Exam 4: Endocrine, Neuro, and Emergencies Flashcards
1
Q
Leading cause of CVD, renal failure, blindness, nontraumatic lower limb emputation
A
DM
2
Q
Screening for DM
A
Begin at 45
FPG, 2 hour glucose tolerance, A1C
3
Q
Assessment every 3 months in dm
A
Fundoscopic exam, oral cavity exam, thyroid, heart, skin, feet
4
Q
Dx for DM
A
Random plasma glucose >200
FPG >126
A1C >6.5
5
Q
Step 1 DM management
A
A1C >7
Lifestyle management + begin metformin
6
Q
Metformin
A
LIVER: Suppresses hepatic glucose production
SE: GI, no hypoglycemia
CI in Cr >1.4
7
Q
Glipizide
A
PANCREAS: stimulates insulin secretion
SE: weight gain, hypoglycemia
8
Q
Acarbose
A
SMALL INTESTINE: Delays digestion
CI: IBD, colonic ulcer, gastroperesis, Cr >2
SE: gas
9
Q
Pioglitazone
A
MUSCLE: improve insulin sensitivity
SE: weight gain, edema
CI: HF
10
Q
Dulaglutide
A
GLP1 agonist
INJECTABLE
Stimulates insulin secretion in fed state, suppresses glucagon, slows gastric emptying
11
Q
Canagliflozin
A
SLG2 inhibitors
Increased glucose secretion in urine
SE: UTI, genital infections
12
Q
Microvascular complications of DM
A
Diabetic retinopathy, nephropathy, neuropathy
13
Q
Earliest indication of renal damage from DM
A
Microalbuminuria–test annually
If confirmed, tx with ACEI
14
Q
Topical tx for diabetic neuropathy
A
Capsaicin cream or lidocaine patch
15
Q
Acanthosis nigricans common in
A
metabolic syndrome
16
Q
Antihypertensives effective in reducing BP and increasing insulin sensitivity
A
Alpha blockers and ACEI
17
Q
Most sensitive indicator of overall thyroid function
A
TSH
18
Q
Imaging to evaluate anatomy of thyroid gland
A
ultrasound
19
Q
Most common cause of goiter in developed country
A
chronic autoimmune thyroiditis
Leads to increased TSH
20
Q
Complications of thyroid surgery
A
Hypoparathyroidism
Hoarseness
21
Q
Education after radioiodine treatment for thyroid nodules/cancer
A
No kissing or exchanging saliva for 5 days, no close contact with infants or pregnant women for 5 days, no breastfeeding, flush toilets twice after urinating, take tylenol for sore throat
22
Q
Most common cause of hyperthyroidism
A
Graves disease
23
Q
Baseline ____ before methimazole/PTU
A
LFT and CBC
24
Q
SE of methimazole/PTU
A
Rash, jaundice, arthralgias
25
Effects of hypothyroidism on body
Impaired myocardial contractility, impaired lipid metabolism, hypertension, fatigue, weight gain, reduced GFR, constipation
26
Most common progressive motor neuron disease
ALS
27
ALS
Dysfunction of both upper motor neurons and lower motor neurons
Asymmetric weakness evident in the limbs first, usually arms
Foot drop, difficulty walking, weakness lifting arm
Bowel and bladder function spared
28
Bells palsy
Acute, UNILATERAL weakness or paralysis of CN7, onset <72 hours
Self-limiting
Usually caused by triggering event--URI or ischemia to the nerve
29
Bells palsy incidence highest in
pregnancy, first week postpartum, women with pre-eclampsia
30
PE of bells palsy
Smooth forehead, widened palpebral fissure, inability to close eye, flattened nasolabrial fold, asymmetric smile
Ask to smile, show teeth, puff out cheeks, raise eyebrows, close eyes tightly
31
Tx of bells palsy
STEROIDS within 72 hours of onset (prednisone)
May add antivirols
Lubricate and protect eye
32
Lacunar strokes
Seen more in elderly and diabetics
| Affects small arterioles
33
Abrupt onset of severe headache
Subarachnoid hemorrhage stroke
34
Most common initial procedure to discriminate between strokes
CT
35
Most important independent and modifiable risk factor for stroke
Hypertension
36
Early AD signs
Short term memory loss with anxiety and depression
37
Middle AD signs
Worsening of memory and language and judgement, disorientation to time and place, paranoia, hallucinations, delusions, UI
38
Late AD signs
Motor rigidity, prominent neuro abnormalities including apraxia and agnosia, severe language and cognitive impairment
39
Baseline brain imaging study for dementia
Non contrast CT
40
2 classes of drugs for AD
Cholinesterase inhibitors
| NMDA antagonists
41
Cholinesterase inhibitors
Donepezil, rivastigmine, galantamine
42
NMDA antagonists
Memantine
43
Peripheral causes of vertigo
BPPV, Vestibular neuritis, acute labyrinthitis, meniere disease, ototoxicity, head trauma
44
Central causes of vertigo
Brainstem or cerebellar ischemia or hemorrhage, tumors, MS, Migraine syndrome
45
Cardiac conditions associated with syncope
Arrhythmias, sick sinus syndrome, MVP, AS, heart block
46
Pre-syncope causes
Dehydration, hypotension, cough
47
Hallpike-Dix maneuver
Check for spontaneous nystagmus while sitting on exam table, put patient in recumbent position and observe for nystagmus with head tilting to each side
48
2 most common cause of BPPV
Head trauma and prior viral inner ear infection
49
First line tx of BPPV
Canalith repositioning procedure
50
Headaches due to
Serotonin, dopamine, substance P, calcitonin
51
Limit headache abortive agents to
<2 days per week to avoid rebound headache
52
First line for headaches
tylenol, aspirin, nsaids
53
When to use preventative medications for headaches
>4/month
54
First line preventative meds for cluster headaches
Verapamil and lithium
55
Encephalitis primarily due to
Herpes, arbovirus, enterovirus
56
Most common cause of bacterial meningitis for children <1 month
GBS and E Coli
57
Most common cause of meningitis for elderly
Strep pneumoniae
58
Tx of meningitis
Vanco + ceftriaxone
59
Most common hypokinetic movement disorder
Parkinson disease
60
Tx of essential tremor
Beta blockers, anticonvlsants, benzos
61
Cardinal symptoms of PD
Resting tremor, bradykinesia, rigidity, postural instability
62
PD due to
Depletion of dopamine
63
Tx of PD
Levodopa
Selegiline
Trihecyphenidyl + Benzotropine (for tremor primarily)
Amantadine (mild)
64
Simple partial seizure
No loss of consciousness
65
Tx of SE
Lorazepam or diazepam
66
1st line tx of seizures
Levetiracetam--Keppra
| Does not cause sedation, does not induce liver enzymes, acceptable in pregnancy
67
Women and AED
Should be given a higher dose of OCP (estrogen >50) and give 1g folic acid/day to decrease birth defects
68
Pre-diabetes labs
FPG 100-125
A1C 5.7-6.4
2 hour plasma glucose 140-199
69
A1C can not be used for diagnosis in
Pregnancy, hemoglobinopathy, abnormal erythrocyte turnover
70
Subsequent testing for DM
Repeat A1C, fasting lipids, UA, microalbuminuria, thyroid, serum Cr
71
C peptide level for DM
<0.5 indicates type 1 DM
72
Meds that can cause hyperglycemia
Steroids, hormonal therapy, immunosuppressants, nicotinic acid, protease inhibitors, atypical antipsychotics, diuretics
73
Do not use metformin if
Cr >1.4
| Liver impairment or alcoholic patients
74
Do not use TZD in
HF
| Liver disease
75
Exanatide
Enhances glucose dependent insulin secretion
And slows gastric emptying
SC
76
A1C should be repeated
at least 2 times per year in patients with good control
| Quarterly in patients who are not meeting goals
77
Fasting hypoglycemia
Low sugar levels >5 hours after eating
| BG does not return to normal without glucose ingestion or administration
78
Reactive hypoglycemia
Acute
Symptoms 2-4 hours following a meal reach in carbs
Causes: GI surgery, congenital deficiency of carb enzymes, late insulin release, extreme exertion, sepsis or HF, sulfonylureas
79
Induced hypoglycemia
Most common
| Meds and alcohol most common causes
80
Most reliable method of diagnosing hypoglycemia
plasma glucose 72 hour fast
81
Leading complication of hospitalization for older adults
Delirium
82
If altered mental status in elderly check for
UTI or pneumonia first
83
First clinical episode of MS
Usually focal neurologic deficit such as eye pain or visual disturbance
84
Dx MS
o Events must be at least 2 distinct episodes lasting more than 24 hours occurring at least 30 days apart and there must be evidence of at least 2 different locations
85
Tx of MS exacerbation
High dose IV steroids
86
Pregnancy effect on MS
Neuroprotective
87
Decision for high intensity statin
>20% risk
88
Digoxin blocks conduction at
AV node
89
Goal of A Fib
Ventricular rate control
| Prevent rapid ventricular response
90
Normal TSH range
0.35-5.5
91
Amiodarone can cause
Hyperthyroidism and pulmonary fibrosis
92
Tx of vertigo
antihistamine (meclizine), diamox, antiemetics
93
Pt with PD subjectively complains of
Fatigue
94
What can affect levodopa
Antacids and vitamins
95
Abortive therapy for migraine
Triptans
| Fiorecet 2-3 days
96
Tx of encephalitis
Antiviral + seizure control with dilantin
97
Tx of herpes zoster
Acyclovir
Capsaicin cream, amitriptyline or neurontin
Sometimes can add narcotics
98
Trigeminal neuralgia higher risk if
hypertension, MS
99
Anaphylaxis reaction
rapid release of immunoglobulin E
| Immune hypersensitivity reaction--activation of mast cells and basophils
100
Number one cause of TBI in children <14 and adults >65
falls
101
Talk and deteriorate syndrome
utter recognizable words after head injury and then deteriorate to severe brain injured conditions within 48 hours
102
Normal GCS
15
103
Brain dead GCS
3
104
first sign of brain injury in older adults
confusion or change in behavior
105
What meds should not be taken for 1 week following brain injury
narcotics, aspirin, alcohol
106
Heat stroke
Core body temp >104, CNS abnormalities
Red, hot, dry skin
Tachycardia, hypotension
107
Heat exhaustion
Less severe; due to excess sweating
Fatigue, sweating, nausea, diarrhea, hypotension
No CNS involvement
SKin pale and flushed
108
Complications related to heat stroke
Rhabdomyolysis, renal/hepatic/cardiac failure
109
At risk population for heat stroke
Elderly, people who take beta blockers or diuretics or anticholinergics
110
Most common cause of burns
radiation
111
1st degree burn
superficial
no blisters or vesicles
blanches with pressure
Cool compress, aloe vera, ibuprofen
112
2nd degree burn
superficial partial-thickness
epidermal and upper layer of dermis
Vesicles and blisters
Tx: silvadene, neosporin, bacitracin
113
3rd degree
full thickness
All nerves destroyed
No pain
skin grafting required
