Medical Management Flashcards by Taylor Duckworth (2025)

What is the murmur of a patient with aortic stenosis

Crescendo-decrescendo systolic murmur

Murmur-Aortic regurgitation

Decrescendo blowing diastolic murmur

Murmur-mitral stenosis

opening snap

Murmur-mitral regurgitation

Holosystolic, blowing murmur

Murmur-mitral valve prolapse

Midsystolic click

Murmur-mitral valve prolapse syndrome

Midsystolic click

Systolic or Diastolic HF have an S3 murmur

Systolic with a dilated left ventricle

Systolic or Diastolic HF have an S4 murmur

Diastolic with left ventricle hypertrophy

Treatment for VTachy

Cardioversion

VTach caused by

Myocardial infarction, cardiomyopathy, electrolyte abnormality, blunt trauma, infections or infiltrative disease

AFib caused by

HTN
Valvular disease
CAD
HF

AFib diagnosed by

Absent P waves

Treatment for Afib and Aflutter in an unstable situation

Cardioversion

Treatment for paroxysmal supra ventricular tachycardia (PSVT)
(4 pts)

Vagal maneuvers,
adenosine,
medical management,
ablation

WPW Syndrome-Etilogy

Accessory pathway between atria and ventricles due to congenital separation during fetal development; risk of sudden cardiac deaths and tachyarrhythmias

Bradycardia etiology?
(7 causes-4 i’s)

Ischemic, infectious, infiltrative, autoimmune, conditioned heart, medication, neurologic

CHADS scoring table

C-CHF
H-HTN-BP consistently above 140/90 mHg
Age>75 yrs
D-DM
S-Prior stroke or transiet ischemic attack or thromboembolism (2 is for 2 points if yes_

Type I Heart Block ECG finding

Increased PR interval

Type IIa Heart Block ECG finding

Increased PR interval until dropped QRS

Type IIb Heart Block ECG finding

Regularly dropped QRS with constant PR interval

Type III Heart Block ECG finding

Complete dissociation of P waves and QRS complexes

Primary HTN

No identifiable cause

2ndary HTN
(6 causes)

Indetifiable cause such as:
Renal artery stenosis
diabetic nephropathy
Thyroid disease
cocaine use
pheochromocytoma
OSA

Diagnosis of HTN

at least 2 elevated BP readings on 2 different occasions
Stage 1: SBP from 140-159, DBP from 90-99
Stage 2: SBP >160, DBP >100

Beta Blocker used for:
Side effects:

MI, CAD, CHF
Bronchospasm, AV node blockade

ACE Inhibitor
Side Effects:

Diabetes, MI, proteinuria, CHF
SIDE EFFECTS: Cough, Renal Failure

Thiazide use
Side Effects

Combination therapy:
Hypokalemia

Difference of HTN Urgency vs Emergency

Urgency, BP >180/120
Emergency, BP >180/120 with evidence of end organ damage

Duke Criteria, definite IE

2 major; 1 major & 3 minor; 5 minor

Duke Criteria, possible IE

1 major & 1 minor; 3 minor

Duke Criteria, major criteria

Positive blood culture, Echo with evidence of endocardial involvement

Bacteria associated with IE

Staph Aureus-IV
Native Valve-Viridans Streptoocci, S aureus, enterocci
Prosthetic Vavle-S epidermidia, S aureus
Culture Negative-HACEK organism

HACEK organism

Minor Criteria of Dukes

-Predisposition to IE (IV drug use, indwelling catheter, diabetes)
-Fever
-Vascular phenomena )Janeway lesions, arterial emboli, intracranial hemorrhage, splinter hemorrhage)
-Microbiologic evidence
-Immunologic phenomena (Osler nodes, Roth spots)

Janeway lesions

Splinter hemorrhages

Abx treatment for native valve IE with Viridans streptococci, Aureus, enterococci

Vanocmycin and gentomycin

METs

Metatbolic equivalent of tasks

METs score

What is RV, TV, ERV, and FRC

What is FEV1, FVC, TLC

Name three types of obstructive lung disease

COPD,
Asthma
Cystic Fibrosis

Name three types of restrictive lung disease

Sarcoidosis,
Interstital lung disease
Collagen Disorder

Extraparenchymal restrictive types of pulmonary disease

Obesity
Scoliosis
Myasthesia Gravis
Diaphragmatic Weakness
Cervical spine injury

Compare FEV1, FVC, FEV1/FVC, lung volume, flow rates between obstructive and restrictive lung disease

True or False, Asthma has a prolonged expiratory phase

True, it does have prolonged expiratory duration with expiratory wheezing

Mild Intermittent Asthma Definition & Treatment

Def: <2 days week with PEF> 80% (PEF = peak expiratory flow)
Treatment: Bronchdilator as needed like albuterol, salmeterol

Mild PersistentAsthma Definition & Treatment

Def: >2 days week, but less than 1 time a day with PEF> 80% (PEF = peak expiratory flow)
Treatment: Low-dose inhaled steroids like Fluticasone, hydrocortisone, prednisolone

Moderate PersistentAsthma Definition & Treatment

Def: daily symptoms with PEF>60% but less than 80% (PEF = peak expiratory flow)
Treatment: Low-dose inhaled steroids like Fluticasone, hydrocortisone, prednisolone & albuterol, salmeterol (beta 2 agonist)

Severe PersistentAsthma Definition & Treatment

Continuous symptoms with PEF < 60%, add oral steroids to everything mentioned above.

Beta 2 agonists for asthma treatmetn

relaxation of bronchial muscle due to increase in cAMP formation

Corticosteroids role in asthma treatment

Suppresses inflammatory response and decreases mucosal edema like Fluticasone, hydrocortisone, prednisolone

What is Montelukast

a leukotriene modifier used for asthma treatmetn which is an antagonist that decreases bronchoconstriction

What is Zileuton

A leukotriene formation inhibitor that treats asthma

What is ipratropium bromide used for

It blocks cholinergic constriction causing bronchodilation

Asthma vs COPD

Asthma is reversible, COPD is not reversible, both are obstructive lung diseases

Chronic bronchitis def

Chronic productive cough for 3 months in 2 consecutive years…blue bloater

What’s a pink puffer”

Refers to emphysema which is enlargement of airways and wall destruction distal to bronchioles, “pursed lip breathing

COPD its with arterial blood gas analysis will show

Hypercarbia
hHypoxemia

What deficiency can be associated with emphysema patients?

Alpha 1 antitrypsin deficiency

FEV1 can determine severity of COPD, true or false

True, it is on stages based on FEV which determine treatment

What is ARDS?

Acute respiratory distress syndrome associated with bilateral lung infiltrates?

What causes ARDS?
(6 pts)

Pneumonia
Aspiration
Trauma
Acute pancreatitis
inhalation injury,
Reperfusion injury

ARDS is diagnosid by a ration of PaO2 to FiO2 that is less than _____?

200

PE symptoms? ( 6 pts)

-Dyspnea,
-hemoptysis,
-fever,
-cough,
-tachypnea,
-tachycardia

V/Q scan in treatment PE

Ventilation without perfusion suggests PE

What anticoagulant treats PE

Heparin bridge to Coumadin to maintain iNR of 2-3 for at leasts 3-6 months

What is the modified wells criteria

Something that determines the likelihood of PE and if greater than 4, someone likely has PE?

What are the criteria for modified wells criteria? (7 pts)

signs/symptoms of DVT
-PE is primary diagnosis
-HR >100 bpm
-immbilized for at least 3 days or surgery in previous 4 weeks
-previous diagnosed PE or DVT
-Malignancy with treatment
-Hemoptysis
-DVT

What determines acute renal failure?

Increase in serums creatinine >0.3 mg/dL over baseline
-Urine output less than 0.5 cc/kg/hr for more than 6-12 hrs

A-Acidosis
E-Electrolyte abnormality
I-Ingestion
O-Overload
U-Uremia

Chronic renal fialure

What predicts progression of chronic renal failure

Protienuria

-Pericarditis due to fluid overload
-Hyperkalemia
-Anemia
-Acidosis
-Renal osteodystorphy due to phosphate issues
-Dialysis infections

T/F, leukocyte esterase and nitrites and protein in abundance are found in abnormal urine

True, possible urine infection

Glucose absent in abnormal urine?

False, it is present due to renal fialure

What is primary nephrotic syndrome?

direct damage to glomeruli causing massive proteinuira

-Peripheral edema,
-hypoalbuminemia,
-hyperlipidemia,
-increased proteinuria

Membranous nephropathy

Goodpasture syndrome

What is focal segmental glomerulosclerosis

What is minimal change disease

What is secondary nerphrotic syndrome

Damage of glomeruli secondary to systemic disease.

What is a kimmelstiel-Wilson lesion

It is a lesion associated with nephrotic syndrome and diabetes mellitus

What two pathologies have positive Congo red stains?

Multiple Myeloma & Amyloidosis

What is nephritic disease?

It is inflammatory disorder in the glomeruli

Glomerulonephritis

RBCs in urine with or without cellular casts and proteinuria

-HTN,
-edema,
-oliguria,
-hematuria

Decreased complement levels is associated with what kind of nephritic disease?

Immune complex glomerulonephritis

What is Pauci immune glomerulonephritis

It is glomerulonephritis associated normal complement levels

IgA nephropathy?

IgA deposits in mesangium

Wegners granulomatosis pathology

Necrotizing crescent disease

Churg-Struss syndrome

Necrotizing crescent disease

In evaluating pH and PaCO2, how do you tell if it s metabolic or respiratory disorder?

Discuss the differences of metabolic acidosis, alkalosis in terms of PaCO2 and bicarbonate.

How do you determine the anion gap?

AG: Na- (CL+HCO2) < 12

If aG <12, acidosis is due to…

loss of bicarbonate (i.e. diarrhea)

If AG>12, acidosis is due to increase of

nonvolatile acid (lactic acidosis.

Metabolic acidosis etiology is best determined by th emneumonic MUDPILES

Symptoms of Metabolic acidosis

Hyperventilation (compensatory_
-Decreaed tissue perfusion
-Decreased CO
-Altered mental status
-Arrhythmias
-Hyperkalemia

How do you manage metabolic acidosis

What is metabolic alkalosis

Increased blood pH with increased bicarbonate

What are the etiologies of Metabolic alkalosis

1-Extracellular fluid expansion-like adrenal disorders causing increased mineralocorticoid secretion; increased reabsorption of bicarbonate and sodium and secretion of chloride
2-Extracellular fluid contraction-Vomiting, nasogastric suction causing hydrochloric acid and bicarbonate loss, excessive use of diuretics

What are the signs/symptoms of metabolic alkalosis

Hypokalemia,
elevated bicarbonate,
elevated pH,
Hypoventilation,
arrhythmia,
decrease in cerebral blood flow

Metabolic alkalosis, treated with?

Volume and K replacement

REspiratory acidosis diagnosis

Decreased blood pH with arterial PaCO2 > 40

What causes respiratory acidosis?

-COPD
-Brainstem injury
-Respiratory muscle fatigue
-Drug overdose causing hypoventilation

What are signs of respiratory acidosis?

Confusion
headaches
Fatigue
CNS

How to treat respiratory acidosis

Consider mechanical ventilation with severe acidosis, deteriorating mental status, and impending respiratory failure.

What is respiratory alkalosis

Alveolar hyperventilations with increased blood pH and a decrease in PaCO2 ( breathing quickly into a bag to help it)

What are the causes of respiratory alkalosis

-Anxiety
-Sepsis
-Pregnancy
-Liver Disease
-Pulmonary embolism
-Asthma

What are the symptoms of respiratory alkalosis?

-Decreased cerebral blood flow
-Lightheadedness
-Anxiety
-Perioral Numbness
-Arrhythmias

How to treat respiratory alkalosis

Breathe into paper bag, rebreathe CO2 and decrease the pH

What are symptoms of hyponatermia

Lethargy, seizures, nausea/vomiting, confusion

Hyponatremia can be caused by SIADH which stands for?

Syndrome of inappropriate antidiuretic hormone secreiton

What happens if you rapidly improve sodium levels?

It can lead to demyelinating encephalopathy

Treatment of hyponatremia

What are symptoms of hypernatermia

-Lethargy
-Weakness
-Irritability
-Seizure
-Polyuria

Treatment of hypernatermia

-Treat diabetes insepitius, replace isotonic fluid

Hypokalemia? better or worse than hyperkalemia

Hypokelimia is better tolerated than hyperkalemia

Symptoms of hypokalemia

-Muscle weakness but usually less than 2.5
-Abnormal ECT
-Prominent U waves and QT prolongation

How to treat hypokalemia

Potassium replacement and magnesium replacement

Symptoms of Hyperkalemia

-Poorly tolerated, especially when level is above 5.5, a patient with chronic renal disease may normally have an elevated potassium level

Symptoms of Hyperkalemia

-ECG changes
-Peaked T waves, and PR interval lengthening, disappearance of p waves and QRS prolongation, final-ventricular asystole
-Respiratory failure
-Nausea/vomiting
-Muscle weakness

How to treat hyperkalemia

Shift potassium intracellular with insulin and desctorse
-Diuretics
-ECG changes.

Which has bloody diarrhea…chron’s or ulcerative colitis?

Ulcerative colitis

Which has patchy transmural inflammation….Chron’s or ulcerative colitis?

Chron’s disease

Which has continuous mucosal inflammation….Chron’s or ulcerative colitis?

Ulcerative colitis

Which is associated with uveitis, erythema nodosum and ankylosing spondylitis…chron’s or ulcerative colitis

Ulcerative colitis

Where does ulcerative colitis occur?

colon to th erectum

Where does Chron’ disease occur?

anywhere in the GI but propensity to the illeum

Ulcerative colitis…increased malignancy risk or decrease

Increased

Diagnosis, Transmission and Treatment of Hep A/B/C

Hepatitis B serology

T/F: GERD is associated with adenocarcinoma and Barrett esophagus

True

ESLD: Etiology

Chronic hepatocellular injury leads to fibrosis of liver

Symptoms of ESLD:

Fatigue,
anorexia,
impotence,
mElena,
spider nevi,
gynecomastia,
jaundice,
testicular atrophy,
coarse hand tremor,
caput Medusa,
spider telangiectasia,

Complications of ESLD

-Esophageal varices
-Ascites
_increase in bleeding risk
-Portal HTN
-Hepatic encephalopahty

Child-Turcotte Pugh score

-Associated with ESLD and the following factors
-Ascites
-Encephalopahty
-Albumin
-Prothrombin Time
-Bilirubin

Which type of anemia is associated with iron deficiency?

Microcytic

Which type of anemia is associated with renal deficiency?

Normocytic

Which type of anemia is associated withB12/Folate deficiency?

Macrocytic

What symptoms are associated with microcytic, normocytic, and microcytic anemias

Sickle Cell disease is caused by what

A homozygous defect in gene for beta-globulin that produces hemoglobin S

What diagnoses sickle cell disease

Target cells, sickle cells, Howell Jolly bodies, Hemoglobin S on smear

How do you treat sickle cell disease?

Folate
Hydroxyurea
Agressive Hydration
Analgesia
Oxygen
Transfuse for major surgery 9-10 g hemoglobin

What acute complications are associated with sickle cell disease?

Stroke
Splenic infarc
Osteomyelitis

FActor 8 deficiency symptoms and treatment?

Spontaneous bleeding, treat with desmopressin or factor replacement

FActor 9 deficiency symptoms and treatmetn?

Spontaneous bleeding, prolonged PTT, treat with factor replacement

vWF deficiency (von Willebrand disease) symptoms and treatments?

What is immune thrombocytopenia purpura

DIC

Disseminated Intravascular Coagulation-A coagulopahty associated with serious illness

What is thrombocytopenia?

aThrombocytopenia is a condition that occurs when the platelet count in your blood is too low.

What is desmopressin?

Desmopressin is used to treat central cranial diabetes insipidus. It is a clotting promoter and diuretic

DIC leads to symptoms of

thrombocytopenia and excessing bleeding or clotting

Diagnosis of DIC is discovered with

Decreased fibrinogen, platelets, increased PT/partial thromboplastin time (PTT), d-dimertest, schistocytes present

Treatment of DIC:

treat underlying cause; platelets and cryprecipaite for bleeding, low-dose heparin for clotting

What is the INR goal for patients with mechanical heart valves

3 to 4

Factor V Leiden (Venous or Arterial thrombosis?

Venous

Protein C/S deficiency and Heparin-INdcued Thrombocytopenia…arterial or venous thrombosis?

Arterial and Venous

Lab and REversiblity for warfarin

INR and FFP and Vitamin K reverse it

Heparin-Lab and REversiblity

Lab-PTT and platelet count
Reversability-Protamine

Low molecular weigh heparin-Lab and REversiblity

Lab-Antifacotr Xa
Reversibility-No

Fondaparinum Lab and REversiblity

Lab-None
Reversibility: No

Diabigatran Lab and REversiblity

Lab-None
Reversability-None

Diabetes Mellitus Daignosis

Complications of DM Type I versus DM Type II

Name complications of diabetes (7)

-Retinopathy
-Neuropathy
-Nephropathy
-Infections
-MI
-CVD
-Stroke

Is glargine long acting or short acting insulin?

It is long acting (24 hrs

Is lispro long acting or short acting insulin?

It is short acting (3-4 hrs)

What is the mechanism of metformin?

It decreases insulin resistance and glucose production?

What is the mechanism of sulfonylurea?

It is known as glburide and stimulates insulin release

What is the mechanisms of meglitinide (repaglindide)

Stimulates pancreas to release insulin

What is the mechanism of pioglitazone

Decreases insulin resistance peripherally

What is the goal of treatment for Diabetes

BP < 130/85
LDL- , 100, total glycerides <150, HDL >40
Smoking cessation
HbA1c < 7

What is good control for DM

HbA1c between 7-8.5 is good
Fasting glucose <130
Peak postpranidal glucose <180

What is diabetic ketoacidosis

It is an insulin deficiency and glucagon excess that causes severe hyperglycemia and ketogenesis. Severe hyperglycemia causes an osmotic diuresis leading to dehydration and volume depletion.

What are symptoms of DKA

-Abdominal pain
Nausea
Vomiting
Kussmaul respirations
Ketone breath
Anion gap metabolic acidosis
Marked dehydration
Tachycardia
Polydipsia
Polyuria
Weakness
Altered Consciousness

What is a diagnosis of DKA?

Serum glucose >250, metabolic acidosis pH >7.3 and serum bicarbonate < 15, increased anion gap, ketonuria, ketonemia, hyperkalemia, and hyponatremia

What is the treatment of DKA

IV insuline at 0.1 units/kg
-drip at 0.1 units/kg/hr
-Normal saline replacement
-Decrease insulin once AG has closed and acidosis has resolved
-Monitor K
Add dextrose to IV lfuids when glucose is below 250
-Monitor Na, K, and Mg levels

Hypohtyroid diagnosis

Elevated TSH and decreased T4

What are the symptoms of hypothyroidism?

fatigue,
-weight gain
-cold intolerance
-depression

What are the symptoms of hyperthyroidism

-Palpitations
-Heat intolerance
-Sweating
-Anxiety

Graves disease hyper or hypothyroidism?

Explain Adrenal Disorders

What is an adrenal crisis?

Shock, nausea, vomiting, confusion, fever,, can be fatal

What is Addison’s disease?

What is cushing’s syndrome?

It is caused by exogenous steroids, pituitary adenoma, ectopic ACTH, adrenal hyperplasia.

Symptoms of Cushing’s syndrome

-Moon facies
-Buffalo hump,
HTN
-Truncal obesity
-Depression
Striae
-Diabetes
-Osteopenia
-Hypokalemia
-Metabolic acidosis

When do you have to conduct a dexamethasone suppression test or 24 hr urine free cortisol level?

For Cushing syndrome

How many hormones released by pituitary gland? (6)

-ACTH
TSH
-LH/FSH
-GH
-Prolactin

“mediastinal crunch” produced by the heart beating against air-filled tissues. Associated with pneumomediastinum

Metformin. It can also cause the GI tract to become upset.

a.Freely crosses: high lipid solubility and CO2, non ionized

a.Beta-2-transferrin is a carbohydrate free glycoprotein produced by neuraminidase activity in the brain which is uniquely found in the cerebrospinal fluid (CSF) and perilymph.

.Vancomycin (Red Man Syndrome). The cause of this is what?

a.TR, MR, VSD - Pansystolic (Holosystolic) murmurs often occur with regurgitant flow across the atrioventricular valves

a.Drug has myelosuppressive effects which can increase rise of infection and bleeding tendency by causing low WBC and platelets counts

a.Decreased amount of megakaroctes which is the progenitor cell for platelets

a.Adenosine – first line choice ACLS

Minute ventilationincreased 50%
Alveolar ventilationincreased 70%
Tidal Volumeincreased 50%
Oxygen consumptionincreased 20%
Respiratory rate increased 15 %
Dead spaceno change
Vital capacityno change
Lung complianceno change
Closing volumeno change or decreased
Total compliancedecreased 30%
Airway Resistancedecreased 36%
Expiratory Reserve vol. decreased 20%
Total lung capacity decreased 0-5%
Functional residual capacity decreased 20%

a.Reversible obstructivelug disease

a.Normal Ca2+, normal PO4, and elevated alkaline phosphatase

a.von Willdebrands

a.Potassium – hyperkalemia leading to cardiac issues

a.Titrate midazolam to effect - (Patient anxious getting IV with basic tachycardia and no arrhythmia on EKG)

What symptoms show up in hypopituitarism?

Depends on hormone deficiency, GH, LH/FSH, TSH, ACTH, antidiuretic hormone

What is the etiology of hyperpitutarism?

Adenoma, prolactinoma

Symptoms of hyperpituitarism?

Headache, vision changes, additional symptoms specific released from pituitary gland

Hypercalcemia Symptoms

Etiology of hypercalcemia,

Malignancy (parathyroid hormone-related protein)
Local osteolysis
Granulomatous disorders
Paget disease

Treatment of hypercalcemia

Saline infusion for urinary excretion.
-Consider diuretics to inhibit calcium reabsorption and bisophosphonates or calcitonin when hypercalceimia is secondary to malignancy
-Glucocorticoids may be used to treat hypercalcemia in patients with multiple myeloma

Hypocalcemia Symptoms

-Neuromuscular excitability (seizures, tetany)
-Chvostek sign (ipsilateral twitching of the facial muscles occurs)
-Trousseau sign (when a carpopedal spasm of the hand and wrist occurs )
-Prolonged QT interval

Sarcoidosis and what does a lip biopsy show

Rheumatoid Arthritis Diagnosis

Rheumatoid arthritis includes 6 diagnoses from either…

Joint involvement, serology, acute phase reactants (CRP and ESR), with a duration greater than 6 weeks.

In which classification of arthritis does movement improve pain?

Rheumatoid arthritis

Differences between rheumatoid arthritis and osteoarthritis

Diagnosis of Lupus and symptoms

Symptoms: Arthralgias, malar rash (photosensitive), oral ulcers, pancytopenia, serositis
Diagnosis: Anti-double standard DNA (anti-dsDNA), antinuclear antibody (ANA testing, anti-Smith antibodies, antiphospholipid antibodies.

Myasthenia Gravis Definition

Autoimmune disorder with auto-antibodies to acetylcholine receptor

Treatment of Myasthenia Gravis

Physostigmine (anti cholinesterase inhibitor)

Scleroderma definition and symptoms

Collagen overproduction
Associated with GERD, Raynaud’s disease and skin tightening.

Progressive systemic Sclerosis

Disorder of connective tissue with thickening of dermal collagen bundles and fibrosis and vascular abnormalities in internal organs with symptoms of vasomotor disturbance (HTN), fibrosis, skin atrophy, muscle atrophy, internal organ dysfunction

Sjrogren Syndrome Definition

Systemic autoimmune disease in which immune system attacks exocrine glands

Sjrogren’s Syndrome Diagnosis

ANA, RF, anti-SSA/B autoantibodies
Lip Biopsy
Eye exam, Schrimer test
Sialography

Allergies…IgE

Type I, anaphylaxis

Allergies Type 2

Antibodiy mediated cytotoxic reactions, penicillin-induced hemolytic anemia,

Type 4 Allergies

Delayed hypersensitivity activating T cells-poison ivy dermatitis

Which serology test is associated with Wegner granulmatosis?

ANCA

Which serology test is associated with just lupus and sjrogren syndrome

Anti SSA, Anti SSB

Static Epilepitus

Continous seizure activity > 30 min or recurrent seizures without rturn of consciousness
-Treatment: Check airway, breathing, circulation, consider thiamine, glucose, bentos, phenytoin

Seizure

abnormal discharge of cortical neurons

CVA

Acute onset focal neurologic changes secondary to blood flow disruption to the brain.

Ischemic Stroke

Emboli from internal carotid artery or heart causing blood vessel blockage

Ischemic stroke-contrast or no contrast for scan

No contrast

Hemorrhagic Stroke

Associated with headache and loss of consciousness with HTN being primary cause

Neurolepic Malignant Syndrome

What drug is used for muscle ridigidty in Neuroleptic Malignant Syndrome?

Dantrolene

Serotonin Syndrome

Excess of serotonergic active in the CNS and peripheral serotonin recpetroms from therapeutic drug use, recreational drug use, or drug interactions.

Symptoms of Serotonin Syndrome ( 13)

-Headache
-Agitation
-Confusion
-Shivering
-Sweating
-Hyperthermia
-HTN
-Tachycardia
-Nausea
-Vomiting
-Hyper-reflexia
-Tremors
-Muscle Twitching

Differences between Serotonin Syndrome & Neuroleptic Malignant Syndrome

Is alcohol a stimulant or depressant?

Depressant

What does alcohol do?

When does delirium tremens occur?

Usually 36 hrs after the last drink

Delirium tremens occurs with what symptoms

HTN
Tachycardia
Agitation
Hyperthemia

Symptoms monitored for alcohol withdrawl

Nausea/vomiting
-Anxiety
-Visual distrubance
-Paroxysmal Sweats
-Tactile disturbance
-Orientation
-Auditory disturbance
-Headache
-Agitation
-Tremors

Treatment for alcohol withdrawl/dilirum tremns

-Hydrations
-Correct eletrolyte imbalance
-Thiamine, 100 mg IV daily for 3 days, then orally daily
-Folic acid
-Benzodiazepines (long acting benzos are preferred)-clonazepam

Parkin’s Disease: Symptoms & Treatment

Huntington Disease

Progressive autosomal dominant disease (cytosine-adenine guanine expansion in DNA)

Pathology of Huntington Disease

Atrophy of the caudate nucleus with symptoms of chorea, dementia, psychiatric symptoms

Alzeheimer’s Disease

Unkown etiology; however theory of low acetylcholine being involved

Alzheimer Disease Symptoms:

Mild forgetfulness with poor concentration and changes in personality that worsen in later stages to paranoid delusions, hallucinations and need for assitance

Alzheimer’s Disease

Avoid anticholinergics, donepezil is first line agent.

Lewy body dementia

Loss of cholinergic neurons and death of dopaminergic neurons

Symptoms of Lewy body dementia

Variation in cognition and attention; recurrent hallucinations and Parkinson-like motor symptoms

Treatment for Lewy body Dementia

Donepezil for cognition and levodopa for motor symptoms; otherwise palliation

Shock

Pathophysiologic state associated with decreased tissue perfusion and hypoxia.

Categories of Shock
Cardiogenic, Hypovolemic, Distributive

Stages of Shock-Initial

No signs of shock but cells starting to use anaerogic metabolism

Stages of shock-Compensatory

Reversible-Yes
Compensatory mechanisms try to reverse the symptoms of shock (eg hyperventilation to correct acidosis)

Stages of Shock-Progressive

Rerversible-No
Compensatory mechanisms cannot correct shock symptoms, leading to worsening acidosis and decreased organ perfusion

Stages of Shock-Refractory

Reversible-No
Organ failure and death

Treatment for shock

Agressive IV fluid (2 Liters), except for cardiogenic shock

Shock - Class I

Blood Loss < 15%, Pulse - Normal, Blood Pressure- Normal, Respiratory Rate - Normal, Urine output- Normal, Orientation- Normal
Treatment- minmal

Shock Class II
Blood Loss
Pulse
Blood Pressure
Respiratory Rate
Urine Output
Orientation
Treatment

Shock Class III
Blood Loss
Pulse
Blood Pressure
Respiratory Rate
Urine Output
Orientation
Treatment

Blood Loss-30-40%
Pulse-Increased, >120
Blood Pressure-Decreased
Respiratory Rate-Marked tachypnea
Urine Output-20 cc/hr
Orientation-Confused
Treatment-Agressive fluids and packed RBCs

Shock Class IV
Blood Loss
Pulse
Blood Pressure
Respiratory Rate
Urine Output
Orientation
Treatment

Blood Loss->40%
Pulse-Increased, >140, non palpable
Blood Pressure-Marked Decreased
Respiratory Rate-Marked tachypnea
Urine Output-Negligible
Orientation-Comatos
Treatment-Agressive therapy

Fever Etiology - 5 Ws

Wind (pneumonia)
Water (Urinary tract infection)
Walking (DVT/PE)
Wound (surgical site infection)
Wonder drugs (drug fever)

When to give fluids?

Fever
Drains
Gastrointestinal Losses
Burns

Crystalloid the gold standard for volume replacement?

Yes, it is

Signs of postoperative fluid overload

-Pitting Edema
-HTN
-Lung crackles
-shortness of breath
-Increased jugular vein distention

Atrial Fibrillation- 1st step

-Systemic illness,
-Pulmonary embolus
-Acute MI
-Thyroid Disease

A fib EKG finding

Wavy EKG with loss of P waves

Treatments of Afib include

Beta blockers
Calcium channel blocckers
Cardioversion
Anticoagulation

Acute myocardial infarction diagnosis on an ECG

-ST elevations
-T wave Changes
-Q waves for acute MI diagnosis

Chest Pain Work UP

Postopeartive Respiratory Therapy for Asthma

-Supplemental oxygen
Short-acting beta agonist
Systemic steroids
-IV magneium sulfate

Postoperative respiratory therapy for PE

-Supplemental oxygen
-Heparin therapy

Postoperative Respiratory Therapy for Guillan-Barre syndrome

Supplemental oxygen
Mechanical ventilation
Plasmapheresis or IV immunoglobulin syndrome

Pneumonia post-operative workup

Culture sputum
Unasyn or Zosyn

Treatment for post-operative status epileptics

Patients with long term/chronic steroid use include:

-People taking a daily dose of 20 mg or more of prednisone
-More than 3 weeks of steroid treatment
-An accute cortisol deficiency secondary to surgical stress with in a patient with adrenal insufficnecy

5 conditions that require abs prophylaxis prior to procedures

-Prosthetic cardiac valve
-Prosthetic material for cardiac valve repair
-Hx of IE
-Congenital heart disease
-Unrepaired cyanotic CHG within 6 months of repair
-Repaired CHD with residual disease
- cardiac transplant patients who have developed valvulpathy

Are dialysis patients, joint replacement patients, or solid organ transplant patients required to receive prophylaxis.

Nope, only if recommended by their doctor.

a.Methylprednisolone: high doses of corticosteroids may be given at 1-2 mg/kg/d until the disease activity is suppressed adequately

a.H. influenza

a.Less resorption

a.Gram negative rods, Bartonella henselae

a.Gardner syndrome - sebaceous cysts, osteomas, desmoids tumors, gastrointestinal polyps, multiple teeth,

a.Pneumothorax

a.H. influenza

a.Inhibits the production of interleukin IL-2 by helper T-cells thereby blocking T cell activation and proliferation

a.Tingling or electric sensations in a nerve upon percussion – Distal tingling to percussion