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IM
Rounds
211
Medical
Graduate
01/16/2014

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Term
Presenting features of PE
Definition
dyspnea, excentuated S2, hemoptysis, JVD, chest pain
Term
o2 and co2 and acid/base in pe
Definition
lo O2 lo CO2
respiratory alkalosis
Term
EKG in PE
Definition
S1Q3T3
large S in I
large Q in III
inverted T in III
Term
echo in PE
Definition
R atrial dilatation
mccullens sign
Term
xr in PE
Definition
either nothing
possibly hamptons hump
Term
tx PE
Definition
if unstable: IVF, vasopressor, mechanical vent, thrombolytics

if stable: LMWH then hep or warfarin longterm
Term
maintenance PE prophy
Definition
3 mo if PE was provoked
6 mo if unprovoked
for life if more than one event
Term
wells criteria
Definition
1. PE most likely
2. HR over 100 or hx of DVT/PE
3. Immobile
4. Hemoptysis/Cancer
Term
Tests for PE
Definition
D dimer neg rules out
if positive you can do spiral ct to confirm
Term
dx criteria of DM
Definition
1. postbrandial >126 x 2
2. fasting + sx >200 x 2
3. hbaic > 6.5
Term
pre DM dx?
Definition
hbaic 5.7-6.4
Term
goal sugar in DM
Definition
90-130
Term
bp med in dm
Definition
acei
Term
urinalysis in dm
Definition
checking for renal damage
microalbunuria 30-300 : start acei
macro: >300
Term
ldl goal in dm
Definition
70-100
Term
tx peripheral neuropathy
Definition
gabapentin
Term
at what a1c do you start insulin
Definition
8
Term
dosing units of insulin for first time user
Definition
kg/2 = # of units
half of the units are long acting
half split into three doses with meal
Term
dosing insulin in hosp if not a first time user?
Definition
.3 U/kg if pt is lean
.4 if normal weight
.5 if obese
.6 if very obese
Term
novalin
Definition
70nph
30 regular insuline
Term
onset and duration of short acting insulin
Definition
15-30 min
2-4 hr
Term
onset and duration of intermediate acting insulin
Definition
onset 1-2 hours
can last up to 12 hours
Term
how long does long acting insulin last?
Definition
up to 24 hours
Term
goal for random glucose in dm
Definition
< 180
Term
metformin lab abnormality
Definition
lactic acidosis
Term
moa metformin
Definition
dec glu prod by liver and inc insulin sensitivity
Term
contra for metformin
Definition
acute heart or kidney decomp, ARF,
Term
which dm drug causes edema
Definition
tdz
Term
contra of tdz
Definition
liver fail, hep b, hep c
chf
Term
moa tdz
Definition
activate PPARs dec insulin resistance
Term
what are the sulfonylureas
Definition
glyburide, glipizide, glimepriride
Term
ade SUs
Definition
hypoglycemia
Term
moa SUs
Definition
DPP4 inhibitor
Term
which can cause pancreatitis
Definition
exenatide
Term
moa of exentide
Definition
glp agonist to inc insulin secreation
Term
grading of ulcers
Definition
1. nonblanchable erythema with skin intact
2. superficial/partial thickness skin loss (blister or abrasion)
3. full thickness loss (extends to fascia)
4. necrosis, damage to mm bone, tendon, joint
Term
equation for renal compensation for respiratory acidosis
Definition
if acute: increase 1 bicarb for every ten increase in CO2

if chronic: increase 3 bicarb for every ten increase in CO2
Term
equation for repiratory comp for metabolic acidosis
Definition
pCO2 = (1.5 x HCO3) + 8 +- 2
Term
drug eluting stent
Definition
coronary stent that secretes paclitaxel or sirolimus
Term
long term management in pt with a drug eluting stent or bare metal stent? how are the risks different?
Definition
BMS has higher risk of recanalization due to scar formation.
DES has a higher risk of thrombosis.
Both are treated with aspirin, clopidogrel and coumadin long term.
Term
correcting Ca for hypoalbuminemia
Definition
every drop in albumin of 1, add .8 to calcium
Term
free water deficit equ
Definition
FWD = .6(wt in kg) * ((current Na/140) -1)
Term
What physiologically is causing dec O2 sat in PE?
Definition
increased a-a gradient
Term
what causes alveolar hypoventilation
Definition
obstructive lung disease and obesity
Term
is septic arthritis monoarticular or poly
Definition
mono
Term
what type of arthritis in sarcoid
Definition
poly in knees and ankles
Term
how does viral arthritis px
Definition
symmetric small joint inflammatory arthritis. resolves in 2 mo. nsaid tx only.
Term
chlordiazepoxid?
Definition
benzo in etoh wd
Term
what lab value is the best indicator of orthostatic intol
Definition
hi BUN/CR
Term
hiatal hernia complication
Definition
barretts esophagus and then adenocarcinoma of stomach
Term
what results in a narrowed confidence interval
Definition
increased number of participants in study
Term
effect modification
Definition
when an external variable positively or negatively impacts the effect of a risk factor on the disease of interest.
Term
malignant otitis externa
Definition
granulation of external ear
usually in elderly dm
due to pseudomonas
ear pain and drainage
facial nerve damage
Term
complications of malignant otitis externa
Definition
osteomyelitis of skull base and cn damage
Term
lytic lesion at bone epiphysis
Definition
giant cell carcinoma
Term
other features of giant cell bone cancer
Definition
benign but locally aggressive
in young ppl
pain and swelling at joint
Term
pathology of giant cell bone cancer
Definition
osteoclast giants
polygonal, round, oval or elongated monomuc
Term
bakers cyst
Definition
popliteal synovial cyst
swelling medial knee
2/2 degen joint disease
Term
osgood schlatter disease
Definition
overuse injury in kids who grow too pfast.
knee xr shows avulsion of apophysis of tibial tubercul
Term
osteitis fibrosa cystica
Definition
parathyroid cancer --> hi pth
brown tumors
salt and pepper skull, bone cysts
also especially on raidal aspect of middle fingers
Term
xr findings of osteoarthritis
Definition
joing space narrow, subchondral sclerosis
Term
osteoid osteoma
Definition
pain esp at night
nsaids work well
sclerotic, cortical lesion
central nidus of lucency
Term
first line for acne
Definition
topical retinoids
Term
acute GVHD after bone marrow transplantation looks like _____ and is the result of _____
Definition
skin and gi issues
donor T cells
Term
best test of lactose intol
Definition
H breath test
Term
what is osmotic gap in osmotic diarrhea
Definition
over 50
Term
what qualifies as first degree AV block
Definition
PR interval over 5 small boxes (from beginning of P to beginning of R)
Term
pt on mechanical vent has low co2 and o2. how do you fix
Definition
add peep
or if fio2 is less than 40, you can inc it to 40
Term
what should fio2 be below at all times
Definition
40
Term
what lung gas measurement do you see in restrictive lung disease

why
Definition
increase a-a grad
paco2 may be ok

due to v1 mismatch
Term
infection of submandibular space complication
Definition
ludwigs angina. can get to tissue surrounding airway
Term
infection of parapharyngeal space
Definition
erosion of carotid artery and jugular thrombophlebitis
Term
what space connects to mediastinum
Definition
retropharyngeal
Term
tx dermatitis herpetiformis in celiacs
Definition
dapsone
Term
most commonly why do ppl have allergy to blood products give?
Definition
they are iga deficient so they have anti IgA ab
Term
result of mismatched abo blood
Definition
dic
Term
management of stroke in sickle cell pt
Definition
exchange transfusion + continue hyrdoxyurea
Term
lab changes in CKD hyperparathyroidism vs primary hyperparathyroidism
Definition
both hi PTH
CKD: hi phos, lo ca, lo d)
can get hi ca in later later tertiary stages

primary CKD: hi Ca, kidney stones, etc
Term
sx of drug induced esophagitis
Definition
retrosternal cp
epigastric burning
swallowing discomfort
Term
causes of drug induced esophagitis
Definition
tetracyclines
aspirain and many nsaids
aledronate
potassium chloride
quinidine
Fe
Term
What type of kidney issues do ppl with hodgkins lymphoma have
Definition
minimal change disease
Term
what kind of kidney issues do ppl with carcinomas have
Definition
membranous nephropathy
Term
is minimal change disease nephrotic or nephritic
Definition
nephrotic
Term
what type of bruit seen in renal artery stenosis
Definition
\sytolic diastolc
Term
what bp is found in pt with renal artery stenosis
Definition
they have htn
they also may have different pressures on each artm (higher on left
Term
Alports syndrome
Definition
1. Nephritic Syndrome
2. Type 4 Collagen issue
3. Split BM
4. Occular disturbances
5. Deafness
6. X linked dominant
Term
Bergers disease
Definition
1. Nephritic syndrome
2. IgA overproduced
3. Deposits on Mesangium
4. URI, gastroenteritis, pharyngitis
5. glomerulonephritis
6. sx overlap with henoch schoenlein
7. most common cause of nephritis
Term
major features of nephritic syndrome
Definition
1. inflammatory
2. proteinuria < 3.5
3. rbc casts
5. htn
6. hi nitrogen in blood
7. oliguria
8. hematuria
Term
post-strep glomerulonephritis
Definition
1. post GAS pharnygitis
2. neutrophils
3. children
4. edema
5. IF granular
6. lumpy bumpy
7. subendothelial deposits
Term
RPGN
Definition
1. Rapidly progressing glomerulonephritis
2. nephritic
3. poor prognosis
4. fibrin and C3B deposits
5. goodpastures
6. wegeners
7. microscopic polyangitis
8. crecents
Term
Amyloidosis
Definition
1. Primary type = AL (Ig light chain)seen in Multiple myeloma or AA (liver protein)
2. Secondary = from RA or TB
3. Nephrotic syndrome
4. green apple biferengence
5. congo red stain
Term
diabetic glomerulonephropathy
Definition
1. nephrotic syndrome
2. Kammelsteil wilson nodules
3. nonenzymatic glycosylation of arterioles and BM
4. mesangium expansion
5. type 4 collagen deposits
5. hyaline arthersclerosis
Term
Focal Segmental Glomerulonephosis
Definition
1. Nephrotic
2. in IV drug users and those with Aids
3. hyaline and segmental sclerosis
4. poor prognosis
5. microscopic hematuria
6. some proteinurea
7. little IF
6. EM shows epithelial damage
Term
Membranoproliferative glmomerulonephritis
Definition
1. two types
2. Type 1 = split gbm due to mesangium
granular IF
subendothelial deposits
seen in Hep C
Type 2 = C3nephritic factor
high density deposits
Term
Membranous GN
Definition
1. nephrotic
2. thick glomerular bm
3. spike and dome
4. HepB
5. lupus
6. gold
7. solid tumors
Term
Minimal Change disease
Definition
1. Nephrotic
2. on EM see podocyte effacement
3. Normal on LM
4. some loss of albumin
5. tx with steroids
6. may be post infection
7. seen in hodgkins lymphoma
8. loss of negative charge
Term
nephrotic syndrome in general
Definition
1. proteinuria > 3.5
2. hyperlipidemia
3. edema
4. fatty casts
5. thromboembolism
6. inc risk of infection
Term
Pagets disease of bone features
Definition
1. normal ca and phosphate
2. high AP and urinary hydroxyproline
3. skull bone resoprtion and slcerosis
4. due to osteoclastic bone resorption causing woven bone
5. esp femur, axial skeleton, skull
6. skull hypertrophy --> deafness
7. elevated c and p telopeptide and hydroxyproline and deoxypridinoline
Term
ca, p and ap in hyperparathyroidism
Definition
1. hi ca
2. lo p
3. hi ap
Term
hi ca, normal p, normal AP?
Definition
milk alkali
Term
methanol intox sx
Definition
nv
anion gap metabolic acidosis
epigastric pain
hyperemic optic disk
hypokalemia from vomiting
Term
anion gap equation
Definition
Na - {Cl + HCO3) = 8-12
Term
causes of anion gap metabolic acidosis
Definition
Methanol poison
Uremia
Diabetic ketoacidosis
Propylene glycol
Isoniazid
Lactic acidosis (from metformin)
Ethanol poisoning
Salisylates
Term
HBcAg vs anti HBcAg
Definition
HBc is not detected
but HBcAg detected in gap period
Term
what two test for pt with acute hep b sx
Definition
antiHBcAg
HBsAg
Term
Lab studies in DKA vs HHGS (hyperosmolar hyperglycemic state seen in T2DM)
Definition
DKA
1. glucose 250-500
2. bicarb < 18
3. AGAP > 8-12
4. serum osmolality < 320
5. ketones in blood
HHGS
1. Glucose > 600
2. Osmolality > 320
3. Bicarb > 18
4. Normal AGAP
5. no ketones
Term
what TB drug changes fluids to red
Definition
rifampin
Term
age of giant cell arteritis
Definition
post 50
Term
major signs
Definition
new onset headache
jaw claudication
visual loss (retinal artery ischemia)
polymyalgia rheumatic sx
bruits around vessels that come off aorta
Term
discoloration of lymph follicles in dark brown discolored colon
Definition
bisacodyl (antrhaquinon containing laxative)
Term
herpes simplex keratitis feature
Definition
pain
photophobia
blurred vision
tearing
redness
past episodes
corneal vesicles and dendritic ulcers
Term
herpes zoster opthalmicus
Definition
fever
malaise
burning
itching
vesicular rash and dendritic ulcers
but less of the vision loss changes seen in herpes simplex keratitis
Term
antibodies in hashimotos
Definition
antithyroid peroxidase ab
Term
antibodies in graves disease
Definition
TSI (thyroid stimulating immunoglobulins)
Term
tx uncomplicated mild to moderate pyelo
Definition
TMPSMX or Cipro PO
Term
tx uncomplicated severe pylo
Definition
ceftriaxons, cipro, tmpsmx IV
Term
what constitutes complicated pyelo
Definition
indwelling urinary catheter, urinary obstruction, hospital acquired, immunosuppressed etc
Term
tx mild to mod complicated pyelo
Definition
IV ceftriaxone or cefepime
Term
tx severe complicated pyelo
Definition
amp-sulbactam, ticar clav, pip tazo, carbapenems, aztreonam
Term
tx pyelo in preggo
Definition
ceftriaxone +- gentamicin

aztreonam
Term
how long do you continue oral abx for uti after in hospital tx
Definition
10-14
Term
intense focal vertebral pain wo neurological pain
Definition
vertebral compression fractures
Term
ligamentous sprain of back
Definition
traced to specific event
more painful with movement
feels better in morning
Term
CD4 less than 50
Definition
MAC
Term
prophy for MAC
Definition
azithro or clarithro
Term
dipyramidole
Definition
used in exercise stress test
induces coronary steal
causes coronary vasodilation but if cad present theyre already maximally dilated so the blood flows to on diseased areas and the diseased areas falter causing symptoms.

also used as antiplatelets
Term
gynecomastia
spider nevi
emphysema
PAS +
Definition
alpha antitrypsin
Term
NKHS is? who gets it?
Definition
nonketotic hyperosmolar syndrome
seen in T2DM
Term
sx of NKHS
serum osmolality
Definition
glucose in urinalysis
may have recent infection or stressor
causes hi stress hormones
osmotic diuresis --> dehydration
osmolality >320
AMS --> confusion --> coma
intraocular hypotension from hyperosmolarity
Term
peak airway pressure
Definition
maximum pressure measured as tidal volume is being delivered in intubated pt. measured via inspiratory hold.
is the resistive pressure + plateau pressure, where plateau pressure is elastic pressure + PEEP
Term
what does peak pressure tell us about a pt
Definition
elevated peak pressure with normal plateau pressure: bronchospasm, mucus plug, biting ET tube.

elevated peak pressure with elevated plateau pressure: pneumo, PEdema, pneumonia, atelectasis, right mainstem intubation
Term
what bp med cases the most peripheral edem?
Definition
Ca channel blocker
Term
what arrythmia seen in dig toxicity?
Definition
atrial tachycardia with AV block
Term
what does dipstick show in UTI
what do they indicate
Definition
nitrates and esterase
esterase indicates pyuria
Term
class IA antiarrythmics
Definition
quinidine, procainamide, disopyramide
Term
class IB antiarrythmics
Definition
lidocaine, mexiletine, tocainide
Term
class IC antiarrythmics
Definition
flecainide, propafenone
Term
class II antiarrythmics
Definition
betablockers
Term
class III antiarrythmics
Definition
ibutilide, sotalol, bretylium, amiodarone, doetilide
Term
class IV antiarrythmics
Definition
ccb (verapamil, diltazem)
Term
What channels do each class effect?
Definition
1: Na
2: BB
3: K
4. CCB
Term
What does sodium channel blocking do to AP?
Definition
1. decreases slope of phase zero
2. increase threshod for firing abnormal pacemaker cells
Term
How do BB work on heart?
Definition
1. decrease slope of phase zero thru dec cAMP and dec Ca
Term
Of the class 1 agents, which dissociated from NA channel slowest
Definition
class 3
Term
which prolong QRS
Definition
class 3
Term
Wchich prolong PR interval
Definition
CCB
Term
how do CCB work
Definition
slow conduction velocity
Term
which increases QT int
Definition
IA
Term
which give ade HA and tinnitus
Definition
quinidine
Term
which causes reversible SLE sx
Definition
procainamide
Term
which contraindicated post MI
Definition
IC
Term
which causes torsades
Definition
IA
Term
which is esp useful post MI, why
Definition
IB preferentially affects ischemic purkinge and vent tissue
Term
whats useful in vtach that progresses to VF
Definition
IC
Term
which prolongs refractory period in AV node
Definition
IC
Term
ade amiodarone
Definition
pulmo fibrosis, hepatotoxitiy, hypo/hyperthyroidism
Term
which causes contsip, flushing, edema, CV effects
Definition
CCB
Term
how does adenosine work
Definition
inc K+ out of cells to hyperpolarize
Term
use of adenosine
Definition
to dx or abolish SVT
Term
whcih is used in refractory SVT
Definition
IC
Term
use of MG
Definition
torsades, digoxin tox
Term
what joints spared in RA
Definition
distal interphalangeal
Term
What part of axial skeleton effected in RA
Definition
cervical spine
Term
osteoarthritis vs RA
Definition
osteo involved DIP
Term
antibody test for RA
Definition
antiCCP
hi IgM rhematoid factor
hi CRP and ESR
Term
loss of pigmentation around orifaces
Definition
leukoderma
Term
prophy against MAC
Definition
azithro
Term
opioid intoxication
Definition
depressed mental ststus
dec bowel sounds
hypotension
bradycardia
miosis
Term
most common arryythmia post CABG
Definition
atrial fib
Term
management of afib post cabg
Definition
if hemodynamically stable: amiodarone or quinidine

if unstable: cardioversion
Term
fungus ball that rolls around in lungs, with fragmented septae
Definition
aspergillosis
Term
features of temporal arteritis
Definition
PMR
claudication
hi ESR
HA, scalp pain
visual loss
subclavicular bruit
Term
dark brown discoloration of colon with lymph follicles shining as pale patches (meanosis coli)
Definition
abuse of antraquinone laxatives like bisacodyl
Term
herepes simplex keratitis vs herpes xoster opthalmicus
Definition
both have vesicular rash and dendtiric corneal ulcers.
zoster is more in elderly.
both have burning and itching, zoster is more on skin tho.
Term
anti TPO
Definition
antithyroglobulin in hashimotos
Term
tx of uncomplicated pyelo
Definition
1. mild to mod: tmpsmx, cipro
2. severeL ceftriax, cipro, tmpsmx iv
Term
tx complicated pyelo
Definition
1. mild to mod: ceftriax, cipr, cefepime iv
2. severe: amp-sul, tic-clav, pip-tazo, carbapenem, aztreonam +- genta
Term
tx pyelo in preg
Definition
ceftriax +- genta, aztrea
Term
how long on oral
Definition
10-14 days
Term
intense, focal vertebral pain WO neuro sx
Definition
compression fracture from vertebral body demineralization from old age probs
Term
dipyridamole
Definition
used as antiplatelet
also used to dx angina pectoris
vasodialates coronaries, but cant vasodialate diseased ones so the healthy ones steal blood from diseased ones and cause sx (coronary steal)
Term
TEN vs SJS
Definition
TEN > 30%
SJS < 10%
Term
eye changes in non-ketotic hyperglycemia
Definition
blurred vision from intraocular hypotension 2/2 hyperosmolarity
Term
using peep and peak in ventilation
Definition
1. Peak = plateau + resistive pressure
2. Plateau is result of compliance
3. Plateau = compliance (aka elastic pressure) + PEEP
4. High peak pressure with normal plateau = mucus plug, obstruction, biting tube, bronchospasm
5. hi peak pressure + high plateau pressure = pneumothorax, pneumonia, atalectasis, R mainstem intubation, pulmonary edema
Term
What bp med causes significant edema
Definition
CCB
Term
what arrythmia seen in dig toxicity
Definition
atrial tachy with AV block
Term
what does atrial tachycardia with av block look like on EKG
Definition
150-250 bpm (slower than flutter at 250-350)
P waves present, but look different
Term
how does sublingual nitroglycerin help in angina
Definition
vasodialate veins, arterioles, and coronaries.
systemic venodia dec preload and LVEDV and dec wall o2 demand and stress. also dec afterload.
Term
what type of hypersensitivity in drug induced rash
Definition
IgE type 1
Term
when is opening snap heard?
Definition
after s2
Term
features of mitral stenosis
Definition
opening snap
diastolic
best heard with pt lying on side and held expiration
Term
what pco2 indicates asthma attack going bad
Definition
normal or elevated
Term
features of osteoarthritis in hpi
Definition
worse with activity
morning stiffness
tenderness and limited ROM
Term
xr of osteoarthritis
Definition
narrowing of joint space with osteophyte formation
Term
hepatorenal syndrome general features
Definition
decreased GFR w/o any known cause
seen in end stage liver disease
probs due torenal vasoconstriction
does not respond to saline bolus
Term
hepatorenal syndrome types
Definition
1: raipdly progressive
2: moer slowly, death usually due to infection and hemorrhage
Term
ultimate tx of hepatorenal syndrome
Definition
dialysis, liver transplant
Term
finger glubbing in COPD
Definition
malignancy
Term
5 common ade of amiodarone
Definition
thyroid
hepato
corneal deposits
check lft, tft, pft
skin change (blue grey)
pulmonary fibrosis
Term
what fluid do you give in dehyrdation hypernatremia
Definition
iv saline
Term
tx of mild vs severe hypovolemic hypernatremia
Definition
iv saline if severe
if mild can do 5 dextrose wtih .45 saline
Term
what abx causes hyperkalemia
Definition
tmpsmx
Term
dx test for bronchiectasis
Definition
CT
Term
PCWP in ARDS vs PEdema from fluid overload
Definition
PCWP > 18 means pulmonary edema probs from cardiac issue
PCWP < 18 means ARDS
Term
contr to succinylcholine
Definition
hyperkalemia
succinylcholine --> hyperkalemia --> arrythmias
Term
what HIV drug causes crystal induced nephropaty
Definition
indinavir (protease inhibitor)
Term
pemphigus vulgaris vs bullous pemphigoid
Definition
PV is the blistering skin peeling disease with IgG in epipdermis

BP is pruritic with tense blisters, IgG and C3 at dermal epidermal junction
Term
triple and quadruple therapy for h pylori pud
Definition
1. triple: amoxicillin, ppi, clarithromycin
2. quadruple: bismuth, metronidazole, tetracycline and PPI.
Term
What electrolyte changes are seen in CKD
Definition
hi K
lo Ca
hi P
Metabolic acidosis
Term
What EKG changes seen in CKD due to the lo Ca and hi K
Definition
short PR
long QT
peaked T waves
Term
ethylene glycol intox tx
Definition
bicarb and fomipizole
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