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UW 1 Flashcards

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1
Q

ECG effects of Hyperkalemia

A

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

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2
Q

Treatment of Hyperkalemia

A

C BIG K

Calcium chloride or gluconate (IV)
Bicarbonate, B-2 agonists
Insuline/Glucose
Kayexalate

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3
Q

Hypernatremia correction/management

A
  1. Determine free water deficit: total body water + (Na/140 -1)
  2. Rate of replacement: 0.5mEqL/L/H (over 48 to 72hrs)

Use normal saline until euvolemic

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4
Q

Hypernatremia Dxx

A

Urine Osmolality <300:
Diabetes insipidus

Urine Osmalality >600:
External losses (vomiting, diarrhea)
Na gain: hypertonic saline

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5
Q

Hyponatremia dxx

A

Look for algorithm pg 505 First aid step 2

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6
Q

Management of hyponatremia

A

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

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7
Q

K regulation

What cuases shif to intra or extracelluar space

A

Shift to intracellular space:
Insuline
B2 agonist
Alkalosis

Shift to extracellular space:
   Acidosis
   Increase osmolality
   Exercise
   Cell lysis
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8
Q

ECG findings in Hypokalemia

A

T wave flattening
U wave (additional wave after Twave)
ST segment depresion leading to AV block

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9
Q

Management of Hypokalemia

A 
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)
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10
Q

Hypercalcemia symptoms

A

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

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11
Q

Hypocalcemia symptoms

A

Abdominal and muscle cramps
Dyspena
tetany
perioral and achral paresthesias

Chevostek sing (face twitch in facial stimulation)
Trousseau (arm spasm on pressure cuff)
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12
Q

Low Mg effect in Calcium regulation

A

Low Mg causes PTH resistance

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13
Q

Low Mg effect on electrolites

A

Low MG causes

Hypocalcemia
Hypokalemia

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14
Q

Defects in Renal Tubular Acidosis

A

Type I: H secretion
Type II: HCO3 reabsorption
Type III: Aldosterone resitance or deficiency

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15
Q

Why do you find sypmtoms of hypocalcemia in hyperventilating patients?

A

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

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16
Q

AKI definition

A

Decline in renal function compared to a previous state in < 3months. (Increase in creatinine)

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17
Q

CKD definition

A

> 3months of GFR <60ml/min or sings of chronic kidney damage even with normal GFR

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18
Q

2 hyperparathyroidsm in CKD

A

Decreased phosphate excretion
decreased vitamin D production
Leading to hypocalcemia and renal osteodystrophy

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19
Q

Consequeances of renal failure

MAD HUNGER

A 
Metabolic Acidosis
Dyslipidemia (especially triglerides)
Hyperkalemia
Uremia
Na/water retention
Growth retardation/development
Erithropoyetin failure
Renal osteodystrophy
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20
Q

Pathophysiology of AKI (types)

A

Prerenal: decreased perfusion
Intrinsic: injury within the nephron
Extrinsic: outflow obstruction

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21
Q

Labs in Prerenal vs Intrinsic AKI

A

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

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22
Q

Cuases of Acute interstital nephritis and Acute tubular necrosis

A

AKI after medication

Pee (diuretis)
Pain (NSAIDs)
Penicillins and cephalosporins
PPI
rifamPin

Acute tubular necrosis: ischemia, glomerulonephritis, rhabdomyolisis, embolic disease

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23
Q

Treatment of abnormal bleeding in uremia

A

Desmopressin

Increases factor VIII
Deficient in renal failure

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24
Q

AEIOU criteria of dialysis

Study These Flashcards
A 
Acidosis
Electrolite abnormalities
Ingestion (salicilates, theophyline, methanol, barbiturates, lithium, ethylene glycol)
Overload (fluids)
Uremia
25
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
26
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
27
Pathophysiology of AKI in rhambdomyolisis (2)
Decreased renal perfusion (fluids toward damage tissue) | Direct damage from pigments
28
VIPoma presentation
WDHA Watery diarrhea Hypokalemia Achloridia (Dehidration, muscle weakness, flushing)
29
Exenatide: brand name, MOA, SE
- exanatide = Byetta - MOA: GLP-1 receptor agonist - 2nd line w/metformin - low hypoglycemia risk - SE: weight loss
30
Most common causes of folic acid deficiency
- poor diet | - drugs: phenytoin, methotrexate, TMP
31
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)
32
Buprenorphine
Opioid partial agonist used in the treament of opioid use and pain management
33
Smoking cessation pharmacologic treatment
Bupropion | Verenicline
34
Acute dystonia treatment
Acute muscle contractions or spasm | Benztropine or dephinedramine
35
Akathisia treatment
Perception of restlesness B-blocker (propranolol) Benzos and anticholinergics may work
36
Parkinsonism treatment
Benztropine or amantadine
37
Tardive dyskinesia managment (3)
1. Stop agent or reduced dose if possible 2. Valvenezine, deutetravenazine 3. Switch to quetiapine or clozapine
38
Indications for cystoscopy (6)
1. Gross hematuria with no evidence of glomerular disease. 2. Microscopic hematuria with no evidence of glomerular disease and high risk factors (smoking, chronic cistitys, paint, metal exposure; cyclophosphamide) 3. Recurrent UTIs 4. Obstructive symptoms with suspicious for stricture, stone 5. Abnormal bladder imaging or cytology 6. Irritative symptoms without infection
39
Management of IUFD and complication
<24 weeks Dilatation and evacuation >24 weeks Labor induction Fetal retention can lead to CID
40
Insidious loss of peripheral vision Need of frequent lens changes Mild headache Impaired adaptation to darkness
Open angle glaucoma
41
Open angle glaucoma
``` Insidious loss of peripheral vision Need of frequent lens changes Mild headache Impaired adaptation to darkness Cupping of the optic nerve ```
42
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
43
Extreme sudden onset eye pain, blurred vision, headache, nausea and vomiting Hard red eye, pupils dilated and non reactive
Closed angle glaucoma
44
Closed angle glaucoma
Extreme sudden onset eye pain, blurred vision, headache, nausea and vomiting Hard red eye, pupils dilated and non reactive
45
Closed angle glaucoma treatment
B-blockers (timolol, betaxolol) to decrease aqueous humor production Pilocarpine to increase aqueous outflow (cholinomimetic) Acetazolamide Laser if medication fails
46
Test for corneal examination
Fluorescein exam
47
Symptoms and Xray of pulmonary contusion
Tachypnea, tacycardia, hypoxia Xray: 1st can be normal Hours later: Patchy pulmonary infiltrate (non restricted by anatomic landmarks)
48
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
49
Treatment for ADHD
Stimulants: amphetamines (metylphenidate, dextroamphetamine) Non stimulant: atomoxetine Others: a2-adrenergics: clonidine, guanfacine antidepresants: bupropione, TCAs
50
Diseases associated with celiac disease
Down Syndrome Other autoinmune: diabetis type 1, thyroiditis,
51
Clinical sings suspecious for celiac disease in children /adolescents
``` Growth delay Abdominal bloating / diarrhea Microcitic anemia (sugesting nutritional deficiencies) ```
52
Anti tissue transglutaminase antibody
Celiac disease
53
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)
54
Alpha-synuclein neurodegenerative disorders
Parkinson Lewi body dementia (visual hallucinations, parkinsonism, fluctuation of consciousness) Multiple system atrophy (parkinsonism, autonomic dysfuntion, wide spread neurological sings)
55
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
56
Painless Ulcer with raised borders Dxx
Syphilis: regional adenopathies. size 1-2cm Granuloma inguinale: no adenopathies. Size 5-10mm
57
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
58
Management of solid brain metastasis
Surgery if stable extracraneal disease and good performance status

Uworld Gaby (77 decks)

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