Hospital Med Flashcards
(196 cards)
1
Q
What are the 4 different types of hospital admissions?
A
- In patient
- Observation
- Outpatient in bed
- General inpatient (hospice)
2
Q
What are the components of a hospital admission? (6)
A
- Ambulance record
- Prior-hospitalizations
- Outpatient records, notes, labs
- Meds
- Examine patient
- Admit the pt (med rec, orders, documentation)
3
Q
What are things to consider when discharging a patient?
A
- Where will they go?
- family dynamics
- Environmental factors (weather)
4
Q
What are some manifestations of AKI? (4)
A
- frequently astmptomatic
- edema
- HTN
- decreased UO
5
Q
What are some lab manifestations of AKI?
A
- albumineria
- increased BUN
- hyperK
- hypoK
6
Q
What are 2 ways to prevent AKI?
A
- Sustain renal perfusion
- don’t clog the pipes (preparation for contrast due, aggresive IVF in presence of hemolysis/rhabdo)
7
Q
What is the most important step in managing AKI?
A
identify the cause!
8
Q
What are 3 other ways to manage AKI?
A
- meticuous management of intake (water- UO and 500mL, phosporus monitoring (calcinosis- aluminum containting p-binders)
- renal consult
- dialysis
9
Q
What are 3 criteria used to stage AKI?
A
- RIFLE (risk, injury, failure)
- AKIN (AKI network)
- KDIGO:
- rise in cr more than 0.3
- decrease in UO (less than 3 over 6 hours)
10
Q
What is the most often cause of prerenal azotomia?
A
inadequate perfusion
11
Q
What are 3 ways of inadequate perfusion?
A
- Hypovolemia
- Oliguric
- prolonged renal ischemia
12
Q
What are 4 manifestations of renal azotemia?
A
- glomerulonephritis
- nephrotoxins
- Nephritis (immune modulated)
- minimal change disease (nephrotic syndrome)
13
Q
What are some nephrotixic conditions? (6)
A
- ischemia
- radiocontrast
- toxins
- DIC
- intrinsic obstruction
- intrarenal precipitation (Ca, etc)
14
Q
Which kidney disease is immune-modulated?
A
Nephritis
15
Q
What is the usual culprit of post-renal azotemia?
A
urinary obstruction
16
Q
What are 4 ways of getting urinary obstruction?
A
- prostatism
- tumors
- calculi
- urethral obstruction
17
Q
What are 4 comorbidities that can lead to CKD?
A
- AKI
- HTN
- DM
- Vascular disease
18
Q
What is microalbumineria defined as?
A
30-300 mg/day albumin
19
Q
What are spot urine albumin/cr ratios?
A
- 17-250 men
- 25-355 women
20
Q
What GFR qualifies as stage 1 CKD?
A
GFR over 90
21
Q
What qualifies as stage 2 GFR?
A
GFR 60-89
22
Q
What qualifies as stage 3A?
A
GFR 45-59
23
Q
What is 3B CKD?
A
30-44
24
Q
What is stage 4 CKD?
A
15-29
25
What is stage 5 CKD?
Under 15
26
How to manage somone with CKD inpatient to avoid AKI?
1. Diet (low Na, protein, K, P)
2. Avoid nephrotoxins (NSAIDS, radiocontrast)
3. water management (THINK about IVF)
27
What are some causes of HYPERkalemia? (8)
1. AKI/CKD
2. adrenal insufficiency
3. dietary intake (potatoes, bana)
4. hemolysis (blood draw, clottin
5. Metabolic acidosis
6. BB
7. insulin deficiency
8. aldosterone antagonists
28
What clinical manifestations of HYPERk?
- weakness
- paralysis
- cardiac arrythmias (peaked T)
29
How do you treat HYPERk?
- Treat the cause
- IVF
- kayexalate (if not hypovolemic)
- limit K intake
- insulin + dextrose (dextrose so they don't get hypoglycemic)
- Beta-adrenergics
30
what does HYPOmagnesia cause?
HYPOk
31
What are other causes of HYPOk? (8)
1. decreased intake
2. diuretics
3. diarrhea
4. laxatives
5. insulin
6. beta-agonists
7. stress hypothermia
8. alkalosis
32
What are clinical manifestations of HYPOk?
- weakness/rhabdo
- glucose intolerance
- cardiac arrhythmias
33
How do you treat HYPOk?
- potassium replacement
- PO vs IV
- Mg replacement (ALWAYS CHECK MAGNESIUM!)
34
How do you dx HYPERna?
urine osmolality
35
What do you think if urine osmolality is low (under 150?)
diabetes insipidus
36
What do you think if urine osmolality is high? (over 300)
osmotic diuresis
37
How do you treat hyperNA?
1. NS initially if volume depleted
2. transition to 1/2 NS and 1/2 D5
3. Avoid correction faster than 0.5/L/hr to avoid cerebral edema
38
What is diabetes insipidus?
low ADH
39
What is an iatrogenic way of giving someone hyperna?
1 amp bicarb
40
What is generally associated with elevated ADH?
hyponatermia
41
What is hyperosmolar hyponatremia?
Elevated levels of another osmolyte (glucose, proteins, lipids)
42
What type of hypoNA does SIADH generally cause?
euvolemic hypoNA
43
What does CHF/cirrhosis typically cause?
hypervolemic hypoNA
44
What can cause hypovolemic hypoNA?
1. Extra-renal losses(vomiting, diarrhea, dehydration)
| 2. Renal losses (thiazides, adrenal insufficiency)
45
What is the risk of correcting hypnatremia too quickly?
osmotic demyelination syndrome
46
What are common causes of ADH elevation in hospitalized patients (7)?
1. Pain
2. Volume depletion
3. Trauma
4. Medications (SSRIs, thiazides)
5. neoplasm
6. severe nausea
7. neuropsychiatic meds
47
Who can present atypically with MIs?
- women
- elderly
- diabetics (NAUSEA)
48
How long does it take for troponins to show up?
6 hours
49
How soon do you want to get an EKG someone with a suspected ACS?
w/n 10 minutes
50
Who is at risk for ACS? (6)
1. ST elevation/new LBBB
2. ST depression/T-wave inversion
3. Chest pain w/hemodynic instability
4. dynamic EKG changes
5. known CAD w/reminiscent pain
6. high risk hx pos/neg troponins
51
Who is at moderate risk for ACS? (4)
1. atypical CP w/CAD and normal/unchanged EKG
2. CP with nonspecific ST depression (dominant R leads)
3. Low risk hx w/normal EKG and positive troponins
4. Angina patient with rest angina w/spontaneous resolution or promptly after NTG
52
Who is at low risk?
atypical chest pain with atypical
53
What is the tx plan for someone with an uncertain CP dx?
1. Admission
2. MONA (morphine, oxygen, nitro, ASA)
3. ACLS prn
4. CBC, electrolytes (K and Mg-- arrhythmias!)
5. Troponin (serial check)
6. telemetry
54
How do you tx someone with a known STEMI/UAP?
1. MONA
2. ASA/antiplatelet agents
3. P2Y12-R blocker
4. BB (long-term CHF)
5. heparin
6. statin
7. If CHF- diuretics, NTG IV
55
What are the criteria used to determine patients TIMI score? (7)
1. over 65
2. over 3 risk factors for CHD
3. Prior coronary stenosis (over 50 percent)
4. ST deviation on admit EKG
5. Over 2 anginal episodes in 24grs
6. elevated cardiac biomarkers
7. Use of ASA in prior 7 days
56
What does the TIMI tell you?
2 week risk of death, new/recurrent MI or severe recurrent ischemia requiring revascularization
57
Do you get TTE or TEE for afib?
TTE
58
When would you get TEE for afib?
indicated for presence of LA thrombus
59
What are benefits of rhythm control for afib tx?
- optimal CO
| - improve LV function
60
What are adverse effects of rhythm control
- high chance of recurrence of afib
- pro-arrhytmia
- lots of SE
61
Who are good candidates for rhythm control?
1. younger, more active patients
2. pts with contraindication for anticoag
3. patient who rate is uncontrollable and or can't tolerate AF
4. patients who REQUEST IT
62
What are different options for rhythm control?
1. DC cardioversion (if afib for over 48 hours, 3-4 weeks full anticoag first)
2. pharm (amiodarone, flecainide)
3. non-pharm (MAZE procedure, radiofrequecy, catheter ablation)
63
What are meds you can give for rate control?
diltiazem. verapamil, digoxin
64
Why do you have to watch out for with CCBs?
hypotension!
65
How does digoxin work?
slows HR and INCREASES CO
66
What are high risk factors that increase a patients stroke risk with chronic AF?
- Over 65yo
- hx stroke
- DM
- HTN
- CHF (LV dysfunction)
- Increased LA size
67
What are some low risk factors for stroke risk in patients with chronic AF?
- Under 60
| - heart disease with preserved LV function, normal LA size
68
What is the CHAD score used for?
to determine if a patient should be anticoagulated
69
What are the components of CHAD score? (8)
1. CHF (1 point)
2. HTN (1 point)
3. Over 75yo (2 points)
4. DM (1 point)
5. Stroke/TIA/TE (2 points)
6. Vascular disease (prior MI/PAD) (1 point)
7. Age 65-74 (1 point)
8. Female (1)
70
What should you do with someone with a CHAD score of 1?
consider anticoag
71
What should you do with someone with a CHAD score od 2 or higher?
anticoag
72
what is a benefit of novel anticoag agents?
no bridging needed!
73
What are precipitating causes of acute CHF?
1. IVF (main culprit)
2. medication adjustments/erros
3. Transfusion
4. post-op
5. afib
74
What classifies systolic heart failure?
EF under 40 percent
75
What classifies diastolic HF?
impaired relaxation
76
What is acute management of CHF?
1. IV diuretic
2. O2
3. NTG SL
4. Morphine
5. Na restriction
6. Fluid restriction
7. AVOID NSAIDS
8. Avoid empiric use of antiarrhythmics
77
When should you get a consult for CHF?
Presenting with TRIAD of hypotension, oliguria and low CO (low pulse, cool/pale extremities)
78
When do you need to admit someone with CHF?
moderate to severe
79
What is considered hypoglycemia?
glucose under 70
80
What are complications associated with hypoglycemia?
1. arrhythmias
2. delerium
3. aspiration events
4. falls
81
What are the most common culprits of hypoglycemia?
1. sulfonylureas
2. sliding scales
3. intensive insulin therapy
82
What are the glucose goals for non-critically ill hospitalized patients?
Pre-meal: under 140
Fasting no lower than 90
Average random glucose under 180
83
What do you want to do when prescribing sulfonylureas?
1. hold for any chance of poor PO intake
2. Write SPECIFIC nursing orders
3. don't forget about other oral agents
84
What so you want to do when prescribing sliding scale?
1. safer with short-acting insulin
| 2. don't "set it and forget it"
85
How do you treat someone is asymptomatic or midly symptomatic hypoglycemia?
- 20g oral glucose (glucose tabs/gels, juice/milk, snack , full meal)
- one amp of D50
86
What are the adverse effects of hyperglycemia? (3)
1. increased risk infection (decreased immune system/neutrophil function)
2. Volume depletion/dehydration (renal failure, severe electrolyte disturbances)
3. calorie and protein loss (poor healing, edema)
87
What is the glucose goal when treating hyperglycemia?
Under 180!
88
What DM med can cause lactic acidosis when used with contast dye?
metformin
89
What DM meds can cause ventricular dysfunction?
TZDs
90
What are some barriers to consider when discharging a DM patient?
1. insurances
2. pharmacy
3. equipment
4. can patient work equipment
5. sustainability
91
What are some common causes of upper GI bleeds?
- Ulcers (NSAIDs, Stress)
- esophageal varices (cirrhosis)
- esophagitis/gastritis (candida, ETOH)
- portal HTN (cirrhosis)
- Angiodysplasia
- mass lesions
- mallory-weiss syndrome
- no lesion identified (10-15 percent)
92
what does orthostatic hypotension mean?
15 percent total volume loss
93
What does supine hypotension mean?
40 percent total volume loss
94
What tests does everyone with a GI bleed get?
1. CBC (H/H)
2. CMP
3. coag panel
4. type and cross
95
What indicates an emergency GI bleed?
hypotension (of any kind) and frank blood witnessed
96
What is initial management of an anticoag patient with a GI bleed?
1. stop medication
2. rank severity of bleed
3. call PharmD
4. reverse effects (INR over 1.5, Vit K IV/po, Kcentra)
97
What are some clinical features of a COPD exacerbation?
- increased cough
- increased sputum
- worsening dyspnea
- wheezing
- tachynea
- increased respiratory effort (SOB, accessory muscle use, tripoding)
- hypoxia
98
Does a normal spirometry r/o COPD/asthma risk of exacerbation?
NOPE
99
What is GOLD staging?
Stage 1: mild COPD (over 60 percent)
Stage 2: Moderate COPD (under 60 percent)
Stage 3: Severe COPD (under 30 percent)
100
How much oxygen can a nasal cannula supply?
Up to 6L
101
What is a vapotherm?
high flow nasal O2 and positive pressure
102
Should steroids be given for COPD exaberbation?
YES (IV first 24 hrs and then PO)
103
When should someone with COPD get abx?
Mod/severe exacerbation
104
What qualifies as a mod/severe COPD exacerbation?
At least 2 or 3 cardinal sxs (dyspnea, increased sputum, increased sputum purulence)
105
What abx should you give someone with uncomplicated COPD with no risk factors?
Macrolide
106
What abx do you give someone with complicated COPD and at least 1 risk factor?
flouroquinolones or augmentin
107
What are risk fartors for COPD?
1. Over 65
2. FEV1 under 50 percent
3. Over 3 exacerbations/year
4. Cardiac disease
108
What is the average length of stay for someone with a COPD exacerbation?
5 days
109
What do you do initially on admission with COPD patient?
maximize therapy (albuterol, oxygen, solu-medrol)
110
What do you do mid-way (day 2-3) of COPD patient?
1. change to PO steroid
2. continue inhalants
3. start to wean O2
4. encourage patient to ambulate
111
What do you do just before d/c of COPD patient?
1. all meds converted to PO
2. ambulate patient, check ambulatory O2
3. Be sure patient has good f/u
112
What are high risk populations for VTEs?
- critical illness
- cancer
- stroke
- PG
- heart failure
- MI
- Over 75yo
- hx VTE
- prolonged immobility
- renal failure
- inherited hypercoagable state
113
What do you need to be careful of with someone on heparin?
HIT
114
What is a red flag for HIT?
50 percent reduction in platelets
115
What are the components of Wells score for DVT?
1. Active cancer (w/n 6 months) (1 point)
2. paralysis/recent plaster immobilization of LE (1 point)
3. recently bedridden for 3 days or major surgery w/n 4 weeks (1 point)
4. entire leg swollen (1 point)
5. calf swelling by more than 3cm when compared to asx leg (1 point)
6. pitting edema (1 point)
7. collateral superficial veins (1 point)
8. alternative dx less likely than that of DVT (2 points)
116
When does the well score qualify as likely DVT?
2
117
What Wells Score qualifies as high probability?
3 or higher
118
How do you treat DVT?
1. admit to hospital
2. start IV heparin or lovenox AND po coumadin (AT THE SAME TIME!)
3. continue for 5 days
4. once INR at goal (2-3) stop IV (after 5 days) and rely just on PO coumadin
119
What is the clinical presentation of a submassive PE?
- dyspnea and tachypnea at rest/with exertion
- pleuritic pain
- cough
- orthopnea
- calf/thigh pain and/or swelling
- wheezing and coarse breath sounds
- hemoptysis
120
What are sxs of a massive PE?
All submassive sxs PLUS HYPOTENSION
121
When should you order a hypercoagable panel for a patient with PE?
AFTER initial tx period is over (3 months out) and anticoag has been stopped
122
What are indications for an IVF filter?
- can't use pharm anticoag
- developed complication/recurrence
- retrievable filter designs preferred
123
What are general variables associated with SIRS?
- Temp over 100, under 96.8
- HR over 90
- RR over 20
- altered mental status
- significant edema (over 20mL/kg over 24hrs)
- HYPERGLYCEMIA (glucose over 140)
124
What are inflammatory variables of SIRS?
1. leukocytosis or leukopenia
2. Normal WBC with over 10 percent immature forms
3. plasma CRP elevated
4. plasma procalcitonin
125
How do you treat someone with SIRS?
- start gentle fluid resuscitation and admit patient
| - obtain blood cultures
126
What is sepsis?
SIRS plus infection
127
What classifies severe sepsis?
2 SIRS criteria AND infection AND end organ damage
128
What qualifies as end organ damage? (6)
1. Hypotension
2. Renal failure
3. Shock liver (bilirubin over 2)
4. coagulopathy (platelets under 100, INR over 2.5, PTT over 60)
5. Respiratory failure
6. elecated lactic acid
***Does NOT count organ dysfunction that is from chronic conditions/medications
129
What qualifies as septic shock?
Severe hypotension persistent in the first few hours AFTER aggressive fluid resuscitation
130
How do you manage severe sepsis?
broad spectrum abx
131
What are the major Duke criteria?
1. postive blood culture x2 with common offenders and NO CLEAR PRIMARY FOCUS
2. persistenly positive blood cultures after or during treatment
3. TTE evidence of vegetation or NEW regurg mumur
4. Other imaging starting question of intracardiac abnormality
132
What are Duke minor criteria?
1. Presence of valvular heart disease NOS
2. IVDU
3. fever
4. unexplained vascular phenomenon (conjunctival hemorrahge, cutaneous petechiae, embolism, hemorrhage)
133
What are common pathogens of endocarditis?
- Strep viridians
- Staph aureus
- Enterococcus
134
What is the imaging test of choice for endocarditis?
TEE
135
What is hematogenous osteomyelitis?
1. bacteremia (from whatever source) leads to seeding of bacteria w/n bone
2. monomicrobial
3. blood and bone cultures should match
136
What is contiguous osteomyelitis?
1. bacteria seeds the bone from adjacent tissue
2. polymicrobial
3. blood cultures may or may not be positive
137
What type of osteomylelitis is associated with DM?
contiguous
138
What is the presentation of someone with DM and contigurous oestomyelitis?
slow, insidious onset with skin disruptions that slow to heal
139
How do you dx osteomyelitis?
- inflammatory markers may or MAY NOT be positive
| - Imaging (MRI PREFERRED)
140
How do you treat osteomyelitis?
1. ID and surgery (podiatrist)
2. broad spectrum IV abx (metronidazole, cefepime and vanco)
3. follow bone cultures DAILY and laser in on tx once organism/sensitivity identified
141
How long is the treatment for osteomyelitis?
6 weeks
142
What is the most common pathogen of CAP?
strep pneumonia
143
How do you determine whether to treat someone with CAP inpatient or outpatient?
CRB-65 scoring
144
What is CRB-65 scoring?
1. confusion (1 point)
2. RR over 30bpm (1 point)
3. hypotension (1 point)
145
What CRB-65 qualifies for inpatient management?
OVER 1
146
What qualifies for an automatic admission for someone with CAP?
hypoxia
147
What type of abx treatment is used in pneumonia treatment?
EMPIRIC
148
What is abx of choice for CAP?
fluroqunolone (moxiflocain, levofloxacine, gemifloxacin)
149
Are steroids usually used for treatment of CAP?
not commonly used but supported in critical illness cases where the pathogen is NOT influenza/aspergillus
150
Is repeat imaging needed for CAP?
not needed it clinical improvement (consider CT chest)
151
What are factors associated with HCAP? (5)
1. IV therapy, wound care, or IV chemotherapy w/n 30 days
2. LTC living
3. hospitalization in acute care hosp. for at least 2 days w/n 90 days
4. Pna that occurs 48hrs or more after admission and did not appear to be incubating at time of admission (nosocomial pna)
5. Pna that develops more than 48-72hrs after endotracheal intubation (ventilator associated pna)
152
How do you manage HCAP?
1. ALL need hospitalizations
| 2. almost ALL need EMPIRIC abx
153
Why is HCAP harder to treat than CAP?
longer list of offending agents-- MULTI-DRUG RESISTANCE (MDR)
154
What antibiotics do you use to treat someone with HCAP WITHOUT risk facors for MDR?
1. Ceftriaxone
| 2. Levaquin or Avelox
155
How do you treat someone with HCAP WITH MDR risks? (worry about pseudomonas, MRSA, etc)
"Triple antibiotic therapy"
1. Zosyn
2. Fluoroquinolone (cipro/levaquin)
3. vancomycin
ALL GIVEN IV (PICC line)
156
What is the length of treatment for someone with HCAP
7 days minimum
157
When can you change abx to PO equivalents for HCAP?
48-72hrs after start of treatment ONLY if excellent clinical response to IV therapy
158
What are risk factors for MDR? (5)
1. receipt abx w/n preceding 90 days
2. current hospitalization longer than 5 days
3. High frequency of abx resistance in the community or in the specific hospital unit
4. Immunosuppresion
5. severe septic shock
159
What is aspiration pneumonia?
Compromise in usual defenses that protect lower airways (glottic closure, cough reflex, other clearing mechanisms)
160
What is management of someone with aspiration pna?
1. STRICT NPO until speech therapy eval and can recommend safe swallowing strategies
2. modified barium swallow to better define dysphagia
3. Repeat MBS may be needed to re-eval and determine if patient can graduate to more liberal diet modification plan
161
What is abx of choice for aspiration pneumonia?
1. Clindamycin IV if hospitaliztion needed
2. PO augmentin if oral therapy preferred/needed
2. If MDR risk: Zosyn in "triple abx therapy" takes place of clindamycin
162
What qualifies as a complicated UTI?
1. DM
2. PG
3. Sx more than 7 days
4. hospital-acquired infection
5. renal failure
6. urinary obstruction
7. PRESENCE INDWELLING CATHETER, stent, nephrostomy tube
8. recent urinary tract intstrumentation
9. functional/anatomic abnormality in urinary tract
10. Hx childhood UTIs
11. renal transplantation
12. Immunosuppression
163
What are atypical signs of UTI?
1. fatigue/malaise
2. "moms not herself"- forgetful, confusion, disorientation
3. unsteady on feet
4. foul-smelling urine
5. elevated cr/actual renal failure
164
How do you dx UTI?
UA (clean catch or straight cath sample)
165
What are you looking for on UA?
- leuko esterase
| - NITRITES (most predictive of UTI)
166
What signifies the urine specimen has been contaminated?
epithelial cells
167
What should you always make sure to get when someone has a UTI?
culture and sensitivity
168
How long until the culture results?
12-24 hrs
169
How long until the sensitivity results?
48-72 hrs
170
What are some commonly uncommon pathogens of UTIs?
1. Vancomycin resistant enterococcus (VRE)
2. Extended spectrum beta-lactamase E. coli or Klebsiella (ESBL)
3. Methicillin-resistant staph aureus (MRSA)
171
What are BAD abx choices for complicated UTIs?
1. Macrobid
2. Bactrim
Due to resistance and renal toxicity in elderly
172
What are recommened abx for complicated UTIs?
Flouroquinolone (CIPRO)
173
What are S/S of acute alcohol withdrawal?
- insomnia
- tremulousness
- mild anxiety
- GI upset
- anorexia
- HA
- diaphoresis
- palpitations
174
How do you treat acute alcohol withdrawal?
1. Banana baf (IVF, dextrose, minerals, THIAMINE)
2. Electrolytes (
3. BENZOS
4. CIWA
175
What are S/S of delirium tremens? (5)
1. delirium (encephalopathy)
2. hallucinations
3. tachycardia
4. HTN
5. Hyperthermia
176
When does delirium tremens begin?
onset 48-96hrs after last drink (can persist as long as 5 days)
177
What are risk factors for developing DT?
1. Sustained drinking
2. hx DT
3. Older than 30yo
4. concurrent illness
5. significant withdrawal sxs in presence of elevated BAL
178
How do you treat DT?
- NOT behavioral health unit!!
| - aggressive IV BENZOS
179
What is wenicke encephalopathy?
ACUTE brain disorder causing petechial hemorrhaging and necrosis in midbrain structures
180
What is the classic triad of wernickes?
1. encephalopathy/delirium
2. gait ataxia
3. oculomotor dysfunction (EOM not intact)
181
Does a normal thiamine exclude WE?
Nope!
182
How do you treat WE?
IV thiamine
183
What do you have to be careful of when treating WE?
glucose admin can precipitate WE!
184
What is Korsakoff's?
consequence of untreated/repeated episodes of WE
Chronic, late neuropsychiatric d/o
185
What are 3 characteristics of Korsokoffs?
1. cognitive impairment
2. retrograde and anterograde amnesia
3. brain imaging positive for atrophy
186
What causes cerebellar degeneration?
nutritional deficiency and neurotoxic effects of chronic alcohol use
187
What are S/S of cerebellar degeneration?
1. gait ataxia
2. poor gross motor coordination
3. inability to handwrite
4. dysarthria (speech difficulty)
Cognitive capability still INTACT
188
What is prognosis for someone with cerebellar atrophy?
may improve slightly with abstinence and good nutrition but is LARGELY IRREVERSIBLE
189
What is alcohol hallucinosis?
visual hallucinations in absence of other autonomic/neuro complications
190
What is the course of alcohol hallucinosis?
presnet in 24hrs after last drink and are self-limited by 3rd day
**May be mistaken for DT/WE
191
What are neuromuscular complications from drinking?
1. peripheral neuropathy
| 2. myopathy
192
What is treatment for peripheral neuropathy?
1. abstinence
2. ongoing thiamine PO
3. maximize nutrition
193
What are sxs of myopathy?
Weakness, pain, swelling, of affected muscles
194
What can myopathy be associated with?
- rhabdo
- dysphagia
- heart failure
195
What is management of myopathy?
1. Check CK and cr
| 2. careful with IVF and monitor for arrhythmias (check phosphate)
196
What are people with myopathy at risk for?
dysphagia (get speech therapy eval before feeding)
