QBANK CARDS Flashcards
AVNRT
Atrioventricular Nodal Re entrant Tachycardia
- Most common form of paroxysmal Supra ventricular Tachycardia (SVT)
- Caused by a reentry mechanism do to presence a dual electrical pathway (slow & fast pathway) in the AV node.
- Vagal maneuvers increase parasympathetic tone which will cause temporary slowing of conduction in the AV node and an increase in the AV node refractory period leading to termination of AVNRT.
Urine Incontinence
STRESS
URGENCY
MIXED
OVERFLOW
Urine Incontinence /Stress/Tx
Leaking with valsalva
Lifestyle modification
Pelvic floor exercises
Pessary
Pelvic floor surgery
Urine Incontenence / Urgency / TX
Sudden, overwhelming or frequency need to void.
Tx: - lifestyle modification
- bladder training
- antimuscarinic drugs
Urine Incontinence/ Mixed /Tx
Feature stress and urgency
Tx: variable depends on predominant symptom.
Urine Incontinence / Overflow / Tx
Constant involuntary dribbling and incomplete emptying
Tx: - Identification and correction of underlying cause
- Cholinergic agonists
- intermittent self catheterization
Detrusor over activity
By Parasympathetic
Need to void + loss of urine
Tx:
OXYBUTYNIN
Decrease Ach activity (help increase bladder capacity and decrease detrusor contraction) decrease sense of urgency
If patient can’t tolerate antimuscarinic treatment due to the side effects ( dry mouth, constipation, blurry vision )
MIRABEGRON
BETA adrenergic agonist
Essential tremor
Tx: 1) BB (propanolol)
2) Anticonvulsants (Primidone)
- Howerver non selective Beta blocker are relatively contraindicated in patients with reactive airway disease
(Asthma, COPD, Heart block )
PRIMIDONE
Clozapine
Agranulocytosis (neutropenia)
Weight gain
Metabolic syndrome
Seizures
Ileus
Myocarditis
Hypothyroidism
Topical glucocorticoid (eye drops)
Systemic glucocorticoid
Can raise IOP ( Intraocular pressure )
Lhermitte Sign
Neuropathic pain
With neck movement
Fetal Hydrops
Inmune -> Rh Alloinmunization
Non inmune -> Parvovirus B19
-> Fetal Aneuploidy
-> Cardiovascular abnormalities
-> Thalassemia (Hb Barts)
OAG (open angle glaucoma)
Insidious loss of peripheral vision related to atrophy of the optic nerve head.
Signs: enlargement of the optic cup and increase cup disc ratio (cupping of optic disc) late finding.
- patient with steroid induced OAG, may develop central blurriness due to central edema.
- Chronic use of glucocorticoid
=> Cataracts
Hereditary Spherocytosis
Clx: hemolytic Anemia
Jaundice
Splenomegaly
Lab:
⬆️ MCHC
(-) COOMBS Test
Spherocytosis on peripheral smear
⬆️ Osmotic fragility on acidify glycerol lysis test
Abnormal eusin -5 maleimide biding test
Beck triad
Hypotension
JVD
Decreased heart sounds
Pulsus Paradoxus
SBP ⬇️ > 10mmHg
During Inspiration
Baclofen
Tx for spasticity
Enhance of CNS inhibitory neurotransmitter (GABA)
Agonist of GABA -B Rc
Child Pugh
Ascitis
Bilirrubin
Clotting (Pt)
Diet (serum albumin)
Encephalopathy (presence or absence )
Child Pugh mortality of 40% predictable with
Bilirrubin >2mg/dL
Albumin <3g/dL
PT >16sec
Encephalopathy
Child Pugh mortality 80-85 %
3 of this present:
Bilirrubin >4mg/dL
Albumin <2g/dL
PT >16sec
Encephalopathy
Ascitis
AMONIA alone is 150mg/dL
Mortality close to 100% if all exist
Tizanidine
Alpha 2 adrenergic agonist
Also improves spasticity
Perhaps by decreasing alpha motor neuron excitability
Gabapentin
Neuropathic pain
Ex Pt with MS
Not effective for spasticity
Modafinil
Inhibit Dopamine transporters to increased arousal and can be used to improve fatigue
In Pt with MS
Pramipexole
Dopamine Agonist
Tx restless leg syndrome
No improve spasticity
Oxybutynin
Blocks M3 Rc at the bladder
Preventing detrousor contractions
Often used to treat urge incontinences which commonly occurs as a result of a MS
Hypovolemia
Decreases renal perfusion
Activation of RAAS
Hypovolemia -> RAAS Activation
Aldosterone stimulates aggressive Na re absorption in the collecting tubules in effect to sustain blood volume.
Consequently most pt with Hypovolemia (unless taking diuretics or experiencing renal impairment)have decrease urine sodium
The fractional excretion of sodium (ratio of sodium clearance to renal creatinine clearance )
Is tipically <1%
Anion gap metabolic acidosis
Methanol
Uremia
Diabetes ketoacidosis
Propylene glycol / paraldehyde
Isoniazid / Iron
Lactic acidosis
Ethylene glycol (antifreeze)
Salicilate (aspirin)
Complications of positive pressure ventilation
Alveolar Damage
Pneumothorax
Hypertension
Intermittent Asthma
Caused by leukocytes-induced acute and reversible bronchoconstriction
Cerebellar Hemorrhage
Risk Factors
HTN
Antithrombic tx (warfarin, aspirin)
Cerebral amyloid angiopathy
Cerebellar Hemorrhage
Manifestations
Headaches, nausea, vomiting
Ipsilateral ataxia, dysarthria, vertigo
Nystagmus
Cranial neuropaties
Loperamide
OTC antidiarrheal med
Stim Mu Opiod Rc in the GI tract and reduces peristalsis.
Loperamide overdose (opiod intoxication)
In high dose can cross BBB producing opiod like symptoms such as :
Respiratory depression and…
Naloxone
Opiod antagonist to be adm to restore adequate ventilation
Rest of Tx : primarily supportive
Skin MRSA infection Tx
Clindamycin
Doxy
Linezolid
TMP-SMX
Most common complication after a Post-ERCP
Acute Pancreatitis
Pituitary Apoplexi
Thunder clap headache
Is a rapid onset <1Hr often associated and abnormal mental status
When associated with hypotension (central adrenal insufficiency)
Billatersl visual field deficit ( compression of the optic chiasm)
Ophthalmoplegia ( oculomotor nerve III)
Genetic mutation alters control of inteacellular calcium
Triggered by volatile anesthetics
Succinylcholine
Excessive Heat
Malignant hyperthermia
Genetic mutation alters control of inteacellular calcium
Triggered by volatile anesthetics
Succinylcholine
Excessive Heat
Malignant hyperthermia
Malignant Hyperthermia Tx
- Resp / Vent Support
- Imediato cassation on causative anesthetic
- Dantrole
