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41 Cards in this Set

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Dx and antibx tx for cholecystitis
dx: US #1, HIDA if necessary
tx: cefazolin, cefoxitin 1.5g IV one dose
Charcots Triad
cholangitis:
1. fever/chills
2. juandice
3.RUQ pain
Reynold Pentad
charcot triad + hypotension and altered mental status
Dx of Cholangitis
RUQ u/s if ERCP is not available
-elevated LFTs usually
DDx of episgastric pain (name 5)
Acute pancreatitis
MI
GI bleed
Peptic ulcer dz
GERD
Ransons Criteria for Pancreatitis
5 items
1. glucose >200
2.Age>55
3.LDH>350
4.AST>250
5.WBC>16,000
DDx for lower quadrant/pelvic pain
9 items
1. appendicitis
2.ovarian torsion
3.ovarian cyst rupture
4.ectopic
5.PID
6. Hernia
7.neprholithiasis
8.diverticulitis
9.uti
3 signs done on PE for appendicitis
1. Psoas: pain with active flexion against resistance or passive extension of R leg
2. rovsing: RLQ pain with palpatin of LLQ
3.obturator: pain wiht internal rotation of the flexed R hip
Dx study for appendicitis
Abdominal CT with oral contrast
antibx tx for appendicitis
cefoxitin or cefotetan 2 g IV within 2 hours of surgery
Dx test for ovarian torsion
Pelvic U/S with doppler is test of choice
Direct vs Indirect Hernia
Indirect: contents pass through internal inguinal ring and canal, protrude lateral to inferior epigastric vessel

Direct: contents protrude medial to inferior epigastric vessels through Hesslebach triangle
Outpatient antibx tx for diverticulitis
(two drug regimen)
Bactrim DS po BID or Cipro 500-750mg po bid PLUS

Flagyl 500 mg po QID or Augmentin 500/125mg po TID

X 10-14 days
inpatient antibx tx for diverticultiis
amp 1-3g q4-6hrs, gentamicin 2mg/kg IV and flagyl 1g IV
Ruptured AAA triad
1. back pain
2. hypotension
3.pulsatile abdominal mass
HCO3 is down in _________
and ________ in acid/base disorders
metabolic acidosis and respiratory alkalosis
hco3 is up in _____ and ______ in acid/base disorders
metabolic alkalosis and respiratory acidosis
CAUSES OF METABOLIC ACIDOSIS WITH ANION GAP

*MUDPILES
Methanol
Uremia
DKA
Paradehyde
iron/isoniaxid od
lactic acidosis
Ethanol
Salicylate OD
Causes of metabolic acidosis WITHOUT anion gap
Carbonic anyhdrase inhibitor tx
Hyperalimentation
Addisons dz
Renal tubular acidosis
Diarrhea
Fanconi Syndrome
Causes of respiratory alkalosis
Chloride responsive (>15)
Vomiting
Diarrhea
Diuretic overuse
NG suction
Volume depletion
Causes of Respiratory Alkalosis
CNS lesion
PRegnancy
Sepsis
High altitude
Salicylate tox
Liver failure
hyperventilation
CHF
PE
PNA
Hyperthyroidism
Causes of Metabolic alkalsosi
Chloride unresponsive (Cl<15)
Diretic overuse
Bartter syndrome
hypomagnesemia
hyperaldosteronism
liddle dz
Name three intial things you would do to manage DKA
1. Bolus IV fluids 1-2 L initially, dont overhydrate too fast!
2. 10 units insulin at first, then 0.1mg/kg insulin drip if needed, stop drip if glucose reaches 250
3.KCl with fluid if less than 4.5 (will be elevated at first, then drop once acidosis is corrected, give after correction)
Sodium Correction with hyperglycemia
For Q 100mg/dL glucose more than 100, Na+ drops 1.6meq from 140.

ex Glucose-200-->Na+=138.4
Causes of hyponatremia of Urine Na+ is > 20meq
(Na lost renally)
Hypovolemic: Diuretic overuse, salt wasting nephrophaty, mineralocorticoid def.
Euvolemic: SIADH, hypothyroidms, glucocorticoid def.
Hypervolemic: ARF/CRF
Causes of hyponatremia with Urina Na < 10meq (implies extrarenal Na loss)
Hypovolemic: vomiting, diarrhea, NGT drainage, third spacing
Euvolemic: Psychogenic polydipsia, dilution of infant formula
Hypervolemic: Decrease effective IVF, CHF, Cirrhosis, asictes, nephrotic syndrome
Tx of hyponatremia:
1.hypovolemic cause
2. euvolemic cause
3.hypervolemic cause
1. hypovolemic: volume and Na+ restoration with NS, correct over 24 hours
2. restrict free water intake
3. fluid restriction, lasix 10-40mg IV X 1to prevent or treat volume overload
central pontine myelinolysis
occurs from excessvely rapid correction, consists of dysarthria, sx, quadriparesisi and hypotension
RBC cast in ARF indicates _________
glomerulonephritis
WBC cast in ARF indicates _________
pyelonephritis
granular cast in ARF indicates _________
ATN
Fatty cast in ARF indicates___________
Nephrotic syndrome
hyaline cast in ARF indicates _________
dehydration, low renal blood flow
Prerenal causes of ARF
(3 main causes)
1. Dehydration ( decreased renal perfusion from volume depletion)
2.postsurgical third spacing (volume redistribution)
3.CHF (decreased cardiac output)
Intrinsic causes of ARF
1. ATN most common
2. neprhotoxic agent ie IV contrast, Aminoglycoside, acute rhabdo
3.vasculitis, hetaic failure, renal vascular thrombosis or embolization
4. NSAIDs, Acute interstitial nephritis from drug exposure ie PCN, NSAIDs, diuretics
Causes of Postobstructive ARF
1. prostatism, prostate CA, bladder neck obstruction
2.STD hx, urethral obstruction
3. hx of malignancy, late term pregnancy, radiation tx, b/l renal stones
4. neurogenic bladder
Fomepizole is drug used for what type of intoxication?
methanol/ethylene glycol
Causes of Altered Mental Status

*AEIOUTIPS*
Alcohol, arrythmia
Epilepsy, encephalopathy, endocrinopathy, electrolyte abnormality
Insulin
Overdose, oxygen
Uremia
Trauma, tumor,thermal
Infection
Psychiatric
Stroke, SAH, SDH, seizure,shock
tx of cat/dog/human bites
Augementin
organism of cat/dog bites
Pasteurella multocida
organism of human bites
Eikenella