FIRST AID * from Q&A for the USMLE STEP 2 CKSelected High Yield conceptsEndocrinePOOR prognostic factor**Thyroid noduleHoarseness--< implies vocal cord impairment due to tumor involvement of recurrent laryngeal nerve malignant tumor that has etended !eyond thyroid gland and invaded local structuresSulfonylureas"in #$ type % &ly'ipide- &ly!uride ($O)* increase insulin secretion to normali'e glycemiaHYPOglycemia and +T gain )#,-RS- effect***History of total thyroidectomyhypothermia. $yedema coma and no hormonal replacement hyponatremia-hypoglycemia- mental status changes. o!esit-perior!ital edemaR/* 0lood thyroid function tests PR1OR to 2evothyroine T3 and T4 admon***PT +1TH HYP-RTHYRO1#1S$. (R1S5 of developing678 years old&1,- Propylthiouracil9 Other ris:s* ;)R#1); )rrythmyas- )trial fi!rillation!one density a!normalities in su!clinical hyeprthyroidism )9;9-***Hyper;)2;-$1) due to sarcoidosis* -2-,)T-# chronic cough-constiaption-hilar adenopathy -hypercalcemiaSarcodosis"hyeprcalcemia secondary to increased ephropathy ? #ia!etes $ellitusconvert )ngiotensin 1 to angiotensin 11 ??and slo@ nephropathy in #$ ?? );- constrict );-1s inhi!it );-. so )ngiotensin 11 is decreased A)ngiotensin 11-BB-R->T arteriole in glomeruli R0B and &BRC **#ilates So. );-1s R0B and &BR and reduces macro-proteinuria -BB-R->T arteriole***>S)1#sprerenal failure inhi!iting prostaglandings and R0B )ffect :idney go chronic go to intrarenal failureischemia. !ut if prolonged ischemia tu!ulointerstitial ? acute tu!ular necrosis>S)1#s inhi!it prostaglandins;O>STR1;TAprostaglandins dilates )BB-R->T arteriole R0B &BRC So >S)1#s )BB-R->T arteriole R0B &BR***&lycosylated H! $easured for glycemic@hen H! is eposed to much glucoseD a lot of glucose !ind toH! and control!ecause the lifetime of an R0; is S tumors --carcinomas9--H1&H R1S5 of acEuired treatment related )cute $yelogenous 2eu:emias At-)$2C follo@ing treatment @ith cytotoic drugs9 t)$2 is universally refractory to :no@n therapies9Musculoskeletal**Systemic sclerosis or2;SS and #;SS A#iffuse cutaneous systemic sclerosisC sclerodermaS@ollen cutaneous systemic sclerosis indurated fingers and hands***2;SS* 1f s:in findings limited to hands Alimited cutaneous systemic sclerosisC 2;SS opposed to #iffuse Systemic Sclerosis9 )ssociated to ;R-ST syndrome @ith nodules fingers pads- deposits of su!cutaneous fat. RaynaudIs phenomenon. episodic vasoconstriction of small arteries in the fingers causing pallor and cyanosisD-2-,)T-# )nti-centromere reflu. dysphagia. esophageal dysmotilityautoanti!odies**Scleroderma* pulmonary disease in K8L cases and is the leading cause of death**#;SS* #iffuse Systemic sclerosis* -2-,)T-# )nti-Scl-K89 S:ing findings are etended proimally past the @rists M symptoms of ;R-ST syndrome9-1>;R-)S-# R1S5 of* pulmonary fi!rosis Aleading cause of deathC**Patient @ith +olff Par:inson +hite syndrome M symptoms of #rug induced lupus#ue to Procainamide class 1) antiarrythmic used in +P+N syndrome to prevent atrial fi!rillation**Other drugs causing #rug induced S2-* Hydrala'ine. isoniacid. minocycline. PTG. lithium. car!ama'epine. and phenytoin**#uchenne muscular dystrophy #$#*-Present at !irth /-lin:ed Rec. does not !egin until age 4-= years9-;lues* maternal uncle99Resp failure died and normal female unaffected in the family-)ffect proimal musculature. difficulty clim!ing stairs-+ill roll to prone position and use their arms to clim! up their legs and then thigh muscles to rise to standing9-#evelop hyperlordosis and scoliosis !ecause @ea:ness of truncal muscles9due to chest deformities and muscle-1mpaired respiratory function @ea:ness. reEuire tracheostomy-;retine :inase elevated. primary muscular disorder Ano neurological disorderC-#eath* 4rd decade due to Resp9 failure or cardiomyopathy history of trauma follo@ed !y an**Rha!domyolysisetended period of inactivity or crushes inOuries and then a gross hematuria -(classic cause of rha!domyolysis-Grine AMC for !lood !y dipstic: !utsuggest myoglo!inA-C for R0;s !y micro eam-+idespread muscle cell damage leads to release of intracell components into systemic circulation9 )lso elevations of 5. uric acid. PO3. creatinine. 0G>. structural proteins as myoglo!in that accumulated in :idney lead to hemoglo!inuria and )cute Renal Bailure9**Polymyalgia rheumatica AP$RC* is associated or lin:ed to Temporal giant cell arteritis in pts ( =8. @ith su!acute or chronic onset of symmetrical pain and morning stiffness in large proimal Ooints including shoulders. hip girdle. and nec:9 Pt has trou!le getting dressed !ecause of stiffness9-Pain is due to Synovitis and !ursitis of Ooints9 +t loss and fatigue elevated -SR9-R/* Prednisone* R)P1# R-SPO>S- @ith prednisone confirm diagnosis even @ith lo@ dose steroid**Osteoarthritis pain* tend to @orsen through the day @ith increasing activity**1nflammatory pain* tend to @orsen in the morning after a period of inactivity and improve through the day @ith activity**Rheumatoid arthritis pain* morning stiffness. similar to P$R. !ut involves more Ooints. smaller Ooints. hands and feet9 R/* H1&H dose steroids- difficult to manage. other anti-rheumatic drugs**Scaphoid or navicular fracture* initialrays not al@ays detect the fracture. especially inany patient @ith suspected scaphoid non-displaced fractures9 )s &eneral RuleSplint immo!ili'ation fracture !ut A-C initial -ray should !e treated @itha PThum! Spica SplintH and re-evaluated in % @ee:s91n follo@ up visit* Repeat / ray to detect fracture of the proimal