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Clin Med 2 > Final > Flashcards

Final Flashcards

1
Q

Jaundice with what kind of bilirubin is concerning in neonates?

A

Conjugated

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2
Q

Gilbert syndrome

A

Benign, asymptomatic jaundice, autosomal dominant

Indirect bili increased, usually too low to show jaundice

Intermittent and generally asymptomatic

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3
Q

Crigler najar syndrome type 1

A

Unconjugated increased, persistent, fatal kernicterus

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4
Q

Cigler najjar type 2

A

Unconjugated hyperbilirubinemia

Later onset, mild elevation

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5
Q

Reye’s syndrome

A

Encephalopathy, fatty liver, transaminitis

Avoid ASA!

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6
Q

Hemochromatosis

A

Autosomal recessive

Heme uptake increased in liver, pancreas, heart

Hyperpigmentation, fatigue, impotence, DM

Phlebotomy to treat

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7
Q

Wilson disease

A

Autosomal recessive

Disrupted copper transport, deposits in liver and brain, can look like Parkinson’s in a young patient

Kayser fleischer pathognomonic, elevated copper in urine

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8
Q

AAT deficiency

A

AAT made in hepatocytes, can lead to cholestasis. Antiprotesase that acts in the lungs

Can lead to early onset emphysema

Stop smoking!

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9
Q

Primary biliary cirrhosis

A

Chronic autoimmune destruction of bile ducts, usually women 40-60

Way increased alk phos, xanthomas, jaundice, portal HTN

AMA positive!

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10
Q

Liver abscess

A

Fever, chills, pain, cough

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11
Q

Cavernous hemangioma

A

Vascular lesion in liver, no risk of bleed

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12
Q

Focal nodular hyperplasia

A

Hypervascular mass with stellate appernce

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13
Q

Hepatocelluar adenoma

A

20-40 women on OCP

Small risk of malignant transformation

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14
Q

HHC is 80% in cases of…

A

Cirrhotic liver

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15
Q

HCC

A

Cachexia, weakness, weight loss, sudden increase in alk phos

Triple phase CT shows rapid contrast filling with washout !

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16
Q

Fulminant

A

Within 8 weeks of onset of acute liver dz

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17
Q

Subfulminant

A

8 weeks to 6 months from onset of acute liver disease

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18
Q

Acute liver failure manifestations

A

Hepatic encephalopathy

Impaired synthetic function

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19
Q

Acute liver failure caused by…

A

APAP in a lot of cases, like half

Also viral hepatitis

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20
Q

Hepatic encephalopathy

A

Ammonia commonly elevated, but not the only factor

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21
Q

Asterixis

A

Most specific exam finding for hepatic encephalopathy

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22
Q

Fetor hepaticus

A

Sweet, fecal odor of breath, ammonia and ketones

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23
Q

Depuytren’s contracture and gynecomastia found in…

A

Liver disease

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24
Q

Child Pugh score

A

ABC stages

Encephalopathy, ascites, bilirubin, albumin, PTT

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25
Q

TIPS

A

Shunt placed between portal and hepatic veins to bypass the liver in portal HTN

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26
Q

Another scotch and tonic

A

AST at least 2x ALT in alcoholic liver disease

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27
Q

Alcoholic liver disease prognosis

A

Reverses with abstinence, this is the cornerstone of treatment

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28
Q

Non alcoholic fatty liver disease

A

Effects a lot of the population

Metabolic syndrome increases the risk, correct the modifiable risk factors

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29
Q

Cholelithiasis presentation

A

Biliary colic

Nausea belching, bloating

Pain after eating, may radiate to the back

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30
Q

Acute cholecystitis presentation

A

Vomiting, peritoneal signs, jaundice

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31
Q

Ascending cholangitis

A

ERCP emergently!!!

Can cause charcot’s triad- RUQ pain, fever, jaundice

then reynold’s Pentad!- charcot’s plus AMS, hypotension

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32
Q

Primary sclerosing cholangitis

A

Men 20-50, patients have IBD, fibrosis of biliary tract

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33
Q

Hep B labs

A

HBsAg- active infection
HBsAb- immunity, vaccine or from infection

HBcAb- following an active infection

HBeAg- actively infectious

HBeAb- infectivity reduced, acute phase over

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34
Q

Hep C

A

Illness often mild and asymptomatic, high rate of chronic hepatitis

Associated with a lot of other systemic symptoms!

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35
Q

Autoimmune hepatitis

A

All ages, often younger females

ANA or ASMA, other autoimmune diseases

White blood cells attacking the liver

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36
Q

Budd chiari syndrome

A

Occlusion of hepatic vein, usually thrombotic, polycythemia vera in half of cases

Causes pain, ascites and HM

**doppler

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37
Q

Which pancreatic enzyme is more sensitive?

A

Lipase

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38
Q

Sentinel lop

A

Paralysis and accumulation of gas, acute pancreatitis

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39
Q

Colon cutoff sign

A

Gas filled section of colon abruptly ending at pancreas

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40
Q

Pancreatic cancer pearls

A

St mary Joseph’s nodule- periumbilical nodule, mets

Painless jaundice

Courvoisier’s sign- palpable gallbladder = neoplastic obstruction

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41
Q

Hemobilia

A

Blood in biliary fluid, sign of biliary cancer until proven otherwise

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42
Q

Boerhaave syndrome

A

Rupture of esophagus due to vomiting

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43
Q

Singultus

A

Hiccups

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44
Q

Intractable hiccups

A

Chronic renal failure

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45
Q

Organic cause of hiccups

A

Doesn’t go away when you sleep, psychogenic cause does go away when you sleep

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46
Q

Normal transit time

A

35 hours, up to 72 hours

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47
Q

Normal transit constipation

A

Incomplete evacuation, psychosocial stress

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48
Q

Slow transit constipation

A

Infrequent stools, lack of urge, poor response to fiber and laxatives

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49
Q

Non inflammatory diarrhea

A

Water, non bloody
Periumbilical cramping, bloating
Maybe vomiting if food poisoning

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50
Q

Inflammatory diarrhea

A

Blood, pus, fever
Urgency, tenesmus
Must be distinguished from ulcerative colitis
Tissue damage from invasive organism or toxin

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51
Q

Chronic diarrhea is …

A

Greater than 4 weeks

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52
Q

Secretory diarrhea

A

Excessive stool water from extra electrolytes

Decreased electrolyte absorption or simulated electrolyte secretion in the intestines

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53
Q

Osmotic diarrhea

A

Ingestion of poorly absorbed cations (mg) and anions (sulfate) or carb malabsorption

Increased stool osmotic gap

Weight loss, steatorrhea, fecal fat >10

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54
Q

Shigella

A

Very high attack rate
Hemorrhage, bloody mucoid stools in small volume

Can cause reiter’s syndrome (uveitis, arthritis, urethritis) and HUS

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55
Q

Campylobacter can cause…

A

Guillan barre

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56
Q

Shigatoxin diarrhea

A

Can cause HUS, very deadly

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57
Q

Taenia solium

A

Can migrate to eyes and brain, cause neurocystercercosis

Punched out lesions in the brain

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58
Q

Ascaris lumbricodes

A

Free swimming, liver heart and lungs

Eosinophilia, urticaria, cough

Can be vomited out

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59
Q

Candida esophagitis looks…

A

Shaggy

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60
Q

Herpetic esophagitis

A

Volcano like appearance, multinucleated giant cells

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61
Q

Which is worse, alkaline or acid?

A

Alkaline

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62
Q

Eosinophilic esophagitis

A

Could be inflammatory response to allergies

Genetic

Need endoscopy with bx to confirm

Peripheral eosinophilia

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63
Q

Achalasia

A

Slowly progressive dysphagia

Loss of peristalsis in deep esophagus and failure of LES to relax

BIRD BEAK APPEARANCE on barium swallow

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64
Q

What is required for achalasia diagnosis?

A

Manometry

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65
Q

DES barium findings

A

Rosary need or corkscrew esophagus

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66
Q

Zenker’s goes through what?

A

Killian’s triangle

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67
Q

Schatzki ring

A

Circumferential mucosal structure at lower esophageal ring

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68
Q

Plummer Vinson syndrome

A

Triad of:
Irone deficiency
Dysphagia
Cervical esophageal web

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69
Q

Etiology of esophageal cancer

A

Squamous cell most common worldwide

Adenocarincoma most common in the US (distal 1/3)

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70
Q

Coffee ground emesis

A

Gastritis

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71
Q

H pylori

A

Spiral gram negative rod

Inflammation and injury in intestine, fecal Ag immunoassay or urea breath test!

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72
Q

Pernicious anemia gastritis

A

Autoimmune destruction

Decreased intrinsic factor secretion and B12 malabsorption, elevated gastrin production

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73
Q

Most common site of ulcer

A

Antrum

Then lesser curvature

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74
Q

Ulcers feel better with…

A

Food and antacids, especially duodenal ulcers

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75
Q

Zollinger ellison syndrome

A

Gastrinoma

Gastrin secreting neuroendorcine tumor, often in the gastrinoma triangle or the duodenum

2/3 are malignant

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76
Q

Zollinger ellison syndrome diagnosis

A

Secretin stimulation test- give secretin and it increases gastrin secretino in a gastrinoma

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77
Q

What is the dividing line of upper and lower GI?

A

Ligament of treitz, suspensions ligament of duodenum

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78
Q

Dieulafy’s legion

A

Abnormally dilated submucosal artery that erodes overlying mucosa and bleeds

Angiodysplasia

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79
Q

Melena

A

Blood in stool, dark and tarry from UGIB

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80
Q

Hematochezia

A

Usually lower GI bleed, more frank blood, but still can be from an UGIB

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81
Q

Norm for lower GI bleeds

A

Hematochezia

Brown stools with blood mixed or streaked, bright red from colon, maroon from small bowel

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82
Q

Painless large volume bleed =

A

Diverticular dz

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83
Q

Gastroparesis diagnostics

A

Gastric scintigraphy, measures gastric retention after a meal

KUB/CT may show dilation

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84
Q

Ogilvie syndrome

A

Massive cecal/ascending colon dilation, high risk of perforation

Critically ill inpatients

Similar to ileus but more sever

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85
Q

Intestinal atresia

A

Hx of polyhydramnios

Bilious vomiting

Double bubble sign, gas in stomach and proximal duodenum

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86
Q

Celiac

A

Diffuse damage to proximal small intestine from immunologic response to gluten

Dermatitis herpetiformis (itchy papulovesicles)

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87
Q

Whipple disease

A

Fatal if untreated

Hyperpigmentation, LAD, diarrhea, arthralgias, weight loss, fever

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88
Q

Diagnostic for lactase deficiency

A

Hydrogen breath test or 2 week lactose free diet

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89
Q

Coiled spring sign

A

Small bowel obstruction

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90
Q

X-ray distinguishing SBO from LBO

A

LBO, haustral markings don’t cross the entire lumen

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91
Q

String of pearls

A

Bowel obstructions

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92
Q

Wandering spleen

A

Risk of torsion with movement

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93
Q

Most common surgical problem in pregnancy?

A

Appendicitis

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94
Q

Peritonitis/abscess

A

Peritonitis more free with aerobes

Abscess more often with anaerobes

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95
Q

Incarceration vs strangulation

A

Incarceration means it cannot be manually reduced

Strangulation means that there is ischemia and necrosis

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96
Q

Diastasis recti

A

Separation of rectus abdominis muscles with intact facia

Bulges like a hernia, but there is no defect

Seen in obesity and post pregnancy

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97
Q

Indirect hernia

A

Though inguinal ring

Can feel it on the tip of finger

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98
Q

Direct hernia

A

Hesselbachs triangle, feel it on the side of your finger

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99
Q

Femoral hernia

A

More commonly female

Often incarcerated/strangulated

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100
Q

Mesh too tight on hernia repair, risk damaging…

A

Ilioinguinal nerve

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101
Q

C diff microbiology

A

Gram positive anaerobe
Spore forming
Toxin producing
Need to wash hands, not use alcohol

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102
Q

Diagnosis of c diff

A

EIA for toxin- need a high toxin burden

PCR- very expensive

Culture- takes time

Flex sig/colonoscopy- pseudomembranous colitis

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103
Q

How long should symptoms be present before diagnosis of IBD?

A

3 months

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104
Q

Diagnostic criteria of IBS

A

Rome III

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105
Q

CD or UC has more family hx risk?

A

Crohn’s

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106
Q

Aphthous ulcers more common in…

A

Crohn’s disease

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107
Q

Most common skin disorder with IBD

A

Erythema nodosum - red subQ pretibial nodules

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108
Q

Which has transmural inflammation?

A

Crohn’s dz

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109
Q

Which has more perianal dz?

A

Crohn’s

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110
Q

Cobblestoning seen in…

A

Crohn’s

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111
Q

Advanced adenoma

A

Take 5 years to develop

Greater liklihood of malignant transformation, 10 years to develop malignancy

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112
Q

Polyps in the ….. colon associated with more advanced neoplasia

A

Proximal

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113
Q

If >10 polyps, consider…

A

Familial polyposis syndrome

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114
Q

3-10 adenomas, >1 cm with high grade dysplasia, rescope in …

A

3 yeras

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115
Q

Lynch syndrome

A

Hereditary nonpolyposis colon cancer

Autosomal dominant, can lead to endometrial CA, ovarian CA, and others

Fewer polyps, but progress to cancer in 1-2 years!

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116
Q

Bethesda criteria

A

Should be considered for genetic testing for lynch syndrome

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117
Q

Colorectal cancer findings

A

Apple core lesion

CEA (>5 is bad)

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118
Q

Screening for colorectal cancer

A

Start at age 50, 45 in black patients

Colonoscopy every 10 years, all other every 5 yeras

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119
Q

Hemorrhoids are…

A

Normal anatomic structures!

Become symptomatic when venous pressure rises and they become engorged

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120
Q

Thrombosed external hemorrhoids

A

Young healthy adults

Coughing, heavy lifting or straining

Painful, tense, bluish perianal nodule

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121
Q

Pilonidal cyst location

A

Skin/soft tissue infection near upper gluteal cleft

122
Q

Most common anal cancer

A

Squamous cell carcinoma

HPV

123
Q

Most common solid tumor of young adult males

A

Testical cancer

90% are germ cell tumors

124
Q

Bell clapper deformity

A

Intravaginal, testicular torsion

125
Q

Torsion of testicular appendage

A

Blue dot sign

Paratesticular nodule on superior testicle

126
Q

Interstitial cystitis

A

Painful bladder sydrome, pain with bladder filling

Relieved by urination

127
Q

Unexplained hematuria in older patient (especially male smoker)=

A

Bladder CA until proven otherwise

128
Q

DIAPPERS

A 
Delirium
Infection
Atrophic urethritis/vaginitis
Pharmaceuticals
Psych factors
Excess urine output
Restricted mobility
Stool impaction

*urinary incontinence

129
Q

Prostate cancer PSA levels

A

> .75 annual increase, PSA velocity

130
Q

Most common kidney stones

A

Calcium oxylate

Envelope

131
Q

Struvite crystals

A

Infection
Coffin lid
Staghorn calculi
Proteus, pseudomonas

132
Q

If a patient has normal erections during sleep or in the early am…

A

Organic dz (like a vascular cause) is unlikely.

133
Q

Ischmic priapism

A

Emergency, more common

134
Q

Txt of ischemic priapism

A

Less than 4 hours, give phenylephrine

Greater than 4 hours, give phenylephrine AND aspirate the blood

135
Q

If increased FSH and LH, …

A

Primary testicular failure

136
Q

If decreased FSH and LH, then…

A

Secondary testicular failure

Hypothalamic or pituitary issue

137
Q

Lichen sclerosis

A

Inflammation
Epithelial thinning
Itching and pain

Onion skin
Cigarette paper skin

May lose anatomical landmarks, severe stenosis of vaginal opening

138
Q

Lichen simplex chronicus

A

Itch that rashes
Scratching/rubbing from irritant dermatitis

Hyperplastic/hyperpigmented areas

139
Q

Lichen planus

A

Chronic burning/itching
Insertional dyspareunia
Profuse vaginal discharge

Wickham striae, reddened ulcerated lesions, patchy distribution

140
Q

Vulvar vestibulitis

A

Inflammation of vestibular glands

New onset insertional dyspareunia and pain with tampon insertion

Light touch with moistened cotton applicator recreates exact pain

141
Q

Normal vaginal pH

A

4-.5

142
Q

If elevated vaginal pH, suggests…

A

BV or trich

143
Q

BV clinical presentation

A

Sometimes asymptomatic

White, thin and homogenous discharge that has a fishy smell

144
Q

Amsel’s criteria

A 
For BV, need 3/4:
Homogenous white discharge
Clue cells 
PH >4.5
Positive whiff test
145
Q

Wet mount finding in candidiasis

A

Budding yeast and hyphae

146
Q

Findings in trich

A

Strawberry cervix

Wet prep shows motile trichomonads

147
Q

Gonorrhea

A

Gram negative diplococci

148
Q

Gonorrhea presentation

A

Symptomatic during menses
Urinary pain, frequency, urgency
Purulent discharge
Could develop into PID

149
Q

Gold standard for gonorrhea

A

Culture

150
Q

Initial test for gonorrhea

A

NAAT

First morning urine

151
Q

Most common STI

A

Chlamydia

152
Q

Post coital bleeding…

A

Chlamydia

153
Q

Difference in men and women test for chlamydia

A

Women is vaginal swab

Men is first catch urine

154
Q

Lifespan of sperm

A

No more than 5 days

155
Q

Lifespan of ovum after ovulation

A

24 hours

156
Q

Fertile

A

5 days before ovulation to 24 hours after

157
Q

Estrogen suppresses…

A

Lactation

158
Q

Phyllodes tumor

A

Looks like fibroadenoma, but rapidly enlarges, can progress to CA

159
Q

Triple negative breast cancer

A

Poor prognosis because it doesnt have any of the receptors that hormone therapies target to kill the cancer

160
Q

Preservation of axillary lymphtics in breast cancer

A

Sentinel lymph node bx

Radiotracer dye injected near tumor, tracks to nodes, excise those nodes it tracks to

161
Q

Cervical cancer risks

A

HPV, specifically 16, 18 an 31

Smoking

HIV

162
Q

Postcoital spotting

A

Cervical cancer!

163
Q

Pap test every…

A

3 years if 21-29 (and one option if >30)

If >30, can do pap and HPV testing every 5 years

164
Q

Aceto white

A

Abnormal areas

165
Q

Schiller test

A

Normal epithelium absorbs the stain, nonstaining needs to be bx’d

166
Q

Unopposed estrogen =

A

Endometrial growth, risk factor for endometrial cancer

167
Q

Follicular phase is…

A

Estrogen dominant

168
Q

Luteal phase is…

A

Progesterone dominant

169
Q

Endometrial eval indicated for…

A

Any bleeding postmenopausal woman

170
Q

Tumor marker for extra uterine spread

A

Ca 125

171
Q

Hydatidiform mole

A

Proliferation of trophoblast

Not a viable pregnancy, markedly elevated HcG, snowstorm or honeycomb uterus on US

172
Q

Vague GI concerns in an older female, think…

A

Ovarian cancer

173
Q

If mid luteal progesterone concentration is less than…then…

A

3, evaluate patient for causes of anovulation

174
Q

MCC of secondary dysmenorrhea

A

Endometriosis

175
Q

Chronic pelvic pain

A

6 months or more

176
Q

Uterosacral nodularity

A

Classic for endometriosis, but often not present

177
Q

Dx of endometriosis

A

Tissue biopsy, must have 2 or more:

Endometrial epithelium
Endometrial glands
Endometrial stroke
Hemosiderin laden macrophages

178
Q

Elevated hormone in menopause

A

FSH

179
Q

Oligomenorrhea

A

Reduction in the frequency of menses, cycle lengths of >40 days and <6 month

180
Q

Hypomenorrhea

A

Reduction in the number of days or the amount of menstrual flow

181
Q

Amenorrhea

A

Always check pregnancy@

182
Q

String of pearls on ovary

A

PCOS

183
Q

Reinke albuminoid crystals

A

Pathognomonic for hilar cell tumors

184
Q

Cushing diagnosis

A

Overnight dexamethasone suppression test

185
Q

Polymenorrhea

A

Frequent menstrual bleeding, less than 21 day cycles

186
Q

Menorrhagia

A

Prolonged or excessive uterine bleeding occuring at regular intervals

187
Q

Metrorrhagia

A

Irregular menstrual bleeding/bleeding between periods

188
Q

Menometrorrhagia

A

Frequent menstual bleeding that is excessive and irregular in amount and duration

189
Q

Stages of vaginal prolapse

A

Stage 2- between 1 cm above and 1 cm below the hymen
Stage 3- greater than 1 cm past the hymen, but at least some of the vaginal mucosa is not everted
Stage 4- complete eversion

190
Q

Pregnancy is a high…

A

Progesterone state and estrogen state

191
Q

Bohr effect

A

Compensated respiratory alkalosis during pregnancy, facilitates oxygen delivery to the fetus and co2 removal rom the fetus

192
Q

HPL effect in pregnancy

A

Diabetic effect, makes a type 2 diabetes environment

Insulin resistance, hyperplasia of the insulin secreting beta cells

193
Q

Trimesters in pregnancy

A

First trimester is up to 14 weeks
Second is 14-28 weeks
Third is 28 weeks- delivery

194
Q

Quickening occurs..

A

16-20 weeks GA

195
Q

Naegele’s rule

A

Add 9 months and 7 days from the first day of the last menstrual period

196
Q

Fundal height measuring

A

20-36 weeks

197
Q

Fetal heart tones

A

110-160

198
Q

Screening for diabetes

A

24-48 weeks

199
Q

Ritgen maneuver

A

Giving the baby’s chin upward pressure

200
Q

Inspect umbilical cord for…

A

2 umbilical arteries and 1 umbilical vein

201
Q

Degree of lacerations in delivery

A

2nd- underlying subq tissue
3rd- rectal sphincter, but not mucosa
4th- extends into rectal mucosa

202
Q

Late deceleration

A

Reflect hypoxemia of the fetus with CST or NST

203
Q

STOP late decels

A

Sterile vaginal exam
Turn patient on left side
Oxygen
Pitocin off

204
Q

Biophysical profile scores

A

Normal = 8-10

Equivocal is 6

Abnormal is <4

205
Q

<20 weeks growth

A

Hyperplastic, number of cells

symmetric growth restriction

206
Q

> 20 weeks growth

A

Hypertrophic, size of cells is growing

Asymmetric intrauterine growth restriction

207
Q

Vasa previa

A

Unprotected fetal vessels lying over the cervix

Can cause large bleeds, requires c section

208
Q

Placenta accreta, increased and percreta

A

Accreta- attaches to myometrium

Increta- invades the myometrium

Percreta- penetrates through the myometrium

209
Q

External version

A

Don’t perform before 36 weeks GA

Initially without anesthesia, can re attempt at 39 weeks with epidural

210
Q

Fetal fibronectin asay

A

Vaginal swab of posterior fornix, if negative then there is a 99% chance for NO preterm delivery

211
Q

McDonald versus shirodkar cerclage

A

McDonald- suture placed at cervical/vaginal junction

Shirodkar- suture placed at internal os

212
Q

Bishop score

A

If 6 or greater, induce because it should go well

If they are induced, how likely will it be to a spontaneous vaginal birth

213
Q

Stay in hospital after birth

A

2 days if vaginal

3-4 days if C section

214
Q

HELLP

A

Hemolysis
Elevated liver enzymes
Low platelets

215
Q

Transvaginal US vs. transabdominal US levels

A

Vaginal- 1000-2000

Abdominal- 5000-6000

216
Q

Medicinal approach to abortion is appropriate…

A

<49 days gestation

217
Q

Isoimmunization can occur when…

A

Rh negative mom has a fetus with a rh positive dad (rh positive baby)

218
Q

Screening for rh

A

1st prenatal visit

28 weeks

Delivery

219
Q

Anti D immunoglobulin administered at …

A

28 weeks

Postpartum to a negative mom that delivers positive baby

220
Q

MCC of post partum hemorrhage

A

Uterine atony

221
Q

Anemia in pregnancy is when…

A

Hgb is less than 11, hct is less than 33%

222
Q

Prevention and traetment of folic acid deficiency anemia

A

.4 mg of folic acid for prevention

1 mg daily of folic acid for treatment

223
Q

Antiphospholipid syndrome

A

Recurrent pregnancy losses

Treated with heparin and ASA

224
Q

Group b strep screening

A

Between 35-37 weeks GA, if positive treat with antibiotics during labor

225
Q

DM type 1B

A

Idiopathic, inflammation but not anti islet autoantibodies

226
Q

Latent autoimmune diabetes of adulthood

A

Adult age of onset, don’t need insulin for about 6 months

227
Q

Maturity onset diabetes of the young

A

Rare, mild form of noninsulin dependent DM

Impaired glucose-induced secretion of insulin

228
Q

OGTT

A

Restrict carbs, 8 hours fast, no smoking or exercise the day of the test

0 and 120 minute blood draws

229
Q

Serum fructosamine

A

Eval of glucose levels in the preceding 1-2 weeks

Greatly affected by serum albumin, but helpful when there are hemoglobinopathies

230
Q

DM test values for fasting plasma glucose, OGTT and HbA1c

A

Fasting- >126

2 hour OGTT- >200

HbA1c- >6.5

231
Q

Nonproliferative diabetic retinopathy

A

Early stages

Microaneurysms, dot hemorrhages, exudates and retinal edema

232
Q

Proliferative diabetic retinopathy

A

Leading cause of blindness in the US

New, fragile capillary growth, hemorrhages, increased risk of retinal detachment from fibrous tissue growth

233
Q

Isolated peripheral neuropathy

A

Sudden onset with subsequent recovery, motor abnormalities predominate

Vascular ischemia, traumatic damage

Cranial and femoral nerves

234
Q

Monitoring hba1c

A

Every 3 months if treatment changes or not at goal

Every 6 months if stable and at goal

235
Q

DKA triad

A

Hyperglycemia
Ketonemia
Anion gap metabolic acidosis

236
Q

Cornerstone of DKA treatment

A

Fluid replacement! Need to restore normal perfusion

Keep BS between 250-300 to prevent hypoglycemia/cerebral edema

237
Q

Sodium bicarb replacement in DKA

A

If pH is less than 7

238
Q

Whipple triad

A

Pancreatic beta cell tumor

  1. Hx of hypoglycemic symptoms
  2. Fasting BS less than 45
  3. Glucose administration leads to recovery
239
Q

Noninsulinoma pancreatogenous hypoglycemia syndrome (islet cell hyperplasia)

A

Hyperinsulin hypoglycemia after meals, but not with fasting!

240
Q

Occult diabetes

A

Exaggerated insulin release after initial hyperglycemia from GTT

Delay in early insulin release, potential diabetics!

241
Q

Most common cause of worldwide hypothyroid

A

Iodine deficiency

242
Q

Posterior pituitary secreted

A

Oxytocin and ADH

243
Q

Gigantism vs acromegaly

A

In gigantism, epiphyseal plates are still open. Acromegaly they are already closed

244
Q

Acromegaly labs

A

IGF-1, normal values of this rule out this diagnosis

245
Q

Pituitary apoplexy

A

Sudden onset of HA, visual changes, AMS, hormonal abnormalities

Hemorrhagic or ischemic

246
Q

Cortex vs medulla

A

Cortex secretes steroids and estrogen/androgen

Medulla secretes the catecholamines

247
Q

Conn syndrome

A

Hyperaldosteronism from an adrenal adenoma

248
Q

Adrenal insufficiency diagnosis

A

ACTH stimulation test

Pretest serum cortisol, administer synthetic ACTH

Cortisol should double within an hour, and if it doesn’t the adrenals aren’t functioning properly

249
Q

Pheochromocytoma

A

Severe HA
Tachy/palpitations
Perspiration

250
Q

Hypocalcemia effect on muscles

A

Causes hyperexcitability!

251
Q

Hypercalcemia on muscles

A

Causes hypoexcitbaility, depresses neuronal activity

252
Q

3 ways that PTH increases calcium

A

Bone resorption
Renal reabsorption
Increased intestinal absorption

253
Q

Hypoparathyroidism presentation

A

Tetany, muscle cramps/spasms, tingling, lethargy or anxiety, cataracts, prolonged QT

254
Q

Pseudohypoparathyroidism

A

Congenital resistance to PTH

Hypercalcuria and hypocalcemia, PTH still acting normally at the level of the bone so short metacarpal bones, short stature, osteodystrophy

255
Q

Secondary hyperparathyroidism

A

CKD/dialysis

Phosphorus is not getting excreted, PTH thinks we are hypoglycemia

256
Q

Hyperparathyroidism presentation

A

Bones, stones, abdominal groans, psychic moans with fatigue overtones

Brown tumors, kidney stones

257
Q

Post op secondary hyperparathyroidism

A

Hungry bones that soak up ca

Persistently low ca triggers PTH release

258
Q

Defective mineralization of bones…

A

Rickets in kids

Osteomalacia in adults

259
Q

Paget dz of bone/osteitis deformans

A

Excess bone mass with little integrity

Tibial bowing, chalkstick fx, hearing loss

260
Q

If thyroid nodule is greater than 2 cm…

A

Use TSH

261
Q

Follicular thyroid CA

A

Elevated thyroglobulin

More aggressive than papillary

262
Q

Medullary thyroid cancer

A

Secrete calcitonin, CEA

Flushing, diarrhea

263
Q

Osmolality equation

A

2(sodium) plus glucose/18 plus BUN/2.8

264
Q

Serum osmolality reference range

A

285-295

265
Q

If spot urine is less than 10, suggests…

A

Extrarenal salt loss, kidneys are trying to hold onto sodium

266
Q

DI

A

ADH deficiency or resistance

If deficiency, its central DI
If resistance, its nephrogenic DI

267
Q

DI workup

A

Desmopressin challenge

Central DI will have decreased thirst and urination if given desmopressin (tx of choice)

268
Q

Hypokalemia effect on neuromuscular

A

Tougher to trigger action potential

269
Q

Hyperkalemia effect on neuromuscular

A

Easier to trigger action potential, hyperexcitability

270
Q

Mg and K

A

Mg inhibits K secretion, so if hypokalemia, HAVE to check Mg levels

271
Q

Hypokalemia on EKG

A

U waves

St depression

Broadened and flattened T waves

PVCs

272
Q

Drugs causing hyperkalemia

A

K sparing diuretics
ACEIs ARBs
Trimethoprim
Digitalis toxicity

273
Q

Hyperkalemia EKG changes

A

Peaked T waves
Wide QRS
V Fib

274
Q

KDIGO criteria for AKI

A

Increase in serum Cr >.3 in 48 hours

Increase in serum Cr >1.5x baseline within prior 7 days

Urine volume 6 hours

Any of these!

275
Q

Prerenal AKI

A

MCC

Renal hypoperfusion
BUN:Cr >20:1, low excretion of sodium in the urine

276
Q

NSAIDs and ACE inhibitors effect on glomerulus

A

NSAIDs dilate the afferent arteriole

ACEIs and Arbs constrict the efferent arteriole

277
Q

Postrenal AKI

A

Obstructive

Increased urine sodium
Isosthenuria (urine and plasma osmolality become the same)

278
Q

2 causes of acute tubular necrosis

A

Ischemia

Nephrotoxin

279
Q

Interstitial nephritis

A 
Drugs are the culprit! 
Fever
Rash
Eosinophilia 
RBCs in urine
280
Q

Renal tubular acidosis

A

Defect in wither proximal tubular bicarb reabsorption or defect in distal tubule hydrogen ion secretion

Normal anion gap, hyperchloremic metabolic acidosis

281
Q

Nephritic

A

Hematuria
Proteinuria <3 g
HTN
Edema

282
Q

Postinfectious GN

A

Lumpy bumpy/starry sky pattern on immunofluorescence

Sub epithelial humps

1-3 weeks post infection

283
Q

IGA nephropathy

A

Gross hematuria, associated post infection 1-2 days

284
Q

Pauci immune GN

A

Fever, malaise, weight loss prodrome

ANCA subtyping

285
Q

Anti GBM GN

A

Goodpasture syndrome with hemorrhage in the lungs

286
Q

Membranoproliferative GN

A

Tram track appearance, nephritic or nephritic syndrome

287
Q

Nephrotic

A

Hyperproteinuria
Hypoalbuminemia
Hypertriglyceridemia
Edema

288
Q

Minimal change dz

A

Kids

Fused foot processes

289
Q

Membranous nephropathy

A

MCC of Primary nephrotic syndrome in adults

DVT is a common initial sign

Spike and dome pattern

290
Q

HTN plus abdominal mass, think…

A

PKD

291
Q

Complications of PKD

A

Cerebral aneurysm in the circle of Willis, other vascular issues

292
Q

Swiss cheese kidney =

A

Medullary sponge kidney

293
Q

Wilms tumor

A

Most common malignant renal tumor of childhood

294
Q

MCA stroke findings

A

More face and arm deficits
Aphasia
Neglect of non dominant

295
Q

ACA stroke findings

A

Leg more than face/arm deficits
Abulia, paratonic rigidity, grasp reflex
Incontinence

296
Q

PCA findings

A

Visual abnormalities
3rd CN palsy
Spontaneous pain

297
Q

Vertebrobasilar stroke findings

A 
Ataxia
Dizziness
NV
CN palsies
Coma
298
Q

Vegetative state

A

Intact wakefulness, sleep wake cycles, but absent awareness

299
Q

Minimally conscious state

A

Intact wakefulness, and awareness but poor response

300
Q

Locked in syndrome

A

Intact awareness and wakefulness

Clin Med 2 (8 decks)

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