Pocket Medicine: The Massachusetts General Hospital Handbook of Internal Medicine (123 page)

BOOK: Pocket Medicine: The Massachusetts General Hospital Handbook of Internal Medicine
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S
a
O
2
is measured in any arterial sample (usually 93—98%)
S
v
O
2
(mixed venous O
2
) is measured in RA, RV or PA (assuming no shunt) (nl ~75%)

PULMONARY

CXR in heart failure

• ↑ cardiac silhouette (in systolic dysfxn, not in diastolic) • Pulmonary venous hypertension: cephalization of vessels (vessels size > bronchi in upper lobes), peribronchial cuffing (fluid around bronchi seen on end → small circles), Kerley B lines (horizontal 1—2-cm lines at bases), ↑ vascular pedicle width, loss of sharp vascular margins, pleural effusions (~75% bilateral) • Pulmonary edema: ranges from ground glass to consolidation; often dependent and central, sparing outer third (“bat wing” appearance)
Dead space
= lung units that are ventilated but not perfused
Intrapulmonary shunt
= lung units that are perfused but not ventilated

NEPHROLOGY

Anion gap
(AG) = Na − (Cl + HCO
3
) (normal = [alb] × 2.5; typically 12 ± 2 mEq)

Delta-delta
(ΔΔ) = [Δ AG (ie, calc. AG - expected) / Δ HCO
3
(ie, 24 - measured HCO
3
)]

Urine anion gap
(UAG) = (U
Na
+ U
K
) − U
Cl

HEMATOLOGY

✓ PTT q6h after every Δ (t
1

2
of heparin ~90 min) and then qd or bid once PTT is therapeutic ✓ CBC qd (to ensure Hct and plt counts are stable)

Warfarin-heparin overlap therapy

• Indications: when failure to anticoagulate carries ↑ risk of morbidity or mortality (eg, DVT/PE, intracardiac thrombus)
• Rationale: (1) Half-life of factor VII (3—6 h) is shorter than half-life of factor II (60—72 h);
∴warfarin can elevate PT
before achieving a true antithrombotic state
(2) Protein C also has half-life less than that of factor II;
∴theoretical concern of
hypercoagulable state
before antithrombotic state
• Method: (1) Therapeutic PTT is achieved using heparin
(2) Warfarin therapy is initiated
(3) Heparin continued until INR therapeutic for ≥2 d and ≥4—5 d of warfarin
(roughly corresponds to ~2 half-lives of factor II or a reduction to ~25%)

OTHER

NOTES

ABBREVIATIONS

 

5′-NT

5′-nucleotidase

6-MP

6-mercaptopurine

AAA

abdominal aortic aneurysm

AAD

antiarrhythmic drug

Ab

antibody

ABE

acute bacterial endocarditis

ABG

arterial blood gas

abnl

abnormal

ABPA

allergic bronchopulmonary aspergillosis

abx

antibiotics

AC

assist control

ACE

angiotensin converting enzyme

ACEI

ACE inhibitor

ACI

anemia of chronic inflammation

ACL

anticardiolipin antibody

ACLS

advanced cardiac life support

ACS

acute coronary syndrome

ACTH

adrenocorticotrophic hormone

ACV

acyclovir

ADA

adenosine deaminase

ADH

antidiuretic hormone

ADL

activities of daily living

AF

atrial fibrillation

AFB

acid-fast bacilli

AFL

atrial flutter

AFP

ɑ-fetoprotein

AFTP

ascites fluid total protein

AG

aminoglycoside

anion gap

Ag

antigen

AGN

acute glomerulonephritis

AI

aortic insufficiency

AIDS

acquired immunodefic. synd.

AIH

autoimmune hepatitis

AIHA

autoimmune hemolytic anemia

AIN

acute interstitial nephritis

AIP

acute interstitial pneumonia

AKI

acute kidney injury

ALF

acute liver failure

ALL

acute lymphoblastic leukemia

ALS

amyotrophic lateral sclerosis

ALT

alanine aminotransferase

AMA

anti-mitochondrial antibody

AMI

anterior myocardial infarction

AML

acute myelogenous leukemia

amy

amylase

ANA

antinuclear antibody

ANCA

antineutrophilic cytoplasmic Ab

AoD

aortic dissection

AoV

aortic valve

APC

activated protein C

APL

acute promyelocytic leukemia

APLA

antiphospholipid Ab

APS

antiphospholipid Ab synd.

ARB

angiotensin receptor blocker

ARDS

acute resp distress synd.

ARV

antiretroviral

ARVC

arrhythmogenic RV CMP

AS

aortic stenosis

ASA

aspirin

ASD

atrial septal defect

AST

aspartate aminotransferase

asx

asymptomatic

AT

atrial tachycardia

ATII

angiotensin II

ATIII

antithrombin III

ATN

acute tubular necrosis

ATRA

all-
trans
-retinoic acid

AV

atrioventricular

AVA

aortic valve area

AVB

atrioventricular block

AVNRT

AV nodal reentrant tachycardia

AVR

aortic valve replacement

AVRT

AV reciprocating tachycardia

a/w

associated with

AZA

azathioprine


alkaline phosphatase

b/c

because

BAL

bronchoalveolar lavage

βB

beta-blocker

BBB

bundle branch block

BCx

blood culture

BD

bile duct

BDZ

benzodiazepines

bili.

bilirubin

BIPAP

bilevel positive airway pressure

BIV

biventricular

BM

bone marrow

bowel movement

BMD

bone mineral density

BMI

body mass index

BMS

bare metal stent

BNP

B-type natriuretic peptide

BOOP

bronchiolitis obliterans with organizing pneumonia

BP

blood pressure

BPH

benign prostatic hypertrophy

BRBPR

bright red blood per rectum

BS

breath sounds

BT

bleeding time

BUN

blood urea nitrogen

bx

biopsy

BYCE

buffered charcoal yeast extract

C

complement

c/s

consult

c/w

compared with

consistent with

CABG

coronary artery bypass grafting

CAD

coronary artery disease

CAH

congenital adrenal hyperplasia

CALLA

common ALL antigen

CAPD

chronic ambulatory peritoneal dialysis

CBC

complete blood count

CBD

common bile duct

CCB

calcium channel blocker

CCl
4

carbon tetrachloride

CCP

cyclic citrullinated peptide

CCS

Canadian Cardiovascular Society

CCY

cholecystectomy

CD

Crohn’s disease

CEA

carcinoembryonic antigen

carotid endarterectomy

ceph.

cephalosporin

CF

cystic fibrosis

Cftx

ceftriaxone

CFU

colony forming units

CHB

complete heart block

CHD

congenital heart disease

CHF

congestive heart failure

CI

cardiac index

CIAKI

contrast-induced AKI

CIDP

chronic inflammatory demyelinating polyneuropathy

CJD

Creutzfeldt-Jakob disease

CK

creatine kinase

CKD

chronic kidney disease

CLL

chronic lymphocytic leukemia

CMC

carpometacarpal (joint)

CML

chronic myelogenous leukemia

CMML

chronic myelomonocytic leukemia

CMP

cardiomyopathy

CMV

cytomegalovirus

CN

cranial nerve

CO

carbon monoxide

cardiac output

COP

cryptogenic organizing PNA

COPD

chronic obstructive pulm dis.

COX

cyclo-oxygenase

CP

chest pain

CPAP

continuous positive airway pressure

CPP

cerebral perfusion pressure

CPPD

calcium pyrophosphate dihydrate

Cr

creatinine

CrAg

cryptococcal antigen

CRC

colorectal cancer

CrCl

creatinine clearance

CRP

C-reactive protein

CRT

cardiac resynchronization therapy

CsA

cyclosporine A

CSF

cerebrospinal fluid

CSM

carotid sinus massage

CT

computed tomogram

CTA

CT angiogram

CTD

connective tissue disease

CV

cardiovascular

CVA

cerebrovascular accident

CVD

cerebrovascular disease

collagen vascular disease

CVID

common variable immunodefic.

CVP

central venous pressure

CVVH

continuous veno-venous hemofiltration

CW

chest wall

cx

culture

CXR

chest radiograph

CYC

cyclophosphamide

d

day

D

death


MS

change in mental status

DA

dopamine

DAD

diffuse alveolar damage

DAH

diffuse alveolar hemorrhage

DAT

direct antiglobulin test

DBP

diastolic blood pressure

d/c

discharge

discontinue

DCIS

ductal carcinoma
in situ

DCMP

dilated cardiomyopathy

Ddx

differential diagnosis

DES

drug-eluting stent

DFA

direct fluorescent antigen detection

DI

diabetes insipidus

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