Tidbits Flashcards
1
Q
Top 3 causes of acidosis
A
LA
Uremia
DKA
2
Q
Fiorcet
A
Acetaminophen + butalbital + caffeine
3
Q
Reynalds pentad
A
RUQ tenderness Jaundice Fever Shock (hypotension or tachycardia) AMS
4
Q
Becks triad
A
Hypotension
Distended neck veins
Muffled heart sounds
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
6
Q
Immediate differential for syncope
A
Arrhythmia
Stroke
Anemia
GI bleed
Vasovagal
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
8
Q
️EMERGENCY dialysis indications
A
Overload
Electrolyte abnormalities
9
Q
Increased qrs without electrical criteria for BBB
A
Interventricular conduction defect
10
Q
Length of time it takes av fistulas to mature
A
6 weeks
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
12
Q
When should you not screen for a Cancer if you suspect it
A
If their 10 yr survival rate is low
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
14
Q
HPV screening ages
A
21-30: Pap q3yrs
30-65: HPV + pap q5yrs
15
Q
Mammography screening
A
Digital q2yrs from 50-75
16
Q
HCV ab screen
A
Everybody born between 1945-1965
17
Q
Yamaguchi syndrome
A
Apical variant of HCM; has large qrs complexes and deep, spike like t wave inversions
18
Q
Versed generic
A
Midazolam
19
Q
Tx of thyroid storm
A
- Propanolol
- PTU/methimazole
- Iodide
- Cortisone
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
21
Q
Tiny PERC mnemonic
A
Hormones Age > 50 DVT or PE history Coughing blood Leg swelling O2 sats <95% Tachycardia, trauma Surgery
22
Q
Nausea med to use in acute gastritis
A
Raglan
Has anti gastroparesis qualities
23
Q
Empiric treatment of endometritis
A
Rocephin and flagyl
24
Q
Ehrlichia lab findings
A
Leukopenia
Increased LFTs
️Thrombocytopenia
25
Labs to order for sudden headache
CBC, BMP, coags, toxicology, EKG, ct head
26
HAV presentation
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
27
EKG findings with pulmonary hTN
RAD
Sinus tachycardia
Right atrial overload (peaked p waves in V2)
️Decreased limb voltage
28
Mandela effect
Fake memories reinforced by social communities, false news, and misleading photographs
29
Labs to order in suspected stroke
```
Ct head
Glucose
BMP, CBC
Lipids
EKG
Trops
PT/INR
O2 sat
```
Also consider b-hCG, UDS, blood alcohol, ABG, ️️CXR, and EEG
30
Exclusion criteria for tPA
```
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
```
31
chronic bronchitis definition
Persistent cough and sputum for > 3 months a year in 2 consecutive years
32
Latuda
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
33
Taivicay
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,
34
Truvada
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
35
Diuretic contraindicated in gout
Thiazides
36
RA diagnostic criteria
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)
37
️Chronic treatment of gout
Probenecid
38
Pts who need a statin
1. Known athersclerotic disease
2. DM patients age 40-75 with ldl > 190
3. 10 year ASCVD risk >7.5% and ldl 70-190
39
Best medicine to raise HDL
Nicotinic acid (15-30%)
40
Best medicines to lower TGLs
Fenofibrate/Gemfibrozil
25-40% lower
⭐️can cause gallstones, increased LFTs
⭐️increased risk of myalgia when used with statins
41
Medicine that prevents cholesterol absorption
Ezetimibe
Lowers ldl by 15%
42
Bentyl
Dicyclomine
Used for IBS
43
Empiric MRSA Tx
1. Vanc
2. Daptomycin
3. Linezolid
44
Activity against GNR and anaerobes
1. Unasyn
2. Zosyn
3. 3rd generation cephalosporin and flagyl
4. FQN and flagyl
45
Unasyn
Ampicillin and Sulbactam
46
Medication to prescribe for patient on ️Chronic high dose prednisone
Bactrim
47
How long should sutures stay in
7-10 days
48
Cefodroxil
1st gen cephalosporin used to Tx UTI, joint infxn, skin and suture infxn
49
Lopressor
Metoprolol tartrate
Immediate release
50
Toprol
Metoprolol Succinate
XR
51
Imitrex
Sumatriptan
52
1st line prophylaxis for ️Chronic daily headache
Amitryptiline
53
Medication for AMS in geriatric Pts
Risperidal
54
Valium
Diazepam
55
Red flag back pain signs
Age > 70
Hx of malignancy
Hx of osteoporosis
Weight loss
LE weakness
Fever
Signs of RF
IVDA
56
Big R waves in V1-V6
Indicative of past MI
57
Pentad of TTP
1. Fever
2. Thrombocytopenia
3. Schistocytes
4. AMS
5. Renal problems
58
Albumin needed for transfusion w/ hypoalbuminemia
25%
59
NSTEMI LOVENOX DOSING
1MG/KG Q 12H
60
Dyspepsia
Upper abdominal GI pain
61
Reasons to order endoscopy in pts with new-onset dyspepsia
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
62
Treatment of peptic ulcer
Omeprazole + clarithromycin +metronidazole or amoxicillin
Penicillin allergy? =>> Bismuth subsalicylate + metronidazole + tetracycline
63
Causes of digital clubbing
1. Lung cancer (and by far the most common)
2. Bronchiectasis
3. Chronic lung abscess
64
Horner syndrome
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
65
Chest pain in lung cancer suggests what?
Pleural involvement or neoplastic invasion of the chest wall
66
Squamous cell carcinoma
- Central lesion
- Localized symptoms caused by bronchial obstruction (atelectasis, pneumonia)
- Cavitary lesions
* Produces PTHrP
67
Adenocarcinoma characteristics
Peripherally located
Mets early (CNS, bones, adrenals)
**LOWEST ASSOCIATION W SMOKING
68
Large Cell Carcinoma characteristics
Peripheral lesion
Mets to CNS, mediastinum
=>> SVC SYNDROME AND/OR HOARSENESS W COMPRESSION OF LARYNGEAL NERVE
69
Monitoring of solitary pulmonary nodule
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
70
Amount of insulin to administer w/ hypokalemia
10 units + 1amp glucose
71
Xanax dose in first time for pt
.25 TID
72
Treatment for pts w/o parathyroid glands
Ca2+ AND calcitriol
73
Midodrine
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
74
Contraction alkalosis
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
75
Broca's aphasia
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
76
Agrammatism
Lack of full sentences; sometimes call "telegraphic speech"
"tree...children...run"- describing a park
77
Wernicke's aphasia
Fluent aphasia w/ markedly impaired comprehension
Voluminous but meaningless speech (word salad) w/ neologisms
78
Conduction aphasia
Fluent aphasia w/ preserved comprehension BUT w/ impaired repetition
79
Transcortical motor aphasia
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
80
Transcortical sensory aphasia
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
81
Indications for chest tube drainage
Empyema
Positive Gram stain or cx of thoracentesis sample
Presence of loculations
pH < 7.2
Glucose <60
LDH >1000
82
Point at which to remove a chest tube draining fluid
Drainage rate <50mL/day
83
Treatment for multiloculated empyemas
4-6 weeks of abx
tPA, DNAase to help clear loculations
-Can use VATS if tPA and DNAase fail to clear them
84
Complications of cirrhosis
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
85
Ascites diagnosis w/ SAAG criteria
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
86
Hemochromatosis problems
DM
Cirrhosis
Hypogonadotropic hypogonadism
Arthropathy
Cardiomyopathy
87
Middle aged woman w/ fatigue, pruritis, and elevated AP
Primary biliary cirrhosis
-AI disease causing destruction of small-medium bile ducts
88
What lab value is chronically elevated in sickle cell pts
WBC
2/2 chronic microvascular clots
*****VERY LOW THRESHOLD TO TX W/ ABX FOR THESE PTS
89
What type of pneumonia is assoc. w/ intravascular hemolysis?
Mycoplasma pneumoniae
-Also has the cold agglutinins
90
How to measure for pulsus paradoxus
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
3. Keep deflating till you hear a sound every beat
4. Difference between 2 and 3 is pulsus paradoxus
91
Treatment of pericarditis
COLCIHINE and NSAIDs
-If pt had MI 2-3 wks ago, think of Dressler as cause
92
Abx to start on pt w/ hx of ESBL
Meropenem
93
ECMO indications
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
94
ECMO CIs
Significant aortic regurg
Severe peripheral arterial disease
Bleeding diathesis
Recent CVA or head trauma
Uncontrolled sepsis
95
Surgical obesity candidates
BMI >40
BMI >35 w/ DM, HTN, HLD, OSA, GERD, OA, NASH
-Must have psych eval, stop smoking, have tried lifestyle modifications
96
Roux-en-Y bypass
Results in 60-70% EXCESS weight loss
- Must supplement Fe, B12, Ca-VitD
- Good for reflux because the stomach is bypassed
97
Dumping Syndrome
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
98
Labs to order at 6 month intervals on post-gastric surgery pts
```
CMP
CBC
B12
Ferritin
Folate
B12
PTH
Vit D
```
99
San-Fran Syncope Rule for Admission
```
CHF
Hcrt <30%
Bad EKG
SOB
SBP <90
```
100
Tests to order on syncope pts
```
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)
101
Reasons to evaluate for metastatic disease w/ prostate cancer diagnosis
PSA >20
PSA >10 with a T2 or higher tumor
Gleason score 8
T3 or T4 tumor
102
Hypereosinophilic Syndrome
Eosinophil count >1500 w/o 2/2 cause and evidence of organ
103
Causes of eosinophilia
```
CT disease
Helminths
Idiopathic (HES)
Neoplasia
Allergy
```
104
Management of SVT
Adenosine; also could try fluid Bolus
*Make sure to call cards as well
105
Consult presentation
Tell what's happened, what you're differential was, and what you have done
106
Contraindications to heparin
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
107
Lexiscan
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)
108
NYHA classes
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
109
Mechanisms of drugs in HF
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
110
Indications for ICD or pacers in HF
Cardiac resynchronization therapy (CHT): Decreased EF + widened QRS
ICD: Elevated risk of ventricular arrhythmia
111
When to call HF "diastolic dysfnxn"
When EF exceeds 40%
112
Most important RFs for PVD
Cigarette smoking
DM
-HTN, dysplipidemia, and elevated homocysteine also play role tho
113
Patients who need revascularization in PVD
ABI
114
Young woman who has arm claudication, Raynaud's, fever, and weight loss
Takayasu arteritis; inflammatory condition of the aortic branches
115
Acute arterial occlusion signs
```
Pain
Pallor
Pulselessness
Parasthesia
Poikilothermia
Paralysis
```
116
Causes of a-fib
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)
117
A pt who is in a-fib for how long should be anticoagulated?
>48 hrs
If planning to cardiovert the patient, patient should receive 3-4 weeks of anticoagulation BEFORE AND AFTER to reduce risk of embolism
118
Level to reverse INR at
9
-Give vitamin k
119
New diabetic drug that has black box warning for pancreatitis
Victoza (liraglutide)
120
Reasons to get repeat colonoscopy in 3 yrs
Villous adenoma
Multiple, tubular adenomas
One tubular adenoma >1cm in size
121
4 statin benefit groups
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%
122
High intensity statin groups
1-2; 3-4 (if ASCVD >7.5%)
Lipitor (atorvastatin) 40-80
Crestor (rosuvastatin) 20-40
123
Moderate intensity statin group
1-2 (if CI to high-intesntity); 3-4 if ASCVD <7.5%
Lipitor (atorvastatin) 10-20
Pravachol (pravastatin) 40-80
124
Statin monitoring
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-SOFA criteria
AMS (GCS <15)
RR > 22
SBP < 100
126
Things to do within 1hr of identify sepsis
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
Causes of nocturia
Disease: BPH, CHF, DM, OSA
Surgeries, irritants, fluids, lifestyle
Meds: Diuretics, Anticholinergics, Opioids, Sympathomemetics
128
Alpha blockers for BPH
-zosins
***Tamsulosin is selective
ADRs: Retrograde ejaculation
129
5-alpha reductase inhibitors
- sterides
- Should cause 50% reduction in PSA after 6 months
ADRs; ED, decreased libido
130
Oxybutynin
Anticholinergic
ADRs; Urinary retention, dry eyes/mouth, constipation
131
Sarcoidosis can cause what abnormal lab finding
Hypercalcemia
This is due to increased 1a-hydroxylation that increases the level of activated Vitamin D
132
Bilateral adrenal hemorrhage
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
Possible problem w/ long term opioid use
Hypogonadotropic hypogonadism
-Can possibly also cause secondary adrenal insufficiency
134
3 screening tests for Cushings
1 mg dexamethasone suppression test
24hr urine free cortisol excretion
Evening salivary cortisol
135
Positive urine anion gap with nonanion gap metabolic acidosis
Type I or Type IV RTA
136
Type I RTA causes
Sjogrens
RA
137
Type I RTA Tx
Alkalinization of urine
Citrate supplementation to prevent citrate stones (Pts have hypocitruria)
138
Type IV RTA
Basically hyporeninemic hypoaldosteronism
Presents in diabetic Pts
Tx: low potassium diet; loop diuretics
139
Alcoholic ketoacidosis Pathophysiology
️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
chronic respiratory acidosis rule
4-10 rule
Hco3 increases 4 for every 10 in pco2
141
chronic respiratory alkalosis rule
5-10
Hco3 ️️Decreased 5 for every 10 decrease in pco2
142
Way to check for NaCl response in metabolic alkalosis
Check urine Cl
If <10, they will respond
143
Treatments for multiple myeloma
Stem cell transplant
Chemotherapy with high dose pulsed Dexamethasone and thalidomide/lenalidomide + bortezomib
144
Minimal Change Disease
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
Focal Segmental GLomerulosclerosis
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
Membranous Nephropathy
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
Membranoproliferative glomerulonephritis
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
DM nephropathy
Light microscopy shows sclerosis of mesangium and Kimmelstiel-Wilson nodules
Tx: BG control, ACEI/ARB
149
Diabetic medication that decreases CV mortality
Empagliflozin
Decreased CV death, CHF hospitalization, nephropathy, and microalbuminuria
150
Incidentaloma protocol
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
Prolactinoma level
>200
Other causes: Risperidone, primary hypothyroidism (increased TRH)
152
Agars
Macconkey: Grows GNR
Chocolate (Thayer-Martin): Grows neisseria
153
Diabetic foot infection tx
Mild =>> Dicloxacillin, clindamycin, or Keflex for 1-2 weeks
Severe =>> Vanc + Cefepime
**Never use wound vacs
154
Multiple System Atrophy
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
EKG finding w/ PE
S1Q3T3
156
What stage is a lung cancer if there is a malignant effusion?
Stage IV
157
What can cause splenic microcaclifications?
Histoplasmosis
158
Tx for hepatic encephalopathy
Lactulost +/- rifaximin
*Degree of NH4 in blood does not correlate w/ severity
159
Ratio of spironolactone:lasix to give for abdominal ascites
40:100
160
Becks Triad
Hypotension
Elevated JVD
Distant heart sounds
161
Kussmaul Sign
Increased in JVD during inspiration
Associated w/ pericarditis
Will also hear a pericardial knock
162
Imaging for pericarditis
MRI
163
Constrictive Pericarditis
Inflammation and granulation tissue forming a thickend fibrotic adherent sac caused by radiation, viral infection, and uremia
164
Immediate treatment for cardiac tamponade prior to pericardiocentesis
IV fluids
-Pts are preload dependent; helps them to maintain cardiac output
165
Possible manifestations of aortic dissection
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
When operative repair of AAA is indicated
>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
Management of DKA
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
How much stronger is dexamethasone relative to prednisone
4x
169
Vax to give prior to splenectomy
H. flue, Neisseria, and S. pneumoniae 2 WEEKS BEFORE
-Also give plts and IVIG if splenectomy occurring due to ITP
170
Platelet level at which spontaneous ICH can occur
<10
171
Treatment for acute alcoholic hepatitis
Pentoxyfylline 400 TID
172
Portal Vein Thrombosis
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
What electrolyte does dialysis not remove?
Phosphate
174
BBs that you can use w/ cocaine-induced MI
Labetalol or carvedilol
-These also have a-blocking activity
175
Tx of acute gout if there is CI to NSAIDs
Steroids
176
More likely bacterial isolates for endocarditis
S. sanguinis, S. mutans
177
Labs to check on DM pt who is receiving chronic blood transfusions, dialysis
Fructosamine
178
Causes of generalized decreased I- uptake in thyroid
Exogenous admin of T4
Thyroiditis
179
What fluid do you give someone w/ liver failure?
NS
LR contraindicated because the liver cant metabolize the lactate to HCO3
180
Characteristics of primary scleorsing cholangitis
Affects young males
Involves large intra and extrahepatic ducts
Assoc. w/ UC
No serologic markers
Can lead to stricture, cholangitis, or cholangiocarcinoma
181
Primary Biliary Cirrhosis characteristics
Affects older females
Located in smaller intrahepatic bile ducts
Assoc. w/ AI diseases like RA
Anti-mitochondrial antibody
Can lead to hepatic cirrhosis
182
Good negative rule out for PCP
LDH < 220 =>>> almost certainly NOT PCP
183
Tx for acute PCP
Bactrim + Steroids
184
Tx of cryptococcal meningitis
Ampho B + flucytosine
-Then chronic treatment w/ oral fluconazole
185
Tx of MAC
Clarithromycin
-Azithromycin is for prophylaxis
186
Nephrotic Syndrome
Protein >3.5 over 24hrs
Hypoalbuminemia (<3g/dl)
Hyperlipidemia
Edema
187
Risks of nephropathy
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
24 hour ambulatory pressure consistent w/ HTN
125/75
189
Hemorrhagic spinal fluid w/ symptoms of meningitis
HSV meningitis
190
TB meningitis findings
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
Syndromes w/ positive ANA
Scleroderma
Sjogrens
Dermatomyositis
Polymyositis
SLE
192
anti-RNP abs are w/ what disease?
MCTD
193
STOP BANG
Snoring loudly
Tired during day
Observed stop breathing
Pressure
BMI>35
Age>50
Neck circumference >40cm
Gender (male)
194
Diabetic patient who has tense edema on abdomen and scrotum, blisters, crepitus, and Bsx
Fournier Gangrene
Tx: Debridement, broad spectrum abx
-May ultimately require cystostomy, colostomy, or orchiectomy
195
Patient on warfarin and is treated for COPD exacerbation who develops bleed
CORTICOSTEROIDS ELEVATE INR
196
How much should Vitamin K reduce INR
2 units =>> .5 INR
197
Mcconell's Sign
No squeezing of the R ventricle but the apex is still kicking on echo
=>>> Indicative of Acute Pulmonary embolism
198
Colchicine ADRs to warn gout pts about
Diarrhea
BM suppression
199
Spine sign
Appearance of radioopaque lumbar vertebrae relative to the superior vertebrae on lateral xray
=>>Very indicative of infectious process
200
Tx for vaginal symptoms of menopause
Topical estrogen
201
RA patient who has splenomegaly, pancytopenia, and lymphadenopathy
Felty Syndrome
-Typically w/ severe, nodule forming RA on the extensor surfaces
202
Young man who has morning stiffness in back that worsens with rest
Ankylosing spondylitis
Xray would likely show sacroiliitis w/ increased sclerosis around the sacroiliac joints
203
Venofer
Iron sucrose
204
Hyde's Syndrome
GI bleed + AS
205
Indications for aortic valve replacement
Area = 400m/s
Pressure gradient >40mmHg
206
Which type of HCV can we treat?
Genotype 1
207
Type of stool softener to use w/ bowel obstruction
Osmotic
208
How long does FFP last?
8 hrs
209
What does the ventricle do with cardiac tamponade?
Diastolic collapse
210
When do you treat w/ bisphosphonates?
Only once osteoporosis is actually diagnosed
Or w/ FRAX score >20% or hip break score >3%
211
Patient with episodic flushing, wheezing, and diarrhea
Carcinoid tumor
-Order 5-HIAA test
212
VIPoma
Neuroendocrine, pancreatic tumor producing watery diarrhea and hypokalemia
213
Treatment of chronic pancreatitis induced malabsorption
Pancreatic enzyme supplementation
214
Patrick maneuver
Externally rotate patients hip and cross their leg
- Basically make a number 4
- Helps to illicit pain in the sacroiliac joint
215
With what condition does erythema multiforme minor occur?
HSV
216
What drugs can SJS occur with?
Any, but most common sulfa drugs and NSAIDs
217
Serum sickness
Type III HSN rxn characterized by fever, polyarthralgia, urticaria, lymphadenopathy, and glomerulonephritis
Tx: Anithistamines; aspirin
218
How to prevent IV dye allergy
Pretreatment w/ diphenhydramine 12hrs before study
219
DUKE Criteria
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
Indications for surgical management of endocarditis
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
IVF rate for acute pancreatitis
250-300ml/hr
222
What to tell patients you start on Warfarin
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
Parexa
Factor Xa reversal for Xarelto; still VERY EXPENSIVE
224
What should you do if paracentesis gets >5L?
Give 7g of albumin at 5; 7 more for every L after
225
Patient who is having tense abdominal cramps and is a hippie
Hyperemesis cannabis
Tx: Shower
"Take a shower, ya dirty hippie"
226
Should you give oral or IV steroids for COPD?
Just give oral as long as they can take it
227
Ways to evaluate fall risk
STRATIFY Scale for Identifying Fall Risk Factors
or
Morsse Fall Scale
...however, do not give excessive focus on score
228
RBBB treatment
Asymptomatic=none
Syncope= Consider pacemaker
229
MCTD antibody
Anti-U1 ribonucleoprotein
230
Perioperative insulin
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
Autoimmune polyglandular syndrome
Causes adrenal insufficiency; typically have antibodies to all 3 zones of the adrenal gland
232
Bartter's Syndrome
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
Gitelman's Syndrome
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
Workup for PVC
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
Vestibular neuritis
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
Things to tell pts when starting bisphosphonates
Take the medicine on an empty stomach, with a large quantity of water, and remain upright for 30 minutes
237
Factors of an acceptable screening test
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
Outpatient CAP treatment
Azithro 500 BID
-COPD/DM/CHF/Liver disease/Cancer: Macrolide + Doxy and Augmentin or LVQ for 5 days
239
Inpatient CAP treatment
Order cultures, Urine antigen testing, CXR
Empiric: Rocphin/Ceftaroline/Unasyn + Macrolide then target
Treat for 7 days
240
Treatment of aspiration pneumonia
Unasyn or Oral Augmentin/Metro+ Amox
241
Antibiotic management of diverticulitis
FQN + metro
or
Augmentin
242
Labs to order in euvolemic hyponatremia before calling it SIADH
Cortisol
TSH
243
Reason pts get hyponatremia following surgery
Transient increase in ADH secretion
244
Hepatotoxic dose of acetaminophen
10g
4g in those w/ preexisiting liver injury
245
BiPAP
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
Low risk calculator for PE
PERC
```
Hormones
Age >50
DVT
Coughing blood
LE swelling
O2 <95%
Tachycardia
Surgery
```
-If negative for all of these, probably doesnt need workup
247
Dose of tPA for massive PE
100mg/2hrs
248
Tx of diverticulitis
Outpt =>>Augmentin
Inpt =>> Ceftriaxone + Metronidazole (consider Zosyn if severe)
Sx? =>> Hartmann's Pouch
249
What follow up do patients w/ diverticulitis need?
Colonoscopy 4-8 weeks after recover (1 in 100 have occult cancer)
250
AVNRT
P wave is buried in QRS
1: 1 conduction
- Can consider vagal maneuver, adenosine, CCB, BB
251
AVRT
Inverted retrograde P waves following QRS
Can consider: vagal maneuvers, adenosine, CCB, BBs
252
Junctional tachycardia
Inverted p wave before or after QRS or buried in QRS complex
Can consider: dilt, BBs, treat underlying cause definitively
253
Hidradenitis Suppurativa treatment
️Topical clinda
Tetracycline
Oral clinda + rifampin
Adalimumab
Retinoic
254
Treatment for Bells Palsy
Eye patch while sleeping
Artificial tears
Prednisone 1mg/kg/day for 7-10 days
255
Anticoagulant to use in patients w/ DVT and significant renal disease
Heparin
256
Westermark sign
Dilation of proximal pulmonary vessels w/ collapse of distal vasculature in PE
257
Hampton Hump
Triangular, rounded pleural-based infiltrate w/ its apex pointed towards the hilum seen in PE
258
EKG findings on PE
T wave inversion in leads V1-V4
RBBB
S1Q3T3
259
Well's Criteria
Suspected DVT
Alternate diagnosis less likely
Tachycardia
Immobilization/surgery in past 4 weeks
Hemoptysis
Malignancy
260
PERC
Age <50
Pulse <100
SaO2>94
No unilateral leg swelling
No hemoptysis
No recent trauma/surgery
No prior PE/DVT
No hormone use
261
Indirect CT venography
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
ABG in PE
CAN BE NORMAL; DOES NOT EXCLUDE
263
UTI med to avoid in patients over 65
Macrobid
-Can cause AMS
264
Azilect
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
Phenobarbital for alcohol withdrawal
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
Prehn's SIgn
Relief of testicular pain w/ elevation of the testis
-Seen in epididymitis
267
Bell clapper deformity
When the epididymis is not totally connected to the testicle so it floats freely in the ballsac =>> torsion
268
NPO
Nil per os
269
Mackler Triad
Vomiting
Lower CP
Subcutaneous emphysema
270
Classic GI cocktail
Antacid
Lidocaine
H2 blocker
271
Appearance of POCUS in pneumothorax
Curtain-drawing appearance
272
Other EKG finding in pericarditis
Isolated PR elevation in aVR; diffuse PR depression
273
Hamman crunch
Heart beat w/ loud crunching sound; consistent w/ spontaneous pneumomediastinum
274
J wave
Small, upwards deflection after the QRS seen in hypothermia
275
Med to give patient coding who is on dialysis
Calcium chloride
-Pt likely has hyperkalemia
276
Milrinone
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
Chronotrope
Medication that changes the electrical activity of the heart
278
Acute Chest Syndrome criteria
Two of the following:
New lobar or segmental pulmonary infiltrate or focal abnormality on CXR
Fever >101.3
Respiratory symptoms
Hypoxemia
Chest pain
279
Management of priapism due to sickle cell disease
Pain management
Aspiration of corpus cavernosum
Irrigation of corpus cavernosum w/ epinephrine
Urology consult
Consider exchange transfusion
280
Fluids to give someone w/ ACS in sickle cell disease
Hypotonic; do not bolus
281
THING TO CALCULATE ON ALL UREA STUDIES
FENA AND FEUREA YAH DINGUS
282
Epinephrine dosing for anaphylaxis
.01mg/kg; up to 3 doses in first 5 mins
Usually about .3-.5mg
283
Icatibant
Bradykinin receptor antagonist that reduces inflammation
Particularly promising for ACEI induced angioedema
284
Terbutaline
Selective B2-agonist
May be preferable w/ acute asthma exacerbations and have not responded to inhaled agonists
285
Singulair
Montelukast; leukotriene antagonist
286
Trauma history pneumonic
```
A-llergies
M-edications
P-MH
L-ast meal
E-vents leading up to and involving accident
```
287
Narcotic Bowel Syndrome
Paradoxical worsening abdominal pain in the setting of opioid use
-Manage by tapering off opioids, exercise, laxatives, stress reduction
288
Statin to give people who had statin-induced myopathy
Rosuvastatin; is water soluble and should therefore not go into the tissues
289
MC ADR of lithium
Multinodular goiter
290
ARDS definition criteria
PaO2/FiO2 < 300
291
PA cath measurement parameters
```
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
What must be given to patient's who require multiple blood transfusions for hypovolemic shock?
Albumin 25 g
293
Risk factors for candidemia
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
MARS Hepatic Support System
Bioartificial liver that utilizes veno-venal dialysis concept that basically acts as a temporary liver in fulminant hepatic failure
295
King's College Hospital Criteria
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
Predictor for successful weaning from ventilator
NIF <25cmH2O
297
Goal plateau pressure in patients on vent
<30cmH2O
298
What to do if patient starts destabilizing immediately after extubation?
Try NIV before reintubating
299
AMS pneumonic
```
Withdrawal
Infection
Toxins/drugs
CNs path
Hypoxia
```
Heavy metals
Acute vascular insult
Trauma
300
Propofol infusion syndrome
Rhabdomyolysis, acute renal failure, lactic acidosis, and hemodynamic instability following prolonged propofol infusion of >48hrs or high dose infusion >5mg/kg/hr
301
Vent settings if hypercapnic
Increase IPAP by 2cm increments
302
Vent settings if hypoxemic
Increase IPAP and EPAP by 2cm intervals
303
Upper limit of IPAP on vent
20-25cm H2O
304
Maximal EPAP on vent
10-15cm H2O
305
Starting FiO2 level on vent
100%; decrease as pt tolerates
306
Respiratory rate on vent
12-16
Depends on CO2 though
