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First Aid for the USMLE Step 2 CK (8th Ed.) | Medicine (MD/DO) School Study Aid
Pheochromocytoma
- Cause/Mechanism
- Adrenal Medulla Tumor
- Increased Catecholamines
- Assessment
- Episodic Hypertension
- Diaphoresis
- Abdominal or Chest Pain
- Interventions
- Surgery
- Antihypertensives
- Phenoxybenzamine
- Metyrosine (Demser)
- Considerations
- Do Not Palpate Abdomen
3 mins
Insulin
- Rapid Acting
- Insulin Lispro (Humalog)
- Insulin Aspart (Novolog)
- Insulin Glulisine (Apidra)
- Short Acting
- Regular Insulin (Humulin R)
- Intermediate Acting
- Isophane NPH (Humulin N)
- Long Acting
- Detemir (Levemir)
- Glargine (Lantus)
2 mins
Diabetic Ketoacidosis (DKA) Signs and Symptoms
- Kussmaul respirations
- Dehydration
- Abdominal Pain
- Nausea/vomiting
- Psychosis
- Fruity breath Odor
1 min
Diabetic Ketoacidosis (DKA) Treatment
- Initial Management
- IV Normal Saline
- Regular Insulin Drip
- Subsequent Management (correction of electrolytes)
- Potassium (K+)
- Glucose
- Treat Underlying Cause
- Monitoring
- Venous pH
- Serum Bicarbonate (HCO3)
1 min
Diabetic Ketoacidosis (DKA) Diagnosis and Labs
- Diagnosis
- Blood glucose Increased > 250 mg/dL
- Anion gap metabolic acidosis
- Decreased pH < 7.3
- Decreased serum bicarbonate < 18
- Plasma ketones
- Other Labs
- Hyperkalemia
1 min
Acarbose (Precose) and Miglitol (Glyset) (Alpha Glucosidase Inhibitors)
- Mechanisms
- Alpha Glucosidase Inhibitors
- Delays Absorption of Carbohydrates
- Indications
- Type 2 Diabetes
- Side Effects
- Flatulence
- Diarrhea
- Anemia
- Cramps
- Considerations
- Monitor LFTs
- Oral Glucose for Hypoglycemia
2 mins
Exenatide (Byetta)
- Mechanism
- Incretin Mimetic
- GLP-1 Synthetic Analog
- Indications
- Type 2 Diabetes
- Side Effects
- Hypoglycemia
- Nausea and Vomiting
- Diarrhea
- Thyroid Cancer
- Pancreatitis
- Renal Failure
- Considerations
- (Give Exenatide) One Hour After Other Medications
- Adjunct Therapy
3 mins
Glyburide and Glipizide (2nd Generation Sulfonylureas)
- Mechanisms
- 2nd Generation Sulfonylureas
- Blocks Potassium Channels in Beta Cells
- Stimulate Release of Insulin
- Indications
- Type 2 Diabetes
- Side Effects
- Hypoglycemia
- Considerations
- More Potent
- Beta Blockers Reduce Effects
- Avoid Alcohol
- Avoid Breastfeeding
2 mins
Metformin
- Indications
- Diabetes Mellitus Type 2
- Polycystic Ovary Syndrome (PCOS)
- Mechanism of Action
- Decreased Gluconeogenesis
- Increased Insulin Sensitivity
- Side Effects
- Lactic Acidosis
- GI Distress
- Weight Loss
- B12 Deficiency
- Contraindication
- GFR < 30 ml/min
2 mins
Pioglitazone (Thiazolidinediones)
- -glitazones Suffix
- Mechanism
- Binds PPAR-Gamma
- Decreases Insulin Resistance
- Indications
- Type 2 Diabetes
- Side Effects
- Weight Gain
- Heart Failure
- Myalgia
- Hypoglycemia
- Upper Respiratory Infection
- Considerations
- Increased Risk of Bladder Cancer
- Increased Fracture Risk in Women
- Monitor Liver Enzymes
2 mins
Sitagliptin (Januvia) and Saxagliptin (Onglyza) (DPP-4 Inhibitors)
- -gliptin Suffix
- Mechanisms
- DPP-4 Inhibitor
- Increases Insulin Release
- Indications
- Type 2 Diabetes
- Side Effects
- Pancreatitis
- Upper Respiratory Infection and Inflammation
- Stevens-Johnson Syndrome
- Considerations
- Used as Add-on Agents
2 mins
Sulfonamides Mechanisms
- Bacteriostatic
- Gram-Positive
- Gram-Negative
- Nocardia
- Chlamydia
- PABA antimetabolites
- Inhibit dihydropteroate synthase
- Sulfamethoxazole
- Sulfisoxazole
- Sulfadiazine
1 min
Sulfonamides Side Effects
- Side Effects
- Hypersensitivity
- Nephrotoxicity
- Photosensitivity
- Kernicterus in Infants
- Displaces Warfarin from Albumin
- Considerations
- Hemolysis with G6PD Deficiency
3 mins
Graves' Disease Characteristics
- Women 20-40 years old
- Pathophysiology
- Anti-TSH Receptor Antibodies
- Symptoms
- Ophthalmopathy
- Exophthalmos
- Hyperthyroidism
- Goiter
- Pretibial Myxedema
1 min
Graves' Disease Labs and Treatment
- Labs
- Decreased TSH
- Increased T3
- Increased T4
- Radioactive Iodine Uptake (RAIU)
- Treatment
- Beta blocker
- Methimazole
- Radioiodine Ablation
1 min
Hyperthyroidism Assessment
- Assessment
- Heat Intolerance
- Exophthalmos
- Warm, Moist Skin and Silky Hair
- Tremors
- Goiter
- Diarrhea
- Weight Loss
- Tachycardia
- Hypertension
- Amenorrhea
- Diagnosis
- Decreased TSH with Elevated Free T4
- Radioactive Iodine Uptake (RAIU)
2 mins
Hyperthyroidism Interventions
- Drug Therapy
- Propylthiouracil (PTU)
- Methimazole (Tapazole)
- Iodine
- Beta Blockers
- Other Therapies
- Radioiodine Ablation
- Thyroidectomy
- Complications
- Thyrotoxicosis
- Post-Surgery Hypocalcemia
2 mins
Hypothyroidism Assessment
- Assessment
- Weight Gain - Edema
- Lethargy
- Cold Intolerance
- Bradycardia
- Hypertension
- Brittle Nails and Dry Skin
- Constipation
- Goiter
- Prolonged Menses
- Slowed Thinking
- Diagnostic Tests
- Decreased Free T4
- Increased TSH
2 mins
Hashimoto's Thyroiditis
- Symptoms
- Hypothyroidism with Bouts of Hyperthyroidism
- Enlarged, Nontender Thyroid
- Mechanism
- Autoimmune
- Anti-Thyroid Peroxidase (TPO)
- Anti-Thyroglobulin
- Lab Findings
- Hurthle Cells
- Lymphoid Follicles
- Associations
- HLA-DR5 and HLA-DR3
- Increased Risk Of Non-Hodgkin Lymphoma
2 mins
Osteoporosis Assessment
- Highest Risk
- Postmenopausal Women
- Long Term Corticosteroids
- Assessment
- Kyphosis
- Dowager's Hump
- Loss of Height
- Back Pain
- Pathologic Fractures
- Spinal Compression Fracture
1 min
Alendronate (Fosamax)
- Mechanism
- Inhibits Osteoclasts
- Indications
- Osteoporosis
- Paget's Disease
- Side Effects
- Esophageal Ulcers
- Musculoskeletal Pain
- Vision Changes
- Atrial Fibrillation
- Osteonecrosis of the Jaw
- Considerations
- Take on Empty Stomach
- Remain Upright
2 mins
Osteoporosis Interventions
- Increased Calcium Intake
- Vitamin D Supplements
- Bisphosphonates
- Raloxifene
- Denosumab
- Calcitonin
- Teriparatide
- Bone Densitometry (DEXA) Scan
- Weight Bearing Exercises
2 mins
Primary Hyperparathyroidism
- Assessment
- Hypercalcemia
- Kidney Stones
- Osteoporosis
- Arrhythmias
- Diagnostic Tests
- Increased Calcium and Decreased Phosphorus
- Considerations
- Prevent Injury
- Medication Education
- Surgery
1 min
Cushing's Syndrome Characteristics
- More Common in Women
- Exogenous Etiologies
- Glucocorticoids
- Endogenous Etiologies
- Decreased ACTH
- Primary Adrenal Disease
- Increased ACTH
- Pituitary Adenoma (Cushing's Disease)
- Paraneoplastic: Small Cell Carcinoma
- CRF-releasing Tumors
2 mins
Cushing's Syndrome Symptoms And Diagnosis
- Symptoms/Findings
- Osteoporosis
- Amenorrhea
- Truncal Obesity
- Skin Changes
- Buffalo Hump
- Immune Suppression
- Moon Facies
- Hypertension
- Decreased Insulin Sensitivity
- Diagnosis
- 24-hour urine free Cortisol
- Dexamethasone Suppression Test
2 mins
Acromegaly Assessment
- Mechanism
- Excess Growth Hormone (GH)
- Signs and Symptoms
- Protruding Jaw
- Large Lips and Nose
- Hearing Loss
- Enlargement of Hands and Feet
- Vision Changes and Headache
- Joint Pain
- Peripheral Neuropathy
- Hyperglycemia
2 mins
Prolactinoma
- Pituitary Adenoma
- Galactorrhea
- Prolactin Inhibits Gonadotropin Releasing Hormone
- Impotence
- Amenorrhea
- Bitemporal Hemianopsia
- Treat with Dopamine
2 mins
Adrenal Gland (Advanced)
- Characteristics
- Adrenal Cortex
- Zona Glomerulosa
- Aldosterone
- Zona Fasciculata
- Cortisol
- Zona Reticularis
- Androgens
- Adrenal Medulla
- Chromaffin Cells
- Epinephrine & Norepinephrine
2 mins
Syndrome Of Inappropriate Antidiuretic Hormone (SIADH)
- Pathophysiology
- Hypersecretion of ADH
- Increased Sensitivity to ADH
- Signs & Symptoms
- Serum Hypoosmolality
- Coma and Seizure
- Dilutional Hyponatremia
- Cramps and Tremors
- Euvolemia
- Change in LOC
2 mins
Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Nonpharmacologic Interventions
- Monitor Serum and Urine Osmolality
- IandOs with Daily Weights
- Restrict Fluid Intake
- Monitor Cardiovascular and Neurological Status
- Seizure Precautions
2 mins
Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Pharmacologic Interventions
- Diuretics
- Hypertonic IV Fluids
- Demeclocycline
- Tolvaptan and Conivaptan
1 min
Addison's Disease
- Mechanism
- Chronic 1° Adrenal Insufficiency
- Atrophy
- Destruction
- Symptoms
- Deficiency In Cortisol And Aldosterone
- Skin Hyperpigmentation
- Increased POMC
- Hypotension
- Hyperkalemia
- Acidosis
- Addisonian Crisis
- Diagnosis
- ACTH (Cosyntropin) Stimulation Test
- Treatment
- Exogenous Cortisol
2 mins
11 Beta-Hydroxylase Deficiency
- Pathophysiology
- Decreased Cortisol
- Decreased Aldosterone
- Increased Sex Hormones
- Increased 11 Deoxycorticosterone (11 DOC)
- Signs and Symptoms
- Hypertension
- Masculinization
1 min
17 Alpha Hydroxylase Deficiency
- Decreased Cortisol
- Decreased Sex Hormones
- Increased Mineralocorticoids (DOC)
- Hypertension
- Hypokalemia
- XY Externally Phenotypic Female
- No Internal Reproductive Structures Due to Mullerian Inhibitory Factor
- XX Externally Phenotypic Female
- Sexual Infantilism
2 mins
21 Hydroxylase Deficiency
- Pathophysiology
- Decreased Cortisol
- Increased 17 Hydroxyprogesterone
- Decreased Aldosterone
- Signs and Symptoms
- Hypotension
- Increased Renin
- Hyperkalemia
- Female Pseudohermaphroditism
2 mins
MEN 1 (Multiple Endocrine Neoplasia)
- Pathophysiology
- Autosomal Dominant
- Menin Mutation (Tumor Suppression Gene)
- Chromosome 11
- Signs and Symptoms
- Pancreatic Endocrine Tumors
- Pituitary Tumors
- Parathyroid Adenomas
2 mins
MEN 2A (Multiple Endocrine Neoplasia)
- Pathophysiology
- Autosomal Dominant
- RET Gene
- Signs and Symptoms
- Medullary Thyroid carcinoma
- Calcitonin
- Parathyroid
- Pheochromocytoma
45 secs
MEN 2B (Multiple Endocrine Neoplasia)
- Pathophysiology
- RET Gene
- Autosomal Dominant
- Signs and Symptoms
- Medullary Thyroid Carcinoma
- Pheochromocytoma
- Mucosal Neuromas
- Marfanoid Body Habitus
2 mins
Pseudohypoparathyroidism Type 1A
- Characteristics
- Defect in PTH Receptor
- Increased PTH
- Hypocalcemia and Hyperphosphatemia
- Autosomal Dominant
- Mutation in GNAS Gene
- Maternal Imprinting
- Clinical Features
- Short Stature
- Shortened 4th Fingers
- Developmental Delay
- Subcutaneous Calcifications
- Tetany
- Seizures
- Management
- Calcium and Vitamin D Supplementation
3 mins
Nephrogenic Diabetes Insipidus Characteristics and Presentation
- Characteristics
- Defect in ADH Receptor
- Normal or Increased ADH Levels
- Decreased Urine Osmolality
- Etiologies
- Kidney Disease
- Drugs
- Lithium
- Electrolyte Disturbances
- Clinical Features
- Polyuria and Polydipsia
- Nocturia
- Hypovolemia
2 mins
Primary Polydipsia
- Characteristics
- Increased Free Water Intake
- Psychiatric Diseases
- Diagnosis
- Hyponatremia
- Normal or Decreased Plasma Osmolality
- Decreased Urine Osmolality
- Water Deprivation Test
- Management
- Water Restriction
2 mins
Nephrogenic Diabetes Insipidus Diagnosis and Management
- Diagnosis
- Hypernatremia
- Normal or Increased Plasma Osmolality
- Decreased Urine Osmolality
- Water Deprivation Test
- Desmopressin Test
- Management
- Stop Triggers
- Thiazide Diuretics
- Amiloride
- Indomethacin
3 mins
Secondary Hyperparathyroidism
- Characteristics
- Hypocalcemia or Hyperphosphatemia
- Increased Parathyroid Hormone (PTH)
- Increased Alkaline Phosphatase (ALK-P)
- Reactive Parathyroid Hyperplasia
- Etiologies
- Chronic Kidney Disease
- Vitamin D Deficiency
- Diagnosis
- Laboratory Tests
- Management
- Treat Underlying Disorder
- Phosphate Binders
- Vitamin D Supplements
2 mins
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