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Primary Care
Endocrin, neuro
| Question | Answer |
|---|---|
| what are sx's of hypothyroidism | cold intolerance, fatigue, heavy menstrual bleeding, wt gain, myxedema coma |
| what ethnic group/gender is at highest risk of developing DM? | hispanic females |
| what obesity value(s) puts someone at high risk for DM? | BMI>27 or greater than 120% of IBW |
| what labs/conditions put you at high risk for DM? | HDL<35, trigs>250, BP>140/90, gestational diabetes or infant>9lb, PCOS, hx of elevated BG |
| What are values for OGGT and FPG that indicate DM (if 2 successive values are higher) | OGGT=200, FPG=126 |
| What are desirable BG values for diabetics (pre-prandial, post-prandial, HS, A1c) | pre=80-120, post=100-180, HS=100-140, A1c<7% |
| Where does metformin act in the body? Sulfonylureas? Glitazones? Acarbose? Miglitol? | met = reduce hepatic glucose output, reduce peripheral insulin resistance; sulf=increases insulin output; glit=same as metformin; acarb=delay carb absorption; Mig = same as acarb |
| what are microalbumin goals in DM? | 30mg/24hrs, or 20microg/min on timed, or 30mg/g creatinine on random sample |
| what are times to peak and durations of action for following insulins: Aspart, Lispro, NPH, regular, Glargine | as listed: Aspart/Lispro = 1/4-5; regular=2/6-10, NPH=5/10-20, Glargine=24hrs |
| how does DKA present? | N/V, weakness/lethargy, fruity breath, abd pain, hyperventilation |
| what is effect of acidosis on K and Na | K = hyperkalemia due to H+ pushing K out of cells; Na = pseudohyponatremia (glucose goes into interstitial space and sucks Na with it) |
| rank AA's, hispanics, and caucasians in risk for osteoporosis | low to High: AA, hispanic, caucasian |
| what are RF's for osteoporosis? | hx of adult fx, hx of fracture in 1st relative, current smoker, wt<127lb |
| what BMD ranges coincide with normal, osteopenia, and osteoporosis? | normal=BMD at most 1 SD below normal; osteopenia = BMD 1-2.5 SD's below normal; osteoporosis = BMD >2.5 SD's below normal |
| what are nutrition recommendations in osteoporosis? | Ca 1500mg/day (diet+supplements), 400IU vit D/day in summer, 1000IU in winter or age>65 |
| what are meds used in osteoporosis that inhibit resorption, maintain/increase bone mass? Which increase bone formation? | bisphosphonates, estrogen, SERMS (raloxifene - selective estrogen receptor modulator), calcitonin; Forteo |
| what is effect of once-daily PTH? Continuous PTH? | bone remodeling; bone resorption, which may decrease bone mass? |
| what is thyroid fxn test? | 131-thyroid uptake |
| what are likely diagnoses with hyperthyroidism and no enlarged thyroid? | Graves or iatrogenic causes |
| what are likely diagnoses with hyperthyroidism and enlarged thyroid? | Graves, toxic multi-nodular goiter, thyroiditis |
| what are likely diagnoses with hypothyroidism and no enlarged thyroid? | Hashimoto, iatrogenic |
| what are diagnostic criteria for a migraine? | POUND - pounding, onset 4-72hrs, unilateral, nausea, disabling |
| what are less intuitive HA signs that are danger signs? | head pain spreading to shoulders, new HA in CA or Lyme or HIV pt |
| criteria for neuroimaging in headache | change in pattern, worsening, focal neuro sx's, worse w/ cough/sex/exertion, orbital bruit, onset >40yo |
| what is the relationship between triptans and cutaneous allodynia in migraines? | if allodynia is present, triptans much less likely to work |
| describe menstrual migraines | close temporal relation to onset of menstruation, connnected to decrease in estrogen levels, longer/more severe |
| which triptan has the fastest onset? what are SE's of triptans? | rizatriptan; chest/throat pressure, flushing, paresthesias. Also drowsiness, dizziness, malaise |
| what are contraindications for triptans? | ischemia stroke, ischemic HD, prinzmetal's angina, uncontrolled HTN (all due to vasoconstrictive effects) |
| what is concern re SSRI's and triptans? | serotonin syndrome triad |
| what is serotonin syndrome triad? | cognitive (confusion, hypomania, etc), autonomic (shivering, sweating, fever, etc), and somatic (twitching, hyperreflexia, tremor) effects |
| describe use/efficacy of ergots | poor bioavailability, effectiveness unclear, maybe best effective in pts with long, frequent migraines |
| what is best way to use dihydroergotamine? | combined with anti-emetic- increases efficacy |
| what is a consideration wrt oral agents and migraine tx? | migraine may cause gastric stasis, limiting processing of med |
| what are classes of migraine prophylaxis? | antihypertensives: BB, ACE, thiazide, ARB, CCB. Antidepressants (TCAs) |
| describe cluster HA | 25-50yo men >women, repetitive, unilateral, rapid onset, around eye/temple, restlessness, redness/stuffy nose/rhinorrhea, N/V, photophobia, same time each day |
| Cluster tx | oxygen, triptans; prophylaxis = verapamil, prednisone, trigeminal nerve blocks |
| what is most common HA type? | tension |
| Describe tension HA | generalized pressure/tightness, occasionally overlapped features with migraine; analgesic abuse, psychological factors more likely |
| how does HA in brain tumor present? | 50%, usually tension-like, bifrontal but worse ipsilaterally, worse with Valsalva/cough/sneeze |
| describe etiology/ presentation of ITN | idiopathic intracranial HTN - women, obese, near daily HA, "graying out", diplopia, dizziness, increased in AM, papilledema |
| describe essential tremor | slow frequency physiologic tremor; can be genetic (Katherine Hepburn) |
| essential tremor tx | BB (unless pulm dz), primidone, tranq's (benzos) |
| which is more common: hemorrhagic or ischemic stroke? | ischemic: 80% |
| what are primary locations for hypertensive ICH? | thalamus, basal ganglia, pons, cerebellum |
| what are deficits for each hypertensive ICH location? | All include depressed LOC. thalamus/basal ganglia = contralateral motor/sensory, aphasia. cerebellum = ipsilateral ataxia. Pons = vertigo, diplopia, crossed signs. |
| what is presentation of subarachnoid hemorrhage? | severe HA, meningismus, depressed LOC |
| what is more common - upper or lower GI bleed? | upper |
| how do you differentiate acute and chronic diarrhea's? | acute < 6wks |
| how do fat, protein, and carb malabsorption present, in terms of stools and physical presentation? | fat=steatorrhea, carb= bloating/soft diarrhea, protein = edema, muscle wasting |
| what are rome criteria for constipation? | at least 12 wks in the prior 12 mos, the following must happen at least 1/4 of time: straining, lumpy, incomplete evacuation, sense of obstruction, manual maneuvers, <3 defecations / week |
| what drug classes can cause constipation | CCB's, diuretics, anticholinergics, opioids |
| what defines an upper GI bleed? | above ligament of Treitz |
| what unusual blood lab can be used to check for bleeding? | BUN rise out of proportion to creatinine |
| #1 cause of upper GI bleed | PUD |
| #1 cause of lower GI bleed | diverticulitis |
| what test is extremely sensitive and can help localize lower GI bleeding? | tagged RBC scan |
| differentiate between acute, persistent, and chronic diarrhea | acute = <14d; persistent = 14-30 days; chronic = more than a month |
| what is mnemonic for bloody diarrhea? | MESSY CACA - medication, E coli, Salmonella, Shigella, yersinia, Campylo, Amoeba, C diff, Aeromonas |
| what org is associated with undercooked meat, unpasteurized juices? Cruise ships? Day care? Gay men? Seafood? Meat and dairy w rapid illness? | E coli; norovirus; rotavirus; Entamoeba histolytica; vibrio; S aureus |
| what org is associated with fried rice? | Bacillus |
| what food is associated with salmonella? | poultry, eggs, dairy, or fecal-oral |
| what complications are associated with salmonella? | osteomyelitis, endocarditis, arthritis |
| what population is shigella associated with? | day care, long-term care |
| what bug can mimic an appy, has long-term infection? | yersinia |
| what bug is associated with 10+ bloody BM's / day? (animals are reservoirs, much comes from chicken) | Campylobacter |
| which bug uses spore transmission | C diff |
| what is possible effect of abx tx on salmonella or c diff? On E coli? | can prolong shedding; can worsen course of toxin |
| what are tx recommendations in salmonella | don't treat unless young, old, or immunocompromised |
| define odynophagia; what is it significant for; what infections cause this? | painful swallowing; often reflects erosive dz; CMV, herpes, candida, HIV |
| what is one dz that can cause impaired peristalsis? | Reynaud's |
| what is significance of heartburn onset after age 50? | warrants further investigation (younger doesn't) |
| what is ambulatory pH used for measuring? | Frequency/duration of acid contact, Correlation of acid contact with symptoms. Indications: Refractory symptoms and normal EGD, Atypical Symptoms, Failure to respond to pharmacologic therapy, Patients considered for antireflux surgery |
| what is barrett's esophagus? what is its significance? | change from squamous to columnar epithelium; 30x increased risk of adenocarcinoma of esophagus |
| what % of pop has GERD? what % of them have Barrett's? What % of them develop CA? | 7%; 10-20%; up to 2% |
| what is significant about a positive HGD (hi-grade dysplasia) biopsy of Barrett's? | +40-75% CA risk |
| what is best way to dx gastritis | biopsy NOT endoscopy |
| what are mechanisms (causes) for gastritis | stress, drugs (etoh, nsaids), trauma (ET tubes), vascular (ischemia), reflux injury, H pylori |
| is H pylori more prevalent in whites or blacks? | blacks |
| what is best test for H pylori? | urease breath test |
| what can cause false negative on H pylori testing? | PPI, abx, or bismuth use (will not affect serology or histology) |
| what is tx for H pylori? | ppi, clarith, amox (or flagyl) |
| what needs to be done following eradication? | confirmation test (20% require retreatment) |
| what is h pylori associated with? | GU, DU, gastric adenocarcinoma, MALT lymphoma |
| how do you easily differentiate GU from DU? | food makes PU worse, DU better |
| what is most discriminating symptom for PUD? | pain that wakes pt up at night (more often in DU pts) |
| what are complications of PUD? Most common? | hemorrhage, perforation, gastric outlet obstruction; hemorrhage |
| what is a significant risk of long-term PPI use? | increased risk of hip fx |
| who is at risk for NSAID complications? | prior GI event, age, concomitant NSAID/corticosteroid/anticoag use, chronic dz |
| what unusual med is used for preventing NSAID complications? Precautions with use? | misoprostol; causes abd discomfort/diarrhea, not for fertile women |
Created by:
mrwillia