internal medicine shelf study Flashcards
(82 cards)
systems to assess for end organ dmg in presence of marked HTN
Eyes: papilledema
CNS: AMS, HTN encephalopathy when >240/140, neuro findings
Kidneys: RF, hematuria
CV: unstable angina, MI, CHF, pulmonary edema, aortic dissection
lungs: pulmonary edema
hypertensive emergency
BP >220/120 in presence of end organ dmg
urgency if no end organ dmg.
Features of PRES (posterior reversible encephalopathy syndrome)
result of HTN emergency
sx: insidious onset of HA, AMS, LOC, visual change, sz
CT: posterior cerebral WM edema
increased BP overwhelm autoreg mechs of cerebral vessels –> arteriolar dilation –> edema
dx with clinical, MRI
tx:
1. lower BP with IV meds
2. correct electrolytes
3. stop sz if occuring
if pt presents with severe HA and marked HTN
- lower BP w/hydralazine
- head CT. if negative,
- lumbar puncture
risk factors for aortic dissection
Long standing HTN Cocaine Trauma CT diseases Biscuspid aortic valve coarctation of aorta 3rd trimester of pregnancy
initial medical therapy of aortic dissection
IV beta blockers to lower HR and force of LV ejection
IV sodium nitroprusside to lower systolic BP below 120
most AAAs occur where?
between renal arteries and iliac bifurcations
symptoms suggesting expansion and impending rupture of a AAA
sudden onset of severe pain in back or lower abdomen, radiating to groin, buttocks, or legs
Grey Turner’s sign (ecchymoses on back and flank)
Cullen’s sign: ecchymoses around umbilicus
triad of abdominal pain, hypotension, and pulsatile abd mass
ruptured AAA, emergent laparotomy indicated
Leriche’s syndrome
atheromatous occlusion of distal aorta just above the bifurcation causing BL claudication, impotence, and absent/diminished femoral pulses
…. causes calf claudication, while …… causes buttock and hip claudication
femoral or popliteal disease
aortoiliac occlusive disease
Diagnosis of PVD
ankle to brachial index (ABI), which is the ratio of systolic BP at ankle to systolic BP at arm.
nml is 0.9-1.3
if>1.3, noncompressible vessels, severe disease
if <0.7, claudication
if <0.4, rest pain
clinical features of acute arterial occlusion
Six Ps Pain (acute onset) Pallor Polar (cold) Paralysis Paresthesias Pulselessness (use doppler)
many patients with history of …. eventually develop CVI (chronic venous insufficiency)
DVT
In chronic venous insufficiency, …. causes two things: edema and brawny induration
ambulatory venous HTN due to the destruction of Deep venous valves and valves in the perforator vv
when superficial thrombophlebitis occurs in different locations over a short period of time
think of Migratory superficial thrombophlebitis (secondary to occult malignancy, often of pancreas)
signs and symptoms common to all forms of shock
hypotension
oliguria
tachycardia
AMS
changes of
- CO
- SVR
- PCWP
in: cardiogenic shock
- CO is decreased
- SVR is increased
- PCWP is increased
hx of MI, angina, heart disease, get echo
see JVD
changes of
- CO
- SVR
- PCWP
in: hypovolemic shock
- CO is decreased
- SVR is increased
- PCWP is decreased
hx of trauma, GIB, vom, diarrhea
changes of
- CO
- SVR
- PCWP
in: septic shock
- CO is increased
- SVR is decreased
- PCWP is decreased
changes of
- CO
- SVR
- PCWP
in: neurogenic shock
all are decreased
SC injury, neuro deficits present
definition of cardiogenic shock
systolic BP <90
urine output <20mL/hr
adequate LV filling pressure
vasopressors used in treatment of cardiogenic shock
Dopamine is often the initial drug used
Dobutamine may be used in combo with DA
NE or phenylephrine may be used in severe or resistant cases
diagnostic criteria of SIRS
WBC >12000 or < 4000, or >10% bands
Tachypnea or PaCO2 <32 mmHg
Fever >38 or T <36
tachycardia >90bpm
Sepsis is SIRS + positive blood cultures
