Endocrine and General Medical

Question 1

Cause of Diabetic Ketoacidosis

Answer 1

Lack of Insulin or Insulin Resistance.

Excess blood sugar causes increased water in body which diuresis fluid, Potassium, and Phosphorus. (Causing Metabolic Acidosis)

Question 2

Treatment of Diabetic Ketoacidosis

Answer 2

Aggressive fluid hydration
K+ and Pho4 replacement
Insulin dosing at 0.1 u/kg
Consider D5w once CBG <300 mg/dl
Do not drop glucose >100 mg/dl/hr

Question 3

Hyperglycemic Hyperosmolar Non-ketonic Coma (HHNK/HHNC)

Answer 3

Excessive sugar but body is still making and using insulin

Question 4

Presentation of HHNK

Answer 4

Severe dehydration
Hyperglycemia (>800 common)
Elevated BUN /Creatine
Hypernatremia
No Ketones

Question 5

Treatment of HHNK

Answer 5

Aggressive fluid replacement
Insulin
Anticipate hypokalemia

Question 6

Cause of Diabetes Insipidus (DI)

Answer 6

Lack of anti-diuretic hormone caused by Head injury or Dilantin

Question 7

Presentation of Diabetes Insipidus

Answer 7

Extreme urinary output with low osmolarity and specific gravity.
Hypernatremia

Question 8

Treatment of Diabetes Insipidus

Answer 8

Aggressive fluid replacement
Vasopressin
dDavP

Question 9

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

Answer 9

Excessive production of ADH

Question 10

Causes of SIADH

Answer 10

Small cell / oat cell carcinoma

Head injury

Question 11

Presentation of SIADH

Answer 11

Dilutional Hyponatremia
Seizures
Cerebral edema
Elevated Urine osmolarity / specific gravity

Question 12

Treatment of SIADH

Answer 12

Restrict fluids
Diuresis
Demeclocycline (ADH receptor antagonism)

Question 13

GI Hemorrhage Treatment

Answer 13

Treat shock with 3:1 Crystalloid/Blood
NG/OG
Octreotide (Sandostatin) 25-50 mcg IVP then drip
Vasopressin

Question 14

Causes of Grave’s Disease / Thyrotoxicosis (Thyroid storm / Hyperthyroid)

Answer 14

Increased Thyroid production due to surgery Uncontrolled DM
AMI
Toxemia

Question 15

Presentation of Grave’s Disease (Hyperthyroid)

Answer 15

Any new tachycardia/A Fib in otherwise healthy females
Dramatic weight loss
CP /SOB/ Palpitations
Tremors / Nervousness

Question 16

Treatment of Grave’s Disease (Hyperthyroid)

Answer 16

Anti-thyroid Meds
Anti-pyretics
Consider Iv glucocorticoids (Dexmethasone)
Fluids / Electrolytes

Question 17

Thyroid controls _____.

Answer 17

Metabolic rate (Body Idle Speed)

Question 18

Causes of Hypothyroid / Myxedema Coma

Answer 18

Autoimmune disorder most commonly triggered by infection.

Officially Myxedema Coma upon any change in LOC.

Question 19

Presentation of Hypothyroid

Answer 19

Primarily women, almost exclusively over age 60.
>90% of cases in winter.

Fatigue, weight gain, deep voice, coarse hair

Question 20

Treatment of Hypothyroid

Answer 20

Levothyroxine

Supportive care

Question 21

Cause of Addison’s Disease / Adrenal Insufficiency

Answer 21

Not producing enough steroids caused by Autoimmune disease (Primary Addison’s)

Low levels of ACTH (Secondary Addison’s)

Question 22

Presentation of Addison’s Disease / adrenal Insufficiency

Answer 22

Poor catecholamine production
Failure to respond to exogenous pressor agents
Inadequate aldosterone, cortisol, and androgens

Question 23

Treatment of Addison’s Disease / Adrenal Insufficiency

Answer 23

Avoid abrupt discontinuation of chronic glucocorticoids

May need to initiate steroids

Question 24

Causes of Cushing’s Disease

Answer 24

Producing excessive steroids due to:
Chronic glucocorticoid use with abrupt discontinuation
Pituitary disorders (too much ACTH release)
Oat cell carcinoma (“fake” cortisol)
Adrenal carcinoma (too much produced)

Question 25

Presentation of Cushing's Disease

Answer 25

Upper body obesity with thin arms and legs Rounded face Buffalo Hump Fatigue, HTN, Hyperglycemia

Question 26

Treatment of Cushing's Disease

Answer 26

Initiate or Reduce Glucocorticoids Supportive Surgery

Question 27

Causes of Pancreatitis

Answer 27

ETOH abuse Biliary stone disease Steroids and antibiotics Infections

Question 28

Presentation of Pancreatitis

Answer 28

Low Calcium levels Concomitant Sepsis and ARDS Renal failure Cullen's sign

Question 29

Treatment of Pancreatitis

Answer 29

``` Fluid resuscitation NPO with OG/NG Meperidine Antibiotics for sepsis Anticipate worsening progression ```

Question 30

Causes of Bowel Obstruction

Answer 30

Post operative adhesions Malignancy Crohn's disease Hernia's

Question 31

Presentation of Bowel Obstruction

Answer 31

Bowel ischemia results in sepsis | Pancreatitis common

Question 32

Treatment of Bowel Obstruction

Answer 32

NPO with OG/NG Aggressive fluid and pain control Anti-emetics Antibiotics

Question 33

Causes of Hepatic Encephalopathy

Answer 33

ETOH abuse Liver Failure Cirrhosis / Hepatitis (causing ammonia toxicity)

Question 34

Presentation of Hepatic Encephalopathy

Answer 34

Increased AST, ALT, BUN | "Coarse Muscle Flapping"

Question 35

Treatment of Hepatic Encephalopathy

Answer 35

Stop GI bleeding NG / OG for blood evacuation in bowel Stop protein intake Correct K+ levels

Question 36

Cause of Splenic Disease / Rupture

Answer 36

Trauma (Most commonly affected organ in blunt trauma)

Question 37

Presentation of Splenic Disease / Rupture

Answer 37

Left shoulder pain (Kehr's sign) | Shock

Question 38

Treatment of Splenic Disease / Rupture

Answer 38

Supportive care Aggressive fluid replacement and PRBC's Surgery

Question 39

Brudzinski's Sign

Answer 39

Flexion of knees on neck flexion  Possible bacterial meningitis (or subarachnoid bleed) "Chin to chest will cause knees to flex"

Question 40

Kernig's Sign

Answer 40

Inability to flex hamstring or leg due to pain. Indicative of Meningitis

Question 41

Cullen's Sign

Answer 41

Periumbilical bruising indicative of Pancreatitis

Question 42

Grey-Turner's Sign

Answer 42

Flank and groin bruising indicative of Pancreatitis

Question 43

Kehr's Sign

Answer 43

Left shoulder pain indicative of Splenic injury

Question 44

Murphy's Sign

Answer 44

Pain upon palpitation of RUQ while breathing in indicative of Gallbladder problems

Question 45

Levine's Sign

Answer 45

Fist over chest indicative of Cardiac problems

Question 46

Define Hypertensive Crisis

Answer 46

Extremely elevated blood pressure WITH signs and symptoms of end organ damage Headache, N/V, Visual changes, creatine/RBC in urine

Question 47

Treatment of Hypertensive Crisis

Answer 47

Lower BP no more than 25% per hour and no lower than patient's "normal"

Question 48

Important dermatomes

Answer 48

T4: Nipples T10: Umbilicus C3/4/5: Innervates the diaphragm

Question 49

Meningitis

Answer 49

Inflammation of meninges Disease carried in CSF Triad of neck stiffness, photophobia, and headache

Question 50

6 P's of Arterial Occlusion

Answer 50

``` Pain Pallor Paresthesia Poikilothermia Pulselessness Paralysis ```

Question 51

The most definitive assessment of shock is ____.

Answer 51

Lactic Acidosis (Lactate >4)