Step Up To Medicine Quick Hits Flashcards
Indications for surgery in primary hyperparathyroidism ?
5
- Age 400mg in 24 hours.
What is pseudohyperparathyroidism
End organ resistance to PTH. Labs will show Hypocalcemia, hyperphos, High PTH, Low urine cAMP.
Effects of cortisol
4
- Impaired collagen prodution and enhanced protein catabolism.
- Anti-insulin effects
- Impaired immunity: inh. PMN’s and T cells
- Enhances catacholamines
What is the difference in pigmentation between Cushings syndrome and Cushings Disease
In Cushings Syndrome, (Glucocorticoids from adrenals) ACTH will be low and will not cause hyper-pigmentation. In Cushings Disease ACTH will be from the pituitary and cause hyper-pigmentation.
How can you differentiate between cushings disease and bushings syndrome in a lab test ?
High dose Dexamethasone Suppression Test.
How can you tell with labs if the cushings is caused by an ectopic ACTH tumor ?
High ACTH / Cortisol No suppression with low or high dose dexa, No response with CRH test.
Workup for ectopic ACTH tumor ?
Chest CT, Abdominal CT, Octreotide Scan
If all of these criteria are met the diagnosis is pheochromocytoma until proven otherwise … (5)
- headache
- Profuse sweating
- Palpitations
- Tachycardia
- Apprehension or sense of impending doom.
Rules of 10 for pheochromocytoma
10% familial 10% bilateral 10% malig 10% multiple 10% In children 10% extra-axial Most common location is at organ off zuckerland at aortic bifurcation.
What do you treat pheochromocytoma patients with 10-14 days pre-op ?
phenoxybenzamine, then 2-3 days out Alpha block and Beta Block
MEN-1
3-P’s
Parathyroid Hyperplasia (90%)
Pancreatic Islet Cell tumor
Pituitary Tumor
MEN-2A
Sipple “MPH”
Medullary Thyroid Adenoma
Phenochromocytoma
Hyperparathyroidism
MEN 2-B
“MMMP”
Mucosal Neuromas
Medullary Thyroid Carcinoma
Marfanoid Body Habitys
Phenochromocytoma
Effects of Aldo
Increased activity of Na/K ATPase pumps
- Na retention and ECF expansion with HPTN
- Potassium Loss causing hypokalemia
Excess Aldo increases secretion of H+ Ions resulting in metabolic alkalosis.
What is an adrenal incidentaloma ?
Nonfunctioning adrenal tumor. First you must rule out functionality, Then resect any tumor over 6cm.
Any patient who is hypertensive with hypokalemia
Suspect Aldo Excess
Most common cause of addison disease worldwide
TB, or abrupt discontinuation of exogenous corticosteroids.
Ovarian cysts, pseudoprecocious puberty, polystoic fibrous dysplasia of bone, cafe au lei spots
McCune Albright Syndrome
Lipid profile in insulin resistance
Hypertriglyceridemia with HDL depletion
Management of diabetics, Routine survalence (8)
- HbA1C Q3mo goal 40
- Microalbuminuria Q-Year, ACE if positive
- BUN/Cr yearly
- Eye Exam Yearly
- BP below 130/80
- Daily Aspirin over 30
- Pneumococcal Vaccine
Diagnostic Criteria for Diabetes
Fasting over 126 on two occasions
200 with symptoms
OGTT >200 at 2hrs
A1C over 6.5%
When do you use oral hypoglycemics
140 - 240 glucose range
Sulfonureas
Stim Pancreas to make more insulin
Metformin
Enhances insulin sensitivity, Blocks gluoneogenesis
**GI Upset + Lactic Acidosis
Acarbose
Reduces glucose absorption
Thiazolidinediones
reduces insulin resistance.
Key components of DKA
Hyperglycemia (450-850)
Positive Urine Ketones (Increased Anion Gap)
Metabolic Acidosis (pH
DD of DKA
Alcoholic Ketoacidosis HHNS Hypoglycemia Sepsis Intoxication
Features of HHNS
Severe hyperosmolarity
Hyperglycemia
Dehydration
Acidosis and Ketosis are absent
Parkinsonian symproms and autonomic instability
Shy-Drager Syndrome
Basic defect in Parkinsons
Dopamine pathway is compromised and the cholinergic system operates unopposed. Therefore to treat it enhance dopamine or inhibit Ach
Drugs that cause parkinsonian like affects
Neuroleptic drugs, metaclopyramide, reserpine.
Basic derangement in alzheimers
Impaired cortical cholinergic function. Thus Cholinesterase inhibitors can increase these patients function.
Cholinesterase Inhibitors
Dopenzil, Rivastigmine, Galantamine
Vitamin treatment in Alz
Mega vitamin E
Treatment for lewy body dementia
Segeline
Treatment of Myasthenia Gravis
AchE inhibitors Pyridostigmine
Treatment of Guilliam Barre
Monitor pulmonary function in the hospital. Plasmapheresis and IVIG
NO STEROIDS
Medications that will exacerbate symptoms of MG
Antibiotics, B-Blockers, Anti arrhymics.
Lambert eaton is associated with
Small cell carcinoma of the lung.
Patient with atopic dermatitis that later forms umbilicated vesicles
Eczema Herpeticum
Before starting a RA patient on methotrexate you should test them for ?
Hep B, Hep C, and TB
Pathophysiology of PCOS
GnRH excess that causes LH and FSH to become greatly elevated preventing ovulation
Diagnostic criteria for cyclic vomiting syndrome
> 3 episodes up to 4x/hr in 6mo period
No symptoms between episodes
No underlying condition
Management of TCA overdose
- Anticholinergic
- Electrocardio problems
Na-HCO3 for cardioprotection
GABA agonist for seizures
What murmers need transthoracic eco ?
Mid systolic murmers in grades 1-2 in asymptomatic patients.
Should Beta Blockers be given to asthmatics ?
NEVER
Blood gas in an asthmatic
Low CO2 secondary to hyperventilation. If it begins to normalize then respiratory failure is imminant
Is Dyspnea normal in response to rapid changes in temperature and humidity ?
Yes.
Quickest method to diagnose asthma in the ED in a very acute setting
Peak flow: Normal is 450-650 in men and 350-500 in women.
What test do you get in a never smoker with emphysema ?
Alpha-1 AT level.
What other abnormalities will a patient with Alpha-1-AT deficiency have ?
Neonatal hepatitis, liver failure, and cirrhosis.
PFT’s in emphysema
Decreased FEV1 / FVC, Increased TLC, and Decreased DLCO
Unilateral nontender lymphnode in an older smoker with a normal CBC ?
Highly suspective of SCC. This is the most common head and neck cancer in elderly.
What findings are highly indicative of severe mitral regard ?
Displaced apical impulse, holosystolic murmur, and third heart sound.
MCC of holosystolic murmur in White people ?
Mitral prolapse, secondary to myxamatous degeneration of the valve. When the condition is severe there will not be a click, it will be holo-systolic.
Rheumatic heart disease usually causes what problem with the mitral valve ?
Mitral stenosis.
Crystals are yellow when oriented East / west and blue when oriented North / south
Negative Bifringance, monosodium urate.
Fatigue abdominal pain and constipation, microcytic anemia with basophilic stippling
Suspect acute lead poisoning, get an occupational history
Neuropathy, nephropathy, and neuropsych problems. Microcytic anemia with basophilic stippling.
Chronic lead exposure, get an occupational history
Disseminated encephalitis following vaccinations ?
Treatment?
Gullian Barre syndrome,
Plasmapheresis or IVIG
Locked in syndrome is usually caused by infarction or hemorrhage in the ?
Ventral Pons. Remember they are fully aware but lose all control except for muscles of respiration, blinking, and vertical eye movements.
Ipsilateral medial rectus palsy with optic neuritis
MS, –> get an LP check the CSF for oligoclonal bands.
Treat with high dose steroids
What causes calcium oxalate stones ?
Anything that alters the absorption of fatty acids and bile salts ( surgery, small bowel disease, chronic diarrhea )
Indications for C-Section in post term pregnancy ?
What if the patient refuses when both are present ?
Oligohydramlos and late decelerations
You have to honor the patients wishes. In the US the mother has ultimate rights over the unborn child.
Man who travels a lot for work and has thrombocytopenia needs to be tested for ?
HIV and Hep-C
Test for B12 deficency
Shillings Test. Also look for hyperhsegmented neutrophils
Gram negative bacteria in the sputum of a patient who is intubated. What ABX ?
Pseudomonas, Piperacillin / Tazobactam
Why do patients with cirrhosis become edematous or even develop pulmonary edema ?
Hepatic hydrothorax is caused by transadative pleural effusions and is more common on the right side. It is due to a deficiency in the production of albumin.
Treat with therapeutic thoracicocentesis and a salt restricted diet –> then a transhepatic
Insidious onset of bilateral radicular back pain brought on by climbing stairs and released by leaning forward.
Lumbar spinal stenosis. Disc herneation on step 2 will usually be an acute onset event.
What causes nasal furouncliosis.
usually a staph folliculitis infection.
Uncontrollable daytime sleepiness
Modafinil
Cataplexy
Sodium Oxibate
Why would a patient with cirrhosis have ascites
Low albumin
3mo post partum a woman has been passing dark clots. The then presents with a PE. What is the diagnosis.
Choriocarcinoma. Workup with BhCG. The most common area to metastasize is the lung.
37 year old with a new onset anal fissure, what is the next best step ?
Stool softeners and local anesthetic
Ground glass cytoplasm with pasta bodies in a thyroid malignancy
Papillary thyroid cancer.
Thyroid cancer that invades local blood vessels
Follicular thyroid cancer.
Workup for suspected piagets disease of the bone ?
Lytic and plastic bone lesions with elevated ALP.
Treatment is bisphosphonates.
Treatment for repeat bee sting anaphylaxis
Venom Immunotherapy
Ascites and Cirrhosis in a man with no EtOH history and a BMI of 24
Workup with Hep B and Hep C serology.
Low Platelets and clotting….
HIT, Ab bound to PF4. Treat with Leparudin or Agatroban
Normal platelets but increased bleeding time and PTT.
Von Willfabrands Disease
Parkland Formula for Burn Fluids.
Adult: Kg x BSA x3-4
Kid: Kg X BSA x 2-4. Topical ABX only
Burn topical that does not penetrate eschar but can cause leukopenia
Silver Sulfadiazine. Leukopenia, not great for 3rd degree
Does Penetrate Eschar… But hurts like hell
Mafanide
Does not penetrate Eschar but causes hypokalemia and hyponatremia
Silver Nitrate
Rhabdomyolysis, what do you test ?
K, because of cell lysis.
Compartment syndrome
> 30mm Hg
Treatment of pulmonary contusion.
Deep breaths and pain control.
How do you treat flail chest ?
Intercostal nerve block.
How do you treat tension pneumo ?
Needle Decompression.
Post traumatic epigastric abdominal pain
Get a Abd CT. pancreas or duodenum rupture.
Myasthenia Gravis
Auto Ab to Ach Receptor
Guillian Barre
Inflammatory demyelinating polyneuropathy
Preceded by viral or mycoplasma illness (MG vs GBS)
GBS.
Ascending weakness and paralysis (MG vs GBS)
GBS.
One you can not give steroids to (MG vs GBS)
GBS must be treated with plasmapheresis and IVIG.
Ascending paralysis (MGvs GBS)
GBS
Weakness with repetitive use (MG vs GBS )
MG.
