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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
Methadone side effects
Prolongs QT=> Torsades | Respiratory Depression
26
What is Demerol Used for?
Meperidine Post-Op rigors Hem-Onc Post Transfusion (not for pain)
27
PO administration of opiates
Feel Effects in 30 mins Peak in 1.5-2 hours Wear off in 3-4 hrs
28
IV Administration of Opiates
Feel Effects in 5-10 mins Peak in 30 minutes Wear off in 2-3 hrs
29
Long Acting Formulations of Opiates
``` Morphine -> MS-Contin Oxycodone -> Oxycontin Fentanyl Hydromorphone Hydrocodone ```
30
Dosing of Long Acting Opiates
``` q12hours dosing + Breakthrough Dose (10-15% of 24 hour dose0 ```
31
TD Fentanyl Dosing
12mcg/hr ->25 ->50 ->75 ->100 Relief in 18-24 hours Dose q72hrs
32
PCA Basal Morphine Dose?
Patient's 24 hour PO Morphine Equivalent -> divide by 3 to convert to IV -> divide by 24
33
PCA Demand Morphine dose?
50% of basal rate (Ex: 10mg/hr basal rate => 5mg demand dose) Lockout q10mins
34
Gold Standard Morphine Dose IV?
10mg IV
35
How to calculate Fentanyl Patch dose?
PO Morphine 24 hour total -> Divide by 2 -> xxxmcg/hr fentanyl path dose Ex: 50mg morphine in 24 hrs -> 25mcg/hr fentanyl TD
36
SE of Meperedine
CNS Excitability -> Seizures Renally Excreted (Do NOT USE in renal insufficiency) Tachycardia (Atropine derivative) Serotonin Syndrome (with MAOis, SSRIs)
37
Adjuvant Pain Therapy Options
Neuropathic: Gabapentin, TCA, Benzos, Flexeril, Lidocaine patch ``` Exercise Heat Pack distraction Spiritual Therapy Psychologist ```
38
HTN Emergency?
>180/120 with end organ damage
39
HTN Urgency?
Severe HTN without end organ damage
40
Tx for HTN Emergency
Rapidly lower DBP to 100-110 (1-6 hrs)
41
Tx for HTN Urgency
Slowly lower DBP to 100-110 (24-48 hrs)
42
HTN Emergency + Acute MI | Tx?
Nitros | AVOID: BB, hydralazine
43
HTN Emergency + Pulm Edema Tx?>
Nitro | Loop Diuretics
44
HTN Emergency + CHF. Which meds can you use?
``` IV Loop Diuretic (Furosemide) IV Vasodilators (Nitroprusside) IV Nitroglycerin ACE-i (Enalapril) Fenoldopam ```
45
HTN Emergency + CHF. Which meds should you avoid and why?
AVOID Hydralazine: inc HR Beta Blcoker: decreases contractility **Nitroprusside: if acute renal failure due to cyanide toxicity
46
Signs and symptoms of Cyanide Toxicity
``` Hypotension Metabolic Acidosis (Lactic Acidosis) ```
47
Medications use in Aortic dissection
Beta Blocker: ESMOLOL > Labetalol/Propranolol AFTER BB: Vasodilator (Nitroprusside)
48
Problem with using ACE-i and K+Sparing Diuretic together
Hyperkalemia!
49
Patient with BP of 160 but no complaints?
Continue outpatient HTN meds
50
Anti-HTN Meds to start in patient with with angina?
BB/CCB
51
Anti HTN Meds to start post MI in patient?
BB ACE-i Aldosterone Antagonist
52
Anti HTN Meds for patient with edema?
Diuretic + Restrict Na to 2g daily
53
Patient with mechanical valve, infection, fever, heart murmur. next step?
TTE -> then TEE
54
Glycemic Control of Critically Sick Inpatient Patients
Therapy Goal: 140-180
55
Non-Critically Sick Patients Glycemic Goal
Premeal: <140 Random: <180
56
Which PO antidiabetic medication can you give to hospitalized patient?
Thiazolidinediones (Glitazones)
57
Impact of renal failure on glycemic control?
Decreased Insulin Clearance Decreased gluconeogenesis Result: HYPOGLYCEMIA
58
Changes in insulin dose based on GFR
>30: no change 15-29: Reduce to 70% <15 or Dialsysi: Reduce to 50%
59
Effects of glucocorticoids on gycemic control:
Hyperglycemia Inc gluconeogenesis -> inc fasting glucose Inhibit glucose uptake in adipose tissue -> inc postprandial glucose
60
Glycemic Control of Patient on Continuous Tube Feeds
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
Glcyemic control of patient once tube feed is stopped
Give IVF with same amount of glucose
62
Features of DKA
``` Ketosis, Acidosis, Dehydration Hyperglycemia (>450) AG Met Acidosis (pH<7.3) Serum Bicarb (<15) Ketones Fruity Breath Kussmaul Resp AMS ```
63
Tx List for DKA
IVF, Insulin, Potassium
64
Features of HHS
``` Hyperosmolar, Osmotic Diuresis, Profound Dehydration Hyperglycemia (>600) Serum pH normal Bicarb normal Hyperosmolarity (>320osm) ```
65
Tx of HHS
aggressive IVF | low dose insulin
66
Hypothermia in diabetic patient
Hypothyroidism | Sepsis
67
Tx of DKA
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
Tx of DKA once BG < 200
Switch IVF to D5NS | Switch to subq insulin after 12-16 hrs
69
Acute Rehab
Patient requiring intensive medical program and >3hrs of PT per day In special rehab facility
70
Subacute Rehab
Patient requiring <3hrs PT per day | Can be in rehab facility, qualified NH
71
Day Rehab
Outpatient full or half days of PT 3-5 days a week
72
Fluid Replacement Options
0.9NS: 154mEq NaCl LR: Na,Cl,K,Ca,HCO3, higher pH, lower osm Hypertonic Saline: 1/2NS + Glucose (77mEq Na)
73
Serum Osm
2Na + Glucose/18 + BUN/2.8
74
FeNa
(Una/Pna)/(Ucr/Pcr)
75
UOsm in Euvolemic Hyponatremia
Low
76
Causes of Euvolemic Hyponatremia
``` SIADH Medication: opiates, thiazides Hypothyroidism Adrenal Insufficiency Beer Potomania, Tea and Toast Diet ```
77
Causes of Hypovolemic Hyponatremia
Renal Loss: Diuretics, osmotic diuresis, adrenal insufficiency, cerebral salt wasting ``` Extrarenal losses: NVD Sweating Blood Loss third Spacing ```
78
Causes of Hypervolemic Hyponatremia
``` Pregnancy Cirrhosis Nephrosis CHF Renal Failure ```
79
Max rate of Na increase when treating Hyponatremia
No more than 6mEq/L per 24 hrs
80
Bicarb vs Normal Saline?
Bicarb if pH <6.9 Also for QRS prolongation or severe metabolic acidosis
81
AIDs patient with hyponatremia
SIADH
82
What electrolyte problem can furosemide cause?
``` Hypokalemia Metabolic Alkalosis (Hypochloremic) ```
83
How to treat hypokalemia?
PO better than IV Max 10mEq/L/hr through IV Max 20mEq/L/hr through central line CHECK Mg LEVELS!
84
At what level can hypercalcemia cause problems?
>15
85
Pathophysiology of hypercalcemia causing dehydration
Downregulates vasopressin receptors -> Nephrogenic DI -> loss of free water -> hypercalcemia- > renal failure
86
Tx of Hypercalcemia
Volume Expansion with IVF
87
Tx for Status Epilepticus
IV Benzo
88
IVDA with acute onset bilat LE paralysis, compressive cord lesion, and osteo?
Surgical Decompression | Abx
89
Dependence?
Withdrawal at cessation
90
Tolerance
Increased dose required for analgesia
91
Addiction
impaired functioning

Sub I Wards (3 decks)

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