Ace Your First Aid for the USMLE Step 1 (2021) Classes and Exams with Picmonic: #1 Visual Mnemonic Study Tool for Physician Assistant (PA) Students

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First Aid for the USMLE Step 1 (2021) | Physician Assistant (PA) School Study Aid


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Hyponatremia
Assessment
< 135 mEq Na+
Nausea and Vomiting
Decreased LOC
Confusion / Lethargy
Seizures
Priority Interventions
Assess Airway
Reduce Diuretic Dosage
Fluid Excess Hyponatremia
Mannitol (Osmitrol)
Fluid Restriction
Fluid Deficit Hyponatremia
Hypertonic Solution (3% or 5% NaCl)
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2 mins
Hypernatremia
Assessment
> 145 mEq/L Na+
Change in LOC
Extreme Thirst
Orthostatic Hypotension
Dry Flushed Skin
Muscle Twitching
Seizures
Priority Interventions
Prevent Dehydration
Hypotonic Solutions (0.225% or 0.45% NaCl)
Sodium Restriction
Diuretics
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2 mins
Hypokalemia
Assessment
< 3.5 mEq/L
Muscle Weakness
Arrhythmia
U Wave
Ileus
Hyporeflexia
Interventions
IV K+ Infusion at 5-10 mEq/hr
Give Orally with Food
Nursing Considerations
Monitor Respiratory Status
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3 mins
Hyperkalemia
Assessment
> 5.0 mEq/L K+
Abdominal Cramps
Muscle Weakness
Diarrhea
Arrhythmia
Tall, Peaked T Waves
Interventions
IV Calcium
Infusion of Glucose and Insulin
Loop or Thiazide Diuretics
Kayexalate
Dialysis
Prevention Education
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2 mins
Hypocalcemia
Assessment
< 8.5 mg/dL Ca2+
Decreased Bone Density
Muscle Spasms
Tetany
Chvostek's Sign
Trousseau's Sign
Increased DTR
ECG Changes
QT Prolongation
Considerations
Oral and IV Replacement of Ca2+
Seizure Precautions
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2 mins
Hypercalcemia
Assessment
> 10.5 mg/dL Ca2+
Pathologic Fractures
Lethargy
Hypercoagulation
Constipation
ECG Changes
QT Shortening
Interventions
No Calcium Intake
Chelating Drugs
Calcitonin
Bisphosphonates
Loop Diuretics instead of Thiazide Diuretics
Considerations
Increased Risk for Renal Calculi
Increase Fluids
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3 mins
Hypomagnesemia
Assessment
Confusion
Increased Deep Tendon Reflexes (DTRs)
Neuromuscular Irritability
Seizures
Muscle Cramps
Tremors
Insomnia
Tachycardia
Interventions
Magnesium Sulfate
Foods High in Magnesium
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1 min
Hypermagnesemia
Assessment
Flushing
Lethargy
Muscle Weakness
Decreased Deep Tendon Reflexes (DTRs)
Decreased Respirations
Bradycardia
Hypotension
Interventions
Dialysis
IV Calcium Gluconate
Diuretics
Avoid Antacids and Laxatives containing Mg2+
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2 mins
Phosphate (PO43-) Lab Value
2.5 to 4.5 mg/dL
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29 secs
Syndrome Of Inappropriate Antidiuretic Hormone (SIADH)
Pathophysiology
Hypersecretion of ADH
Increased Sensitivity to ADH
Signs & Symptoms
Serum Hypoosmolality
Coma and Seizure
Dilutional Hyponatremia
Cramps and Tremors
Euvolemia
Change in LOC
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2 mins
Primary Hyperaldosteronism
Etiology
Increased Aldosterone Secretion
Adrenal Adenoma
Bilateral Adrenal Hyperplasia
Clinical Features
Hypertension
Hypokalemic Metabolic Alkalosis
No Significant Edema
Diagnosis
Increased Aldosterone
Decreased Renin
Abdominal CT Scan
Management
Aldosterone Antagonists
Surgery
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3 mins
Bartter Syndrome
Pathophysiology
Autosomal Recessive
Thick Ascending Limb of Loop of Henle
Defective NKCC Cotransporter
Decreased Na+ Reabsorption
Decreased Ca2+ Reabsorption
Increased Aldosterone
Clinical Features
Hypovolemia
Polyuria and Polydipsia
Metabolic Alkalosis
Mimics Loop Diuretics
Nephrolithiasis
Treatment
Spironolactone (Aldactone)
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4 mins
Gitelman Syndrome
Pathophysiology
Autosomal Recessive
Defective Sodium-Chloride Cotransporter in Distal Tubule
Mechanism Mimics Thiazide Diuretics
Clinical Presentation
Cramping and Tetany
Severe Fatigue
Polyuria
Diagnosis
Hypokalemia
Metabolic Alkalosis
High Urine Chloride
Treatment
Electrolyte Supplements
Spironolactone
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4 mins
Liddle Syndrome
Pathophysiology
Autosomal Dominant
Collecting Duct
Gain of Function Mutation in Epithelial Sodium Channel (ENaC)
Excess Na+ and H2O Reabsorption
Clinical Features
Decreased Renin
Decreased Aldosterone
Hypertension with Hypokalemia
Metabolic Alkalosis
Pseudohyperaldosteronism
Treatment
Amiloride and Triamterene
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3 mins
Syndrome Of Apparent Mineralocorticoid Excess (SAME)
Pathophysiology
11 Beta-Hydroxysteroid Dehydrogenase Deficiency
Elevated Cortisol
Low Renin
Low Aldosterone 
Causes
Autosomal-Recessive
Licorice (glycyrrhetinic acid) Ingestion
Signs & Symptoms
Hypertension
Hypokalemia
Metabolic Alkalosis
Treatment
Potassium-Sparing Diuretics
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4 mins

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