UW 13 Flashcards
How does acute massive PE present?
Syncope
Shock
Cath values in acute massive PE
High RA and PA pressure
Normal PCWP
Hypovolemic shock Cath values
Low intravascular volume
Low RA, RV, PA, PCWP
High SVR
Cardiogenic shock cath values
High PCWP, SVR
Low CO
Septic shock cath values
Peripheral VD
High CO
Low SVR
Low RA, PA, PCWP
HIV testing
- ELISA
2. Western Blot = confirm
Pulmonary Cavitation in HIV
M.TB Atypical Mycobacteria Nocardia Gram - Rods Anaerobes
Nocardia
Gram +
Weakly acid fast
Filamentous branching Rod
Immunocompromised hosts
Tx for Nocardia
TMP-SMX
Lack of response to progestin withdrawl =
Low estrogen
Staph Scalded Skin Syndrome
Pathophys
Presentation
Toxin targets desmoglein 1 = keratinocyte adhesion in superficial epidermis
Prodrome of fever, irritability and skin tenderness
Erythema starts on face -> genearlizes 24-48 hours
Superficial flaccid blisters develop
Nikolsky sign +
Impetigo pressentation
Flaccid blisters
Honey colored crusted lesion
Nikolsky -
TX for Hairy cell leukemia
Cladribine - Purine analog
AE’s of Cladribine
Neuro
Renal
Opioid Presentation
Miosis
Depressed mental status
Depressed RR, bowel sounds
HypoTN, Bradycardia
Best predictor of intoxication in opioid toxicity
Respiratory Rate
Conditions that cause V/Q Mismatch
Pulmonary embolism
Atelectasis
Pleural Effusion
Pulmonary Edema
A-a gradient and acid base in
V/Q mismatch
A-a increas
Acid base seen in Alveolar hypoventilation
Respiratory Acidosis
High PaCO2
Low PaO2 - may just be this alone, 50-80
Causes of Alveolar Hypoventilation and Respiratory Acidosis
Pulmonary/thoracic dz: COPD, OSA, Obesity hypoventilation, scoliosis
NM Dz: MG, Lambert-Eaton, GBS
Drugs: Anesthetics, narcotics, sedaties
Primary CNS dysfnc: Brainstem lesion, infxn, stroke
What does A-a gradient measure
PAO2 - PzO2
Measures oxygen transfer from alveoli to blood
What is a normal A-a gradient
< 15
Causes of hypoxemia
Reduced inspired oxygen tension Hypoventilation Diffusion limitation Shunt V/Q mismatch
What is the most common presentation of Primary Hyperparathyroidism (PH)
Asymptomatic 80%
How to differentiate PH from familial hypocalciuric hypercalcemia
24-hour urinary calcium
> 250 = PH
< 100 = Familial
TX for Asymptomatic PH
Surgery (parathyroidectomy) if 1+
- Serum Calcium >1mg/dL above upper limit
- Young < 50yoa
- BMD < -2.5 any site
- Reduced Renal Fnc (GFR < 50mL/min)
When is bisphosphonates the TX in PH
- Refuse surgery
2. Hx of oxteopenia/osteoporosis
Presentation of hypercalcemia in malignancy (labs)
Low PTH
mod-severe Hypercalcemia = > 13
Presentation and pathophys of hypercalcemia due to immobilization
Immobilized pt
Pre-existing high bone turnover
Median onset - 4 wks
High bone turnover = increased osteoclastic activation
TX for hypercalcemia due to immobilization
- Hydration
2. Bisphosphonates
Presentation of Ehrlichiosis
Tick bite - white tail deer SE and SC US (Arkansas) Flu-like illness - febrile, malaise Neuro sx's No rash
Labs in Ehrlichiosis
Leukopenia
Thrombocytopenia
High LFTs
High LDH
DX for Ehrlichiosis
Intracytoplasmic morulae in WBCs
PCR
TX for Ehrlichiosis
Doxycycline
2nd line = Chloramphenicol
Presentation for RMSF
Maculopapular rash involving palms and soles after fever
Do we vaccinate pts w influenza that are symptomatic (moderate to severe)
No. CDC recommends agasint it
TX for influenza
Oseltamivir, Zanamivir (NA inhibitor) - If pt presents w/in 48 hrs of onset OR - sx's not improving or high risk IC'd, pregnant, > 65, Native American
TX for Bartonella henselae
Azithromycin
Eschar presentation
moderate full thickness burn w pain and swelling = eschar constriction
Management for Eschar
- IVF
- Analgesics
- Topical Abx and wound dressing
- Monitor for signs of healing
- Doppler US for peripheral pulses and compartment pressure
- 25-40 = threshold for escharotomy
ABO incompatibility seen in?
Group O Mother
Group A or B Baby
A and B Ags are antigenic - mother forms IgG abs to A or B = cross placenta
EEG w sharp, triphasic and synchronous discharges
Creutzfeldt-Jakob Disease
Creutzfeldt Jakob Presentation
Rapidly progressive dementia
Myoclonus
Sharp, triphasic synchronous discharges on EEG
Acne TX
- Topical retinoids, salicylic
- benzoyl peroxide
- Topical Abx = erythromycin, clindamycin
- Oral Abx
- Oral isotretinoin = only for unresponsive severe
TX for acne that is severe or nodular OR moderate acne unresponsive to topical Abx
Oral Abx
MOA of spirnolactone
Blocks effects of testosterone at receptor
MC symptoms of MR
Exertional dyspnea
Fatigue
- Decreased CO and increased LA Pressure
Pt with MR + dry cough
Pulmonary congestion/edema
Severe dz
LV dysfnc
What does PCWP measure
LA Pressure
LVEDV
Hypovolemic shock findings
HypoTN Tachycardia Low CO High SVR Low CVP, PCWP
Bacteria in IE w nosocomial UTI, cytoscopy
Enterococcus
Differentiate b/t IM and Primary HIV infxn
Rash and diarrhea = less common in IM
Tonsillar exudates = uncommon in primary HIV
