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Internal Medicine Flashcards

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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
Treatment of acute hepatic encephalopathy
Lactulose
26
What is portal hypertension?
Increased pressure in the portal (liver) vein. Often caused by liver cirrhosis
27
A common complication of cirrhosis
Gastroesophageal varices in ~1/2 of cirrhosis patients - screen every 1-2 years
28
Treatment of gastroesophageal varices
Beta blocker (eg. propranolol) or variceal band ligation
29
Signs of chronic liver disease
``` Ascites jaundice peripheral edema spider angiomata caput medusa testicular atrophy ```
30
What is spontaneous bacterial peritonitis?
Infection of ascites
31
What are the causes of ascites?
``` Cirrhosis (85% of ascites) Malignancy TB Nephrotic syndrome Right sided heart failure Pancreatic duct disruption ```
32
Calculation for determining if ascites is due to portal hypertension
serum albumin - ascites albumin >1.1 = portal hypertension
33
Treatment of ascites
``` loop diuretic (eg. lasix) spironolactone 2 grams/day sodium restriction diet ```
34
What is hepatorenal syndrome?
Decline in renal function due to cirrhosis because of decreased blood flow to the kidneys
35
What are the causes of decompensated heart failure?
``` Ischemia Arrhythmia Nonadherence to meds High sodium diet Infections HTN NSAIDs Renal failure pulmonary embolism anemia ```
36
What is the most frequent comorbidity of primary sclerosis cholangitis?
Ulcerative Colitis - In 80%
37
What liver enzymes are usually elevated for cholangitis?
ALP, Bili, GGT cholangitis
38
What liver enzymes are usually elevated for hepatitis?
AST, ALT
39
Causes of liver disease
``` Hepatitis - Autoimmune, A, B, C Primary biliary cholangitis Primary sclerosing cholangitis Hemochromatosis Wilson's disease Alpha-1 antitrypsin deficiency Malignancy NAFLD Alcohol Drugs ```
40
What is hemochromatosis?
Hemochromatosis is a 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
What is Primary biliary cholangitis and | Primary sclerosing cholangitis?
Diseases that result in the blockage of the bile duct causing bile to back up into the liver and damage it
42
What is Wilson disease?
Wilson disease is a rare genetic disorder characterized by excess copper stored in various body tissues, particularly the liver, brain, and corneas of the eyes
43
What is Alpha-1 antitrypsin deficiency?
Alpha-1 antitrypsin deficiency is an inherited disease that causes an increased risk of having COPD, liver disease and vasculitis
44
What is NAFLD?
Nonalcoholic fatty liver disease is a condition in which excess fat builds up in your liver not related to alcohol use.
45
What is NASH?
Non-alcoholic steatohepatitis is an advanced form of NAFLD which can result in cirrhosis and liver failure
46
What should you give to patients staying immobile for a long period of time?
Lovenox - to prevent a clot
47
What factors are included in the Wells score for DVT?
``` active cancer paralysis bedridden for 3 days or surgery within 4 weeks previous DVT tenderness pitting edema asymmetric calves large visible veins ```
48
What factors are included in the Wells score for pulmonary embolism?
``` Previous PE or DVT Immobilization or surgery in past 4 weeks cancer hemoptysis tachycardia clinical signs of DVT ```
49
What blood test can you order for DVT/PE specifically?
D-dimer
50
Besides lowering the K+, what do you need to do if a patient is hyperkalemic?
EKG and give calcium gluconate
51
How can you lower potassium?
- Dextrose (D50) followed by insulin - K+ binder like kayexalate - diuretic - bicarb - salbutamol (8 puffs) - dialysis if all else fails
52
What could hyperkalemia show on EKG?
peaked T waves | wide QRS
53
What are the criteria for dialysis?
``` Acidosis Electrolyte imbalance Intoxication Overload Uremia ``` AEIOU
54
What are the causes of delirium?
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
What is cardiogenic shock?
- Shock due to MI, cardiac tamponade, acute mitral regurg, etc. - exremities are often cold
56
What is distributive shock?
- Septic, anaphylaxic or spinal shock | - extremities are warm
57
What is hypovolemic shock?
- Low intravascular volume due to blood loss, diarrhea, emesis or poor oral intake - extremities are cold
58
Causes of upper GI bleed
- Peptic ulcer disease (due to NSAIDs or H Pylori) - Gastritis - Esophagitis - Variceal bleeding (due to cirrhosis) - Mallory Weiss tear
59
Treatment of H pylori
Triple therapy - PPI, amoxicillin, clarithromycin
60
Type of arrhythmia with wide vs narrow QRS
Wide - Ventricular tachycardia | Narrow - Atrial fibrillation
61
Does low CO2 represent respiratory/metabolic, acidosis/alkalosis?
respiratory alkalosis respiratory because it involves CO2 *When you hyperventilate you lose CO2 making you more basic and fainting
62
Does high CO2 represent respiratory/metabolic, acidosis/alkalosis?
respiratory acidosis respiratory because CO2 is involved
63
Does low HCO3 represent respiratory/metabolic, acidosis/alkalosis?
metabolic acidosis
64
Does high HCO3 represent respiratory/metabolic, acidosis/alkalosis?
metabolic alkalosis
65
What is pulmonary hypertension?
Increased pressure in the pulmonary artery (artery leading from the heart to the lungs)
66
What are some causes of pulmonary hypertension?
Heart failure COPD PE Cirrhosis
67
2 main types of COPD
Chronic bronchitis and emphysema
68
What is chronic bronchitis? What are the symptoms?
``` 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
What is emphysema ? What are the symptoms?
A type of COPD Permanent enlargement and destruction of alveoli Thin, dyspnea, quiet chest Pink puffer
70
Signs of a COPD exacerbation
Increased cough Increased sputum production Dyspnea
71
What is cor pulmonale?
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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