Endo CIS

Question 1

polydipsia, polyuria, polyphagia, kussmaul respirations

Answer 1

• polydipsia- prolonged excessive thirst
• polyuria- excessive urination
• polyphagia- excessive eating
• kussmaul resp- deep rapid respirations assoc w acidosis

Question 2

Anion Gap- MUDPILES

Answer 2

• Methanol
• Uremia (kidney failure)
• Diabetic ketoacidosis
• Paraldehyde/Propylene glycol
• Infection/Iron/Isoniazid
• Lactic acidosis
• Ethylene glycol
• Salicylates

Question 3

Anion Gap- GOLDMARK

Answer 3

• Glycols (ethylene and propylene)
• Oxoproline, metabolite of paracetamol
• Lactic acidosis
• D-lactase (GI disorders)
• Methanol
• Aspirin
• Renal failure
• Ketoacidosis (starvation/ETOH/DKA)

Question 4

Abd pain- diff dx- GI

Answer 4

• GERD
• gastritis (beer intake- epigastric area)
• PUD (high stress)
• obstruction of small/large bowel (no prior sx’s to cause adhesions, no hx of GI problems as a child)
• inflammation- ileitis, pancreatitis
• infectious
• vascular, mesenteric thrombosis (no hx of clotting)

Question 5

Abd pain- diff dx- GU

Answer 5

• renal lithiasis

- blocked ureter, testicular torsion (writhing in pain)

Question 6

abd pain- diff dx- toxic causes

Answer 6

-black widow spider bite, snake bite

Question 7

abd pain- diff dx- metabolic

Answer 7

• uremia
• hyperlipidemia
• DKA!!!!

Question 8

DKA

Answer 8

-kussmaul breathing, unintentional wt loss, polyuria, polydipsia, polyphagia, hyperglycemia, positive ketones in urine and blood, low pH with anion gap

Question 9

DKA- admit where

Answer 9

-ICU

Question 10

DKA- IV fluids

Answer 10

• electrolyte replacement (insulin will drive K into cells, so they usually become hypokalemic)
• K, Mg, Ph
• correct sodium when sugar is high (Na + [(glucose - 100) x 0.016)]

Question 11

what comes in CMP?

Answer 11

• albumin, blood urea nitrogen, carbon dioxide, creatinine, glucose
• calcium, potassium, sodium, chloride
• total bilirubin and protein, liver enzymes
• need to order Mg and P separate

Question 12

why do we change the type of IV fluid being used?

Answer 12

• initially NS

- switch to D5 1/2 NS!!! when pt on insulin gtt when their glucose gets to 250 to prevent hypoglycemia!!!

Question 13

goal of tx?

Answer 13

• FIX acid base disturbance NOT bring sugar to normal level

- they can have a normal sugar and still have an anion gap acidosis

Question 14

DKA- findings

Answer 14

-diffuse abd pain, fruity breath, unintentional weight loss, ketonuria, hyperglycemia

Question 15

when can you end the protocol

Answer 15

when gap is closed
-switch to subcutaneous insulin, stop gtt 2 hrs after admin of SQ long acting (they will go right back into DKA if you stop too soon)

Question 16

viscerosomatic reflexes for pancreas and kidney

Answer 16

Symp
-pancreas- T5-9 
-kidneys- T9-L1
Parasymp:
-pancreas and kidneys- OA,AA

Question 17

chapman pts

Answer 17

• pancreas- R 7th intercostal space

- kidneys- 1” superior and 1” lateral to umbilicus

Question 18

lymphatic drainage

Answer 18

• right duct- right head and neck, right UE, all lung lobes except upper left
• thoracic duct- rest of body

Question 19

lymphatic- sequence of tx

Answer 19

• thoracic inlet
• thoracic area
• abd area
• UE and LE
• head and neck
• thoracic inlet