Read Pocket Medicine: The Massachusetts General Hospital Handbook of Internal Medicine Online
Authors: Marc Sabatine
Tags: #Medical, #Internal Medicine
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- |
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 |
Aϕ | 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 |
DCMP | dilated cardiomyopathy |
Ddx | differential diagnosis |
DES | drug-eluting stent |
DFA | direct fluorescent antigen detection |
DI | diabetes insipidus |