Podcast
Questions and Answers
What is an important factor that contributes to the high mortality rate associated with mesenteric ischemia?
What is an important factor that contributes to the high mortality rate associated with mesenteric ischemia?
What complication is indicated by a tensely distended abdomen in ICU patients?
What complication is indicated by a tensely distended abdomen in ICU patients?
Which of the following findings might suggest increased pressure in the mediastinum due to abdominal issues?
Which of the following findings might suggest increased pressure in the mediastinum due to abdominal issues?
What is the primary concern when considering decompression in cases of Abdominal Compartment Syndrome?
What is the primary concern when considering decompression in cases of Abdominal Compartment Syndrome?
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In a patient presenting with tachycardia, tachypnea, and a soaked bed, what is the most likely etiology after cranial surgery?
In a patient presenting with tachycardia, tachypnea, and a soaked bed, what is the most likely etiology after cranial surgery?
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What vital sign is indicative of potential shock in a 35-year-old female with a temperature of 103.1?
What vital sign is indicative of potential shock in a 35-year-old female with a temperature of 103.1?
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Sepsis often presents with which combination of acute changes?
Sepsis often presents with which combination of acute changes?
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What is the most common characteristic of Abdominal Compartment Syndrome?
What is the most common characteristic of Abdominal Compartment Syndrome?
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What could be a subtle indication on a CT scan suggestive of mesenteric ischemia?
What could be a subtle indication on a CT scan suggestive of mesenteric ischemia?
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What is one of the long-term risks in patients presenting with abdominal surgery-related complications?
What is one of the long-term risks in patients presenting with abdominal surgery-related complications?
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What are the classic symptoms associated with hyperglycemia in diabetes mellitus?
What are the classic symptoms associated with hyperglycemia in diabetes mellitus?
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In a patient presenting with myxedema coma, which of the following is a key presentation triad?
In a patient presenting with myxedema coma, which of the following is a key presentation triad?
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What characterizes an Addisonian crisis?
What characterizes an Addisonian crisis?
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Which disorder is characterized by excessive fluid intake leading to insufficient antidiuretic hormone?
Which disorder is characterized by excessive fluid intake leading to insufficient antidiuretic hormone?
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What is one of the common presentations of a pheochromocytoma?
What is one of the common presentations of a pheochromocytoma?
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What is the main concern in septic shock?
What is the main concern in septic shock?
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What is a common cause of upper gastrointestinal bleeding?
What is a common cause of upper gastrointestinal bleeding?
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Which condition would most likely lead to presenting with Coke-colored urine?
Which condition would most likely lead to presenting with Coke-colored urine?
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What is the primary treatment strategy for patients with rhabdomyolysis?
What is the primary treatment strategy for patients with rhabdomyolysis?
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Which of the following is NOT a complication of chronic hyperthyroidism?
Which of the following is NOT a complication of chronic hyperthyroidism?
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What is a primary symptom of Addisonian crisis?
What is a primary symptom of Addisonian crisis?
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What complication can arise from untreated hyperthyroidism during acute illness?
What complication can arise from untreated hyperthyroidism during acute illness?
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Which of the following is a notable laboratory finding in patients with diabetes insipidus?
Which of the following is a notable laboratory finding in patients with diabetes insipidus?
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What is the main therapeutic intervention for managing severe cases of rhabdomyolysis?
What is the main therapeutic intervention for managing severe cases of rhabdomyolysis?
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Which of the following conditions presents with elevated amylase and lipase levels?
Which of the following conditions presents with elevated amylase and lipase levels?
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What is a characteristic symptom of Cushing's syndrome?
What is a characteristic symptom of Cushing's syndrome?
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Which type of abdominal bleeding is typically characterized by melena?
Which type of abdominal bleeding is typically characterized by melena?
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What condition is indicated by referred pain to the left shoulder?
What condition is indicated by referred pain to the left shoulder?
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In cases of severe dehydration due to Addison's disease, which vital sign may be observed?
In cases of severe dehydration due to Addison's disease, which vital sign may be observed?
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Which disorder leads to hypernatremia as a result of hemoconcentration?
Which disorder leads to hypernatremia as a result of hemoconcentration?
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What vital sign is most concerning for hypoperfusion in a 35-year-old female with a high fever?
What vital sign is most concerning for hypoperfusion in a 35-year-old female with a high fever?
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Which of the following conditions is the MOST likely cause of the presenting symptoms in the 45-year-old female post-glioblastoma surgery?
Which of the following conditions is the MOST likely cause of the presenting symptoms in the 45-year-old female post-glioblastoma surgery?
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What aspect of mesenteric ischemia contributes to its 80% mortality rate?
What aspect of mesenteric ischemia contributes to its 80% mortality rate?
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What immediate risk is presented by the tense abdominal compartment syndrome?
What immediate risk is presented by the tense abdominal compartment syndrome?
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What laboratory finding is most likely to be present in patients suspected of sepsis?
What laboratory finding is most likely to be present in patients suspected of sepsis?
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Which symptom is commonly observed in patients experiencing abdominal compartment syndrome?
Which symptom is commonly observed in patients experiencing abdominal compartment syndrome?
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What significant risk does decompression pose in cases of abdominal compartment syndrome?
What significant risk does decompression pose in cases of abdominal compartment syndrome?
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What might vague CT findings in mesenteric ischemia indicate?
What might vague CT findings in mesenteric ischemia indicate?
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In an ICU patient with abdominal compartment syndrome, what occurs due to the abdomen compressing the mediastinum?
In an ICU patient with abdominal compartment syndrome, what occurs due to the abdomen compressing the mediastinum?
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What is NOT a typical presentation in a patient suffering from myxedema coma?
What is NOT a typical presentation in a patient suffering from myxedema coma?
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Study Notes
Diabetes Mellitus
- Impaired ability to synthesize glucose
- Glucose spills into urine
- Three P’s of hyperglycemia: Polyuria, Polydipsia, Polyphagia
- Prolonged hypoglycemia can cause neuronal damage
Thyroid Disorders
-
Myxedema Coma
- Low thyroid, results from chronic, untreated hypothyroidism
- Slowed metabolism
- Key presentation triad:
- Altered mental status, lethargy
- Thermoregulatory failure
- Precipitating event
-
Thyroid Storm
- Critical hyperthyroidism
- Known hyperthyroidism with acute changes
- New onset a-fib, new onset dilated cardiomyopathy, new onset psychosis w/ abnormal vitals
- Hyperthermia
- CONSIDER IN ANY SEPTIC-APPEARING PATIENT WITHOUT ANY FOCUS OF INFECTION!
Adrenal Disorders
-
Adrenal Insufficiency
-
Addison’s Disease
- Deficiency of steroid hormones, chronic disease
- Improper regulation of sodium, potassium, and water
-
Addisonian Crisis
- Sudden onset exacerbation of Addison’s symptoms
- Shock, AMS, hyperthermia, severe n/v leading to dehydration
- Can be caused by TBI in patients with no history of Addison’s
-
Addison’s Disease
-
Cushing’s Syndrome
- Too much cortisol production by adrenals
- Weight gain, depression, weakness, thin skin, bruising
- Does not present emergently
-
Pheochromocytoma
- Catecholamine secreting tumor
- May present in hypertensive crisis
- Manage acutely with antihypertensives
- Requires surgical removal of tumor
Pituitary Disorders
-
Diabetes Insipidus
- Insufficient antidiuretic hormone
- Neurogenic: pituitary disorder
- Nephrogenic: poor renal response to ADH
- Dipsogenic: excessive fluid intake
- Gestagenic: rare complication of pregnancy
- Huge amounts of dilute urine
- Hemoconcentration, hypernatremia
- Supportive care, treat primary cause
- Insufficient antidiuretic hormone
-
SIADH
- Too much antidiuretic hormone
- Production
- Secretion
- Dilutional lab value derangements
- Urine osmolality increases
- Hyponatremia
- Too much antidiuretic hormone
Anaphylaxis
-
CONSIDER ANAPHYLAXIS IN THE PRESENCE OF TWO OR MORE INVOLVED SYSTEMS, EVEN IN THE ABSENCE OF AIRWAY INVOLVEMENT OR HYPOTENSION.
- Respiratory
- Hypotension
- Skin Signs
- Gastrointestinal
-
PRIORITIZE EPINEPHRINE
- Underutilized
- Safe, effective
- Adult dose: 0.3mg IM vastus lateralis
- Pediatric dose: 0.01mg/kg IM vastus lateralis
- Deleterious cardiac effects are a myth
Sepsis
- “Life threatening organ dysfunction caused by a dysregulated host response to an infection.”
- Cytokine release
- Malperfusion
- Massive loss of vascular tone
-
Septic shock
- Increased capillary permeability
- Leading cause of mortality in infection
- Increased capillary permeability and vasodilation causes distributive shock
-
Sepsis Related Organ Failure Assessment Tool (qSOFA)
- GCS ≤ 12
- Systolic BP ≤ 100 mmHg
- RR ≥ 22 breaths/minute
-
qSOFA scores
- 2 or 3 points = increased risk of mortality
-
Other signs of sepsis
- GCS 0.3 mg/dL or 1.5x baseline
- Increased BUN
- Hyperkalemia
- Edema
Acute Renal Failure (ARF)
-
Types of ARF
-
Prerenal
- Pathology BEFORE the kidney
- Hypoperfusion of kidneys
-
Intrarenal
- Pathology WITHIN the kidney
- Intrinsic kidney disease
- Rhabdomyolysis
- Toxicity (ibuprofen overuse, etc.)
-
Postrenal
- Pathology AFTER the kidney
- Obstruction
-
Prerenal
Rhabdomyolysis
- Excessive muscle breakdown, causing myoglobinemia
- Crush injuries
- Extended down time post fall
- Exertional
- Presents with Coke-colored urine, extreme muscle pain, edema
- Elevated CK
- Mild: 1,000-5,000 u/L
- Moderate: 5,000-15,000 u/L
- Severe: >15,000 u/L
Rhabdomyolysis Treatment
- Fluid administration
- LR
- Titrate fluids to maintain 100mL/hour urine output
- Dialysis in severe cases
- Protect patient from nephrotoxins
Abdominal Pathology
-
GI Bleeding
-
Upper (UGIB)
- Presents with: hematemesis, melena
- Causes: Esophageal varices, excessive vomiting, peptic ulcer disease, Mallory-Wiess tear
-
Lower (LGIB)
- Presents with: hematochezia
- Causes: colitis, Crohn’s, diverticulitis, internal hemorrhoids
-
Upper (UGIB)
-
Treatment of GI Bleeding
- Blood transfusion
- Antibiotics
- Proton Pump Inhibitors
- TXA
- Octreotide
-
Esophageal Varices
- Results from late stages of portal hypertension
- Life threatening hemorrhage requires tamponade tube: Minnesota or Blakemore
-
Pancreatitis
- Presents with: epigastric pain, n/v, inflammatory ileus, elevated amylase (3x baseline) and lipase
-
Inflammatory
- Caused by: gallstones, chronic alcohol abuse, ERCP complications
-
Necrotizing
- Dysregulated caustic secretions
- MODS, SIRS
-
Disorders of the Spleen
- Presents with Kehr’s sign: referred pain to left shoulder
- Causes: splenomegaly, atrial fibrillation
-
Bowel Problems
- Ileus
-
Diverticulitis
- LUQ pain
- Usually constant and present for days
-
Colitis
- Bloody diarrhea, colicky abdominal pain
-
Crohn’s Disease
- Variable symptoms for years
- Fatigue
- Prolonged diarrhea with weight loss
-
Appendicitis
- Periumbilical pain that radiates to RUQ
- Rebound tenderness
- McBurney’s Point
- Surgery vs.antibiotics
-
Mesenteric Ischemia
- 80% mortality
- Vague signs and symptoms
- Subtle and vague CT findings
-
Abdominal Compartment Syndrome
- Primarily affects critical ICU patients
- Tensely distended abdomen
- Abdomen pushes on mediastinum compressing heart
- Causes increased PIP and MAP
- Compresses renal vasculature
- Decompression: huge risk v.benefit analysis
Questions:
- The patient is a 35-year-old female with no past medical or psychiatric history. Her husband called 911 after she pulled a hose into the house and began to spraying the walls screaming that the house was on fire. He is adamant that she is healthy but stated that she has been very tired for the past two weeks which is abnormal. Her vital signs are Pulse 130, RR 28, BP 86/42, SpO2 99%, Temp 103.1. You suspect: Thyroid Storm
- The patient is a 45-year-old female who is 3 weeks status post-surgery to remove a glioblastoma. She presents with tachypnea, tachycardia, and she is lying in a bed that is soaked with urine. The most likely etiology is: Diabetes Insipidus
Diabetes Mellitus
- Impaired ability to synthesize glucose
- Glucose spills into urine
- Three P’s of Hyperglycemia: Polyuria, Polydipsia, Polyphagia
- Prolonged hypoglycemia can cause neuronal damage
Thyroid Disorders
Myxedema Coma
- Low thyroid, results from chronic, untreated hypothyroidism
- Slowed metabolism
- Key presentation triad: Altered mental status, lethargy, Thermoregulatory failure
- Precipitating event
Thyroid Storm
- Critical hyperthyroidism
- Known hyperthyroidism with acute changes
- New onset a-fib
- New onset dilated cardiomyopathy
- New onset psychosis w/ abnormal vitals
- Hyperthermia
- Consider in any septic-appearing patient without any focus of infection!
Adrenal Disorders
Adrenal Insufficiency
-
Addison’s Disease
- Deficiency of steroid hormones, chronic disease
- Improper regulation of sodium, potassium, and water
-
Addisonian crisis
- Sudden onset exacerbation of Addison’s symptoms
- Shock, AMS, hyperthermia, severe n/v leading to dehydration
- Can be caused by TBI in patients with no history of Addison’s
Cushing’s Syndrome
- Too much cortisol production by adrenals
- Weight gain, depression, weakness, thin skin, bruising
- Does not present emergently
Pheochromocytoma
- Catecholamine secreting tumor
- May present in hypertensive crisis
- Manage acutely with antihypertensives
- Requires surgical removal of tumor
Pituitary Disorders
Diabetes Insipidus
- Insufficient antidiuretic hormone
- Neurogenic : pituitary disorder
- Nephrogenic : poor renal response to ADH
- Dipsogenic : excessive fluid intake
- Gestagenic : rare complication of pregnancy
- Huge amounts of dilute urine
- Hemoconcentration, hypernatremia
- Supportive care, treat primary cause
SIADH
- Too much antidiuretic hormone
- Production
- Secretion
- Dilutional lab value derangements
- Urine osmolality increases
- Hyponatremia
Anaphylaxis
- Consider anaphylaxis in the presence of two or more involved systems, even in the absence of airway involvement or hypotension.
- Respiratory
- Hypotension
- Skin signs
- Gastrointestinal
-
Prioritize epinephrine
- Underutilized
- Safe, effective
- Adult dose: 0.3mg IM vastus lateralis
- Pediatric dose: 0.01mg/kg IM vastus lateralis
- Deleterious cardiac effects are a myth
Sepsis
- “Life threatening organ dysfunction caused by a dysregulated host response to an infection.”
- Cytokine release
- Malperfusion
- Massive loss of vascular tone
-
Septic shock
- Increased capillary permeability
- Leading cause of mortality in infection
- Increased capillary permeability and vasodilation causes distributive shock
-
Sepsis Related Organ Failure Assessment Tool (qSOFA)
- GCS ≤ 12
- Systolic BP ≤ 100 mmHg
- RR ≥ 22
Acute Renal Failure (ARF)
-
Prerenal : pathology BEFORE the kidney
- Hypoperfusion of kidneys
-
Intrarenal : pathology WITHIN the kidney
- Intrinsic kidney disease
- Rhabdomyolysis
- Toxicity (ibuprofen overuse, etc.)
-
Postrenal : pathology AFTER the kidney
- Obstruction
Rhabdomyolysis
- Excessive muscle breakdown, causing myoglobinemia
- Crush injuries
- Extended down time post fall
- Exertional
- Presents with Coke-colored urine, extreme muscle pain, edema
- Elevated CK
- Mild: 1,000-5,000 u/L
- Moderate: 5,000-15,000 u/L
- Severe: >15,000 u/L
Rhabdomyolysis Treatment
- Fluid administration
- LR
- Titrate fluids to maintain 100mL/hour urine output
- Dialysis in severe cases
- Protect patient from nephrotoxins
Abdominal Pathology
GI Bleeding
-
Upper (UGIB)
- Presents with: hematemesis, melena
- Causes: Esophageal varices, excessive vomiting, peptic ulcer disease, Mallory-Wiess tear
-
Lower (LGIB)
- Presents with: hematochezia
- Causes: colitis, Crohn’s, diverticulitis, internal hemorrhoids
Treatment of GI Bleeding
- Blood transfusion
- Antibiotics
- Proton Pump Inhibitors
- TXA
- Octreotide
Esophageal Varices
- Results from late stages of portal hypertension
- Life threatening hemorrhage requires tamponade tube: Minnesota or Blakemore
Pancreatitis
- Presents with: epigastric pain, n/v, inflammatory ileus, elevated amylase (3x baseline) and lipase
-
Inflammatory
- Caused by: gallstones, chronic alcohol abuse, ERCP complications
-
Necrotizing
- Dysregulated caustic secretions
- MODS, SIRS
Disorders of the Spleen
- Presents with Kehr’s sign: referred pain to left shoulder
- Causes: splenomegaly, atrial fibrillation
Bowel Problems
- Ileus
-
Diverticulitis
- LUQ pain
- Usually constant and present for days
- Colitis : bloody diarrhea, colicky abdominal pain
-
Crohn’s Disease
- Variable symptoms for years
- Fatigue
- Prolonged diarrhea with weight loss
Appendicitis
- Periumbilical pain that radiates to RUQ
- Rebound tenderness
- McBurney’s Point
- Surgery vs.antibiotics
Mesenteric Ischemia
- 80% mortality
- Vague signs and symptoms
- Subtle and vague CT findings
Abdominal Compartment Syndrome
-
Primarily affects critical ICU patients
-
Tensely distended abdomen
-
Abdomen pushes on mediastinum compressing heart
-
Causes increased PIP and MAP
-
Compresses renal vasculature
-
Decompression: huge risk v.benefit analysis
-
Questions:*
-
The patient is a 35-year-old female with no past medical or psychiatric history. Her husband called 911 after she pulled a hose into the house and began to spray the walls screaming that the house was on fire. He is adamant that she is healthy but stated that she has been very tired for the past two weeks which is abnormal. Her vital signs are Pulse 130, RR 28, BP 86/42, SpO2 99%, Temp 103.1. You suspect:
- d. Thyroid Storm
-
The patient is a 45-year-old female who is 3 weeks status post-surgery to remove a glioblastoma. She presents with tachypnea, tachycardia, and she is lying in a bed that is soaked with urine. The most likely etiology is:
- c. Diabetes Insipidus
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Description
This quiz covers key concepts related to diabetes mellitus, thyroid disorders, and adrenal insufficiencies. It encompasses symptoms, physiological effects, and critical conditions such as myxedema coma and thyroid storm. Test your understanding of these important endocrine functions and pathologies.
