Precipitating factors in DKA:

5I

-Infection: UTI, Pneumonia
-Ischemia: MI, CVA
-Inflammation: pancreatitis
-Insulin: wrong insulin dose non-compliance
-Iatrogenic: surgery, drugs steroids, thiazides, antipsychotics, chemotherapy.
بعد د. محمد قاسم

#Endocrine

•Parameters indicate severe diabetic ketoacidosis:

-pH < 7
-Blood ketone > 6 mmol/L
-Bicarbonate < 5 mmol/L
-Anion gap >16 mmol/l
-Potassium < 3.5 mmol/L on admission
-Tachycardia or bradycardia
-Systolic blood pressure <90 mmHg
-Oxygen saturation <92% on air
-GCS < 12.

#Diabetes

.

Von Hippel-Lindau syndrome:


-Vascular tumors (hemangioblatoma orangiomatosis)
-Bilateral renal cell carcinoma
-Pheochromocytoma


Von HIPPEL-Lindau syndrome: Hemangioblastoma,Increa ed risk of renal cell carcinoma, Pheochromocytoma, Pancreatic lesions (cysts,cystadenomas, and neuroendocrine tumors), Eye Lesions (retinal angiomas or hemangioblastomas.

#Neurology

A Thrombophilia Screen comprises:

-Antithrombin (previously called Antithrombin III)
-Protein C
-Protein S
-Lupus Anticoagulant
-Factor V Leiden
-Prothrombin Gene Mutation
-anti-β-2-Glycoprotein-1 antibodies
-anti-Cardiolipin antibodies.

#Blood

Remember:

-Pheochromocytoma is associated with MEN 2, Neurofibromatosis, von Hippel-Lindau syndrome.

#Endocrine

•Why dexamethasone is used in suppression test? Why not other steroids like prednisolone?

-Because, dexamethasone does not cross react in radioimmunoassay for cortisol. But other steroids can cross react.

يعني ما تتأثر القراءة به.
#Endocrine

Remember:

-In pituitary tumor, there is high ACTH and high cortisol.

-In ectopic ACTH syndrome, there is high ACTH and high cortisol.

-In adrenal tumor, there is low or undetectable ACTH and high cortisol.

-Cushing’s disease and cortisol secreting adrenal tumor are 4 times common in women than men. But ectopic ACTH syndrome is more in men.

#Endocrine.

Remember:

-Amiodarone also has a cytotoxic effect on thyroid follicular cells and inhibits conversion of T4 to T3 (increasing the ratio of T4:T3).

-20% develop hypothyroidism or thyrotoxicosis!

#Endocrine

Remember:


-Worldwide, iodine deficiency is the most common cause of preventable impaired cognitive development in children.
#Endocrine

Remember:

-Iodine deficiency is not associated with an increased risk of Graves’ disease or thyroid cancer, but the high prevalence of nodular autonomy does result in an increased risk of thyrotoxicosis and this risk may be further increased by iodine supplementation.

Antihypertensives with co-morbidity.

#Cardiology

-Drug of choice for pt suffering of gout and hypertension is Losartan.

Because it increase the excretion of uric acid by kidney.

-Drug of choice for pt suffering of gout and hyperlipidemia is fenofibrate.

Uricosuric action increase renal excretion uric acid.

#Cardiology

In pregnancy:

-Labetalol is now considered the first line.

Nifedipine is 2nd line.

Methyl dopa is 3rd line (كان الأول زمان).

HTN due to Pheochromocytoma:

-Labetalol.

Asthma with HTN:

Consider CCB.

HTN in asthmatic patient.

Most common metastasis to the heart is malignant melanoma.

#Cardiology

Causes of carpal tunnel syndrome: (ARM PIT).

1- Amyloidosis, Acromegaly.
2- Rheumatoid arthritis and other wrist arthritis.
3- Myxedema (hypothyroidism), multiple myeloma.
4- Pregnancy.
5- Idiopathic ( most common ) .
6- Trauma ( fracture ) , DM .

#Surgery