Integrative Cases IV Flashcards
Aspirin overdose
Acute aspirin or salicylates overdose or poisoning can cause initial respiratory alkalosis though metabolic acidosis ensues thereafter.
Thus, this is often a mixed disorder with competing alkalosis and acidosis that will appear closer to normal pH, but have an elevated anion gap and hyperventilation.
Distal radius fracture
Fracture that is seen commonly in people with low BMD who stop a fall with their hand. In most individuals, this does not cause fracture, however it often uncovers patients with poor bone mineralization.
It is a “site of fragility”
What is going on in this radiograph?
Vertical trabeculation of the vertebrae AND aortic calcification
Preferential loss of horizontal trabeculae. A finding of ostoeporosis or osteopoenia on X-ray.
Aortic calcification also often goes with osteoporosis.
Why do individuals with osteoporosis lose height?
Due to compression fractures in the spine. May be in the thoracic or lumar region.
What is going on in this stomach endoscopy image?
Atrophic gastritis
What is going on in this duodenal endoscopy image?
Scallop mucosa
This is seen in small intestinal enteropathies. Most commonly this indicates celiac’s disease.
What is going on in this colon endoscopy image?
Diverticulitis!
This is what it looks like on endoscopy.
Statistically, the most common cause of continued pathology for celiac’s patients on a gluten free diet is. . .
. . . poor adherence to the diet or accidental gluten consumption.
Sources of “hidden” gluten
Also shampoo, lotion, and makeup! Some celiac’s patients start losing hair because their shampoo contains gluten, a condition that completely resolves when they switch brands!
Characteristics of hereditary hemorrhagic telangiectasia
- Genetic disorder that causes malformed blood vessels and can affect multiple organs of the body.
- Multiple telangiectasias and arteriovenous fistulas in multiple organs (especially liver and brain)
- Often a family history of recurrent epistaxis
Key differences between delirium and dementia
CONFFUSED mnemonic for causes of delirium
- Central nervous system insults (e.g., stroke, seizure, concussion, trauma, subdural hematoma, intracranial bleed)
- Organ insufficiency and ischemia (e.g., cardiac, pulmonary, renal, hepatic, hypertensive encephalopathy)
- Nutritional deficiencies (e.g., thiamine, folate, B12, niacin deficiencies)
- Fluid and electrolyte abnormalities (e.g., dehydration, hypo/hypernatremia, hypercapnia)
- Fever and infection (e.g., meningitis, encephalitis, pneumonia, UTI, sepsis)
- Urinary and GI tract disorders (urinary infection or retention, severe obstipation, fecal impaction)
- Sensory difficulties (e.g., pain, agitation from tethers (such as restraints), deprivation caused by isolation or absence of hearing aids or glasses)
- Endocrine (increased or decreased function of the adrenal, thyroid, parathyroid, or pancreatic glands)
- Drugs and drug withdrawal (e.g., anticholinergics, anticonvulsants, corticosteroids, psychotropics, alcohol, and withdrawal from alcohol, sedatives, or barbiturates).
Nighttime cough and cold formula
Nighttime cough and cold formulas often contain acetaminophen, dextromethorphan, diphenhydramine.
Diphenhydramine is a first-generation antihistamine and often can precipitate delirium in older patients.
Medications that may cause delirium
- Antihistamines (e.g., diphenhydramine)
- Opioids (e.g., hydrocodone)
- Benzodiazepines (e.g., lorazepam)
- Antidepressants (e.g., amitriptyline)
- Steroids (e.g., prednisone)
- Muscle relaxants (e.g., cyclobenzaprine)
- Antiemetics (e.g., promethazine)
Sites commonly affected in osteomalacia
- Ribs
- Tibial plateau
- Metatarsal bones
