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Flashcards in double star Deck (202):
1

BETA LACTAMS

pencillins
cephalosporins

2

LEVOFLOXACIN (LEVAQUIN) -- CLASS

fluroquinolone

3

CEFTRIAXONE (ROCEPHIN) -- CLASS

cephalosporin

4

AZITHROMYCIN (ZITHROMAX) -- CLASS

macrolide

5

CLARITHROMYCIN (BIAXIN) -- CLASS

macrolide

6

ERYTHROMYCIN -- CLASS

macrolide

7

CAP: mgmt for under 65 x4

MACROLIDE - 1 of the following:
- azithromycin (Zithromax)
- clarithromycin (Biaxin)
- erythromycin

OR

TETRACYCLINE: doxy

8

CAP: mgmt 65+ or comorbs x4

FLUOROQUINOLONE
- levofloxacin (Levaquin)
- ciprofloxacin (Cipro)
- moxifloxacin (Avelox)
- gemifloxacin (Factive)

9

Pseudomonas pneumonia: inpt ICU mgmt (rx only)

antipneumococcal/antipseudomonal beta lactam
- piperacillin-tazobactam (Zosyn)
- cefepime (Maxipime)
- meropenem (Merrem)

PLUS
- ciprofloxacin (Cipro)
//or//
- levofloxacin (Levaquin)

10

pneumonia: inpt ICU mgmt (rx only)

BETA LACTAM
- ceftriaxone (Rocephin)

PLUS
- fluroquinolone
//or//
- azithromycin (Zithromax): resistance likely, avoid

11

community acquired MRSA pneumonia: rx x2

vancomycin
//or//
linezolid

12

CA-MRSA cellulitis

choices:
Bactrim
Doxy/mino
Clindamycin

13

Group A Strep cellulitis

choices:
Bactrim + beta lactam (pcn, amoxicillin, Keflex)
Doxy/mino + beta lactam (same as above)
Clindamycin

! -- same as CA-MRSA + BLs -- !

14

cephalexin (Keflex): class + generation of that class

1st generation cephalosporin

15

most common causes of cellulitis: outpatient

Strep pyogenes (group A) -- usually
Staph aureus (less common)
Strep etc. (B, C, G) - rare

16

most common causes of cellulitis: inpatient

- gram negs: E Coli, Klebsiella, Pseudomonas, Enterobacter
- S. aureus (MRSA? CA-MRSA? possibilities endless)
- Strep

17

gram positive organisms

bacillus
clostridium
enterococcus
listeria
staph
strep (strep pneumo is pneumococcus)

18

gram negative organisms

E coli
Enterobacter
Haemophilus
Pseudomonas aeruginosa
Moraxella
Neisseria

19

abx with gram neg coverage

Azithromycin (both)
Cephalosporins (both)
Penicillins (both)

20

abx with gram pos coverage

Azithromycin (both)
Bactrim
Cephalosporins (both)
Clindamycin
Doxycycline
Linezolid
Minocycline
Penicillins (both)
Vanc

21

azotemia lab value

BUN 100+

22

syphilis treatment

Penicillin G

if allergic: doxycline or erythromycin

23

chlamydia treatment

azithromycin or doxycycline

co-treat with gonorrhea (ceftriaxone)

24

gonorrhea treatment

ceftriaxone
azithromycin (to cover chlamydia)

25

chancroid treatment

azithromycin
ceftriaxone
ciprofloxacin

26

#1 underdiagnosed psych disorder

depression

27

which is the priority for patient who can't make own decision: next of kin or advanced directive?

next of kin - ask if they want to go with advanced directive

28

Top 4 Killers of adults

1: CAD
2: cancer
3: lower resp disease (asthma, COPD)
4: CVA

29

#1 mortality in US blacks

CAD

30

#1 mortality in US women

CAD

31

#1 cancer mortality in women

lung

32

leading gyn cancer mortality in women

ovarian

33

leading cancer incidence in women

breast

34

top 2 cancer mortalities in men

lung
prostate

35

top 2 cancer mortalities in all US adults

lung
colorectal

36

TSH normal

0.4 - 5.0

37

FT4 normal

0.8 - 2.8

38

Tot T4 normal

4.5 - 11.5

39

T3 normal

80 - 230

40

urine Na normal

10 - 20

41

serum osm normal

285 - 295

42

MCV normal

80 - 100

43

MCH normal

26 - 34

44

MCHC normal

32 - 36

45

hct normals

M 40 - 54
F 37 - 47

46

TIBC normal

240 - 450

47

ferritin high in anemia

100+

48

fibrogen low in DIC

less than 170

49

FDP high in DIC

45+

50

PT normal + prolonged

11 - 14 sec
19 sec

51

PTT normal + prolonged

25 - 35 sec
42 sec

52

albumin normal

3.5 - 5

53

BPH normal

under 4.5

54

phosphorous normal

3.5 - 5

55

Ca (total x2)

8.5 - 10.5 mg/dL
2.2 - 2.6 mmol/L

56

Ca (ionized x2)

4.5 - 5.5 mg/dL
1.1 - 1.4 mmol/L

57

CO/CI in hypovolemic shock?

58

CVP in hypovolemic shock?

59

PCWP in hypovolemic shock?

60

SVR in hypovolemic shock?

61

SVO2 in hypovolemic shock?

62

CO/CI in cardiogenic shock?

63

CVP in cardiogenic shock?

64

PCWP in cardiogenic shock?

65

SVR in cardiogenic shock?

66

SVO2 in cardiogenic shock?

67

CO/CI in septic shock?

↑ then ↓

68

CVP in septic shock?

↓ then ↑

69

PCWP in septic shock?

↓ then ↑

70

SVR in septic shock?

71

SVO2 in septic shock?

↓ then ↑

72

CO/CI in anaphylactic shock?

73

CVP in anaphylactic shock?

74

PCWP in anaphylactic shock?

75

SVR in anaphylactic shock?

76

SVO2 in anaphylactic shock?

77

CO/CI in neurogenic shock?

78

CVP in neurogenic shock?

79

PCWP in neurogenic shock?

80

SVR in neurogenic shock?

81

SVO2 in neurogenic shock?

82

CO/CI in obstructive shock?

83

CVP in obstructive shock?

84

PCWP in obstructive shock?

85

SVR in obstructive shock?

86

SVO2 in obstructive shock?

87

what is the difference between PAP and PAWP?

pulmonary artery pressure is essentially the "blood pressure" in the pulm art

pulmonary artery wedge pressure is a measurement using a swan ganz catheter and the inflation of a balloon in the pulm art to measure the pressure in front of it - a proxy for left ventricular pressure (and therefore function)

88

How soon should you order antibiotics in newly diagnosed septic shock?

Within 1 hour of diagnosis

89

SVR is high for which shocks and low for which shocks?

high for cardiogenic, hypovolemic, and obstructive

low for the distributives (septic, anaphylactic, neurogenic)

90

what are 5 potential causes of hypovolemic shock?

internal/external bleeding, burns, DKA/HHNK, severe dehydration

91

hypovolemic shock: mgmt

- fluid resuscitation - MAINSTAY! I mean, duh
- PRBCs when indicated by hgb/hct

92

what is the mainstay of treatment for hypovolemic shock?

fluid resuscitation duh

93

what % of blood loss constitutes hypovolemic shock?

results from a loss of greater than 20% circulating blood volume

94

what are 5 potential causes of cardiogenic shock?

MI (most common), dysrhythmia, pericardial tamponade, pulmonary edema, acute valvular regurg

95

what is the most common cause of cardiogenic shock?

acute MI

96

cardiogenic shock: mgmt

- initial, careful admin of IVF
- vasopressor support
- nitroglycerin IV PRN ischemia

97

what is distributive shock?

3 types - all characterized by vasodilation, decreased intravascular volume, reduced peripheral vascular resistance, and loss of capillary integrity

septic, anaphylactic, neurogenic

98

why does hypovolemia result in septic shock?

hypovolemia develops as a result of blood pooling in the microcirculation

99

what is an important diagnostic to order for septic shock in addition to hemodynamic monitoring?

BLOOD CULTURES!!!

100

septic shock: mgmt

- crystalloid fluid resus (mainstay)
- vasopressors
- upon diagnosis of sepsis, abx WITHIN 1 HOUR !!

101

what is the mainstay of treatment for septic shock?

crystalloid fluid resuscitation

102

what is anaphylactic shock?

IgE mediated reaction that occurs shortly after exposure to an allergen

103

anaphylactic shock: mgmt

- maintain airway
- diphenhydramine 25 - 75 mg IV or IM (depends on severity)
- epinephrine 0.3 - 0.5 mg (1:1000 sol) SQ or IM for respiratory distress, stridor, wheezing, etc.
- crystalloid IVF
- IV glucocorticosteroids
- consider H2 antagonist (ranitidine/Zantac)
- inhaled beta agonist for bronchospasm

104

what is the indication for epinephrine in anaphylactic shock management?

respiratory distress, stridor, wheezing, etc

105

what is obstructive shock?

inadequate CO d/t impaired ventricular FILLING

causes ex: massive PE (most common), tension pneumothorax, cardiac tamponade, obstructive valve disease

106

what are 4 causes of obstructive shock?

massive PE (most common), tension pneumothorax, cardiac tamponade, obstructive valve disease

107

what is the most common cause of obstructive shock?

massive PE

108

obstructive shock: mgmt

- maintain BP while initiating tx of underlying cause
- fluid admin + vasopressors

109

what are the 5 steps of managing a patient (from start to finish?)

history
assessment
labs/diagnostics
diagnosis
treat

110

2 rhabdo labs

↑ urine myoglobin
↑ serum creatine kinase

111

lipid panel: normal

-- less than --
CHOL: 200
TRIG: 150
LDL 100
+
HDL: 40 - 60

112

lipid panel: DM/CAD

-- less than --
TRIG: 150
LDL 70
+
HDL: 40+

113

what is a major adverse effect of metoclopramide (Reglan)? what is metoclopramide's class?

tardive dyskinesia
anti-emetic agent + prokinetic (upper GI)

114

schistocyte

fragmented RBC bit
irregularly shaped, jagged, two pointed ends

often seen in hemolytic anemia

115

sideroblastic anemia

bone marrow produces ringed sideroblasts instead of healthy RBCs - r/t defect incorporating Fe into hgb

sideroblasts usually turn into RBCs

116

sideroblastic anemia: labs

↑ Fe
↓ TIBC

117

AEIOU criteria for dialysis

a cidemia
e lectrolyte imbalance
i ntoxication
o liguria
u remia

118

which valve closures are S1?

tricuspid & mitral

119

what is between S1 + S2?

systole; ventricles are squeezing

120

which valve closures are S2?

pulmonic & aortic

121

what is between S2 + S1?

diastole; ventricles are filling

122

what is S3?

kentucky (slushy in a big balloon)
blood passively enters ventricle and sloshes because the vent is overflowing already OR it is a dilated/non-compliant wall
- think: hypovolemia, CHF, pregnancy

123

what is S4?

tennessee (z squeeze/ kick ball into wall)
atrial KICK into extra THICK wall like a soccer ball
- think: MI, LVH

124

which shocks have ↑ PAWP?

cardiogenic ONLY

125

which shocks have ↓ SVR/SVRI?

distributive shocks: sepsis, anaphylaxis, neurogenic

126

in which 2 hemodynamic parameters are all shocks (except septic) ↓?

CO/CI & SVO2

septic is:
CO/CI - ↑ then ↓
SVO2 - ↓ then ↑

127

CO/CI in septic shock?

↑ then ↓

128

SVO2 in septic shock?

↓ then ↑

129

BPH: diagnostics to order

UA: r/o infection
PSA: 4+ abn
transrectal US: if palpable nodule or elevated PSA

130

Your BPH patient's labs came back with elevated PSA. What is your next order?

transrectal US

131

While performing a digital rectal exam your palpate a nodule on your patient's prostate. What is your next order?

transrectal US

132

BPH: mgmt

- observe + refer to urologist as needed
- alpha blockers: terazosin, tamsulosin, prazocin (relax bladder/prostate muscles)
- 5-alpha-reductase inhibitors: finasteride (shrink prostate)
- surgery: TURP, if significant sx persist

133

Hep A lab markers

active: anti-HAV, IgM
recovered: anti-HAV, IgG

NO CHRONIC!

134

Hep B lab markers

active: anti-HBc, HbeAg, HbsAg, IgM
chronic: anti-HBc, anti-HbeAg, HbsAg, IgM, IgG
recovered: anti-HBc, anti-HbsAg

135

Hep C lab markers

acute: anti-HCV, HCV RNA
chronic: anti-HCV

136

What test do you order to differentiate acute from chronic Hep C?

PCR (prior exposure vs current viremia)

137

cardiogenic & obstructive shock: PAWP

cardiogenic: ↑ - LV can't squeeze
obstructive: ↓ - LV isn't filled d/t obstruction of blood

138

cardiac tamponade can cause what kind of shock?

cardiogenic & obstructive

139

pulmonary edema can cause what kind of shock?

cardiogenic

140

pulmonary embolus can cause what kind of shock?

obstructive

141

cluster headache

middle-aged men
very painful, severe, unilateral, perirbita
at night - wakes from sleep
ipsilateral: rhinorrhea, eye redness, nasal congestion

142

which headache do you treat with sumatriptan or ergotamine?

cluster

143

tension headache

most common type of headache
vise-like, tight, generalized
no focal neuro sx

144

which headache do you treat with OTC?

tension

145

migraine headache

classic (aura) vs common (no aura)
r/t dilation + excess pulsation of EXTERNAL CAROTID ARTERY; unilateral, dull or throbbing, focal neuro sx
follow trigeminal pathway

146

which headache do you treat prophylactically with elavil (Amitriptyline), divalproex (Depakote), verapamil (Calan)?

migraine

147

complications of enteral vs parenteral nutritional support

enteral: problems with the solution
- aspiration, d/v, GIB, hyperNa, dehydration, clog, etc

parenteral: problems with the delivery
- pneuo/hemo -thorax, art laceration, catheter sepsis/thrombosis, etc

148

what does urine Na tell you?

distinguishes renal from non-renal causes
20+ = think salt wasting (kidney problem)
-10 = think renal Na retention to compensate for extrarenal fluid loss

149

what is isotonic hyponatremia?

PSEUDO hyponatremia... lab artifact
usually occurs w hld or hyperproteinemia

150

describe the entire hypovolemia thought process.
what lab value do you expect indicating hyponatremia?
what two diagnostics do you assess next and how do you assess them?

1. ELECTROLYTES: hyponatremia is serum Na less than 135

2. OSMOLALITY: hypo-, iso-, hyper- tonic?
2a. if HYPERtonic, treat.
2b. if ISOtonic, treat.
2c. if HYPOtonic, continue to 3.

3. FLUID STATUS: hyper- or hypo- volemic?
3a. if HYPERvolemic, treat.
3b. if HYPOvolemic: fluid loss! Go to 4.

4. UNa, given fluid loss.
4a. 20+, salt wasting (extrarenal forced waste: meds)
4b. -10, salt-retaining (extrarenal fluid loss: kidneys compensating)

151

3 causes: hypovolemic hypotonic hyponatremia + urine Na under 10

FLUID LOSS: kidneys retain Na to compensate

1. dehydration
2. diarrhea
3. vomiting

152

C diff infection is associated with which electrolyte imbalance?

hypovolemic hypotonic hyponatremia + urine Na under 10

mega diarrhea = fluid loss = kidneys retain Na in an attempt to compensate

153

3 causes: hypovolemic hypotonic hyponatremia + urine Na 20+

SALT WASTING: what is making kidneys chuck the Na?

1. diuretics
2. ACE inhibitors
3. mineralocorticoid deficiency

154

what is the most common electrolyte abnormality?

hyponatremia, and most likely --
hypervolemic hypotonic hyponatremia: fluid volume excess states like CHF, edema, liver failure, kidney failure.

155

4 causes of hypervolemic hypotonic hyponatremia

DISEASE PROCESSES LEADING TO FLUID RETENTION.

1. edematous state
2. CHF
3. liver disease
4. advanced renal failure

156

typical cause of hypertonic hyponatremia

Something else that is NOT sodium is causing HIGH SERUM OSMOLALITY.

ex: hyperglycemia -- typically HHNK

157

hypernatremia is usually due to what?

excess water loss (dehydration)

158

what three states can you have with hypernatremia, and what is the management of each?

hypervolemic hypernatremia: free water, loop diuretics, maybe HD
- loop diuretics will get rid of Na and water so replace with free water; HD will help if kidneys can't get rid of Na for some reason

euvolemic hypernatremia: free water
- will reduce Na concentration back to normal

hypovolemic hypernatremia: NS then ½ NS
- patient is extremely dehydrated which is causing the extreme Na concentration. replace fluid while keeping Na up.

159

hyponatremia: mgmt

TREAT UNDERLYING PROBLEM
- symptomatic: NS + loop diuretic
- CNS symptoms: 3% NS + loop diuretic

160

you have a symptomatic hyponatremic patient - what are 2 mgmt strategies?

other symptoms: NS + loop diuretic
CNS symptoms: 3% NS + loop

161

respiratory acidosis vs respiratory alkalosis: patient presentation

respiratory acidosis: this patient looks dead
respiratory alkalosis: this patient is in distress

162

what is the hallmark sign of metabolic acidosis?

low serum HCO3

163

your patient has metabolic acidosis - what is your next step? what does doing this this tell you?

calculate anion gap with
[Na + K] - [HCO3 + Cl]

normal anion gap is 12 +/- 5
if anion gap is increased, the metabolic acidosis is more acute

164

metabolic acidosis: MUD PILES + what it tells you?

M ethanol
U remia
D KA / AKA **
P ropylene glycol
I ron / INH
L actic acidosis **
E thylene glycol
S alicylates

mnemonic for causes of metabolic acidosis with increased anion gap

165

Indications and contraindications for sodium bicarb use in the treatment of metabolic acidosis?

contraindications: no bicarb if DKA or hypoxia
indications: give if severe hyperkalemia

166

what kind of acid/base abnormality would you expect for C Diff?

metabolic acidosis, because you are blowing base out your rear end

167

what kind of acid/base abnormality would you expect with hyperemesis gravidarum?

metabolic alkalosis, because you are up-chucking acid

168

why would you see hyperkalemia in metabolic acidosis?

your body is acidotic, meaning too much H
hydrogen/potassium pumps move extra H into the cell in exchange for a K
if the pump is moving lots of H into cells, then they are spewing out K

169

ipecac: indications + contraindications

indications: at home ingestions
contraindications: detergent and corrosives

170

gastric lavage: indications

only for ingestions greater than 30 minutes ago

171

activated charcoal: dosage

1g/kg to a max of 50g - in water
can repeat q4 hours

172

hypokalemia: causes

GI loss, diuretics and excess renal loss, alkalosis

173

hypokalemia: s/s

muscular cramps/weakness, fatigue

if severe (less than 2.5): flaccid paralysis, tetany, rhabdomyolysis

174

hypokalemia: EKG findings

decreased wave amplitude
U waves, broad T waves
dysrhythmias: PVC, v tach, v fib

175

hyperkalemia: causes

excess intake, renal failure, drugs (NSAIDs), hypoaldosteronism

176

hypoaldosteronism is associated with which electrolyte imbalance?

hyperkalemia - there is not enough aldosterone in the body to keep Na in, so all of the Na is going out in the urine. this means K is being kept instead, and it is really piling up in the serum.

177

aldosterone function

conservation of Na

178

hyperkalemia: s/s

weakness, flaccid paralysis
abdominal distension, diarrhea

179

hyperkalemia: EKG

most patients won't have changes, but peaked T waves are classic

180

hyperkalemia: treatment

exchange resins: Kayexalate

181

hypocalcemia: causes

hypoPTH
hypomag
pancreatitis
renal failure
severe trauma
multiple blood transfusions

182

pancreatitis is associated with what electrolyte imbalance?

hypocalcemia

183

hypocalcemia: s/s

calcium calms - not enough calcium = spastic.

chvostek's (cheek!)
trousseau's sign (twitch!)
increased DTRs

184

hypocalcemia: EKG findings

prolonged QT interval

185

hypocalcemia: mgmt

- look at blood pH, check for alkalosis
- acute: IV calcium gluconate
- chronic: oral supplements, Vit D, etc

186

hypercalcemia: causes

hyperPTH, hyperthyroidism
prolonged immobilization
vitamin D intoxication

187

hypercalcemia: s/s

calcium calms - too much calcium = sluggy.
fatigue, weakness, depresison, n/v, constipation

severe: coma and death (12+ = emergency)

188

what level of Ca is considered a medical emergency?

12+

189

why hypocalcemia with alkalosis?

H and Ca compete for albumin binding site
alkalosis = not much H, therefore albumin binds the shit out of Ca

less Ca available

190

4 Ps of spinal cord injuries

paralysis
pain
paresthesia
position

191

spinal cord injury: C4 and above results in?

quadriplegia

192

spinal cord injury: @ T1 - T2 results in?

paraplegia - can control upper extremities but not trunk

193

cervical spine contains nerves that control what parts of the body?

arm through hand

194

what parkinson's meds increase available dopamine?

carbidopa-levidopa (Sinemet)
amantadine (Symmetryl)
pramipexole (Mirapex)
ropinirole (Requip)

195

what anticholinergics are helpful in parkinson's symptom alleviation?

benztropine (Cogentin)
trihexyphenydyle (Artane)

196

what is the most common cause of dementia?

alzheimer's

197

alzheimer's vs parkinson's deficiencies

alzheimer's: ACh deficiency
parkinson's: dopamine deficiency

198

Left (dominant) CVA symptoms

R hemiparesis
- aphasia
- dysarthria
- difficulty reading/writing

think: LANGUAGE

199

right (non-dominant) CVA symptoms

L hemiparesis
R visual field change
spatial disorientation

think: PERCEPTION

200

vertebrobasilar TIA: symptoms

inadequate vertebral artery flow
- vertigo/dizzy
- ataxia/weakness
- visual field deficit
- confusion

think: DISORIENTATION + PERCEPTION

201

carotid TIA: symptoms

carotid stenosis
- aphasia
- dysarthria
- altered LOC
- weak/numb

think: CLOUDY + MOTOR

202

what is important to remember about SIADH and osmolarity?

urine osmolarity is up but serum osmolarity is down.