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231 Cards in this Set
- Front
- Back
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Stable Angina Mgmt
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Stress EKG/Echo – ST depression
RF modification Rx – Aspirin, b-blocker (nitrates, CCB) PTCA/CABG if high-risk (>70% stenosis) |
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Unstable Angina Mgmt
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Exclude MI
Stress EKG/Echo – ST depression Acute Tx -Hospital Admission -Aggressive Rx – Aspirin, b-blocker, LMWH/Enoxaparin, Nitrates -PTCA/CABG is controversial Chronic Tx -Rx – aspirin, nitrates, b-blockers -RF reduction – statin |
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Prinzmetal Angina Mgmt
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EKG during CP – ST elevation (transient)
Coronary Angiography – vasospasm w/ IV ergonovine CCB or Nitrates (dilators) |
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MI Mgmt
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EKG – peaked T (very early), ST elevation (transmural), Q wave (necrosis), T inversion, ST depression (subendocardial)
Cardiac Enzymes – CK-MB, Troponin I, T Hospital Admission Rx – aspirin, b-blockers, ACEI, statin, O2, nitrates, morphine, LMWH/enoxaparin PTCA/tPA Cardiac Rehab |
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CP Mgmt
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Cardiac enzymes
EKG CXR PE workup |
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CHF Mgmt
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CXR – cardiomegaly, kerley b lines, prominent interstitial markings, PEff
Echo - ↓EF Radionuclide ventricle (technetium 99m) - ↓EF Sodium Restriction Rx – Diuretic (lasix vs. spironolactone), ACEI > b-blocker > Digitalis |
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PAC Mgmt
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EKG – abnl morphology early P wave
No Tx if ASx b-blocker if Sx/palpitations |
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PVC Mgmt
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EKG – wide QRS
No Tx if ASx b-blocker if Sx ICD if repeated and Heart Dz (risk of SCD) |
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AFib Mgmt
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EKG – irregularly irregular, rapid, no P wave
Rate control Rhythm control Anticoagulation -- Acute Unstable – immediate cardioversion Acute Stable -Rate control (60-100) – CCB > b-blocker, +/- digitalis, amiodarone -rhythm control (?watch embolus) – electrical cardioversion > Rx cardioversion (amiodarone etc.) -anticoagulation – INR = 2-3 (warfarin?) Chronic -rate control – CCB or b-blocker -anticoagulation – aspirin (lone AFib < 60yo), Warfarin |
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AFlutter Mgmt
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EKG – sawtooth baseline, less frequent QRS:P (II, III, aVF)
Tx similar to Afib – rate control, rhythm control, anticoagulation |
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Multifocal atrial tachycardia Mgmt
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EKG – 3+ P-wave morphologies
Improve oxygenation/ventilation -good LV – CCB, b-blocker, digoxin -poor LV – digoxin, diltiazem, amiodarone DO NOT USE CARDIOVERSION |
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Paroxysmal Supraventricular Tachycardia Mgmt
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EKG – narrow QRS
Vagus stimulation (delay AV, block reentry) – valsalva, carotid massage Acute/Rx – IV adenosine >> IV CCB/b-blocker/digoxin > DC cardioversion Prevention – digoxin > CCB, b-blocker OR radiofrequency catheter ablation |
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Wolff-Parkinson-White Mgmt
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EKG – short PR, delta wave
Radiofrequency ablation of an arm of reentry loop Type IA, IC antiarrhythmics AVOID DIGOXIN |
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VTach Mgmt
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EKG – 3+ PVCs in a row, HR 100-250, wide/bizarre QRS
Tx reversible causes Sustained – IV amiodarone etc., synchronous DC cardioversion (if unstable), ICD placement Nonsustained -No Tx if no underlying dz -dz/Sx EP study. + ICD |
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VFib Mgmt
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EKG – no p-wave, no QRS
IMMEDIATE DEFIBRILLATION, CPR Epinephrine IV amiodarone followed by shock Chronic – ICD/defibrillator |
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Sinus Bradycardia Mgmt
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HR < 60
Atropine Pacemaker |
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Sick Sinus syndrome Mgmt
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+/- pacemaker
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1st degree AV block Mgmt
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EKG - ↑PR, nl
No Tx |
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2nd degree AV block type I Mgmt
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EKG – progressive ↑PR no P-wave
No Tx |
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2nd degree AV block type II Mgmt
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EKG – sudden no P-wave/dropped QRS
Pacemaker |
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3rd degree AV block Mgmt
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EKG – no correspondence between P and QRS
Pacemaker |
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Dilated Cardiomyopathy Mgmt
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EKG/CXR/Echo (CHF)
CHF Tx - ↓Na, Diuretic/ACEI/b-blocker/digoxin Remove offending agent if one Consider anticoagulation |
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Hypertrophic Cardiomyopathy Mgmt
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Echo
Avoid strenuous exercise Rx – b-blocker > CCB, diuretic Tx Afib Surgery Pacemaker |
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Restrictive Cardiomyopathy Mgmt
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Echo – thick myocardium, ↑RA/LA w/ nl RV/LV
Tx underlying d/o Digoxin if systolic dysfxn (NOT AMYLODOSIS) |
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Myocarditis Mgmt
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Cardiac Enzymes
ESR Supportive Tx Tx underlying cause |
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Acute Pericarditis Mgmt
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EKG – ST elevation and PR depression nl ST T invert T nl
Self-limited Tx underlying cause NSAID > Glucocorticoid |
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Constrictive Pericarditis Mgmt
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EKG – low QRS voltage
CT/MRI – pericardial thickening Cath – square-root sign Surgery (resection of pericardium) |
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Pericardial Effusion Mgmt
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Echo
CXR – water bottle Fluid analysis Pericardiocentesis ONLY IF TAMPONADE Repeat Echo 1-2 wks |
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Cardiac Tamponade Mgmt
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Echo
Cath – equalization of pressures Monitor (if nonhemorrhagic, stable) Pericardiocentesis (if nonhemorrhagic, unstable) Surgery (if hemorrhagic/trauma) |
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Mitral Stenosis Mgmt
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CXR – LAE (early)
Echo Diuretics Warfarin/anti-coagulation Endocarditis prophylaxis Surgery if severe (valvuloplasty > replacement) |
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Aortic Stenosis Mgmt
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CXR – calcification
Echo Cath – valve cm Surgical Replacement |
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Aortic Regurgitation Mgmt
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CXR – LVH, dilated aorta
Serial Echos Endocarditis prophylaxis ↓Na, diuretic, ↓activity (if stable, ASx) Surgical Replacement ACUTE AR EMERGENT REPLACEMENT |
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Mitral Regurgitation Mgmt
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CXR
Echo Afterload reduction (vasodilators, ↓Na, diuretics) Repair > replacement (before ↓LV fxn) |
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Tricuspid Regurgitation Mgmt
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Echo
Tx complications Repair > valvuloplasty (NO PULM HTN) |
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Mitral Valve Prolapse Mgmt
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Echo
No Tx (if ASx) Endocarditis prophylaxis (if murmur) +/- b-blocker (CP) +/- surgery (rare) |
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Rheumatic Fever Mgmt
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Clinical Dx (2 major or 1+2 minor)
Combat Strep – PCN, Erythromycin Combat Rheumatic fever – NSAIDs, monitor CRP Endocarditis prophylaxis – erythromycin or amoxicillin Tx any valve sequelae |
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Infective Endocarditis Mgmt
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Duke Criteria (2 major, 1+3 minor, 5 minor)
IV ABx 4-6 wks (if isolated on Cx) Vanc + 3rd Ceft (if not isolated) |
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Marantic Endocarditis Mgmt
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+/- heparin
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Libman-Sacks Endocarditis Mgmt
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Tx SLE
Anticoagulation |
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ASD Mgmt
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TEE
EKG – RBBB, RAD Surgical repair if bad (Sx or flow > 1.5:1) |
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VSD Mgmt
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Echo
CXR – enlarged Pulm A. Endocarditis Prophylaxis Surgical repair if bad (flow > 1.5:1) |
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Coarctation of Aorta Mgmt
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EKG – LVH
CXR – notched ribs Surgical decompression |
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PDA Mgmt
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CXR – increased pulm vascular markings
Echo Surgical ligation (NOT IF SEVERE HTN OR SHUNT REVERSAL) Indomethacin in premature infants? |
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Hypertensive Emergency Mgmt
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Reduce MAP by 25% in 1-2 hrs
If severe – IV nitroprusside/labetalol/NTG Less severe – oral captopril/clonidine/labetalol/diazoxide |
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Hypertensive Urgency Mgmt
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BP lowered w/in 24 hrs
Oral agents |
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Aortic Dissection Mgmt
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CXR – wide mediastinum
TEE CT/MRI ↓HR – IV b-blockers ↓BP – IV nitroprusside Surgery if proximal, Medical mgmt if distal |
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Abdominal Aortic Aneurysm Mgmt
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US
CT (if stable) Resection/graft (if > 5cm) Emergency repair if ruptured |
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PVD Mgmt
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ABI (<0.7 = claudication, <0.4 = rest pain)
Arteriography Conservative if intermittent claudication – smoking cessation, RF reduction, foot care Bypass graft/angioplasty if rest pain or more severe |
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Acute arterial occlusion Mgmt
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Arteriogram – locate site
EKG – look for MI, AFib Echo – eval valves IV heparin immediate Surgical embolectomy Amputation if > 6hrs/parasthesias/paralysis |
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Cholesterol Embolization syndrome Mgmt
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Supportive Tx, control BP
NO anticoagulation Rare surgery/amputation |
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Mycotic Aneurysm Mgmt
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Blood Cx
IVABx Surgical excision |
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Luetic Heart Mgmt
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IV PCN
Surgical repair |
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DVT Mgmt
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Duplex Doppler US
Venography D-dimer (r/o only) Anticoagulation (heparin bolus Warfarin) tPA (massive PE or unstable) IVF filter (prevents PE only) Surgical prophylaxis – compressions etc, lovenox |
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Chronic Venous Insufficiency Mgmt
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Ulcer prevention – leg extension, stockings etc.
WTD dressings 3x/d Unna boot |
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Superficial Thrombophlebitis Mgmt
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Mild analgesic
Watch cellulitis spread |
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Cardiogenic Shock Mgmt
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EKG – ST elevation (b/c MI, arrhythmia cause)
PCWP monitor ABCs Identify/Tx underlying cause (MI, tamponade, valve, arrhythmia) Dopamine Dobutamine > NE/phenylephrine NO IV FLUIDS IABP |
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Hypovolemic Shock Mgmt
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Clincial – VS, etc.
CVP/PCWP Intubation/ventilation Direct Pressure if hemorrhage IV fluids |
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Septic Shock Mgmt
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Clinical Dx/Blood Cx
IV BSABx at max dose Surgical drainage IV fluids Dopamine > NE if still low BP |
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Neurogenic Shock Mgmt
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Judicious IVF and vasoconstrictors
Supine Maintain temp |
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Atrial Myxoma Mgmt
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CT?
Surgical excision |
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COPD Mgmt
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PFT – decreased FEV-1, decreased FEV-1/FVC, increased TLC
Smoking cessation Inhaled bronchodilators – b2 agonists/albuterol, anti-chol/ipratropium Inhaled corticosteroids Oxygen therapy |
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COPD exacerbation Mgmt
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CXR – r/o pneumonia, pneumothorax
Bronchodilators +/- anticholinergic IV steroids ABX (azithromycin, levofloxacin) Supplemental O2 BIPAP/CPAP intubation |
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Asthma Mgmt
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PFT – obstructive pattern
Spirometry before/after bronchodilators – reversible obstruction Peak flow Bronchoprovocation test CXR – r/o ABG – if respiratory distress Inhaled B2 agonists Inhaled corticosteroids – mod/severe Monteleukast Cromolyn sodium |
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Asthma exacerbation Mgmt
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Inhaled b2 agonist
IV/oral steroids +/- IV Mg Supplemental O2 |
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Bronchiectasis Mgmt
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High-resolution CT
PFTs – obstructive pattern ABx for acute exacerbation (superimposed infxn) Bronchial hygiene – hydration, physiotherapy, inhaled bronchodilators |
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Cystic Fibrosis Mgmt
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Pancreatic enzyme replacement
Fat-soluble vitamin supplements Chest PT Flu vaccine ABx when infected |
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Lung Cancer Mgmt
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CXR
CT Bronchoscopy Surgery w/ XRT if NSC, ChTx w/ XRT if SC |
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Mediastinal Mass Mgmt
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CXR (incidental)
Chest CT |
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Pleural Effusion Mgmt
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CXR – blunting of costophrenic angle
Lateral decubitus CXR – free vs. loculated CT Thoracentesis – fluid analysis, watch out for pneumothorax Diuretics/Na restriction if transudate Tx underlying dz if exudates ABx +/- CT placement/drainage |
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Empyema Mgmt
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CXR
CT chest Aggressive drainage (thoracentesis, may need open if severe) ABx |
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Pneumothorax Mgmt
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CXR – visceral pleura line
Resolve on own if small CT placement if large Supplemental O2 if Sx |
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Tension pneumothorax Mgmt
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Clinical Dx (DO NOT WAIT FOR IMAGING)
Large bore needle in chest CT placement |
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ILD – general Mgmt
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CXR – non-specific…ground glass, honeycombing
CT PFTs – restrictive pattern (high FEV-1/FVC w/ low FEV-1 and very low FVC), low DLCO Tissue Bx UA – check renal w/ Goodpasteurs/Wegeners |
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Sarcoidosis Mgmt
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CXR – bilateral hilar adenopathy
ACE level – elevated Transbronchial biopsy – noncaseating granulomas PFT – not entirely restrictive…ratio is decreased??!? Improve spontaneously in 2yrs Corticosteroids Methotrexate is last resort |
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Histiocytosis X Mgmt
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CXR – honeycomb
CT – cystic lesions +/- steroids, lung transplant |
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Wegeners granulomatosis Mgmt
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Tissue biopsy – granuloma?
c-ANCA immunosuppression/steroids |
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Churg-Strauss Mgmt
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Blood eosinophilia
p-ANCA systemic glucocorticoids |
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Asbestosis Mgmt
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CXR – hazy infiltrate, bilateral linear opacities, lower lobes affected
No Tx |
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Silicosis Mgmt
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Upper lobe fibrosis
PFT – restriction Only Tx is to stop silica exposure |
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Berylliosis Mgmt
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Beryllium lymphocytic proliferation test
Glucocorticoids |
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Hypersensitivity pneumonitis Mgmt
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CXR – pulm infiltrates during acute phase
Remove offending agent +/- glucocorticoids |
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Eosinophilic pneumonia Mgmt
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CXR – peripheral pulm infiltrates
Glucocorticoids |
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Goodpasture syndrome Mgmt
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Anti-GBM Ab
Plasmapheresis, cyclophosphamide, corticosteroids |
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Pulmonary Alveolar proteinosis Mgmt
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Lung Biopsy!
Tx w/ lung lavage G-CSF DO NOT GIVE STEROIDS |
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Idiopathic Pulmonary Fibrosis Mgmt
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CXR – ground glass
Open lung biopsy No effective treatment – O2, steroids, lung transplant |
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Cryptogenic organizing pneumonitis Mgmt
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Steroids
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Radiation pneumonitis Mgmt
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CT scan
Corticosteroids |
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Acute Respiratory Failure Mgmt
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ABG
CXR/CT CBC Tx underlying d/o Breathing – O2, NPPV, intubate |
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ARDS Mgmt
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CXR – bilateral pulm infiltrates
PCWP - <18 (low)…differentiates from cardiogenic ABG Oxygenation, PEEP Tx underlying cause |
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Pulmonary HTN Mgmt
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EKG – RVH/RAD
Echo – dilated pulmA, dilated RA/RV R. cath – increased PA pressure Tx depends on cause |
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PPH Mgmt
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Cardiac Cath - ?elevated pressure
CXR – clear lungs, enlarged arteries PFTs – restrictive pattern EKG – RAD/RVH Lower pulm resistance – IV epoprostenol, CCB Vasodilator – NO, IV adenosine, CCB Anticoagulation +/- lung transplantation |
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PE Mgmt
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V/Q scan
Spiral CT – NOT IF RENAL INSUFFICIENCY d-dimer – sensitive Supplemental O2 Heparin (unfractionated/LMWH) long-term warfarin IVC filter |
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Colon Cancer Mgmt
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Colonoscopy
Fecal Occult Blood CEA – monitor only Surgery – bowel and LN resection ChTx if high stage – 5-FU, leucovorin XRT not effective |
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Rectal Cancer Mgmt
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Colonoscopy
Fecal Occult Blood Surgery – bowel and LN resection ChTx and XRT if high stage – 5-FU only |
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Diverticulosis Mgmt
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Barium Enema
High fiber Psyllium (???) Surgery if bleeding does not stop on own (rare) |
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Diverticulitis Mgmt
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CT w/ IV/PO contrast
BARIUM ENEMA AND COLONOSCOPY ARE CONTRAINDICATED IV ABx Bowel rest/NPO IVF Surgery if Sx > 4 days or recurrent attacks Low-residue diet (no seeds, nuts) |
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Angiodysplasia (Colon) Mgmt
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Colonoscopy
Often no Tx needed (bleeding stops) Colonoscopic coagulation R. hemicolectomy if bleeding persists |
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Acute Mesenteric Ischemia Mgmt
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Mesenteric Angiography
Supportive Tx – IVF, BSABx Occlusion relief depends on cause/type -Direct Papaverine (vasodilator) during angiography if arterial -Direct tPA, embolectomy if embolic -Heparin if venous |
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Chronic Mesenteric Ischemia Mgmt
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Mesenteric angiography
Surgical revascularization |
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Ogilvie Syndrome Mgmt
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R/o mechanical obstruction
Stop offending agent if meds Supportive tx Decompression (enema/NG colonoscopic surgery) |
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Pseudomembranous colitis Mgmt
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Stool sample for C. diff toxin (take 24 hrs)
Flex sig – not used b/c uncomfortable D/C ABx Metronidazole Oral Vanc if resistant |
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Volvulus Mgmt
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Abd film
Sigmoidoscopy – Dx and Tx (if sigmoid…decompression) Barium enema – birds beak Emergent surgery if cecum Elective surgery if sigmoid (high recurrence) |
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Cirrhosis Mgmt
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Liver Transplant – no EtOH 6mo
Tx/Dx as complications arise Varicies -EGD – evaluate varicies -TIPS – lowers portal HTN Ascites -Dx/Tx paracentesis – if ascites (SAAG > 1.1 = portal HTN) -↓Na/diuretics – if ascites -+/- TIPS Hepatic Encephalopathy -NH4 level? -lactulose (prevents absorption) -neomycin (↓ bacterial production) -limit prot in diet Coagulopathy -FFP |
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Spontaneous Bacterial Peritonitis Mgmt
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Paracentesis – WBC > 500, PMN > 250
BSABx (3rd Ceph) Repeat paracentesis Dx in 2-3 days |
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Wilson Disease Mgmt
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↓Ceruloplasmin
D-penicillamine (removes, detox) - ↑AST/ALT ↓Albumin ↑PT/PTT Screen relatives (AR genetics) Zinc (prevents uptake) Liver transplant |
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Hemochromatosis Mgmt
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Iron studies - ↑iron, ↑ferritin, ↓TIBC
Liver Biopsy Genetic testing Repeated phlebotomy Tx complications |
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Hepatocellular Adenoma Mgmt
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CT/US
D/C OCPs Resect if >5cm |
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Cavernous Hemangioma Mgmt
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US
CT w/ IV contrast DO NOT BIOPSY No Tx, unless large/Sx |
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Focal Nodular Hyperplasia Mgmt
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No Tx
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Hepatocellular Carcinoma Mgmt
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Liver Biopsy
AFP – screening, monitoring Tx = resection if possible, otherwise transplant |
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NASH Mgmt
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↑AST/ALT
Tx = metformin, unclear |
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Hemobilia Mgmt
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Arteriogram
Upper GI endoscopy Resuscitation/transfusion May require surgery |
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Polycystic liver cysts Mgmt
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No Tx necessary
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Hydatid liver cysts Mgmt
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Surgical resection (PAIR procedure)
Mebendazole s/p surgery |
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Pyogenic Liver abscess Mgmt
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CT/US
↑LFTs IV ABx Percutaneous drainage |
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Amebic Liver abscess Mgmt
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Serology
↑LFTs CT/US IV metronidazole Percutaneous aspiration if large |
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Budd-Chiari Syndrome Mgmt
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Hepatic venography
SAAG > 1.1 as well (Portal HTN) Surgery Liver transplant if cirrhosis |
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Biliary Colic Mgmt
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RUQ US
No Tx if ASx Elective Cholecystectomy if recurrent |
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Acute Cholecystitis Mgmt
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RUQ US – thick GB wall, pericholecystic fluid, distended GB
CT – assess complications HIDA scan - ??mech, use when US inconclusive, can help r/o NPO/IVF/IVABx Cholecystectomy |
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Acalculous Cholecystitis Mgmt
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Emergent cholecystectomy
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Choledocholithiasis Mgmt
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Bilis
AlkP RUQ US ERCP – Dx and Tx |
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Cholangitis Mgmt
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RUQ US
↑Bili ↑WBC ↑AST,ALT Cholangiography – during acute phase Blood Cx IVF, IVABx CBD decompression – PTC/ERCP/T-tube |
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Gallbadder Carcnioma Mgmt
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Surgery – difficult
Poor prog |
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Primary Sclerosing Cholangitis Mgmt
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ERCP/PTC – bead structuring/dilations of ducts
↑ALP Liver transplant ERCP stent for bile stasis Cholestyramine for pruritis |
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Primary Biliary Cirrhosis Mgmt
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↑ALP
Anti-Mitochondrial Ab Liver Biopsy US/CT – r/o obstruction Liver Transplant Cholestyramine – for pruritis Ca/bisphosphonates – for osteoporosis Ursodeoxycholic acid (bear bile) – slows progression |
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Cholangiocarcinoma Mgmt
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Cholangiography
Resection Stenting if no possible resection Poor prog |
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Choledochal cyst Mgmt
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US
ERCP Resection w/ biliary-enteric anastomosis |
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Bile Duct stricture Mgmt
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Endoscopic stent > surgical bypass
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Biliary dyskinesia Mgmt
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US/CT/ERCP – no stones
HIDA scan – low CCK induced EF Lap-chole or endoscopic sphincterotomy |
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Acute Appendicitis Mgmt
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Clinical Diagosis
CT if atypical Appendectomy |
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Carcinoid Tumor/syndrome Mgmt
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Surgical resection
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Acute Pancreatitis Mgmt
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Amylase/lipase (Lipase more specific)
Ranson for prog – glc, age, LDH, AST, WBC CT NPO/IVF/pain control |
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Chronic Pancreatitis Mgmt
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CT
Abd Xray – calcifications Nl amylase/lipase Narcotic analgesics NPO Pancreatic enzymes H2 blockers Insulin Surgery – ostomy, whipple |
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Pancreatic cancer Mgmt
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CT
CA 19-9, CEA Whipple Palliative stent |
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Esophageal Cancer Mgmt
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Barium swallow
Upper endoscopy TE US Palliation/Esophagectomy depending on stage |
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Achalasia Mgmt
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Barium swallow – birds beak
EGD Manometry Palliation – NTG/CCB, Botox in LES, dilatation, myotomy |
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Diffuse Esophageal Spasm Mgmt
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Manometry
Barium swallow – corkscrew esophagus NTG/CCB, TCA |
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Esophageal Hiatal Hernia Mgmt
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Barium swallow
EGD Sliding = medical or Nissen Fundoplication (15%) Paraesophageal – Nisses fundoplication |
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Mallory-Weiss Mgmt
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EGD
Tx usually not needed (90%) Surgery/embolization if cont to bleed |
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Pummer-Vinson Mgmt
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Esophageal dilatation
Correct nutrition |
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Schatzki Ring Mgmt
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Esophageal dilataion – if no reflux Sx
Fundoplication – if reflux Sx Esophagectomy – if full-thickness necrosis |
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Zenker Diverticulum Mgmt
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Barium Swallow
Cricopharyngeal myotomy |
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Esophageal Perforation Mgmt
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Esophagram/gastrograffin swallow
CXR – pneumomediastinum IVF/NPO/ABx – if small Surgery w/in 24 hrs – if large/pt is ill |
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PUD Mgmt
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EGD – Bx if gastric (malignancy potential)
Electrocautery if bleeding Urea breath test H. Pylori serology Serum gastrin – ZE syndrome PPI Triple Tx if H. Pylori – PPI + 2 ABx?? |
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Acute Gastritis Mgmt
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EGD
PPI Stop NSAIDs |
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Chronic Gastritis Mgmt
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EGD w/ biopsy
H. pylori Triple therapy |
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Gastric Cancer Mgmt
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EGD w/ multiple biopsy
Wide surgical resection +/- ChTx |
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Gastric Lymphoma Mgmt
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EGD w/ biopsy
Tx depends on stage – surgery/XRT/ChTx |
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SBO Mgmt
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XR – dilated loops of small bowel, air fluid levels (prox of obstruction)
IVF/K+/NG suction Surgery if complete or closed |
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Paralytic Ileus Mgmt
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XR – uniform distribution of gas
IVF/NPO/K+/NG suction |
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Celiac Sprue Mgmt
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Anti-gliadin Ab
Colonsocopy/Biopsy – flattened villi of small bowel Gluten-free diet |
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Chrons Dz Mgmt
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Colonoscopy w/ biopsy – apthus ulcer, cobblestone, pseudopolyp, skip lesion
Sulfasalazine > Metronidazole Immunosuppressants – steroids, azathioprine, 6MP Surgery (will have recurrence) |
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Chronic Ulcerative colitis Mgmt
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Colonoscopy w/ biopsy – mucosa/submucosa, continuous, crypt abscess
r/o C. diff Sulfasalzine Steroids for acute Total colectomy (curative) |
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Hyperthryoidism Mgmt
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↓TSH
↑T4 (can be just T3, but rare) Radioactive T3 uptake – measures TBG, high uptake = hyperthyroidism??? Methimazole Propylthiouracil – inhibits T4 T3, preferred in preggers b-blocker Radioiodine 131 ablation – not during preggers/breastfeeding Surgery |
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Thyroid Storm Mgmt
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Clinical Dx?
IVF, cooling blankets, glucose PTU every 2 hrs Iodine b-blockers dexamethasone |
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Hypothyroidism Mgmt
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↑TSH - ↓TSH if pituitary/HT
↓Free T4 Anti-microsomal Ab – if Hashimoto Levothyroxine – effect in 2-4 wks |
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Subacute thyroiditis Mgmt
|
↓Radioiodine uptake (damaged follicular cells)
↓TSH ↑ESR NSAIDs for pain Recovery in months/1yr |
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Subacute lymphocytic thyroiditis Mgmt
|
↓radioiodine uptake
Self-limited |
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Hashimoto thyroiditis Mgmt
|
Nl TFTs
Anti-peroxidase Ab Anti-thyroglobulin Ab Levothyroxine |
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Fibrous/Reidel Thyroiditis Mgmt
|
Surgery
Levothyroxine if hypothyroid Sx |
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Papillary Thryoid Carcinoma Mgmt
|
Lobectomy/isthmusectomy
Total thyroidectomy if > 3cm/bilateral/advanced |
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Follicular Thyroid Carcinoma Mgmt
|
Total thyroidectomy
Post-op iodine ablation |
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Medullary Thyroid Carcinoma Mgmt
|
Total thyroidectomy
|
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Anaplastic thyroid carcinoma Mgmt
|
ChTx/XRT
|
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Pituitary Adenoma Mgmt
|
MRI
Hormone levels Transsphenoidal surgery – unless prolactinoma (bromocriptine) |
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Hyperprolactinema Mgmt
|
↑prolactin
UPT, TFTs – r/o MRI Bromocriptine (Da agonist) – if prolactinoma -surgery if unsuccessful Tx underlying cause – if Rx, thyroid, etc. |
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Acromegaly Mgmt
|
↑IGF-1/Somatomedin C
Glucose suppression test – glucose ↑GH (abnl) MRI Transsphenoidal resection Octreotide |
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Craniopharyngioma Mgmt
|
MRI
Surgical excision |
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Hypopituitarism Mgmt
|
Low levels of hormones
MRI Replacement of hormones |
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DI Mgmt
|
UA - ↓specific gravity, ↓osm
Water deprivation w/ ADH given later -central – responds (increase in urine osm) -nephrogenic – no response Central – DDAVP Nephrogenic – HCTZ (Na reabsorption in prox tubules) |
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SIADH Mgmt
|
Dx of exclusion (r/o causes of ↓Na)
Water load test – large amt of water excreted in urine Tx underlying cause Water restriction Raise Na SLOWLY (rapid central pontine myelinolysis) - < 0.5/hr |
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Pseudohypoparathyroidism Mgmt
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↓Ca
↑Phos ↑PTH ↓urinary cAMP |
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Hypoparathyroidism Mgmt
|
↓Ca
↑Phos ↓PTH ↓urinary cAMP IV Ca Vitamin D Avoid kidney stones (Ca 8-8.5) |
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Hyperparathyroidism Mgmt
|
↑Ca
↑PTH – RELATIVE TO CA (i.e. nl w/ ↑Ca) ↑urine cAMP ↑Cl/Phos Surgery Lasix – Ca excretion DO NOT GIVE HCTZ (Ca sparing) |
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Cushing syndrome Mgmt
|
Low dose o/n dex suppression - cortisol > 5
ACTH – low = adrenal High-dose dex suppression – cortisol decrease = pituitary, remain high = ectopic Tx depends on cause -iatrogenic – taper steroid -pituitary – transsphenoidal surgery -adrenal – adrenal surgery |
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Pheochromocytoma Mgmt
|
Urine metanephrine (#1)/VMA/normetanephrine
Urine/serum Epi/NE MRI Surgical resection w/ early ligation Phenoxybenzamine |
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Primary Hyperaldosteronsim Mgmt
|
↑Aldo, ↓Renin (ratio > 30)
Saline infusion test – aldo > 8.5 Adrenal venous sampling – 1side = adenoma, 2 sides = hyperplasia Adrenalectomy if adenoma Spironolactone if hyperplasia |
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Adrenal Insufficiency Mgmt
|
↓cortisol
Primary vs. Secondary -↓ACTH = secondary -no cortisol increase w/ IV ACTH repeat = primary Daily hydrocortisone Daily Fludrocortisone – not if secondary |
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|
Congenital Adrenal Hyperplasia Mgmt
|
↑17-hydroxyprogesterone
Cortisol/mineralocorticoid Surgical correction of female genitalia |
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Hypoglycemia Mgmt
|
Blood glucose - <50 = Sx
C-peptide – low if surreptitious insulin Sx w/ fasting, relief w/ eating |
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Insulinoma Mgmt
|
72 hr fast
Whipple triad – Sx w/ fasting, relief w/ glc, Sx when glc < 50 Surgical resection |
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ZE syndrome Mgmt
|
Secretin injection - ↑gastrin
Fasting gastrin High dose PPI Attempt curative resection |
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Glucagonoma Mgmt
|
Surgical resection
|
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|
Somatostainoma Mgmt
|
Poor prog, mets
|
|
|
VIPoma Mgmt
|
Surgical resection
|
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|
Pre-Renal ARF Mgmt
|
BUN:Cr > 20
↑Urine Osm ↓Urine Na FENa < 1 Hyaline casts Renal US Tx underlying D/o IV-NS – unless edema/ascites |
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Intrinsic ARF Mgmt
|
BUN:Cr < 20
↑Urine Na FENa > 2-3 ↓Urine Osm Eliminate cause Supportive Tx +/- furosemide if oliguric |
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Postrenal ARF Mgmt
|
Catheter
|
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Chronic Renal Failure Mgmt
|
UA
Cr Renal US ACEI Low protein diet BP control Ca, VitD Dialysis Transplant |
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|
Minimal Change Dz Mgmt
|
EM – fusion of foot processes
Steroid |
|
|
Focal Segmental GS Mgmt
|
Steroids
Cytotoxic agents Immunosuppressive agents Poor prog |
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|
Membranous GN Mgmt
|
EM – thickened glom walls
+/- steroids Good prog |
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|
IgA nephropathy Mgmt
|
EM – IgA and C3 deposition in mesangium
No Tx/steroids |
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Hereditary Nephritis Mgmt
|
No Tx
|
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Membranoproliferative GN Mgmt
|
No Tx
|
|
|
Poststreptococcal GN Mgmt
|
Low complement levels
Antistreptolysin-O Self-limited Supportive Tx – anti-HTN, loop diuretics |
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|
Goodpasture syndrome Mgmt
|
ER – anti-GBM Ab
Variable course |
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|
Acute Interstitial Nephritis Mgmt
|
↑BUN, ↑Cr
Urine eosinophils Remove offending agent Tx infxn if present |
|
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Renal Papillary Necrosis Mgmt
|
Excretory urogram – change in papilla/medulla
Tx underlying Stop offending agent |
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|
Renal tubular acidosis I Mgmt
|
pH = 4.7
urine pH > 6 give NaHCO3 give phos salts |
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Renal Tubular Acidosis II Mgmt
|
Tx underlying cause
Sodium restriction DO NOT GIVE BICARB – no effect |
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Renal Tubular Acidosis IV Mgmt
|
Fludricortisone
Na? |
|
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Hartnup Syndrome Mgmt
|
Nicotinamide
|
|
|
Fanconi Syndrome Mgmt
|
Phos
K Bicarb Na Hydration |
|
|
Adult polycystic kidney dz Mgmt
|
US – cysts on kidney
No Tx Tx HTN Transplant |
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|
Medullary Sponge Kidney Mgmt
|
IVP
No Tx necessary Prevent stones Tx recurrent UTIs |
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|
Renal A. stenosis Mgmt
|
Renal arteriogram – DO NOT USE IF RENAL FAILURE b/c dye
MRA Captopril renal scintigram PTA revascularization > surgery > ACEI/CCB |
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|
Renal V. thrombosis Mgmt
|
Renal venography
IVP Anticoagulation |
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|
Hypertensive Nephrosclerosis Mgmt
|
Tx HTN
|
|
|
Sickle Cell nephropathy Mgmt
|
ACEI
|
|
|
Nephrolithiasis Mgmt
|
UA – hematuria, UTI
KUB – cannot visualize uric acid Analgesia/morphine, IVF, ABx ESWL if <2cm (>5mm) Surgery if >2cm Thiazides help prevent (↓urinary Ca) |
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|
Urinary Tract obstruction Mgmt
|
Renal US – dilation, hydronephrosis
Catheter if acute Dilation vs. prostatectomy depending on cause (stricture, BPH) |
|
|
Prostate Cancer Mgmt
|
DRE
PSA TRUS w/ biopsy Watchful waiting vs. XRT + androgen deprivation |
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|
Renal Cell Carcinoma Mgmt
|
Renal US
Abd CT Radical nephrectomy including gerota fascia, regardless of stage |
|
|
Bladder Cancer Mgmt
|
UA/Cx – r/o infxn
Urine cytology IVP Cystoscopy/Bx Chest CT – staging Tx depends on stage -intravenous ChTx -transurethral removal -radical cystectomy w/ LN removal etc. -cystectomy and systemic ChTx |
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|
Testicular cancer Mgmt
|
Physical exam
Testicular US Tumor markers – b-hCG (chorio), AFP (embryonal) Inguinal testicle removal CT for staging XRT if seminoma LN dissection +/- ChTx for non-seminoma |
|
|
Penile Cancer Mgmt
|
Local excision
|
|
|
Testicular torsion Mgmt
|
Surgical detorsion
Orchiopexy scrotum |
|
|
Epididymitis Mgmt
|
r/o torsion
ABx |
|
|
Hypovolemia Mgmt
|
UOP
Swan Ganz – monitor CVP ↑Na BUN:Cr > 20 ↑Hct (3% for each 1L) Bolus LR/NS Replace blood w/ Crystalloid 3:1 Maintenance w/ D5 1/2NS – 4,2,1 rule (10Kg, 10Kg, rest kg) |
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|
Hypervolemia Mgmt
|
Fluid restriction
Judicious diuretics UOP |
|
|
Hyponatremia Mgmt
|
Urine osmolality
-↓ w/ nl kidneys (dilute the urine, keep the Na) -↑ if ↑ADH (SIADH, CHF, Hypothyroid) Urine Na -↓ w/ nl kidneys (dilute urine, keep Na) ->20 – hypoaldo (lose Na) ->40 – SIADH (lose Na and keep water) Tx underlying d/o Withhold free water > loop diuretics > hypertonic saline slow 1-2 mEq ↑/hr (<8 in first 24 hrs to prevent central pontine myelinolysis |
|
|
Hypernatremia Mgmt
|
UA - ↓vol (keep water) ↑Osm (lose Na)
Desmopressin challenge – to differentiate DI types if cause Isotonic NaCl if hypovolemic w/ free water once stable volume Vasopressin if isovolemic/DI Furosemide w/ D5W if volume overload w/ too much Na |
|
|
Hypocalcemia Mgmt
|
Phos - ↑ if poor renal or ↓PTH, ↑ if ↓Vit D
PTH IV Ca gluconate vs. PO CaCO3 Vit D Correct Mg If ↓PTH – Vit D, PO Ca, thiazide |
|
|
Hypercalcemia Mgmt
|
Phos
PTH Bone scan Urinary cAMP - ↑ in ↑PTH IV NS, furosemide (excrete in urine) Bisphosphanates/calcitonin (prevent bone breakdown) Steroids if vitD/malignancy Hemodialysis if renal failure |
|
|
Hypokalemia Mgmt
|
Tx underlying cause
Oral KCl |
|
|
Hyperkalemia Mgmt
|
IV Ca – stabilize myocardial membrane potential
Glucose, Insulin – shift cells Kayexalate – resin binds in GI Hemodialysis Furosemide |
|
|
Hypomagnesemia Mgmt
|
Mild = oral = Mg Ox
Severe = IV = Mg Sulfate |
|
|
Hypermagnesemia Mgmt
|
IV Ca gluconate (cardioprotection)
Saline/furosemide Dialysis |
|
|
Hypophosphatemia Mgmt
|
Mild – oral capsule
Severe – IV |
|
|
Hyperphosphatemia Mgmt
|
Aluminum (binds)
Hemodialysis |
