June 10-20 Flashcards
What are medications that can cause lithium toxicity?
Anything that decreases Renal Perfusion
Thiazide diuretics, NSAIDs, ACE inhibitors
A patient comes in to the ED c/o worsening N/V/D with associated confusion and agitation. She has a hx of bipolar disorder that has been controlled with treatment. She has recently had a flare up of tension headaches and has been taken ibuprofen for the headaches. What is the best course of action for this patient?
IV hydration
She has sx of lithium toxicity
What tracts are affected with a subacute combined degeneration?
Dorsal Column: Loss of position and vibration sense
Spinocerebellar tract: ataxia
Lateral corticospinal tract: Spastic paresis
What is the mutation in X-linked agammaglobulinemia and what does it cause on a cellular level?
BTK gene mutation
Impaired B cell maturation and Ig production
An 8 month old male is brought to the pediatrician by mother. She states that the patient has had recurrent sinopulmonary infections and has had “gastric issues all his life”. On examination, the patient has smaller than normal tonsils.
On serology, the patient has decreased B cells and normal T cells. What do you suspect?
X linked agammaglobulinemia
What are the sx of X liked agammaglobulinemia?
Recurrent sinopulmonary infections
Chronic enteroviral infection
Small or absent lymphoid tissue
On serology, there will be decreased Igs and B cells
What bacteria commonly cause septic abortions?
Enterobacteriaceae
Group A strep
Staph aureus
What are the clinical manifestations of a septic abortion?
Fever
Lower abdominal pain
Malodorous purulent cervical discharge
Tender uterus with dilated cervix
Which infectious agents can cause reactive arthritis?
Chlamydia Salmonella Shigella Yersinia Campylobacter Cdiff
What are the symptoms of reactive arthritis?
Oligoarthritis Dactylitis Enthesitis Conjunctivitis, anterior uveitis Urethritis, cervicitis, prostatitis Oral ulcers
A pregnant woman comes in with HTN, RUQ pain, and N/V.
Labs show elevated liver enzymes, low platelets, and signs of anemia with some proteinuria, what do you suspect?
HELLP syndrome
What is the MOA of metformin?
Inhibits the mitochondrial glycerophosphatase dehydrogenase
Upregulates AMP activated protein kinase
What are the metabolic effects of metformin?
Decreased hepatic glucose production (gluconeo)
Decreased intestinal glucose absorption
Increased peripheral glucose uptake
Decreased lipogenesis
What are the adverse effects of metformin?
Diarrhea
Lactic Acidosis
Vitamin B12 def
How do bulk forming laxatives ease constipation?
Binds luminal water and decreases the consistency of the stool
What are the side effects of bulk forming laxatives?
Flatulence and abdominal distension
What is the MOA of osmotic laxatives?
Draws water into the lumen
Can cause electrolyte issues and bloating
How do the surfactant laxatives work?
Decreases stool surface tension and lets water enter the stool
What kind of laxatives activates enteric nerves in the myenteric plexus to stimulate peristalsis?
Stimulant laxatives
Which types of laxatives are the following? Polyethylene glycol, magnesium hydroxide, lactulose
Osmotic laxatives
What type of laxative is docusate? How does she work?
Surfactant laxative
Decreases stool surface tension which allows water to enter the stool
Bisacodyl and senna are examples of what kind of laxative? What are the common side effects?
Stimulant laxatives
Can cause abdominal cramping and electrolyte issues
What is the chloride channel agonist laxative?
Lubriprostone
What is methylnaltrexone?
It is a peripherally acting mu opioid receptor antagonist
