Podcast
Questions and Answers
What is primarily elevated in ACTH independent Cushing’s syndrome?
What is primarily elevated in ACTH independent Cushing’s syndrome?
- Aldosterone
- CRH
- ACTH
- Cortisol (correct)
Which method provides the best indication of cortisol suppression in Cushing’s syndrome?
Which method provides the best indication of cortisol suppression in Cushing’s syndrome?
- Evening salivary cortisol test
- 1 mg dexamethasone suppression test (correct)
- 24 hour urine collection
- ACTH measurement
In Conn syndrome, which clinical presentation is commonly observed?
In Conn syndrome, which clinical presentation is commonly observed?
- Hypertension and hypokalemia (correct)
- Diabetes and hypernatremia
- Hypoglycemia and hyperkalemia
- Weight gain and hypercalcemia
What confirms the diagnosis of primary hyperaldosteronism?
What confirms the diagnosis of primary hyperaldosteronism?
Which test would not typically suppress aldosterone in the diagnosis of Conn syndrome?
Which test would not typically suppress aldosterone in the diagnosis of Conn syndrome?
What is a key feature of asthma in children?
What is a key feature of asthma in children?
Which of the following is NOT a component of asthma diagnosis?
Which of the following is NOT a component of asthma diagnosis?
What criteria can indicate the severity of asthma?
What criteria can indicate the severity of asthma?
Which medication should be initially included in an asthma management plan?
Which medication should be initially included in an asthma management plan?
What most likely triggers an exacerbation of COPD?
What most likely triggers an exacerbation of COPD?
How is a significant exacerbation of asthma typically managed in an emergency setting?
How is a significant exacerbation of asthma typically managed in an emergency setting?
In patients with COPD, which symptom is commonly observed?
In patients with COPD, which symptom is commonly observed?
Which medication is used to help prevent exacerbations in asthma patients at discharge?
Which medication is used to help prevent exacerbations in asthma patients at discharge?
What is a contraindication to thrombolysis in a STEMI?
What is a contraindication to thrombolysis in a STEMI?
Which of the following is NOT a sign of tissue hypoperfusion in shock?
Which of the following is NOT a sign of tissue hypoperfusion in shock?
In the management of an acute thrombotic stroke, what is the recommended daily medication after the initiation of thrombolytics?
In the management of an acute thrombotic stroke, what is the recommended daily medication after the initiation of thrombolytics?
What is the proper blood pressure reduction target for managing acute hemorrhagic stroke?
What is the proper blood pressure reduction target for managing acute hemorrhagic stroke?
Which type of shock is characterized by inadequate blood volume?
Which type of shock is characterized by inadequate blood volume?
What is the first-line treatment strategy for NSTEMI?
What is the first-line treatment strategy for NSTEMI?
Which pathogen is considered the most common cause of pneumonia?
Which pathogen is considered the most common cause of pneumonia?
What does a CURB65 score above 2 indicate in pneumonia management?
What does a CURB65 score above 2 indicate in pneumonia management?
In treating pneumonia in the ICU, which combination of antibiotics is typically used?
In treating pneumonia in the ICU, which combination of antibiotics is typically used?
Which chest X-ray finding is characteristic of congestive heart failure?
Which chest X-ray finding is characteristic of congestive heart failure?
Which of the following is NOT a typical indicator of delirium?
Which of the following is NOT a typical indicator of delirium?
Which medication is most commonly associated with causing delirium?
Which medication is most commonly associated with causing delirium?
What characterizes the physical examination of pneumonia according to the findings provided?
What characterizes the physical examination of pneumonia according to the findings provided?
What is a common sign on the chest X-ray associated with pleural effusion?
What is a common sign on the chest X-ray associated with pleural effusion?
What is the characteristic triad used for assessing cardiac tamponade?
What is the characteristic triad used for assessing cardiac tamponade?
What is the primary goal of using PPI in non-variceal bleeding management?
What is the primary goal of using PPI in non-variceal bleeding management?
Which statement about acute liver failure criteria is true?
Which statement about acute liver failure criteria is true?
In the management of alcoholic liver disease, which treatment is considered for moderate to severe alcoholic hepatitis?
In the management of alcoholic liver disease, which treatment is considered for moderate to severe alcoholic hepatitis?
Which test is considered the best positive predictor for diagnosing ascites?
Which test is considered the best positive predictor for diagnosing ascites?
What is a common complication of acute pancreatitis?
What is a common complication of acute pancreatitis?
Which management step is indicated for acetaminophen toxicity in acute liver failure?
Which management step is indicated for acetaminophen toxicity in acute liver failure?
Which of the following represents a criterion for King's Criteria concerning acute liver failure?
Which of the following represents a criterion for King's Criteria concerning acute liver failure?
What is the recommended initial treatment for a patient diagnosed with acute pancreatitis?
What is the recommended initial treatment for a patient diagnosed with acute pancreatitis?
What is the purpose of administering Octreotide in variceal bleeding?
What is the purpose of administering Octreotide in variceal bleeding?
Which diagnostic method is considered therapeutic for obstructive pancreatitis?
Which diagnostic method is considered therapeutic for obstructive pancreatitis?
Which dietary management is advised for hyperlipidemia?
Which dietary management is advised for hyperlipidemia?
Which laboratory finding is typically elevated in alcoholic liver disease?
Which laboratory finding is typically elevated in alcoholic liver disease?
Which of the following is used for the prophylaxis of infection in patients with variceal bleeding?
Which of the following is used for the prophylaxis of infection in patients with variceal bleeding?
What is the most sensitive clinical test for detecting ascites?
What is the most sensitive clinical test for detecting ascites?
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Study Notes
Obstructive Lung Disease
- Asthma: Characterized by chronic airway inflammation, primarily affecting children who often recover in adolescence but may relapse in adulthood.
- Diagnosis in Kids: Symptoms include cough, sputum, wheezing, and shortness of breath (SOB) in response to triggers. Requires evidence of reversible airflow obstruction.
- Reversible Airflow Obstruction: Assessed by a significant increase in PEFR or FEV1 post-bronchodilator or corticosteroid use, and via bronchoprovocation testing.
- Management: Focus on patient education, severity assessment, trigger avoidance, and a medication plan including short-acting β2 agonists (SABA) and inhaled corticosteroids (ICS).
- Exacerbations: Involve identifying and resolving triggers, use of SABA, oral steroids, and emergency interventions if necessary.
COPD (Chronic Obstructive Pulmonary Disease)
- Defined as a chronic, preventable, irreversible airflow limitation leading to persistent respiratory symptoms.
- Exhibits signs of hyperinflation and barrel chest, leading to diaphragm displacement and SOB.
- Symptoms include chronic bronchitis and an increase in exacerbations caused by infections and irritants.
Pneumonia
- Symptoms: Productive cough, high-grade fever, and SOB with chest X-ray showing infiltrates.
- Vital Signs: Febrile with tachycardia and tachypnea.
- Common Pathogens: S.pneumoniae, H.influenzae, C.pneumoniae, and atypical organisms.
- Assessment Tool: CURB65 criteria used for hospital admission decisions.
- Treatment Protocol: Varies from beta-lactam antibiotics combined with macrolides for non-ICU settings to beta-lactam with levofloxacin in ICU. Consider MRSA and Pseudomonas specifics for treatment.
Chest X-Ray Interpretation
- CHF (Congestive Heart Failure):
- Detects enlarged cardiac silhouette, vascular redistribution, and interstitial edema.
- Tamponade:
- Presents with Back's Triad: hypotension, elevated JVP, and diminished heart sounds.
- Pulsus paradoxus indicates drop in SBP during inspiration.
- Pleural Effusion and Pneumonia:
- Pleural edema observed as blunted costophrenic angles and pneumonia shows air bronchograms.
Geriatrics - Delirium
- Acute and potentially reversible cognitive disturbance often marked by inattention and fluctuating course.
- Differential Diagnosis includes dementia and depression, with dementia lacking fluctuation.
- Workup: Includes evaluating medications and possible triggers of delirium.
Non-Variceal and Variceal Bleeding
- Non-Variceal: Pantoloc for maintaining pH > 4; prevents clot degradation.
- Variceal: Octreotide reduces portal pressure. Endoscopic interventions and antibiotics are necessary.
Acute Liver Failure
- Criteria: Encephalopathy with impaired synthetic function (INR > 1.5).
- Management: Supports ABCs, prevents elevated ICP, and treats specific conditions (e.g., HSV infection, autoimmune hepatitis).
Alcoholic Liver Disease
- Diagnosis: Elevated AST:ALT ratios with AST dominance indicating alcoholic liver disease.
- Management includes abstinence, nutritional support, and monitoring for variceal bleeding.
Ascites Management
- Diagnosis through fluid wave test as the primary indicator.
- Management involves dietary restrictions, diuretics, and possible paracentesis.
Acute Pancreatitis
- Complications: Signs include necrotizing pancreatitis and possible respiratory failure.
- Management: Focuses on supportive care, fluid resuscitation, and addressing underlying causes.
Hyperlipidemia Management
- Screening begins at age 40, evaluating lipid profiles and other metabolic markers.
- Management focuses on lifestyle changes and statin therapy based on Framingham risk assessment.
Adrenal Hormone Overproduction
- Cushing’s syndrome: Diagnosed through screening for elevated cortisol.
- Conn syndrome: Characterized by hypertension and hypokalemia; diagnosed via plasma aldosterone/renin ratio.
Stroke Management
- Acute Thrombotic Stroke: Requires ABCs, thrombolytics, and careful BP management.
- Acute Hemorrhagic Stroke: Involves BP control and reversing anticoagulation.
Shock Definition and Classification
- Defined as inadequate blood flow leading to poor metabolic response in tissues.
- Classifications include:
- Hypovolemic: Low fluid volume.
- Cardiogenic: Heart function impairment.
- Obstructive: External obstruction to heart output.
- Distributive: Volume-related issues often due to vasodilation.
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