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75 Cards in this Set
- Front
- Back
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Causes of acute Pancreatitis?
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I GET SMASHED
Idiopathic Gall Stones Ethanol Trauma Steroids Mumps/measles Autoimmune Scorpion Bite Hypercalcemia/lipidemia ERCP Drugs |
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Pt comes in with suspected drug OD. What do you do?
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Do the DONT!
Dextrose O2 Naloxone Thiamine |
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Why do you give thiamine before dextrose in a pt with suspected alcohol OD
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Dextrose can precipitate the acute sx of thiamine deficiency (think Weirnike's encephalopathy)
MOA: Glucose oxidation is a thiamine intensive process, can drive reserves of circulating vital B1 toward intracellular compartment-->aggregates neuro dmg THIAMINE IS A COFACTOR FOR ALPHA-KETOGLUTERATE (think TCA cycle!)--If you give dextrose, you will use up thiamine reserves to breakdown the glucose |
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What is the 4-2-1 rule?
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Fluid rescue in kids
<10kg: 4mL/kg/hr 10-20kg: 40ml/hr + 2mL/kg/hr * (wt-10kg) >20kg: 60Ml/hr + 1 ml/kg/hr * (wt-20kg) |
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Levaquin can cause what EKG change?
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Long QT
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Why does Na tend to be elevated in DKA?
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its not really! must use equation to correct for it
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you have a pt who arrives to the ER with drooping face and right sided weakness. You obtain a non-contrast CT and find the pt has an ischemic stroke. Hx reveals the pt woke up 45 minutes ago with these sx. They have no contraindications to ant-thrombolytic therapy. Can you administer t-PA?
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NO!!!!
While this is tempting to say it is within the 3 hr window to give t-PA you do not know when the pt's sx started because they woke up with the problem!! must know exact onset time or you could kill them |
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What 3 clinical problems are seen in DKA (findings)
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Hyperglcemia
Wide anion gap metabolic acidosis Hyperkalemia |
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Tx for DKA?
what 3 things do you watch while treating? When do you change your initial therapy? What do you do when the anion gap closes? |
initial:
IVF (normal saline) 10 unit bolus of insulin Insulin drip watch: K+, Anion gap, Glucose Switch to D5 fluids when glucose hits 250 (glucose level is down but still wide gap met alk) when the gap closes: now that the gap is closed you can swithc to sub Q insulin |
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Why are people in DKA nauseous?
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They have a great deal of keytones
these are emetic |
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A pt comes in with DKA and has no change in their insulin regimen. What are 2 things you should work them up for?
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MI
Sepsis |
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Name 4 drugs that can cause Renal problems (include at least one Abx)
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Aminoglycosides
Metformin NSAIDs Diuretics |
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pt comes in with stroke. Their BP is 200/100. What do you want to do about that?
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LEAVE IT
when you have a stroke, the ischemic area creates a penumbra of underprofused brain tissue which requires an increased BP to profuse |
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at what BP in stroke do you want to decrease it?
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220 SBP or 120 DBP
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What are stress dose steroids?
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chronic steroid user with adrenal suppression undergoes stressor and needs a boost
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What do you want to do when a stroke pt rolls in
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NON CONTRAST CT
Aspirin Stop anti-coag MRI Determine if t-PA candidate (less than 3 hr onset, no contraindications) Carotid doppler Manage risk factors |
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Common PE causes?
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think Virchows triad (stasis, endothelial dmg, hypercoaguable state)
travel OCP trauma family hx |
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When can you use t-PA in a PE?
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when they have refractory hypoxemia and hypotension
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What way will the mediastinum shift on Xray in the following scenarios
pleural effusion: atelectisis: tension pneumo: |
pleural effusion: away
atelectisis: toward tension pneumo: away |
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What will 1 pack RBCs do to your Hgb and Hct respectively?
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Hgb: increase 1
Hct: increase 3 |
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What % iron saturation is considered Iron deficiency? What is the equation for this?
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>15%
Iron/TIBC |
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What 2 things will you have to check regularly in liver cirrhosis? (aka what 2 thinks that the liver synthesizes will be messed up)
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Albumin
INR (think vitamin K dependent factors) |
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What INR is required before surgery?
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INR<1.5
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Yellow vision is a tox of what heart drug?
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digoxin
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What is a therapeutic INR for a pt on heparin/coumadin
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2-3
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What are 2 common anerobic bugs?
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Clostridum and bactorodies
remember: Can't Breath Air |
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Common cause of cellulitis?
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Staph a
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HTN+Stroke
Antihypertensive of choice? |
CCB
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why do you want to start coumadin 34 hrs after heparin?
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to prevent necrosis
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Mg of aspirin for MI?
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325mg
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Incubation time for pneumonia?
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3-7 days
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Adverse steroid effects?
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Increase glucose
decrease wound healing increase central obesity cushings psychosis increase TSH decrease immune response |
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Side effects of statins?
what do you want to order? |
Rhabdo
Liver problems liver function tests (LFTs) total CPK for rhabdo |
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What is the only contraindication to a stress test?
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Not being able to walk
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What are some of the key features of meningitis?
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Stiff Neck
Fever Altered mental status Nuchal rigidity Kernig's Sign (pt lay with hip and kneed flexed to 90 degrees, pain on extension) Brudzinskis sign: flexion of neck causes involuntary flexion of the knee |
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what are Kernig's Sign and Brudzinskis sign seen in? What are they?
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meningitis
Kernig's Sign (pt lay with hip and kneed flexed to 90 degrees, pain on extension) Brudzinskis sign: flexion of neck causes involuntary flexion of the knee |
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How do you control the following HTN states:
Stroke + HTN: Preg + HTN: MI + HTN What can't you use in HTN and renal artery stenosis? |
Stroke + HTN: CCB
Preg + HTN: Methyldopa/hydralazine MI + HTN: BB What can't you use in HTN and renal artery stenosis? ACEi |
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pt with hepatic encephalitis could have what level increased? What would you use to treat it?
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Ammonia
Lacutlose or Neomycin (aminoglycoside, Oto/Neph tox, not absorbed by intestine, kills bacteria and keeps ammonia levels low) |
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what kind of diet can be used to lower ammonia levels in a pt with hepatic encephalitis
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low protein
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What is a good estimate of serum osmolality
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2 x Na
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What drug is notorious for hyponatremia?
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HCTZ
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What happens if you correct hyponatremia too quickly?
max you can give per hour? per day? |
Central Pontine Myelinolysis
per hour: .5mmol per day: 12 mmol increase |
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pt has a serum sodium of 112, what is the max you can increase it to in one day?
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max is a 12 mmol increase to prevent Central Pontine Myelinolysis...so
124 |
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What are some causes of SIADH?
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small cell carcinoma
Hypothyroid Adrenal insufficiency Pnuemonia Meningitis Diabetes insipidous |
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.75 mg of dexamethazone = ? mg of methyprednisone = ? mg of prednisone = ? mg hydrocortizone
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.75 mg of dexamethazone = 4 mg of methyprednisone = 5 mg of prednisone = 20 mg hydrocortizone
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coumadin acts on what pathway? what factors?
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Extrinsic
Vitamin K dependent (10,9,7,2) |
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What shows L vs R HF?
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Echo
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COPD leading to RHF =
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Cor pulmonale
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give two examples of anemias with MCV>100
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these are macrocytic
B12/Folate def |
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How can you diagnose diabetes (4 ways)
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Fasting glucose>126
Random>200 HbA1c>6.5 2 hr post prandial glucose >140 |
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Why do you stop metformin before giving IV dye?
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Renal failure
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Common side effect of metformin?
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lactic acidosis
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Why do you tapor removal of steroids
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they can cause adrenal suppression
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indications for dialysis?
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Increased K
Fluid overload Metabolic acidosis |
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DVT Prophylaxis?
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Coumadin
Heparin Ambilation Ted Hose Sequential compression |
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FeNa that shows ATN?
pre-renal azotemia? |
ATN: FeNa>2%
pre-renal azotemia: FeNa<1% |
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What is Todd's Palsy
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coma like post seizure state
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what differentiates between a partial and complex seizure
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Change in mental status (seen in complex)
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How long will CK-MB be elevated post MI?
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2 days
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How long will troponin be elevated post MI?
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2 weeks
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What ABX cover anaerobes
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Metronidazole
Lincosemides-Lincomycin/Clindamycin ** Chloremphenacol/thiamphenicol Aztreonam |
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What is acceptable therapeutic INR?
When can you break this? |
2.0-3.0
can have 2.5-3.5 in the following scenarios: aortic valve replacement mitral valve replacement Recurrent systemic embolism anti-phospholipid syndrome with prior DVT |
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What is CURB 65?
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clinical prediction rule that has been validated for predicting mortality in community-acquired pneumonia
Confusion of new onset (defined as an AMT of 8 or less) Urea greater than 7 mmol/l (19 mg/dL) Respiratory rate of 30 breaths per minute or greater Blood pressure less than 90 mmHg systolic or diastolic blood pressure 60 mmHg or less age 65 or older |
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What drug would you use to cover atypical pneumonia? What are the bugs we are talking about?
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Levaquin (FQs)
Mycoplasma, Legionella, Chlamydia |
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What would be the one scenario in which you would see FeNa<1% and you have ATN?
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Contrast dye nephropathy
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what FeNa shows pre-renal azotemia? ATN?
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FeNa<1% pre-renal
FeNa>2% ATN |
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ACEi works on what part of the renal anatomy?
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Afferent arteriole
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What level of Mg is toxic? Lethal? OD tx?
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5
10 Ca : stablize myocytes |
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Acute Migraine tx?
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Sumatriptan..if fails..
NSAIDS...if fails... Valproic acid NEVER OPIODS |
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SIRS criteria?
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Two of the following needed:
core temp>100.4 or less than 96.8 HR>90 Resp rate >20 or PaCO2<32 WBC>12,000 or <4000 |
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define sepsis
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SIRS + infection
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Define severe sepsis
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Sepsis + hypoperfusion or organ dysfunction
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Define septic shock
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Severe spesis + persistent hypotension or hypoperfusion despite adequate fluid rescuscitation
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Pt is in septic shock. What do you want to check first? Tx with?
move down the tx plan |
Check CVP-->fluids
MAP<65 --->vasoactive agents ScvO2<70%---> Transfuse (raise Hg and thus O2 delivery to tissue) if still less than 70---> inotropic agents |
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pt is in Septic shock, you have given fluids but were unable to raise the CVP, what agents would you consider giving next? (2)
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Dopamine (hits alpha for vaso constriction and B1 for cardiac stimulation)
Norepi "levo" (same as above) |
