double star Flashcards
(202 cards)
1
Q
BETA LACTAMS
A
pencillins
cephalosporins
2
Q
LEVOFLOXACIN (LEVAQUIN) – CLASS
A
fluroquinolone
3
Q
CEFTRIAXONE (ROCEPHIN) – CLASS
A
cephalosporin
4
Q
AZITHROMYCIN (ZITHROMAX) – CLASS
A
macrolide
5
Q
CLARITHROMYCIN (BIAXIN) – CLASS
A
macrolide
6
Q
ERYTHROMYCIN – CLASS
A
macrolide
7
Q
CAP: mgmt for under 65 x4
A
MACROLIDE - 1 of the following:
- azithromycin (Zithromax)
- clarithromycin (Biaxin)
- erythromycin
OR
TETRACYCLINE: doxy
8
Q
CAP: mgmt 65+ or comorbs x4
A
FLUOROQUINOLONE
- levofloxacin (Levaquin)
- ciprofloxacin (Cipro)
- moxifloxacin (Avelox)
- gemifloxacin (Factive)
9
Q
Pseudomonas pneumonia: inpt ICU mgmt (rx only)
A
antipneumococcal/antipseudomonal beta lactam
- piperacillin-tazobactam (Zosyn)
- cefepime (Maxipime)
- meropenem (Merrem)
PLUS
- ciprofloxacin (Cipro)
//or//
- levofloxacin (Levaquin)
10
Q
pneumonia: inpt ICU mgmt (rx only)
A
BETA LACTAM
- ceftriaxone (Rocephin)
PLUS
- fluroquinolone
//or//
- azithromycin (Zithromax): resistance likely, avoid
11
Q
community acquired MRSA pneumonia: rx x2
A
vancomycin
//or//
linezolid
12
Q
CA-MRSA cellulitis
A
choices:
Bactrim
Doxy/mino
Clindamycin
13
Q
Group A Strep cellulitis
A
choices:
Bactrim + beta lactam (pcn, amoxicillin, Keflex)
Doxy/mino + beta lactam (same as above)
Clindamycin
! – same as CA-MRSA + BLs – !
14
Q
cephalexin (Keflex): class + generation of that class
A
1st generation cephalosporin
15
Q
most common causes of cellulitis: outpatient
A
Strep pyogenes (group A) -- usually Staph aureus (less common) Strep etc. (B, C, G) - rare
16
Q
most common causes of cellulitis: inpatient
A
- gram negs: E Coli, Klebsiella, Pseudomonas, Enterobacter
- S. aureus (MRSA? CA-MRSA? possibilities endless)
- Strep
17
Q
gram positive organisms
A
bacillus clostridium enterococcus listeria staph strep (strep pneumo is pneumococcus)
18
Q
gram negative organisms
A
E coli Enterobacter Haemophilus Pseudomonas aeruginosa Moraxella Neisseria
19
Q
abx with gram neg coverage
A
Azithromycin (both)
Cephalosporins (both)
Penicillins (both)
20
Q
abx with gram pos coverage
A
Azithromycin (both) Bactrim Cephalosporins (both) Clindamycin Doxycycline Linezolid Minocycline Penicillins (both) Vanc
21
Q
azotemia lab value
A
BUN 100+
22
Q
syphilis treatment
A
Penicillin G
if allergic: doxycline or erythromycin
23
Q
chlamydia treatment
A
azithromycin or doxycycline
co-treat with gonorrhea (ceftriaxone)
24
Q
gonorrhea treatment
A
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.
