All questions to nbme 3 - plz check my answers!! - drjiggy

[ArchivalUser]

Well maybe we should better go from shistocytes ,
autoimmune hemolytic anemia and digoxin induced ( if there is) i think would nt be associated with that

then we have hus and valvular

[ArchivalUser]

41 i would go for lipase , chronic pancreatitis and malabsorbtion of fats ,

[ArchivalUser]

The qs about septic shock

Pathophysiology
a. There is a severe decrease in SVR secondary to peripheral vasodilation. Extremities are often warm due to vasodilation.
b. Cardiac output is normal or increased (due to maintenance of stroke volume and tachycardia).
EF is decreased secondary to a reduction in contractility.
5. Can be complicated by adult respiratory distress syndrome, ATN, DIC, multiple organ failure, or death

Step-Up to Medicine (Step-Up Series)

[ArchivalUser]

just wondering how many qs did u get wrong...

[ArchivalUser]

volume deficits are corrected first. and then electrolytes.
if patient vitals are not stable, correct them with normal saline . once vitals are stable, correct electrolyte abn.here by giving half normal saline.
orthostatic hypotension means 15-20 % fluid loss ! and if that was peds q, it means moderate dehydration !

[ArchivalUser]

I think we give normal saline,because as the patient is dehydrated and hypernatremic, so normal saline will be hypotonic as compared to hypertonic plasma,with time by normal saline slowly hypernatremia will be corrected and fluid will start moving into intracellular compartment,hence we can deal with both dehydration and hypernatremia,then we can use 0.45% saline
in uw says that only use normal saline for correction of dehydration and will also correct electrolytes ....dont ever use half normal saline or dextrose as they leave the intravascular system and dont contribute to volume ........ after correcting defects continue on dextrose as maintenance not half normal saline ( its of no use to kids
choosing between half saline(.45%) and normal saline(.9%) for treatment of hypernatremia .
Whereas normal saline is isotonic to plasma and it will bring down sodium at an optimal rate without any risks.
So whenever treating hypernatremia(whichever the cause) always use normal saline which may sound as a hypertonic solution but its not ,its Isotonic to plasma
I am so sorry ,Huge mistake .If half saline is used to treat hypernatremia it will drop serum sodium at a very fast rate and sodium is exchanged with free water.Further water will flow into brain cells causing them to swell .This can lead to cerebral edema ,potentially resulting in seizures, permanent brain damage, or death.So normal saline is used to prevent rapid correction of hypernatremia

Central pontine myelolysis occurs with Rapid correction of hyponatremia