MS2 exam 3

Cirrhosis

A chronic liver condition in which irreversible scar tissue replaces healthy liver parenchyma, severely impairing the organ's ability to filter blood, synthesize proteins, and metabolize nutrients or medications.

Jaundice

A yellow discoloration of the skin and sclera caused by increased serum bilirubin levels due to impaired hepatic uptake, conjugation, or biliary excretion.

Ascites

The pathological accumulation of fluid within the peritoneal cavity resulting from portal hypertension and decreased oncotic pressure secondary to hypoalbuminemia.

Asterixis

A bilateral, asynchronous hand-flapping tremor elicited during wrist extension; a classic neuromuscular manifestation of hepatic encephalopathy caused by elevated blood ammonia.

Portal Hypertension

Abnormally high hydrostatic pressure within the portal venous system, leading to venous collaterals, splenomegaly, ascites, and esophageal varices.

Esophageal Varices

Fragile, enlarged submucosal veins in the lower esophagus caused by portal hypertension that carry a high risk of rupture, massive hematemesis, and hypovolemic shock.

Hepatic Encephalopathy

A spectrum of neuropsychiatric abnormalities seen in liver failure, driven by the accumulation of neurotoxins such as ammonia in the brain, presenting with confusion, personality changes, and asterixis.

Lactulose

A non-absorbable disaccharide that lowers serum ammonia by trapping it as ammonium in the bowel lumen to be excreted in stool, typically dosed to achieve 2 to 3 soft stools per day.

Rifaximin

A minimally absorbed oral antibiotic that reduces ammonia production by targeting and eliminating ammonia-generating bacterial flora in the gastrointestinal tract.

Octreotide

A synthetic somatostatin analog administered during acute esophageal variceal hemorrhage to induce splanchnic vasoconstriction and decrease portal venous inflow and pressure.

Cholecystitis

Inflammation of the gallbladder wall, most commonly triggered by a gallstone obstructing the cystic duct, characterized by severe right upper quadrant pain that frequently occurs after fatty meals.

Murphy Sign

A clinical diagnostic sign elicited when a patient abruptly halts inspiration during deep palpation of the right upper quadrant due to acute discomfort, indicating acute cholecystitis.

Pancreatitis

Inflammation of the pancreas initiated by premature intra-acinar activation of digestive proenzymes, leading to autodigestion of pancreatic parenchyma and surrounding tissues.

Serum Lipase

The most sensitive and specific laboratory enzyme biomarker evaluated for the diagnosis of acute pancreatitis.

Hypocalcemia in Pancreatitis

A metabolic complication of acute pancreatitis that occurs when free fatty acids released during peripancreatic fat necrosis chelate with circulating ionized calcium, causing neuromuscular irritability and tetany.

Diabetes Insipidus (DI)

A disorder of water homeostasis marked by absolute antidiuretic hormone (ADH) deficiency or renal resistance to ADH, producing profound polyuria, polydipsia, urine specific gravity $< 1.005$, and hypernatremia.

Desmopressin (DDAVP)

A synthetic analog of vasopressin (ADH) that serves as the primary pharmacological replacement therapy for central diabetes insipidus.

SIADH (Syndrome of Inappropriate Antidiuretic Hormone)

A syndrome defined by excessive, uninhibited release of ADH that causes fluid retention, concentrated urine with specific gravity $> 1.030$, dilutional hyponatremia, and an increased risk of cerebral edema.

3% Hypertonic Saline

A high-concentration crystalloid solution indicated for the controlled, cautious correction of severe, acute symptomatic hyponatremia in SIADH to prevent cerebral herniation.

Osmotic Demyelination Syndrome

A severe neurological complication characterized by irreversible brainstem damage, triggered by overly rapid therapeutic elevation of chronic hyponatremic serum sodium levels.

Diabetic Ketoacidosis (DKA)

An acute, rapid-onset diabetic emergency predominantly affecting type 1 diabetics, characterized by hyperglycemia ($\ge 200\,\text{mg/dL}$), metabolic acidosis ($\text{pH} < 7.3$, bicarbonate $< 18\,\text{mEq/L}$), ketonemia (beta-hydroxybutyrate $\ge 3\,\text{mmol/L}$), and an elevated anion gap.

Kussmaul Respirations

A compensatory respiratory pattern of deep, rapid breathing seen in DKA aimed at expiring excess carbon dioxide to mitigate severe metabolic ketoacidosis.

Hyperosmolar Hyperglycemic State (HHS)

A gradual-onset diabetic emergency primarily occurring in type 2 diabetes, presenting with extreme hyperglycemia ($\ge 600\,\text{mg/dL}$), profound hyperosmolality ($> 320\,\text{mOsm/kg}$), and severe dehydration without significant ketoacidosis.

Potassium Safety Threshold (DKA/HHS)

The clinical mandate requiring serum potassium to be assessed and verified to be at or above $3.5\,\text{mEq/L}$ before intravenous insulin initiation, preventing lethal intracellular potassium shifts and arrhythmias.

XABCDE Protocol

An emergency resuscitation hierarchy that mandates immediate life-saving intervention for exsanguinating, catastrophic external hemorrhage (X) prior to proceeding through airway, breathing, circulation, disability, and exposure.

Full-Thickness Burn

A severe burn involving the entire epidermis and dermis into subcutaneous tissue; it appears dry, leathery, and waxy white, brown, or black, and central areas are typically painless due to destroyed sensory nerve endings.

Carbon Monoxide Poisoning

A toxic inhalation injury in which carbon monoxide binds hemoglobin with high affinity; routine pulse oximetry appears deceptively normal, requiring diagnostic confirmation via co-oximetry carboxyhemoglobin levels.

Parkland Formula

A fluid resuscitation calculation for thermal burns determining the first 24-hour volume: $4\,\text{mL} \times \text{body weight (kg)} \times \text{\%TBSA burned}$, with half administered over the first 8 hours and the remaining half over the subsequent 16 hours.

Escharotomy

A surgical incision made through inelastic, full-thickness burn tissue (eschar) to release constrictive circumferential tension, preventing compartment syndrome or restoring restricted chest expansion.

Fasciotomy

A surgical excision through deep muscular fascial layers to relieve dangerously elevated intracompartmental pressures that compromise neurovascular viability.

N-acetylcysteine (NAC)

The specific pharmacological antidote administered to restore glutathione stores and prevent hepatotoxicity following acetaminophen overdose.

Naloxone

A pure competitive opioid receptor antagonist administered rapidly to reverse central nervous system and life-threatening respiratory depression in opioid toxicity.

Deferoxamine

A specific chelating agent administered to bind and facilitate renal clearance of toxic elemental iron in acute iron poisoning.

Activated Charcoal

An oral gastrointestinal adsorbent given early after ingestion of absorbable toxins; it is ineffective for substances such as elemental iron, lithium, caustic corrosives, and alcohols.

Heat Exhaustion

A heat-related illness resulting from significant salt and water depletion, presenting with heavy diaphoresis, dizziness, headache, and a core body temperature that usually remains below $40^\circ\text{C}\,(104^\circ\text{F})$.

Heat Stroke

A life-threatening medical emergency caused by thermoregulatory system collapse, marked by a core body temperature $\ge 40^\circ\text{C}\,(104^\circ\text{F})$, hot skin (sweaty or dry), and acute central nervous system dysfunction.

Hypothermia

An involuntary decline in core body temperature below $35^\circ\text{C}\,(95^\circ\text{F})$, categorized as mild ($32\text{--}35^\circ\text{C}$), moderate ($28\text{--}32^\circ\text{C}$), or severe ($< 28^\circ\text{C}$).

Afterdrop

A phenomenon during hypothermia rewarming in which core body temperature continues to decline as colder, stagnant blood returns from peripheral extremities back into central circulation.