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Step 2 > Electrolytes & Shock > Flashcards

Electrolytes & Shock Flashcards

1
Q

Hyperthermia, seizures, flushed skin, dilated pupils that react, wide QRS

A

TCA OD - QRS width = severity –> ventricular arrhythmia –> NaBicarb

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2
Q

Ascities management

A

Na, H2O restrict, spironolactone, furosemide paracentesis 2-4L

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3
Q

Anion gap

A

Na - (HCO3- + Cl-)

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4
Q

Methanol, Uremia, DKA, Lactic acidosis, Ethylene glycol, Salicylates

A

MUDPILES - anion gap acidosis

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5
Q

Inc pH –> inc albumin+Ca –> hypoCa (ionized)

A

Cramping, weakness, carpopedal spasm,

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6
Q

HypoCa, elevated phosphorous

A

HypoPT - d/t surgery or auto-immune

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7
Q

HypoCa, fatigue, weakness, depression, normal Mg, 2-HPTH, Low Phos

A

VitD deficiency, CKD

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8
Q

Hyperreflexia electrolyte abnormality

A

HypoCa or hypoMag –> low PTH

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9
Q

Grand-mal seizures, prolonged QT electrolyte abnormality

A

HypoCa

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10
Q

Normal/Low Ca, Low 1,25-OH, High Phos, High PTH

A

CKD –> secondary HPT

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11
Q

Low Ca, Short stature, 4th & 5th digits, High PTH, Phos

A

End organ resistance - Gs defect

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12
Q

S/P thyroidectomy, anxiety, fatigue, poor sleep, depression, prolonged QTc

A

HypoCa

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13
Q

Low Ca, Low PTH, High Phos

A

Hypoparathyroidism = surgical removal, auto-immune

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14
Q

Weight loss, irritable, palp, proptosis –> HTN mechanism?

A

Hyperdynamic circulation

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15
Q

Hypothyroidism mechanism of diastolic HTN

A

Inc systemic vasc resistance

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16
Q

Most common causes of hyperCa

A

Malignancy, primary HPT (adenoma 90%)

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17
Q

Malignancy vs. PHPT hyperCa

A

Malignancy >13, low PTH = IL-6

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18
Q

High Ca, high PTH, dec Phos, Sestamibi scan

A

Hyperparathyroid –> resect but can –> hypoCa

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19
Q

High Ca, High PTH levels

A

Primary hyperparathyroidism or Familial (low urine), Lithium

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20
Q

High Ca, Low PTH

A

Malignancy, Vit D, HTCZ, Theophylline, milk alkali

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21
Q

High Ca, Low PTH, High 1,25-OH

A

Granulomatous - Sarcoid or lymphoma

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22
Q

Mildly high Ca, abnormally high/normal PTH, No sx, urine Ca <0.01

A

Familial hypocalciuric hyperCa –> Abn Ca-sensing receptors

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23
Q

Tx for hyperCa

A

Only >14 = IVFs + calcitonin, avoid diuretics in all pts + bisphos LT

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24
Q

Saline non-responsive metabolic alkalosis

A

Cushing, Primary hyperaldosteronism, hypoK <2

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25
Q

Saline responsive metabolic alkalosis

A

Urine Cl <20, vomiting, diuretic, laxative, dehydration

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26
Q

Urine Cl >20, high renin, aldo, bicarb, lowK, lowNa

A

Diuretic abuse

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27
Q

Urine Cl <10
high renin, aldo, bicarb

lowK, lowNa

A

Vomiting or facitious diarrhea

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28
Q

Urine Cl >40, high renin, aldo, bicarb, lowK, normalNa

A

Bartter/Gitelman syndrome

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29
Q

Urine Cl >40, high aldo, bicarb, Na,

low renin, lowK

A

Primary hyperaldosteronism

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30
Q

Urine Cl >40, high renin, aldo, bicarb, Na

LowK

A

Renin-tumor

31
Q

U-waves, muscle cramps, weakness electrolyte abnormality, alkalosis

A

Hypokalemia

32
Q

Asystole, flaccid paralysis electrolyte abnormality, acidosis

A

HyperK

33
Q

Tx of Sx acute hyperK

A

Calcium gluconate or insulin w/ glucose

34
Q

Succ use is CI w/ what electrolyte abn?

A

HyperK – it leads to inc K release, no crush, burns, GB or tumor-lysis

35
Q

Refractory hyperK

A

HypoMag

36
Q

HypoK management

A

10mEq/h

37
Q

Causes of hyperK

A

RF, crush injury, acidosis

38
Q

HyperK management

A

50% dextrose + insulin, IV calcium –> hemodialysis

39
Q

Hypovolemic hypoNa causes

A

Volume depletion, adrenal insufficiency, D/V, Diuretics/renal

40
Q

Euvolemic HypoNa causes

A

SIADH, psychogenic polydipsia, sec adrenal insufficiency, hypothyroid

41
Q

Hypervolemic hypoNa causes

A

CHF, cirrhosis, CKD

42
Q

Serum Osm >290

A

Hyperglycemia, advanced renal failure

43
Q

Serum Osm <100

A

Primary polydipsia, malnutrition (beer binge)

44
Q

Serum Osm 100, Urine Na <25

A

Volume depletion, CHF, cirrhosis

45
Q

Serum Osm 100, Urine Na >25

A

SIADH, adrenal insufficiency, hypothyroidism

46
Q

Tx SIADH

A

Dec fluids, Na tablets, Loops –> hypERtonic saline until serum Na >120

47
Q

Hypovolemic NyperNa management

A

IV 0.9% Saline –> 0.45 when vol replaced = no more than 1mEq/L/h dec

48
Q

MILD Hypovolemic NyperNa management

A

IV 0.45 Saline + 5% Dextrose

49
Q

Euvolemic or hypervolemic hyperNa management

A

D5W

50
Q

HypoNa from SIADH tx

A

Water restriction

51
Q

HypoNa, rapid developing, CNS sx, water intoxication tx

A

3% NS

52
Q

Hypovolemic hypoNa Tx

A

NS or LR

53
Q

Dec vol, dec pressure, inc HR, acidosis, inc osmolarity type of shock

A

Hypovolemic shock - diarrhea, heat, DKA

54
Q

Ulcers, colon Ca, uterus, leukemia, red O2 shock type

A

Hemorrhagic shock

55
Q

Dec SV, CO shock

A

Cardiogenic shock

56
Q

Blood vessels dilate, blood pooling, dec VR shock

A

Neurogenic shock

57
Q

Bronchial spasm, blood vessels dilate, histamine –> hives, V/D shock

A

Anaphylactic shock

58
Q

Profound anion gap acidosis, very low bicarb, disc hyperemia

A

Methanol or ethylene glycol (kidney damage)

59
Q

Dec preload (RA, PCWP), dec CI, O2 sat, INC AFTERLOAD type of shock

A

Hypovolemic shock

60
Q

Inc preload (RA, PCWP), afterload, DEC CI, O2sat type of shock

A

Cardiogenic shock

61
Q

Dec preload (RA, PCWP), afterload, SVR, INC CI, O2 sat

A

Septic shock

62
Q

Dec CO, PCWP, BP, Inc SVR, HR shock

A

Hypovolemic shock

63
Q

Flat neck veins, dec H&H, tachycardia type of shock

A

Hemorrhagic shock

64
Q

JVD + resp distress, absent lung sounds, tracheal deviation

A

Tension pneumothorax

65
Q

JVD + breathing ok, normal CXR, hypotension

A

Pericardial tamponade

66
Q

Pink & warm extremities, low CVP type of shock

A

Vasomotor – sepsis, anaphylaxis, spinal trauma, anesthetics

67
Q

Drugs and mech of hyperK

  1. BBs
  2. ACE/ARBs
  3. K+ sparing (amiloride)
  4. Digoxin
  5. NSAIDs
A
  1. Inhibit B2 K uptake into cells
  2. Inhibit AG-II/AT1 –> dec aldosterone
  3. Block ENaC or aldo receptor
  4. Inhibit Na/K pump
  5. Impairs local PGs –> dec renin and aldo
68
Q

Imaging for free air/perforation

A

Upright CXR

69
Q

Best initial imaging for osteomyelitis

A

XR

70
Q

When to get head CT WITH contrast?

A

Cancer or infection

71
Q

When to get abdominal CT scan?

A

Pancreas
Appendicitis
Most accurate for diverticulitis, Kidney stone (w/o contrast)

72
Q

When to get chest CT?

A

Hilar nodes/sarcoidosis
Mass lesions
PE
Cavities

73
Q

When to get endoscopic ultrasound?

A

Pancreatic head lesions

Gastrinoma

74
Q

When to use gallium or indium scan?

A

Fever of unknown origin - follows iron metabolism transported on ferritin

Indium better for abdomen - tags WBCs

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