NOTES FROM CRUSH STEP 2 MCCUMBI AUDO FILES

ACID-BASE BALANCE IF YOURE ALKALOTIC, LOOK AT CO2 AND BICARBONATE (HCO3) NORMAL CO2 IS 40 +/- 3; NORMAL BICARBONATE IS 24 =/- 2 SUPPOSE YOU HAVE ALKALEMIA. LOOK AT YOUR CO2 TO DETERMINE IF ITS NORMAL OR HIGH IF C02 IS HIGH, YOU HAVE RESPIRATORY ACIDOSIS WITH METABOLIC ALKALOSIS; IF CO2 IS LOW, YOU HAVE RESPIRATORY ALKALOSIS, AND YOU LOOK AT BICARBONATE TO SEE IF ITS HIGH OR LW IF ITS HIGH = RESPIRATORY ACIDOSIS; IF CO2 IS LESS THAN 37 = RESPIRATORY ALKALOSIS THEN LOOK AT BICARB TO SEE IF ITS HIGH (METABOLIC ALKALOSIS), IF ITS LOW (COMPENSATORY METABOLIC ACIDOSIS COMPENSTING FOR RESPIRATORY ALKALOSIS) IN CASES OF RESPIRATORY DISORDERS, IF PaCO2 IS DERANGED, IS Ph and bicarbonate normal FOR EXAMPLE, IF YOU HAVE A RESPIRATORY ALKALOSIS WHERE CO2 IS 30, BICARB IS EXPECTED TO DECREASE BY 2 OR 5 AND ph TO INCRASE BY 0.08 OR 0.04 DEPENDING UPON WHETHER ITS AN ACUTE OR CHRONIC PROCESS RESPIRATORY ACIDOSIS = CO2 IS HIGH B/C OF NOT BREATHIGN OFF ENOUGH CO2: COPD, ASTHMA, OPIOATES, BENZOS, BARBS, FLAIL CHEST, SLEEP APNEA RESPIRATORY ALKALOSIS: ANXIETY (ALONG WITH HYPERVENTILATION), SALICYLATE POISOINING METABOLIC ACIDOSIS = MUDPILES

 METABOLIC ALKALOSIS = HCO3 IS HIGH = DIURECTICS (EXCEPTS CARBONIC ANHYDRASE INHIBITORS), VOMITTING, VOLUME CONTRACTION, HYPERALDOSTERONISM, ANTACOD ABUSE GIVE BICARBONATE FOR SALICYLATE POISOINING, B/C ALKALINIZATION OF URINE SPEEDS EXCRETION ENDOCRINE CAUSES OF ADRENAL INSUFFICIENCY: ADDISIONS, SECONARY ADRENRAL INSUFFICIECY, SHEEHANS SYNDROME ADDISONSS OR PRIMARY ADRENAL INSUFFICIENCY (HYPERKALEMIA, HYPONATREMIA) PATIENT CAN HAVE ADRENAL CRISIS = HYPOTENSION, RENAL FAILURE, ABDOMNIAL PAIN, CARDIOVASCULAR COLLAPSE TX. ADDISONS PATIENTS WITH IV FLUIDS AND HYDROCORTISONE SECONEARY ADRENAL INSUFFICIENCY = CAN OCCUR ANY ANYONE TAKING CORTICOSTEROIDS FOR MORE THAN A MONTH AND THEY STOP ABRUPTLY = GIVE CORTICOSTEROIDS = no hyperpigmentation CUSHINGS DZ USUALLY CAUSED BY PITUATARY ADENOMA, ADRENAL ADENOMA OR, SMALL CELL LUNG CA CAUSE MAKE ACTH BEST SCREENING TEST FOR HYPERADRENALISM = 24-HR. URINE FREE CORTIOSOL; 2ND BEST = DEXAMETHASONE SUPPRESSION TEST ALDOSTERONE MAKES YOU KEEP SODIUM AND DUMP POTASSIUM/PROTONS

RHEUMATOLOGY BECHETS ORAL/GENITAL ULCERS, UVEITIS, ARTHRITIS, ERYTHEMA NODSUM= TX. STEROIDS SHOCKING T THE RENAL DISEASE THE SMOKING/DRINKING THE SIGN/SYMPTOMS/SYNDROMES UPGOINT (POSITIVE) BABINSKI SIGN IS WHEN TOES FAN OUT AFTER STROKING THEM = UMN LESION CULLEN SIGN PERIUMBILLICAL BLUISH DISCOLORATION IS RETROPERITONEAL HEMORRHAGE= SEVERE PANCREATITIS CUSHINGS TRIAD (REFLEX) = HYPERTENSIVE, BRADYCARDIC, RESPIRATORY CHANGES = DUE TO INCREASED INTRACRANIAL PRESSURE TX. MANNITOL LERICHE AORTICOILIAC OCCLUSIVE DISEASEIMPOTENCE, ATHERSCLEROSIS, CLAUDICATION IN THE BUTTOCKS PREHNS (praying) SIGN = LIFTING UP TESTICLE RELIEVES PAIN = EPIDIDYMITS = GRAVITY STRTECHES THE INFLAMMED EPIDYDMIS TINNELS SIGN = TAPPING ON VOLAR OF WRIST CARPEL TUNNEL

ACHLORHYDRIA, WATHERY DIARRHEA, LOW POTASSIUM = VERNER-MORISSION SYNDREOM; SIGN OF VIPOMA IN THE PANCREAS

RANDOM FACTS, PKU SEPTIC PELVIC THROMBOPHLEBITIS = POSTPARTUM FEVER UNRESPONSIVE TO BROADSPRECTRUM ANTIBIOTICS - HEPARIN FOR CURE THE RANDOM II THE RANDOM III THE RANDOM IV THE ATE NIGHT RANDOMNESSL MORBILIFORM MEANS MEASLES-LIKE RASH SERUM SICKNESS = URTICIARIA, PRURITUS, JOINT PAIN, EOSINOPHILIA, SWELLING, MORBILLIFORM ERUPTIONPAIN, FEVER, = CEPHACLOR (2ND GENERATION) COULD CAUSE THIS PERICENTRAL VEIN ZONE (ZONE 3) IS SENSITIVE TO ISCHEMIA OXIDASE P450 SYTEM SHOULD BE CHECKED PRIOR TO TRANSPLANT

 SOMEONE UNABLE TO MAKE IGG2 PROBABLY CANT MAKE IGA AS WELL P. AERIGINOSA/C. DIPTHERIA INHIBIT EF-2 VIA ENDOTOXIN THAT INHIBITS PROTEIN SYNTHESIS WARAFAIN CAUSES SKIN NECROSIS B/T 3-10 DAYS OF THERAPY RD GIVE PREGNANT WOMAN W/URI IN 3 TRIMESTER = GIVE AZITHROMYCN CLASS B ANIMAL STUDIES SHOW NO DEMONSTRATED RISK TO FETUS CIPRO/CLARITHROMYCIN - CLASS C = ANIMAL RISKS; TMP-SMX/DOXYCLINE CATEGORY D = HUMAN/ANIMAL RISKS DONT USE LOTS OF GAPS THE CANCER SCREEN/ADULT IMMUNUNIZATIONS UROLOGY SODIUM ISSUES THE CARDIACNESS ANTIVIRAL OVERVIEW UROLOGY VASCULAR DZ, DVT, COAGS

 THYROID ENDOCRINOLOGY COMPLICATIONS OF PEEP VITAMIN DEFICIENCY GI VASCULAR SURGERY GRAM POSITIVE BACILLI ETC LUNG DRUGS GLOMERULAR NEPHRITIDES ARRHYTHMIA GRAM POSITIVE COCCI CALCIUM, MG, PHOSPHATE SODIUM ISSUES POST-SURGERY, CONFUSED, LETHARGIC, ANOREXIC, SEIZURES = HYPONATREMIA ANTIDIURETIC HORMONE (ADH) REGULATES SODIUM CONCENTRATION = ACTS ON COLLECTING DUCTS, OPENING WATER CHANNELS AND ALLOWS FOR PASSIVE REABORSOPTION OF WATER PRIMARY HORMONE THAT REGULATES TOTAL BODY SODIUM = ALDOSTERONE

 HYPOVOLUEMIA (LOW VOLUME) OR HYPERKALEMIA SIGNALS ALDOSTERONE TO BE RELEASED ALDOSTERONE THE STIMULUS FOR SECRETION OF ADH = HYPEROSMOLALITY (NEED TO SAVE WATER) ALDOSTERONE FUNCTIONS TO REABSORB NA IN EXCHAGE FOR PROTON (ACID) OR POTASSIUM 8 CAUSES OF SIADH: TRAUMA, HEAD INJURY, SURGERY, MENINGITIS, SMALL CELL LUNG CA, PAIN, OTHER LUNG DZ (I.E. TB, INFECTION), OPIODS, CHLOROPROPRAMIDE SIADH CHANGES IN METNAL STATUS, LETHARGIC, HYPONATREMIC, RETAINING WATER, POSSIBLE SEIZURES/COMA/CRAMPS = TX IS WATER RESTRICTION, EMECOCYCLINE (ADH ANTAGONIST) DEMECOCLYCINE CAUSE DIABETES INSIPIDUS TO CHECK VOLUME STATUS WHEN YOU HAVE SODIUM DERANGEMENT= CHECK BP, JVP, ORTHOSTATICS, MUCOUS MEMBRANES, BUN/CR, SKIN TURGOR 3 WAYS TO CLASSIFY HYPONATREMIA IN TERMS OF VOLUME STATUS = HYPOVULEMIC HYPONATREMIA, HYPERVOLUMEIC HYPONATREMIA, EUVOLEMIC HYPONATREMIA 5 THINGS THAT CAUSE HYPOVOLEMIC HYPONATREMIA : DEHYDRATION, DIABETES (DKA), ADDISONS, HP, DIURETICS, HYPOALDOSTERONISM (caused by primary adrenal insufficiency, meds, CAH) 3 CAUSES OF EUVOLEMIC HYPONATREMIA: SIADH, PSYCHODENIC POLYDIPSIA (someone drank more than

12 L of water), OXYTOCIN (stimulates uterine contractions) CAUSES OF HYPONATREMIA: CHF, CIRROHSIS, RENAL FAILURE, NEPHROTIC SYNDROME, TOXEMIA TX OF HYPOVOLEMIC HYPONATREMIA = NORMAL SALINE TX OF EUVOLEMIC/HYPERVOLUMIC HYONATREMIA = RESTRICT FREE WATER 4% SALINE ONLY USED WHEN PATIENTS WITH SIADH ARE HAVING SEIZURES; CORRECT SODIUM AT NO MORE THAN 12 Meq/liter/day OVERLY RAPIDLY REPLETION OF SODIUM (trying to correct hyponatremia) = CENTRAL PONTINE MYELYNOLYSIS CENTRAL PONTINE MYELNOLYSIS SPASTIC PARALYSIS, PSUDOBULBAR PALSY, CHANGES IN MENTAL STATUS ANOTHER TX FOR HYPERVOLUMEIC HYPONATREMIA = DIURESIS, FOR EVERY 100 MG/DL glucose is high in the blood, NA DECREASED 2.4 Meq/l = causeing a false hyponatremia due to osmotic effect HYPERPORTENIAMI/HYPERLIPIDEMAI CAUSE PSUEDOHYPONTARMIA B/C OF OSMOTIC EFFECT CAUSES OF HYPERNATREMIA (MORE THAN 15 Meq) = DIARRHEA, INABILITY TO DRINK, DEHYDRATION, DIURETICS, DIABETES INSIPIDUS (DI), RENAL DZ, ISOSTUNIRA FROM SICKLE CELL TRAIT, IATROGENIC ADMINISTRATION OF EXCESS SALT TX OF HYPERNATREMIA = REPLACE WATER BY GIVING 0.9% NORMAL SALINE THEN 0.45% (HALF NORMAL SALINE)

 ADMINISTERING VASOPRESSIN CORRECTS HYPERNATREMIA IN CENTRAL DI 4 THINGS THAT CAUSE NEPHROGENIC DI: LITHIUM, AMPHOTERICIN B, DEMECOCYCLINE, METHOXYFLURANE TX NEPHORGENIC DI W/THIAZIDES 3 CAUSES OF CENTRAL DI: SARCOID, TUMOR, TRAUMA URINARY CANCER SCREEN/ADULT IMMUNUNIZATIONS CHEST PAIN/MI CHOLESTEROL CHF/ARRHYTMIAS DERMATOLOGY ER DM GENERAL SURGERY ETHICS

 GI BILIARY TRACT GI-DIARRHEA GI-PEDS GI GERIATRICS