QG SB2 (F) Flashcards
W2 QG blocks (15,17,20,23,26) Deck is full
what does DI present w/?
sOSM incr sNa incr
uOSM decr uNa decr
what does HHS stand for?
hyperosmolar hyperglycemic state
what is hashimoto’s thyroiditis associated w/?
- thyroid lymphoma
- other AI disorders
what are the common presenting s/s VIPoma?
diarrhea, flushing, TEA COLORED STOOLS
carcinoid - pulm s/s + tea colored stools
what steroid from the adrenal gland regulates K+?
aldosterone (dumps K+ and reabsorbs Na)
which adrenal insufficiency presents w/ low aldosterone?
1* adrenal insufficiency
what causes central (2*) adrenal insufficiency?
chronic steroid use
what causes 1* adrenal insuficiency?
AI
plasma renin : aldosterone ratio test tests for what?
hyperaldosteronism [>30 = conn’s. ~10 = 2*)
aldosterone is incr. what Na and K values do you expect?
Na incr. K decr.
what med should you use to tx conn syndrome if pt refuses Sx?
eplerenone > spironolactone
aldosterone antagonists = k+ sparing anti-HTN drugs
what PO DM meds cause weightloss?
- GLP-1 antagonist
- SGLT-2 inhib (__gliflozin)
- metformin
ED + testicular atrophy are likely 2/2 _____
hypogonadism
what sex characteristics are altered in cirrhosis?
small testes
gynecomastia
why do you see sex characteristic changes in cirrhosis?
1* gonaadal injury/ HPaxis dysf(x) –> small testes
incr conv androgens –> incr estradiol –> gynecomastia
expected electrolytes low aldosterone?
decr Na. incr K. Low BP.
how do you dx 1* adrenal insufficiency?
- 8am cortisol –> low cortisol
- check ACTH –> high
- ACTH stim test –> No response b/c gland isn’t able to respond to the ACTH in circulation
why can hypothyroidism result in oligomenorrhea?
low T3/T4 –> hypothalamus incr TRH release (so TSH incr and T4 incr) –> BUT incr TRH –> incr prolactin –> decr FSH –> oligomenorrhea
hypocalcemia w/u includes?
- recheck Ca to confirm it’s truly low
2. check Mg, albumin, PTH
in a nL healthy body, incr PTH –> incr Ca + decr Phos. if incr PTH but decr Ca, what is the dx?
- vit D def
- CKD
- pancreatitis (Ca used up in soaponification)
- sepsis
- tumor lysis
what are the blood glucose goals for DM?
preprandial/fasting = 80-130
post-prandial <180
HgA1c <7%
at what age do you stop giving adults the drugs on the Bier’s list?
age >= 65
HgA1c is an indicator of what?
post-prandial glucose (prev 3 mos)
what is the dawn phenomenon?
fasting hyperglycemia 2/2 GH and cortisol release overnight
what IVF should be given initially for volume resuscitation (1st few hours)?
NS (0.9%)
what electrolyte must you keep an eye on when using IVF for fluid resuscitation?
Na
when should 0.45% NS be used for volume resuscitation?
corrected Na is nL or high on recheck
what does PTH incr do to phos?
decr (PTH = phosphate trashing hormone)
incr PTH + incr Ca + decr phos. dx = ?
1* hyperparathyroidism
PTH is being released despite high Ca that should be suppressing it
what is the threshold for malignant hypercalcemia?
Ca > 14
what is necrolytic migratory errythema?
erythematous papules/plaques that grow/coalesce. will have central clearing, blistering, and crusting/scaling edges
how does glucagonoma present?
DM (easily controlled) + rash (NME) + GI (D/C, abd pain, anorexia, wt loss)
what confirms dx of glucagonoma?
glucagon > 500 pg/mL
what are the 1st and 2nd line tx for grave’s dz?
- propranolol (use BB to decr symp activity)
2. PTU/methimazole
why is radioactive iodine a 3rd line tx for grave’s dz (esp. when exopthalmos is present)?
RAI –> rapid thyroid destruction –> immediate release of T3/T4 reserve –> makes s/s temp worse **
**exception = exopthalmos which is irreversible
what comorbid condition should be expected (and r/o) in PCOS pts?
DM (often are obese and will develop insulin resistance)
what is the gold standard for dx DM2 in PCOS pts? (bonus: why?)
oral glucose tolerance test (more sensitive @ detecting glucose intolerance)
obese pts w/ metabolic synd are at incr risk for developing what 3 conditions?
- OSA
- nonalcoholic fatty liver dz
- endometrial cancer
what is metabolic synd?
+dislipidemia (incr cholesterol or incr TG)
+HTN
+DM2
+excess abd fat
what organs suffer first in DM?
eyes and kidneys (b/c have the smallest vasculature)
what does tight blood glucose control do to all-cause-mortality and macrovesicular complications?
effect = uncertain
what is osteomalacia?
defective bone mineralization
what is the MCC of osteomalacia?
severe vit D def
why does decr vit D –> osteomalacia?
decr vit D –> decr Ca and Phos absorp in gut –> incr PTH –> bone break down –> incr ALP
how does the bone matrix look in osteoporosis?
low bone mass. nL mineralization
glucocorticoid deficiency + hypogonadism + hypothyroid. Dx = ?
hypopituitarism
is aldosterone incr/decr/nL in hypopituitarism?
nL (i.e. central adrenal insufficiency)
RAIU results in hashimotos vs subacute thyroiditis vs silent thyroiditis.
hashimotos –> incr (hyperthyroid early in dz process)
subacute thyroiditis –> none
silent thyroiditis –> none
5 causes of 2* HTN
- pheochromocytoma
- RAS
- hyperthyroidism
- Conn synd
- coarctation of the aorta
BP discrepancies btwn R & L extremities. Dx = ?
aortic dissection
BP discrepancies btwn UE & LE. dx = ?
coarctation of the aorta
what might hypothyroid pts present w/ that will not be altered in depression?
decr DTR on P/E
what lab will be high in neuroblastoma?
vanillymandelic acid (VMA)
what causes exopthalmos?
T cell activation –> incr fibroblast –> glycosaminoglycan deposition
what do you monitor to follow resolution of DKA/HSS?
anion gap (when the gap closes DKA has resolved)
why do you need to incr Levo in high estrogen states?
incr estrogen –> clear less TBG (in liver) –> incr TBG
when do you screen for DM?
age > 45 + BP > 135/80
what form of birth control doesn’t require incr Levo dosing in hypothyroid pts?
transdermal estrogen patch (b/c avoids 1st pass metabolism in liver)
what labs are incr in paget’s dz?
incr ALP
incr osteocalcin
what is damaged in guillain-barre synd?
peripheral nerve fibers
tick born paralyis vs guillain-barre paralysis
tick born = rapid (hours) asc. asymmetrical paralysis
GBS = symmetric asc. paralysis that developes d - wks after infec
facial abn in babies w/ in utero EtOH exposure vs downs synd
EtOH exposure = sm palpebral fissures (tiny eyes), smooth philtrum, thin upper lip
DS = slanted palpebral fissures (crooked eyes), sm. low-set ears, flat face
mention of what virus paired w/ a single ring enhancing lesion on MRI suggests dx of 1* CNS lymphoma?
EBV
HIV/AIDS infection thresholds & corresponding tx
pres p jirovechi <200 TMP-SMX
taxes toxo <100 TMP-SMX
mexicans & MAC <50 azithromycin
canadians CMV <50
what labs will all be nL if the liver is working properly?
- albumin
- PT
- PTT
what are the 5 reasons to do emergent hemodialysis?
AEIOU Acidosis Electrolyte abn (K+) Ingestion (ASA, methanol, ethylene-glycol, valproate, carbemazepine) Overload Uremia
what are the 3 common causes of asterixis?
- hepatic encephalopathy
- uremic encephalopathy
- hypercapnia
how does the parkinsonian tremor present?
resting tremor = tremor @ rest stabalizes w/ movement
how does essential tremor present?
intention tremor = tremor present @ rest and w/ movement. typically worsens w/ movement
what is internuclear opthalmaplegia?
disorder of conjugate horizontal gaze
–> eye can’t adduct (so stays midline). contralat eye abds w/ nystagmus
what structure is damaged in internuclear opthamaplegia?
medial longitudinal fasciculus
unilat internuclear opthalmaplegia can result from ____.
lacunar stroke in pontine artery distribution
bilat internuclear opthalmaplegia is assoc w/ what condition?
MS
possible eye presentation in MS = _____. what would you find on P/E?
bilateral internuclear opthalmaplegia
- -neither eye can adduct.
- -both eyes exhibit nystagmus w/ abduction
how to dx insomnia?
- pt has persistent difficulty falling/staying asleep
- no coexisting psych or med dx explain exhibited s/s of insomnia
how to manage severe pain in cancer pts?
- short acting opiod
- transition to transdermal fentanyl patch
- opiods for break through pain
how long does it take to get pain relief from a transdermal fentanyl patch?
~2 day
what class of drugs is ototoxic?
aminoglycosides
which ABX can cause hearing loss & vestibulopathy (vertigo)?
gentamycin
what are nL characteristics of aging?
- intact ADLs
- forgetful but aware of their lapses in memory
- memory of recent events intact
- occasional word finding difficulties
- not lost in familiar settings
pt presents w/ n/v, HA. what do you suspect?
incr ICP
what is the distribution of bleeding in cephalohematoma vs caput seccedaneum?
cephalohematoma –> 1 word = 1 bone. DOES NOT cross sutures
caput seccedaneum –> 2 words = 2 bones. CROSSES sutures
infant/child presents w/ neurological issue + h/o prematurity. what do you expect?
cerebral palsy
if you suspect depression, what 2 questions must you ask before formulating your tx plan?
- have they considered harming themselves or others?
2. do they have any plans to do so?
strategy for answering ethics/best response questions.
BEST ANSWER WILL:
- educate –> w/ empathy
- include doing your job
what electrolyte other than K is lost in high aldosterone states?
H+
what is disruptive mood dysreg disorder?
chronic irritability + frequent temper outbursts
- -generally begins @ age < 10
- -outbursts must occur outside of MDD
what does SIGECAPS stand for?
Sleep decr/incr Interest decr Guilt/worthless incr Energy decr Concentration decr Appetite decr/incr Psychomotor decr Suicidality +
which mood stabalizer is avoided in pts w/ kidney problems?
lithium
when you can’t give lithium, what other psych drug is 1st line for mood stabalization?
valproate
when is bupropion C/I?
- h/o bulemia
- h/o seizure(s)
what is body dysmorphic disorder?
- obsession w/ a physical trait that is “defective”
- DOES NOT INCLUDE CONCERNS ABOUT WEIGHT IF PT MEETS CRITERIA FOR AN EATING DISORDER
1st & 2nd line tx for MDD = ?
- CBT
- SSRI
* *COMBO IS BEST
1st & 2nd line tx for OCD = ?
- CBT
- SSRI
* *COMBO IS BEST
what is CBT?
goal oriented therapy that teaches you how to think about and handle stressors
what is supportive psychotherapy?
talk therapy! it is used to discover underlying problems and for catharsis
which illegal drugs cause incr T?
- ecstasy
- amphetamines
why might a pt on ecstasy present w/ hypothermia?
they drank a lot of water
what is the timeline used in diagnosing adjustment disorder?
s/s onset w/in 3 mos of stressor
s/s last <6 mos from time of onset (i.e. <9 mos after stressor)
tx of choice for adjustment disorders = ?
psychotherapy
what is transvestic disorder?
crossdressing b/c it promotes sexual arousal
what i an empyema?
pleural effusion containing frank pus or bacteria
what does pneumocystis jiroveci look like on CXR?
diffuse bilat interstitial or alveolar infiltrates
i.e. bilat fluffy infiltrates
how do you distinguish btwn consolidation and effusion on physical exam?
- consolidation = dullness + decr breath sounds + incr fremitus
- effusion = dullness + decr breath sounds + decr fremitus
what does consolidation look like on CXR vs empyema?
- consolidation = hazy and contained (w/in a lobe)
- emyema = hazy and diffuse (whole lung) involvement
what does an abscess look like on CXR?
cavity w/ an air fluid level
what is 1st line tx for septic shock?
- IVF w/ NS
2. vasopressors (if not responding)
pt presents w/ hemoptysis + abn renal f(x). ddx = ?
- wegners
2. good pastures
what will be increased in wegners?
C-ANCA (incr WBC w/ Neutrophil predominance)
why might WBC be incr if a pt does not have an infection?
underlying AI process
how does incentive spirometry prevent post-op infx?
-keeps lungs moving and prevents atalectasis which can lead to formation of consolidations
what region of the lungs will asbestos affect?
lung bases
cause comes from the “attic” so infects the base
how will asbestos look on CXR?
basilar pleural plaques
what region of the lungs will sillicosis affect?
apical lungs
cause comes from the ground so infects the apex
what region of the lungs will aspergillosis affect?
apical lungs
cause comes from the ground so infects the apex
what is asbestosis associated w/ ?
- mining
- ship building
- INSULATION
- pipework
pts w/ OSA + obesity hypoventilation synd can develop what?
-chronic low O2 and high paCO2 (i.e. resp acidosis)
how do the kidneys compensate for resp acidosis?
retain HCO3- to minimize acidosis
what are some complications of OSA + OHS?
- 2* erythrocytosis
- pulm HTN
- cor pulmonale
what pan coast tumors?
- type of malignant lung neoplasm
- includes SCC and lung adenocarcinoma
how do pancoast tumors present?
- shoulder pain (MC)
- horner synd (ipsilat ptosis, miosis and anhydrosis)
- C8-T2 compromise (hand weakness, decr sensation in ulnar distribution
- supraclavicular lymph nodes
- wt loss
what is a nL pulse ox reading?
SpO2 > 92%
Q asks what you should do “in addition to tx w/…”. do you need to worry about confirming the dx?
-no. you are already on to the treatment stage
if a pt is not experiencing nasal congestion, rhinorrhea, sore throat or chest pain can they have an URI?
no
when you are given a CXR what should you be evaluating in addition to anatomy and symmetry?
lines/tubes
what is the MC s/e of inhaled corticosteroids?
thrush
how does/long term corticosteroid use can lead to what (esp. if PO distribution)?
adrenal suppression
what causes flail chest?
fracture of >= 3 ribs in 2 places (segment of rib cage is essentially floating)
how does flail chest manifest?
-a portion of the rib cage will be moving opposite the reset of the cage (during insp it will move in and during expr it will move out)
how do you distinguish btwn allergic and non-allergic rhinitis?
allergic = early onset, w/ triggers, pale bluish mucosa non-allergic = age>20, no triggers (but may worsens w/ seasons), red mucosa
how does aspergillosis look on CXR?
fungus ball (i.e. a segmented cavitary lesion)
how do yo diagnose aspergillosis?
aspergillus IgG serology
test for if clinical s/s and positive CXR
how does post-nasal drip manifest?
- dry cough
- will often wake pt up at night
