randoms part 3 Flashcards
acetominophen oversode
if 8-10gs ingested –> n-acetylcystein
- if unclear dosage –> level
- if > 24 hours no therapy
how to treat aspirin oversode?
alkalinizing the urine
benzos can prevent seizures from tricyclic toxicity, so do not
give flumazenil if you suspect TCA overdose and benzo as they wil seize
tricyclics EKG
- fast Na channel blockers
- widened QRS
- prolong QT until torsades!!!
TCA overdose signs
- dry mouth
- constipation
- urinary retension
- widened QRS
-treat with bicarbonate
benzocaine, anesthesitics, nitrites, nitroglycerine, dapsone can all cause?
methemoglobinemia (Fe3+)
organophospate poisoning inhibts acetylcholinesterase causing and cholinergic crisis
salivation, lacrimation, polyuria, diarrhea, bronchospasm, bronchorrhea, respiratory arrest if severe!
anticholinergic is atropin, pralidoxime will reactivate the acetylcholinesterase.
hypokalemia or hyperkalemia predisposes to digitoxin toxicity?
-hypokalemia, cause less K more digitoxin can bind to the K/Na pumps
presentation of digitoxin toxicity?
- hyperkalemia
- confusion
- visual disturbance (yellow halos van goh)
- brady or atrial tach, AV block, ventricual ectopy, arrhythmias such as Afibb with a slow rate.
- EKG will show downsloping of the ST segment in all leads.
- most common arryhtmia is atrial tach with variable AV block.
lead poisoning
acute: abdominal pain, constipation, headaches, peripheral neuropathy, cognitive deftcs, joint pains, anemia (sideroblastic), anorexia
chronic: all the above plus fatigue, insomnia, HTN, neuropsych, nephropathy, misscariages, still birth
methanol or ethylene glycol poinsoning treatment
fomeprizole
cerebral circulation, pressure and PCO2
hyperventilation decreases pCO2, low pCO2 causes cerebral vasoconstriction that decreases volume and pressure
fluid replacement in burns
4 ml x %BSA x kg
head, arm, 9
legs 18 each
chest or back is 18 each
how to treat vtach
- pulseless - shock
- pulse + hemodynamically unstable - shock
- pulse + hemodynamically stable - amiodorone, licaine or procainamide
what is pulseless electrical activity?
- there is no pusle but on the EKG it looks normal
- tamponane, tension pneumo, hypvolemia, hypoglycemia, massive PE, hypoxia, hypothermia, metabolic acidosis, K issues
WPW syndrome
- anatomic abnormality in the cardiac conduction pathyway
- look for the delta wave
- look for SVT alternating with Vtach
- look for an SVT that gets worse with diltiazem or dig
how do you treat WPW sydrome acute? or chronic?
acute: procainamide, amiodarone
chronic: ablation
why are digi and diltiazem bad for WPW syndrome?
the block the AV node and force conduction into the abnomal pathway
multifocal atrial tach is associated with?
COPD
-look for 3 different p wave morphologies
bradycardia treatment
- acute and showing signs of hypoperfusion give atropine
- for complete heart block a pacemaker will need to be inserted
- if asymptomatic just chill
how to treat mobitz type 2?
pacemaker
what is eczema herpeticum?
herpes lesions suprimposed on healing atopic dermatitis lesions
porphyria cutanea tard
blistering skin desease of sunexposed areas
assoc. hep C, estrogen use and hemochromatosis
how to treat mild and severe impetigo?
mild - topical mupirocin, bacitracin
severe - oral dix
cloacillin or cephalexin
community aquire MRSA - doxy, clinda or TMP SMX
erysepalas more often with strep than staph
look for a bright red hot swollen lesion on the face
mild: oral dicloxacilin, cephalexin,
penicillin allergic erythro, clarithro or clinda
MRSA: doxy, clinda, TMP SMX
severe: IV oxacillin, nafcillin, cefazolin, MRSA vanc, linezlid, ceftaroline
erythema multiforme is assoc with
herpes or mycoplasma
-target lesions
steven johns for toxic epidermal necrolysis
SJ 30% body surgace area, rash with mucous membrane involvement , treat with IVIG
leydig cell tumor
sex cord stromal tumor
increased estrogen which supressed LH and FSH
-gynecomastia
the best initial test for cancer with compression, infection, and fracture is? what is the most accurate?
xray
the most accurate is an MRI
how to treat fibromyalgia
- exercise
- amitryptiline
juvenile RA
- fever spikes
- salmon colored rash
- splenomegaly
- pericardial effusion
- mild joint symptoms
in acute lupus flare what can you follow?
- complement levels drop
- anti DSDNA levels rise
- anti-smith and ANA tell nothing
anticardio;ipin antibodies are more often associated with
spontaneous abortion
-two or more first trimester events or one second trimester event
scleroderma CREST renal manifestations
- sudden HTN crisis
- sudden onset of renal failure
- microangiopathic hemolytic anemia
- even DIC
dermatomyositis is assoc with?
cancer
-ovary, lung, GI, lymphoma (non-hodgkin)
sjrogen is associated with
lymphoma
polarteritis nodosa spares?
lungs
polymyalgia rheumatic presentation
pain and stiffness in shoulder and PELVIC girdle muscles
- doffoculty combing hair and rising from chair
- elevated ESR
- normochromic normocytic anemia
- treat with steroids
c-ANCA
wegeners
granulomatous with polyangitis
p-ANCA
churg strass and microscopic polyangitis
cryoglobinemia IG?
immunce complexes are IgM against anti hep c virus IgG
cryoglobinemia presentation
hep c, increased LFT, low C4, joint pain, glomerulonephritis, purpuric skin lesions, neuropathy
treat the hep c
behceht syndrom
asian or middle eastern
- painful oral, gentical ulscers
- erythema nodosum like lesions on the skin
- occular lesions leading to uveitis or blindness
- treat with steroids
how to treat psoriatic arthritis?
- first line NSAIDS
- worsens try methrotrexate
- if that doesnt work try TNF alpha inhibitors
secondary amloidosis is AA
- chronically inflammatory conditions
- chronic infections
AL amloidosis
MM
waldenstrom
light chains
kidney - crescents
RPGN
linear deposists - kidney
good pastures
immune complexes, granular deposists - kidney
lupus nephritis, IgA and post-infectious GN
keeping muscle straight hypokalemia? hyperkalemia? hypocalcemia? hypermagnesimia?
hypoK - muscle weakness and cramps
hyperK- muscle weakness
hypoC - hyperactive deep tendon reflexes and muscle cramps
hyperMg - loss of deep tendon relexes
amiloride
inhibits the enac Na channel in the principle cell
TMP also blocks this channel –> less Na uptake, less K extrectio –> hyperkalemia
nephrotic syndrome and thrombosis
loss of ATIII and others
more often with membranous
hyaline casts
dehydration
NSAIS constrict the afferent arteriole
-inhibt PG so less dilation
ATN toxins
- nsaids
- aminoglycosides, antibiotics, amphotericin, cisplatin, cyclosporin
- prolonged ischemia
- contrast
In ATN the urine cannot be concentrated because the tubule cells are damaged. The urine produced will be similiar osmolality to the blood 300.
acute interstitial nephritis causes
pencillin, sulfa, quinolones, PPI, phenytoin, rifampin
mebranous is assoc with
SLE, hep B. NSAID, breast/lung adenocarcinoma
minimal is associ
NSAID and lymphoma
renal failure, Ca, PO4, PTH and vitamin D
- kidney cant excrete phosphate
- kidney cant transform 25-vit D to 1,25 vit D, so less GI absorption of Ca and PO4, this triggers PTH
- secondary hyperparathyroidism with ~nl or hypo Ca, calcium rleased from the bones causing weak bones.
treatment of TTP
- usually resolves spontaenous
- but severe needs plasmapharesis, if not in the choice influse with FFP
PCKD is assoc
berry aneurysms, MVP
hyperglycemia and pseudohyponatremia
high glucose levels lead to a decrease in Na levels, as an osmotic draw on fluid insid the cells, free water leaves the cell to correct the hyperosmolar serum.
how to treat hyponatermia, mild, moderate and severe
mild - restrict fluids
moderate - saline
severe - hypertonic saline
Distal tuble RTA 1
- nl anion-gap metabolic acidosis
- problems generating bicarb in the distal tubule, often due to problem with the H+ pump,
- so less bicarb is reabsorbed, more basic urine
- urne pH >5.5
- give more bicarb the PT can absorb it to correct acidosis
proximal tubule RTA type II
- problem with reabsorption of bicarb in the PT
- results in more devloiver of bicarb to the DT and CD
- so first the urine pH is basic, but as the body loses all the bicarb less will go to kidney the pH will be low again.
- give bicarb as a test, the urine pH should be even more basic
- give thiazides, thiazide diruretics enhance volume depletion which will enhance bicarbonate reabsorption
type IV RTA hypoaldosteronism
- common in DM
- decreased affect of aldo on DT
- high urine sodium
- hyperkalemia
urine anion gap
+ RTA, -ve diarrhea
urine pH for calcium oxalate formation
alkaline more, so more likely in RTA type 1, as they cant produce H+ and urine remains alkaline
stone removal based on size
2cm surgical
Calcium and hydrochlorothiazide
it promotes distal tubule reabsorption of calcium so makes less calcium in urine
stress incontinence vs urge incontinence
stress – cough, laugh –> this is structural
urge –> neurologic, they have no control, treat with anticholinergices like oxybutynin
neurogenic bladder than wont release
cholinergic agonist like bethenechol
define HTN
140/90
