More Fitzgerald Flashcards Preview

ACNP REVIEW > More Fitzgerald > Flashcards

Flashcards in More Fitzgerald Deck (49)
1

Testing for H. pylori

Histology (requires EGD) and Serology
Urea breath test good for early follow-up
rapid urease

2

H. pylori Testing if patient on PPI

Histology
Serology

3

H. Pylori testing if previously infected and concerned for reinfection

fecal antigen testing
can have false negative with recent PPI use

4

Treatment of H. pylori

10 days of PPI, amoxicillin, and clarithromycin

5

Pretreatment of H. pylori

7-10 days PPI plus levofloxacin plus amoxicillin

6

Perforated ulcer

duodenal ulcers tend to perforate into pancreas causing acute pancreatitis
emergent surgical consult
begin enteric covering antibiotics

7

bleeding ulcer

80 percent resolve spontaneously
FFP if coagulopathic
platelets if less than 50K
lavage pending GI or surgical consult

8

Gerd diagnosis is based on

clinically diagnosed by symptoms

Pyrosis must be present with other symptoms

endoscopy if no response to PPI

9

If patient fails PPI therapy with GERD

manometry

10

Can add what if no response to PPI throughout the day

Add PPI before dinner

IF this doesn't work, refer to GI

11

Incubation period for Hep A and E

2-6 weeks

12

Incubation period for Hep B and C

6 weeks to 6 months

13

Serology for Hep A

Anti-HAV and Immunoglobulin IgG IgM

14

Serology for Hep C

Anti-HCV and HCV RNA means active disease

15

Hepatitis D indications

must have hepatitis B plus Hepatitis D IgM

16

Hepatitis E

no serology

17

Hepatitis G

Only serology is HGV RNA

18

IgG and IgM time frame

IgG previously infected longer than 6 months ago
IgM based on incubation period less than 6 months

19

Immune due to Hep B vaccine

Anti-HBs

20

Acutely infected Hep B

HBsAg, Anti-HBc, IgM anti-HBc,

21

Chronically infected

HBsAg, Anti-HBc No IgM

22

Hepatitis B e antigen HBeAg

serum found during acute and chronic Hepatitis B
means virus is replicating and has high levels of HBV

23

Hepatitis B e antibody HBeAB or anti-HBe

produced by immune system during acute HBV infection
predictor of long term clearance of HBV undergoing antiviral therapy and indicates lower levels of HBV

24

Patients with hepatitis are hospitalized due to

complications from chronic infection or progression of chronic infection

25

Treatment of hepatitis

supportive
hydrate 3-4 liters a day
lactulose for increased ammonia levels
loop diuretics for ascites
paracentesis to relieve intraabdominal pressure
replace albumin losses
chemotherapeutic options for hep B and C

26

In cholecysitits, leukocytosis for more than 24-48 hours suggests

severe infection and possible gangrene

27

in appendicitis start antibiotics

when decision to operate is made

can feel constipation in appendicitis

28

bowel obstructions caused by

mechanical or functional causes

tumore
strictures
ileus due to narcotics

29

clinical presentation of bowel obstruction

time between pain and vomiting suggests location of obstruction

starts with cramping periumbilical pain

30

Radiographic findings of obstruction

horizontal pattern in SBO

frame pattern in LBO

31

Management of obstruction

Fluids

treat medically with partial obstruction
surgical intervention complete obstruction

32

Perforated ulcer finding

leukocytosis
free air on radiographic findings
quiet, rigid abdomen with rebound tenderness

33

Autoimmune thrombocytopenia purpura

clotting impaired when platelets fall less than 50K
Steroid therapy to boost platelets
only give platelets when actively bleeding

34

Aspirin induced coagulopathy

inactivates platelets

35

HIT

induced by antibodies

treatment is to discontinue heparin and start direct thrombin inhibitors

36

uremia induced coagulopathy

platelets inactivated in uremic plasma

treatment DDAVP

37

DIC

preceded by trauma and sepsis
release of thromboplastin
clotting then bleeding
use heparin
treatment is evaluated by increased fibrinogen

38

Anticoagulation effect of warfarin observed when

3-5 days

39

Sideroblastic anemia

increased TIBC, ferritin, iron
low MCV

40

Thalessemia

Normal iron
low MCV

41

BP reduction in stoke only if BP is

above 185/110 if TPA is a candidate
above 220/110 if TPA is not a candidate
goal is to lower BP 15-25% in first 24 hours

42

National institutes of health stroke scale NIHSS

Determines if symptoms related to stroke

0 to 42
0 means no stroke
above 21 means stroke

43

Myasthenia Gravis

autoimmune going from top down
Edrophium helps symptoms
prednisone for treatmentt
plasmaphoresis and immune globulin

44

Guillain barre

bottom up
autonomic manifestations tachy and hypotension
IVIG
recovery often spontaneous

45

Do not perform LP with

increased ICP findings
papiledema

46

Autonomic dysreflexia

injury above T6
exaggerated response to stimulus
remove stimulus

47

Brown sequard syndrome

penetrating trauma
ipsalateral motor and proprioception
contralateral pain and temp
immobilize
give steroids

48

central cord syndrome

cervical spinal cord hyperextension
upper and lower weakness
ICU monitoring for autonomic dysreflexia

49

Cranial nerves

I olfactory- smell
II optic- central and peripheral vision
III Oculomotor- pupil response
IV Trochlear- moves eye down
V Trigeminal- tri forehead, cheek, jaw
VI abducens- eye movement to sides
VII facial- facial movements smile
VIII acoustic- hearing
IX glossopharyngeal- tongue movement
X Vagus uvula
XI spinal accessory- neck shoulders
XII hypoglossal swallow, gag