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COMLEX Level 2CE > QG SB2 (F) > Flashcards

QG SB2 (F) Flashcards

W2 QG blocks (15,17,20,23,26) Deck is full

1
Q

what does DI present w/?

A

sOSM incr sNa incr

uOSM decr uNa decr

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2
Q

what does HHS stand for?

A

hyperosmolar hyperglycemic state

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3
Q

what is hashimoto’s thyroiditis associated w/?

A
  • thyroid lymphoma

- other AI disorders

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4
Q

what are the common presenting s/s VIPoma?

A

diarrhea, flushing, TEA COLORED STOOLS

carcinoid - pulm s/s + tea colored stools

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5
Q

what steroid from the adrenal gland regulates K+?

A

aldosterone (dumps K+ and reabsorbs Na)

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6
Q

which adrenal insufficiency presents w/ low aldosterone?

A

1* adrenal insufficiency

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7
Q

what causes central (2*) adrenal insufficiency?

A

chronic steroid use

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8
Q

what causes 1* adrenal insuficiency?

A

AI

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9
Q

plasma renin : aldosterone ratio test tests for what?

A

hyperaldosteronism [>30 = conn’s. ~10 = 2*)

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10
Q

aldosterone is incr. what Na and K values do you expect?

A

Na incr. K decr.

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11
Q

what med should you use to tx conn syndrome if pt refuses Sx?

A

eplerenone > spironolactone

aldosterone antagonists = k+ sparing anti-HTN drugs

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12
Q

what PO DM meds cause weightloss?

A
  • GLP-1 antagonist
  • SGLT-2 inhib (__gliflozin)
  • metformin
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13
Q

ED + testicular atrophy are likely 2/2 _____

A

hypogonadism

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14
Q

what sex characteristics are altered in cirrhosis?

A

small testes

gynecomastia

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15
Q

why do you see sex characteristic changes in cirrhosis?

A

1* gonaadal injury/ HPaxis dysf(x) –> small testes

incr conv androgens –> incr estradiol –> gynecomastia

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16
Q

expected electrolytes low aldosterone?

A

decr Na. incr K. Low BP.

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17
Q

how do you dx 1* adrenal insufficiency?

A
  1. 8am cortisol –> low cortisol
  2. check ACTH –> high
  3. ACTH stim test –> No response b/c gland isn’t able to respond to the ACTH in circulation
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18
Q

why can hypothyroidism result in oligomenorrhea?

A

low T3/T4 –> hypothalamus incr TRH release (so TSH incr and T4 incr) –> BUT incr TRH –> incr prolactin –> decr FSH –> oligomenorrhea

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19
Q

hypocalcemia w/u includes?

A
  1. recheck Ca to confirm it’s truly low

2. check Mg, albumin, PTH

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20
Q

in a nL healthy body, incr PTH –> incr Ca + decr Phos. if incr PTH but decr Ca, what is the dx?

A
  • vit D def
  • CKD
  • pancreatitis (Ca used up in soaponification)
  • sepsis
  • tumor lysis
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21
Q

what are the blood glucose goals for DM?

A

preprandial/fasting = 80-130
post-prandial <180
HgA1c <7%

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22
Q

at what age do you stop giving adults the drugs on the Bier’s list?

A

age >= 65

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23
Q

HgA1c is an indicator of what?

A

post-prandial glucose (prev 3 mos)

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24
Q

what is the dawn phenomenon?

A

fasting hyperglycemia 2/2 GH and cortisol release overnight

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25
Q

what IVF should be given initially for volume resuscitation (1st few hours)?

A

NS (0.9%)

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26
Q

what electrolyte must you keep an eye on when using IVF for fluid resuscitation?

A

Na

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27
Q

when should 0.45% NS be used for volume resuscitation?

A

corrected Na is nL or high on recheck

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28
Q

what does PTH incr do to phos?

A

decr (PTH = phosphate trashing hormone)

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29
Q

incr PTH + incr Ca + decr phos. dx = ?

A

1* hyperparathyroidism

PTH is being released despite high Ca that should be suppressing it

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30
Q

what is the threshold for malignant hypercalcemia?

A

Ca > 14

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31
Q

what is necrolytic migratory errythema?

A

erythematous papules/plaques that grow/coalesce. will have central clearing, blistering, and crusting/scaling edges

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32
Q

how does glucagonoma present?

A

DM (easily controlled) + rash (NME) + GI (D/C, abd pain, anorexia, wt loss)

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33
Q

what confirms dx of glucagonoma?

A

glucagon > 500 pg/mL

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34
Q

what are the 1st and 2nd line tx for grave’s dz?

A
  1. propranolol (use BB to decr symp activity)

2. PTU/methimazole

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35
Q

why is radioactive iodine a 3rd line tx for grave’s dz (esp. when exopthalmos is present)?

A

RAI –> rapid thyroid destruction –> immediate release of T3/T4 reserve –> makes s/s temp worse **

**exception = exopthalmos which is irreversible

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36
Q

what comorbid condition should be expected (and r/o) in PCOS pts?

A

DM (often are obese and will develop insulin resistance)

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37
Q

what is the gold standard for dx DM2 in PCOS pts? (bonus: why?)

A

oral glucose tolerance test (more sensitive @ detecting glucose intolerance)

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38
Q

obese pts w/ metabolic synd are at incr risk for developing what 3 conditions?

A
  1. OSA
  2. nonalcoholic fatty liver dz
  3. endometrial cancer
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39
Q

what is metabolic synd?

A

+dislipidemia (incr cholesterol or incr TG)
+HTN
+DM2
+excess abd fat

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40
Q

what organs suffer first in DM?

A

eyes and kidneys (b/c have the smallest vasculature)

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41
Q

what does tight blood glucose control do to all-cause-mortality and macrovesicular complications?

A

effect = uncertain

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42
Q

what is osteomalacia?

A

defective bone mineralization

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43
Q

what is the MCC of osteomalacia?

A

severe vit D def

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44
Q

why does decr vit D –> osteomalacia?

A

decr vit D –> decr Ca and Phos absorp in gut –> incr PTH –> bone break down –> incr ALP

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45
Q

how does the bone matrix look in osteoporosis?

A

low bone mass. nL mineralization

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46
Q

glucocorticoid deficiency + hypogonadism + hypothyroid. Dx = ?

A

hypopituitarism

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47
Q

is aldosterone incr/decr/nL in hypopituitarism?

A

nL (i.e. central adrenal insufficiency)

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48
Q

RAIU results in hashimotos vs subacute thyroiditis vs silent thyroiditis.

A

hashimotos –> incr (hyperthyroid early in dz process)
subacute thyroiditis –> none
silent thyroiditis –> none

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49
Q

5 causes of 2* HTN

A
  1. pheochromocytoma
  2. RAS
  3. hyperthyroidism
  4. Conn synd
  5. coarctation of the aorta
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50
Q

BP discrepancies btwn R & L extremities. Dx = ?

A

aortic dissection

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51
Q

BP discrepancies btwn UE & LE. dx = ?

A

coarctation of the aorta

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52
Q

what might hypothyroid pts present w/ that will not be altered in depression?

A

decr DTR on P/E

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53
Q

what lab will be high in neuroblastoma?

A

vanillymandelic acid (VMA)

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54
Q

what causes exopthalmos?

A

T cell activation –> incr fibroblast –> glycosaminoglycan deposition

55
Q

what do you monitor to follow resolution of DKA/HSS?

A

anion gap (when the gap closes DKA has resolved)

56
Q

why do you need to incr Levo in high estrogen states?

A

incr estrogen –> clear less TBG (in liver) –> incr TBG

57
Q

when do you screen for DM?

A

age > 45 + BP > 135/80

58
Q

what form of birth control doesn’t require incr Levo dosing in hypothyroid pts?

A

transdermal estrogen patch (b/c avoids 1st pass metabolism in liver)

59
Q

what labs are incr in paget’s dz?

A

incr ALP

incr osteocalcin

60
Q

what is damaged in guillain-barre synd?

A

peripheral nerve fibers

61
Q

tick born paralyis vs guillain-barre paralysis

A

tick born = rapid (hours) asc. asymmetrical paralysis

GBS = symmetric asc. paralysis that developes d - wks after infec

62
Q

facial abn in babies w/ in utero EtOH exposure vs downs synd

A

EtOH exposure = sm palpebral fissures (tiny eyes), smooth philtrum, thin upper lip

DS = slanted palpebral fissures (crooked eyes), sm. low-set ears, flat face

63
Q

mention of what virus paired w/ a single ring enhancing lesion on MRI suggests dx of 1* CNS lymphoma?

A

EBV

64
Q

HIV/AIDS infection thresholds & corresponding tx

A

pres p jirovechi <200 TMP-SMX
taxes toxo <100 TMP-SMX
mexicans & MAC <50 azithromycin
canadians CMV <50

65
Q

what labs will all be nL if the liver is working properly?

A
  • albumin
  • PT
  • PTT
66
Q

what are the 5 reasons to do emergent hemodialysis?

A 
AEIOU
   Acidosis
   Electrolyte abn (K+)
   Ingestion (ASA, methanol, ethylene-glycol, valproate, carbemazepine)
   Overload
   Uremia
67
Q

what are the 3 common causes of asterixis?

A
  1. hepatic encephalopathy
  2. uremic encephalopathy
  3. hypercapnia
68
Q

how does the parkinsonian tremor present?

A

resting tremor = tremor @ rest stabalizes w/ movement

69
Q

how does essential tremor present?

A

intention tremor = tremor present @ rest and w/ movement. typically worsens w/ movement

70
Q

what is internuclear opthalmaplegia?

A

disorder of conjugate horizontal gaze

–> eye can’t adduct (so stays midline). contralat eye abds w/ nystagmus

71
Q

what structure is damaged in internuclear opthamaplegia?

A

medial longitudinal fasciculus

72
Q

unilat internuclear opthalmaplegia can result from ____.

A

lacunar stroke in pontine artery distribution

73
Q

bilat internuclear opthalmaplegia is assoc w/ what condition?

A

MS

74
Q

possible eye presentation in MS = _____. what would you find on P/E?

A

bilateral internuclear opthalmaplegia

  • -neither eye can adduct.
  • -both eyes exhibit nystagmus w/ abduction
75
Q

how to dx insomnia?

A
  • pt has persistent difficulty falling/staying asleep

- no coexisting psych or med dx explain exhibited s/s of insomnia

76
Q

how to manage severe pain in cancer pts?

A
  1. short acting opiod
  2. transition to transdermal fentanyl patch
  3. opiods for break through pain
77
Q

how long does it take to get pain relief from a transdermal fentanyl patch?

A

~2 day

78
Q

what class of drugs is ototoxic?

A

aminoglycosides

79
Q

which ABX can cause hearing loss & vestibulopathy (vertigo)?

A

gentamycin

80
Q

what are nL characteristics of aging?

A
  • intact ADLs
  • forgetful but aware of their lapses in memory
  • memory of recent events intact
  • occasional word finding difficulties
  • not lost in familiar settings
81
Q

pt presents w/ n/v, HA. what do you suspect?

A

incr ICP

82
Q

what is the distribution of bleeding in cephalohematoma vs caput seccedaneum?

A

cephalohematoma –> 1 word = 1 bone. DOES NOT cross sutures

caput seccedaneum –> 2 words = 2 bones. CROSSES sutures

83
Q

infant/child presents w/ neurological issue + h/o prematurity. what do you expect?

A

cerebral palsy

84
Q

if you suspect depression, what 2 questions must you ask before formulating your tx plan?

A
  1. have they considered harming themselves or others?

2. do they have any plans to do so?

85
Q

strategy for answering ethics/best response questions.

A

BEST ANSWER WILL:

  1. educate –> w/ empathy
  2. include doing your job
86
Q

what electrolyte other than K is lost in high aldosterone states?

A

H+

87
Q

what is disruptive mood dysreg disorder?

A

chronic irritability + frequent temper outbursts

  • -generally begins @ age < 10
  • -outbursts must occur outside of MDD
88
Q

what does SIGECAPS stand for?

A 
Sleep                  decr/incr
Interest               decr
Guilt/worthless   incr
Energy                decr
Concentration    decr
Appetite              decr/incr
Psychomotor      decr
Suicidality           +
89
Q

which mood stabalizer is avoided in pts w/ kidney problems?

A

lithium

90
Q

when you can’t give lithium, what other psych drug is 1st line for mood stabalization?

A

valproate

91
Q

when is bupropion C/I?

A
  • h/o bulemia

- h/o seizure(s)

92
Q

what is body dysmorphic disorder?

A
  • obsession w/ a physical trait that is “defective”

- DOES NOT INCLUDE CONCERNS ABOUT WEIGHT IF PT MEETS CRITERIA FOR AN EATING DISORDER

93
Q

1st & 2nd line tx for MDD = ?

A
  1. CBT
  2. SSRI
    * *COMBO IS BEST
94
Q

1st & 2nd line tx for OCD = ?

A
  1. CBT
  2. SSRI
    * *COMBO IS BEST
95
Q

what is CBT?

A

goal oriented therapy that teaches you how to think about and handle stressors

96
Q

what is supportive psychotherapy?

A

talk therapy! it is used to discover underlying problems and for catharsis

97
Q

which illegal drugs cause incr T?

A
  • ecstasy

- amphetamines

98
Q

why might a pt on ecstasy present w/ hypothermia?

A

they drank a lot of water

99
Q

what is the timeline used in diagnosing adjustment disorder?

A

s/s onset w/in 3 mos of stressor

s/s last <6 mos from time of onset (i.e. <9 mos after stressor)

100
Q

tx of choice for adjustment disorders = ?

A

psychotherapy

101
Q

what is transvestic disorder?

A

crossdressing b/c it promotes sexual arousal

102
Q

what i an empyema?

A

pleural effusion containing frank pus or bacteria

103
Q

what does pneumocystis jiroveci look like on CXR?

A

diffuse bilat interstitial or alveolar infiltrates

i.e. bilat fluffy infiltrates

104
Q

how do you distinguish btwn consolidation and effusion on physical exam?

A
  • consolidation = dullness + decr breath sounds + incr fremitus
  • effusion = dullness + decr breath sounds + decr fremitus
105
Q

what does consolidation look like on CXR vs empyema?

A
  • consolidation = hazy and contained (w/in a lobe)

- emyema = hazy and diffuse (whole lung) involvement

106
Q

what does an abscess look like on CXR?

A

cavity w/ an air fluid level

107
Q

what is 1st line tx for septic shock?

A
  1. IVF w/ NS

2. vasopressors (if not responding)

108
Q

pt presents w/ hemoptysis + abn renal f(x). ddx = ?

A
  1. wegners

2. good pastures

109
Q

what will be increased in wegners?

A

C-ANCA (incr WBC w/ Neutrophil predominance)

110
Q

why might WBC be incr if a pt does not have an infection?

A

underlying AI process

111
Q

how does incentive spirometry prevent post-op infx?

A

-keeps lungs moving and prevents atalectasis which can lead to formation of consolidations

112
Q

what region of the lungs will asbestos affect?

A

lung bases

cause comes from the “attic” so infects the base

113
Q

how will asbestos look on CXR?

A

basilar pleural plaques

114
Q

what region of the lungs will sillicosis affect?

A

apical lungs

cause comes from the ground so infects the apex

115
Q

what region of the lungs will aspergillosis affect?

A

apical lungs

cause comes from the ground so infects the apex

116
Q

what is asbestosis associated w/ ?

A
  • mining
  • ship building
  • INSULATION
  • pipework
117
Q

pts w/ OSA + obesity hypoventilation synd can develop what?

A

-chronic low O2 and high paCO2 (i.e. resp acidosis)

118
Q

how do the kidneys compensate for resp acidosis?

A

retain HCO3- to minimize acidosis

119
Q

what are some complications of OSA + OHS?

A
  • 2* erythrocytosis
  • pulm HTN
  • cor pulmonale
120
Q

what pan coast tumors?

A
  • type of malignant lung neoplasm

- includes SCC and lung adenocarcinoma

121
Q

how do pancoast tumors present?

A
  • 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
122
Q

what is a nL pulse ox reading?

A

SpO2 > 92%

123
Q

Q asks what you should do “in addition to tx w/…”. do you need to worry about confirming the dx?

A

-no. you are already on to the treatment stage

124
Q

if a pt is not experiencing nasal congestion, rhinorrhea, sore throat or chest pain can they have an URI?

A

no

125
Q

when you are given a CXR what should you be evaluating in addition to anatomy and symmetry?

A

lines/tubes

126
Q

what is the MC s/e of inhaled corticosteroids?

A

thrush

127
Q

how does/long term corticosteroid use can lead to what (esp. if PO distribution)?

A

adrenal suppression

128
Q

what causes flail chest?

A

fracture of >= 3 ribs in 2 places (segment of rib cage is essentially floating)

129
Q

how does flail chest manifest?

A

-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)

130
Q

how do you distinguish btwn allergic and non-allergic rhinitis?

A 
allergic = early onset, w/ triggers, pale bluish mucosa
non-allergic = age>20, no triggers (but may worsens w/ seasons), red mucosa
131
Q

how does aspergillosis look on CXR?

A

fungus ball (i.e. a segmented cavitary lesion)

132
Q

how do yo diagnose aspergillosis?

A

aspergillus IgG serology

test for if clinical s/s and positive CXR

133
Q

how does post-nasal drip manifest?

A
  • dry cough

- will often wake pt up at night

COMLEX Level 2CE (23 decks)

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