deck 13 Flashcards
other problem w/ sulfonylureas
- may increase cardiovascular risk
- may shorten time to beta cell burnout
best oral DM drugs
- GLP-1
- help you lose weight,
problem with dropping hyperglycemic patient
- cerebral edema
- GO SLOW
HTN BP goal
140/90
People who need tighter BP goals
1) people w/ albuminuria or proteinuria – 130/80
2)
chlorthalidone vs. HCTZ
chlorthalidone is better - greater BP reduction, longer acting, no electrolyte imbalances.
when to use ARB over ACEI
gout patient. ARBs have uricosuric activity
major cause of resistant HTN
Hyperaldosteronism
Last med you add on to person maxed out on HTN meds
- mineralocorticoids (spironolactone)
Absolute contraindications to ECT?
None
causes of 2ndary HTN
CKD, OSA, primary hyperaldosteronism
testing for primary hyperaldosteronism
morning plasma aldosterone/renin ratio
high risk setting for kids for CAP
day care
Urine burning how to clarify…
- ask if urethral, sometimes patient say stomach is burning
CAP treatment in kids
Oral high-dose amoxicillin (90 mg/kg/day) w/ close outpatient followup
solid foods introduced
4-6 months
Midshaft posteromedial tibial stress fractures management
Air stirrup leg brace (aircast)
initial screening test for late-onset male hypogonadism
serum total testosterone (free testosterone is very expensive)
CENTOR criteria
….
someone with a strep throat and *runny nose or cough
NOT STREP
Low TSH level with person on levothyroxine…
Indicates over replacement. Reduce dosage slightly and repeat TSH level in 2-3 months.
Imaging to look for students in urinary tract
CT pyelogram or US
what generally rules out UTI
no pyuria
sharp, severe heel pain is probably
plantar fasciitis
plantar fasciitis
- pain on plantar surface of heel, worse after prolonged sitting or getting out of bed in morning (first step phenomenon)
- self-resolving
1st line for plantar fasciitis
OTC heel inserts
Most accurate test for ACL teaer
Lachman test, followed by anterior drawer test
mcmurray test tests for
meniscal tears
how do you know if MGUS has progressed to multiple myeloma?
- Presence of end-organ impairment in the presence of M protein, monoclonal plasma cells, or both (hypercalcemia, renal failure, anemia, or skeletal lesions).
- 1% annual risk of progression.
femoral neuropathy
- mononeuropathy common with DM2
- decreased sensation to pinprick and light touch over anterior thigh + reduced motor strength on hip flexion/knee extension.
diabetic polyneuropathy presentation
Symmetric, distal
meralgia parenthetic
- can be secondary to DM but numbness/paresesthia with no motor dysfunction.
iliofemoral atherosclerosis
- relatively common complication of DM
- intermittent claudication involving one or both calf muscles.
other impt exam component of hypothyroidism
achilles reflex. (delayed relaxation phase)
hallmark biochemical feature of referring syndrome
hypophosphatemia
pharyngeal and laryngeal SE’s of inhaled corticosteroids
- sore throat, coughing on inhalation, weak or hoarse voice, oral candidiasis
management of hoarseness that does not resolve
- laryngoscopy (if doesn’t resolve within 3 months)
common false positives in
Codeine often comes up as morphine because morphine is a metabolite of codeine
dizziness differential
- vertigo
- near syncope
- disequilibrium
- light headedness (high correlation with anxiety)
initial management of hypercalcemia of malignancy
- get pt euvolemic
- fluid replacement with NS to correct volume depletion that is always present + enhance renal calcium excretion
brown to black leopard spotting of colonic mucosa?
Melanosis coli - benign condition resulting from abuse of laxatives.
murmurs that increase with valsalva
HOCM + MVP
decreases venous return to heart, thereby decreasing CO
best test for diagnosis of COPD
spirometry
Patients who need CRC screening at age 40
1) 1 first degree relative diagnosed with CRC or adenomatous polyps before age 60
2) at least 2 second degree relatives with CRC cancer
preferred screening for patients at high risk of CRC
colonoscopy
drugs that cause pleurisy
Hydralazine (lupus-induced)
procainamide
quinidine
amiodarone, bleomycin, methotrexate
Drug to convert patient to normal rhythm from WPW rhythm
Procainamide
Amiodarone
relationship between calorie consumption and weight
not a direct relation between daily calorie consumption and weight. An adult male consuming an extra 100 calories a day above his caloric need will not continue to gain weight indefinitely; rather, his weight will increase to a certain point and then become constant. Fat must be fed, and maintaining the newly created tissue requires an increase in caloric expenditure. An extra 100 calories a day will result in a weight gain of approximately 5 kg, which will then be maintained.
