Random Topics from Fitzgerald Flashcards by Alec Williams

Mammography at age

40 annually

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Hypocalcemia correction with low albumin

add 0.8 md/dL calcium for every 1 gram albumin below 4

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Medications that cause hyperkalemia

ACE-I
Heparin
NSAIDs

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Opioid antagonists

Butorphanol
Naloxone
Naltrexone
Pentazocine

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Complications of Acute Rhinosinusits

Orbital cellulitis
Osteomyelitis
Sinus Thrombosis

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Treatment duration for ARS

No risk for resistance and 1st line therapy works= 5-7 days

Resistance7-10 days

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Causes of chronic glaucoma

ethnicity, age, near-sightedness, DM

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S/S of acute closed narrow angle glaucoma

ipsilateral HA
blurry vision
severe periorbital pain
Halos around objects
pain with eye movement

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Normal variant in eye exam for contact wearers

absence of corneal reflex

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Assessment of Asthma

Classify severity

Asthma control

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Two medications that help with allergies in asthma

Leukotriene receptor antagonists (LTRA) -lukast

Omalizumab

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When to consider and when to consult asthma specialist

Consider at stage 3
Consult at stage 4

both if required

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Intubation criteria for asthma exacerbation

after 1 hour of treatment PEF/FEV1 42
absence of wheezing
drowsiness
confusion
bradycardia

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Assessment of COPD

Exacerbation risk
Symptom assessment
Spirometric assessment

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Steroid dose and duration for COPD exacerbation

40 mg/day for 5 days

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Mild-Moderate COPD exacerbation requiring abx

Amoxicillin
Doxycycline
Bactrim

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Severe COPD exacerbation requiring abx

Augmentin
Cephalosporin
Azithromycin
Clarithromycin
Fluoroquinolone

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Booster phenomenon in TB

elders; infected long ago have initial negative mantoux but a positive mantoux when retested up to 1 year later due to first test boosting immune response

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Two-step testing in TB

strategy to distinguish a boost reaction

Person with negative mantoux is retested 1-3 weeks later

Positive with second test= boosted reaction, not recent infection

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PPD for TB

tests for exposure

can produce false positives

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IGRA for TB

used for people who received BCG vaccine
useful in people who do not follow-up with skin tests
Pt should have either TST (mantoux) or IGRA not both

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Most common cause of fatal CAP

Strep. pneumoniae

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Pneumonia associated with close proximity to crowded areas

M. pneumoniae

C. pneumoniae

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CURB-65

Confusion
Urea (BUN >19)
RR >30
BP 65

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Admission for ICU with pneumonia

Shock or Respiratory failure Or three minor criteria: RR greater than 30, PaO2/FiO2 less than 250, Multilobar infiltrates, Confusion, BUN above 20, WBC under 4000, Platelets under 1000 Temp under 36.3, Hypotension requiring fluid resusc

Diagnostic criteria and management of ARDS

bilateral infiltrates PA wedge pressure less than 19 PaO2/FiO2 under 200 TV 6ml/kg Rate 10 PEEP 5-10 Sedation and paralyzing for compliance

LAMA mechanism of action (tiotropium)

anti-inflammatory | mucolytic activity

Highest risk for PE

stasis

Biggest lifestyle modification to reduce HTN

weight loss (5-20 mmHg per 10 kg weight loss)

HTN medication class not to be used with heart failure

CCB

Aldosterone risk with prolonged use

gynecomastia

abrupt withdrawal of clonidine can lead to

rebound HTN

Goal BP reduction in HTN urgency and emergency

Urgency: hours Emergency: reduce MAP no more than 25% within 2 hours then toward 160/100 within 2-6 hours

High risk unstable angina

``` worsening mitral regurg hemodynamic instability sustained VT PCI within 6 months high TIMI/GRACE score Reduce LV EF ```

Treatment in Chronic HF

Ace-I Beta-blockers Control comorbidities Diuresis

Treatment of Acute HF

1. Vasodilator MSO4 Diuresis 1-2x daily amount Inotropes

Acute HF S/S

``` dyspnea at rest coarse rales S3 no peripheral S/S Kerley lines ```

Chronic HF S/S

``` dyspnea with exertion redistribution of flow on X-ray JVD abdominal discomfort peripheral edema ```

Staging of HF (A-D)

A: high risk without structural disease or symptoms B: Structural disease without symptoms C: Structural and symptoms D: Refractory HF

Treatment of pericarditis

pain meds NSAIDs (not in renal failure) Steroids

Phases of cardiac rehab

1: inpatient at hospital 2: medically supervised 3: daily life

target HR for patients with ischemic changes

10 bpm below level of ischemia | must be above resting HR

Most important risk factor in CAD

family history

HgbA1C percents with correlating glucose

``` 5%- 97 6%- 126 7%- 154 8%- 183 9%- 212 10%- 240 11%-269 12%- 298 ```

First line treatment in untreated hyperthyroidism

non-selective BB Nadolol Propranolol Treatment PTU RAI

Signs of addisons disease

``` fatigue hypotension hyperpigmentation arthralgias uncontrolled inflammation ```

T score for osteoporosis

+1 to -1 Normal | -1 to -2.5 prevention to osteoporosis 1500 mg Ca 800units Vit D

Urinary incontinence testing

provocative stress testing PVR voiding records

Short term memory loss in elderly

normal age related change

medication for depression and appetite stimulation

remeron

Majority of elderly falls happen

in patient's home

Intra-renal failure can lead to ischemia when

MAP 30 minutes

Lupus like drug reaction (joint pain) in what meds

``` Procainimide hydralazine INH quinidine minocycline diltiazem ```

Pain relief with BM

IBD

Tension/cramping pain indicates

obstruction gastroenteritis food-related

Inflammatory pain in abd

generalized to localized; worse with movement appendicitis cholecystitis pancreatitis

Ischemic abd pain

deep acute pain, smokers at risk ischemic bowel Mesenteric artery infarct

Surgical abdomen diagnoses

dissecting aneurysm ectopic pregnancy appendicitis perforated organ

Non-surgical abdomen diagnoses

cholelithiasis PID Gastroenteritis

Warning signs of surgical abdomen

``` intractable vomiting Pain before vomiting acute steady pain for hours pain causing syncope pain that disturbs sleep pain >6 hours well localized pain unrelieved by analgesics old abdominal scars ```

Wedge pressure in Cardiogenic shock

increased

Wedge pressure in Obstructive shock

decreased