Effects of cortisol 4

- Impaired collagen prodution and enhanced protein catabolism. - Anti-insulin effects - Impaired immunity: inh. PMN's and T cells - Enhances catacholamines

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.

Step Up To Medicine Quick Hits Flashcards by K. Steven

Indications for surgery in primary hyperparathyroidism ?

Age 400mg in 24 hours.

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What is pseudohyperparathyroidism

End organ resistance to PTH. Labs will show Hypocalcemia, hyperphos, High PTH, Low urine cAMP.

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Effects of cortisol

Impaired collagen prodution and enhanced protein catabolism.
Anti-insulin effects
Impaired immunity: inh. PMN’s and T cells
Enhances catacholamines

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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.

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How can you differentiate between cushings disease and bushings syndrome in a lab test ?

High dose Dexamethasone Suppression Test.

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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.

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Workup for ectopic ACTH tumor ?

Chest CT, Abdominal CT, Octreotide Scan

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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.

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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.

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What do you treat pheochromocytoma patients with 10-14 days pre-op ?

phenoxybenzamine, then 2-3 days out Alpha block and Beta Block

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MEN-1

3-P’s
Parathyroid Hyperplasia (90%)
Pancreatic Islet Cell tumor
Pituitary Tumor

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MEN-2A

Sipple “MPH”

Medullary Thyroid Adenoma
Phenochromocytoma
Hyperparathyroidism

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MEN 2-B

“MMMP”

Mucosal Neuromas
Medullary Thyroid Carcinoma
Marfanoid Body Habitys
Phenochromocytoma

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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.

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What is an adrenal incidentaloma ?

Nonfunctioning adrenal tumor. First you must rule out functionality, Then resect any tumor over 6cm.

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Any patient who is hypertensive with hypokalemia

Suspect Aldo Excess

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Most common cause of addison disease worldwide

TB, or abrupt discontinuation of exogenous corticosteroids.

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Ovarian cysts, pseudoprecocious puberty, polystoic fibrous dysplasia of bone, cafe au lei spots

McCune Albright Syndrome

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Lipid profile in insulin resistance

Hypertriglyceridemia with HDL depletion

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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

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Diagnostic Criteria for Diabetes

Fasting over 126 on two occasions
200 with symptoms
OGTT >200 at 2hrs
A1C over 6.5%

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When do you use oral hypoglycemics

140 - 240 glucose range

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Sulfonureas

Stim Pancreas to make more insulin

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Metformin

Enhances insulin sensitivity, Blocks gluoneogenesis

**GI Upset + Lactic Acidosis

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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.

Step Up To Medicine Quick Hits Flashcards

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