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step 2 disease treatment > randoms part 3 > Flashcards

randoms part 3 Flashcards

1
Q

acetominophen oversode

A

if 8-10gs ingested –> n-acetylcystein

  • if unclear dosage –> level
  • if > 24 hours no therapy
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2
Q

how to treat aspirin oversode?

A

alkalinizing the urine

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3
Q

benzos can prevent seizures from tricyclic toxicity, so do not

A

give flumazenil if you suspect TCA overdose and benzo as they wil seize

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4
Q

tricyclics EKG

A
    • fast Na channel blockers
  • widened QRS
  • prolong QT until torsades!!!
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5
Q

TCA overdose signs

A
  • dry mouth
  • constipation
  • urinary retension
  • widened QRS

-treat with bicarbonate

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6
Q

benzocaine, anesthesitics, nitrites, nitroglycerine, dapsone can all cause?

A

methemoglobinemia (Fe3+)

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7
Q

organophospate poisoning inhibts acetylcholinesterase causing and cholinergic crisis

A

salivation, lacrimation, polyuria, diarrhea, bronchospasm, bronchorrhea, respiratory arrest if severe!

anticholinergic is atropin, pralidoxime will reactivate the acetylcholinesterase.

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8
Q

hypokalemia or hyperkalemia predisposes to digitoxin toxicity?

A

-hypokalemia, cause less K more digitoxin can bind to the K/Na pumps

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9
Q

presentation of digitoxin toxicity?

A
  • 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.
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10
Q

lead poisoning

A

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

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11
Q

methanol or ethylene glycol poinsoning treatment

A

fomeprizole

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12
Q

cerebral circulation, pressure and PCO2

A

hyperventilation decreases pCO2, low pCO2 causes cerebral vasoconstriction that decreases volume and pressure

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13
Q

fluid replacement in burns

A

4 ml x %BSA x kg

head, arm, 9
legs 18 each
chest or back is 18 each

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14
Q

how to treat vtach

A
  • pulseless - shock
  • pulse + hemodynamically unstable - shock
  • pulse + hemodynamically stable - amiodorone, licaine or procainamide
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15
Q

what is pulseless electrical activity?

A
  • there is no pusle but on the EKG it looks normal

- tamponane, tension pneumo, hypvolemia, hypoglycemia, massive PE, hypoxia, hypothermia, metabolic acidosis, K issues

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16
Q

WPW syndrome

A
  • 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
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17
Q

how do you treat WPW sydrome acute? or chronic?

A

acute: procainamide, amiodarone
chronic: ablation

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18
Q

why are digi and diltiazem bad for WPW syndrome?

A

the block the AV node and force conduction into the abnomal pathway

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19
Q

multifocal atrial tach is associated with?

A

COPD

-look for 3 different p wave morphologies

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20
Q

bradycardia treatment

A
  • acute and showing signs of hypoperfusion give atropine
  • for complete heart block a pacemaker will need to be inserted
  • if asymptomatic just chill
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21
Q

how to treat mobitz type 2?

A

pacemaker

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22
Q

what is eczema herpeticum?

A

herpes lesions suprimposed on healing atopic dermatitis lesions

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23
Q

porphyria cutanea tard

A

blistering skin desease of sunexposed areas

assoc. hep C, estrogen use and hemochromatosis

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24
Q

how to treat mild and severe impetigo?

A

mild - topical mupirocin, bacitracin
severe - oral dix
cloacillin or cephalexin
community aquire MRSA - doxy, clinda or TMP SMX

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25
Q

erysepalas more often with strep than staph

A

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

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26
Q

erythema multiforme is assoc with

A

herpes or mycoplasma

-target lesions

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27
Q

steven johns for toxic epidermal necrolysis

A

SJ 30% body surgace area, rash with mucous membrane involvement , treat with IVIG

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28
Q

leydig cell tumor

A

sex cord stromal tumor
increased estrogen which supressed LH and FSH
-gynecomastia

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29
Q

the best initial test for cancer with compression, infection, and fracture is? what is the most accurate?

A

xray

the most accurate is an MRI

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30
Q

how to treat fibromyalgia

A
  • exercise

- amitryptiline

31
Q

juvenile RA

A
  • fever spikes
  • salmon colored rash
  • splenomegaly
  • pericardial effusion
  • mild joint symptoms
32
Q

in acute lupus flare what can you follow?

A
  • complement levels drop
  • anti DSDNA levels rise
  • anti-smith and ANA tell nothing
33
Q

anticardio;ipin antibodies are more often associated with

A

spontaneous abortion

-two or more first trimester events or one second trimester event

34
Q

scleroderma CREST renal manifestations

A
  • sudden HTN crisis
  • sudden onset of renal failure
  • microangiopathic hemolytic anemia
  • even DIC
35
Q

dermatomyositis is assoc with?

A

cancer

-ovary, lung, GI, lymphoma (non-hodgkin)

36
Q

sjrogen is associated with

A

lymphoma

37
Q

polarteritis nodosa spares?

A

lungs

38
Q

polymyalgia rheumatic presentation

A

pain and stiffness in shoulder and PELVIC girdle muscles

  • doffoculty combing hair and rising from chair
  • elevated ESR
  • normochromic normocytic anemia
  • treat with steroids
39
Q

c-ANCA

A

wegeners

granulomatous with polyangitis

40
Q

p-ANCA

A

churg strass and microscopic polyangitis

41
Q

cryoglobinemia IG?

A

immunce complexes are IgM against anti hep c virus IgG

42
Q

cryoglobinemia presentation

A

hep c, increased LFT, low C4, joint pain, glomerulonephritis, purpuric skin lesions, neuropathy

treat the hep c

43
Q

behceht syndrom

A

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
44
Q

how to treat psoriatic arthritis?

A
  • first line NSAIDS
  • worsens try methrotrexate
  • if that doesnt work try TNF alpha inhibitors
45
Q

secondary amloidosis is AA

A
  • chronically inflammatory conditions

- chronic infections

46
Q

AL amloidosis

A

MM
waldenstrom
light chains

47
Q

kidney - crescents

A

RPGN

48
Q

linear deposists - kidney

A

good pastures

49
Q

immune complexes, granular deposists - kidney

A

lupus nephritis, IgA and post-infectious GN

50
Q 
keeping muscle straight
hypokalemia?
hyperkalemia?
hypocalcemia?
hypermagnesimia?
A

hypoK - muscle weakness and cramps
hyperK- muscle weakness
hypoC - hyperactive deep tendon reflexes and muscle cramps
hyperMg - loss of deep tendon relexes

51
Q

amiloride

A

inhibits the enac Na channel in the principle cell

TMP also blocks this channel –> less Na uptake, less K extrectio –> hyperkalemia

52
Q

nephrotic syndrome and thrombosis

A

loss of ATIII and others

more often with membranous

53
Q

hyaline casts

A

dehydration

54
Q

NSAIS constrict the afferent arteriole

A

-inhibt PG so less dilation

55
Q

ATN toxins

A
  • 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.

56
Q

acute interstitial nephritis causes

A

pencillin, sulfa, quinolones, PPI, phenytoin, rifampin

57
Q

mebranous is assoc with

A

SLE, hep B. NSAID, breast/lung adenocarcinoma

58
Q

minimal is associ

A

NSAID and lymphoma

59
Q

renal failure, Ca, PO4, PTH and vitamin D

A
  • 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.
60
Q

treatment of TTP

A
  • usually resolves spontaenous

- but severe needs plasmapharesis, if not in the choice influse with FFP

61
Q

PCKD is assoc

A

berry aneurysms, MVP

62
Q

hyperglycemia and pseudohyponatremia

A

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.

63
Q

how to treat hyponatermia, mild, moderate and severe

A

mild - restrict fluids
moderate - saline
severe - hypertonic saline

64
Q

Distal tuble RTA 1

A
  • 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
65
Q

proximal tubule RTA type II

A
  • 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
66
Q

type IV RTA hypoaldosteronism

A
  • common in DM
  • decreased affect of aldo on DT
  • high urine sodium
  • hyperkalemia
67
Q

urine anion gap

A

+ RTA, -ve diarrhea

68
Q

urine pH for calcium oxalate formation

A

alkaline more, so more likely in RTA type 1, as they cant produce H+ and urine remains alkaline

69
Q

stone removal based on size

A

2cm surgical

70
Q

Calcium and hydrochlorothiazide

A

it promotes distal tubule reabsorption of calcium so makes less calcium in urine

71
Q

stress incontinence vs urge incontinence

A

stress – cough, laugh –> this is structural

urge –> neurologic, they have no control, treat with anticholinergices like oxybutynin

72
Q

neurogenic bladder than wont release

A

cholinergic agonist like bethenechol

73
Q

define HTN

A

140/90

step 2 disease treatment (12 decks)

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