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47 Cards in this Set
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- Back
- 3rd side (hint)
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how to estimate renal function?
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creatinine-based formulae (not serum creatinine alone!)
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timing of AIN 2/2 tx with TMP-SMX
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severla days after treatment, a/w eos in urine, fever, and rash
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effect of TMP and other organic cations (like cimetidine) on creatinine
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competitively inhibitt creatinine secretion in the distal tubule --> creatinine bump
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when to use radioisotope renal scan?
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to evaluate asymmetric blood flow when renal artery disease suspected
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new renal insufficiency with pyuria after tx with antibiotics
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AIN
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what renal pathology a/w indinavir?
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indinavir crystal nephrolithiasis
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what electrolyte abnormality can cause renal failure? How?
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hypercalcemia -- interferes with renal concentrating function and leads to volume depletion, deposits in the renal parenchyma causing fibrosis, and causes afferent arteriolar constriction --> drop in GFR
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common cause of renal failure in HIV pts? Tx?
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TTP; tx with plasma exchange, +/- concurrent antiretrovial tx; can also have classic HIV nephropathy usu a/w significant proteinuria
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decreased anion gap + anemia + proteinuria + hypercalcemia + ARF
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multiple myeloma
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hypercalcemia + acute renal failure
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multiple myeloma (rare otherwise, b/c hyperphosphatemia and decreased renal VitD synth ==> hypocalcemia)
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what is milk-alkali syndrome?
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hypercalcemia caused by ingestion of calcium and alkali (eg calcium carbonate for peptic ulcers) ==> metastatic calcification and renal failure
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incidence of depression among elderly who lose a spouse
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15-35% in first year
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what is megestrol acetate and what is it used for?
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synthetic progestin used an an appetite stimulant in cancer pts w/ cachexia
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which antidepressants classically a/w weight gain?
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TCAs and mirtazapine (SSRIs have variable effect, fluoxetine causes the least wt gain)
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which antidepressant NOT a/w weight gain
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bupropion (maybe even weight loss!)
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which antidepressants safe in pregnancy?
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SSRIs, probably TCAs as well
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common cause of recurrent depression in elderly
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noncompliance with meds (rates as high as 50%)
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dementia vs mild cognitive impairment
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dementia requires chronic memory impairment and impairment of other aspects of intellect severe enough to affect social or occupational functioning
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how to dx carotid sinus syncope?
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carotid sinus massage while checking pulse, look for asystole > 3sec or >50 pt decrease in SBP
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empirical tx for pneumococcal meningitis
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vanc + ceftriaxone (not vanc alone because of unreliable CSF penetration)
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tx of suspected HSV encephalitis
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IV acyclovir (even before confirmation of diagnosis)
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what adjunct tx needed when giving antimicrobials for meningitis? Which bugs?
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corticosteroids (eg dexamethasone) to prevent inflammation from microbe lysis; esp useful with HIB and pneumococcal meningitis
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listeria found in what foods? (2)
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processed meats and coleslaw
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tx of choice for listeria meningitis
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amp/pcn + aminoglycoside (ie amp-gent or pcn-gent)
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TPA in acute ischemic stroke
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only within 3 hrs
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corticosteroids in ischemic stroke
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can be HARMFUL; only used for vasogenic edema from mass lesions (eg tumors)
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IV heparin in pts with acute ischemic stroke
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not necessarily indicated (although used often) -- can increase risk of hemorrhagic transformation of infarction
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what is vegetatitve state?
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complete unawareness of self/environment, preservation of sleep/wake cycles, brainstem, and hypothalamic autonomic functions
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defn of persistent vegetative state
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veg state 1mo after brain injury
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vegetative state vs brain death
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brain death = complete absence of cerebral hemispheric and brainstem function (incl resp drive)
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aura seen with what type of seizure? Most common sensation?
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(complex) partial seizures; aura often consists of rising epigastric sensation; other auras include affective (eg fear), cognitive (eg déjà vu), and sensory (eg olfactory hallucinations)
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what does a complex partial seizure look like?
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lasts < 3mins, pt appears awake but loses contact w environment / doesn’t respond normally. Pts stare, remain motionless, or engage in repetitive, semi-purposeful behavior (automatisms)
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what population most commonly gets absence seizures?
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kids
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non-seizure condition with two or three tonic-clonic jerks
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seen with hypoxia to the brain, as in vasovagal syncope
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mgmt of symptomatic, intermittent complete heart block
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pacemaker
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what drug decrease frequency of relapse in alcohol abuse?
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naltrexone
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which benzos preferred to manage alcohol withdrawal?
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long-acting (eg diazepam) to minimize risk of seizures and delirium
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criteria for at-risk (heavy) alcohol use
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>14drinks/wk for men, >7drinks/wk for women, w/o evidence of abuse or dependence
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pts with cocaine-related hemorrhagic stroke must be evaluated for what?
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cerebral AVM; though cocaine-induced HTN could alone cause hemorrhage, if no h/o chronic HTN, likelihood of underlying AVM is high ==> need cerebral angiography
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initial tx for cocaine intox (3)
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1) sedation with lorazepam (IV or IM); 2) IVF to ensure adequate UOP for possible rhabdomyolisis; 3) EKG to assess for myocardial ischemia
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None
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recommended tx for drug-induced seizures
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benzos (NOT phenytoin! -- poor response)
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s/e of anabolic steroid abuse
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acne, decreased HDL, elevated platelet counts + increased platelet aggregability --> hypercoagulability, libido changes, aggression/rage, testicular atrophy / female virilization
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cholesterol, coagulation
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gynecomastia is a s/e of what recreational drug?
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marijuana
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recreational drugs that can cause panic reactions (3)
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marijuana, cocaine, amphetamines
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how to manage tachycardia in cocaine tox?
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benzos: decrease anxiety, heart rate, and blood pressure; no need for antihypertensive; beta-blockers esp bad because they can unmask alpha-adrenergic effects of cocaine --> inc BP
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in what patients is bupropion contraindicated?
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pts with past or current seizure disorder (bupropion lowers seizure threshold)
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effects of smoking cessation on lung function
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decreased rate of decline of lung function, plus slight IMPROVEMENT in lung function
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