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75 Cards in this Set
- Front
- Back
how to calculate the A-a gradient
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[(Patm - 47) x FiO2] - [(PaCO2/0.8) - PaO2]
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how to trx hypoxemia in pt on ventilator
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increase FiO2 (to increase O2 saturation)
Increase PEEP increase I/E ratio |
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how to trx hypoxemia in a hypercapnic pt
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increase minute ventilation
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how to diagnose ARDS (mnemonic)
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ARDS
Acute onset Ratio (PaO2/FiO2 < 200mmHg) Diffuse infiltration (bilateral pulm infiltrates on CXR) Swan-Ganz wedge pressure < 18mmHg (no evidence of cardiac origin or elevated left atrial pressure) |
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what is ARDS, causes?
pathogenesis? |
acute respiratory failure with
-refractory hypoxemia -decreased lung compliance -noncardiogenic pulm edema -endothelial injury |
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why is PEEP used in trx of ARDS
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to recruit collapsed alveoli
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what is goal oxygenation in trx of ARDS
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PaO2 > 60mmHg
SaO2 > 90% on FiO2 < 0.6 |
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what is pathophys for exudate?
transudate? |
increased pleural vascular permeability
(vascular damage, cancer, infection) -increased PCWP or decreased oncotic pressure |
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physical exam of pleural effusion
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dullness to percussion
decreased breath sounds (may have pleural friction rub) |
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when is thoracentesis indicated in pleural effusion
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new effusions > 1cm in decubitus view
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criteria for pleural effusion to be exudate
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-ratio of pleural to serum protein > 0.5
-ratio of pleural to serum LDH > 0.6 -pleural fluid LDH > 2/3 upper normal limit of serum LDH |
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what indicates a complicated parapneumonic effusion?
what indicates an empyema |
positive gram stain or culture
pH < 7.2 glucose level < 60 -pus |
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how to trx empyema and complicated parapneumonic effusions
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chest tube drainage and atbx
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what causes primary spontaneous pneumothorax
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subpleural apical blebs (tall, thin young males)
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presentation of pneumothorax (mnemonic)
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P-THORAX
Pleuritic pain Tracheal deviation Hyperresonance Onset suddent Reduced breath sounds (dyspnea) Absent fremitus (vibration with speaking) X-rays shows collapse |
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what happens in tension pneumothorax
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pulmonary or chest wall defect acts as one-way valve, bring in air into pleural space during inspiration but trapping air during expiration
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etiologies for tension pneumothorax
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PEEP, penetrating trauma, infection
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physical exam of pneumothorax
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diminished or absent breath sounds
hyperresonance decreased tactile fremitus |
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how to trx tension pneumothorax
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immediate needle decompression (2nd intercostal space midclavicular line)
-chest tube |
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where to perform needle decompression in tension pneumo
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2nd intercostal space at midclavicular line
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causes of obstructive lung disease (mnemonic)
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ABCT
Asthma Bronchiectasis CF Tracheal or bronchial obstruction |
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what 4 things happen in asthma pathophys
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hyperreactivity
airway inflammation mucus plugging smooth m hypertrophy |
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main things seen on exam in asthma pt
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wheezing
prolonged expiratory duration (decreased I/E ratio) accessory muscle use (decreased breath sounds = low FEV1) |
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what will ABG show in asthma pt
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mild hypoxia
respiratory alkalosis (from tachypnea) |
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what will spirometry/PFTs show in asthma pt
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peak flow decreased acutely
decreased FEV1/FVC ratio increased RV and TLC |
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what is Montelukast
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leukotriene antagonist
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what meds are used for asthma exacerbation (mnemonic)
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ASTHMA
Albuterol Steroids Theophylline Humidified O2 Magnesium Anticholinergics |
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how does isoproterenol work?
side effects? |
nonspecific: relaxes bronchial smooth muscle (beta-2)
-tachycardia (b/c beta-1 also) |
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how does theophylline work
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bronchodilation by inhibiting PDE = decreasing cAMP hydrolysis
-limited use b/c narrow therapeutic index (cardio and neurotoxicity) |
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how does cromolyn work
when is it used |
prevents release of mast cell mediators
-exercise-induced bronchospasm -effective only for asthma prophylaxis |
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how does Zileuton work
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5-lipoxygenase pathway inhibitor
-blocks conversion of arachidonic acid to leukotrienes |
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how does bronchiectasis present
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chronic cough w/frequent bouts yellow or green sputum, dyspnea
-possible hemoptysis and halitosis |
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what does CXR show in bronchiectasis
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increased bronchovascular markings
tram lines (parallel lines outlining dilated bronchi d/t peribronchial inflammation and fibrosis) honeycombing |
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how does chronic bronchitis defined
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productive cough > 3months per year for 2 consecutive years
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what causes centrilobular emphysema?
panlobular? |
-smoking
alpha1 anti-trypsin deficiency |
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what is pathognomonic for emphysema in diagnosis
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parenchymal bullae or
subpleural blebs |
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what does ABG show in COPD
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hypoxemia
acute or chronic resp acidosis (increased PCO2) |
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how trx COPD (mnemonic)
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COPD
Corticosteroids Oxygen Prevention (stop smoking, pneumo/influenza vaccines) Dilators (b-agonists, anticholinergics) |
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what level of O2 for supplemental in trx of chronic COPD
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PaO2 < 55mmHg
SaO2 < 89% |
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live (attenuated) vaccines?
inactivated (killed)? |
-MMR, polio (sabin-oral), yellow fever
-cholera, influenza, HAV, polio (salk-IV), rabies |
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criteria to diagnose metabolic syndrome
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3/5:
-Abd obesity (increased waist girth) -Trigs > 150 mg/dL -HDL < 40 (men), < 50 (women) -BP > 130/85 or administration of anti-hypertensive drugs -fasting glucose > 110 |
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what drug can reduce diabetes onset in metabolic syndrome
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metformin
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where see osteoporosis in body, usually
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vertebral bodies, proximal femur, distal radius
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what is pathophys for Paget's disease
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increased rate of bone turnover
-excess resorption and formation of bone -> "mosaic" lamellar bone pattern |
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what causes hearing loss in paget's dz
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nerve entrapment from temporal bone increase in size
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what is most sensitive test for paget's dz?
what do labs show? |
-radionuclide bone scan
-increased ALP! and NL Ca and Phos |
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what causes majority of primary hyperPTH
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adenoma (15% from parathyroid hyperplasia)
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what is most common cause of secondary hyperPTH and what is complication
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phosphate retention in chronic renal failure -> renal osteodystrophy
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what labs show in hyperparathyroidism
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hypercalcemia
hypophosphatemia hypercalciuria |
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how to treat hyperPTH
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IVF (loop diuretics if renal or heart failure)
IV bisphosphanate (4 days to work) Intranasal calcitonin |
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how does hypercalcemia acutely clinically present
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coma, altered mental status
bone dz nephrolithiasis abd pain w/N/V |
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features of Tetralogy of Fallot
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pulmonary stenosis, overriding aorta, ventriculoseptal defect, RVH
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indications to get thyroid function tests
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hyperlipidemia,
unexplained hyponatremia, elevated serum muscle enzymes (anemia, normochromic, normocytic) |
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trx for acute cluster HA
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inhalation of 100% O2
subcu sumatriptan |
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most frequent causative org for malignant otitis externa
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Pseudomonas
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what can happen if untreated Kawasaki dz?
how trx it? |
-coronary aneurysms
-IVIG (and echo at dx) |
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typical Sx of Kawasaki's
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fever for at least 5 days
polymorphous rash (truncal) "strawberry tongue" (diffuse mucus membrane erythema) -erythema of palsm and soles -late desquamation of fingertips |
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Kawasaki dz Sx (mnemonic)
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CRASH AND Burn
Conjunctivitis Rash Adenopathy Strawberry Tongue Hands and Feet (red, swollen, flaky sin) Burn (Fever > 40C for > 5days) |
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trx for JRA
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NSAIDs
(steroids: 2nd line or if carditis) |
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definition of fever of unknown origin
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>38.3C (101F) for at least 3 weeks
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what if neutropenic fever continues after 72 hrs despite atbx
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start antifungal trx
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when does infection usually occur in lyme dz/tick bite
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after tick feeds > 18 hours
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what is secondary form of lyme dz
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migratory polyarthropathies
neurologic phenomena (Bell's palsy) meningitis +/or myocarditis conduction abnormalities (3rd degree heart block) |
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what is tertiary form of lyme dz
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arthritis and subacute encephalitis (memory loss and mood change)
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what does positive ELISA mean in lyme dz
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exposure but not specific for active dz
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how to trx early/primary lyme dz?
secondary/tertiary (late) forms? |
doxycycline
ceftriaxone |
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what kind of vasculitis does Rickettsia cause
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small vessel
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spread of rocky mtn spotted fever rash
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macular starting on wrists and ankles -> spreads centrally and becomes petechial/purpuric
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trx for rocky mtn spotted fever rash
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doxycycline
(or chloramphenicol for multidrug resistant orgs) |
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how to confirm rocky mtn spotted fever dx
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indirect immunofluorescence of rash biopsy
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pregnancy-associated congenital infections (mnemonic)
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TORCHeS
Toxo Other (HIV, parvo, Listeria, TB) Rubella CMV Herpes Syphilis |
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main clinical presentation of Rubella congenital infection
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purpuric "blueberry muffin rash"
cataracts PDA hearing loss |
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when is rubella transmitted to fetus
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first semester
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what congenital infection causes "snuffles"/ mucopurulent rhinitis
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syphilis
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Hutchinson's triad
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congenital syphilis
peg-shapped upper central incisors deafness interstitial keratitis (photophobia, lacrimation) |