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STEP 2 > Step Up To Medicine Quick Hits > Flashcards

Step Up To Medicine Quick Hits Flashcards

1
Q

Indications for surgery in primary hyperparathyroidism ?

5

A
  1. Age 400mg in 24 hours.
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2
Q

What is pseudohyperparathyroidism

A

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

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3
Q

Effects of cortisol

4

A
  • Impaired collagen prodution and enhanced protein catabolism.
  • Anti-insulin effects
  • Impaired immunity: inh. PMN’s and T cells
  • Enhances catacholamines
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4
Q

What is the difference in pigmentation between Cushings syndrome and Cushings Disease

A

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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5
Q

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

A

High dose Dexamethasone Suppression Test.

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6
Q

How can you tell with labs if the cushings is caused by an ectopic ACTH tumor ?

A

High ACTH / Cortisol No suppression with low or high dose dexa, No response with CRH test.

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7
Q

Workup for ectopic ACTH tumor ?

A

Chest CT, Abdominal CT, Octreotide Scan

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8
Q

If all of these criteria are met the diagnosis is pheochromocytoma until proven otherwise … (5)

A
  1. headache
  2. Profuse sweating
  3. Palpitations
  4. Tachycardia
  5. Apprehension or sense of impending doom.
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9
Q

Rules of 10 for pheochromocytoma

A 
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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10
Q

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

A

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

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11
Q

MEN-1

A

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

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12
Q

MEN-2A

A

Sipple “MPH”

Medullary Thyroid Adenoma
Phenochromocytoma
Hyperparathyroidism

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13
Q

MEN 2-B

A

“MMMP”

Mucosal Neuromas
Medullary Thyroid Carcinoma
Marfanoid Body Habitys
Phenochromocytoma

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14
Q

Effects of Aldo

A

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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15
Q

What is an adrenal incidentaloma ?

A

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

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16
Q

Any patient who is hypertensive with hypokalemia

A

Suspect Aldo Excess

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17
Q

Most common cause of addison disease worldwide

A

TB, or abrupt discontinuation of exogenous corticosteroids.

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18
Q

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

A

McCune Albright Syndrome

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19
Q

Lipid profile in insulin resistance

A

Hypertriglyceridemia with HDL depletion

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20
Q

Management of diabetics, Routine survalence (8)

A
  • 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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21
Q

Diagnostic Criteria for Diabetes

A

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

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22
Q

When do you use oral hypoglycemics

A

140 - 240 glucose range

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23
Q

Sulfonureas

A

Stim Pancreas to make more insulin

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24
Q

Metformin

A

Enhances insulin sensitivity, Blocks gluoneogenesis

**GI Upset + Lactic Acidosis

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25
Q

Acarbose

A

Reduces glucose absorption

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26
Q

Thiazolidinediones

A

reduces insulin resistance.

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27
Q

Key components of DKA

A

Hyperglycemia (450-850)
Positive Urine Ketones (Increased Anion Gap)
Metabolic Acidosis (pH

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28
Q

DD of DKA

A 
Alcoholic Ketoacidosis
HHNS
Hypoglycemia
Sepsis
Intoxication
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29
Q

Features of HHNS

A

Severe hyperosmolarity
Hyperglycemia
Dehydration
Acidosis and Ketosis are absent

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30
Q

Parkinsonian symproms and autonomic instability

A

Shy-Drager Syndrome

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31
Q

Basic defect in Parkinsons

A

Dopamine pathway is compromised and the cholinergic system operates unopposed. Therefore to treat it enhance dopamine or inhibit Ach

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32
Q

Drugs that cause parkinsonian like affects

A

Neuroleptic drugs, metaclopyramide, reserpine.

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33
Q

Basic derangement in alzheimers

A

Impaired cortical cholinergic function. Thus Cholinesterase inhibitors can increase these patients function.

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34
Q

Cholinesterase Inhibitors

A

Dopenzil, Rivastigmine, Galantamine

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35
Q

Vitamin treatment in Alz

A

Mega vitamin E

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36
Q

Treatment for lewy body dementia

A

Segeline

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37
Q

Treatment of Myasthenia Gravis

A

AchE inhibitors Pyridostigmine

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38
Q

Treatment of Guilliam Barre

A

Monitor pulmonary function in the hospital. Plasmapheresis and IVIG

NO STEROIDS

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39
Q

Medications that will exacerbate symptoms of MG

A

Antibiotics, B-Blockers, Anti arrhymics.

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40
Q

Lambert eaton is associated with

A

Small cell carcinoma of the lung.

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41
Q

Patient with atopic dermatitis that later forms umbilicated vesicles

A

Eczema Herpeticum

42
Q

Before starting a RA patient on methotrexate you should test them for ?

A

Hep B, Hep C, and TB

43
Q

Pathophysiology of PCOS

A

GnRH excess that causes LH and FSH to become greatly elevated preventing ovulation

44
Q

Diagnostic criteria for cyclic vomiting syndrome

A

> 3 episodes up to 4x/hr in 6mo period
No symptoms between episodes
No underlying condition

45
Q

Management of TCA overdose

  • Anticholinergic
  • Electrocardio problems
A

Na-HCO3 for cardioprotection

GABA agonist for seizures

46
Q

What murmers need transthoracic eco ?

A

Mid systolic murmers in grades 1-2 in asymptomatic patients.

47
Q

Should Beta Blockers be given to asthmatics ?

A

NEVER

48
Q

Blood gas in an asthmatic

A

Low CO2 secondary to hyperventilation. If it begins to normalize then respiratory failure is imminant

49
Q

Is Dyspnea normal in response to rapid changes in temperature and humidity ?

A

Yes.

50
Q

Quickest method to diagnose asthma in the ED in a very acute setting

A

Peak flow: Normal is 450-650 in men and 350-500 in women.

51
Q

What test do you get in a never smoker with emphysema ?

A

Alpha-1 AT level.

52
Q

What other abnormalities will a patient with Alpha-1-AT deficiency have ?

A

Neonatal hepatitis, liver failure, and cirrhosis.

53
Q

PFT’s in emphysema

A

Decreased FEV1 / FVC, Increased TLC, and Decreased DLCO

54
Q

Unilateral nontender lymphnode in an older smoker with a normal CBC ?

A

Highly suspective of SCC. This is the most common head and neck cancer in elderly.

55
Q

What findings are highly indicative of severe mitral regard ?

A

Displaced apical impulse, holosystolic murmur, and third heart sound.

56
Q

MCC of holosystolic murmur in White people ?

A

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.

57
Q

Rheumatic heart disease usually causes what problem with the mitral valve ?

A

Mitral stenosis.

58
Q

Crystals are yellow when oriented East / west and blue when oriented North / south

A

Negative Bifringance, monosodium urate.

59
Q

Fatigue abdominal pain and constipation, microcytic anemia with basophilic stippling

A

Suspect acute lead poisoning, get an occupational history

60
Q

Neuropathy, nephropathy, and neuropsych problems. Microcytic anemia with basophilic stippling.

A

Chronic lead exposure, get an occupational history

61
Q

Disseminated encephalitis following vaccinations ?

Treatment?

A

Gullian Barre syndrome,

Plasmapheresis or IVIG

62
Q

Locked in syndrome is usually caused by infarction or hemorrhage in the ?

A

Ventral Pons. Remember they are fully aware but lose all control except for muscles of respiration, blinking, and vertical eye movements.

63
Q

Ipsilateral medial rectus palsy with optic neuritis

A

MS, –> get an LP check the CSF for oligoclonal bands.

Treat with high dose steroids

64
Q

What causes calcium oxalate stones ?

A

Anything that alters the absorption of fatty acids and bile salts ( surgery, small bowel disease, chronic diarrhea )

65
Q

Indications for C-Section in post term pregnancy ?

What if the patient refuses when both are present ?

A

Oligohydramlos and late decelerations

You have to honor the patients wishes. In the US the mother has ultimate rights over the unborn child.

66
Q

Man who travels a lot for work and has thrombocytopenia needs to be tested for ?

A

HIV and Hep-C

67
Q

Test for B12 deficency

A

Shillings Test. Also look for hyperhsegmented neutrophils

68
Q

Gram negative bacteria in the sputum of a patient who is intubated. What ABX ?

A

Pseudomonas, Piperacillin / Tazobactam

69
Q

Why do patients with cirrhosis become edematous or even develop pulmonary edema ?

A

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

70
Q

Insidious onset of bilateral radicular back pain brought on by climbing stairs and released by leaning forward.

A

Lumbar spinal stenosis. Disc herneation on step 2 will usually be an acute onset event.

71
Q

What causes nasal furouncliosis.

A

usually a staph folliculitis infection.

72
Q

Uncontrollable daytime sleepiness

A

Modafinil

73
Q

Cataplexy

A

Sodium Oxibate

74
Q

Why would a patient with cirrhosis have ascites

A

Low albumin

75
Q

3mo post partum a woman has been passing dark clots. The then presents with a PE. What is the diagnosis.

A

Choriocarcinoma. Workup with BhCG. The most common area to metastasize is the lung.

76
Q

37 year old with a new onset anal fissure, what is the next best step ?

A

Stool softeners and local anesthetic

77
Q

Ground glass cytoplasm with pasta bodies in a thyroid malignancy

A

Papillary thyroid cancer.

78
Q

Thyroid cancer that invades local blood vessels

A

Follicular thyroid cancer.

79
Q

Workup for suspected piagets disease of the bone ?

A

Lytic and plastic bone lesions with elevated ALP.

Treatment is bisphosphonates.

80
Q

Treatment for repeat bee sting anaphylaxis

A

Venom Immunotherapy

81
Q

Ascites and Cirrhosis in a man with no EtOH history and a BMI of 24

A

Workup with Hep B and Hep C serology.

82
Q

Low Platelets and clotting….

A

HIT, Ab bound to PF4. Treat with Leparudin or Agatroban

83
Q

Normal platelets but increased bleeding time and PTT.

A

Von Willfabrands Disease

84
Q

Parkland Formula for Burn Fluids.

A

Adult: Kg x BSA x3-4
Kid: Kg X BSA x 2-4. Topical ABX only

85
Q

Burn topical that does not penetrate eschar but can cause leukopenia

A

Silver Sulfadiazine. Leukopenia, not great for 3rd degree

86
Q

Does Penetrate Eschar… But hurts like hell

A

Mafanide

87
Q

Does not penetrate Eschar but causes hypokalemia and hyponatremia

A

Silver Nitrate

88
Q

Rhabdomyolysis, what do you test ?

A

K, because of cell lysis.

89
Q

Compartment syndrome

A

> 30mm Hg

90
Q

Treatment of pulmonary contusion.

A

Deep breaths and pain control.

91
Q

How do you treat flail chest ?

A

Intercostal nerve block.

92
Q

How do you treat tension pneumo ?

A

Needle Decompression.

93
Q

Post traumatic epigastric abdominal pain

A

Get a Abd CT. pancreas or duodenum rupture.

94
Q

Myasthenia Gravis

A

Auto Ab to Ach Receptor

95
Q

Guillian Barre

A

Inflammatory demyelinating polyneuropathy

96
Q

Preceded by viral or mycoplasma illness (MG vs GBS)

A

GBS.

97
Q

Ascending weakness and paralysis (MG vs GBS)

A

GBS.

98
Q

One you can not give steroids to (MG vs GBS)

A

GBS must be treated with plasmapheresis and IVIG.

99
Q

Ascending paralysis (MGvs GBS)

A

GBS

100
Q

Weakness with repetitive use (MG vs GBS )

A

MG.

STEP 2 (9 decks)

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