COMAT Internal Medicine || with 100% Errorless Solutions.

Heart Failure Exacerbation correct answers -Some of the common symptoms of heart failure include dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, peripheral edema and non-specific abdominal symptoms like nausea and vomiting. -Common physical findings in heart failure exacerbation include peripheral edema, pulmonary crackles, elevated jugular venous pressure, hepatojugular reflex, displaced apical impulse, and S3 gallop. Prevention of HF exacerabtion correct answers MONITOR SODIUM -Medication regimen typically focuses on regression or reverse modeling of the left ventricle with beta blocker, diuretics and ACE inhibitor or Angiotension receptor blocker therapy. -Lifestyle changes include exercise, weight loss and a low sodium diet. -Reduced sodium intake is a key step for prevention in non-pharmacologic management of heart failure. -Water always follows sodium; therefore, monitoring sodium intake is key in monitoring plasma volume in patients. -Increased sodium intake results in increased fluid retention which further decreases the cardiac output. -Sodium restriction is necessary to prevent expansion of the extracellular fluid volume and to prevent peripheral edema to decrease the myocardial wall stress and improve renal flow. -Therefore, sodium intake should be reduced to less than 2 g/day to prevent heart failure exacerbation. Potassium in heart failure correct answers -Potassium levels should be monitored closely in patients on any potassium sparing medications like ACE inhibitors and spironolactone. -Also, low salt substituents for heart failure patients often contain potassium chloride, which should be used in moderation due to risk of hyperkalemia in patients on potassium sparing medications. -However, low sodium intake is more important in prevention of heart failure exacerbation than potassium. Warfarin Skin Necrosis correct answers *Warfarin induced skin necrosis is more frequently seen in individuals diagnosed with protein C deficiency.* -Warfarin therapy is one of the most commonly used regimens for anticoagulation due to its ability to be monitored and readily reversed. -It interferes with the gamma carboxylation of the vitamin K dependent clotting factors such as II, VII, IX, X, protein C, and protein S. -Other than bleeding, one of the known major complications of warfarin therapy is full thickness skin necrosis and sloughing over fatty areas, such as the buttocks, the breast, and the thigh. -This phenomenon is known to occur more frequently in individuals diagnosed with protein C deficiency. -This can usually be avoided by using a heparin or low molecular weight heparin (LMWH) "bridge" until the warfarin level is therapeutic.