General medicine: CL Lai Session 5 Flashcards

1
Q

Reason for 100% oxygen administration

A
  • Small pneumothorax that dont want to tap
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2
Q

APO Mx

A

Complete bed rest
Oxygen
Low salt diet and fluid restriction
Frusemide
IV nitrate
Morphine: reduce preload by pulmonary vasodilation

If BP not stable:
Dopamine (inotropic agent): decreases afterload

Intraaortic balloon

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3
Q

What alcohol intake for men and female?

A

Male: 4 units/day
Female: 2 units/day
1 unit = 10g of alcohol

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4
Q

How to manage alcoholic hepatitis and what factor used?

A

Maddreys discriminant factor includes PT and serum bilirubin

If score >32 use Prednisolone, poor prognosis with 30 day mortality

Another indication for steroid use in alcoholic cirrhosis is hepatic encephalopathy

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5
Q

Nutritional deficiency manifestation caused by alcohol

A
  • Wernickes encephalopathy: confusion, ataxia, opthalmoplegia
  • Korsakoffs psychosis: wernickes encephalopathy + amnesia + confabulation
  • Beriberi (wet beriberi = high output heart failure + peripheral edema; dry beri beri = peripheral neuropathy)
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6
Q

Neurologic conditions caused by alcohol

A

 Cerebellar degeneration
 Cerebral atrophy
 Asymmetrical peripheral neuropathy
 Myopathy (tender)
 Alcoholic seizure disorder (Rum fit) – not epilepsy, alcohol also reduces threshold of seizure
 Withdrawal tremor
 Corpus callosum atrophy (rare) – quadriplegia and reduced intelligence
 Central pontine myelinolysis (rare, also in hypoNa with rapid sodium replenishment): tetraplegia and multiple cranical nerve palsy

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7
Q

Neuropsychiatric conditions caused by alcohol

A

 Delirium tremens: tremor and visual hallucination (large and small animals walking around)
 Alcoholic hallucinosis (auditory hallucination)
 Alcohol dependence
 Morbid jealousy (Orthello syndrome)
 Depression
 Thiamine deficiency: Wernicke‟s and Korsakoff‟s

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8
Q

Haematological effect by alcohol

A

 Folate deficiency and megaloblastic anemia
 Bleeding (chronic bleeding in ?GAVE gastric antral vascular ectasia or portal hypertensive gastropathy)
 Zieve syndrome (hemolysis, jaundice, lipoproteinemia and abdominal pain caused by alcohol withdrawal – reduced delipidization of liver causing hyperlipidemia, causing red cell membrane instability – spur cells which are prone to hemolysis)
 Check reticulocyte count, RDW, PBS showing anisocytosis, indirect bilirubin, AST, haptoglobin (reduced production in liver diseases), methaemalbumin; also the LDL
 Aplastic anemia (bone marrow failure)

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9
Q

Haemolysis lab results

A

Increase in MCV, RDW
Increase unconjugated bilirubin
Decreased haptoglobin
Increased urinary urobilinogen

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10
Q

GI effect from alcohol

A

 Peptic ulcer disease
 Acute or chronic pancreatitis (irreversible, functional impairment)–> alcohol and hypercalcemia (calcific plaque and fibrosis)
 Mallory Weiss syndrome
 Diarrhea

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11
Q

cardiac effect from alcohol

A

 Congestive heart failure due to alcoholic dilated cardiomyopathy (right heart failure at the same time
so no orthopnea!)
 Atrial fibrillation
 :) Reduced coronary artery disease by raising the HDL

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12
Q

Endocrine effect from alcohol

A

 Alcohol induced hypoglycemia
 Alcohol dehydrogenase in liver, oral mucosa, stomach, duodenum
 This enzyme competes for NAD (nicotinamide adenine dinucleotide)
 Reduce gluconeogenesis, in the background of malnutrition (little liver glycogen storage)  Results in hypoglycemia

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13
Q

Causes of hypoNa

A

Dilutional: fluid retention (liver, renal and cardiac) (liver causes the worse). Tx: Fluid restriction (1-1.2L) and low dose diuretics

Normovolemic hypoNa: most common cause is SIADH –> brain (any concussion) and lung (any lesion such as pneumonia)
adrenal crisis (hypocortisolism) which causes reflex increase in CRH (ADH analogue): serum K will be higher (due to hypoaldosteronism. Aldosterone normally reabsorbs Na+ and excretes K+.
Tx: fluid restriction (0.8L), furosemide (lasix), vaptan (vasopressin receptor antagonist). Last line is sodium injection (be very careful to prevent central pontine myelinolysis)

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