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181

CSF of bacterial meningitis

Elevated white count w/ neutrophilic predominance, increased protein, decreased glucose

182

Key feature distinguishing DKA from HONK

ACIDOSIS

DKA will have an ELEVATED ANION GAP

183

What things can precipitate DKA or HONK?

Stress- infections, dehydration, drug use

Increased stress hormones and glucagon increase the patient’s blood sugar and begin the pathological cascade

184

Pseudohyponatremia

Pseudohyponatremia occurs whenever there is a high concentration of glucose, triglycerides, or ketones in the blood. Though the relationship between glucose increase and sodium decrease is nonlinear, a useful rule of thumb is that the sodium concentration will drop 2.5 mEq/L for every 100 mg/dL of glucose rise above normal.

185

Colon cancer screening

Colon cancer screening should begin at age 50 in normal patients (and even younger for high-risk patients) with flexible sigmoidoscopy or colonoscopy

or FOBT (with abnormal referral to colonoscopy or normal repeat every year)

186

Cervical cancer screening

Annually once a woman is >18 years old or becomes sexually active. However, if a woman has had no new sexual partners and three normal Pap smears in a row, you can safely screen her once every three years instead of annually

187

Breast cancer screening

every year or two at age 35 or 40, and then annually after age 50

188

What does a rising pCO2 indicate in asthma attack?

A rising pCO2 in an asthma attack signals impending respiratory failure, not improvement! It is important to recognize that this patient is getting worse, not better. Typically, in an acute asthma attack, the patient's tachypnea causes them to "blow off" CO2, resulting in a primary, uncompensated respiratory alkalosis. Rising CO2 in the face of sustained tachypnea is a very ominous sign - it shows that the patient's airways are so constricted that he is no longer able to get rid of CO2!

189

Management of grade II-III vesicoureteral reflux

Medical management: TMP/SMX or nitrofurantoin until documentation that VUR has disappeared

190

How to classify ascites fluid

SAAG

If the difference between the serum albumin and the ascites albumin is greater than 1.1, then the ascites is caused by portal hypertension [TRANSUDATE] (cirrhosis, right sided CHF, and Budd-Chiari syndrome).

If the SAAG is less than 1.1, then the ascites is NOT caused by portal hypertension [EXUDATE] (pancreatitis, peritonitis, and peritoneal carcinomatosis).

191

Spontaneous bacterial peritonitis ascitic finding

>250 PMNs in the ascitic fluid

192

Lab finding to confirm menopause

Elevated FSH

193

Ddx for non-AG metabolic acidosis

Renal tubular acidosis and GI bicarbonate loss (diarrhea)

194

CV screening recommendations

-HTN: >18
-lipids: M > 35, F > 45, patients > 20 w/ hi risk
-AAA: M never smokers 65-75
-obesity: BMI for all

CAD screening NOT recommended in low-risk individuals

195

Cancer screening recommendations

-colon cancer: > 50 (FOBT annually, flexible sigmoidoscopy every 3-5 yrs, or colonoscopy every 10 yrs)
-lung cancer: M 50-80 w/ 30+ pack-year hx who continue to smoke or who quit less than 15 yrs ago- annual low-dose CT

Routine PSA screening or DRE NOT recommended

Screening for pancreatic cancer or testicular cancer NOT recommended in asymptomatic individuals

196

Tobacco and alcohol screening

Tobacco: Grade A
Alcohol: Grade B

197

Tdap booster

All 19-65

198

Influenza vaccination

Everyone over 6 months

199

Pneumococal polysaccharide (PPSV-23) and pneumococcal conjugate (PCV-13)

All 65+

Select younger (e.g., immunocompromised)

200

Hep B vaccination

health care workers, people exposed to blood or blood products, dialysis patients, IV drug users, individuals with multiple sexual partners or recent STDs, MSM, DM

201

Hep A vaccination

chronic liver disease, use clotting factors, occupational exposure to Hep A, IV drug users, MSM, travel to endemic Hep A areas

202

Meningococcal vaccine

high-risk groups, college dorm residents, military recruits, certain complement deficiencies, functional or anatomic asplenia, travel to endemic countries

203

If emphysema <45 y.o. and/or nonsmoker, think:

alpha-1-antitrypsin deficiency

204

PFTs in COPD

Decreased FVC and FEV1
FEV1/FVC < 0.7 --> OBSTRUCTION

205

Management of stage I COPD

prn short-acting bronchodilators

these include:
-beta-2 agonists (albuterol)
-anticholinergics (ipratropium)

Inhaled > po d/t fewer SEs

206

Management of stage II COPD

long-acting bronchodilator

these include:
-beta-2 agonists (salmeterol)
-anticholinergics (tiotropium)

po methylxanthines (aminophylline, theophylline) are options but have narrow therapeutic windows and multiple DDIs

207

Management of stage III-IV COPD with complications

inhaled steroids (fluticasone, triamcinolone, mometasone)

DO NOT AFFECT RATE OF DECLINE OF LUNG FUNCTION but do reduce the frequency of exacerbations

OXYGEN therapy also recommended in stage IV if there is evidence of hypoxemia [DECREASES MORTALITY if at least 15h/d]

No benefit of oral steroids and many complications

Continuous Abx is controversial- decreases exacerbations but not mortality

208

What precipitates COPD exacerbations?

Bacterial and viral infections, air pollutants

209

Which type of drug is known to precipitate gout attacks?

Thiazide diuretics, since they increase urinary urate reabsorption, causing hyperuricemia

Loop diuretics and chemotherapeutic agents also may cause gout attacks

210

Gout crystal

Monosudium urate (MSU): Needle-shaped, with strong negative birefringence