tag:blogger.com,1999:blog-89152220290615845082024-03-05T08:36:03.877-08:00January 2011 archiveArchive of www.icuroom.netUnknownnoreply@blogger.comBlogger30125tag:blogger.com,1999:blog-8915222029061584508.post-78056373249078853522011-01-31T09:29:00.000-08:002011-01-31T09:29:00.537-08:00<strong><span style="color:#660000;">Q</span>: <em><span style="color:#003333;">52 year old male developed intracranial hemorrhage after receiving thrombolytic therapy for CVA. What is the treatment?<br /></span></em><br /><br /><span style="color:#660000;">Answer</span>: <span style="color:#000000;">Transfusion of cryoprecipitate.<br /><br />Prepare for administration of 6 to 8 units of cryoprecipitate containing factor VIII. It is not a bad idea to also adminster 6 to 8 units of platelets. </span></strong>Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-8915222029061584508.post-31736635828112139012011-01-30T07:38:00.000-08:002011-01-30T07:38:00.497-08:00<strong><span style="color:#660000;">Q:</span> <em><span style="color:#003300;">What is Delta-p value in extremity's Compartment syndrome?<br /><br /></span></em><span style="color:#660000;">A;</span><span style="color:#000000;"> Delta-p is diastolic blood pressure minus intracompartmental pressure. It is a measure of perfusion pressure. Delta-p measurements of less than 30 mm Hg is used for fasciotomy. Other clinical situations should be taken into consideration. </span></strong>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8915222029061584508.post-39312557987608413062011-01-29T00:05:00.000-08:002011-01-29T00:05:00.818-08:00<strong><span style="color:#990000;">Q:</span> <em><span style="color:#003333;">What is Captopril Test ?<br /></span></em><br /><span style="color:#990000;">A</span>; <span style="color:#000000;">It is a simple poor man's test to diagnose renal cause for hypertension. It has high sensitivity but a low specificity.<br /></span></strong><br /><span style="color:#000000;"><strong>In this test, the baseline level of renin in the blood is determined by drawing blood. Then an oral dose of captopril is given and, after an hour, the plasma renin level is determined again. Because captopril blocks the activity of one of the proteins that renin works on, the blood pressure should fall. This decrease in blood pressure is detected by both kidneys, but especially by the one that has a blocked blood supply. This kidney responds by secreting a large amount of renin. Thus an exaggerated renin response after the dose of captopril is suggestive of a renovascular hypertension. hypertension.<br /></strong><br /><br /></span><br /><span style="font-size:78%;color:#000000;">The captopril test for identifying renovascular disease in hypertensive patients. - Am J Med. 1986 Apr;80(4):633-44. </span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8915222029061584508.post-70510100415037315412011-01-28T00:02:00.000-08:002011-01-28T19:31:41.541-08:00<p><strong><em><span style="color:#003333;"><span style="color:#660000;">Q:</span> What is the 'rule of thumb' of Esmolol dose in heart rate (HR) control of Atrial fibrillation?<br /></span></em></strong><br /><br /><strong><span style="color:#660000;">A;</span></strong> <strong><span style="color:#000000;">Following intravenous infusion of esmolol for 30 minutes with dose of: </span></strong></p><ul><li><strong><span style="color:#000000;">50 mcg/kg per minute HR drop by 8% </span></strong></li><li><strong><span style="color:#000000;">100 mcg/kg per minute HR drop by 11% </span></strong></li><li><strong><span style="color:#000000;">150 mcg/kg per minute HR drop by 14% </span></strong></li><li><strong><span style="color:#000000;">200 and above mcg/kg per minute HR drop by 15% </span></strong></li></ul><p><span style="color:#003300;"><span style="color:#660000;"><span style="color:#000000;"><span style="color:#990000;"><span style="font-family:Arial,Helvetica,sans-serif;font-size:85%;color:#000000;"><span style="font-size:100%;"><span style="color:#000000;"><span style="font-size:100%;"><span style="color:#000000;"><span style="font-size:100%;"><span style="color:#000000;"><span style="color:#000066;"><span style="color:#000000;"><span style="font-size:85%;"><span style="color:#660000;"></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></p><p><span style="color:#003300;"><span style="color:#660000;"><span style="color:#000000;"><span style="color:#990000;"><span style="font-family:Arial,Helvetica,sans-serif;font-size:85%;color:#000000;"><span style="font-size:100%;"><span style="color:#000000;"><span style="font-size:100%;"><span style="color:#000000;"><span style="font-size:100%;"><span style="color:#000000;"><strong><span style="color:#000066;"><span style="color:#000000;"><span style="font-size:85%;"><span style="color:#660000;"></span></span></span></span></strong></span></span></span></span></span></span></span></span></span></span></span> </p><p><span style="color:#003300;"><span style="color:#660000;"><span style="color:#000000;"><span style="color:#990000;"><span style="font-family:Arial,Helvetica,sans-serif;color:#000000;"><span style="color:#000000;"><span style="color:#000000;"><span style="color:#000000;"><strong><span style="color:#000066;"><span style="color:#000000;"><span style="color:#660000;">Related Previous Pearl</span>: <em><span style="color:#336666;"><span style="color:#003333;"><a href="http://icuroom-oct-10.blogspot.com/2010/10/q-esmolol-is-metabolised-in.html"><span style="color:#003300;">Esmolol is metabolised in...?</span></a></span></span></em></span></span><span style="font-family:Arial,Helvetica,sans-serif;color:#003300;"><span style="color:#000000;"></span></span></strong></p></span></span></span></span></span></span></span></span><br /><span style="font-size:85%;">Source: AHFS Drug Information. (CR) Copyright, 1959-2010, Selected Revisions January 2010. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8915222029061584508.post-14863684461082876292011-01-27T00:29:00.000-08:002011-01-27T04:06:02.828-08:00<span style="font-size:85%;"><strong>Not all anti-lipids are created equal<br /></strong><br /></span><strong>Q: <em><span style="color:#003333;">What is the equivalency of three major anti-lipids Crestor (Rosuvastatin) Lipitor (atorvastatin) and Zocor (Simvastatin)?<br /></span></em><br /></strong><br /><strong><span style="color:#660000;">Answer:</span> <span style="color:#000000;">Crestor 5 mg = Lipitor 10 mg = Zocor 20 mg </span></strong>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8915222029061584508.post-81310257524571838042011-01-26T10:15:00.000-08:002011-01-27T04:02:02.547-08:00<strong><span style="color:#990000;">Q:</span></strong> <span style="color:#003333;"><em><strong>Which of the following medicines can cause "Red Man Syndrome"?<br /></strong></em></span><br /><span style="color:#003333;"><em><strong>A) Ciprofloxacin,<br /><br />B) Amphotericin B,<br /><br />C) Rifampcin<br /><br />D) Vancomycin<br /><br />E) All of the above</strong></em><br /><br /></span><br /><br /><strong><span style="color:#660000;">Answer</span></strong>: <strong><span style="color:#000000;">All of the above<br /></span></strong><br /><strong><span style="color:#000000;">Antibiotics such as ciprofloxacin, amphotericin B and rifampcin can also potentially cause red man syndrome beside vancomycin. Like vancomycin, they are capable of causing direct degranulation of mast cells and basophils. Red man syndrome is amplified if these antibiotics are combined with vancomycin or with each other. Red man syndrome is also magnified in patients receiving vancomycin and opioid analgesics, muscle relaxants, or contrast dye because these drugs can also stimulate histamine release.<br /><br /></span></strong><strong><span style="color:#000000;"></span></strong>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8915222029061584508.post-16615120223058090032011-01-25T04:57:00.000-08:002011-01-25T04:57:00.473-08:00<strong><span style="color:#660000;">Q:</span> <em><span style="color:#003333;">Why Lasix is called Lasix?<br /></span></em><br /><span style="color:#660000;">Answer:</span> <span style="color:#000000;">Furosemide is sell under brand name Lasix. The name Lasix is derived from the phrase "lasts six (hours)" — referring to its duration of action of 4 to 6 hours!</span></strong>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8915222029061584508.post-74591218928732719622011-01-24T04:06:00.000-08:002011-01-24T04:06:00.872-08:00<strong><span style="color:#660000;">Q:</span><span style="color:#003333;"> </span><em><span style="color:#003333;">53 year old male with ESRD (Renal failure) is in ICU. Nurse ask you to write some prn medicine for BP control. Patient is already on high dose B-blocker. You write for IV Hydralazine. one hour after administration of Hydralazine you have been asked to evaluate patient for mental status change?<br /><br /></span></em><span style="color:#660000;"></span></strong><br /><strong><span style="color:#660000;"></span></strong><br /><strong><span style="color:#660000;">Answer:</span><span style="color:#000000;"> In patients particularly with renal failure/uremia hydralazine may produce a marked decrease in blood pressure, resulting in central reactions such as anxiety, delirium, disorientation, depression, and coma.<br /><br /></span></strong><strong><span style="color:#000000;"></span></strong><strong><span style="color:#000000;">Also Hydralazine is a cerebral vasodilator and is known to increase intracranial pressure which, together with its effect upon systemic blood pressure, reduces the cerebral perfusion pressure.<br /></span></strong>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8915222029061584508.post-476794818015871322011-01-23T00:57:00.000-08:002011-01-23T06:02:16.569-08:00<strong><span style="color:#000000;"><span style="color:#330000;">Q:</span> <em><span style="color:#003333;">What is the difference between "Blue" and "Green" acapella®?<br /><br /></span></em><br /><span style="color:#330000;">Answer:</span> Acapella® is a vibratory Positive Expiratory Pressure (PEP) Therapy System which also combines the benefits of airway vibrations to mobilize pulmonary secretions.<br /><br />PEP devices work by having a one way valve that creates resistance when the patient breathes out against it. With PEP therapy, the pressure difference that occurs when a patient breathes out allows the lungs to fill with additional air, which in turn will push the mucus out as the lungs try to return to an equilibrant volume.<br /><br />Patient inhales deeply with a 3 to 4 second breath hold, alternating with normal breathing. Inspiratory to expiratory ratio is kept around 1:3 to 1:4. After 5-10 exhalations of alternating regular/deep breaths, patient is asked to cough.<br /><br />Blue Acapella - has low expired lung volumes with less than 15 lpm for 3 seconds.<br />Green Acapella - has high expired lung volumes with more than 15 lpm for 3 seconds.</span></strong><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgolMGXR7LMRoPEejrZWkQ5LFiPhH6ikfIwUE3Y0SmPm7fN9WczPiHfEdFaRKtvut9JVWQekuKpK7Rmp8xPEdaczJe_rP1bwBS6d8vitYcVxIW5Q7YUisAH1SzaLothAgdeiUIxixOb_MMh/s1600/Acapella.jpg"><img style="TEXT-ALIGN: center; MARGIN: 0px auto 10px; WIDTH: 250px; DISPLAY: block; HEIGHT: 264px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5565225630364247346" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgolMGXR7LMRoPEejrZWkQ5LFiPhH6ikfIwUE3Y0SmPm7fN9WczPiHfEdFaRKtvut9JVWQekuKpK7Rmp8xPEdaczJe_rP1bwBS6d8vitYcVxIW5Q7YUisAH1SzaLothAgdeiUIxixOb_MMh/s400/Acapella.jpg" /></a><br /><div></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8915222029061584508.post-27320362246988988832011-01-22T21:43:00.000-08:002011-01-21T21:44:26.909-08:00<strong><span style="color:#660000;">Q</span>: <em><span style="color:#003333;">36 year old male is admitted to ICU with severe metabolic acidosis. You suspect sepsis and ordered pan-culture. While reviewing lab you see that urine screen is reported with calcium oxalate crystals. What is your concern?<br /></span></em><br /><br /><span style="color:#660000;">Answer:</span> Ethylene glycol poisoning<br /><br />Ethylene glycol’s major toxicity is a result of it’s metabolites: glycoaldehyde, oxalic acid, glycolic acid, and glyoxylate. Oxalic acid combines with calcium to form calcium oxalate crystals.<br /></strong>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8915222029061584508.post-65915425203606682892011-01-21T18:35:00.000-08:002011-01-21T21:08:43.115-08:00<strong><span style="color:#660000;">Q</span>: <em><span style="color:#003333;">An extremely vasculopath patient (almost impossible to obtain central line) presented to ER with organophosphate poisoning. Till Vascular team access vessel what could be an alternate route of Atropine in its symptomatic treatment?<br /><br /></span></em><br /><span style="color:#660000;">Answer</span>:<span style="color:#000000;"> Sublingual<br /></span></strong><br /><strong><span style="color:#003300;"><span style="color:#660000;"><span style="color:#000000;"><span style="color:#990000;"><span style="font-family:Arial,Helvetica,sans-serif;font-size:85%;color:#000000;"><p><span style="font-size:78%;color:#333300;"></span></p><p><span style="font-size:78%;color:#333300;"></span> </p><p><span style="font-size:78%;color:#333300;">Rajpal S, Ali R, Bhatnagar A, Bhandari SK, Mittal G. </span><a href="http://www.ncbi.nlm.nih.gov/pubmed/20159382" target="_blank"><span style="font-size:78%;color:#333300;">Clinical and bioavailability studies of sublingually administered atropine sulfate</span></a><span style="font-size:78%;color:#333300;">. <i>Am J Emerg Med</i>. Feb 2010;28(2):143-50.</span></p></span></span></span></span></span></strong>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8915222029061584508.post-47140099727662399862011-01-20T06:35:00.000-08:002011-01-20T06:35:00.609-08:00<strong><span style="color:#003300;"><span style="color:#660000;">Q:</span><em> 69 year old male with history of COPD is now recommended to have aerosolized colistin for his pulmonary infection. Which simultaneous order may benefit him?<br /></em></span></strong><br /><strong><span style="color:#000000;"><span style="color:#660000;"></span></span></strong><br /><strong><span style="color:#000000;"><span style="color:#660000;">Answer</span>: Administration of aerosolized colistin may cause bronchospasm, especially in patients with previous related history. Orders to give bronchodilators prior to administration of colistin may prevent the problem.</span></strong>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8915222029061584508.post-34787620297861613622011-01-19T18:33:00.000-08:002011-01-19T18:35:14.866-08:00<strong><span style="color:#000000;"><span style="color:#660000;">Q:</span> <em><span style="color:#003333;">Can you do any lab test for restless leg syndrome (RLS)?</span></em><br /><br /></span></strong><br /><strong><span style="color:#000000;"><span style="color:#660000;">Answer:</span> Yes! Ferritin level<br /></span></strong><br /><strong><span style="color:#000000;">Five major causes described for RLS<br /><br />1. <em><span style="color:#003300;">Iron Deficiency</span></em>: Even without significant anemia, serum ferritin levels below 50 ng per mL can exacerbate RLS symptoms. Serum ferritin levels is now considered essential in the workup of RLS.<br /><br />2. <em><span style="color:#003300;">Neurologic</span></em>: in association with spinal cord and peripheral nerve lesions.<br /><br />3. <em><span style="color:#003300;">Pregnancy</span></em>: RLS may affects women during pregnancy. Symptoms usually subside within a few weeks postpartum.<br /><br />4. <em><span style="color:#003300;">Uremia</span></em>: RLS occurs in up to 50 percent of patients with end-stage renal failure and subside after renal transplantation.<br /><br />5. <span style="color:#003300;"><em>Drug-Induced like</em></span>: tricyclic antidepressants, SSRIs, lithium, Caffeine and dopamine antagonists.</span></strong>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8915222029061584508.post-67576189221130872592011-01-18T06:47:00.000-08:002011-01-18T06:47:00.342-08:00<strong><span style="color:#660000;">Bedside trick - suspecting tracheal aspiration!!</span><br /><br /><span style="color:#000000;">One quick method of suspecting tracheal aspiration or atleast ruling out tracheal aspiration is checking glucose concentration by regular bedside glucose meters. A glucose concentration of more than 20 mg/dl of bloodless tracheal aspirate doesn't confirm but atleast enhance the suspicion of tracheal aspiration.<br /><br />Though literature is full of conflicting data for this method but still it is a very quick, effective and easy way of suspecting or ruling out tracheal aspiration</span>.</strong>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8915222029061584508.post-66232115744628173482011-01-17T11:55:00.000-08:002011-01-17T11:55:00.811-08:00<div align="center"><strong>Picture Diagnosis</strong></div><div align="center"><br /></div><p><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjvMMV2G6vUU9M26Kgy5PO6gLWW2yebFwD-ovcX64ali0t92nV3DzeJE8yaYKZkDuPYw1WIThaCox8RASI3Qm8ywer9PQaA0WYHzFJB-l6wiIlK_vyMVnx-qc6Vok2ytA10RFkH1nkB7QY/s1600/chronicbuddchiarisyndromeandabdominalvarices.jpg"><img style="TEXT-ALIGN: center; MARGIN: 0px auto 10px; WIDTH: 303px; DISPLAY: block; HEIGHT: 400px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5562874938536430706" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjvMMV2G6vUU9M26Kgy5PO6gLWW2yebFwD-ovcX64ali0t92nV3DzeJE8yaYKZkDuPYw1WIThaCox8RASI3Qm8ywer9PQaA0WYHzFJB-l6wiIlK_vyMVnx-qc6Vok2ytA10RFkH1nkB7QY/s400/chronicbuddchiarisyndromeandabdominalvarices.jpg" /></a><br /><br /><strong><span style="color:#660000;">Answer:</span><span style="color:#000000;"> chronic budd chiari syndrome and abdominal varices </span></strong></p><p><strong><span style="color:#000000;"><span style="color:#003333;">Courtesy:</span> <em><span style="color:#000000;">doctorshangout.com</span></em> <a href="http://www.doctorshangout.com/photo/2002836:Photo:8097?xg_source=activity"><span style="color:#660000;">here<br /></span></a></span></strong></p>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8915222029061584508.post-15365336526813349392011-01-16T06:16:00.000-08:002011-01-16T11:47:43.940-08:00<strong>FDA alert: Severe liver injury associated with dronedarone (Multaq) </strong><br /><br /><br /><strong><span style="color:#003300;"><span style="color:#660000;"><span style="color:#000000;"><span style="color:#990000;"><span style="font-family:Arial,Helvetica,sans-serif;color:#000000;"><span style="color:#003300;"><em>"The U.S. Food and Drug Administration (FDA) is alerting healthcare professionals and patients about cases of rare, but severe liver injury, including two cases of acute liver failure leading to liver transplant in patients treated with the heart medication dronedarone (Multaq)"</em></span><br /><br /></span></span></span></span></span></strong><strong><span style="color:#003300;"><span style="color:#660000;"><span style="color:#000000;"><span style="color:#990000;"><span style="font-family:Arial,Helvetica,sans-serif;color:#000000;"><p class="head1_body"><span style="color:#000066;">See full alert <a href="http://www.fda.gov/Drugs/DrugSafety/ucm240011.htm" target="_blank"><span style="color:#660000;">here</span></a></span></p></span></span></span></span></span></strong>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8915222029061584508.post-54425224904909526242011-01-15T00:22:00.000-08:002011-01-15T00:22:00.681-08:00<strong><span style="color:#003300;"><span style="color:#660000;"><p align="center"><span style="font-size:85%;color:#000000;"><span style="color:#990000;"><span style="color:#000000;">Abiocor - Total artificial heart</span></span></span></span></span></strong><br /></p><p align="center"><br /><object width="480" height="385"><param name="movie" value="http://www.youtube.com/v/oHvIwkYRFV4?fs=1&hl=en_US&rel=0"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><br /><embed src="http://www.youtube.com/v/oHvIwkYRFV4?fs=1&hl=en_US&rel=0" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="480" height="385"></embed></object></p>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8915222029061584508.post-27751478999287223382011-01-14T00:05:00.000-08:002011-01-14T00:06:20.096-08:00<strong><span style="color:#660000;">Q</span>: <em><span style="color:#003333;">What is takotsubo cardiomyopathy?<br /><br /></span></em><br /><span style="color:#660000;">Answer</span>: <span style="color:#000000;">Takotsubo cardiomyopathy, also known as broken-heart-syndrome, or simply stress cardiomyopathy, is a type of non-ischemic cardiomyopathy.<br /><br />The hallmark of the disease is bulging out of the apex of the heart with preserved function of the base that earned the syndrome its name "tako tsubo", or octopus trap in Japan, where it was first described.The cause appears to involve high circulating levels of catecholamines. If individual survives their initial presentation, patient usually improves within 2 months. For unknown reason - Takotsubo cardiomyopathy is more commonly seen in post-menopausal women. </span></strong>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8915222029061584508.post-46889724749628908012011-01-13T10:13:00.000-08:002011-01-13T10:13:00.220-08:00<strong>On physical exam - a dying art</strong><br /><br /><strong><span style="color:#660000;">Q:</span> <em><span style="color:#003300;">What is uremic frost?<br /></span></em><br /><span style="color:#660000;">Answer:</span> <em><span style="color:#000000;">Uremic frost is a dermatological manifestation of severe azotemia. When the blood urea nitrogen level is high, the concentration of urea in sweat increases greatly. Evaporation of sweat causes urea to crystallize and deposit on the skin.<br /><br /></span></em></strong><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjR8D6fPHBWPdIlagTsabNT_RpLeRYphrqubob8sBa5pb5P_Po-WQekjKeFjeGbuU1uHa2bfY5EL-3rz8s-oYrtDW95_LN4mYmf6rtPic7xLeUs36LWgv-dul3ld7XyrGO7iE2a7FT8GuCn/s1600/urfrost.jpg"><img style="TEXT-ALIGN: center; MARGIN: 0px auto 10px; WIDTH: 335px; DISPLAY: block; HEIGHT: 205px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5561549896412190466" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjR8D6fPHBWPdIlagTsabNT_RpLeRYphrqubob8sBa5pb5P_Po-WQekjKeFjeGbuU1uHa2bfY5EL-3rz8s-oYrtDW95_LN4mYmf6rtPic7xLeUs36LWgv-dul3ld7XyrGO7iE2a7FT8GuCn/s400/urfrost.jpg" /></a>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8915222029061584508.post-87182840717362103772011-01-12T06:19:00.000-08:002011-01-12T06:19:00.724-08:00<strong><span style="color:#000000;"><span style="color:#660000;">Q:</span> <em><span style="color:#003333;">Beside central diabetes, nephrogenic and gestational diabetes insipidus - what is Dipsogenic Diabetes Insipidus (DI)?</span></em></span></strong><br /><strong><span style="color:#000000;"><em><span style="color:#003333;"></span></em><br /><br /><span style="color:#660000;">Answer:</span> Dipsogenic DI is due to a defect or damage to the thirst mechanism, which is located in the hypothalamus. This defect results in an abnormal increase in thirst and fluid intake that suppresses ADH secretion and increases urine output.<br /><br /><em><span style="color:#003333;">Clinical significance:</span></em> Desmopressin (or other drugs) should not be used to treat dipsogenic diabetes insipidus because they may decrease urine output but not thirst and fluid intake. This fluid "overload" can lead to water intoxication, leading to hyponatremia and so brain damage.<br /><br />There is no effective treatment but some recommends small doses of DDAVP at bedtime to relieve nocturia.</span></strong>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8915222029061584508.post-4322150551138347372011-01-11T06:22:00.000-08:002011-01-11T06:22:00.193-08:00<strong><span style="color:#660000;">Q:</span></strong> <strong><em><span style="color:#003300;">28 year old patient is admitted to ICU after traumatic brain injury. While evaluating films with radiologist he shows concerns of ischemia to pituitary gland, hypothalamus and surrounding structures. Which treatments you need to be worried if symptoms of Panhypopituitarism develops? </span></em></strong><br /><br /><br /><strong><span style="color:#000000;"><span style="color:#660000;">Answer:</span> Pituitary hormones of clinical significance include </span></strong><br /><strong><span style="color:#000000;"><ul><li>adrenocorticotropic hormone (ACTH), </li><li>follicle-stimulating hormone (FSH), </li><li>luteinizing hormone (LH), </li><li>growth hormone (GH), </li><li>prolactin, </li><li>thyroid-stimulating hormone (TSH), and </li><li>antidiuretic hormone (ADH) </li></ul><p><br />4 essential treatments to keep in mind: </p><ol><li>Desmopressin acetate (DDAVP) if Diabetes insipidus develops. </li><li>Hydrocortisone: Should be initiated even before workup is initiated. </li><li>Levo-thyroxine </li><li>Reproductive hormones (Estrogen or Testosterone) </li></ol><p><em>Growth hormone is not routinely replaced in adults.<br /></em></p></span></strong>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8915222029061584508.post-51811175176662045142011-01-10T10:47:00.000-08:002011-01-10T10:47:00.474-08:00<p><strong><span style="color:#000000;"><span style="color:#990000;">Q:</span> <em><span style="color:#003333;">Describe 5 functions of angiotensin II ?</span></em><br /><br /><br /><span style="color:#660000;">Answer:</span> One of the functions of the kidney is to monitor blood pressure.<br /><br />Kidney secretes renin.<br /><br />Renin acts on angiotensinogen, splitting off a fragment called angiotensin I.<br /><br />angiotensin I is cleaved by a angiotensin converting enzyme (ACE) — producing angiotensin II.<br /><br />Angiotensin II </span></strong></p><strong><span style="color:#000000;"><ul><li>constricts the walls of arterioles closing down capillary beds </li><li>stimulates the proximal tubules in the kidney to reabsorb sodium ions </li><li>stimulates the adrenal cortex to release aldosterone. (Aldosterone causes the kidneys to reclaim still more sodium and water). </li><li>increases the strength of the heartbeat; </li><li>stimulates the pituitary to release the vasopressin. </span></strong></li></ul>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8915222029061584508.post-87271498209776814012011-01-09T03:39:00.000-08:002011-01-09T03:39:00.411-08:00<strong><span style="color:#660000;">Q</span>: <em><span style="color:#003333;">Name 3 conditions each which may make fibrinogen level to go up or down?</span></em><br /><br /><br /><span style="color:#660000;">Answer:<br /><br /></span><em>Conditions/drugs which may cause decrease fibrinogen levels:</em></strong><br /><ul><li><strong> Anabolic steroids, </strong></li><li><strong>Phenobarbital and </strong></li><li><strong>Valproic acid </strong></li></ul><p><strong><em>Conditions/drugs which may cause increase fibrinogen levels:</em></strong></p><ul><li><strong> Pregnancy, </strong></li><li><strong>Cigarette smoking, and </strong></li><li><strong>Estrogen</strong></li></ul>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8915222029061584508.post-14712628640352885712011-01-08T03:34:00.000-08:002011-01-08T03:34:00.823-08:00<strong><span style="color:#000000;"><span style="color:#660000;">Q:</span> <em><span style="color:#003333;">54 year old male developed life threatening GI bleeding after Fondaparinux (arixtra) administration post orthopedic surgery. FFP and pRBC is ordered and volume resuscitation started. What else can be done to counter effect of Fondaparinux (Arixtra)?<br /><br /></span></em><br /><br /><br /><span style="color:#660000;">Answer</span>: Recombinant Factor VIIa<br /><br />Low-molecular-weight heparins are inhibitors of factor Xa, but have small therapeutic window and has the risk of bleeding. Fondaparinux has a long elimination half-life.<br /><br />rFVIIa overcome the inhibition of thrombin generation and normalize the fondaparinux-induced prolongation of aPTT and PT. Sensitive thrombin-generation assays demonstrated the efficacy of rFVIIa in restoring impaired thrombin formation after fondaparinux administration. rFVIIa reverses not only the anticoagulant effect of fondaparinux but also the profibrinolytic effects of this agent, probably through activation of thrombin-activatable fibrinolysis inhibitor (TAFI).</span></strong><br /><br /><br /><br /><br /><span style="font-size:78%;color:#003333;">Reference:<br /><br />Ability of Recombinant Factor VIIa to Reverse the Anticoagulant Effect of the Pentasaccharide Fondaparinux in Healthy Volunteers - Circulation. 2002;106: 2550</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8915222029061584508.post-57477931963464334862011-01-07T06:00:00.000-08:002011-01-07T06:00:02.427-08:00<strong><span style="color:#660000;">Q:</span> <em><span style="color:#003333;">Which is more sensitive bedside diagnostic in ruling out Pneumothorax - CXR or ultrasound (Choose one)?<br /></span></em><br /><br /><span style="color:#660000;">Answer:</span> <span style="color:#000000;">Ultrasound<br /><br />It is now pretty much establish that bedside ultrasound (can be easily learn and perform by intensivist) is more sensitive in detecting pneumothorax.<br /><br />(see video in this regard in our videos section)<br /></span><br /></strong><br /><br /><span style="font-size:78%;">Reference:<br /><br />Wilkerson RG, Stone MB (January 2010). "Sensitivity of bedside ultrasound and supine anteroposterior chest radiographs for the identification of pneumothorax after blunt trauma". Acad. Emerg. Med. 17 (1): 11–17</span>Unknownnoreply@blogger.com0