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Internal Medicine > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What are the values dx for DM?

A

HbA1c—> more than 6.5%
FBS: >126mg/dl
RBS: >200mg/dl with Sx of hyperglycemia
OGTT: >200mg/dl

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2
Q

What are the values dx for Pre-diabetics or values which increase the risk for diabetes?

A

HbA1c: 5.7-6.4%
FBS: 100-125mg/dl
RBS: 140-199mg/dl
OGTT: 140-199mg/dl

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3
Q

Important point for diabetes

A

If a patient is Asymp, a positive test should be reconfirmed with the same test on a d/f day for diabetes

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4
Q

What will be effect of intensive glycemic controlon complications of type 2 DM?

A

Macrovascular—–> No change
Microvascular——> decrease

No change in mortality if HbA1c is 6-7% But mortality increases if it is less than 6%

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5
Q

Name the test to assess the risk of diabetic foot ulcer

A

Monofilament test is used to document peripheral sensoryneuropathy

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6
Q

What are the d/f in lab values of DKA and HONK?

A

DKA::
Glucose is 250-500mg/dl with increased Anion gap
low Bicarb with positiveserum ketones and decreased Serum osmolality

HONK::
Glucose is 600mg/dl with normal Anion gap
Normal Bicarb with normal serum ketones and increased Serum osmolality

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7
Q

How to managed HONK?

A

Aggressive hydration with normal saline initially then with 0.45% saline
IV insulin

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8
Q

When to switch insulin route in DKA? (from IV to S/C)

A

When patient able to eat
RBS less than 200mg/dl
anion gap less than 12
serum HCO3 more than 15

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9
Q

Name the diabetic medications which can be used in renal insufficiency

A

Piogiltazone

DPP-IV inhibitors (Sitagliptin)

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10
Q

Name the diabetic medications which decreased the body weight

A

GLP-1 receptor agonist (Exenatide)

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11
Q

Name the diabetic medications which are weight neural

A

Metformin

DPP-IV inhibitors (Sitagliptin)

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12
Q

Name the diabetic medication which increased the weight

A

Pioglitazone (TZDs)

Sulfonylureas

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13
Q

Important point of diabetic medication

A 
Add Sulfonylureas when metformin failed
Add Pioglitazone (TZDs) when both metformin and Sulfonylureas not tolerate
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14
Q

Why is serum sodium level high in central DI?

A

Thirst mechanism also disturbed in central DI result intake of water is low
whereas in nephrogenic DI, thirst mechanism is intact so serum sodium level is normal

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15
Q

Important point of DI and primary polydipsia

A

DI—-> Euvolemic hypernatremia

Primary polydipsia——> Euvolemic hyponatremia

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16
Q

Name the medications which can cause diabetes insipidus and other causes

A 
Lithium
Demeclocyline
foscarnet
Cidofovir
amphotericin

Other cause hypercalcemia and receptor mutation

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17
Q

Important point of testosterone deficiency

A

Normal size is: length 4-7cm with volume 20-25ml

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18
Q

What are the absolute contraindications of COCPs?

A

Cirrhosis/liver cancer/Breast cancer

Hx of smoking Or IHD
Hx of venous thromboembolic disease

Stage 2 HTN
Currently smoker

Migraine with aura
Major surgery with immobilisation

Less than 3 wk postpartum

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19
Q

Triad of Zollinger ELLISON SYNDROME

A

Multiple refractory ulcer in stomach and distal part of intestine

Gastrin level more than 1000pg/ml in presence of normal gastric pH

Secretin stimulation test

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20
Q

How to approach Zollinger ELLISON SYNDROME ?

A

Check serum gastrin level off PPI therapy for 1 week

If less than <110 pg/ml——>no gastrinoma
If 110-1000pg/ml——>secretin stimulation test—> if positive—-> localise gastrinoma via imaging

If more than 1000pg/ml—->check gastric pH off PPI therapy for 1 week—->if less than 4—>localise gastrinoma via imaging
And if more than 4——> no gastrinoma

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21
Q

Important point of Zollinger ELLISON SYNDROME

A

calcium infusion study is usually reserved for patients who have gastric acid hypersecretion and are strongly suspected of having gastrinoma despite a negative secretin test.

Calcium infusion can lead to an increase in serum gastrin levels in patients with gastrinoma

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22
Q

Triad of GLUCAGONOMA

A

Diabetes mellitus

Necrolytic migratory erythema

GIT SxS like diarrhoea

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23
Q

Triad of VIPOMA

A

Secretory Watery diarrhoea with increase sodium and osmalal gap <50mOsm/kg

Low Stomach acid

Low potassium with high calcium and glucose

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24
Q

How to approach hyperprolactinemia in pre menopausal female?

A

Rule other causes and then MRI brain

If asymptomatic and size <1cm—>No treatment

If symptomatic and size >1cm—>dopamine agonist
Do surgery if size >3cm or refractory to meds

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25
Q

How to approach acromegaly?

A

First get IGF-1 level—> if elevated—->OGTT—->if inadequate suppression—->MRI of brain

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26
Q

What are the causes of hyper androgenism in females?

CIA PON

A

Cushing syndrome
Increase Prolactin
Acromegaly

P PCO
O ovarian / adrenal tumor
N non classic CAH

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27
Q

Triad of Idiopathic hirsuitism

A

Due to excessive conversion of testosterone to DHT in hair follicles.

Usually +ve family history and no virilization.

17 OH-progesterone and androgens usually normal

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28
Q

How to d/f hyperandrogenism due to adrenal and ovarian tumor?

A

If increases Testosterone and normal DHEAS—-> ovarian tumor

If relatively normal testosterone and increase DHEAS—-> adrenal tumor

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29
Q

Important point of hyper androgenisation

A

DHEAS is specific for adrenal glands and is sulfated form of DHEA.

DHEA is produced by both ovaries and testes

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30
Q

What does meant by secondary amenorrhea?

A

Amenorrhea for menses for more than 3 cycles Or more than 6 months

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31
Q

How to approach secondary amenorrhea?

A

Get BHCG and rule out pregnancy first And then find other causes

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32
Q

What are the causes of Hyperthyroidism in which thyroglobulin level is high?
TIE

A 
T= thyroiditis
I = Iodide exposure
E = Extraglandular production
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33
Q

Name the cause of Hyperthyroidism in which thyroglobulin level is low?

A

Exogenous hormone

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34
Q

What are the causes of Hyperthyroidism in which RAIU is high?

A 
Grave disease (diffuse uptake)
Toxic adenoma / multinodular goiter (nodular uptake)
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35
Q

What are the conditions present with this pattern of TFT; TSH low and FT4 normal ?

A

FT3 is high—>T3 toxicosis

FT3 is normal—>subclinical Hyperthyroidism/Early pregnancy/non-thyroid illness

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36
Q

What are the causes of thyroiditis?

A 
Hashimoto
Silent thyroiditis (painless)
Subacute thyroiditis (De Quervain thyroiditis) painful
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37
Q

Classified the causes of thyroiditis in term of Radioactive iodine uptake

A

Variable uptake —-> Hashimoto

Low uptake —-> Silent and subacute thyroiditis

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38
Q

Triad of Subacute thyroiditis (De Quervain thyroiditis)

A

Occur after viral illness

Painful tender Goiter and SxS of hyperthyroid

Increase in ESR and CRP

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39
Q

Name the medication which decreases the absorption of levothyroxine

A

Bile acid binding reagents
Iron / Calcium and aluminium hydroxide
PPI / Sucralfate

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40
Q

Important point of thyroid medication

A

Oral estrogen or pregnancy (↑estrogen)—>↓ clearance of TBG—>↑TBG—>↓free T4—>↑dose of levothyroxine
Also by tamoxifen / raloxifene / Heroin / methadone

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41
Q

Name the medication which decreases TBG concentration

A

Anabolic steroid / Androgen / Steroid / slow release nicotinic acid

TBG conc decrease —> T4 increase—> decrease dose of levothyroxine

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42
Q

Name the medications which increases thyroid hormone metabolism

A

Rifampin
Phenytoin
Carbamazepine

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43
Q

What are the test to dx the cause of thyroid nodule

A

TFT
U/S neck
FNAC

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44
Q

What to do if patient with thyroid nodule and with out risk factors of US finding of cancer?

((In case US finding or having risk factor of cancer stat FNAC))

A

1) TSH—-> If low—-> do RAIU

RAIU—-> Hot nodule—->t/m Hyperthyroidism
And if cold nodule—-> Do FNAC

2) If TFT is normal or increase—> FNA

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45
Q

To whom parathyroid surgery is beneficial?

A

Serum calcium >1mg/dl above upper limit of normal range

Young age <50 Primary

Bone marrow density T-score

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46
Q

Name the medication for hyperparathyroidism

A

Bisphosphonate can be used in those who refuse surgery and have prior history of osteopenia/osteoporosis

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47
Q

What are the causes of hypercalemia in which PTH level remain normal or low?

A

Malignant::
Malignancy

Non malignant::
Vit-D toxicity

Drug induced / milk alkali syndrome
Granulomatous disease

Thyrotoxicosis
ImMobilization

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48
Q

How lymphoma increases the calcium level?

A

By increasing the production of Vit-D3 result absorption of calcium from Gut

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49
Q

Name the cancer which increases the calcium level by producing PTHrP

MOA —-> PTH receptor activation and excessive bone resorption

A

Squamous cell carcinoma
Renal and bladder cancer

Ovarian and Endometrial cancer
Breast cancer

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50
Q

Why D3 level low in Humoral induced hypercalemia?

A

PTHrp does not induce conversion of 25-OH vitamin-D to 1,25-diOH vitamin D to the same extent as PTH and hence its levels will be low or low normal

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51
Q

How to t/m hypercalemia due to ImMobilization?

A

Hydration and Bisphosponates

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52
Q

Important point

A

Hypoalbuminemia—>may decrease total calcium level and not ionized calcium level

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53
Q

What are the findings of Osteomalacia on imaging?

A

Thining of cortex with reduced bone density and concave shaped vertebral bodies (codfish)
B/L and symmetrical pseudofracture (looser bones)

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54
Q

What are the lab findings of Paget disease?

A

Normal ions values along with PTH

Marker of bone resorption (c-telopeptide, n-telopeptide) and bone formation (alkaline phosphatase, osteocalcin)—significantly ↑.

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55
Q

What is the CBC finding in patient with adrenal insufficiency?

A

Increase level of eosinophils

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56
Q

Important point of adrenal insufficiency

A

Etomidate shouldn’t be used as it inhibit steriod synthesis and acute adrenal crisis—>avoid in pts suspected of HPA suppression

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57
Q

How to treat Primary hyperaldosteronism?

A

If U/L adrenal adenoma–> surgery Or Potassium sparing diuretic if poor surgical candidate

If B/L—-> Aldosterone antagonist

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58
Q

How alcohol causes hypogonadism?

A

Suppressing LH release from pituitary Or by directly inhibiting testosterone production from testes

59
Q

Important point

A

Normal to have gynecomastia in boys during puberty

It will resolve in few months to 2 yes without intervention

60
Q

If patient has localised gangrene in foot what is the stage?

A

Stage 5

61
Q

If patient has extensive gangrene involved the whole foot what is the stage of foot ulcer?

A

5

62
Q

If patient has deep ulcer penetrating to ligament or muscle but no bone involved or abscess formation what is the stage of foot ulcer?

A

2

63
Q

Important point

A

Patient with anorexia have EUTHYROID hypothyroxinemia

Normal TSH
Normal to decrease T3 / T4

64
Q

How d/f malignancy increase the serum calcium level?

A

By increasing production of Vit-D3
Increase PTHrP

Bony Mets

65
Q

Important point

A

PTHrp doesn’t involve in production of Vit-D3 so it’s level will be low

66
Q

How to d/f thyroid storm / pheochromocytoma / malignant hyperthermia?

A

No fever or rigidity in pheochromocytoma

Fever but no rigidity in thyroid storm

Fever plus rigidity in Malignant hyperthermia

67
Q

How LDL and TAG level increase in hyperthyroidism?

A

By decreasing the activity of LPL

And decreasing the activity of LDL receptor

68
Q

Name the antiarrhythmic which QT interval

A

Class IA
Amidarone

Class 3
Sotalol

69
Q

Name the antiarrhythmic which QRS duration

A

Class-1a (procainamide)

Class 1C (flecainde)
Amidarone
70
Q

Name the antiarrhythmic which PR interval

A

Class 2

Amidarone / sotalol
Class 4

71
Q

How to approach menopause treatment?

A

If mild Vasomotor sxs—>behavioural modification

If mod-severe—-> SSRI (if contradiction of HRT)

If no CI Of HRT—->check Uterus–>if present give HRT and if absent give Progesterone

72
Q

D/f b/w Simple and complex Breast cyst findings

A

Simple—>Thin wall fluid filled (anechoic) without solid or echogenic debri

Complex—>Thick wall sepated with solid and cystic component

73
Q

How to manage Complex Breast cyst?

A

Bx

74
Q

How to manage SIMPLE breast cyst?

A

If Asymptomatic—> Obs

If sxs FNA

75
Q

How to manage Symptomatic SIMPLE breast cyst?

A

Do FNA

If bloody aspirate—> Bx and imaging

If non-bloody aspirate—>if cyst resolve—>no management further OR if persist or Recurrent—> bx and imaging

76
Q

How to Approach asymptomatic Isolated proteinuria in kids ?

Asymptomatic Isolated means just proteinuria without other findings

A

Check Pr/Cr ratio—>if increase renal disease

If normal—>check protein in next Urine D/R
If increase—>orthostatic
If negative—->Transient

77
Q

How to Approach Primary hyperthyroidism?

A

Check Signs of Graves disease
If no signs —->RAIU

If high uptake—> Graves or Toxic/multi nodular goiter
If low uptake—>check thyroglobulin level

If low level —> exogenous hormone
If high level—->thyroiditis Or Iodide exposure

78
Q

Difference b/w lab report of DKA and HONK

A

DKA:::
Met-Acidosis with increase anion gap
Positive ketones with glucose 250-500mg/dl
Serum osmolality less than 320

HONK::
Normal anion gap without Met-Acidosis
Negative or small ketones with glucose ≥600
Serum osmolality more than 320

79
Q

What are the cause of Erectile dysfunction?

Remember PENIS

A

Psychological

E endocrine like DM , low testosterone

N Neurogenic

I insufficient blood flow

Substance like antiHTN/ antidepressants/ ethanol

80
Q

How to d/f psychogenic and organic Erectile dysfunction?

A

Intact nocturnal and early morning penile erection seen in psychogenic

Whereas both these affected in organic causes

81
Q

Which nerves involved in Erection?

A

Parasympathetic S2-S4

Sympathetic T11-T12

82
Q

Triad of Euthyroid sick syndrome

A

Seen in non thryoid illness

Normal T4 and TSH

Decrease total and Free T3

83
Q

How thyroid hormone production increase to meet metabolic demand in pregnancy?

A

Estrogen increase TBG result increase only in bound hormones

B-HCG stimulates TSH receptor increase thryoid hormones

Both these suppress TSH

84
Q

TFT Pattern in Pregnancy

A

Increase Total 4

Mild Increase or unchanged free T3

Deceased TSH

85
Q

How to Approach PPROM from 34 wks till less than 37 wk?

A

Delivery

GBS ppx ABx like penicillin
± Steroid

86
Q

How to approach uncomplicated PPROM before 34 wks?

Remember FACE

A

F fetal surveillance
A Abx like azomax and ampicillin
C corticosteroids
E expectant management

87
Q

How to approach complicated PPROM before 34 wks?

Complicated means infection or Fetal /maternal compromise

C-DAM

A

Corticosteroids
D immediate delivery
A Abx like ampicillin and Gentamicin
M magnesium if before 32 weeks

88
Q

What are the indications of Anti thyroid medication in GRAVES diseases?

A
  • Pregnancy
  • Old age with limited life expectancy

Mild hyperthyroidism
Preparation for Radioactive iodine Or thyroidectomy

89
Q

What are the indications of RADIOACTIVE IODINE in GRAVES diseases?

A

Mod-severe hyperthyroidism

With or without mild ophthalmopathy

90
Q

What are the indications of Thyoidectomy in GRAVES diseases?

A

1) Very large Goiter
2) Retrosternal Goiter with Obs SxS

3) Co existing primary hyper parathyroidism
4) thyroid cancer!!??

5) Pregnant who can’t tolerate Anti thyroid meds
6) severe ophthalmopathy

91
Q

How Serum And urine calcium level increase in Hyperthyroid?

A

Increase osteoclasts activity result increased Sr. calcium level —-> -ve PTH—-> No absorption of calcium from kidney—-> loss of calcium in urine

92
Q

Important point of thyrotoxic myopathy

A

Both in acute and chronic type, proximal weakness occur but in acute distal weakness also

There is no bulbar or respiratory muscle involvement

93
Q

What are the S.E of anti thyroid medication?

A

Both cause agranulocytosis

  • Prophylthiouracil—-> Hepatic failure and ANCA associated vasculitis
  • Methiamzole—->1st trimester teratogen and cholestasis
94
Q

How to manage thyroid storm?

A

1) BB like propanol
2) Steroid like hydrocortisone

3) PTU followed by iodine solution to decrease synthesis and release of hormones
4) find and treat the underlying cause

95
Q

Triad of Painless (Or silent) thyroiditis

A

Non tender small Goiter

Positive TPO Ab with low radioactive uptake

Brief episode of hyperthyroid

96
Q

How GENERALIZED RESISTANCE TO THYROID HORMONE present?

A

Autosomal dominant Occur due to peripheral resistance

SxS of hypothyroid with Increase T3 and T4

Normal or mild increase in TSH

97
Q

How FHH occurs?

A

Defect in calcium sensor of PTH gland result loss of negative feedback on Gland by hyercalcemia

98
Q

Triad of VIPOMA

A

Secretory water diarrhoea with osmolal gap less than 50

Low K, Chloride

increase Calcium and Glucose

99
Q

How to dx and manage VIPOMA?

A

Serum VIP level
Image like CT or MRI to localise tumor

Rx is IV volume repletion
octreotide to ↓ diarrhea
possible hepatic resection with mets to liver

100
Q

Name the condition causing a Vit-D induced hypercalcemia

A

ENDOGENOUS::
Lymphoma
Granulomatous diseases like sarcoidosis

EXOGENOUS::
Supplement
Calcidoil (Vit D2)

Calcitriol (Vit D3)
Calcipotirene (topical Vit-D derivative)

101
Q

How bony mets increase Calcium level?

A

Release cytokines to stimulate bone resorption

Seen in breast cancer , multiple myeloma and lymphoma

102
Q

How to approach Low serum calcium level?

A

Check Sr. magnesium
Drug induced
Due to citrate or increase volume

If not b/c of above —-> Check PTH

103
Q

What are the causes hypocalcemia in which PTH is high?

A

Tumor lysis syndrome

Inflammation like pancreatitis or sepsis

Endocrine like CKD / Vit-D deficiency

PTH resistance

104
Q

What are the causes hypocalcemia in which PTH is low?

A

Removal of gland via surgery

Autoimmune like polyglandular autoimmune syndrome

Infiltrative disorder like mets, Wilson diseases or hemochromatosis

105
Q

Triad of Pseudohypoparathyroidism type 1A (Albright hereditary osteodystrophy)

A

Low calcium level despite Increase PTH

Obesity and Shortened 4th/5th digits

short stature and developmental delay

106
Q

What is the cause of Pseudohypoparathyroidism 1A?

A

autosomal dominant

Due to inactive G-protein alpha subunit causing end-organ (kidney and bone) resistance to PTH

Defect must be inherited from mother due to imprinting.

107
Q

Triad of Pseudopseudohypoparathyroidism

A

SxS same as of Albright hereditary osteodystrophy

No end organ resistance so PTH and calcium remain normal

Occurs when defective C, protein alpha subunit is inherited from father but Normal maternal allele maintains responsiveness of kidney to PTH.

108
Q

Define Osteomalacia

A

due to defective mineralization of osteoid bone matrix

Low Phosphorus and calcium—> Increases PTH—> bone resorption—> increase ALP

109
Q

What are the causes of PRIMARY adrenal insufficiency?

A

1) Autoimmune
2) Adrenal haemorrhage/infarction due to anticoagulant or N.meningitis

3) Infection like Tb, HIV or disseminated fungal
Mets like lung cancer

4) Acute illness, injury or surgery in patient with steroid used, CAH or chronic adrenal insufficiency

110
Q

Approach to HTN and hyperkalemia

A

Plasma Aldo/renin ratio—>if normal find other cause

If increase—>adrenal suppression test —>if negative -> find other cause
If positive—>adrenal imaging

111
Q

Evaluate HTN and hypokalaemia in adrenal imaging (CT scan)

A

If it shows discrete U/L adrenal adenoma and age less than 40—> surgery

If CT normal or age >40 with abnormal CT—>adrenal venous sampling

If sampling shows —-> B/l adrenal hyperplasia —-> medical t/m
If shows u/L —->surgery

112
Q

What are the cause hypertension with low k, aldo and renin?

A

CAH
Cushing syndrome

Exogenous mineralocorticoids
Deoxycorticosterone producing adrenal tumor

Steroid resistance
Altered aldosterone metabolism

113
Q

What are the cause hypertension with low k, renin but increase aldosterone?

A

Conn syndrome

B/L adrenal hyperplasia

113
Q

What are the cause hypertension with low k but increase in renin and aldosterone?

A

CHF
Cirrhosis
Co arctation of aorta

Reno-vascular HTN
Renin secreting Tumor

Diuretic abuse
Malignant HTN

113
Q

What are the causes of Androgen deficient Gynecomastia?

A

Renal failure
Increase prolactin level

Male hypogonadism due to testicular damage or Klinefelter syndrome

114
Q

What are the causes of gynecomastia due to increase level of oestrogen or peripheral conversion?

Remember ACT

A

Antiandrogenic Or herbal Drugs
Androgen use
Aromatase activity

Cirrhosis

Tumors producing estrogen
Thyrotoxicosis

115
Q

Important point of DKA

A

Direct assay beta-hydroxybutyrate (BH), which is predominant ketone in DKA

116
Q

Classified the anti DM meds in terms of decreasing HBA1c

A

Metformin , sulfonylureas> Giltazone>GLP 1 receptor agonist> DPP inhibitors

117
Q

What are the S.e of different DM meds?

A

1) Lactic acidosis causes by metformin

2) CHF, Bone fracture, bladder cancer, Edema by Giltazone

118
Q

Name the tumor which causes hypoglycaemia but shows low level of Insulin, C peptide and pro insulin

A

NON-BETA CELL TUMOR

Produce IGF II—->insulinomimetic effect when bind to insulin receptor—->hypoglycemia—->↓ insulin, c peptide and proinsulin

119
Q

What are the major risk factors of OSTEOPOROSIS?

A

Non Modifiable::
Advanced age with Low body weight
Post menopausal

Modifiable::
Smoking
Sedentary life style
Excessive alcoholic

120
Q

Triad of Milk alkali syndrome

A

PTH independent hypercalcemia due to excessive intake of Calcium

Metabolic alkalosis with low phosphate

Acute kidney injury

121
Q

How to manage milk alkali syndrome?

A

Normal saline followed by lasix

Discontinued all causative agents

122
Q

How Ophthalmolopathy in GRAVE disease worsen due to radioactive iodine?
It occurs due to effects of activated T cells and TSH receptor Ab (TRAB) on retro orbital fibroblast and adipocytes

A

Radioactive iodine increase the TRAB which worsen Ophthalmolopathy so give Steroid anti thyroid meds

123
Q

What are the risk Factors of ELDERLY ABUSE?

A

Woman
Advance age >80 yrs

Cognitive impairment like dementia or depression

Physical disability due to hip fracture or stroke

124
Q

How ELDERLY abuse present?

Stat call adult protective services

A

1) Sexual abuse sxs like anogenital trauma
2) signs of neglect like malnourished or pressure ulcers

3) non osteoporotic fracture like spiral fracture of long bones
4) Injuries or bruising at atypical location like trunk or thigh

125
Q

What are the Effects of AMIDARONE on thyroid gland? Both present as hypothyroidism

A

1) Iodine induced Inhibition of thyroid hormone synthesis (Wolff chaikoff effect)

Present like hypothyroidism(Up TSH and down T4) so give levothyroxine

2) Decrease T4-T3 conversion (down T3 ; up T4 and normal to increase TSH) which doesn’t need treatment

126
Q

What are the Effects of AMIDARONE on thyroid gland? Part 2 (both present as hyperthyroidism)

AMIDARONE induced thyrotoxicosis (AIT)

A

TYPE 1 AIT:
Due to iodine induced Increase hormones synthesis present as hyperthyroidism so give antithyroid drugs.

Type 2 AIT:
Due to destructive thyroiditis give Steroid as TX

127
Q

How to d/f AIT 1 and 2 on TFT and RAIU?

A

Both have up T4 / T3 and Down TSH

AIT 1 has low RAIU and increase vascularity on U/S due to increase production of hormones

AIT 2 has undectable RAIU and low vascularity on U/S due to increase destruction which release hormones

128
Q

What are the consequences of adding insulin in Refeeding syndrome?

A

Increase Sr.Na and water leads to CHF and pul edema

Low thiamine —> wernicke encephalopathy

Low ions like K, Mg and Ph —> fits and arrhythmia

129
Q

How to approach Rabies PEP if bitten by PETS like dog, Cat or ferret?

A

Is animal available for Quarantine?

If no—-> stat PEP

If yes—-> 10 days observation and No PEP if animal is healthy

130
Q

How to approach Rabies PEP if bitten by high risk wild animal like bat, racoons, shunk, fox and coyote?

A

Is animal available for testing?

If no —-> stat PEP

If yes—-> Euthanize and test; if test positive give PEP

131
Q

How to approach Rabies PEP if bitten by (1) low risk animal like rabit rat mouse chipmunk and Squirrel
or (2) livestock or unknown wild animal?

A

First case—> NO PEP

2nd case —-> contact public health department

132
Q

Name the anti diabetic meds given for CVS patient

A

Metformin

GLP-1 Agnoist like Liraglutide
SGLT2 Inhibitor like Empagliflozin

133
Q

How to treat Comedonal acne?
Located at nose, forehead and chin

Remember GAS

A

Topical retinoids like Glycolic acid, Azelaic, Salicylic

134
Q

How to manage mild, mod and severe Inflammatory acne?

It shows inflammatory erythematous papules and pustules

A

If mild give—> Topical retinoids plus benzoyl peroxide

If moderate—> topical ABx like Clindamycin or erythromycin

If severe—> Oral Abx

135
Q

How to manage moderate, severe and unresponsive Nodular (cystic) acne?

A

Moderate—-> topical (ABx + benzoyl peroxide) + topical ABx

Severe —-> add oral Abx
Unresponsive—-> Oral isotretinoin

136
Q

What are the complications of PCO?

MONE

A

M Metabolic syndrome LIKE DM or HTN
O OSA
N NASH
E Endometrial hyperplasia or cancer

137
Q

Triad of Osler weber rendu syndrome

Autosomal dominant

A

Recurrent nasal bleeding and clubbing

Ruby colored papules blanch with pressure (telangiectasia)

AV malformation with reactive polycythemia

138
Q

What are the IMMEDIATE and Delayed cause of Post operative fever?

A

• IMMEDIATE (within 6hours after surgery)
Tissue trauma
Blood product
Malignant hyperthermia

• DELAYED (After 1month)
Viral Infections
SSI (indolent organism)

139
Q

What are the Acute Infective and Non Infective cause of Post operative fever?
After 24 hour but before 1

A

• INFECTIVE::
Nosocomial Infection
SSI (due to Group A strep / C perfringen)
Catheter site Infection

• Non INFECTIVE:
MI
PE and DVT

140
Q

What are the sub Acute Infective and Non Infective cause of Post operative fever

After 1 week but before 1 month

A

• INFECTIVE::
Catheter site Infection
Clostridium difficile

• NON INFECTIVE
DVT / PE
Drug fever

141
Q

What are the typical features of Edward syndrome?

Face—>Hands—>thorax—->Abdomen—->Lower limb

A

Face shows small jaw with prominent occiput and low set Ears

Clenched hands with Overlapping fingers
Heart and Renal defects

Limited hip abduction and Rocker bottom feet

142
Q

What are the typical features of Patau syndrome?

Face—>Hand–>thorax with abdomen—>lower limb

A

Face shows small eye with small head Or holoprosencephaly

Hands shows more than 5 fingers

Cardiac with Renal defects and Umbilical hernia / Omphalocele

Rocker bottom feet

Internal Medicine (14 decks)

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