CCS

Question 1

Quid of DKA criteria (4)

Answer 1

blood sugar level > 250 mg/dl
Bicarb < 15
Ketonemia
elevated anion gap

Question 2

Could Amylase and lipase elevated in DKA

Answer 2

yes

Question 3

Normal bicarb

Answer 3

24-30

Question 4

How to control Anion Gap

Answer 4

Na- (Cl +Hco3)

Question 5

normal anion Gap

Answer 5

10-14 meq

Question 6

criteria for hyperosmolar state(5)

Answer 6

glucose more than 600 mg/dl
serum osmolarity more than 330
absent or minimal ketonemia
arterial PH above 7.3
serum bicarb above 20

Question 7

Mechanism of fluid and electrolytes depletion in HS

Answer 7

osmotic diuresis

Question 8

How to calculate serum osmolarity

Answer 8

2Na + glucose/18 + BUN/2.8

Question 9

Normal serum osmolarity

Answer 9

275-295

Question 10

normal arterial PH

Answer 10

7.35-7.45

Question 11

corner stone of DKA treatment (3)

Answer 11

Hydration
Insulin
Potassium replacement

Question 12

Hydration urgency phase in DKA (3)

Answer 12

1-2 liters in bolus
500 ML per hour during first 4 hours
continue with 250 ml for several hours

Question 13

second phase of hydration in DKA if no signs of dehydration

Answer 13

continue with 1/2 NS 250-500 cc per hour for 3 to 4 hours

Question 14

volume repletion in DKA

Answer 14

4 to 10 liters

Question 15

What to do in DKA when glycemia is < ou egal a 250

Answer 15

DW 5 or 10%

Question 16

How to give insulin

Answer 16

O,1 U/kg en bolus followed by 0,1 U/kg per hour in continuous infusion

Question 17

Potassium replacement in DKA criteria (3)

Answer 17

K < 5.3
No EKG changes
Normal renal function

Question 18

what about Bicarb and phosphore replacement

Answer 18

no evidence of clinical relevance

Question 19

Quid of ABCD

Answer 19

Airway
breathing
circulatory
drugs

Question 20

Airway quid (3)

Answer 20

Airway suction
give O2
Pulse oxymetry

Question 21

Quid of Breathing

Answer 21

Endotracheal intubation

Question 22

criteria for endotracheal intubation (3)

Answer 22

If you cannot protect the airway
No improvement with nasal or face mask o2
pao2 < 55 or Paco2 > 50

Question 23

quid of C

Answer 23

IV access
Cardiac monitoring
foley
Obtain a finger stick glucose

Question 24

Quid of D (3)

Answer 24

drugs if unconscious without trauma
give thiamine
Naloxone
Dextrose 50%

Question 25

Narcotic overdose signs(2)

Answer 25

Hypotension | Pinpoint pupils

Question 26

Why hypotension in narcotic overdose

Answer 26

Peripheral vasodilation

Question 27

treatment of narcotic overdose

Answer 27

Naloxone | Activated charcoal if intoxication comes from ingestion

Question 28

clue indicating hemolytic anemia (3)

Answer 28

Jaundice with indirect bilirubin predominant Bite cells on peripheral smear Anemia

Question 29

intravascular hemolysis cause

Answer 29

IGM causing destruction by IGM

Question 30

Extravascular hemolysis cause

Answer 30

IGG causing GR destruction using Macrophages in spleen or liver

Question 31

Lab: intravascular hemolysis (3)

Answer 31

``` Hemoglobinuria High LDH Low haptoglobin shistocytes , helmet cells or fragmented red blood cells on Peripheral smear High reticulocytes count ```

Question 32

Peripheral smear in intravascular hemolysis (3)

Answer 32

shistocytes helmet cells fragmented red blood cells

Question 33

Lab in extravascular hemolysis

Answer 33

``` Increased indirect bilirubin high LDH low haptoglobin spherocytes High reticulocyte count ```

Question 34

Peripheral smear in Extravascular hemolysis

Answer 34

spherocytes

Question 35

Why low haptoglobin

Answer 35

Haptoglobin is a transporter of protein, transports newly released indirect bilirubin and is rapidly used up in hemolysis