UW 1 Flashcards
ECG effects of Hyperkalemia
K: 6-7
PR prolongation
Tall t wave
K: 7-8
Flattening of P wave
ST segment elevation
K: >8
Widened QRS
AV Node block
Sine waves
Treatment of Hyperkalemia
C BIG K
Calcium chloride or gluconate (IV)
Bicarbonate, B-2 agonists
Insuline/Glucose
Kayexalate
Hypernatremia correction/management
- Determine free water deficit: total body water + (Na/140 -1)
- Rate of replacement: 0.5mEqL/L/H (over 48 to 72hrs)
Use normal saline until euvolemic
Hypernatremia Dxx
Urine Osmolality <300:
Diabetes insipidus
Urine Osmalality >600:
External losses (vomiting, diarrhea)
Na gain: hypertonic saline
Hyponatremia dxx
Look for algorithm pg 505 First aid step 2
Management of hyponatremia
Hypervolemic: loop diuretics
Euvolemia: Fluid restriction (1l/day) +/- diuretics. High Na diet
Hypovolemia: Saline
Correct over 72hrs (8-10 mEq/L/d) @ 0.5 mEq/L/h
K regulation
What cuases shif to intra or extracelluar space
Shift to intracellular space:
Insuline
B2 agonist
Alkalosis
Shift to extracellular space: Acidosis Increase osmolality Exercise Cell lysis
ECG findings in Hypokalemia
T wave flattening
U wave (additional wave after Twave)
ST segment depresion leading to AV block
Management of Hypokalemia
K repletion (oral preferred over IV) If IV necessary: continuous infusion over bolus (do not exceed 20mEq/l/h Bolus for symptomatic and ECG changes Replace magnesium (hypomagnesemia makes it difficult to correct K)
Hypercalcemia symptoms
Bones, stone, Groans, Psychiatric overtones;
Osteopenia/fractures
Kidney stones
Abdominal pain: anorexia constipation
Psychiatric overtones: weakness, fatigue, irritability, altered mental status
ECG: Short QT
Nephrogenic diabetes insipidus: Cant concentrate urine. May lead to dehidration
Hypocalcemia symptoms
Abdominal and muscle cramps
Dyspena
tetany
perioral and achral paresthesias
Chevostek sing (face twitch in facial stimulation) Trousseau (arm spasm on pressure cuff)
Low Mg effect in Calcium regulation
Low Mg causes PTH resistance
Low Mg effect on electrolites
Low MG causes
Hypocalcemia
Hypokalemia
Defects in Renal Tubular Acidosis
Type I: H secretion
Type II: HCO3 reabsorption
Type III: Aldosterone resitance or deficiency
Why do you find sypmtoms of hypocalcemia in hyperventilating patients?
Hyperventilation causes Respitarory alkalosis
High pH cuases ionized Ca to bind to albumin because hydrogens ions are displaced
Total calcium is normal, ionized calcium decreases
AKI definition
Decline in renal function compared to a previous state in < 3months. (Increase in creatinine)
CKD definition
> 3months of GFR <60ml/min or sings of chronic kidney damage even with normal GFR
2 hyperparathyroidsm in CKD
Decreased phosphate excretion
decreased vitamin D production
Leading to hypocalcemia and renal osteodystrophy
Consequeances of renal failure
MAD HUNGER
Metabolic Acidosis Dyslipidemia (especially triglerides) Hyperkalemia Uremia Na/water retention Growth retardation/development Erithropoyetin failure Renal osteodystrophy
Pathophysiology of AKI (types)
Prerenal: decreased perfusion
Intrinsic: injury within the nephron
Extrinsic: outflow obstruction
Labs in Prerenal vs Intrinsic AKI
BUN/Creatinine:
>20;1 (prerenal) <15:1(intrinsic)
FeNa and Urine Na
<1% <20mEq/L(prerenal) >2%>40mEq/L(intrinsic)
Urine Osmol
>500 (prerenal)
<350 (Intrinsic) damage tubules cant reabsorb
water, cant concentrate urine
Cast
Prerenal: Hyaline (more than normal) Intrinsic: RBC cast
Cuases of Acute interstital nephritis and Acute tubular necrosis
AKI after medication
Pee (diuretis) Pain (NSAIDs) Penicillins and cephalosporins PPI rifamPin
Acute tubular necrosis: ischemia, glomerulonephritis, rhabdomyolisis, embolic disease
Treatment of abnormal bleeding in uremia
Desmopressin
Increases factor VIII
Deficient in renal failure
AEIOU criteria of dialysis
Acidosis Electrolite abnormalities Ingestion (salicilates, theophyline, methanol, barbiturates, lithium, ethylene glycol) Overload (fluids) Uremia
Labs in Rhabdomyolisis
High K and PO4. (due to cell lysis)
Low Ca due to deposition in damage tissue
CK >1000
Dark Urine with +blood test but no RBC
Causes of rhabdomyolisis
Crush injury
Prolonged inmoblization (CNS depresants like opioids, benzos, alcohol)
Muscle activity (seizures and exercise)
Drug (statin, fibrates, colchicine, ethanol, cocaine)
Vasoconstriction: cocaine and amphetamines
Pathophysiology of AKI in rhambdomyolisis (2)
Decreased renal perfusion (fluids toward damage tissue)
Direct damage from pigments
VIPoma presentation
WDHA
Watery diarrhea
Hypokalemia
Achloridia
(Dehidration, muscle weakness, flushing)
Exenatide: brand name, MOA, SE
- exanatide = Byetta
- MOA: GLP-1 receptor agonist
- 2nd line w/metformin
- low hypoglycemia risk
- SE: weight loss
Most common causes of folic acid deficiency
- poor diet
- drugs: phenytoin, methotrexate, TMP
Treatment for alcohol cravings (2)
Naltrexone (blocks u-opiod receptor blocker). Can precipitate opioid withdrawal in patients taking opioids.
Acamprostate: first line in patients with liver disease or opioid use. (MOA: glatamete modulator)
Buprenorphine
Opioid partial agonist used in the treament of opioid use and pain management
Smoking cessation pharmacologic treatment
Bupropion
Verenicline
Acute dystonia treatment
Acute muscle contractions or spasm
Benztropine or dephinedramine
Akathisia treatment
Perception of restlesness
B-blocker (propranolol)
Benzos and anticholinergics may work
Parkinsonism treatment
Benztropine or amantadine
Tardive dyskinesia managment (3)
- Stop agent or reduced dose if possible
- Valvenezine, deutetravenazine
- Switch to quetiapine or clozapine
Indications for cystoscopy (6)
- Gross hematuria with no evidence of glomerular disease.
- Microscopic hematuria with no evidence of glomerular disease and high risk factors (smoking, chronic cistitys, paint, metal exposure; cyclophosphamide)
- Recurrent UTIs
- Obstructive symptoms with suspicious for stricture, stone
- Abnormal bladder imaging or cytology
- Irritative symptoms without infection
Management of IUFD and complication
<24 weeks
Dilatation and evacuation
> 24 weeks
Labor induction
Fetal retention can lead to CID
Insidious loss of peripheral vision
Need of frequent lens changes
Mild headache
Impaired adaptation to darkness
Open angle glaucoma
Open angle glaucoma
Insidious loss of peripheral vision Need of frequent lens changes Mild headache Impaired adaptation to darkness Cupping of the optic nerve
Open angle glaucoma treatment
Latanoprost, bimatoprost (topical prostaglandin, increases drainage)
B-blockers (timolol, betaxolol) to decrease aqueous humor production (careful in patients with asthma)
Pilocarpine to increase aqueous outflow
Acetazolamide (not as usefull in open angle)
Laser if medication fails
Extreme sudden onset eye pain, blurred vision, headache, nausea and vomiting
Hard red eye, pupils dilated and non reactive
Closed angle glaucoma
Closed angle glaucoma
Extreme sudden onset eye pain, blurred vision, headache, nausea and vomiting
Hard red eye, pupils dilated and non reactive
Closed angle glaucoma treatment
B-blockers (timolol, betaxolol) to decrease aqueous humor production
Pilocarpine to increase aqueous outflow (cholinomimetic)
Acetazolamide
Laser if medication fails
Test for corneal examination
Fluorescein exam
Symptoms and Xray of pulmonary contusion
Tachypnea, tacycardia, hypoxia
Xray: 1st can be normal
Hours later:
Patchy pulmonary infiltrate (non restricted by
anatomic landmarks)
Pes Anserious pain syndrome
Pain of medial aspect of knee below the joint line
Pes anserious is formed by: sartorious, semitendinous and gracilis tendon
Cause by over use or trauma, exacerbated by pressure of opposite knee when laying in the side
Treatment for ADHD
Stimulants: amphetamines (metylphenidate, dextroamphetamine)
Non stimulant: atomoxetine
Others:
a2-adrenergics: clonidine, guanfacine
antidepresants: bupropione, TCAs
Diseases associated with celiac disease
Down Syndrome
Other autoinmune: diabetis type 1, thyroiditis,
Clinical sings suspecious for celiac disease in children /adolescents
Growth delay Abdominal bloating / diarrhea Microcitic anemia (sugesting nutritional deficiencies)
Anti tissue transglutaminase antibody
Celiac disease
REM behavior disorder
Motor behavior during REM
Dream enactment
Patient easily awaken and oriented
May be prodrome to Alpha-synuclein neurodegenerative disorders (parkinson, lewi body dementia, multiple system atrophy)
Alpha-synuclein neurodegenerative disorders
Parkinson
Lewi body dementia (visual hallucinations, parkinsonism, fluctuation of consciousness)
Multiple system atrophy (parkinsonism, autonomic dysfuntion, wide spread neurological sings)
Female patient with rapidly progressive shortness of breath, constipation, vomiting, abdominal distention. Palpable adnexal mass, not movil, nodular. Dx and managment
Possible Epithelial ovarian cancer
CA-125
Exploratory laparotomy. Hysterectomy/BSO with omectomy and paraaortic lymphadenopathy
Painless Ulcer with raised borders Dxx
Syphilis: regional adenopathies. size 1-2cm
Granuloma inguinale: no adenopathies. Size 5-10mm
Takayasu Arteritis
Presentation, Labs, Studies, Tx
Young asian female
Arm claudication, BP discrepancies between arms, pulse deficit (lower legs)
Constitutional symptoms
Elevated ESR, CRP
Thickening of vascular wall, narrowing of lumen
Aortic dilatation, widened mediastinum
Treat with systemic glucorticoid
Management of solid brain metastasis
Surgery if stable extracraneal disease and good performance status
