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75 Cards in this Set

  • Front
  • Back
how to calculate the A-a gradient
[(Patm - 47) x FiO2] - [(PaCO2/0.8) - PaO2]
how to trx hypoxemia in pt on ventilator
increase FiO2 (to increase O2 saturation)
Increase PEEP
increase I/E ratio
how to trx hypoxemia in a hypercapnic pt
increase minute ventilation
how to diagnose ARDS (mnemonic)
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)
what is ARDS, causes?
pathogenesis?
acute respiratory failure with
-refractory hypoxemia
-decreased lung compliance
-noncardiogenic pulm edema

-endothelial injury
why is PEEP used in trx of ARDS
to recruit collapsed alveoli
what is goal oxygenation in trx of ARDS
PaO2 > 60mmHg
SaO2 > 90% on FiO2 < 0.6
what is pathophys for exudate?
transudate?
increased pleural vascular permeability
(vascular damage, cancer, infection)

-increased PCWP or decreased oncotic pressure
physical exam of pleural effusion
dullness to percussion
decreased breath sounds
(may have pleural friction rub)
when is thoracentesis indicated in pleural effusion
new effusions > 1cm in decubitus view
criteria for pleural effusion to be exudate
-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
what indicates a complicated parapneumonic effusion?

what indicates an empyema
positive gram stain or culture
pH < 7.2
glucose level < 60

-pus
how to trx empyema and complicated parapneumonic effusions
chest tube drainage and atbx
what causes primary spontaneous pneumothorax
subpleural apical blebs (tall, thin young males)
presentation of pneumothorax (mnemonic)
P-THORAX
Pleuritic pain
Tracheal deviation
Hyperresonance
Onset suddent
Reduced breath sounds (dyspnea)
Absent fremitus (vibration with speaking)
X-rays shows collapse
what happens in tension pneumothorax
pulmonary or chest wall defect acts as one-way valve, bring in air into pleural space during inspiration but trapping air during expiration
etiologies for tension pneumothorax
PEEP, penetrating trauma, infection
physical exam of pneumothorax
diminished or absent breath sounds
hyperresonance
decreased tactile fremitus
how to trx tension pneumothorax
immediate needle decompression (2nd intercostal space midclavicular line)
-chest tube
where to perform needle decompression in tension pneumo
2nd intercostal space at midclavicular line
causes of obstructive lung disease (mnemonic)
ABCT
Asthma
Bronchiectasis
CF
Tracheal or bronchial obstruction
what 4 things happen in asthma pathophys
hyperreactivity
airway inflammation
mucus plugging
smooth m hypertrophy
main things seen on exam in asthma pt
wheezing
prolonged expiratory duration (decreased I/E ratio)
accessory muscle use
(decreased breath sounds = low FEV1)
what will ABG show in asthma pt
mild hypoxia
respiratory alkalosis (from tachypnea)
what will spirometry/PFTs show in asthma pt
peak flow decreased acutely
decreased FEV1/FVC ratio
increased RV and TLC
what is Montelukast
leukotriene antagonist
what meds are used for asthma exacerbation (mnemonic)
ASTHMA
Albuterol
Steroids
Theophylline
Humidified O2
Magnesium
Anticholinergics
how does isoproterenol work?
side effects?
nonspecific: relaxes bronchial smooth muscle (beta-2)

-tachycardia (b/c beta-1 also)
how does theophylline work
bronchodilation by inhibiting PDE = decreasing cAMP hydrolysis

-limited use b/c narrow therapeutic index (cardio and neurotoxicity)
how does cromolyn work
when is it used
prevents release of mast cell mediators

-exercise-induced bronchospasm
-effective only for asthma prophylaxis
how does Zileuton work
5-lipoxygenase pathway inhibitor
-blocks conversion of arachidonic acid to leukotrienes
how does bronchiectasis present
chronic cough w/frequent bouts yellow or green sputum, dyspnea
-possible hemoptysis and halitosis
what does CXR show in bronchiectasis
increased bronchovascular markings
tram lines (parallel lines outlining dilated bronchi d/t peribronchial inflammation and fibrosis)
honeycombing
how does chronic bronchitis defined
productive cough > 3months per year for 2 consecutive years
what causes centrilobular emphysema?
panlobular?
-smoking

alpha1 anti-trypsin deficiency
what is pathognomonic for emphysema in diagnosis
parenchymal bullae or
subpleural blebs
what does ABG show in COPD
hypoxemia
acute or chronic resp acidosis (increased PCO2)
how trx COPD (mnemonic)
COPD
Corticosteroids
Oxygen
Prevention (stop smoking, pneumo/influenza vaccines)
Dilators (b-agonists, anticholinergics)
what level of O2 for supplemental in trx of chronic COPD
PaO2 < 55mmHg
SaO2 < 89%
live (attenuated) vaccines?
inactivated (killed)?
-MMR, polio (sabin-oral), yellow fever

-cholera, influenza, HAV, polio (salk-IV), rabies
criteria to diagnose metabolic syndrome
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
what drug can reduce diabetes onset in metabolic syndrome
metformin
where see osteoporosis in body, usually
vertebral bodies, proximal femur, distal radius
what is pathophys for Paget's disease
increased rate of bone turnover
-excess resorption and formation of bone -> "mosaic" lamellar bone pattern
what causes hearing loss in paget's dz
nerve entrapment from temporal bone increase in size
what is most sensitive test for paget's dz?
what do labs show?
-radionuclide bone scan

-increased ALP! and NL Ca and Phos
what causes majority of primary hyperPTH
adenoma (15% from parathyroid hyperplasia)
what is most common cause of secondary hyperPTH and what is complication
phosphate retention in chronic renal failure -> renal osteodystrophy
what labs show in hyperparathyroidism
hypercalcemia
hypophosphatemia
hypercalciuria
how to treat hyperPTH
IVF (loop diuretics if renal or heart failure)
IV bisphosphanate (4 days to work)
Intranasal calcitonin
how does hypercalcemia acutely clinically present
coma, altered mental status
bone dz
nephrolithiasis
abd pain w/N/V
features of Tetralogy of Fallot
pulmonary stenosis, overriding aorta, ventriculoseptal defect, RVH
indications to get thyroid function tests
hyperlipidemia,
unexplained hyponatremia,
elevated serum muscle enzymes
(anemia, normochromic, normocytic)
trx for acute cluster HA
inhalation of 100% O2
subcu sumatriptan
most frequent causative org for malignant otitis externa
Pseudomonas
what can happen if untreated Kawasaki dz?
how trx it?
-coronary aneurysms

-IVIG (and echo at dx)
typical Sx of Kawasaki's
fever for at least 5 days
polymorphous rash (truncal)
"strawberry tongue" (diffuse mucus membrane erythema)
-erythema of palsm and soles
-late desquamation of fingertips
Kawasaki dz Sx (mnemonic)
CRASH AND Burn
Conjunctivitis
Rash
Adenopathy
Strawberry Tongue
Hands and Feet (red, swollen, flaky sin)
Burn (Fever > 40C for > 5days)
trx for JRA
NSAIDs
(steroids: 2nd line or if carditis)
definition of fever of unknown origin
>38.3C (101F) for at least 3 weeks
what if neutropenic fever continues after 72 hrs despite atbx
start antifungal trx
when does infection usually occur in lyme dz/tick bite
after tick feeds > 18 hours
what is secondary form of lyme dz
migratory polyarthropathies
neurologic phenomena (Bell's palsy)
meningitis +/or myocarditis
conduction abnormalities (3rd degree heart block)
what is tertiary form of lyme dz
arthritis and subacute encephalitis (memory loss and mood change)
what does positive ELISA mean in lyme dz
exposure but not specific for active dz
how to trx early/primary lyme dz?
secondary/tertiary (late) forms?
doxycycline

ceftriaxone
what kind of vasculitis does Rickettsia cause
small vessel
spread of rocky mtn spotted fever rash
macular starting on wrists and ankles -> spreads centrally and becomes petechial/purpuric
trx for rocky mtn spotted fever rash
doxycycline
(or chloramphenicol for multidrug resistant orgs)
how to confirm rocky mtn spotted fever dx
indirect immunofluorescence of rash biopsy
pregnancy-associated congenital infections (mnemonic)
TORCHeS
Toxo
Other (HIV, parvo, Listeria, TB)
Rubella
CMV
Herpes
Syphilis
main clinical presentation of Rubella congenital infection
purpuric "blueberry muffin rash"
cataracts
PDA
hearing loss
when is rubella transmitted to fetus
first semester
what congenital infection causes "snuffles"/ mucopurulent rhinitis
syphilis
Hutchinson's triad
congenital syphilis
peg-shapped upper central incisors
deafness
interstitial keratitis (photophobia, lacrimation)