Inpatient Medicine Flashcards
(152 cards)
1
Q
HIT- 4T’s
A
thrombocytopenia
timing:
thrombosis (skin)
no other cause
2
Q
Charcot’s Triad
A
RUQ pain, jaundice, fever
acute cholangitis
3
Q
Reynold’s Pentad
A
ruq, jaundice, fever
hypotension + confusion
50% mortality
4
Q
DIC physiology=
A
abnormal activation of coagulation sequence
microthrombi throughout microcirculation
bleeding+thrombosis occuring
5
Q
DIC consumption of
A
platelets
fibrin
coag factors
6
Q
DIC labs
A
increased BT, PT, PTT decreased platelets increased fibrin, D-dimer decreased fibrinogen \+schistocytes
7
Q
HIT type 1
A
onset 1-4 days
nadir 100,000
not Ab mediated and w/o thromboembolic
observe
8
Q
HIT type II
A
Onset 5-10 days
nadir 20,000
antibody mediated, thromboembolic events and hemmorhagic
9
Q
Acute Pulmonary Edema- BP Control
A
nitroglycerin or nitroprusside for afterload and preload reduction
10
Q
Paget Disease
A
- elevated alk phos
- bone pain
- treat with bisphosphonates
11
Q
Maturity Onset Diabetes of the Young (MODY)
A
AD
age 10-45
Lean body type, family history
normal C peptide, do NOT require treatment with insulin
12
Q
Octreotide- mechanism of action in esophageal varices/HTN
A
vacoconstricting dilated splanchic blood vessels
13
Q
TIPS
A
shunting blood from portal to hepatic vein
14
Q
Lactulose - Mechanism of Action
A
actulose is metabolized by bowel flora and make the lumen more acidic, traps NH4+ in colon and decreases ammomnia in the blood
also may decrease ammont of urease producing bacteria
15
Q
Hep B: Vaccinated
A
anti-HBs NOT anti-HBc
16
Q
Hep B: Exposure and Immune
A
anti-HBs
anti-HBc
17
Q
Hepatitis B Surface Antigen / HBsAg
A
infection: recurrent or chronic
18
Q
Hepatitis B Surface Antibody / HBsAb
A
immunity: vaccination or infection
19
Q
Hepatitis B Core Antibody / antiHBc
A
IgM- Acute Infection
IgG- Chronic Infection
20
Q
Hepatitis B e-antigen / HBeAg
A
infectivity
21
Q
Hepatitis B e-antibody/ HBeAb or antiHBe
A
low infectivity, window period between HBsAg and anti-HBs
22
Q
Primary TB
A
walled off in granulomas
23
Q
Secondary TB
A
reactivated
24
Q
AKI- Official Definition
A
1.5xCr
GFR decreased by 25%
UOP less than 0.5 ml/kg/hr x 6 hr
25
Location of RTAs
type 1 - distal
type 2 - proximal
type 4 - distal
26
Causes of RTAs
type 1 - decreased secretion of H+
type 2 - decreased reabsorption of Bicarb
type 4 - aldosterone def/resistance
27
BiPAP- how to exhale CO2
increase IPAP
| increase rate
28
Lasix/Spirolactone Ratio
2:5
| 20 Lasix, 50 spirolactone
29
IDA Labs Summary
Elevated TIBC, transferrin
Decreased transferrin saturation
Decreased ferritin
30
Primary Hyperparathyroidism Differential
- Malignancy
- Familial Hypocalciuria Hypercalcemia
- Drugs (lithium, thiazides)
31
Primary Hyperparathyroidism
- Elevated Ca
- Elevated or Normal (inappropriate) PTH
- Decreased Phos
- Increased Vitamin D
32
Loop diuretic mechanism
thick ascending limb of Henle
| Bind Na/2Cl/K receptor, block NaCl reasborption
33
Direct Thrombin Inhibitors
argatroban
| bivalirudin
34
Factor Xa inhibitor
fondaparinux
35
Chronic pancreatitis- classic triad
pancreatic calcifications
steatorrhea
DM
36
Revised Cardiac Risk Index
H/o ischemic heart disease, CHF, CVA
| Pre-op factors: Cr>2, insulin use,
37
ADH - mechanism/function
increase water reabsorption by kidney's collecting ducts
38
SIADH diagnosis
hyponatremia
inappropriate concentrated urine >100
plasma osm < 270
39
SIADH treatment
H20 restriction
NS or salt tabs+loop
Lithium or Demeclocyline
40
ST changes
has to be in 2 continguous leads
greater than 1mm for limb leads
greater than 2mm for chest leads
41
SIRS
Hr 90
RR 20
T 101, 96
WBC 12, 4
42
Light's Criteria
exudative if one of the following
ratio of pleural to serum protein 0.5
ratio of pleural LDH to serum LDH 0.6
PLeural LDH 0.6 or 2/3 ULN
43
amaurosis fugax
ischemic event involving retinal artery
| often carotid bruit on neck
44
Heberden's Nodules
DIP
45
Bouchard's Nodules
PIP
46
Uncomplicated UTI Adults Outpatient Medications
Bactrim, Macrobid, Fosfomycin
47
Iron Absorbed In
duodenum
48
When to Start ESA in CKD
when hemoglobin is less than 10
| target 10-11.5
49
Warm Autoimmune Hemolytic Anemia
IgG
| SLE, CLL (lymphoproliferative disorder)
50
Cold Autoimmune Hemolytic Anemia
IgM
| EBV, Mycoplasma
51
Target Cells
Thalassemia
52
anti-NMDA receptor encephalitis
classically a young woman with teratoma + psychosis
53
Chvostek Sign
tapping facial nerve elicits contraction of facial muscles in HYPOcalcemia
54
Bronchiectasis Physiology =
permanent abnormal DILATION and DESTRUCTION of bronchial walls
55
ACS IV Septum Rupture
w/in 10 d
| new onset systolic murmur
56
Centrilobular Emphysema
- smoking
| - upper lung zones
57
Panlobular Emphysema
- alpha-1 antitrypsin
| - lung bases
58
Hoarseness in Adults, remember
recurrent laryngeal nerve palsy 2/2 mass
59
Categories for Thrombocytopenia Differential
- Decreased Production
- Increased Destruction
- Increased Consumption
- Sequestration
60
Thrombocytopenia- Decreased Production
bone marrow dysfunction - myelofibrosis, aplastic anemias, granulomatosis disease etc
Nutrient Deficiencies- b12 or folate
61
Thrombocytopenia- Increased Destruction
Splenomegaly/Sequestration
ITP, HIT
MAHA- HUS, TTP
62
Thrombocytopenia- Increased Consumption
DIC
| Bleeding
63
Herpes Zoster- what should you test for
HIV!! (looking for reason for being immunocompromised)
64
Postherpatic Neuralgia
Pain >1 month after infection
65
Ramsey Hunt Syndrome
vesicular rash in external ear
| associated with ipsilateral peripheral facial palsy and altered taste
66
Zoster treatment
if w/in 72 hours of presentation
67
How to Recheck a platelet count
drawn in citrate or heparin (not EDTA)
68
TTP testing
ADAMTS13 level less than 10%
69
Treatment of acute ITP
symptomatic or platelets less than 30,000
70
HIT diagnosis
screening test: platelet factor 4 (sensitive but not specific)
confirmatory test: serotonin release assay or heparin-induced platelet aggregation assay
71
Polyarthritis
more than 5 joints
72
Oligoarthritis
2-4 joints involved
73
Viral causes of acute polyarthritis
parvovirus
rubella
HIV, Hepatitis B
74
enthesis
structure on the site of ligament or tendon inserting into bone
suggestive of spondyloarthritis
75
RA and morning stiffness
usually >60 minutes
76
ESR =
- fall of erythrocytes through through anticoagulated plasma
- erythrocytes are negative charged
- fibrinogen and APR neutralize the charges and cause slower rate (higher ESR)
77
Anti-U1-RNP
MCTD
78
Anticentromere
Crest Syndrome
79
Anti–Scl-70 (antitopoisomerase-1)
Systemic Scleroderma
80
Anti–Jo-1
Polymyositis
81
Antihistone
drug induced lupus
82
Cryoglobulins
Vasculitis; hepatitis C; myeloma; SLE; RA
83
Secondary Sjogren Syndrome
response to another rhem disease, most commonly RA and SLE
84
Sjogren patients at risk for...
non-Hodgkin lymphoma
| due to chronic lymphocyte activation
85
Reasons for CT prior to LP in Adults
```
Immunocompromised state
History of CNS disease
Seizure within 1 week of presentation
Papilledema
Abnormal level of consciousness
Focal neurologic deficits
```
86
Felty Syndrome
Form of RA w/
splenomegaly
chronic neutropenia
87
Nephrotic Syndrome (4)
Proteinuira
HLD
Edema
Hypoalbuminemia
88
Nephritis Syndrome (4)
Hematuria
Mild Proteinuria
HTN
Azotemia/AKI
89
Central DI
Central: low ADH from posterior pituitary
90
Nephrogenic DI
Nephrogenic: ADH secretion normal but tubules cannot respond
91
DI Diagnosis
- urine low SG and low osmolality
- water deprivation test
- Urine osm will ot increase with DI
- W/ desmopressin, urine osm will will NOT correct with nephrogenic version
92
TCA overdose therapy
sodium bicarbonate
93
Dermatomyositis
gottron's papules, heliotropic rash
association with any malignancy
anti-jo
94
High Reticulocyte Count
hemolysis or blood loss
95
Transudative Pathophysiology
elevated capillary pressure
| or decreased plasma oncotic pressure
96
Monitoring frequent transfusions
hypocalcemia from citrate binding
hyperkalemia or hypokalemia
metabolic alkalosis (from citrate metabolism).
97
SLE mainstay of treatment
hydroxychlorquine
98
Causes of lymphocytosis in pleural effusions
- Malignancy
- TB, histo, blasto, etc
- RA
- Chylous effusion
99
Diuretic Conversion
1 bumex
20 toresmide
40 furosemide
100
Plasma Osmolality
275-295
101
Osmolal Gap
Difference between calculated and measured should be less than 10
Greater than this suggests LWM alcohol
102
Diuresis with Kidney Injury
Urea Diuresis (kind of osmotic diuresis)
103
Methacholine Challenge Test
FEV1 reduction by 20%
| high NPV, but many things can make this positive
104
DLCO
gas transfer than alveolar/capillary unit
| proportional to surface area of functional lung
105
Bronchodilator Response
12% increase in FEV1 or FVC or both
| at least 200 ml
106
Things that cause false decrease in pulse saturations
- CO
- methemoglobinemia
- topical anesthetics
- methylene blue
107
Medications that Reduce Frequency of COPD Exacerbations
Azithromycin
| Roflumilast
108
Muddy brown casts
ATN
109
RBC casts
glomerular disease
110
WBC casts
pyelo or AIN
111
Pancolitis DDx
IBD
Infectious - E coli
Ischemia - hypotension or drugs
112
Asthmatic triad
wheezing, nasal polyps, ASA sensitivity
113
Single use of LABA in asthma?
increased risk of asthma related death
114
When should you get alpha anti-trypsin
less than age 45 with a strong family history and/or w/o strong risk factors
115
How to diagnosis bronchiectasis when looking at CT
airway larger than accompanying vessel
116
MDS can transform to....
AML
117
Chronic Myeloid Leukemia and associated genetics
BCR-ABL fusion gene/Philadelphia chromosome
| treat w/ tyrosine kinase inhibitors
118
Polycythemia Vera
elevated Hgb
fatigue, HA, erythromyelgia, pruritic, HTN, thrombosis
JAK2 mutation
119
Polycythemia Vera Treatment
ASA for thrombosis, sometimes hydroxyurea
| Phlebotomy
120
Most common secondary cause of polycythemia vera
testosterone
121
Essential Thrombocytopenia
50% have JAK2 mutation
| can have headaches, dysthesias of hands/feet, visual disturbances, TIAs
122
Essential Thrombocytopenia Treatment
hydroxyurea
123
Hyperkalemia- always consider...
pseudohyperkalemia
| K is intracellular so will rise with Cell Death (first pumping, elevated WBC, platelets)
124
Hyperkalemia in patients who make urine!
R/o obstruction, hyperglycemia
Loop diuretics + Normal Saline
Fludrocortisone
125
How to think about ILD
- smoking related
- steroid responsive
- CT related
- exposure related
126
Obesity Hypoventilation Syndrome triad
- obesity
- sleep disordered breathing
- day time hypercapnia
127
autoPEEP
intrathoracic pressure remains positive at end of exhalation
| can decrease venous return
128
C diff treatment (adults, kids)
adults PO vanc or fidaxomicin
| kids PO vanc or flagyl
129
DKA definition based on numbers
glucose >250
pH <7.3
+ketones
130
When to discontinue beta blockers in cirrhotics
Systolics <90
AKI
Na 120
131
High Risk Lung Nodules
6mm
spiculated
upper lobes
132
Subtype of lung nodule with highest risk of malignancy
subsolid
133
qSOFA
quick sequential organ failure assessment
RR>22
SBP <100
altered mental status
134
Treatment of Invasive Candidiasis
capsofungin, micafungin
| poor penetration in CNS and eye though- use azole or amph B
135
Treatment of histoplasmosis
itraconazole
| disseminated/severe disease- amph B
136
Treatment duration for CLABSI
7-14 days (non S aureus)
| S aureus - 4 weeks
137
HAP
Pneumonia 48 hours after hospitalizations
138
VAP
Pneumonia 48 hours after mechanical ventilation
139
Treatment for ESBL organisms
meropenem!
140
Physiology of Type II RTA (Proximal)
damage to proximal tubule (where bicarbonate is reabsorbed)
Lower TM of bicarb and will pee out Bicarbonate
aka loss of bicarb/HCO3-
141
Causes of Type II RTA
Fanconi syndromes
drugs - acetazolamide, topiramate
Multiple Myeolma
142
Physiology of Type I RTA (Distal)
failure to excrete Hydrogen
143
Causes of Type I RTA
autoimmune (SLE, RA, sjogens)
Amph B
obstructive uropathy, sickle cell anemia
144
Physiology of Type IV RTA
hyperkalemia interferes with ammonia, hence you can't store H+ in ammonium
145
Causes of Type IV RTA
chronic hyperkalemia AKA diabetes, ACE/ARB
| obstructive uropathy, sickle cell anemia
146
Antisynthetase Syndrome
ILD
Raynauld
Mechanics hands
Anti jo
147
Cameron Lesions
Seen with hiatal hernias
148
Predictor of DM membranous nephropathy
DM for at least 8 years
149
Treatment of calcium oxalate stones
Potassium citrate
150
First Line CAP in Adults
doxy or azithromycin
151
First Line CAP In adults w/ recent antibiotic use or medical issues
Fluroquinolone
| Beta lactam + macrolide
152
Autoimmune adrenalitis testing
21 hydroxylase antibodies
