1
Q
Pruritic rash affecting the web spaces of the hands. Also seen with patients close contacts. Diagnosis and txmnt
A
Scabies
Permethrin cream
2
Q
3 day old with bilious vomiting, abd distension, failure to pass meconium, and gas a stool expulsion with DRE. Diagnosis and what is the gold standard test would you use?
A
Hirschsprung’s disease
rectal suction biopsy
3
Q
When would you use anal rectal manometry vs. rectal suction biopsy to diagnose Hirschsprung’s disease?
A
Rectal suction biopsy is the gold standard with higher sensitivity.
Rectal manometry is also less accurate in babies < 1 month
4
Q
2 possible tests that can help diagnose upper GI obstruction?
A
Abd US
Upper GI series
5
Q
When would you use a contrast enema for diagnosis and txmnt?
A
Contrast enema can help you diagnose and treat intussusception
6
Q
Abd cramps, vomiting, high pitched bowel sounds, leukocytosis, and a tender groin mass. Diagnosis and txmnt
A
Incarcerated inguinal hernia. Requires surgical management
7
Q
Management of asymptomatic primary hyperPTH?
A
Regular followup of calcium, Cr, and Dexa
8
Q
When would you want to screen for MEN in a patient with hyperPTH?
A
If they are very symptomatic or if they have a FMH of MEN
9
Q
Multiple erythematous plaques with central clearing beginning on the extremities. Rash name and leading cause?
A
Erythema multiforme caused by HSV
10
Q
Difference between erythematous plaques with central clearing in erythema multiforme and erythema migrans
A
Migrans (Lyme disease) is slow spreading an centered around the tick bite.
Multiforme occurs faster and has multiple lesions
11
Q
<30 yo with palpable breast mass. What studies do you get?
A
US first then mammogram if it is equivocal
12
Q
< 30 yo with breast mass gets imaging that shows simple cyst. Management? What if it is a complex cyst?
A
Needle aspiration for simple cyst to decompress. Image guided core biopsy for complex cyst
13
Q
> 30 yo with breast mass. What studies do you order? What if the initial tests make you more concerned about malignancy?
A
Mammogram first. Follow up with US if equivocal.
Image guided core biopsy if imaging is concerning
14
Q
When do you initiate HTN meds?
A
Observe for 1 year with behavior modifications. Can also start if there is organ damage or a high risk comorbidity like ACS
15
Q
When can physicians talk to families about organ procurement?
A
When they are specially trained to do so
16
Q
When would you treat with racemic epinephrine? Describe symptoms
A
Croup
Barky cough with inspiratory stridor
17
Q
Cough, post-tussive emesis, and lympocytosis. Dx and txmnt
A
Pertussis
treat with macrolides like azithromycin
18
Q
Kid with lung issue. When would you treat with
- azithromycin
- ceftriaxone
- oseltamivir
- prednisone
- racemic epi
A
- pertussis
- Staph pneumonia
- Influenza
- Asthma exacerbation
- Croup
19
Q
Multiple, bilateral, small, round nodules in the upper lobes on chest imaging are likely
A
Silicosis
20
Q
Bilateral linear and reticular opacities, irregular bronchovascular thickening of the upper lobes, and enlarged mediastinal and hilar lymph nodes
A
Sarcoidosis
21
Q
Management of asymptomatic hernias in kids.
A
Hernia repair electively in 1-2 weeks. Operate urgently if incarcerated
22
Q
Hydrocele management
Varicocele management
Cryptorchidism management
A
Hydrocele- Reassurance and observation. REsolve in 1 yr
Varicocele - may require surgery in early puberty if symptomatic
Cryptorchidism - Wait until 6 months as they may descend
23
Q
When would you consider giving menopausal hormone therapy? Who would you not give it to?
A
MHT for healthy women less than 60
Greater risk if >60, have CHD, liver disease, previous stroke or breast cancer
24
Q
On dyslipidemia meds and get strep throat which is treated with antibiotics. Get muscle soreness and increased CK. What happened?
A
Statin induced myositis. The macrolide antibiotic cann affect statin metabolism
25
Increased PTT with normal PT. Possible causes with h/o bleeding. Possible causes if no hx of bleeding
Hemophilia A, B and vWF disease would all have h/o bleeding
Acquired hemophilia due to a factor VIII inhibitor if no h/o bleeding
26
Liver cyst with fever. No organisms on bacterial culture. Aspirate is thick, dark brown fluid like anchovy paste. Cause?
Protozoal infection with entamoeba histolytica
27
Txmnt of acute prostatitis?
TMP-SMX of ciprofloxacin for 6 weeks
28
When to surgically repair AAA? Non surgical management
- >5.5 cm
- Increased in size more than 0.5 cm in 1 yr
- Symptomatic with back or abd pain
Re-eval w/ US or CT every 6 months
29
When can a pt w/ uncomplicated MI return to work?
| When can a pt w/ MI and heart failure return to work?
Uncomplicated - 2 weeks
| Complicated 3-4 months
30
Txmnt of Kawasaki Dz?
ASA and IVIG
| Echo to r/o complications
31
Complications of Kawasaki dz
Coronary artery aneurysms
| MI
32
Common causes of recurrent cellulitis
tinea pedis infection
lymphedema
severe venous insufficiency
33
3 steps for evaluating hematochezia in hemodynamically stable pts
1. Colonoscopy, if no source then
2. EGD, if no source then
3. Capsule endoscopy or repeat EGD
34
4-5 steps for evaluation hematochezia if hemodynamically unstable
1. Resuscitate
2. +/- Surgery or IR consult
3. EGD
No source and still unstable
4a. Angiography
No source, but stable
4b. Colonoscopy
No source
5b. Capsule endoscopy
35
Menstrual bleeding common for uterine fibroids
Heavy, regular bleeding
36
When would you give protamine sulfate?
To reverse heparin due to bleeding
37
Warfarin patient develops a serious bleed, how would you tx?
Stop warfarin
| Reverse with Vitamin K and add FFP.
38
Long QT and short QT, what is the relationship with calcium
Long QT - hypocalcemia
| Short QT - hypercalcemia
39
Old lady lives in a home, gets admitted to the hospital for PNA and gets antbiotics and a foley. She gets worse one day after the foley and has a few loose stools. Dx?
C. diff
40
Connect electrical alternans to hypotension
There is a pericardial effusion causing alternans. The cardiac tamponade is reducing flow into the right heart leading to decreased cardiac preload.
41
When should a patient be counseled about renal replacement therapy? What does renal replacement therapy mean?
When their GFR < 30
Renal replacement therapy means
kidney replacement, hemodialysis, or peritoneal dialysis
42
When do you add EPO in CKD?
when Hgb< 10
43
Normocytic anemia, hypercalcemia, mild renal insufficiency, and bone pain. Dx? What test should you order?
Multiple myeloma
| 24 hour urine protein electrophoresis
44
Soft, scrotal mass that increases in size with Valsalva. What are they at risk for? How would you tx?
Varicocele
At risk for testicular atrophy and infertility due to increased temp
Gonadal vein ligation in young boys w/ atrophy
NSAIDs and scrotal support in older men
45
Newborn has cyanosis when feeding that improves with crying. Dx? What would you do to confirm?
Choanal atresia.
| Try passing a nasogastric catheter
46
1st step for evaluating tracheoesophageal fistula
Insert gastric catheter followed by XR
47
Txmnt of symptomatic, recurring, malignant pleural effusion
Large volume thoracentesis followed by chemical pleurodesis. Palliative txmnt
48
Parameters for lead intoxication
< 44 = mild
45-69 = moderate
>70 = severe
49
Lead intoxication txmnt based on severity
Contact local public health - mild
DMSA - moderate intoxication
Dimercaprol and EDTA -severe
50
What test should be done on a pt with PCP PNA after starting antibiotic txmnt that would affect management? Why?
What would you do?
ABG analysis
Lysis of organisms can lead to an inflammatory response that causes hypoxia
If partial pressure of O2 is <70 or alveolar-arterial gradient is >35 then give steroids
51
4 cases in which you would prescribe antibiotic prophylaxis prior to a invasive procedure for infective endocarditis?
1. Prosthetic cardiac valves
2. Previous endocarditis
3. Valvulopathy in pt who received cardiac transplant
4. Congenital heart dz
52
Txmnt for acetaminophen toxicity depending on time since ingestion
< 4hrs - activated charcoal
| >4 hrs - N-acetylcysteine (NAC)
53
What environmental factor has the greatest increase of risk for pancreatic cancer?
Cigarette smoking
54
What kind of pt gets a implantable cardioverter-defibrillator (ICD) vs cardiac resynchronization therapy w/ biventricular pacemakre?
ICD- 1. Prior MI and LVEF <30%
2. NYHA Class II or III heart failure and LVEF < 35%
Biventricular pacemaker - LVEF <35% w/ long QRS
55
Man w/ impotence, ED, galactorrhea, and bitemporal hemianopsia. Txmnt 1st and 2nd line?
First line - dopamine agonist like bromocriptine or cabergoline
2nd line - Surgery
56
What is the mechanism of Factor V Leiden causing thrombophilia?
Resistance to the anti-thrombotic effect of protein C
57
How to treat QRS prolongation (>100 sec) in TCA OD
Give bicarbonate increases TCA binding so that it doesn't bind Na channels
58
4 tests to order in an obese patient
1. HgbA1c
2. Lipids
3. LFTs
4. TSH
59
How does orlistat work for weight loss?
Inhibits pancreatic lipases, which decrease fat absorption and lead to diarrhea
60
How do you dx EHEC?
| How do you tx it?
- Stool culture (sorbitol-MacConky agar)
- Shiga toxin
Tx:
Supportive therapy
Avoid abx due to risk of HUS
61
Triad of hemolytic uremic syndrome?
1. Acute renal failure
2. Microangiopathic hemolytic anemia
3. Thrombocytopenia
62
Iron and ferritin levels in iron deficiency anemia vs. thalassemia
Fe deficiency - decreased iron and ferritin
Thalassemia - Normal to increased iron and ferritin
63
Pregnant pt with RA. Which meds should be stopped and when
Continue hydroxychloroquine d/c methotrexate 3 months prior to pregnancy due to NTD
64
Screening tests for neural tube defects?
2nd trimester US and AFP
65
Kidney transplant pt on immunosuppressives gets AKI and biopsy shows renal tubular damage w/ prominet basophilic intranuclear inclusions. DX? Txmnt?
BK-virus induced nephropathy (Polyoma virus)
Decrease immunosuppression and possible antiviral therapy
66
How much of Medicaid is children?
About 50%
67
When should you deliver a diabetic mom with a baby weighing > 9.9 lbs, and how should the baby be delivered?
Deliver by c-section at 39 weeks
68
One difference between hypothyroid myopathy and inflammatory myopathy?
Hypothyroid myopathy does not have muscle soreness at baseline and may have other hypothyroid features
69
3 medications that would reduce the frequency of migraines
Propanolol
Valproate
Amitryptiline
(ergotamines are better to abort headaches not prevent them).
70
How could you reduce ventilator associated ARDS complications?
Decrease tidal volume. Prevents overdistending alveoli and causing barotrauma.
71
4 Ps of lichen planus
Pruritic
polygonal
planar
purple
72
Pt is volume down and develops hypotension after being started on a ventilator. What is the txmnt and why?
Ventilator increases intrathoracic pressure and decreases preload. Tx w/ NS bolus
73
What are pts with nephrotic syndrome at increased risk for?
Thrombotic event, possibly due to loss of anticoagulants in the urine.
74
3 risks associated w/ Parvovirus B19 in a pregnant pt
1. Fetal anemia
2. Hydrops fetalis
3. Fetal demise
75
What would you do to monitor for severe complications from Parvovirus B19 in a pregnant pt
Periodic US
76
Elevated Iron, ferritin, and transferrin and some mild psych sxs. Dx? What test would you get?
Hereditary hemochromatosis
| genetic studies looking for HFE mutation
77
Name an abx that can cause esophagitis?
Doxycycline
78
1st step if pt is haveing COPD exacerbation an impending respiratory failure?
1st - non-invasive positive pressure ventilation
2nd- Intubation
79
Txmnt for candida vulvovaginitis? Pregnant vs. non-pregnant
Pregnant - vaginal clotrimazole, miconaole, or nystatin
Non-pregnant - oral Fluconazole
80
3 causes of metabolic alkalosis w/ hypokalemia
Vomiting, diuretic use, and inherited Na wasting conditions
81
What bx do you worry about w/ furuncles and carbuncles? 3 meds you could use.
Clindamycin
Doxycycline
TMP-SMX
82
Kid w/ focal seizure. What is the gold standard evaluation?
MRI brain to evaluate for a mass
83
Difference in timing between a cohort study and a case-control study?
Cohort study - prospective. Follows cohort of pts split up by risk factor
Case-control - looks back retrospectively to see if those whoa developed the dz had the exposure
84
UC pt has cholestatic pattern liver injury, What test should you order?
Consider primary sclerosing cholangitis. Order endoscopic cholangiography
85
Side effects of olanzapine and clozapine
Weight gain
| Metabolic effects like DM
86
Side effects of TCA
Anticholinergic - Dry mouth, blurred vision, constipation, confusion, and urinary retention.
87
One sign that is different in truncus arteriosus vs. hypoplastic left heart syndrome
Truncus arteriosus would have a systolic ejection murmur
88
How could you keep a PDA open? How could you close it?
Prostaglandin E1
NSAIDs
89
Rh- Mom with 2nd Rh+ baby. If the Ab test is negative how would you treat. What if it were positive?
Anti-D IG @ 28 weeks and < 72hrs after delivery
If positive anti-D Ig will make no difference since she is already alloimmunized
90
1st test to order when evaluating PCOS? Next test to assess for a commonly associated syndrome?
Pelvic US
Oral glucose tolerance test to eval for DM
91
Txmnt for primary mitral regurg with LVEF 30-60%?
Mitral valve repair or replacement
92
Why is early txmnt so important in shingles?
Decreases long term complications like post-herpetic neuralgia
93
How long before it's called infertility in a 30 yo F, 35 yo F?
30 - 1 year of unprotected sex
35 - 6 months of unprotected sex
94
Triad of disseminated gonococcal infxn
Tenosynovitis of distal extremities
Dermatitis - pustules on hands and feet
Polyarthralgia - asymmetric and migratory
95
Txmnt for disseminated gonoccocal infxn
IV CTX and a single dose of azithromycin
96
Does PEG placement improve outcomes in demeneted pts?
No proven benefit
97
Reflexes in Guillain-Barre? CSF findings. Txmnt?
Hyporeflexia
Increased protein and NL leukos
IVIG or plasmapharesis. Watch resp status
98
Txmnt for sick sinus syndrome with tachy-brady?
Pacemaker for bradycardia. Then rate control meds for tachy
99
Motor signs of PD and laterality
Bradykinesia
Cogwheel rigidity
Resting tremor
u/l onset and persistent asymmetry
100
2 causes of acute tubular necrosis
Renal ischemia
| Contrast-induced nephropathy
101
How can you differentiate contrast-induced nephropathy from aortic atheroembolism in a pt after cardiac cath?
Contrast - muddy brown casts in urine
Atheroembolism - eosinophilia and eosinophiluria
102
What is BUN/Cr in prerenal azotemia?
20:1
103
Hematuria
Flank pain
Firm, nontender abd mass, which moves with respiration
Renal cell carcinoma
104
When should oral nutrition begin in a pt w/ acute pancreatitis?
As soon as they have an appetite
105
Frontline txmnt for chronic gout
```
Start allopurinol (xanthine oxidase inhibitor)
Support w/ colchicine (or NSAIDs if, intolerant) for flares
```
106
Abnl thrombotic event, splenomegaly, and erythrocytosis. What test would you order to dx?
Genetic mutation analysis for JAK2 mutation. Suspicious for polycythemia vera
107
Txmnt for postpartum thyroiditis
Propanolol
108
Possible ongoing issues w/ postpartum thyroiditis?
Increased risk of persistent goiter and chronic thyroid sxs
109
In what kind of study would you use an odds ratio? Show odds ratio calculation.
Odds ratios can be used in case-control studies (retrospective)
(a/c)/(b/d) or ad/bc. The sums are not used in the denominator because they cross out
110
What meds would you give a sexual assault victim. Name organism you are treating.
- HIV: Tenofovir -emtricitabine w/ raltegravir
- Chlamydia - azithromycin
- Gonorrhea - CTX
- Trichomonas (if seen on the slide) - Metronidazole
- HBV immunoglobulin and vaccine (if non-immune)
111
Txmnt for gallstone pancreatitis c/b acute cholangitis? 1st step and back up
ERCP can confirm dx and remove stone
Pecutaneous cholecystostomy is reasonable if the pt has CI for ERCP
112
Schizophrenic w/ persistent negative sxs, but well controlled on 1st gen anti-psychotic
Social skills training not change to 2nd gen anti-psychotic
113
PT on SSRI has sexual dysfxn. How would you tx?
Switch to bupropion or mirtazapine; or keep SSRI and augment w/ sildenafil
114
Which has a greater effect on decreasing blood pressure, smoking or weight loss?
Weight loss is more significant.
115
Are diffuse ST elevations always present in peri-infarction pericarditis?
No. They may be affect by post-MI changes.
116
What is the timing for Dressler syndrome?
Several weeks after MI
117
What is the txmnt for viral or idiopathic pericarditis?
Colchicine or NSAIDs
118
Txmnt for peri-infarction pericarditis?
High dose ASA
119
Most common complication of bacterial conjunctivitis? Most common type of pt?
Keratitis - infection of the cornea
| Most common in contact wearers
120
Lung cancer. When would you biopsy a hilar node vs. supraclavicular node?
Get the hilar node if the cancer is isolated to the lung
Get the supraclavicular node if there are mets
121
How can you distinguish a confounder from effect modification?
When stratifying results:
No effect on direction or strength = confounder
Different effects in the different stratum = effect modification
122
Back pain that increases w/ extension? DX?
Spinal stenosis
123
1st and 2nd meds in asthma exacerbation? Next steps?
```
SABA
Then ipratropium (anticholinergic) for 1 hr
```
Oral or IV corticosteroids and then magnesium
124
Emergency contraceptivs
1. Most effective
2. Most effective if pt has cervicitis
3. A backup oral option
1. Copper IUD
2. Ulipristal (antiprogestin)
3. OCP
125
Esophageal varices causing hematemesis can be treated with what med? What can be used to prevent future hemorrhage?
Octreotide
| Nonselective beta blockers like propnaolol
126
1st line txmnt for bacterial conjunctivitis? Contact wearers? Why?
Polymixin-trimethoprim drops or azithromycin drops
Contacts get a fluorquinolone to cover for psuedomonas
127
What are the 2 most important factors when considering prognosis in COPD?
Age
| FEV<40
128
What is the difference between a physician attending a conference and a physician lecturing at a conference when it comes to accepting gifts?
Just attending - can't get anything
Lecturing - can accept reimbursement for flight or honoraria
129
What V/Q scan result can help you decide that the pt doesn't have a PE?
It has to be normal V/Q. Low or moderate probability does not r/o and must be tested further.
130
Paraneoplastic syndrome with Squamous cell carcinoma (SCC)?
Hypercalcemia due to PTHrP
131
Paraneoplastic syndromes associated w/ small cell lung cancer?
SIADH
132
What txmnt should be given to a brain dead organ donor to protect the organs? (3)
Keep euvolemic, normotensive, and normothermic.
Give IVF, demospressin, and pressors if needed
133
What kind of smoker should be screened for lung cancer and by what modality?
Age 55-80
30 pk yr history, either current smoker or quit w/in last 15 yrs.
Annual CT chest
134
Apnea of prematurity vs. periodic breathing
Periodic breathing is brief, 5-10 secs
Apnea of prematuriy is >20 secs and resolves when they hit 37 weeks
135
Cause of exudative effusion w/ lymphocyte predominance and increased adenosine deaminase (ADA)?
TB infxn
136
Chronic non-productive cough that worsens w/ exercise, forced expiration, and allergen exposure? Dx?
Cough variant asthma
137
3 HTN meds that can cause pancreatitis
Furosemide
chlorthalidone
Hydrochlorothiazide
138
What is a more subtle sign of hemodynamic instability when evaluating hematochezia? First test after resuscitating?
Orthostatic hypotension
EGD, then colonoscopy if equivocal
139
Definition of sensitivity?
| Definition of specificity?
Sensitivity - probability of a diseased person testing +
Specificity - probability of a non-diseased person testing -
140
Differences on contrast enema between Hirschsprungs and meconium ileus (CF)?
Hirschsprungs - Normal or narrow colon w/ dilated large bowel
Meconium ileus - has consistent microcolon
141
Case fatality rate vs mortality rate?
Case fatality - proportion of people with a condition who die from that condition
Mortality rate - Probability of dying from a condition in the general population
142
Attack rate definition?
Proportion of people who develop a disease amongst the total population at risk
143
Test for identifying infantile hypertrophic pyloric stenosis
Abd US
144
What kind of acidosis would you expect in a pt w/ 21-hydroxylase deficiency (CAH)
Hyperkalemic metabolic acidosis
145
What is a risk factor for hypertrophic pyloric stenosis in infants under 2 weeks?
Previous txmnt w/ azithromycin or erythromycin
146
In preparation for early surgery in peptic ulcer perforation what 3 things can you do in the preoperative setting?
1. IVF
2. Broad spectrum abx covering Gram - organisms
3. PPI
147
Does a higher or lower negative likelihood ratio point to a lower likelihood that the disease is present?
A lower magnitude NLR means it is less likely the disease is present.
148
PT w/ an anal abscess is a greatest risk for developing what?
Fistula
149
Txmnt for dyspepsia w/ typical GERD sxs
PPI trial
150
Txmnt of dyspepsia w/o GERD sxs. If >60 vs. <60. If <60 what test next? Txmnt?
>60 - endoscopy
<60 - H. pylori testing
If H. pylori + - triple therapy
If H. pylori negative Get PPI trial
151
What is triple therapy for H. pylori?
Omeprazole
Clarithromycin
Amoxicillin
152
How and when do you confirm H. pylori eradication?
Fecal antigen test or urea breath test 4 weeks later
153
Decreased sample size leads to an increase in Type I or Type II errors?
Increases Type II errors (Failing to reject a false null hypothesis) - false negative
154
What is it called when you repeat a primary study calculation after modifying certain criteria?
Sensitivity analysis
155
What type of study is best for infectious outbreaks or rare diseases?
Case control studies
156
Normal distribution. What % is w/in 1, 2, and 3 SD?
1 SD - 68%
2 SD - 95%
3 SD - 99.7%
157
Negatively skewed data. Order mean, median, and mode. What about for positively skewed data?
Modemedian>mean
158
What tests should be considered for analyzing data if you are comparing proportions? When would you use one over another?
Big sample size - Chi-square test
| Small sample size - Fisher's exact test
159
What test would you consider if you are analyzing your data based on the means? What helps you choose?
Paired T-test - same individual over time (dependent variable)
Student's T-test - Independent samples w/ 2 groups
ANOVA - More than 2 groups
160
Type I error is?
Incorrectly concluding there is an association
161
Type II error is?
Incorrectly concluding there is not an association
162
What does 1-Beta mean?
Power of the study. Probability of accurately detecting an association
163
In Fe deficiency anemia what increases first, Hgb, Hct, or retic ct?
Retic ct
164
How can you prevent preeclampsia in those w/ increased risk
Daily ASA @ 12 wks gestation
165
Loss of pupillary rxn, vertical gaze paralysis, loss of optokinetic nystagmus, and ataxia. Dx?
Parinaud syndrome classic for a pineal tumor
166
Associated conditions w/ craniopharyngioma?
Diabetes insipidus and deficiency of 1 or more of the anterior pituitary hormones.
167
Blood type A or B baby born to type O 2nd time mom has hyperbilirubinemia (unconjugated) and positive direct Coombs w/in first 24hrs of life. Dx?
ABO incompatibility
168
Type of hyperbiliruinemia seen in biliary atresia
Increased direct bilirubin as the bili still gets conjugated. It just can't be released.
169
What type of hyperbilirubinemia occurs in breast milk jaundice?
Increased indirect bilirubin
170
What kind of hyperbili in G6PD deficiency?
Increased indirect bili. It doesn't get conjugated.
171
3 Ds of niacin deficiency
dementia
dermatitis
diarrhea
(stomatitis and cheilosis)
172
Erythematous, pruritic, painful rash that doesn't respond to steroids and starts clearing from the center. Also has mild DM. Dx?
Glucagonoma
173
What is a herbal medication that is used to tx BPH?
saw palmetto
174
4 alternative meds that can increase bleeding risk?
Garlic
Ginko biloba
Ginseng
Saw palmetto
175
```
Common side effects:
Statins
Sulfonylureas
Metformin
Thiazolidione (pioglitazone)
```
Statins - myositis and hepatotoxicity
Sulfonylureas - hypoglycemia
Metformin - Lactic acidosis
Thiazolidione - Fluid retention due to Na reabsorption
176
1st test to order when assessing hypercalcemia?
PTH to determine if the increase in Ca is independent of PTH
177
Central hypothyroidism and hyponatremia. What tests should you perform?
Morning cortisol and since it is low you would follow up w/ ACTH level and ACTH stim test
178
CAH:
1. Nl genitalia and HTN
2. Ambigous genitalia and hypotension, Increased K
3. Ambigous genitalia and HTN
1. 17 alpha-hydroxylase deficiency
2. 21-hydroxylase deficiency
3. 11 beta-hydroxylase deficiency
179
What hormone would you expect to be elevated in 21-hydroxylase deficiency?
17-hydroxyprogesterone
180
Chronic hypoparathyroidism w/ low/normal calcium and high urine calcium. Txmnt?
Give thiazide diuretic to decrease urine calcium and increase serum calcium
181
What kind of complications does tight glycemic controll affect?
Reduces microvascular complications like nephropathy and retinopathy
182
Best treatment for hyperthyroid during pregnancy? 2 answers
Propylthiouracil for the 1st trimester (may cause liver failure)
Methimazole for the 2nd and 3rd trimester (teratogen)
183
What lcass of medication is octreotide?
Somatostatin analog
184
Txmnt of sulfonylurea poisoning? 1st and 2nd line
1st - Dextrose
2nd - Octreotide - Decreases insulin secretion
185
3 long term complications of untreated hyperthyroidism
1. Arrhythmia
2. Cardiomyopathy
3. Osteoporosis
186
Low testosterone, low FSH/LH, Elevated LFts, tan skin, and hepatomegaly. Dx? Txmnt?
Hereditary hemochromatosis
| Tx w/ phlebotomy
187
What is penicillamine used to tx?
Wilsons dz
188
What disease can develop when treating w/ lithium, and how would you tx it?
Lithium induced hypothyroidism
| Tx w/ continuing lithium and starting levothyroxine
189
3 common complications of NF1?
Optic gliomas
Scoliosis
Pseudoarthroses
190
MEN, syndromes:
1. 3 Ps
2. 2 Ps
3. 1 P
1. HyperPTH
Pituitary tumor
Pancreatic tumor
2. Hyper PTH
Pheochromocytoma
Medullary thyroid CA, Increased calcitonin
3. Pheochromocytoma
Medullary thyroid CA (increased calcitonin)
Mucosal neuromas
191
3 things that would push you to perform Parathyroidectomy?
1. Symptomatic hyperCa
2. end organ complications
3. Urinary Ca > 400
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