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23 Cards in this Set
- Front
- Back
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m/c complication associated with continuous ambulatory peritoneal dialysis
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Peritonitis
- S.aureus - DOC: intraperitoneal administration of cefazolin and cetazidime |
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Sx: SOB, fever
PE: bilateral crackles, ABGs - hypoxia CXR: bilateral lower lung field infiltrates |
Dx: Severe Pneumonia
- if they have low WBC count, pt might be immunocompromised -- think about PCP - Next Step: immunofluorescence of an induced sputum sample is required for def dx of PCP |
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Waldenstrom Macroglobulinemia
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- Occurs in the elderly
- high level of IgM - lymphoplasmacytic infiltrate in BM - hyperviscosity syndrome: cryoglobulinemia, coagulation abnormalities, sensorimotor peripheral neuropathy, anemia, deposition of IgM in skin, GI, kidneys - SSx: weakness, anorexia, fever, weight loss, Raynaud phenomenon, hepatomegaly, splenomegaly, lymphadenoapthy, peripheral neuropathy, skin changes |
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Alpha-1-antitrypsin deficiency
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- young age
- presents with COPD & panacinar emphysema - PP: mutation -- abn. configuration -- accumulation o fhepatocytes -- damage & fibrosis - protein fails to inhibit elastase therefore, you have pulmonary parenchymal destruction |
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Hyperkalemia
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- tented T waves
- widen QRS - short QT - P-R prolongation |
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Tx for Hyperkalemia
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1. w/EKG changes: Calcium Gluconate/Chloride to stabilize the cardiac membrane
2. w/hyperglycemia: Insulin 3. w/metabolic acidosis: Bicarbonate |
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Livedo Reticularis
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- skin manifestation of antiphospholipid Ab Syndrome
- APLS: acquired hypercoagulable state - thrombosis, spontaneous abortions, thrombocytopenia, circulating Abs, thrombocytopenia - prolonged aPTT |
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SSx: progressive dysphagia of solids and liquids
Dx: Upper GI shows smooth, beaklike tapering |
Dx: Achalasia
PP: failure of peristalsis in esophagus with increased tone of LES Tx: Endoscopy to confirm diagnosis, alternate therapy is botulinum toxin |
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Pt has Afib w/meds suddenly develops severe abdominal pain followed by bloody bowel movements
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Dx: acute mesenteric ischemia
- usu. pts pain is out of proportion to physical exam findings - anion gap metabolic acidosis: when bowel infarcts occur (d/t ischemia/emboli) it releases enzymes that make pt acidemic - Tx: HYDRATE AGGRESSIVELY, broad-spectrum Abx, heparin |
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SSx: Pulsus Paradoxus, Hypotension, Electrical Alternans
Echo: pericardial effusion, RV collapse |
Dx: Cardiac Tamponade
Tx: Emergent Pericardiocentesis and drainage with pericardial window |
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- low Ca
- high PO4 - low PTH - SSx: fatigue, irritable, circumoral numbness, paresthesias of hands & feet and muscle cramps |
Hypoparathyroidism
- because PTH causes renal excretion of phosphate, we see hyperphosphatemia |
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Severe Hypocalcemia
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- carpopedal spasm
- Chvostek sign - Trousseau sign - Laryngospasm - Seizures |
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Low Ca
Low PO4 High PTH |
Vit D deficiency
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Low Ca
High PO4 High PTH |
Pseudohypoparathyroidism
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Low Ca
High PO4 High PTH |
2* Hyperparathyroidism
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High Ca
High PO4 Low PTH |
Excess Vit D
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Hypertrophic Obstructive Cardiomyopathy
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- Asymmetric thickening of septum at level of aortic outflow tract
- Sx: dyspnea, chest pain, arrhythmias associated with sudden death may occur - Tx: implantable cardiac debrillator |
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DOC sticks himself with a needle
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greatest risk of contracting Hep B > hep C > HIV
- 1, 2, and 6 months |
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- Spasms
- Jaw stiffness - Dysphagia - Fever and chills - Opisthotonus |
Dx: Tetanus
Tx: Ig + antitoxin + antimicrobial therapy w/PCN G or metronidazole |
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What happens if the pt is still experiencing Sx after maximal medical management?
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Percutaneous Coronary Angiography - maps out the diseased vessels and dictates future management s.a angioplasty or stenting
- LAD or 2-3 vessel disease -- candidate for CABG |
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Erythropoietin
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indicated for tx of anemia associate with chronic renal failure
- EPO induced HTN is seen in approx 33% of dialysis pts develops rapidly in pts with low hct values |
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- severe epigastric pain that radiates to his back
- N/V |
Dx: Acute Pancreatitis
- serum elevation of amylase and lipase - d/t alcoholism or gallstones - destroying exocrine gland tissues releases enzymes s.a phospholipase -- circulates through bloodstream and damages the alveolar capillary membranes in lungs -- ARDS |
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Close contacts of a pt with meningococal meningitis should recieve chemoprophylaxis
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Tx: 600mg Rifampin BID for 2d
- ciprofloxacin, or Ceftriaxone - pt can take vanco and ceftriaxone |
