Systems Path

Question 1

hyperPTH secondary to CKD/ESRD

Answer 1

• -initial hypoCa+ and hyperPO4
• -elevated PTH (and subsequent hyperCa2+ with bone lesions)
• -anemia that is NORMOCHROMIC and NORMOCYTIC (no EPO)
• -(+) for protein and casts in urinalysis
• -hyperkalemia

Question 2

value for heavy proteinuria

Answer 2

> 3.5g/d (24hrs)

Question 3

Urinalysis Findings for
Nephrotic Syndrome (differential for CKD)

Answer 3

proteinuria in addition to

a. ) edema
b. ) hypercholesterolemia
c. ) hypoalbuminemia

Question 4

2nd trimester at 20 weeks gestation, pt presents with

a. ) rapidly-progressing HTN (severe values are anything > 160/110)
b. ) proteinuria

Answer 4

pre-eclampsia

Question 5

peri-operative acute onset tachycardia, hypotension, elevated temperature; early conscious signs include nausea & vomiting, dehydration

Answer 5

Thyrotoxicosis aka Thyroid Storm

• -clinical presentation mimics Malignant Hyperthermia
• -ER intervention is same: rapid response thyroid blocking drugs, IV glucose, corticosteroids

Question 6

Earliest warning sign in Malignant Hyperthermia (Auto Dominant)

Answer 6

hypercapnia

Question 7

Eruptive Xanthomatosis

Answer 7

Skin lesion seen in uncontrolled diabetics, especially young men with IDDM in conjunction with hyperlipidemia/cholesterolemia. Are multiple, small, firm, yellow, raised bumps with a red halo.

• -possibly itchy
• -locations: back of hands, the feet, arms, buttocks

Question 8

Digital Sclerosis

Answer 8

Thickening and tightening of skin on finger joints and backs of hands, associated with uncontrolled diabetes (Type 1). Stiffening creates difficulty in movement.

**differential Dx = scleroderma

Question 9

Acanthosis Nigricans

Answer 9

Thickening and velvety darkening of skin folds (axillary) in people that are overweight and most likely pre-diabetic.

Question 10

Mucormycosis

Answer 10

Opportunistic fungal infection in uncontrolled diabetics in which hyphae invade blood vessels, eventually resulting in local tissue necrosis.

• -most common tissues involved: sinuses, brain, lungs
• -cerebral infection most frequent; s/s include one sided headache behind the eyes, sinusitis
• -rapidly progresses in include periorbital edema, nasal discharge of black necrotic tissue

Question 11

stones, bones (abdominal) moans, (psychic) groans

Answer 11

The clinical constellation of effects seen in Hypercalcemia.

Question 12

Kayser-Fleischer Ring

Answer 12

Brown or coppery-yellow ring around the corneal limbus of the eye (ie junction of the sclera and cornea), seen in Wilson’s Disease.

Question 13

Arcus Senilis

Answer 13

Opaque gray, blue or white ring around the corneal limbus that appears in adults and elders with hyperlipidemia or hypercholesterolemia.

Question 14

Limbus Sign

Answer 14

Milky, cloudy white ring around the corneal limbus in patients with hypercalcemia. Represents dystrophic calcification.

Question 15

Metastatic cancers most commonly associated with osteolysis and hypercalcemia (3):

Answer 15

breast, lung and myeloma

Question 16

Pathognomonic sign of CHF in the presence of HTN.

Answer 16

Tachycardia - ie HR is constantly elevated, even at rest!

In healthy people, increased workload (ie via exercise) first triggers an increase in cardiac “contractility”, THEN next an increase in HR. However, this increased HR will quickly normalize after exercise ceases.

Question 17

Changes in ion concentration that would weaken the heart: decreased HR, flaccidity and poor contractility, dilation of chambers, etc.

Answer 17

1. HYPOCALCEMIA: obviously now a decrease in ions needed to initiate Action Potential as well as allow muscle contraction
2. HYPERKALEMIA: because excess K+ diffuses through the leaky K+ channels enough to alter normal resting mV of the inner membrane of the cardiac mt cell
   - -other severe consequences: AV conduction block

Question 18

Congenital Heart Defects that cause severely-increased pressure in the RV (and likewise, RV hypertrophy):

Answer 18

1. Tetralogy of Fallot: pulmonary artery constriction in conjunction with VSD (similar to the PDA in which blood from RV bypasses the lungs)
2. Interventricular Septal Defect
3. Transposition of Great Arteries: RV is now pumping “dirty” blood through the high-ATM aorta and into systemic circulation
4. Patent Ductus Arteriosus: normal in fetal circulation since blood bypasses the lungs and goes from the Pulmonary Artery directly to the aorta (as well as from RA to LA via Foramen Ovale); however, the shunt is supposed to close at birth.

Question 19

Which surface of the stethoscope is best for detecting high pitched sounds like S1, S2,

Answer 19

Diaphragm