritoneal carinomatosis
  • TB peritonitis
  • Pancreatic ascites
  • Bowel obstruction/infxn
  • Serositis
  • Nephrotic syndrome
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86
Q

Hemochromatosis problems

A

DM

Cirrhosis

Hypogonadotropic hypogonadism

Arthropathy

Cardiomyopathy

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87
Q

Middle aged woman w/ fatigue, pruritis, and elevated AP

A

Primary biliary cirrhosis

-AI disease causing destruction of small-medium bile ducts

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88
Q

What lab value is chronically elevated in sickle cell pts

A

WBC

2/2 chronic microvascular clots

*****VERY LOW THRESHOLD TO TX W/ ABX FOR THESE PTS

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89
Q

What type of pneumonia is assoc. w/ intravascular hemolysis?

A

Mycoplasma pneumoniae

-Also has the cold agglutinins

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90
Q

How to measure for pulsus paradoxus

A
  1. Inflate cuff beyond point where you hear any Korotkoff sounds
  2. Slowly deflate until you hear sounds.
  3. Note pressure at which you hear intermittent sounds
  4. Keep deflating till you hear a sound every beat
  5. Difference between 2 and 3 is pulsus paradoxus
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91
Q

Treatment of pericarditis

A

COLCIHINE and NSAIDs

-If pt had MI 2-3 wks ago, think of Dressler as cause

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92
Q

Abx to start on pt w/ hx of ESBL

A

Meropenem

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93
Q

ECMO indications

A

Acute hemodynamic deterioration
-Cardiogenic shock, cardiopulmonary arrest w/ severe pulmonary congestion

High risk percutaneous coronary intervention

Fulminant myocarditis presenting w/ cardiogenic shock

Post-cardiotomy circulatory failure

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94
Q

ECMO CIs

A

Significant aortic regurg

Severe peripheral arterial disease

Bleeding diathesis

Recent CVA or head trauma

Uncontrolled sepsis

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95
Q

Surgical obesity candidates

A

BMI >40

BMI >35 w/ DM, HTN, HLD, OSA, GERD, OA, NASH

-Must have psych eval, stop smoking, have tried lifestyle modifications

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96
Q

Roux-en-Y bypass

A

Results in 60-70% EXCESS weight loss

  • Must supplement Fe, B12, Ca-VitD
  • Good for reflux because the stomach is bypassed
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97
Q

Dumping Syndrome

A

Early: Sudden sugar is loaded into the small bowel
=»>Diarrhea

Late: Sugar is absorbed in massive amnt so insulin is released
=»Hypoglycemia

**Other complications of Roux-En-Y and G-sleeve include late strictures in ppl who continue smoking or use NSAIDs

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98
Q

Labs to order at 6 month intervals on post-gastric surgery pts

A 
CMP
CBC
B12
Ferritin
Folate
B12
PTH
Vit D
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99
Q

San-Fran Syncope Rule for Admission

A 
CHF
Hcrt <30% 
Bad EKG 
SOB
SBP <90
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100
Q

Tests to order on syncope pts

A 
EKG
? Carotid Sinus Massage 
Orthostatics 
Tilt table
Echo (if hx of structural disease)
Telemetry

CBC, BMP, BNP (dont need trop but it will probs be done by ED)

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101
Q

Reasons to evaluate for metastatic disease w/ prostate cancer diagnosis

A

PSA >20

PSA >10 with a T2 or higher tumor

Gleason score 8

T3 or T4 tumor

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102
Q

Hypereosinophilic Syndrome

A

Eosinophil count >1500 w/o 2/2 cause and evidence of organ

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103
Q

Causes of eosinophilia

A 
CT disease
Helminths 
Idiopathic (HES)
Neoplasia
Allergy
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104
Q

Management of SVT

A

Adenosine; also could try fluid Bolus

*Make sure to call cards as well

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105
Q

Consult presentation

A

Tell what’s happened, what you’re differential was, and what you have done

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106
Q

Contraindications to heparin

A

Active bleed (intracranial, abdominal, GI)

Severe bleeding diathesis

Severe ️Thrombocytopenia (<50,000)

Site and extent of trauma, time interval since event (up to pt judgment and depends on need of Anticoagulation)

Invasive procedure or obstetric procedure

Previous intracranial hemorrhage

Intracranial or spinal tumor

Neuraxial anesthesia

Severe, uncontrolled hTN

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107
Q

Lexiscan

A

Low affinity agonist of adenosine receptors causing ️increased ️coronary blood flow and mimics increase seen with exercise; used for cardiac stress testing

CIs: second/third degree AV block; sinus node dysfunction without a pacemaker

ADRs: cardiac condition disturbance, tachycardia, flushing, PVCs, chest discomfort, angina, headache, dyspnea (all common)

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108
Q

NYHA classes

A

I: No limitation during ordinary physical activity

II: Slight limitation of physical activity; develops fatigue or dyspnea w/ moderate exertion

III: Marked limitation of physical activity. Even light activity produces symptoms

IV: Symptoms at rest. Any activity causes worsening

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109
Q

Mechanisms of drugs in HF

A

BBs: Prevent and reverse adrenergically mediated intrinsic myocardial dysfnxn and remodeling

ACEI: Reduce pre/afterload and prevent remodeling
***INITIAL DOC for tx

Nitrates: Reduce preload and clear pulmonary congestion

Diuretics: Decrease preload

DIgoxin: Does not improve mortality

Spironolactone: Symptomatic relief in pts w/ class III or IV HF

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110
Q

Indications for ICD or pacers in HF

A

Cardiac resynchronization therapy (CHT): Decreased EF + widened QRS

ICD: Elevated risk of ventricular arrhythmia

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111
Q

When to call HF “diastolic dysfnxn”

A

When EF exceeds 40%

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112
Q

Most important RFs for PVD

A

Cigarette smoking

DM

-HTN, dysplipidemia, and elevated homocysteine also play role tho

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113
Q

Patients who need revascularization in PVD

A

ABI

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114
Q

Young woman who has arm claudication, Raynaud’s, fever, and weight loss

A

Takayasu arteritis; inflammatory condition of the aortic branches

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115
Q

Acute arterial occlusion signs

A 
Pain
Pallor
Pulselessness
Parasthesia
Poikilothermia
Paralysis
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116
Q

Causes of a-fib

A

Sick-sinus syndrome (tachy-brady syndrome)

Holiday heart (alcohol consumption/cardiomyopathy)

Stress or increased sympathetic tone (acute illness, pheo)

Pulmonary disease (especially PE)

Hyperthyroidism

Pericarditis

Ischemic Heart Disease

Structural heart disease (HTN, mitral disease)

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117
Q

A pt who is in a-fib for how long should be anticoagulated?

A

> 48 hrs

If planning to cardiovert the patient, patient should receive 3-4 weeks of anticoagulation BEFORE AND AFTER to reduce risk of embolism

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118
Q

Level to reverse INR at

A

9

-Give vitamin k

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119
Q

New diabetic drug that has black box warning for pancreatitis

A

Victoza (liraglutide)

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120
Q

Reasons to get repeat colonoscopy in 3 yrs

A

Villous adenoma

Multiple, tubular adenomas

One tubular adenoma >1cm in size

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121
Q

4 statin benefit groups

A
  1. Evidences of ASCVD (history of MI, stroke, angina, PVD, TIA, etc.)
  2. LDL >190
  3. DM age 40-75 w/ LDL 70-189
  4. 40-75 years w/ LDL 70-189 and estimated ASCVD 10 yr risk >7.5%
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122
Q

High intensity statin groups

A

1-2; 3-4 (if ASCVD >7.5%)

Lipitor (atorvastatin) 40-80

Crestor (rosuvastatin) 20-40

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123
Q

Moderate intensity statin group

A

1-2 (if CI to high-intesntity); 3-4 if ASCVD <7.5%

Lipitor (atorvastatin) 10-20

Pravachol (pravastatin) 40-80

124
Q

Statin monitoring

A

Baseline lipids (then every 6-12 months after)

Baseline LFTs, A1c, SCr, and CPK in pts with history or family history of statin side effects; also caution in pts w/ liver disease

LDL <40? =» Consider decreasing dose

125
Q

Q-SOFA criteria

A

AMS (GCS <15)

RR > 22

SBP < 100

126
Q

Things to do within 1hr of identify sepsis

A

Antibiotics; broad spectrum

Fluids; 30ml/kg via PIV w/ LR (monitor UOP)

Lactate (weak recommendation) >2 (
=» repeat in 2hrs; should go down by 10%

Vasopressors (start even before an IV bolus is done)

  • Levofed
  • Vasopressin (in addition to; not solely)
  • Phenylephrine (less chance of arrhythmia)
  • Dobutamine (use in specifically cardiogenic shock)
127
Q

Causes of nocturia

A

Disease: BPH, CHF, DM, OSA

Surgeries, irritants, fluids, lifestyle

Meds: Diuretics, Anticholinergics, Opioids, Sympathomemetics

128
Q

Alpha blockers for BPH

A

-zosins

***Tamsulosin is selective

ADRs: Retrograde ejaculation

129
Q

5-alpha reductase inhibitors

A
  • sterides
  • Should cause 50% reduction in PSA after 6 months

ADRs; ED, decreased libido

130
Q

Oxybutynin

A

Anticholinergic

ADRs; Urinary retention, dry eyes/mouth, constipation

131
Q

Sarcoidosis can cause what abnormal lab finding

A

Hypercalcemia

This is due to increased 1a-hydroxylation that increases the level of activated Vitamin D

132
Q

Bilateral adrenal hemorrhage

A

Patient who presents w/ GI disturbance, lethargy, weakness, hypotension, shock, hypoglycemia, and electrolyte imablances

RFs: Anticoagulant therapy, hemostasis abnormalities, sepsis

Imaging: Order abdominal CT

Tx: Stress-dose hydrocortisone (50-100mg q6hrs)

133
Q

Possible problem w/ long term opioid use

A

Hypogonadotropic hypogonadism

-Can possibly also cause secondary adrenal insufficiency

134
Q

3 screening tests for Cushings

A

1 mg dexamethasone suppression test

24hr urine free cortisol excretion

Evening salivary cortisol

135
Q

Positive urine anion gap with nonanion gap metabolic acidosis

A

Type I or Type IV RTA

136
Q

Type I RTA causes

A

Sjogrens

RA

137
Q

Type I RTA Tx

A

Alkalinization of urine

Citrate supplementation to prevent citrate stones (Pts have hypocitruria)

138
Q

Type IV RTA

A

Basically hyporeninemic hypoaldosteronism

Presents in diabetic Pts

Tx: low potassium diet; loop diuretics

139
Q

Alcoholic ketoacidosis Pathophysiology

A

️Decreased carb intake reduces insulin secretion and alcohol ️Inhibits gluconeogenesis

➡️ lipolysis and production of b-Hydroxybutyrate and some acetoacetate
⭐️Acetest is weakly positive

With treatment, acetoacetate worsens so it may seem like the acidosis is getting worse

140
Q

chronic respiratory acidosis rule

A

4-10 rule

Hco3 increases 4 for every 10 in pco2

141
Q

chronic respiratory alkalosis rule

A

5-10

Hco3 ️️Decreased 5 for every 10 decrease in pco2

142
Q

Way to check for NaCl response in metabolic alkalosis

A

Check urine Cl

If <10, they will respond

143
Q

Treatments for multiple myeloma

A

Stem cell transplant

Chemotherapy with high dose pulsed Dexamethasone and thalidomide/lenalidomide + bortezomib

144
Q

Minimal Change Disease

A

Causes: Idiopathic, NSAIDs, penicillins

Presentation: Usually acute, hypoalbuminemia, elevated cr, proteinuria, hypercholesterolemia

Path: Light Micro= Normal
EM= Effacement of the foot processes
IF= Negative

Tx: Steroids at 1mg/kg for at least 8 weeks

-Also use low salt diet, ACEI, and statins

145
Q

Focal Segmental GLomerulosclerosis

A

MC nephrotic syndrome in blacks and hispanics

Assos: HIV, heroin, SCA

Presentation: Edema over weeks; severe HTN

Path: Light micro= Focal scarring

Tx: Steroids alone or Cyclosporine/Tacrolimus for 6 months

146
Q

Membranous Nephropathy

A

MC nephrotic syndrome in whites

Assoc: Hep B/C, tumors, lupus, drugs
-Check LFTs, serology, ANA, C3 and C4, UDS, cancer screening, and anti-PLA2R abs

Path: Light= Thick GBM on stain
EM= Spike and dome
IF= Granular

Tx: Low risk => ACEI/ARB + Statin
High Risk =» Cyclophosphamide and prednisone altering; takes 6 months

147
Q

Membranoproliferative glomerulonephritis

A

2 types: Immune complex mediated and C3 mediated
UA shows dysmorphic RBCs and RBC casts

Immune: HBV/HCV, BCx, ANA

Also order SPEP levels

Path: Light micro= Tram tracking (big line down middle of glomerulus)
EM= Subendothelial deposits
IF= Commplement deposits (appear granular)

Tx: Treat underlying disease

148
Q

DM nephropathy

A

Light microscopy shows sclerosis of mesangium and Kimmelstiel-Wilson nodules

Tx: BG control, ACEI/ARB

149
Q

Diabetic medication that decreases CV mortality

A

Empagliflozin

Decreased CV death, CHF hospitalization, nephropathy, and microalbuminuria

150
Q

Incidentaloma protocol

A

Micro (<1cm): Measure prolactin (if negative, reimage in 6 months)

Macro: 8am cortisol, FT4, TSH, IGF-1 (if all negative and no symptoms, reimage in 12 months)

151
Q

Prolactinoma level

A

> 200

Other causes: Risperidone, primary hypothyroidism (increased TRH)

152
Q

Agars

A

Macconkey: Grows GNR

Chocolate (Thayer-Martin): Grows neisseria

153
Q

Diabetic foot infection tx

A

Mild =» Dicloxacillin, clindamycin, or Keflex for 1-2 weeks

Severe =» Vanc + Cefepime

**Never use wound vacs

154
Q

Multiple System Atrophy

A

Presentation: Akinetic-rigid parkinsonism, autonomic failure w/ urogenital dysfnxn, cerebellar ataxia, and pyramidal signs

  • Pts may have orthostatic hypotension, sleep apnea
  • Cause is unknown

***Can help diagnose by a parkinsons pt who has a POOR response to L-dopa

-In fact, diagnostic criteria is 1. parkinsonism, 2. urinary dysfnxn/orthostatic hypot 3. poor l dopa response

155
Q

EKG finding w/ PE

A

S1Q3T3

156
Q

What stage is a lung cancer if there is a malignant effusion?

A

Stage IV

157
Q

What can cause splenic microcaclifications?

A

Histoplasmosis

158
Q

Tx for hepatic encephalopathy

A

Lactulost +/- rifaximin

*Degree of NH4 in blood does not correlate w/ severity

159
Q

Ratio of spironolactone:lasix to give for abdominal ascites

A

40:100

160
Q

Becks Triad

A

Hypotension

Elevated JVD

Distant heart sounds

161
Q

Kussmaul Sign

A

Increased in JVD during inspiration

Associated w/ pericarditis

Will also hear a pericardial knock

162
Q

Imaging for pericarditis

A

MRI

163
Q

Constrictive Pericarditis

A

Inflammation and granulation tissue forming a thickend fibrotic adherent sac caused by radiation, viral infection, and uremia

164
Q

Immediate treatment for cardiac tamponade prior to pericardiocentesis

A

IV fluids

-Pts are preload dependent; helps them to maintain cardiac output

165
Q

Possible manifestations of aortic dissection

A

Horner syndrome
-compression of superior cervical ganglion

MI

Pericardial tamponade

Aortic regurg

Bowel ischemia, hematuria
-If it involves mesenteric or renal arteries

HTN

Hemiplegia
-carotid artery involvement

166
Q

When operative repair of AAA is indicated

A

> 5.5 cm or if expanding at greater than .5cm per year or if aneurysm is symptomatic

Surveillance = 3-12 month intervals depending on risk of rupture

167
Q

Management of DKA

A
  1. Fluids
    • over first hr, infuse 1-2L NS
    • Correct TBW deficit at rate of 250-500ml/hr
    • gentler hydration in pts w/ CHF or ESRD
  2. Insulin
    • Goal=glucose reduction of 80-100mg/dl/hr
    • Initial bolus of .1-.15U/kg
    • Followed by continuous insulin of .1U/kg/hr w/ hourly glucose
    • Slow rate to 0.05U/kg/hr when glucose levels are <300
    • Give D5W when glucose <300; insulin still needed for ketone resolution and the d5w will prevent hypoglycemia
    • Give subq insulin 30mins before stopping infusion to avoid rebound acidosis
  3. Bicarbonate
    • Only give if pH <7 or w cardiac instability, severe hyperkalemia
    • Bicarb can causes hypokalemia, paradoxical CNS acidosis
  4. Electrolytes
    • Total deficit of K, PO4, and Mg
    • Give K once [K]<5
    • Monitor cardiac fnxn
    • PO4 given if <1
    • Mg and Ca as needed
168
Q

How much stronger is dexamethasone relative to prednisone

A

4x

169
Q

Vax to give prior to splenectomy

A

H. flue, Neisseria, and S. pneumoniae 2 WEEKS BEFORE

-Also give plts and IVIG if splenectomy occurring due to ITP

170
Q

Platelet level at which spontaneous ICH can occur

A

<10

171
Q

Treatment for acute alcoholic hepatitis

A

Pentoxyfylline 400 TID

172
Q

Portal Vein Thrombosis

A

Symptoms: Maybe none, also maybe abdominal pain that is progressive, fever, dyspepsia, variceal bleeding,
Fever, chills, painful liver=septic PVT

Diagnosis: Doppler abdominal US (90%) sensitive or abdominal CT w/ contrast

Tx: Lovenox w/ transition to warfarin for 6 months ; can consider transition to oral NOAC if there is no underlying liver disease

173
Q

What electrolyte does dialysis not remove?

A

Phosphate

174
Q

BBs that you can use w/ cocaine-induced MI

A

Labetalol or carvedilol

-These also have a-blocking activity

175
Q

Tx of acute gout if there is CI to NSAIDs

A

Steroids

176
Q

More likely bacterial isolates for endocarditis

A

S. sanguinis, S. mutans

177
Q

Labs to check on DM pt who is receiving chronic blood transfusions, dialysis

A

Fructosamine

178
Q

Causes of generalized decreased I- uptake in thyroid

A

Exogenous admin of T4

Thyroiditis

179
Q

What fluid do you give someone w/ liver failure?

A

NS

LR contraindicated because the liver cant metabolize the lactate to HCO3

180
Q

Characteristics of primary scleorsing cholangitis

A

Affects young males

Involves large intra and extrahepatic ducts

Assoc. w/ UC

No serologic markers

Can lead to stricture, cholangitis, or cholangiocarcinoma

181
Q

Primary Biliary Cirrhosis characteristics

A

Affects older females

Located in smaller intrahepatic bile ducts

Assoc. w/ AI diseases like RA

Anti-mitochondrial antibody

Can lead to hepatic cirrhosis

182
Q

Good negative rule out for PCP

A

LDH < 220 =»> almost certainly NOT PCP

183
Q

Tx for acute PCP

A

Bactrim + Steroids

184
Q

Tx of cryptococcal meningitis

A

Ampho B + flucytosine

-Then chronic treatment w/ oral fluconazole

185
Q

Tx of MAC

A

Clarithromycin

-Azithromycin is for prophylaxis

186
Q

Nephrotic Syndrome

A

Protein >3.5 over 24hrs

Hypoalbuminemia (<3g/dl)

Hyperlipidemia

Edema

187
Q

Risks of nephropathy

A

Hypercoagulability 2/2 decreased ATIII and Proteins C and S

Increased infection risk 2/2 decrease gammaglobulins

Hypotransferrinemia =» IDE

Vit D deficiency 2/2 loss of vitamin-d binding protein

188
Q

24 hour ambulatory pressure consistent w/ HTN

A

125/75

189
Q

Hemorrhagic spinal fluid w/ symptoms of meningitis

A

HSV meningitis

190
Q

TB meningitis findings

A

Extremely low glucose
**Will fall even LOWER after 48 hrs so repeat LP if there has been no diagnosis in this timeframe

High protein

Low WBC

191
Q

Syndromes w/ positive ANA

A

Scleroderma

Sjogrens

Dermatomyositis

Polymyositis

SLE

192
Q

anti-RNP abs are w/ what disease?

A

MCTD

193
Q

STOP BANG

A

Snoring loudly
Tired during day
Observed stop breathing
Pressure

BMI>35
Age>50
Neck circumference >40cm
Gender (male)

194
Q

Diabetic patient who has tense edema on abdomen and scrotum, blisters, crepitus, and Bsx

A

Fournier Gangrene

Tx: Debridement, broad spectrum abx

-May ultimately require cystostomy, colostomy, or orchiectomy

195
Q

Patient on warfarin and is treated for COPD exacerbation who develops bleed

A

CORTICOSTEROIDS ELEVATE INR

196
Q

How much should Vitamin K reduce INR

A

2 units =» .5 INR

197
Q

Mcconell’s Sign

A

No squeezing of the R ventricle but the apex is still kicking on echo

=»> Indicative of Acute Pulmonary embolism

198
Q

Colchicine ADRs to warn gout pts about

A

Diarrhea

BM suppression

199
Q

Spine sign

A

Appearance of radioopaque lumbar vertebrae relative to the superior vertebrae on lateral xray

=»Very indicative of infectious process

200
Q

Tx for vaginal symptoms of menopause

A

Topical estrogen

201
Q

RA patient who has splenomegaly, pancytopenia, and lymphadenopathy

A

Felty Syndrome

-Typically w/ severe, nodule forming RA on the extensor surfaces

202
Q

Young man who has morning stiffness in back that worsens with rest

A

Ankylosing spondylitis

Xray would likely show sacroiliitis w/ increased sclerosis around the sacroiliac joints

203
Q

Venofer

A

Iron sucrose

204
Q

Hyde’s Syndrome

A

GI bleed + AS

205
Q

Indications for aortic valve replacement

A

Area = 400m/s

Pressure gradient >40mmHg

206
Q

Which type of HCV can we treat?

A

Genotype 1

207
Q

Type of stool softener to use w/ bowel obstruction

A

Osmotic

208
Q

How long does FFP last?

A

8 hrs

209
Q

What does the ventricle do with cardiac tamponade?

A

Diastolic collapse

210
Q

When do you treat w/ bisphosphonates?

A

Only once osteoporosis is actually diagnosed

Or w/ FRAX score >20% or hip break score >3%

211
Q

Patient with episodic flushing, wheezing, and diarrhea

A

Carcinoid tumor

-Order 5-HIAA test

212
Q

VIPoma

A

Neuroendocrine, pancreatic tumor producing watery diarrhea and hypokalemia

213
Q

Treatment of chronic pancreatitis induced malabsorption

A

Pancreatic enzyme supplementation

214
Q

Patrick maneuver

A

Externally rotate patients hip and cross their leg

  • Basically make a number 4
  • Helps to illicit pain in the sacroiliac joint
215
Q

With what condition does erythema multiforme minor occur?

A

HSV

216
Q

What drugs can SJS occur with?

A

Any, but most common sulfa drugs and NSAIDs

217
Q

Serum sickness

A

Type III HSN rxn characterized by fever, polyarthralgia, urticaria, lymphadenopathy, and glomerulonephritis

Tx: Anithistamines; aspirin

218
Q

How to prevent IV dye allergy

A

Pretreatment w/ diphenhydramine 12hrs before study

219
Q

DUKE Criteria

A

Endocarditis w/ (+)2 major, 1 major and 3 minor, or 5 minor

Major:

Isolation of typical organisms (viridans, enterococci, S. bovis, or HACEK) from two separate blood cultures, or persistently positive cultures with other organisms

Evidence of endocardial involvement either w/ echocardiogram evidence or new valvular regurgitation

Minor:

Predisposing valvular lesion

Fever

Vascular phenomena (PE, mycotic aneurysm, Janeway lesions)

Immunologic phenomena (glomerulonephritis, Osler nodes, Roth Spots, positive RF

Positive blood cultures not meeting major criteria

220
Q

Indications for surgical management of endocarditis

A

Intractable CHF

> 1 serious systemic embolic episode

> 10mm vegetation w/ high risk of embolism

Uncontrolled infection (positive cx after 7 days of therapy)

No effective antimicrobials (fungal endocarditis)

Prosthetic valve infxn

Local suppurative complications (abscess formation)

221
Q

IVF rate for acute pancreatitis

A

250-300ml/hr

222
Q

What to tell patients you start on Warfarin

A

Reversible

Susceptible to CYP inhibition so must check other meds

Daily checks

Avoid green leafy vegetables

Better if you have increased risk of major bleed

223
Q

Parexa

A

Factor Xa reversal for Xarelto; still VERY EXPENSIVE

224
Q

What should you do if paracentesis gets >5L?

A

Give 7g of albumin at 5; 7 more for every L after

225
Q

Patient who is having tense abdominal cramps and is a hippie

A

Hyperemesis cannabis

Tx: Shower

“Take a shower, ya dirty hippie”

226
Q

Should you give oral or IV steroids for COPD?

A

Just give oral as long as they can take it

227
Q

Ways to evaluate fall risk

A

STRATIFY Scale for Identifying Fall Risk Factors

or

Morsse Fall Scale

…however, do not give excessive focus on score

228
Q

RBBB treatment

A

Asymptomatic=none

Syncope= Consider pacemaker

229
Q

MCTD antibody

A

Anti-U1 ribonucleoprotein

230
Q

Perioperative insulin

A

Usually give about half the daily insulin dose and hold any short acting (give whatever type the patient takes_

  • During surgery, patients should have D5W at 100cc/hr w/ frequent intraoperative accuchecks
  • For long procedures, patients usually require IV insulin
231
Q

Autoimmune polyglandular syndrome

A

Causes adrenal insufficiency; typically have antibodies to all 3 zones of the adrenal gland

232
Q

Bartter’s Syndrome

A

Presents in childhood w/

Growth and mental retardation
Hypokalemia
Metabolic alkalosis
Polyuria, polydipsia

Path: Defect in NaCl reabsorption in the thick ascending limb in the loop of Henle; volume depletion leads to secondary hyperaldosteronism resulting in increased urinary K+ loss and H+ secretion

233
Q

Gitelman’s Syndrome

A

AR disorder presenting w/ hypokalemia, metabolic alkalosis, hypomagnesemia, hypocalciuria but this is not usually diagnosed until late childhood/adulthood

Clinical: Arm/leg cramping due to electrolyte abnormalities
Fatigue
Polyuria, nocturia
Chondrocalcinosis (due to hypomagnesemia)

Path: Dysfunction of the NaCl

234
Q

Workup for PVC

A

Workup for structural heart disease; treatment of this will typically decrease amount of PVCs

Typically though, you can use BB to reduce symptoms, however, there is no evidence that this improves survival

235
Q

Vestibular neuritis

A

Postviral inflammatory disorder that is acute, spontaneous, and characterized by rapid onset of vertigo w/ n/v and gait instability

PE: Horizontal/torsional nystagmus suppressed w/ visual fixation
-Fast phase beats AWAY from affected side
Rapid turning of head toward side of lesion causes inability to maintain visual fixation (eyes will drift from examiner)

Tx: Corticosteroids typically shorten duration; symptomatic otherwise w/ physical therapy

236
Q

Things to tell pts when starting bisphosphonates

A

Take the medicine on an empty stomach, with a large quantity of water, and remain upright for 30 minutes

237
Q

Factors of an acceptable screening test

A
  1. Condition must be important health problem
  2. Should be an effective treatment
  3. Available and affordable facilities
  4. Needs to be preclinical stage when disease can be detected
238
Q

Outpatient CAP treatment

A

Azithro 500 BID

-COPD/DM/CHF/Liver disease/Cancer: Macrolide + Doxy and Augmentin or LVQ for 5 days

239
Q

Inpatient CAP treatment

A

Order cultures, Urine antigen testing, CXR

Empiric: Rocphin/Ceftaroline/Unasyn + Macrolide then target

Treat for 7 days

240
Q

Treatment of aspiration pneumonia

A

Unasyn or Oral Augmentin/Metro+ Amox

241
Q

Antibiotic management of diverticulitis

A

FQN + metro

or

Augmentin

242
Q

Labs to order in euvolemic hyponatremia before calling it SIADH

A

Cortisol

TSH

243
Q

Reason pts get hyponatremia following surgery

A

Transient increase in ADH secretion

244
Q

Hepatotoxic dose of acetaminophen

A

10g

4g in those w/ preexisiting liver injury

245
Q

BiPAP

A

EPAP (splints the airway open) + IPAP (pressure pushing air in_

Difference b/w two pressures determines volume delivery

-Used for COPD (bronchoconstriction, increased dead space, mechanical failure), OHS, CHF, ARDS

246
Q

Low risk calculator for PE

A

PERC

Hormones
Age >50
DVT
Coughing blood 
LE swelling 
O2 <95%
Tachycardia 
Surgery

-If negative for all of these, probably doesnt need workup

247
Q

Dose of tPA for massive PE

A

100mg/2hrs

248
Q

Tx of diverticulitis

A

Outpt =»Augmentin

Inpt =» Ceftriaxone + Metronidazole (consider Zosyn if severe)

Sx? =» Hartmann’s Pouch

249
Q

What follow up do patients w/ diverticulitis need?

A

Colonoscopy 4-8 weeks after recover (1 in 100 have occult cancer)

250
Q

AVNRT

A

P wave is buried in QRS

1: 1 conduction
- Can consider vagal maneuver, adenosine, CCB, BB

251
Q

AVRT

A

Inverted retrograde P waves following QRS

Can consider: vagal maneuvers, adenosine, CCB, BBs

252
Q

Junctional tachycardia

A

Inverted p wave before or after QRS or buried in QRS complex

Can consider: dilt, BBs, treat underlying cause definitively

253
Q

Hidradenitis Suppurativa treatment

A

️Topical clinda

Tetracycline

Oral clinda + rifampin

Adalimumab

Retinoic

254
Q

Treatment for Bells Palsy

A

Eye patch while sleeping

Artificial tears

Prednisone 1mg/kg/day for 7-10 days

255
Q

Anticoagulant to use in patients w/ DVT and significant renal disease

A

Heparin

256
Q

Westermark sign

A

Dilation of proximal pulmonary vessels w/ collapse of distal vasculature in PE

257
Q

Hampton Hump

A

Triangular, rounded pleural-based infiltrate w/ its apex pointed towards the hilum seen in PE

258
Q

EKG findings on PE

A

T wave inversion in leads V1-V4

RBBB

S1Q3T3

259
Q

Well’s Criteria

A

Suspected DVT

Alternate diagnosis less likely

Tachycardia

Immobilization/surgery in past 4 weeks

Hemoptysis

Malignancy

260
Q

PERC

A

Age <50

Pulse <100

SaO2>94

No unilateral leg swelling

No hemoptysis

No recent trauma/surgery

No prior PE/DVT

No hormone use

261
Q

Indirect CT venography

A

Exposes to more radiation but in PIOPED II showed increase in sensitivity to 83-90% (specificity still 96%) when down w/ CTA

-Greatest benefit is suggested to be in sicker patients, centers w/ less experience, and older equipment

262
Q

ABG in PE

A

CAN BE NORMAL; DOES NOT EXCLUDE

263
Q

UTI med to avoid in patients over 65

A

Macrobid

-Can cause AMS

264
Q

Azilect

A

Rasiligine
-MAO-B inhibitor

-Has experimental evidence of neuroprotective effects which may delay the onset and progression of dementia

ADRs: Orthostatic hypotension, headache, nausea, dyskinesia

CIs: Meperidine, methadone, tramadol, cyclobenzaprine, dextromethorphan, or other MAO-B inhibitor use

265
Q

Phenobarbital for alcohol withdrawal

A

Associated w/ shorter ICU stays ( 2 days), overall hospital stays, and decreased risk of invasive ventilation requirement

-Has a long half life; do not need to use anti-epileptic dosing

266
Q

Prehn’s SIgn

A

Relief of testicular pain w/ elevation of the testis

-Seen in epididymitis

267
Q

Bell clapper deformity

A

When the epididymis is not totally connected to the testicle so it floats freely in the ballsac =» torsion

268
Q

NPO

A

Nil per os

269
Q

Mackler Triad

A

Vomiting

Lower CP

Subcutaneous emphysema

270
Q

Classic GI cocktail

A

Antacid

Lidocaine

H2 blocker

271
Q

Appearance of POCUS in pneumothorax

A

Curtain-drawing appearance

272
Q

Other EKG finding in pericarditis

A

Isolated PR elevation in aVR; diffuse PR depression

273
Q

Hamman crunch

A

Heart beat w/ loud crunching sound; consistent w/ spontaneous pneumomediastinum

274
Q

J wave

A

Small, upwards deflection after the QRS seen in hypothermia

275
Q

Med to give patient coding who is on dialysis

A

Calcium chloride

-Pt likely has hyperkalemia

276
Q

Milrinone

A

Used as inotropic medicine

Dose:
(Loading) 50mcg/kg over 10mins

MoA: Phosphodiesterase inhibitor in cardiac and vascular tissue that results in vasodilation and inotropic effects w/ little chronotropic activity

277
Q

Chronotrope

A

Medication that changes the electrical activity of the heart

278
Q

Acute Chest Syndrome criteria

A

Two of the following:

New lobar or segmental pulmonary infiltrate or focal abnormality on CXR

Fever >101.3

Respiratory symptoms

Hypoxemia

Chest pain

279
Q

Management of priapism due to sickle cell disease

A

Pain management

Aspiration of corpus cavernosum

Irrigation of corpus cavernosum w/ epinephrine

Urology consult

Consider exchange transfusion

280
Q

Fluids to give someone w/ ACS in sickle cell disease

A

Hypotonic; do not bolus

281
Q

THING TO CALCULATE ON ALL UREA STUDIES

A

FENA AND FEUREA YAH DINGUS

282
Q

Epinephrine dosing for anaphylaxis

A

.01mg/kg; up to 3 doses in first 5 mins

Usually about .3-.5mg

283
Q

Icatibant

A

Bradykinin receptor antagonist that reduces inflammation

Particularly promising for ACEI induced angioedema

284
Q

Terbutaline

A

Selective B2-agonist

May be preferable w/ acute asthma exacerbations and have not responded to inhaled agonists

285
Q

Singulair

A

Montelukast; leukotriene antagonist

286
Q

Trauma history pneumonic

A 
A-llergies 
M-edications 
P-MH 
L-ast meal 
E-vents leading up to and involving accident
287
Q

Narcotic Bowel Syndrome

A

Paradoxical worsening abdominal pain in the setting of opioid use

-Manage by tapering off opioids, exercise, laxatives, stress reduction

288
Q

Statin to give people who had statin-induced myopathy

A

Rosuvastatin; is water soluble and should therefore not go into the tissues

289
Q

MC ADR of lithium

A

Multinodular goiter

290
Q

ARDS definition criteria

A

PaO2/FiO2 < 300

291
Q

PA cath measurement parameters

A 
CVP 
RAP 
RVP 
Pulmonary artery pressure 
PCWP
CO 
SVO2 
Indirectly: SVR, CI

-Indications include unexplained volume shock, severe cardiogenic shock, or presence of pulm htn on echo

***However, no survival benefit w/ monitoring

292
Q

What must be given to patient’s who require multiple blood transfusions for hypovolemic shock?

A

Albumin 25 g

293
Q

Risk factors for candidemia

A

Ruptured viscus

Upper GI surgery

Indwelling lines w/ TPN

Prior use of broad-spectrum abx

Blood transfusion

Neutropenia

Hematological malignancy

Hemodialysis

Burns

Prior enteric bacteremia

Recent fluconazole use

294
Q

MARS Hepatic Support System

A

Bioartificial liver that utilizes veno-venal dialysis concept that basically acts as a temporary liver in fulminant hepatic failure

295
Q

King’s College Hospital Criteria

A

Criteria for hepatic transplantation:

pH <7.3 after resuscitation irrespective of encephalopathy

or

PT >100seconds and creatinine >300umol/L in patients w/ Grade III or Grade IV encephalopathy

296
Q

Predictor for successful weaning from ventilator

A

NIF <25cmH2O

297
Q

Goal plateau pressure in patients on vent

A

<30cmH2O

298
Q

What to do if patient starts destabilizing immediately after extubation?

A

Try NIV before reintubating

299
Q

AMS pneumonic

A 
Withdrawal 
Infection
Toxins/drugs
CNs path
Hypoxia

Heavy metals
Acute vascular insult
Trauma

300
Q

Propofol infusion syndrome

A

Rhabdomyolysis, acute renal failure, lactic acidosis, and hemodynamic instability following prolonged propofol infusion of >48hrs or high dose infusion >5mg/kg/hr

301
Q

Vent settings if hypercapnic

A

Increase IPAP by 2cm increments

302
Q

Vent settings if hypoxemic

A

Increase IPAP and EPAP by 2cm intervals

303
Q

Upper limit of IPAP on vent

A

20-25cm H2O

304
Q

Maximal EPAP on vent

A

10-15cm H2O

305
Q

Starting FiO2 level on vent

A

100%; decrease as pt tolerates

306
Q

Respiratory rate on vent

A

12-16

Depends on CO2 though

Residency (5 decks)

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