IM 2

jmanderson's version from 2016-08-21 20:22



Question Answer
Dx pt w/ HTN, severe HA, sweat, palpitations, hyperglycemia, hyperlipidemiapheo
definitive dx test for pheo24 hr urine metenephrine
tx of choice for pheosurg resection
pheo’s are 10% what (7 things)extra-adrenal, malignant, mult, asx, familial, bilat, kids


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dx secondary HTN w/ hypoK, mm weakness, polyuria, polydipsiaprimary hyperaldosteronism
dx secondary HTN w/ elevated cortisol, hypoK, moon facies, central obesity, buffalo humpcushing’s
what rx can tx cushingsketoconazole


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what stage of HTN 120-139/80-89preHTN
what stage of HTN 140-159/90-99stage 1 (tx if >140/90)
what stage of HTN >160/100stage 2
diff btw HTN emergency v. urgencyboth >180/120, but emergency has END ORGAN DAMAGE


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1st line Rx for HTNthiazides (HCTZ)
when not to use HCTZrenal impairment
what population is ACEI/ARB contraindicatedpregnancy
what diuretic is best for asx ventricular dysfxn and sx heart failure (decreases CV mortality)ACEIs
big AEs of ACEIshyperK, renal insuff, angioedema, cough (bradykinin), hypotension
DOC HTN emergencynitroprusside
AE of nitroprusside long dose >24-48 hrscyanide toxicity
anti-HTN Rx for HTN urgency or dark-skinned folkCCBs
Preferred Rx for gestational HTNmethyldopa, labetalol, nifedipine, delivery
African American HTN Rxthiazides, CCB
CKD or proteinuria HTN RxACEI/ARB
1st line tx for pts in stage 1 HTNlifestyle modif (DASH, exercise, low Na, lose weight)



Question Answer
2 Q for depression screenover past 2 wk have you had little pleasure in doing things? been feeling down, depressed, hopeless?
ddx of major depressionmajor dep. disorder (2 wk), dysthymia (2 y), situational reaction, bipolar, seasonal affective disorder, PMS,, grief rxn, dementia, generalized anxiety, hypothyroid, meds, DB, OSA, CHF, Addison’s, drugs, fibromyalgia
major dep. disorder length for dxSIGECAPS qd for at least 2 wk
dysthymia length for dxSIGECAPS at least half the time for at least 2 yr
what conditions can come w/ depressionpanic, anxiety, PTSD, OCD
mood disorders often seen w/ what? so do what screen?substance abuse, CAGE screen
initial tx for depressioncounseling + SSRI
takes how long for SSRI to kick in for mood4-6 wks
AEs of SSRIsanticholinergic, suicidal ideation


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major barrier to depression txd/c of Rx due to bad AEs (50% of pts)
asses risk for suicide (risk/protective factors)suicidal thought/intent/plan, tx ideation w/ tx and monitoring, tx plans w/ psych referral
when to consult psychiatrist for depressionlittle/no improvement w/ tx (2+ meds fail), suicidal ideation, manic/psychotic
follow-up for major depression w/ suicidal featuressee pts 2 and 4 wk after therapy to assess drug adherence, AEs of Rx, and suicide risk
Labs of hypothyroidismhigh TSH (>10 microU/mL), low free T4
pt w/ afib, PVC, tachy, check what lab?TSH/T4
MCC hyperthyroid and most specific labs?Graves, low TSH / high T4, anti-TSH receptor
dx – proptosis of eyes, eye palsy, pretibial myxedema, low appetite, wt gain, sweat, tachy, HTN, tremor, inc DTRs, diarrhea, heat intoleranceGrave’s (hyperT4)
lab diff b/w hyperthyroid and thyrotoxicosisradioactive iodine uptake (high in hyperT4, nl/low in thyroiditis)



Question Answer
4 cut off labs that can dx DBrandom BG >200, fasting BG >126, H1c >6.5, OGTT >200
rapid acting insulin names, onset, peak, durationlispro, aspart, alulisine, onset 12 min, peak 1.5 hr, duration 4 hr
short acting insulin names, onset, peak, durationregular insulin, onset 0.5 hr, peak 3 hr, duration 6 hr
intermediate acting insulin names, onset, peak, durationNPH, onset 2 hr, peak 7 hr, duration 15 hr
long acting insulin names, onset, peak, durationglargine, detemir, onset 2 hr, no peak, duration 24 hr
DB pt goal LDL<100 (tx w/ statin, DB is CHD risk equivalent)
what to labs to screen DB pts for macrovasc. complicationsBP and chol
what dx? impaired fasting glucose or OGTT 100-126, assoc. w/ insulin resistance and CAD, pre-DBglucose intolerance
what dx? high BP + high serum glucose + excess body fat around waits + HLDmetabolic syndrome (inc. risk of DB, CHD, CVA)
what life threatening compl.? usually DM2, BG >600, pH>7.3, HCO3 >15, osm >320, (-) serum ketoneshyperglycemic hyperosmolar syndrome
what life threatening compl.? usually DB1, inc. anion gap metabolic acidosis, polyuria, polydipsia, blurry vision, N/V, abd pain, (+) serum ketonesDKA


Question Answer
DOC DM2 w/ H1C btw 7-10metformin (biguanide)
metformin CI in whoCHF (reduces EF)
metformin AEsno hypoglycemia, change in wt, GI sx, exacerbates CHF, lactic acidosis
DM Rx that activates PPAR-gamma in fat/mm to inc. insulin sensitivitythiazolinediones (pioGLITAZONE, rosiGLITAZONE)
glitazone AEsno hypoglycemia, edema, CHF risk, wt gain, MI/CVD risk, hepatotoxic (monitor LFTs)
glitazone CI in whoCHF class 3 or 4
what to monitor w/ glitzones LFTs (hepatotoxic)
DM Rx that is GLP-1 analog (inc. insulin sec, dec. glucagon, delay gastric empty)exenatide, pramlintide
exentide, pramlintide AEsN/V, pancreatitis, no hypoglycemia, wt loss
DM Rx that dec. carb absorption from gut, (AE – GI upset)acarbose
DM Rx that is DPP-4 inhibitor (inhibit GLP-1 and GIP decredation to inc. insulin secretion)sitaGLIPTIN, saxaGLIPTIN
Gliptin (DPP-4 inh.) AEsurticarial/angioedema
DM pts in hosp need glucose btw what?140-180 (if too aggressive, inc. hypoglycemia mortality)
What 2 preventive vaccines to DB pts needpneumococcal and influenza
DM ptt w/ microalbuminuria, must start what Rx to protect kidneysACEI/ARB
Mgmt of CAD risk in DM ptsdaily ASA, sotp smoking, BP <130/80, LDL<100
DKA mgmt.replace K+, IV 0.9% saline with regular IV insulin until glucose is 250 mg/dL, then can switch to 0.45% saline with 5% dextrose to avoid hypoglycemia
HHS mgmt.replace K+, correction of hypovolemia with 0.9% saline (a total of 1 unit) before insulin; half of fluid deficit should be replaced in first day with remaining replaced in the next 2-3 days