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47 Cards in this Set

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how to estimate renal function?
creatinine-based formulae (not serum creatinine alone!)
timing of AIN 2/2 tx with TMP-SMX
severla days after treatment, a/w eos in urine, fever, and rash
effect of TMP and other organic cations (like cimetidine) on creatinine
competitively inhibitt creatinine secretion in the distal tubule --> creatinine bump
when to use radioisotope renal scan?
to evaluate asymmetric blood flow when renal artery disease suspected
new renal insufficiency with pyuria after tx with antibiotics
AIN
what renal pathology a/w indinavir?
indinavir crystal nephrolithiasis
what electrolyte abnormality can cause renal failure? How?
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
common cause of renal failure in HIV pts? Tx?
TTP; tx with plasma exchange, +/- concurrent antiretrovial tx; can also have classic HIV nephropathy usu a/w significant proteinuria
decreased anion gap + anemia + proteinuria + hypercalcemia + ARF
multiple myeloma
hypercalcemia + acute renal failure
multiple myeloma (rare otherwise, b/c hyperphosphatemia and decreased renal VitD synth ==> hypocalcemia)
what is milk-alkali syndrome?
hypercalcemia caused by ingestion of calcium and alkali (eg calcium carbonate for peptic ulcers) ==> metastatic calcification and renal failure
incidence of depression among elderly who lose a spouse
15-35% in first year
what is megestrol acetate and what is it used for?
synthetic progestin used an an appetite stimulant in cancer pts w/ cachexia
which antidepressants classically a/w weight gain?
TCAs and mirtazapine (SSRIs have variable effect, fluoxetine causes the least wt gain)
which antidepressant NOT a/w weight gain
bupropion (maybe even weight loss!)
which antidepressants safe in pregnancy?
SSRIs, probably TCAs as well
common cause of recurrent depression in elderly
noncompliance with meds (rates as high as 50%)
dementia vs mild cognitive impairment
dementia requires chronic memory impairment and impairment of other aspects of intellect severe enough to affect social or occupational functioning
how to dx carotid sinus syncope?
carotid sinus massage while checking pulse, look for asystole > 3sec or >50 pt decrease in SBP
empirical tx for pneumococcal meningitis
vanc + ceftriaxone (not vanc alone because of unreliable CSF penetration)
tx of suspected HSV encephalitis
IV acyclovir (even before confirmation of diagnosis)
what adjunct tx needed when giving antimicrobials for meningitis? Which bugs?
corticosteroids (eg dexamethasone) to prevent inflammation from microbe lysis; esp useful with HIB and pneumococcal meningitis
listeria found in what foods? (2)
processed meats and coleslaw
tx of choice for listeria meningitis
amp/pcn + aminoglycoside (ie amp-gent or pcn-gent)
TPA in acute ischemic stroke
only within 3 hrs
corticosteroids in ischemic stroke
can be HARMFUL; only used for vasogenic edema from mass lesions (eg tumors)
IV heparin in pts with acute ischemic stroke
not necessarily indicated (although used often) -- can increase risk of hemorrhagic transformation of infarction
what is vegetatitve state?
complete unawareness of self/environment, preservation of sleep/wake cycles, brainstem, and hypothalamic autonomic functions
defn of persistent vegetative state
veg state 1mo after brain injury
vegetative state vs brain death
brain death = complete absence of cerebral hemispheric and brainstem function (incl resp drive)
aura seen with what type of seizure? Most common sensation?
(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)
what does a complex partial seizure look like?
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)
what population most commonly gets absence seizures?
kids
non-seizure condition with two or three tonic-clonic jerks
seen with hypoxia to the brain, as in vasovagal syncope
mgmt of symptomatic, intermittent complete heart block
pacemaker
what drug decrease frequency of relapse in alcohol abuse?
naltrexone
which benzos preferred to manage alcohol withdrawal?
long-acting (eg diazepam) to minimize risk of seizures and delirium
criteria for at-risk (heavy) alcohol use
>14drinks/wk for men, >7drinks/wk for women, w/o evidence of abuse or dependence
pts with cocaine-related hemorrhagic stroke must be evaluated for what?
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
initial tx for cocaine intox (3)
1) sedation with lorazepam (IV or IM); 2) IVF to ensure adequate UOP for possible rhabdomyolisis; 3) EKG to assess for myocardial ischemia
None
recommended tx for drug-induced seizures
benzos (NOT phenytoin! -- poor response)
s/e of anabolic steroid abuse
acne, decreased HDL, elevated platelet counts + increased platelet aggregability --> hypercoagulability, libido changes, aggression/rage, testicular atrophy / female virilization
cholesterol, coagulation
gynecomastia is a s/e of what recreational drug?
marijuana
recreational drugs that can cause panic reactions (3)
marijuana, cocaine, amphetamines
how to manage tachycardia in cocaine tox?
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
in what patients is bupropion contraindicated?
pts with past or current seizure disorder (bupropion lowers seizure threshold)
effects of smoking cessation on lung function
decreased rate of decline of lung function, plus slight IMPROVEMENT in lung function