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Internal Medicine > Internal Medicine > Flashcards

Internal Medicine Flashcards

1
Q

What does it mean to have diabetes? How is type 1 different from type 2?

A

Simply, glucose cannot enter cells.
Type 1 - The pancreas doesnt make insulin which is required for glucose to enter cells
Type 2 - The pancreas makes insulin but the insulin receptors on cells are not working properly so glucose can’t get into the cells as easily

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2
Q

How is type 1 and 2 diabetes treated?

A

Type 1 - The pancreas doesnt make insulin so give them insulin

Type 2 - Lifestyle changes can make the insulin receptors more sensitive to insulin, as can Metformin, etc. If it gets severe, add insulin so that the more insulin the more likely they are to bind to the receptors

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3
Q

What happens if diabetes is left untreated?

A

The blood glucose is really high because it can’t enter the cells which causes:

  • increased risk of CVD (plaque formation)
  • retinopathy, glaucoma, cataracts
  • neuropathy, especially in feet
  • poor wound healing
  • nephropathy
  • DKA
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4
Q

How can diabetes be diagnosed?

A

A1C of 6.5%
Random glucose of 11.1 mmol/L
Fasting blood glucose 7 mmol/L

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5
Q

What is diabetic ketoacidosis (DKA)? Is it more likely in type 1 or 2?

A
  • More likely in type 1
  • The body isn’t able to use glucose as fuel so it uses fatty acids as a fuel source instead. Burning fatty acids produces ketones which builds up in the blood making the blood more acidic
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6
Q

What are the lab values of DKA?

no numbers, just high/low

A
  • High ketones
  • Low insulin
  • High glucose
  • Anion gap metabolic acidosis (Na - Cl - HCO3 >12)
  • May see hypokalemia due to osmotic diuresis (inhibits reabsorption of water and electrolytes)
  • Often you will see normal potassium or false hyperkalemia because K+ moves out of cells into the blood (looks like hyperkalemia but is not)
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7
Q

Symptoms/Signs of DKA

A
  • Hypovolemia/dehydration
  • Nausea, Vomiting
  • Abdominal pain/cramps
  • Confusion
  • Lethargy
  • Deep, rapid breathing - Kussmaul respirations
  • Altered LOC
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8
Q

Treatment for DKA

A
  • First give Isotonic IV fluids (they are hypovolemic and dehydrated) - normal saline!
  • IV Insulin (unless low K+) followed by SQ
  • Potassium (unless high)
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9
Q

When should/shouldn’t you give insulin to a patient with DKA?

A

If K+ <3.3 DO NOT give insulin until potassium is elevated.
Insulin will cause their potassium to shift from extracellular to intracellular making their hypokalemia even more severe

If K+ 3.3-5.2 give insulin and potassium

If K+ >5.2, give insulin

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10
Q

What is hyperosmolar hyperglycemic syndrome (HHS)? Is it more common in type 1 or type 2 diabetes?

A

In type 2 DM.
Glucose is not getting into the cells so the body is basically starving. Because insulin is present, it prevents the body from using fatty acids to make ketone bodies so the patient is not acidotic like DKA.

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11
Q

Signs/symptoms of hyperosmolar hyperglycemic syndrome (HHS)?

A
  • High blood glucose
  • Fatigue
  • Weight loss
  • Thirst and frequent urination
  • Extreme dehydration (tachycardia, hypotension)
  • Confusion

NO abdominal pain like DKA

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12
Q

What makes someone frequently urinate with untreated diabetes?

A

In diabetes, the kidneys can’t reabsorb all the glucose so you pee out a lot of the glucose. In general, water likes to follow wherever glucose is so water is pulled out of the cells and exits in urine with the glucose

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13
Q

What are the causes of DKA?

A
  • Sepsis (#1)
  • Sickness (eg. viral)
  • Stress/Surgery
  • Stopping insulin
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14
Q

What are the causes of HHS?

A
  • Illness

- Infections

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15
Q

Treatment for HHS

A

Give normal saline first then IV Insulin

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16
Q

What is the treatment for C diff?

A

Fidaxomicin 200mg po BID x 10 days
preferred due to lower recurrence rate

Vancomycin 125-500mg po QID x 10 days
-cheaper for the patient

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17
Q

What’s an easy way to tell the axis for an EKG?

A

Lead 1 and 2 are facing away from each other - they have LEFT each other

Lead 1 and 2 are facing towards each other - they are RIGHT for each other

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18
Q

What is the treatment for heart failure with EF <40% (HFrEF)?

A

Triple therapy:

ACE inhibitor, beta blocker, mineralocorticoid receptor antagonist

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19
Q

How do you treat a STEMI?

A 
Recatheterization
Dual antiplatelet therapy (ASA + plavix)
ACEi
beta blocker
nitrates only if angina persists
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20
Q

Treatment for unstable angina

A

Nitro spray
dual antiplatelet therapy (ASA + plavix)
unfractionated heparin or lovenox

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21
Q

What is a normal EF?

A

> 55%

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22
Q

Treatment for ventricular tachycardia

A

Cardiovert back into sinus rhythm
Implanted cardiac defibrillator (ICD)
Pt goes home on Amiodarone

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23
Q

Why might someone with A fib need anticoagulation? Who would need it?

A 
They are at a higher risk of stroke
CHADS need anticoagulants:
CHF
Hypertension
Age 65+
Diabetes
Stroke in the past
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24
Q

Signs of decompensated cirrhosis

A

Acute deterioration of liver function:
jaundice
ascites
hepatic encephalopathy (confusion)

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25
Q

Treatment of acute hepatic encephalopathy

A

Lactulose

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26
Q

What is portal hypertension?

A

Increased pressure in the portal (liver) vein. Often caused by liver cirrhosis

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27
Q

A common complication of cirrhosis

A

Gastroesophageal varices in ~1/2 of cirrhosis patients - screen every 1-2 years

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28
Q

Treatment of gastroesophageal varices

A

Beta blocker (eg. propranolol) or variceal band ligation

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29
Q

Signs of chronic liver disease

A 
Ascites
jaundice
peripheral edema
spider angiomata
caput medusa
testicular atrophy
30
Q

What is spontaneous bacterial peritonitis?

A

Infection of ascites

31
Q

What are the causes of ascites?

A 
Cirrhosis (85% of ascites)
Malignancy
TB
Nephrotic syndrome
Right sided heart failure
Pancreatic duct disruption
32
Q

Calculation for determining if ascites is due to portal hypertension

A

serum albumin - ascites albumin >1.1 = portal hypertension

33
Q

Treatment of ascites

A 
loop diuretic (eg. lasix)
spironolactone
2 grams/day sodium restriction diet
34
Q

What is hepatorenal syndrome?

A

Decline in renal function due to cirrhosis because of decreased blood flow to the kidneys

35
Q

What are the causes of decompensated heart failure?

A 
Ischemia
Arrhythmia
Nonadherence to meds
High sodium diet
Infections
HTN
NSAIDs
Renal failure
pulmonary embolism
anemia
36
Q

What is the most frequent comorbidity of primary sclerosis cholangitis?

A

Ulcerative Colitis - In 80%

37
Q

What liver enzymes are usually elevated for cholangitis?

A

ALP, Bili, GGT cholangitis

38
Q

What liver enzymes are usually elevated for hepatitis?

A

AST, ALT

39
Q

Causes of liver disease

A 
Hepatitis - Autoimmune, A, B, C
Primary biliary cholangitis
Primary sclerosing cholangitis
Hemochromatosis
Wilson's disease
Alpha-1 antitrypsin deficiency
Malignancy
NAFLD
Alcohol
Drugs
40
Q

What is hemochromatosis?

A

Hemochromatosis isa disorder in which the body can build up too much iron in the skin, heart, liver, pancreas, pituitary gland, and joints. Too much iron is toxic to the body and over time the high levels of iron can damage tissues and organs

41
Q

What is Primary biliary cholangitis and

Primary sclerosing cholangitis?

A

Diseases that result in the blockage of the bile duct causing bile to back up into the liver and damage it

42
Q

What is Wilson disease?

A

Wilson disease isa rare genetic disorder characterized by excess copper stored in various body tissues, particularly the liver, brain, and corneas of the eyes

43
Q

What is Alpha-1 antitrypsin deficiency?

A

Alpha-1 antitrypsin deficiency is aninheriteddisease that causes an increased risk of havingCOPD,liver disease and vasculitis

44
Q

What is NAFLD?

A

Nonalcoholic fatty liver disease isa condition in which excess fat builds up in your liver not related to alcohol use.

45
Q

What is NASH?

A

Non-alcoholic steatohepatitis isan advanced form of NAFLD which can result in cirrhosis and liver failure

46
Q

What should you give to patients staying immobile for a long period of time?

A

Lovenox - to prevent a clot

47
Q

What factors are included in the Wells score for DVT?

A 
active cancer
paralysis
bedridden for 3 days or surgery within 4 weeks
previous DVT
tenderness
pitting edema
asymmetric calves
large visible veins
48
Q

What factors are included in the Wells score for pulmonary embolism?

A 
Previous PE or DVT 
Immobilization or surgery in past 4 weeks 
cancer 
hemoptysis 
tachycardia
clinical signs of DVT
49
Q

What blood test can you order for DVT/PE specifically?

A

D-dimer

50
Q

Besides lowering the K+, what do you need to do if a patient is hyperkalemic?

A

EKG and give calcium gluconate

51
Q

How can you lower potassium?

A
  • Dextrose (D50) followed by insulin
  • K+ binder like kayexalate
  • diuretic
  • bicarb
  • salbutamol (8 puffs)
  • dialysis if all else fails
52
Q

What could hyperkalemia show on EKG?

A

peaked T waves

wide QRS

53
Q

What are the criteria for dialysis?

A 
Acidosis
Electrolyte imbalance
Intoxication
Overload
Uremia

AEIOU

54
Q

What are the causes of delirium?

A

Drugs - intoxication, alcohol withdrawal, anticholinergics

Infections

Metabolic - hypoglycemia, electrolyte abnormalities, liver or renal failure

Environmental - restraints, change in environment

Structural - stroke, hemorrhage, ischemia, brain tumor

55
Q

What is cardiogenic shock?

A
  • Shock due to MI, cardiac tamponade, acute mitral regurg, etc.
  • exremities are often cold
56
Q

What is distributive shock?

A
  • Septic, anaphylaxic or spinal shock

- extremities are warm

57
Q

What is hypovolemic shock?

A
  • Low intravascular volume due to blood loss, diarrhea, emesis or poor oral intake
  • extremities are cold
58
Q

Causes of upper GI bleed

A
  • Peptic ulcer disease (due to NSAIDs or H Pylori)
  • Gastritis
  • Esophagitis
  • Variceal bleeding (due to cirrhosis)
  • Mallory Weiss tear
59
Q

Treatment of H pylori

A

Triple therapy - PPI, amoxicillin, clarithromycin

60
Q

Type of arrhythmia with wide vs narrow QRS

A

Wide - Ventricular tachycardia

Narrow - Atrial fibrillation

61
Q

Does low CO2 represent respiratory/metabolic, acidosis/alkalosis?

A

respiratory alkalosis

respiratory because it involves CO2

*When you hyperventilate you lose CO2 making you more basic and fainting

62
Q

Does high CO2 represent respiratory/metabolic, acidosis/alkalosis?

A

respiratory acidosis

respiratory because CO2 is involved

63
Q

Does low HCO3 represent respiratory/metabolic, acidosis/alkalosis?

A

metabolic acidosis

64
Q

Does high HCO3 represent respiratory/metabolic, acidosis/alkalosis?

A

metabolic alkalosis

65
Q

What is pulmonary hypertension?

A

Increased pressure in the pulmonary artery (artery leading from the heart to the lungs)

66
Q

What are some causes of pulmonary hypertension?

A

Heart failure
COPD
PE
Cirrhosis

67
Q

2 main types of COPD

A

Chronic bronchitis and emphysema

68
Q

What is chronic bronchitis? What are the symptoms?

A 
A type of COPD
Clinical diagnosis: daily productive cough for 3 months or more for 2 consecutive years
Overweight and cyanotic 
Leg edema 
Crackles, wheezing
Blue bloater
69
Q

What is emphysema ? What are the symptoms?

A

A type of COPD
Permanent enlargement and destruction of alveoli
Thin, dyspnea, quiet chest
Pink puffer

70
Q

Signs of a COPD exacerbation

A

Increased cough
Increased sputum production
Dyspnea

71
Q

What is cor pulmonale?

A

Right ventricle of the heart enlargement caused by pulmonary hypertension. Often leads to right sided heart failure

Internal Medicine (1 decks)

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