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Primary Care 2 > Exam 4: Endocrine, Neuro, and Emergencies > Flashcards

Exam 4: Endocrine, Neuro, and Emergencies Flashcards

1
Q

Leading cause of CVD, renal failure, blindness, nontraumatic lower limb emputation

A

DM

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2
Q

Screening for DM

A

Begin at 45

FPG, 2 hour glucose tolerance, A1C

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3
Q

Assessment every 3 months in dm

A

Fundoscopic exam, oral cavity exam, thyroid, heart, skin, feet

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4
Q

Dx for DM

A

Random plasma glucose >200
FPG >126
A1C >6.5

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5
Q

Step 1 DM management

A

A1C >7

Lifestyle management + begin metformin

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6
Q

Metformin

A

LIVER: Suppresses hepatic glucose production
SE: GI, no hypoglycemia
CI in Cr >1.4

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7
Q

Glipizide

A

PANCREAS: stimulates insulin secretion
SE: weight gain, hypoglycemia

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8
Q

Acarbose

A

SMALL INTESTINE: Delays digestion
CI: IBD, colonic ulcer, gastroperesis, Cr >2
SE: gas

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9
Q

Pioglitazone

A

MUSCLE: improve insulin sensitivity
SE: weight gain, edema
CI: HF

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10
Q

Dulaglutide

A

GLP1 agonist
INJECTABLE
Stimulates insulin secretion in fed state, suppresses glucagon, slows gastric emptying

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11
Q

Canagliflozin

A

SLG2 inhibitors
Increased glucose secretion in urine
SE: UTI, genital infections

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12
Q

Microvascular complications of DM

A

Diabetic retinopathy, nephropathy, neuropathy

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13
Q

Earliest indication of renal damage from DM

A

Microalbuminuria–test annually

If confirmed, tx with ACEI

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14
Q

Topical tx for diabetic neuropathy

A

Capsaicin cream or lidocaine patch

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15
Q

Acanthosis nigricans common in

A

metabolic syndrome

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16
Q

Antihypertensives effective in reducing BP and increasing insulin sensitivity

A

Alpha blockers and ACEI

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17
Q

Most sensitive indicator of overall thyroid function

A

TSH

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18
Q

Imaging to evaluate anatomy of thyroid gland

A

ultrasound

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19
Q

Most common cause of goiter in developed country

A

chronic autoimmune thyroiditis

Leads to increased TSH

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20
Q

Complications of thyroid surgery

A

Hypoparathyroidism

Hoarseness

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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

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22
Q

Most common cause of hyperthyroidism

A

Graves disease

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23
Q

Baseline ____ before methimazole/PTU

A

LFT and CBC

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24
Q

SE of methimazole/PTU

A

Rash, jaundice, arthralgias

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25
Q

Effects of hypothyroidism on body

A

Impaired myocardial contractility, impaired lipid metabolism, hypertension, fatigue, weight gain, reduced GFR, constipation

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26
Q

Most common progressive motor neuron disease

A

ALS

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27
Q

ALS

A

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

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28
Q

Bells palsy

A

Acute, UNILATERAL weakness or paralysis of CN7, onset <72 hours
Self-limiting
Usually caused by triggering event–URI or ischemia to the nerve

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29
Q

Bells palsy incidence highest in

A

pregnancy, first week postpartum, women with pre-eclampsia

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30
Q

PE of bells palsy

A

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

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31
Q

Tx of bells palsy

A

STEROIDS within 72 hours of onset (prednisone)
May add antivirols
Lubricate and protect eye

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32
Q

Lacunar strokes

A

Seen more in elderly and diabetics

Affects small arterioles

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33
Q

Abrupt onset of severe headache

A

Subarachnoid hemorrhage stroke

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34
Q

Most common initial procedure to discriminate between strokes

A

CT

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35
Q

Most important independent and modifiable risk factor for stroke

A

Hypertension

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36
Q

Early AD signs

A

Short term memory loss with anxiety and depression

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37
Q

Middle AD signs

A

Worsening of memory and language and judgement, disorientation to time and place, paranoia, hallucinations, delusions, UI

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38
Q

Late AD signs

A

Motor rigidity, prominent neuro abnormalities including apraxia and agnosia, severe language and cognitive impairment

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39
Q

Baseline brain imaging study for dementia

A

Non contrast CT

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40
Q

2 classes of drugs for AD

A

Cholinesterase inhibitors

NMDA antagonists

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41
Q

Cholinesterase inhibitors

A

Donepezil, rivastigmine, galantamine

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42
Q

NMDA antagonists

A

Memantine

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43
Q

Peripheral causes of vertigo

A

BPPV, Vestibular neuritis, acute labyrinthitis, meniere disease, ototoxicity, head trauma

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44
Q

Central causes of vertigo

A

Brainstem or cerebellar ischemia or hemorrhage, tumors, MS, Migraine syndrome

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45
Q

Cardiac conditions associated with syncope

A

Arrhythmias, sick sinus syndrome, MVP, AS, heart block

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46
Q

Pre-syncope causes

A

Dehydration, hypotension, cough

47
Q

Hallpike-Dix maneuver

A

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
Q

2 most common cause of BPPV

A

Head trauma and prior viral inner ear infection

49
Q

First line tx of BPPV

A

Canalith repositioning procedure

50
Q

Headaches due to

A

Serotonin, dopamine, substance P, calcitonin

51
Q

Limit headache abortive agents to

A

<2 days per week to avoid rebound headache

52
Q

First line for headaches

A

tylenol, aspirin, nsaids

53
Q

When to use preventative medications for headaches

A

> 4/month

54
Q

First line preventative meds for cluster headaches

A

Verapamil and lithium

55
Q

Encephalitis primarily due to

A

Herpes, arbovirus, enterovirus

56
Q

Most common cause of bacterial meningitis for children <1 month

A

GBS and E Coli

57
Q

Most common cause of meningitis for elderly

A

Strep pneumoniae

58
Q

Tx of meningitis

A

Vanco + ceftriaxone

59
Q

Most common hypokinetic movement disorder

A

Parkinson disease

60
Q

Tx of essential tremor

A

Beta blockers, anticonvlsants, benzos

61
Q

Cardinal symptoms of PD

A

Resting tremor, bradykinesia, rigidity, postural instability

62
Q

PD due to

A

Depletion of dopamine

63
Q

Tx of PD

A

Levodopa
Selegiline
Trihecyphenidyl + Benzotropine (for tremor primarily)
Amantadine (mild)

64
Q

Simple partial seizure

A

No loss of consciousness

65
Q

Tx of SE

A

Lorazepam or diazepam

66
Q

1st line tx of seizures

A

Levetiracetam–Keppra

Does not cause sedation, does not induce liver enzymes, acceptable in pregnancy

67
Q

Women and AED

A

Should be given a higher dose of OCP (estrogen >50) and give 1g folic acid/day to decrease birth defects

68
Q

Pre-diabetes labs

A

FPG 100-125
A1C 5.7-6.4
2 hour plasma glucose 140-199

69
Q

A1C can not be used for diagnosis in

A

Pregnancy, hemoglobinopathy, abnormal erythrocyte turnover

70
Q

Subsequent testing for DM

A

Repeat A1C, fasting lipids, UA, microalbuminuria, thyroid, serum Cr

71
Q

C peptide level for DM

A

<0.5 indicates type 1 DM

72
Q

Meds that can cause hyperglycemia

A

Steroids, hormonal therapy, immunosuppressants, nicotinic acid, protease inhibitors, atypical antipsychotics, diuretics

73
Q

Do not use metformin if

A

Cr >1.4

Liver impairment or alcoholic patients

74
Q

Do not use TZD in

A

HF

Liver disease

75
Q

Exanatide

A

Enhances glucose dependent insulin secretion
And slows gastric emptying
SC

76
Q

A1C should be repeated

A

at least 2 times per year in patients with good control

Quarterly in patients who are not meeting goals

77
Q

Fasting hypoglycemia

A

Low sugar levels >5 hours after eating

BG does not return to normal without glucose ingestion or administration

78
Q

Reactive hypoglycemia

A

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
Q

Induced hypoglycemia

A

Most common

Meds and alcohol most common causes

80
Q

Most reliable method of diagnosing hypoglycemia

A

plasma glucose 72 hour fast

81
Q

Leading complication of hospitalization for older adults

A

Delirium

82
Q

If altered mental status in elderly check for

A

UTI or pneumonia first

83
Q

First clinical episode of MS

A

Usually focal neurologic deficit such as eye pain or visual disturbance

84
Q

Dx MS

A

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
Q

Tx of MS exacerbation

A

High dose IV steroids

86
Q

Pregnancy effect on MS

A

Neuroprotective

87
Q

Decision for high intensity statin

A

> 20% risk

88
Q

Digoxin blocks conduction at

A

AV node

89
Q

Goal of A Fib

A

Ventricular rate control

Prevent rapid ventricular response

90
Q

Normal TSH range

A

0.35-5.5

91
Q

Amiodarone can cause

A

Hyperthyroidism and pulmonary fibrosis

92
Q

Tx of vertigo

A

antihistamine (meclizine), diamox, antiemetics

93
Q

Pt with PD subjectively complains of

A

Fatigue

94
Q

What can affect levodopa

A

Antacids and vitamins

95
Q

Abortive therapy for migraine

A

Triptans

Fiorecet 2-3 days

96
Q

Tx of encephalitis

A

Antiviral + seizure control with dilantin

97
Q

Tx of herpes zoster

A

Acyclovir
Capsaicin cream, amitriptyline or neurontin
Sometimes can add narcotics

98
Q

Trigeminal neuralgia higher risk if

A

hypertension, MS

99
Q

Anaphylaxis reaction

A

rapid release of immunoglobulin E

Immune hypersensitivity reaction–activation of mast cells and basophils

100
Q

Number one cause of TBI in children <14 and adults >65

A

falls

101
Q

Talk and deteriorate syndrome

A

utter recognizable words after head injury and then deteriorate to severe brain injured conditions within 48 hours

102
Q

Normal GCS

A

15

103
Q

Brain dead GCS

A

3

104
Q

first sign of brain injury in older adults

A

confusion or change in behavior

105
Q

What meds should not be taken for 1 week following brain injury

A

narcotics, aspirin, alcohol

106
Q

Heat stroke

A

Core body temp >104, CNS abnormalities
Red, hot, dry skin
Tachycardia, hypotension

107
Q

Heat exhaustion

A

Less severe; due to excess sweating
Fatigue, sweating, nausea, diarrhea, hypotension
No CNS involvement
SKin pale and flushed

108
Q

Complications related to heat stroke

A

Rhabdomyolysis, renal/hepatic/cardiac failure

109
Q

At risk population for heat stroke

A

Elderly, people who take beta blockers or diuretics or anticholinergics

110
Q

Most common cause of burns

A

radiation

111
Q

1st degree burn

A

superficial
no blisters or vesicles
blanches with pressure
Cool compress, aloe vera, ibuprofen

112
Q

2nd degree burn

A

superficial partial-thickness
epidermal and upper layer of dermis
Vesicles and blisters
Tx: silvadene, neosporin, bacitracin

113
Q

3rd degree

A

full thickness
All nerves destroyed
No pain
skin grafting required

Primary Care 2 (5 decks)

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