Allergic Reactions & Anaphylaxis, Hematologic Disorders, Electrolyte & Fluid imbalance

Question 1

symptoms of water retention (generalized swelling, muscle cramps)

tx mild: water restriction, oral replacement
tx severe: slow replacement over 48-72 hrs w/ hypertonic saline (3%-5% saline solution)

Answer 1

hyponatremia (associated w/ over hydration)

Question 2

h/a, nausea, confusion, ataxia, a reflexia

Answer 2

NA < 130

Question 3

intractable vomiting, seizures, coma, brain herniation, respiratory arrest

Answer 3

NA < 120

Question 4

correcting too rapidly can cause central pontine myelinolysis (flaccid paralysis, dysarthria, dysphagia, hypotension)

tends to elevata and decrease w/ chloride

Answer 4

sodium

Question 5

signs of dehydration (weakness, lethargy, hypotension, tachycardia, dry mucous membranes, poor skin turgor, thirst, AMS including fatigue, confusion, coma)

tx: correct hypovolemia and lower serum levels, treat underlying cause (fever, vomiting, DI, etc)

Answer 5

hypernatremia (associated w/ dehydration)

Question 6

causes muscular excitability - irritability, n/v, diarrhea

Answer 6

early hyperkalemia

Question 7

causes muscular weakness - fatigue, generalized weakness, distal limb paresthesia, Tetany, respiratory depression, ascending paralysis

Answer 7

late hyperkalemia

Question 8

in order of occurrence - peaked t wave, elongated PR interval, absent p wave, enlarging QRS complex, sine wave

Answer 8

cardiovascular signs of hyperkalemia

Question 9

Calcium Chloride (10 ml, max 20 ml) or calcium gluconiate (10-30 ml) ivp

Answer 9

stabilize cardiac membrane in hyperkalemia

Question 10

high dose nebulized albuterol (10-25 mg)

insulin 10 units IVP combined w/ 100 ml of 50% dextrose IVP

Answer 10

shifts potassium into the cell in hyperkalemia

Question 11

HD
normal saline and furosemide
ion exchange resin (kayexalate)

Answer 11

remove potassium from cell in hyperkalemia

Question 12

common causes are renal failure, cellular death (rhabdo, tumor lysis syndrome, crush injury, burns), acidosis

Answer 12

hyperkalemia

Question 13

frequently asymptomatic (more likely in rapid decline or pre-existing cardiac disease)

causes weakness (hyporeflexia, latent tetany, paralysis to the LE, resp failure, paresthesia)

prominent u wave on ecg (causing a “camel hump” appearance to the T-wave, ST depression

often coexists w hypomagnesemia

Answer 13

hypokalemia

Question 14

decreased DTRs, constipation, anorexia, n/v, fatigue, diffuse body aches, bradycardia, hypotension

Answer 14

s/s of neuromuscular depression

Question 15

muscle cramping, titanic contractions, hyperreflexia, perioral or finger paresthesia, +chvosteks or trousseau, seizures

Answer 15

s/s neuromuscular excitability

Question 16

dark leafy greens, nuts, seeds, fish, beans, whole grains, avocados, yogurt, bananas, dried fruit, dark chocolate

Answer 16

foods high in mag

Question 17

facial nerve tapping elicits facial or eye twitching

Answer 17

chvosteks sign

Question 18

inflate bp cuff to 20 above SBP for 3 min, carpal spasms will be induced

Answer 18

trousseaus sign

Question 19

causes neuromuscular depression, tall t waves, depressed st segments

Answer 19

hypermagnesemia

Question 20

mild to moderate - asymptomatic

sever - neuromuscular excitability, prolonged PR interval, widened QRS

Answer 20

hypomagnesemia

Question 21

causes neuromuscular excitability, prolonged ST segment and inverted t wave

Answer 21

hypocalcemia/hyperphosphatemia

Question 22

causes neuromuscular depression, shortened ST segment and QT interval

Answer 22

hypercalcemia/hypophosphatemia

Question 23

congenital hemolytic anemia that occurs mainly in those of west African descent

Answer 23

sickle cell disease

Question 24

blood trapped in spleen leading to engorgement causing acute anemia, shock and LUQ pain

most common between 1-4 yrs old

Answer 24

splenic sequestration

Question 25

overtime trapped blood cells cause spleen to shrink and lose fxn over time

increased risk of infection

Answer 25

hypersplenism

Question 26

vascular occlusion in the bones leading to bone pain

Answer 26

avascular necrosis

Question 27

occlusion and infarction of lung vessels causing inflammation, PE and bronchospasm

symptoms include decreased O2 sats, SOB, fever and chest pain

Answer 27

acute chest syndrome

Question 28

frequently related to malignancies, splenic disorders or bone marrow disorders

usually asymptomatic, erythromelalgia, paresthesia, signs of spontaneous clotting

tx - low dose asa, treat underlying cause

Answer 28

thrombocytosis

Question 29

redness or pain of the digits/hands

Answer 29

erythromelalgia

Question 30

may be immune (especially pediatric following viral illness), drug induced, liver failure

tx- prednisone for immune causes

Answer 30

thrombocytopenia

Question 31

most common bleeding disorder affecting 1% of population
affects makes and females

milder bleeding disorder that may cause skin, mucosal bleeding, recurrent epistaxis, unusual bruising, GI bleeding, menorrhagia

tx- DDAVP

Answer 31

von willebrand’s disease

Question 32

used to treat von willebrands and mild forces of hemophilia a (stimulates production of factor VIII but does not immediately replace)

Answer 32

DDAVP (desmopressin acetate)

Question 33

variant form of factor VIII

congenital sex-linked disorders that affect males

bleeding into soft tissues, muscles, or joint capsules (most common), prolonged bleeding from cuts, tooth extractions or surgery, compressive hematoma, hematuria, intracranial bleeding

tx - factor VIII

Answer 33

hemophilia a (classic)

Question 34

variant form of factor IX

congenital sex-linked disorders that affect males

bleeding into soft tissues, muscles, or joint capsules (most common), prolonged bleeding from cuts, tooth extractions or surgery, compressive hematoma, hematuria, intracranial bleeding

tx- factor IX

Answer 34

hemophilia b (Christmas disease)

Question 35

abnormal activation of the body’s clotting system that signals sever underlying problems, involves both abnormal clotting and bleeding

decreased platelet count, fibrinogen levels, hgb and hct
increased PT/PTT, d-dimer

Answer 35

DIC