Fourth 100 Flashcards
Pt c/o diffuse headache, worse when leaning forward. No edema, but JVD is obvious.
Top diagnosis?
Treatment?
SVC syndrome - something is compressing the vena cava.
Top cause - malignancy (either lymphoma or lung CA)
Treatment - treat the CA. Usually radiation.
Patient presents with both UMN and LMN issues - diagnosis?
Usual age of onset?
Next step?
ALS
Over 40
Nerve conduction, EMG, neuroimaging to rule out other causes
Common cause of complex partial seizures in adults?
Temporal lobe epilepsy
Patient with multiple issues, including shiny, hairless thin-skinned foot. Cause of the foor presentation?
Next step?
How to interpret this?
Peripheral vascular disease (he prob has diabetes or something similar)
Ankle-Brachial Index
Normal: 1.0-1.3 … PVD: 0.4-0.9 … Severe ischemia: <0.4
What drug can be given prophylactically to minimize gallstone formation?
Ursodeoxycholic acid
How will phosphate & calcium levels change with CKD?
How will the parathyroids react?
High phosphorus (phosphate retention by kidneys) and Low calcium (abnormal Vit. D processing by kidneys)
Parathyroids will hypertrophy
Plasma and urine osmolalities with SIADH?
Plasma osmo - low (200)
Urine sodium - high (>40)
Normal values for plasma osmo, urine osmo and urine sodium
Plasma osmo: 275-290
Urine osmo: 50-1400
Urine sodium: 30-40
What medication to give for overflow incontinence?
Cholinergic agonist (bethanechol)
First line treatment to prevent esophageal varicies?
What then?
B-blockers
If this fails, TIPS, band ligation or nitrates
Potential lethal SE of PTU (and what other drug)?
Next steps?
How will labs influence decision?
Agranulocytosis
1) stop PTU or methimazole
2) throat culture, abx (incl pseudomonas), and WBC count
3) if WBC1500, look for another source of throat infxn
Reason for bone issues with Vit. D deficiency? In adults?
In kids?
Defective mineralization of bone in adults, bone AND cartilage in kids
What are the 3 forms of calcium?
Which one is the active form?
How does pH affect these?
Ionized (45), albumin-bound (40) and anion-bound (15)
Ionized Ca
Increased pH (alkalosis) increases albumin affinity, so that goes up, ionized Ca goes down - presents with hypocalcemia
First step with asymptomatic hyperparathyroidism?
Sestamibi scan (scan to localize the adenoma and assess its weight in relation to the gland)
Previously healthy pt with new HTN, weakness, muscle cramps and fatigue - top of ddx?
What is causing the symptoms?
Hyperaldosteronism
Body hangs on to sodium (HTN) with subsequent loss of potassium (cramps, weakness)
Compare DI with SIADH & polygenic polydipsia
Treatments?
DI - dilute urine with high plasma osmo, treat w DDAVP (nasal)
SIADH - conc. urine (high osmo) w low plasma osmo, treat with demeclocycline
Poly.Polydipsia - dilute urine with dilute plasma, stop drinking!
Dilute urine with high plasma osmo - next step?
What will that tell us?
DI - give water deprivation followed by vasopressin (AVP) test
If urine osmo increases with AVP, think CENTRAL DI
If urine osmo stays unchanged, think NEPHROGENIC DI
Treatment for nephrogenic DI?
Indomethacin (NSAID) and HCTZ
If lithium is the cause, treat with Amiloride
Symptomatic sudden hyperthyroidism - initial treatment?
What then?
Beta blocker (propranolol)
Radioactive iodine (unless pregnant, then PTU)
Which antibodies are present in pts with Hashimoto’s?
Anti-TPO Abs
Pts with Hashimoto’s have increased risk for what type of CA?
Lymphoma of the thyroid
Patient presents with new onset muscle pains, high CK, & weakness - top of ddx?
Hypothyroidism
Think of what when a patient prefers ice water?
Diabetes insipidus
Top 2 causes of benign thyroid nodules?
- Colld nodules
- Follicular adenoma
(Most common MALIGNANT = papillary)
