AAC 1 Flashcards
(44 cards)
What is Well’s criteria
Used to determine pretest probability of PE:
♣ Wells Scoring Criteria:
• Clinical symptoms of DVT (leg swelling, pain with palpation) = 3
• Other diagnosis less likely than PE = 3
• Heart rate > 100 = 1.5
• Immobilization (>/= 3 days) or surgery in the previous 4 weeks = 1.5
• Previous DVT/PE = 1.5
• Hemoptysis = 1
• Malignancy = 1
Describe what to do for different scoring of Well’s
• Wells <2 = low probability
o Get D-dimer
♣ If low = likely not PE
♣ If elevated = continue with further testing
• Wells >4-6 = high probability o CTA with IV contrast ♣ Best test ♣ Must have normal kidney o V/Q scan ♣ Can perform with abnormal kidneys ♣ Must have a normal CXR
Describe CURB 65
PNEUMONIA SEVERITY SCORE:
• Criteria:
o C = Confusion (based upon a specific mental test or new disorientation to person, place, or time)
o U = Urea (BUN >7)
o R = Respiratory Rate >/= 30
o B = Blood Pressure (systolic <90 or diastolic <60)
o 65 = Age >65
Describe pneumococcal vaccine PPSV23 and who it is used for
♣ Contains capular material from 23 serotypes that have historically been responsible for the majority of pneumonoccal infections
♣ Because polysaccharides alone cannot be presented to T-cells, the vaccine induces a relatively T-cell-independent B-cell response that is less effective in young children and the elderly
Describe pneumococcal vaccine PCV13 and who it is used for
♣ Consists of capsular polysaccharides from 13 of the most common serotypes that have been covalently attached to the inactivated diphtheria toxin protein
♣ This polysaccharide-protein conjugate induces a T-cell-depended B-cell response, resulting in improved immunogenicity due to the formation of higher-affinity antibodies and memory cells
How will Leydig tumors present in terms of
- Testosterone
- Estrogen
- LH
- FSH
Elevated testosterone and estrogen (gynecomastia) with secondary inhibition of LH and FSH
Diagnose:
- Hypotension
- Increased venous pressure, JVD
- Clear lung sounds
Cardiac tamponade
What physical exam finding is often found in pericardial effusion
Inability to palpate PMI
Describe defect in Factor V Leiden
Most common hereditary thrombophilia
♣ Mutation that makes Factor Va resistant to inactivation by protein C
♣ Increased coagulation
Imaging for osteonecrosis of the femoral head
MRI
Describe hereditary hemorrhagic telangiectasia
♣ Aka Osler-Weber-Rendu syndrome
♣ Inherited disorder of blood vessels
♣ Presentation:
• Telangiectasias, recurrent epistaxis, skin discoloration, arteriovenous malformations, Gi bleeding, hematuria
o AVMs in the lungs can shunt blood from the right to the left side of the heart, causing chronic hypoxemia, digital clubbing, and reactive polycythemia
Describe CBC in polycythemia vera
♣ CBC will show an increase in all 3 cell lines (RBC, Leukocytes, and platelets)
Describe mutation in polycythemia vera
o JAK2 kinase mutation
♣ Normally, RBC production is depended on EPO released by the kidney and liver in response to tissue hypoxia
♣ EPO activates JAK2 tyrosine kinase, which differentiates late myelid cells into erythrocytes
♣ In PV, RBC production is driven by a constitutively active JAK2 gene rather than by tissue hypoxia; therefore, EPO levels tend to be low
What is the defect in Hashimotos
- Most common cause of hypothyroidism
* Autoimmune destruction (antithyroid peroxidase and antithyroglobulin antibodies)
What is the defect in Graves disease
• Thyroid stimulating immunoglobulin (TSI) stimulates TSH receptor
Describe CHADSVASC
• CHADSVASC Score risk of stroke for patients with A-fib/A-flutter o CHA(2)DS(2)VASc o Components: ♣ C = CHF or LVEF = 40% ♣ H = HTN ♣ A = Age >/= 75 ♣ D = DM ♣ S = Stroke/TIA/Thromboembolism ♣ V = Vascular disease ♣ A = Age 65-74 ♣ S = Sex (female)
Describe order of method for reading EKGs
- Rate
- Rhythm
- Axis
- Chambers
- Intervals
- Ischemia/Infarct
Method for rate in EKG
• (1) Count the number of QRS complexes on the full strip and multiply by 6
• (2) Count how many dark lines the QRS complexes are apart
o If two adjacent QRS complexes are one big line apart, the HR is 300
o If two adjacent QRS complexes are 2 big lines apart, the HR is 150
o . . . 300, 150, 100, 75, 60, 50,
Method for rhythm in EKG
♣ Normal sinus rhythm • All of the following MUST be true: o P wave must preceded every QRS o QRS must come after every P o P wave must be upright in lead II
Method for axis in EKG
• Basically everything between lead I and aVF (even though this is technically only 0 to 90)
• In a normal ECG, you would see a positive deflection of QRS in leads I and II or in Leads I and aVF
o The only time you need to look at lead II is if you are positive in lead I and negative in lead aVF
o Usually this means this is L axis deviation UNLESS it falls between -30 and 0
o So you need to check lead II
♣ If lead II is positive, then it is normal (between -30 and 0)
♣ If lead II is negative, then it is real L axis deviation
EKG method for R atria
• Enlargement = peaked P-waves in lead 2
o Peaked = >2 little boxes in lead II and > 1 small box in lead V1
EKG method for L atria
• Enlargement = S shape P-wave in lead V1 (aka positive and then negative deflection)
o Because this is the point where direction changes from positive to negative
PR interval - how long should it be and what does it mean
♣ PR interval should be <5 small boxes (200 ms)
• Prolonged means heart blocks
o 1st degree = prolonged PR (>0.2 sec)
o 2nd degree Type I = PR getting longer and longer until dropped beat
o 2nd degree Type II = Dropped beat with stable PR
o 3rd degree = no relationship between P and QRS
QRS interval - how long should it be and what does it mean
♣ QRS should be <3 small boxes (120 ms)
• If QRS is narrow, then signal came from atria
• Prolonged = bundle branch block or signal being initiated by ventricle
