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Sub I Wards > Wards Study Guide > Flashcards

Wards Study Guide Flashcards

1
Q

AIDS pt with diffuse infiltrates on CXR

A

Toxo
PCP
MAC

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2
Q

AIDs pt with diffuse pulmonary infiltrates and fever. Likely Dx? What do you do?

A

Dx: Likely PCP
Do:
Isolate. Start Bactrim and await final dx

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3
Q

Empiric Coverage for Diabetic pt with foot ulcer/sepsis?

A

Vanc/Mero
Vancomycin + Imipenem/Piperacillin+Tazobactam/Aztreonam + Metronidazole
Surgical Debridement Early (May require revascularization or amputation)

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4
Q

Lady with urosepsis- > started on Zosyn -> Cx come back in 2 days with E.Coli susceptible to Amp and other things, what do you do?

A

D/C Zosyn and use Amp

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5
Q

How to dx true catheter UTI if symptomatic?

A

UCx with >100000 cfu/ml regardless of UA
OR
UCx with 1000cfu/ml with evidence of pyuria on UA (+Leukocyte esterase and/or nitrites)

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6
Q

Gram positive diplococci in pairs seen on CSF. What abx do you start?

A

Ceftriaxone + Vancomycin

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7
Q

Lady with sepsis and s.pyogenes superficial fasciitis s./p debridement. Contact or General Precautions?

A

Contact Precautions if wound is large and with drainage

If minor, general

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8
Q

Full thickness pressure ulcer with eschar on patient. Next Step: Debridement or Wound Vac?

A

Debridement => need to remove necrotic tissue for wound vac to even be considered

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9
Q

What is Fever?

A

38.3C

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10
Q

FUO is most commonly

A 
Infectious
Autoimmune
Neoplastic
Drugs
Factitious
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11
Q

Central Line Infection most likely cause?

A

Staph

Get gram + coverage => Vanco

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12
Q

When do you use vanc?

A 
Culture proven infxn
Clinical signs and symptoms of infection due to resistant pathogen
MRSA/Pneumococcus
Quinolone ppx
Intensive chemotherapy patients
Hypotension or CV compromise
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13
Q

Empiric therapy for Neutropenic Fever?

A

Combo: Piperacillin + Gentamicin/Tobramycin/Amikacin
Mono: Imipenem, Meropenem, Cefepime, Ceftazidime

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14
Q

Neutropenic fever not responding to imipenem or big gun abx?

A

If not effective after 5d of treatment => think Fungal!

Empiric Coverage with:
Amphotericin B
Voriconazole
Capsofungin

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15
Q

Gram + Causes of Neutropenic fever

A

Coag Neg Staph, MRSA, S.Pneumo, Corynebacterium, Streptococci, Enterococci

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16
Q

Gram - Causes of Neutropenic Fever

A

E.Coli, Klebsiella, Pseudomonas, Enterobacter

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17
Q

Anaerobes causing neutropenic fever

A

C.Diff

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18
Q

Fungal causes of neutropenic fever

A

Candidda

aspergillus

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19
Q

MC reaction to blood products? What should you do?

A

Febrile Non-Hemolytic Reaction

Give Acetaminophen before platelet transfusion

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20
Q

Infectious Diseases with Blood Transfusion (Most to Least)

A

HepB > HTLV, Hep C, HIV

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21
Q

WHO Step 3 Ladder

Level 1

A

VAS of 1-3 (MILD)

Use: NSAIDs, ASA, Tylenol

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22
Q

Max dose of acetaminophen?

A

3g per 24 hrs

1.5 for patients with underlying liver dz

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23
Q

WHO Step 3 Ladder

Level 2

A

VAS 4-8 (Moderate)
Use:
Percocet (Oxycodone + Acetaminophen)
Norco/Vicodin/Lortab (Hydrocodone + Acetaminophen)
Tramadol (Ultram)
Tylenol #2,3,4 (Codeine 15,30,60 + Acetaminophen)

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24
Q

WHO Step 3 Ladder

Level 3

A 
VAS 8-10 (SEVERE)
Use:
Morphine: PO, IV, IM, Suppository
Hydromorphone: "  "
Oxycodone: PO /suppository
Fentanyl: TD/IV/CNS/Candy(Transmucosal)
*Safest drug in liver and kidney failure!
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25
Q

Methadone side effects

A

Prolongs QT=> Torsades

Respiratory Depression

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26
Q

What is Demerol Used for?

A

Meperidine
Post-Op rigors
Hem-Onc Post Transfusion (not for pain)

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27
Q

PO administration of opiates

A

Feel Effects in 30 mins
Peak in 1.5-2 hours
Wear off in 3-4 hrs

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28
Q

IV Administration of Opiates

A

Feel Effects in 5-10 mins
Peak in 30 minutes
Wear off in 2-3 hrs

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29
Q

Long Acting Formulations of Opiates

A 
Morphine -> MS-Contin
Oxycodone -> Oxycontin
Fentanyl
Hydromorphone
Hydrocodone
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30
Q

Dosing of Long Acting Opiates

A 
q12hours dosing
\+
Breakthrough Dose (10-15% of 24 hour dose0
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31
Q

TD Fentanyl Dosing

A

12mcg/hr ->25 ->50 ->75 ->100

Relief in 18-24 hours
Dose q72hrs

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32
Q

PCA Basal Morphine Dose?

A

Patient’s 24 hour PO Morphine Equivalent -> divide by 3 to convert to IV -> divide by 24

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33
Q

PCA Demand Morphine dose?

A

50% of basal rate (Ex: 10mg/hr basal rate => 5mg demand dose)

Lockout q10mins

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34
Q

Gold Standard Morphine Dose IV?

A

10mg IV

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35
Q

How to calculate Fentanyl Patch dose?

A

PO Morphine 24 hour total -> Divide by 2 -> xxxmcg/hr fentanyl path dose

Ex:
50mg morphine in 24 hrs -> 25mcg/hr fentanyl TD

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36
Q

SE of Meperedine

A

CNS Excitability -> Seizures
Renally Excreted (Do NOT USE in renal insufficiency)
Tachycardia (Atropine derivative)
Serotonin Syndrome (with MAOis, SSRIs)

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37
Q

Adjuvant Pain Therapy Options

A

Neuropathic: Gabapentin, TCA, Benzos, Flexeril, Lidocaine patch

Exercise
Heat Pack
distraction
Spiritual Therapy
Psychologist
38
Q

HTN Emergency?

A

> 180/120 with end organ damage

39
Q

HTN Urgency?

A

Severe HTN without end organ damage

40
Q

Tx for HTN Emergency

A

Rapidly lower DBP to 100-110 (1-6 hrs)

41
Q

Tx for HTN Urgency

A

Slowly lower DBP to 100-110 (24-48 hrs)

42
Q

HTN Emergency + Acute MI

Tx?

A

Nitros

AVOID: BB, hydralazine

43
Q

HTN Emergency + Pulm Edema

Tx?>

A

Nitro

Loop Diuretics

44
Q

HTN Emergency + CHF. Which meds can you use?

A 
IV Loop Diuretic (Furosemide)
IV Vasodilators (Nitroprusside)
IV Nitroglycerin
ACE-i (Enalapril)
Fenoldopam
45
Q

HTN Emergency + CHF. Which meds should you avoid and why?

A

AVOID
Hydralazine: inc HR
Beta Blcoker: decreases contractility
**Nitroprusside: if acute renal failure due to cyanide toxicity

46
Q

Signs and symptoms of Cyanide Toxicity

A 
Hypotension
Metabolic Acidosis (Lactic Acidosis)
47
Q

Medications use in Aortic dissection

A

Beta Blocker: ESMOLOL > Labetalol/Propranolol

AFTER BB:
Vasodilator (Nitroprusside)

48
Q

Problem with using ACE-i and K+Sparing Diuretic together

A

Hyperkalemia!

49
Q

Patient with BP of 160 but no complaints?

A

Continue outpatient HTN meds

50
Q

Anti-HTN Meds to start in patient with with angina?

A

BB/CCB

51
Q

Anti HTN Meds to start post MI in patient?

A

BB
ACE-i
Aldosterone Antagonist

52
Q

Anti HTN Meds for patient with edema?

A

Diuretic + Restrict Na to 2g daily

53
Q

Patient with mechanical valve, infection, fever, heart murmur. next step?

A

TTE -> then TEE

54
Q

Glycemic Control of Critically Sick Inpatient Patients

A

Therapy Goal: 140-180

55
Q

Non-Critically Sick Patients Glycemic Goal

A

Premeal: <140
Random: <180

56
Q

Which PO antidiabetic medication can you give to hospitalized patient?

A

Thiazolidinediones (Glitazones)

57
Q

Impact of renal failure on glycemic control?

A

Decreased Insulin Clearance
Decreased gluconeogenesis
Result: HYPOGLYCEMIA

58
Q

Changes in insulin dose based on GFR

A

> 30: no change
15-29: Reduce to 70%
<15 or Dialsysi: Reduce to 50%

59
Q

Effects of glucocorticoids on gycemic control:

A

Hyperglycemia

Inc gluconeogenesis -> inc fasting glucose
Inhibit glucose uptake in adipose tissue -> inc postprandial glucose

60
Q

Glycemic Control of Patient on Continuous Tube Feeds

A

BG check q6hrs
Decrease total dose
10% if glucose <120
20% if glucose <80

If clear liquid diet + tubes : give 1 unit for each 15g carbs

61
Q

Glcyemic control of patient once tube feed is stopped

A

Give IVF with same amount of glucose

62
Q

Features of DKA

A 
Ketosis, Acidosis, Dehydration
Hyperglycemia (>450)
AG Met Acidosis (pH<7.3)
Serum Bicarb (<15)
Ketones
Fruity Breath
Kussmaul Resp
AMS
63
Q

Tx List for DKA

A

IVF, Insulin, Potassium

64
Q

Features of HHS

A 
Hyperosmolar, Osmotic Diuresis, Profound Dehydration
Hyperglycemia (>600)
Serum pH normal
Bicarb normal
Hyperosmolarity (>320osm)
65
Q

Tx of HHS

A

aggressive IVF

low dose insulin

66
Q

Hypothermia in diabetic patient

A

Hypothyroidism

Sepsis

67
Q

Tx of DKA

A

Initial IV Insulin Bolus: 0.1u/kg IBW
Insulin Drip: 0.1u/khg IBW/hr
IVF: NS if normal CV function, 1/2 NS if decreased CV Function
Potassium: IV 40mEq/L if patient not oliguric

68
Q

Tx of DKA once BG < 200

A

Switch IVF to D5NS

Switch to subq insulin after 12-16 hrs

69
Q

Acute Rehab

A

Patient requiring intensive medical program and >3hrs of PT per day
In special rehab facility

70
Q

Subacute Rehab

A

Patient requiring <3hrs PT per day

Can be in rehab facility, qualified NH

71
Q

Day Rehab

A

Outpatient full or half days of PT 3-5 days a week

72
Q

Fluid Replacement Options

A

0.9NS: 154mEq NaCl
LR: Na,Cl,K,Ca,HCO3, higher pH, lower osm
Hypertonic Saline: 1/2NS + Glucose (77mEq Na)

73
Q

Serum Osm

A

2Na + Glucose/18 + BUN/2.8

74
Q

FeNa

A

(Una/Pna)/(Ucr/Pcr)

75
Q

UOsm in Euvolemic Hyponatremia

A

Low

76
Q

Causes of Euvolemic Hyponatremia

A 
SIADH
Medication: opiates, thiazides
Hypothyroidism
Adrenal Insufficiency
Beer Potomania, Tea and Toast Diet
77
Q

Causes of Hypovolemic Hyponatremia

A

Renal Loss: Diuretics, osmotic diuresis, adrenal insufficiency, cerebral salt wasting

Extrarenal losses:
NVD
Sweating
Blood Loss
third Spacing
78
Q

Causes of Hypervolemic Hyponatremia

A 
Pregnancy
Cirrhosis
Nephrosis
CHF
Renal Failure
79
Q

Max rate of Na increase when treating Hyponatremia

A

No more than 6mEq/L per 24 hrs

80
Q

Bicarb vs Normal Saline?

A

Bicarb if pH <6.9

Also for QRS prolongation or severe metabolic acidosis

81
Q

AIDs patient with hyponatremia

A

SIADH

82
Q

What electrolyte problem can furosemide cause?

A 
Hypokalemia
Metabolic Alkalosis (Hypochloremic)
83
Q

How to treat hypokalemia?

A

PO better than IV

Max 10mEq/L/hr through IV
Max 20mEq/L/hr through central line

CHECK Mg LEVELS!

84
Q

At what level can hypercalcemia cause problems?

A

> 15

85
Q

Pathophysiology of hypercalcemia causing dehydration

A

Downregulates vasopressin receptors -> Nephrogenic DI -> loss of free water -> hypercalcemia- > renal failure

86
Q

Tx of Hypercalcemia

A

Volume Expansion with IVF

87
Q

Tx for Status Epilepticus

A

IV Benzo

88
Q

IVDA with acute onset bilat LE paralysis, compressive cord lesion, and osteo?

A

Surgical Decompression

Abx

89
Q

Dependence?

A

Withdrawal at cessation

90
Q

Tolerance

A

Increased dose required for analgesia

91
Q

Addiction

A

impaired functioning

Sub I Wards (3 decks)

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