Pulmonary, Neurology, Cardiology, Endocrinology, and Pharmacology Review

Flashcards covering key concepts from the lecture notes, designed for vocabulary review.

Dead Space

Increased V/Q ratio, perfusion is zero; improves with oxygen.

Shunt

Decreased V/Q ratio, ventilation is zero; causes hypoxic vasoconstriction; O2 doesn't improve PaO2. Causes include COPD/Emphysema, PNA, atelectasis, pulmonary edema, CF, FB aspiration.

PE sensitive sign

Sinus Tachycardia is most sensitive.

Modified Wells >4

PE Likely --> CTA

D-dimer

High sensitivity and NPV; a negative D-dimer test most likely rules out PE, has low specificity.

CTA CI for PE

Do V/Q scan.

Contrast-induced nephropathy prevention

IV isotonic soln (NaCl or Nabicarb) before and after contrast; hold diuretics and metformin before contrast in CKD.

Hypoglossal nerve injury

Tongue deviates to the side of injury.

Facial nerve injury

Asymmetric smile (marginal mandibular branch MC injured).

Recurrent laryngeal nerve injury

Change in voice.

Infant w GER 1st line

Reassurance + feeding modification (upright positioning after feeds, burp during feeds, frequent small volume feeds); self resolves by 1 yo.

Pyloric stenosis baby

Abd U/S - 1st month of life + non-bilious projectile vomit w feeds.

Severe hydronephrosis </ 28 wks preg

Percutaneous nephrostomy tubes or ureteral stents.

Severe hydronephrosis >/37 wks preg

Delivery.

Borderline personality disorder mood pattern

Rapid + brief mood shifts (hrs - days) in response to a stressor.

Borderline personality disorder 1st line

Dialectical behavior therapy (psychotherapy).

BP2 definition

MDE >/2 wks + hypomanic episodes >/4 days.

PCOS = 1st line

Weight loss (target BMI <25).

PCOS anovulatory cycles treatment

Combined OCPs = endometrial protection; progestin IUD if no pregnancy desired; ovulation induction = Letrozole.

Letrozole

Aromatase inhibitor = reduces estrogen production, stimulating FSH secretion and inducing ovulation.

Clomiphene MOA for PCOS

Estrogen rec antag in hypothalamus → in pulsatile GnRH secretion in Pit → inc FSH n LH in ovaries

SIADH Na btw 130-135

Asx hyponatremia → fluid restrict.

SIADH Na btw 120-130

Asx or Mild Sx hyponatremia → fluid restrict.

SIADH Na <120

Severe Hyponatremia (Sz/coma) → hypertonic 3% saline.

SIADH causes

Carbamazepine, SSRI, NSAID, Small cell Lung cancer.

Carbamazepine

Inactivates Na channels = 1st line for trigeminal neuralgia, focal sz; 2nd line gen tonic/clonic; AE: SIADH, 1st trim teratogen, agranulocytosis, hepatotoxic, SJS, cytp450 inducer.

MCD causes

T cell cytokine mediated podocyte injury → steroids (prednisone).

Kids on steroids for MCD

Need opthalmologic exams for early cataracts detection.

Steroid AE

Cataracts + impaired linear growth.

ADHD kids >/6 yo

Methylphenidate or amphetamines - If not working or develop intolerable S.E → switch to other drug - Atomoxetine (SNRI) or Clonidine (a-adrenergic agonists.

ADHD kids 4-5 yo

Behavioral interventions alone (parent-child behavioral therapy).

Atomoxetine

Black box warning - inc risk of suicide ideation in kids/teens; SNRI = block reuptake of NE → inc levels of NE + dopa in synaptic cleft.

Methylphenidate

Indirect + central sympathomimetic = inc release + blocks reuptake of NE + dopa = inc levels in synaptic cleft → improved cognition + concentration.

Buproprion

For smoking cessation aid + MDD (atypical antidepressant) - Avoid in those w/seizure = lowers sz threshold.

Acute infectious diarrhea high risk

Bloody stools or High grade fever, requiring hospitalization , diarrhea > 7 days, immunocompromised, elderly.

CGD PPX txt

TMP-SMX + itraconazole.

CGD

Recurrent bacterial and fungal infxn by cat + orgs (SA, burkholderia, Serratia, Nocardia, Aspergillus); NADPH oxidase mutation (X-rec) → impaired neutrophilic intracellular killing (cellular burst) → granulomas, LAD, cat + infxns (skin, lungs, GI, bone, UTI).

MDD

/2 wks of >/5 out of 9 Sx: of depressed mood + SIGECAPS.

Septal perforation

Cocaine abuse.

Cocaine metabolite

Benzoylecgonine.

Pt w substance abuse (cocaine)

Perform a non-judgemental “brief counseling intervention” to engage in pt discussion, educate pt on risks, develop collaborative goals for reducing use, open discussion of txt options.

1 cause of dementia

Alzheimer.

2 cause of dementia

DLB (dem w lewy bodies).

NL pressure hydroceph (NPH)

Triad: cog impairments + urinary incontinence + abnl gait.

DLB definition

Dementia 1st + >/2 of these sx: fluctuating cognitions , visual hallucinations, parkinsonism, REM sleep disorder (loss of nl REM -sleep atonia).

DLB txt

Very sensitive to antipsychs → Use low dose, 2nd gen antipsychs (quetiapine).

DMD

Elevated CK (Proximal LE weakness) = severe Dz - B/L calf enlargement in toddlers (2-3 yo) - Common cause of death = dilated cardiomyopathy; dystrophin gene muta (X-link) → no dystrophin on muscle cytoskeleton → muscle atrophies & replaced w fatDx = muscle bx; Management = glucocorticoids (prednisone)/Screenings: serial EKGs + Echo; PFTs /Prognosis: wheelchair bound by teenager; death by 20-30 from resp/HF; 40.

MG

Proximal UE weakness = Ach rec Ab.

Tethered cord/ transverse myelitis

LE weakness + bowel/bladder dysfxn - MRI spine.

Charcot-marie tooth

Nerve conduction studies show dec conduction but sural n. Bx shows the demyeli + remyeli of large nerve fibers - Distal weakness + sensory (numbness, pain).

Post op hypoxemia 0 causes

Airway obstruction/edema (stridor) - from ETT or pharynx muscle laxity/ Residual anesthesia effect - anesthesia, benzos, opiates (dec RR or TV).

Post op hypoxemia Early causes

Bronchospasm (wheezing).

Post op hypoxemia 1-5 days

PNA (fever, WBC, infiltrate CXR)/ Atelectasis = thoracoabd surgeries; splinting, red cough, retained secretion).

Post op hypoxemia >3 days

PE - CP, tachy, o2 doesn’t help.

Post op fevers = 5 W’s

Wind, water, walking, wound, weird.

Post op fever 0 days

Malignant hyperthermia (anesthesia thing).

Post op fever 1-2 days

Atelectasis + PNA.

Post op fever 3 days

UTI.

Post op fever 5 days

DVT/PE.

Post op fever 7 days

Infxn.

Post op fever 8-14 days

Abscess.

Endometriosis

Adnexal mass (endometrioma) that is large + tender on deep palp; ass/w pelvic pain worse w bowel movements (dyschezia) + rectovaginal nodularity on exam (classic presentation)MC implantation sites: ovaries, cul-de-sac, broad ligaments, uterosacral liga, FT, sigmoid colon Txt = OCP

Uterine sarcoma

Ass/w pelvic radiation + tamoxifen use.

Tethered cord synd in 5 yo boy

Progressive back pain + LMN (weakness/hyporeflexia) + bladder dysfxn - MCC = closed spinal dysraphism (spina bifida occulta) +/- ass/w/ hair tuft/lipoma).

BB toxicity

No p waves + Bradycardia; Give Glucagon.

BB bradycardia + hypotension

D/t b1 block on heart; IVF → +/- calcium gluconate to inc BP: Atropine if HD instability (symptomatic).

Calcium gluconate

1st line for CCB (verapamil) toxicity.

Low cardiac risk of noncardiac surgeries

Breast (lump/mastect), endoscopy, cataract.

Pharmacologic stress tests

Adenosine myocardial perfusion imaging, dobutamine echo.

Tamoxifen

Causes inc endome proliferation (SERM).

T1aN0 of SCC of glottis confined

Radiation therapy, laser excision, or partial vocal cordectomy.

T4 glottic cancer

Total laryngectomy - Invades thyroid cartilage or direct extralaryngeal spread.

T3 lesions of glottis

Induction chemo followed by radiation to preserve the larynx - Confined to larynx w vocal cord fixation.

TOF definition

Rt ventricular Outflow tract obstruction (RVOT)- decreases pulm BF/ Overriding aorta/ RV Hypertophy/ VSD (cyanotic).

Sustained polymo VT

Torsades → IVMagSulfate.

Sustained Monomo VT

WPW → Amiodarone.

4 HF drugs improving mortality

Angiotensin-neprilysin inhibitor/ BB/ Aldost antag/ SGLT2 inhib.

PEA & Asystole

Unshockable rhythm → CPR/chest compressions.

VF/Pulseless VT

Shockable rhythm → defibrillation shock.

Parasternal heave

RVH.

Pulsus paradoxus

Decline in BP >10 mmhg on inspiration = cardiac tamponade (CP, dyspnea, hypotension, JVD, muffled heart sounds).

Pre-op AF if HDS w/uncontrolled rate

Rate control w/ BB or ND-CCB - If it works → proceed to surgery - If doesnt work → electrical cardioversion (synch shock).

Pre-op AF if HDU

Electrical cardioversion + DELAY surgery to find the cause.

Severe AS

Aortic jet velocity >/ 4 m/sec OR mean transvalvular gradient >/40 mm Hg on ECHO - Symptomatic (angina, syncope, exertional dyspnea); LVEF <50%; undergoing a CABG.

Sx pt + severe AS

Gets AV replacement to inc long term survival (reduce mortality).

Amlodipine AE

Peripheral LE edema.

ACEI AE

Cause nonpitting swelling of SQ or submucosal tissue (lips/tongue/face/upper airway.

1st AV Block

Equally prolonged PR.

2nd AV block type 1

Increasingly prolonged PR (there's a pattern) + a drop - R-R is irreg but there's a pattern = reg irreg.

2nd AV block type 2

Same PR length + random drops → needs pacemaker.

3rd AV block

P n QRS don't follow each other → pacemaker - Think of Lyme Dz.

TAPVR

Pulmonary veins drain into RA Severe cyanosis, snowman sign on CXR (in supracardiac.

DI

No ADH to reabsorb H2O = concentrated serum (mild inc Na) + dilute urine.

SIADH definition

Too much ADH = Dilute serum (dec Na) + concentrated urine.

Hypothyroid

Dec free h2o excretion = Hypotonic, hyponatremia.

Migraines Abortive

NSAID (naproxen) or Sumatriptans.

Migraines PPX

Topiramate, BB (propranolol), or Amitriptyline.

Diamond-Blackfan

Triphalangeal thumbs, red-cell aplasia → anemia ONLY).

Fanconi anemia

Thumb + forearm malformations, aplastic anemia→ pancytopenia.

Mycoplasma PNA

Can have maculopap rash → txt w/macrolide, resp FQ, or Doxy.