IM endo

Card Set Information

Author:
TerryZ
ID:
247507
Filename:
IM endo
Updated:
2013-11-29 08:31:32
Tags:
internal medicine IM endocrine endo
Folders:
IM
Description:
Internal medicine - endocrine
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  1. HThy - S/Sx
    • Nerv, insomn, irrit
    • Hand tremor, HActiv, tremulousness
    • palpitations
    • muscle weakness
    • Thy gland: ^, bruit, tender, bumpy, irreg
    • Eyes: proptosis, lid lag
    • CV: arrythm, /BP
    • Skin: warm, moist, pretibial myxedema
    • Neuro: brisk DTR, tremor
  2. HoThy - S/Sx
    • Sx: fatique, weak, leth, heavy menstr, wt (10-30)~obese, cold intol, constip, ment, arthralg, depress, hear, hoarse
    • Gen: h/o URI + fever
    • Skin: dry, coarse hair, puffy, -lat brows
    • CV: bradyc, non-pit edema, carpal tunnel, slow relax DTRs
    • Thy: goiter
  3. Lipids - RF
    smoke, HTN, vHDL, FHx early CHD, 45M/55F, Sx-atic carotid a. dz, PAD, AAA
  4. Lipids - goals
    • CHD/eq: LDL<100, ~HDL<130
    • 2+ RFs:  LDL<130, ~HDL<160
    • 0-1 RF:   LDL<160, ~HDL<190
  5. Lipids - therapy selection
    •                            Lifestyle    Drugs 
    • CHD(eq)                LDL>100  LDL>130
    • 2+RFs 10y:10-20% LDL>130  LDL>130
    •           10y<10%                  LDL>160
    • 0-1 RF                  LDL>160  LDL>190
  6. LDL & non-HDL goals
    non-HDL = LDL + 30
  7. Lipid goal hierarchy
    • 1: LDL (unless TG>500 -> pancreatitis)
    • 2: TG < 200
    • 3: HDL > 40
  8. Lipids - meds
    • .                   LDL   TG   HDL
    • Statins             -      -       -
    • Bile acid seq     -      o       +
    • Nicotinic aid      -      -       +
    • Fibric acids        -      -       +
  9. Lipids - statins
    • M: HMG Co A reductase inhibitors
    • X: lova,prava,simva,fluva,atorva,ceriva
    • S: myop, /liver enz
    • C: !A/C liver dz
    •     ?cyclo,macrolides,~fung,P450 inhib
  10. Lipids - bile acid sequestrants
    • X: choles-tyramine, -tipol, -evelam
    • S: GI distress, const, drug absorp
    • C: !dysbetalipoproteinemia, TG>400
  11. Lipids - nicotinic acid
    • X: crystal(IR), niaspan(XR), (SR), niacin
    • S: flush(w/ASA),HGly,Gout,UGI,hepatox
    • C: !C liver dz, //gout; ?DM, HUric, PUD
  12. Lipids - fibric acids
    • X: gemfibrozil, fenofibrate, clofibrate
    • S: dyspepsia, gallstones, myopathy
    • C: !//renal dz, //hepatic dz
  13. SIADH - facts
    • Def: //ADH(pit/ect)->/H20 & conc urine
    • Eff: HoNa, -/vol, HoNa, /ANP, ~RAAS
  14. SIADH - causes
    • Tumor: Neopl(LPPB),lymphom,leukem
    •            Ect ADH; SCC of lung
    • CNS d/o: stroke, head trauma, infect'n
    • Pulm d/o: pneumo, TB
    • Ventilator: PP
    • Med: vincr,ssri,cprop,oxy,morph,desmo
    • Post-op: <-anestheia, P
  15. SIADH - S/Sx
    • A HoNa: 2/2 brain swell (ICF vol,neuro)
    •    leth,somn,wk,\refl+extensor plantar;
    •    untreated -> seiz, coma, death
    • C HoNa: asympt,anorex,N/V,\CNS
  16. SIADH - Dx
    • Exclusion
    • HoNa, inapprop conc urine
    • U-Osm > S-Osm (U-Osm>100)
    • U-Na > 30 mEq/L
    • \S-uric acid; -\BUN, Cr
    • nml fn - thy, adren, renal, card, liver
    • ~signif HVol
  17. SIADH - Tx
    • Cause: correct underlying
    • Asymp: \H20; NS+loop diur (faster);
    •    LiCO3, demeclocycline (xADHr, SE!)
    • Symp: \H20; NS(HTonic sev);
    •    Too fast->demyel syndr(<.5mEq/L/h)
    • Emerg: seiz/coma,Na<120
    •    HTon 250mL 3%NaCl 1-2mg/kg/hr
    • Drugs: selectv arginine vasopres antag
    •    conivaptan, tolvaptan(mod-sev HoNa)

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