An afebrile 45yo M with no history of lung disease or smoking presents with CC of productive cough x 3 weeks. What is your most likely diagnosis? What is your next step?
Diagnosis: Acute Bronchitis
Next step: Short acting bronchodilators, antitussives
What is acute bronchitis?
inflammation of the tracheobronchial tree
What color of sputum is indicative of a bacterial infection?
Trick Question. the color of your lung butter is irrelevant
A febrile 45yo M with no history of lung disease or smoking presents with CC of productive cough x 3 weeks. What is your most likely diagnosis? What is your next step?
Diagnosis: pneumonia Next Step: Chest Xray
What is Rhinosinusitis?
Inflammation of the nasal cavity and obstruction of 1+ paranasal sinus.
What is the most likely etiology of bronchitis/URIs/Sinusitis/Pharyngitis?
the vast majority is viral. common viruses are Influenza, parainfluenza, adenovirus, rhinovirus, and Ebstein-Barr
What are the three most common bacterial infections in the head and upper airway? What are the first line agents to treat them?
Strep pneumoniae, H. influenea, and Moraxella catarrhalis 1st line agents are 10-14 days of amoxicilin or Trimethoprim-sulfa
The #1 cause of pharyngitis is...
Viral. But you still have to rule out Group A Strep
a 7yo girl comes in with abrupt onset of sore throat, fever, palatal petechiae, tender cervical adenopathy, and no cough. What is the most likely diagnosis.
This person hits every criteria of the CENTOR score. The most likely diagnosis is GAS. Epstein-Barr (Mono) can present very similarly. A "classic" sign of mono is splenomegaly and LUQ pain.
a 7yo daughter of some crazy ass anti-vaxers, comes in with abrupt onset of sore throat, fever, drooling, tender cervical adenopathy, and no cough. What is the most likely diagnosis. What is the causative agent.
This is very suggestive of epiglottis. This is an emergency as you can loose the airway. This is caused by H. Ifluenza type B (HiB)
What are the complications of an untreated GAS infection?
Rheumatic fever, glomerulonephritits (can occur with or without appropriate antibiotic treatment), toxic shock, mitral valve vegetations-->prolapse later in life.
What is the most common cause of otitis externa (swimmers ear)?
Pseudomonas Patients with DM are at risk of OE becoming "malignant OE"
a 56yo obese male presents with substernal chest pain, SOB, and diaporesis that began with minimal exertion. What is the most likely diagnosis? What is the next diagnostic step? Therapeutic step?
Unstable angina. Next step in dx: ECG and CX. Then Troponin, CBC, CK, CK-MB Next step in treatment: IV access and MONA. (Morphine, Oxygen, Nitro, Aspirin) + Beta-blockers and glycoprotein IIb/IIIa inhibitor. Avoid/discontinue short acting dihydropyridines (nifedipine)
What are the 4 classes of Angina per the New York Heart Association?
Class I: Angina only with strenuous activity Class II: Angina with above average activity level Class III: Angina with ADLs Class IV: Angina at rest
What are the common causes of angina?
Atherosclerosis, Coronary artery spasm, cocaine use
What drugs should be given post MI?
the combination of Nitro and Beta blockers has been shown to reduce the risk of a subsequent MI. ACE-Inhibitors given within 24 hours prevent Left Ventricular remodeling and thus recurrent ischemic events.
What are the risk factors for CAD?
Smoking, age, DM, DLP, HTN, family history, male gender, post-menapause, homocystinemia, LVH.
If angina persists for >30 min with rest what is likely occurring?
a myocardial infarct
a 50yo male with a 1 week history of URI comes in with sharp chest pain that radiates to the trapezius and increases with respiration and decreases with leaning forward. on EKG you find ST elevation in most leads. What is the most likely diagnosis?
Pericarditis. A MI has dull pain and the ST elevation will correspond with the focus (II, III, and AVF if the LAD is involved)
a 50yo male comes in with a tearing chest pain that radiates to his back. On Xray you find a widened mediastinum. What is the most likely diagnosis?
a 50yo male comes in with a "boring" chest pain that radiates to his back. He has an elevated amylase. What is the most likely diagnosis?
a 50yo male with a 1 week history of URI comes in with pleuritic chest pain, fever, and dyspnea. What is the most likely diagnosis?
a thin 50yo Caucasian male smoker comes in with a sudden onset unilateral pleurtic chest pain. On exam he has decreased breath sounds. What is the most likely diagnosis?
a 50yo male comes in with a sudden onset pleuritic chest pain, tachycardia, tachypnea, and hypoxemia. What is the most likely diagnosis?
a 46yo female with CKD and long standing uncontrolled HTN presents with periorbital edema and decreased urination. on UA she has hyaline casts, 3+ protein, and glucose. Negative for ketones. What is her most likely diagnosis. Next Step?
Acute Kidney injury on CKD next step: Serum electrolytes, BUN, Cr.
a 46yo female with CKD and long standing uncontrolled HTN presents with periorbital edema and anuria. Chest xray shows pulmonary edema. What is the most likely diagnosis? therapy needed?
end-stage renal disease (ESRD) Therapy: Dialysis and eventually renal transplant.
What are the most common etiologies of CKD?
diabetes, HTN, and glomerulonephritis
What lab do you get to evaluate GFR?
How do you stage CKD?
Based off of GFR: Normal: 90-120 mL/min Stage I: >90 mL/min but in the presence of signs of CKD (proteinuria, hematuria) Stage II: 60-89 mL/min Stage III: 30-59 mL/min Stage IV: 15-29 mL/min Stage V:
What common drugs affect kidney function?
NSAIDs, aminoglycosides, radiographic contrast