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Endocrine & MSK — USMLE Step 2 CK Notes

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Lambert Eaton Syndrome

Less likely to have ocular (ptosis) and bulbar (dysphagia, dysarthria) sx (cf MG) AP amplitude improves w rep nerve stimulation Have diminished/absent DTRs (cf MG) w AN dysfunction: constipation; dry mucosa etc

MC in legs; Pts must have chest CT d/t strong association with SC lung cancer

SIADH

URINE concentration of >100 and low serum osmolality

Sodium excretion typically high (>40) as kidneys not retaining to bump up blood volume

Psychogenic polydipsia/beer potomania Urine osmolality LOW (<100) as pee out excess water with low serum osmolality

DKA

Most deaths in children d/t cerebral oedema

——> presents 4-12hrs after starting tx. (Headache)

Vomiting and abdo pain; mental state changes

Kussmaul resp (deep, rapid breathing)

Dehydration

GI Sx predominate

Sx d/t acidosis from ketone accumulation (d/t FA breakdown in liver)

Glucose 200-500

pH <7.3; AG >14

Serum/urine ketones

Best index to monitor response to tx: Serum AG, electrolytes, venous pH and serum glucose

Hyperosmolar Hyperglycaemic state

T2DM

Glucose >600

Norm AG, norm pH and bicarbonate

No ketones

Gradual hyperglycaemic sx eg polyuria

Altered mentation

Sx d/t osmolality!

Tx: Aggressive hydration with norm saline; IV Insulin

K if <5.3

Translocational hyponatraemia Hyperosmolar hyperglycaemic state

High serum osmolality which may manifest clinically as dehydration (d/t osmotic diuresis) and neuro dysfunc (lethargy; myoclonic jerks)

Hyperkalaemia present d/t solvent drag of IC K by fluid shifting into blood stream

Only 2 diseases involve DIP Joints —> OA and Psoriatic Arthritis (Overdose mnemonic)

Thyrotoxicosis with normal or increased RAIU: Graves; Toxic multinodular goiter; toxic nodule

Thyrotoxicosis with decreased RAIU: THYROIDITIS Release of Preformed Thyroid Hormone ——> decreased synthesis

Pheochromocytoma

Tumour of adrenal MEDULLA

Intermittent sweating; HA and palpitations +/- elevated glucose

MEN2, NF1 and VHL association Phenoxybenzamine then propanolol

RA has cervical spine involvement!

Euthyroid Sick syndrome

Low T3, normal T4 and TSH in setting of acute illness

D/t decreased conversion of T4 to T3

—-> acute illness: high cortisol, inflamm cytokines, starvation and medications (glucocorticoids)

Torn meniscus

Medial joint line tenderness with effusion

Pain when getting up from a low position

MCL tear

Medial joint line tenderness w/o effusion

ACL tear

Significant swelling and effusion

Quad tendon tear pulls patella DOWN. QeD!! Patellar tendon tear pulls patella UP

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