USMLE Step 3 pt. 2 Question and Answer

what is the best initial thing to do in a patient with a hyperosmolar hyperglycemic state - aggressive volume resuscitation - they are generally severely volume depleted then IV insulin *avoid management of hyperkalemia because these guys usually have a total body potassium deficit what can occur in patients with poorly controlled diabetes - hyperosmolar hyperglycemic state (HHS) or DKA describe Hyperosmolar hyperglycemic state (HHS) - -likely in DM T2 -negative serum ketones (which confirms its not DKA) -bicarb is almost normal -dehydrated because osmotic diuresis caused by hyperglycemia -maybe showing mild acute renal failure -increased serum osmolality = neurologic symptoms -hyperkalemic due to relative insulin insufficiency and hyperosmolality - in spite of an overall body potassium deficit caused by increase urinnary excretion what are the clinical features of compartment syndrome - -pain out of proportion to injury -pain increased on passive stretch -rapid tense swelling -paresthesia (early) - "ant crawling or burning sensation" how is compartment syndrome diagnosed - measurement of tissue pressures - CP > 30 mmHg or delta pressure (diastolic pressure - compartment pressure) < 20-30 mmHg = significant CS what is saw palmetto commonly used for - tx of BPH not efficacious what is garlic often used for - hypercholesterolemia not efficacious what is St. John's wort used for - tx of depression not efficacious what is glucosamine and chondroitin used for - osteoarthritis not efficacious what is kava kava - herbal prep may help with anxiety and insomnia - potential risk of severe liver toxicity what is a side effect of saw palmetto - increased bleeding risk what is a side effect of black cohosh - -hepatic injury -increased bleeding (anti-platelet properties) what is black cohosh - post menopausal sx - doesn't work what are the side effects of St. John's wort - -drug interactions - antidepressants (serotonin syndrome), Ohs, anticoagulants (decreased INR), dig -hypertensive crisis