Internal Medicine

Monday, June 27, 2016

1. Chronic kidney disease, stage IV

2.

History of B12 deficiency + Microcytosis?

3.

Code Status: Full Code?

a.

Types of Code pt want in emergent situations

i. Full Code: Intubation + CPR
ii. Intubate Only:
iii. DNR: No Intubaton or CPR
iv. There is no code for CPR only b/c it doesnt occur independetly.
v. Full Code by Default: Noone has asked yet. Go ask!

4.

High osmolality with low albumin?

5.

Diagnostic Results XR mandible: Dental cariesa involves the right mandibular first molar tooth. Periapical lucencyb in the left second premolar tooth.
Impactedc left molar tooth. Multiple dental filling materials.Recommend dedicated Panorexd for further evaluation.
a.
b.

Permanently damaged areas in teeth that develop into tiny holes.

Opposite of opacity; region in an image caused by an absorber of lower x-ray attenuation than its surrounding tissues

c.
d.

A panorex is an xray that provides a full view of the upper and lower jaws, teeth, temporomandibular joints (TMJs) and sinuses

6.

MEND Score: 13
a. Miami Emergency Neurologic Deficit.

7.

Abx
a.
b.
c.
d.

Aztreonam: It is the only Monobactams. Binds to PBP-3 and prevents peptidoglycan cross linking. Synergistic with Aminoglycosides. No cross
allergenicity with PCN. Less susceptible to beta-lactamases. Gram only. Used in PCN allergic pt. and renal pt. who cant tolerate
aminoglycosides.
Neosporin: Topical, against Gram+ staphylococci and streptococci (like ampicillin). It inhibits cell wall synthesis in bacteria and can be used
internally, but it may cause kidney damage.
Fosfomycin: broad spectrum, bactericidal antibiotic for oral administration. Can treat UTI
Clindamycin: Blocks Peptidyl transferase translocation at 50S. Bacteriostatic. Anaerobic inf + GAS inf Treats anaerobic inf above the
diaphragm - vs Metronidazole. SE: Pseudomembranous Colitis, fever, diarrhea.

Tuesday, June 28, 2016

1.

5 Ps:
a.
b.
c.
d.
e.

Pain
Position Turn pt to a comfortable position
Personal Care Bathroom?
Proximity Everything w/in pt. reach call light, telephone, etc.
Plug-ins Ensure all electricals are plugged in. Also, limit clutter of electrical equipment.

2.

Normally, we dont look for Phosphorus in labs b/c it is readily available in all the foods. However, if pt. is malnourished, check it.

3.

Diverticulum cause? High Pressure. Ex- Ureter diverticulum will be because high pressure in ureter due to BPH.

4.

Li-Fraumeni syndrome: ~ SBLA cancer syndrome (sarcoma, breast, leukemia, adrenal gland). Both copies of the p53 gene must be knocked out for tumor
formation (2-hit hypothesis).
a.
b.

5.

Loss is seen in > 50% of cancers.

Germline mutation results in Li-Fraumeni syndrome (2nd hit is somatic), characterized by the propensity to develop multiple types of
carcinomas and sarcomas
Catheter Types

6.

a. Condom Catheter: Catheter goes over the penis and acts like a condom
b. Indwelling Catheter: Catheter goes in the urethra.
We always admit pt w. Pneumo. Figure out d/f types of Pneumo and there plans healthcare vs community vs
a.

Read the uptodate article about health care associated pneumo (<90days)

7.

3 beta-blockers approved in CHF: Metoprolol, Bisoprolol, Carvedilol

8.

COPD Management:

9.

Acute Encephelopathy

10. SIRS criteria: Detects risk of severe sepsis.

a. Sepsis: SIRS + Inf
b. Shock: Hypotension + Severe Sepsis
11. Chest Pain:
a.
b.
c.

Typical Chest Pain 3/3

Atypical Chest Pain 2/3
Non-Cardiac Chest Pain 1/3
i. Substernal Pain
ii. Worst w/ exertion
iii. Relieved by rest
12. Grand Round: Management of Kidney Stones
a. W
Wednesday, June 29, 2016
1. Oxygen delivery and their concentration: http://www.atitesting.com/ati_next_gen/skillsmodules/content/oxygen-therapy/equipment/delivery-devices.html
a. Room Air has 21% (FiO2) O2 PaO2 98-100%
b. For each additional L of O2 3% increase in O2 conc.
i. Ex 3L O2 will increase PaO2 30%
c. If going above 5L, humidify (2-3L) the O2.
d. High Flow O2
e. Mini VD mask increment is 5% from 30% to 50%. No bag vs non rebreather
f. Non-Rebreather Mask 60%-100%
g. BI-PAP Positive air Pressure
i. noninvasive, ventilation-assistance modality that provides higher airway pressure during inspiration and lower pressure during
expiration, usually delivered by a face mask. Bette than CPAP and PEEP because they have higher P during inspiration and expiration
resulting in Pneumothorax. Restrictive Lung Dz pt dont need help with expiration and high P during expiration is bad.
h. Intubation
2. Fluids and Electrolytes

3.