CLINICAL STUDY Flashcards
HYPERKALEMIA
Charrectrised by clinical presentation of confusion, past history of chronic renal failure and diabetes requiring medication and dialysis and ecg finding of tall tented t waves
Hyper kalemia is a serious electrolytes disturbance which could lead to ventricular fibrillation and cardiac arrest
Therefore most important and immediate step in management should be to prevent development of arythmias , for that best management option is iv calcium gluconate
CALCIUM GLUCONATE STABILIZE CARDIAC MEMBRANE AND PREVENT ARYTHMIAS
HYPERKALEMIA MANAGEMENT
The urgency at which hyperkalemia needs to be treated is determined by level of pottasium and presence /absence of associated ECG changes
A pottasium level > or equal to 7 mmmol and hyperkalemia associated ecg changes need urgent treatment
2 nd step:: prevent further accumulation of pottasium
3rd step::—stabilize cardiac muscle::administer intravenous calcium glouconate if there is hyperkalemia associated ecg changes thus should help stabilize myocardium
Further doses may be required if ecg changes persist
You would expect ecg changes to improve within 1-3 minutes of administration of iv calcium glouconate
4 th step::—shift pottasium intracellularly::-
Tretment to shift pottasium into the cell and out of serum includes
INSULIN GLUCOSE INFUSION :insulin helps shift pottasium from extracellullar to intracellullar ,while glucose helps to maintain cappillary blood glucose
SALBUTAMOL::-used as adjacent therappy
5th step::::——remove pottasium from body
CALCIUM POLYSTERENE SULFONATE RESIN(via git)
HEMODIALYSIS LAST OPTION AS IN resistent hyperkalemia
PULMONARY EMBOLISM
SYMPTOMS::—-Patient presenting with chest pain shortnes of breath(dyspnea) and heomoptysis,cogh
WELLS SCORE::—-wells criteria uses estimate patients probability of getting PE
1)Symptoms of DVT(swelling of legs,redness ,tenderness to palpate)—3 POINT
2)tachycardia(>100 bpm)—-1.5 points
3)recent surgery/immobilisation—1.5 points
4)DVT/PE history—-1.5 points
5)heamoptysis— 1 point
6)malignancy —1 point
PULMONARY EMBOLISM MANAGEMENT
Blood tests::-
Test for clot dissolving substance D DIMER,high level may indicate likelihood of blood clots
Blood test can also measure oxygen and co2 in your blood , a clot in a blood vessel in your lungs may lower oxygen in blood
CHEST X RAY::for rule outing other disorders mimicing pulmonary embolism
ULTRASOUND::— uses sound waves to scan veins in your thigh knee and calf to check for dvt
CT PULMONARY angiography::—
VENTILATION PERFUSION SCAN::— when there is need of avoiding radiation we do this method
TREATMENT:::———
Blood thinners(anticoagulants)
Warfarin
Heparin
Enoxaparin
ANTI PLATELLET DRUGS(prevent blood cells from clumping togethor)
Aspirin
Clopidogerl
Dipyridamole
Ticlopidine
NEWER ANTICOAGULANTS WITH LESS BLEDING
DABIGATRAN
apixaban
Rivaroxaban
ACUTE ANGLE CLOSURE GLOUCOMA
CLINICAL PRESENTATION::- Sudden severe painfull eye Red eye Reduced vision or blurred vission Vomiting during clinical exam Fixed slightly dilated pupil TREATMENT::—-standard ist line and defenitive treatment is laser iridotomy A laser used to create a hole in the iris to allow aquous humour to flow from the posterior chamber into anterior chamber relieving eye preasure
WHY YOU SHOULD NOT TAKE COMBINED ORAL CONTRACEPTIVES IF YOU HAVE MIGRAINES WITH AURA
Combined oral contraceptives Associated with increased risk of ischemic heart disease
The risk of ischemic heart disease doubled in patients who experience migraines with focal aura
ASTHMA
1)SPIROMETRY
Measures volume of air expelled from lungs after maximal inspiration
Positive result:FEV1/FVC RATIO<7
2)FRACTIONAL EXHALED nitric oxide
Measures exhaled n20,marker of easinophilic inflamation
Positive result::ppb>40 in adults and ppb>35 in children
3)BRONCHODILATOR REVERSIBILITY::
Measures change in spirometry before and after (15min) saba inhalation
Positive result::fev1>12-/-
PEAR EXPIRATORYFLOW RATE::-
Measures maximum speed of expiration
Monitor twice daily for 2-4 wks
Positive results::-variability >20-/-
DIRECT BRONCHIAL CHALLENGE TEST::-
Measures change in spirometry after methacholine ,histamine inhalation
Positive result::-8mg or less causing>20-/- drop in fev1
MOST COMMON CAUSE OF LEFT AXIS DEVIATION
Left anterior fascicular block
LEPROSY
Also called as hansen disease
Mainly causes skin lesion and nerve damage
Mainly effect skin eye nose and peripheral nerves
Symptoms::-
Skin finding main symptom
Sensory loss
Anhidrosis
Neuropathic pain
Palpable peripheral nerves
Muscle atrophy
Weakness
Nasoseptal perforation
In advanced stage::-thinning if eyebrows hair eyelashes
They commonly effect trigeminal nerve so one can reduced sensation of cornea and conjuctiva
VITAMIN B12 DEFECIENCY A/W CHRONS DISEASE
Is a macrocytic anemia presenting with general symptoms of anemia
Can have mild jaundice, glossitis
Angular cheliosis,
Neuropsychotic manifestations seen like,,irittability,deppresion,psychosis
Sore red toungue and corners of mouth
VITAMIN B12 defeciency may lead to sub acute degenration of spinal cord ,presents with a mixture of UMN signs(extensor plantars)LMN SIGNS(absent reflex),usually cortico spinal tracts and dorsal column most effected, but spinothalamic part not effected so patients may feel temp and pain sensation
HEPATIC ENCEPHALOPATHY
The loss of brain function when a damaged liver doesnt remove toxins from blood
Generally oc
