- Stress - Structural abnormalities - Hyperthyroidism - Heart failure - Alcohol - PE (may be due to catecholamine surge)

Per Dr. Soesilo - Usually okay to control just the rate - If symptomatic, then also want to control the rhythm - Anticoagulation

Internal Med 2 Flashcards by Giselle McIntyre

What are components of qSOFA

Positive screen is associated with poor outcomes

Criteria (positive if >/=2)

RR >/= 22
AMS
Systolic BP = 100

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What are SIRS criteria

T >38 or <36
RR >20
HR >90
WBC >12,000 or <4,000

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Definition of septic shock

Sepsis (SIRS + confirmed/presumed infectious source) + refractory hypotension despite adequate fluid resuscitation (30 cc/kg)

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What bugs / empiric drugs should you use in sepsis before you have cultures

MRSA = Vancomycin
Gram neg rods (E. Coli) = Cefepime (CTX doesn’t cover psuedomonas)
Psuedomonas = Cefepime
Anaerobes = Metronidazole

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What is your goal in a day for increasing Na in hyponatremic patients?

8-10 increase in sodium level in a day

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What should be your initial questions/evaluation of a patient with upper GI bleed

Liver disease
ETOH
NSAIDs
h/o bleeding
PMH
Coagulopathy
Past endoscopy

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What meds should you give initially for an upper GI bleed

PPI
Octreotide
Abx (Ceftriaxone for infection prophylaxis in ANY cirrhotic patient)
Transfuse only when Hgb <7

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How should you treat someone with persistent tachycardia

If hemodynamically unstable, will probably need electricity

If hemodynamically stable, need to slow heart rate to see underlying rhythm
- Valsalva, carotid massage
- Adenosine
Then assess underlying rhythm

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Triggers of Afib

Stress
Structural abnormalities
Hyperthyroidism
Heart failure
Alcohol
PE (may be due to catecholamine surge)

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Treatment of Afib

Per Dr. Soesilo

Usually okay to control just the rate
If symptomatic, then also want to control the rhythm
Anticoagulation

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What is CHADVASC score

Calculates the risk of stroke for patients with A-fib/A-flutter

Age, gender, DM, HTN, h/o prior embolic event, h/o CHF

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What are the 4 components you must treat in CHF

Preload = Volume status/Diuretics (e.g. Furosemide)
Afterload = (decrease vasoconstriction)
— ACEI
— ARBs
— Hydralazine (+ nitro)
Beta blockers (remodelling)
Aldosterone receptor antagonists (remodelling)

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How do you determine anion gap?

Na - (Cl + HCO3)

>12 = anion gap
8-12 = non-anion gap

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What are the causes of anion gap metabolic acidosis

Anion gap = adding acid to the blood
o	MUDPILES:
♣	M – Methanol
♣	U – Uremia (renal failure) 
♣	D – Diabetic ketoacidosis
♣	P –  Propylene glycol/Paraldehyde
♣	I – Isoniazid/Iron
♣	L – Lactic acidosis
♣	E – Ethylene glycol (antifreeze)
♣	S – Salicylates (aspirin)

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What are the causes of non-anion gap metabolic acidosis

Non-anion gap = Losing excessive HCO3-

o Diarrhea, Renal tubular acidosis, Spironolactone, Acetazolamide

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Acronym for uses of acute dialysis

AEIOU

Acid, electrolytes, intoxication, overload, uremia

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Describe cause and findings of immune thrombocytopenia (ITP)

o IgG autoantibodies to GP2b3a
o Antibodies produced by plasma cells of spleen and antibody-bound platelets consumed by macrophages of spleen
o Often associated with HIV

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Treatment of ITP

♣ Steroids and IVIG (autoimmune treatment)

♣ Splenectomy

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Describe cause and findings of thrombotic thrombocytopenic purpura (TTP)

o Platelets used up in pathologic formation of microthrombi in small vessels
o Due to decreased ADAMTS13, enzyme that normally cleaves vWF for degradation
♣ No vWF degradation = abnormal platelet adhesion = microthrombi

o Findings (Pentad):
♣ Thrombocytopenia = platelets being used up
♣ Microangiopathic hemolytic anemia = RBCs sheared by microthrombi
♣ Renal insufficiency (thrombi involve vessels of the kidney)
♣ Neurological symptoms (confusion, HA, seizures, coma) – thrombi involve vessels of CNS
♣ Fever

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What are common causes of thrombocytopenia due to decreased platelet production

Study These Flashcards

o Viral infections (e.g. EBV, Hep C, HIV)
o Chemotherapy
o Myelodysplasia
o Alcohol use
o Congenital (e.g. Fanconi)
o Vitamin B12 or folate deficiency (causes pancytopenia)

What are common causes of thrombocytopenia due to increased platelet destruction

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o	SLE
o	Medications (e.g. Heparin)
o	Idiopathic thrombocytopenic purpura
o	Disseminated intravascular coagulation 
o	Thrombotic thrombocytopenic purpura
o	Hemolytic Uremic Syndrome
o	Anti-phospholipid syndrome

Risk factors for aortic dissection. Which is the most common

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♣ HTN (most common)
♣ Marfan syndrome
♣ Cocaine use

Complications of aortic dissection

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♣ Stroke (carotid arteries)
♣ Acute aortic regurgitation (aortic valves)
♣ Horner syndrome (superior cervical sympathetic ganglion)
♣ Acute myocardial ischemia/infarction (coronary artery)
♣ Pericardial effusion/cardiac tamponade (pericardial cavity)
♣ Hemothorax (pleural cavity)
♣ Lower extremity weakness or ischemia (spinal or common iliac arteries)
♣ Abdominal pain (mesenteric artery)

How does thyrotoxicosis cause HTN

Study These Flashcards

T3 acts as a positive ionotrope and chronotrope, leading to tachycardia, high BP

Acronym to think about Altered mental status

MIST: - M = metabolic (electrolytes, glucose, liver, TSH) - I = infection/inflammatory - S = structural (stroke, seizure, bleeds, tumor) - T = toxins (intoxication, withdrawal AEIOU - A = alcohol - E = electrolytes - I = iatrogenic - O = oxygen - U = uremia

When do you get a CT prior to LP in a patient with suspected meningitis

If pt has a focal neuro deficit

What is the next thing you should look at in an EKG of a patient with tachycardia

Narrow vs. Wide QRS

How can you further divide narrow QRS tachycardia

Regular vs. Irregular rhythm

Ddx for Narrow QRS tachycardia with regular rhythm

``` o 1. Sinus tachycardia o 2. Atrial tachycardia (due to ectopic nodes that fire quicker than SA node) o 3. AVRT o 4. AVnRT o 5. Atrial flutter ```

Ddx for widened QRS tachycardia with irregular rhythm

o 1. Atrial fibrillation o 2. Flutter with variable block o 3. Multifocal atrial tachycardia (MAT)

Go through the steps of reading an EKG . . . no seriously . . . DO IT

- Rate - Rhythm - Axis - Intervals - Chambers - Ischemia/infarct

What are the 3 criteria to diagnose BBB

- Wide QRS - Inverted T-waves in precordial leads - No q-waves in V5 or V6

What will you see on EKG in PE

• S1Q3T3 o S waves in lead I o Q waves in lead III o Inverted T waves in lead III

What is Cushing triad in brain injury

* Triad of hypertension, bradycardia, and respiratory depression in response to increased intracranial pressure * Increased ICP =pressure constricts arterioles in brain = cerebral ischemia = sympathetic response = increases peripheral vasoconstriction, thus increasing BP = aortic baroreceptors sense increased BP = respond with reflex bradycardia and respiratory depression

What will you see with (1) Protein, (2) glucose, (3) cells,, (4) culture in: Bacterial meningitis

♣ Cells = polymorphs ♣ Protein = high ♣ Glucose = low ♣ Other = culture and gram stain may be positive

What will you see with (1) Protein, (2) glucose, (3) cells,, (4) culture in: Viral meningitis

♣ Cells = lymphocytes ♣ Protein = high ♣ Glucose = Normal ♣ Other = Viral PCR may be positive

What will you see with (1) Protein, (2) glucose, (3) cells,, (4) culture in: TB meningitis

♣ Cells = lymphocytes ♣ Protein = high ♣ Glucose = very low ♣ Other = positive for acid-fast bacilli

What med must you include in suspected aspiration pneumonia

Clindamycin

Empiric tx of community acquired pneumonia for a previously healthy OUTpatient

♣ Macrolide (e.g. Azithromycin) or doxycycline

Empiric tx of CAP for outpatient with comorbidities

Fluoroquinolone or beta-lactam + macrolide • Beta-lactam does not work against atypicals (Chlamydia, Legionalla, Mycoplasma) so need to add macrolide

Empiric tx of CAP in non-ICU inpatient

♣ Fluoroquinolone (IV) – respiratory fluoroquinolones = Levofloxacin, Moxifloxacin ♣ Beta-lactam (e.g. Ceftriaxone) + macrolide (IV)

Empiric tx of CAP in ICU inpatient

♣ Beta-lactam + macrolide (IV) | ♣ Beta-lactam + fluoroquinoloe (IV)

Empiric tx of bacterial meningitis in pt age 2-50 Include bugs you are trying to treat

♣ Bugs • Strep pneumo, Neisseria meningitides ♣ Abx • Vancomycin + 3rd generation cephalosporin

Empiric tx of bacterial meningitis in pt age >50 Include bugs

♣ Bugs: • S. pneumo, N. meningitides, Listeria ♣ Abx: • Vancomycin + Ampicillin + 3rd generation cephalosporin

Empiric tx of bacterial meningitis in immunocompromised pt Include bugs

♣ Bugs: • S. pneumo, N. meningitides, Listeria, gram negative rods ♣ Abx: • Vancomycin + Ampicillin + Cefepime

Empiric tx of bacterial meningitis in pt with recent neurosurgery/penetrating skull trauma

♣ Bugs: • Gram-negative rods, MRSA, coagulase negative staph ♣ Abx: • Vancomycin + Cefepime

Ddx for tachycardia with wide QRS with regular rhythm

o 1. Ventricular tachycardia | o 2. SVT with aberrancy (BBB)

Ddx for tachycardia with wide QRS and irregular rhythm

o 1. SVT with aberrancy | o 2. Ventricular fibrillation

What does HR of 150 clue you in to?

A-flutter

Internal Med 2 Flashcards

(49 cards)