Step I HTN question

[BrooklynDO]

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I ran into this question and was a bit stuped...
"youre treating a 25 your old male patient for htn for a while now, and he comes in so you order a lytes screen, checking for na, cl, k, mg, etc al"
which are you most concerned with?
no mention of specific meds, answer choices listed a-h various electrolytes

anyone?
😡

 

[annushka]

I ran into this question and was a bit stuped...
"youre treating a 25 your old male patient for htn for a while now, and he comes in so you order a lytes screen, checking for na, cl, k, mg, etc al"
which are you most concerned with?
no mention of specific meds, answer choices listed a-h various electrolytes

anyone?
😡

Interesting question. I'd be concerned about sodium probably. Na has the most effect on extracellular osmolarity and thus on pressure. Also you know his aldosterone is out of whack if his Na is going up. And aldosterone out of whack=uncontrolled HTN.

Now, how funny will it be if after this big huge explanation the correct answer is something else

 

[southerndoc]

Hyperaldosteronism rarely presents with hypernatremia. It usually presents with hypokalemia.

You must ask yourself, in this age group, what would you be concerned with... Pheo? RAS? Conn?

Ask yourself which is the most common for a 25-year-old male and how it would present.

I think I would want the potassium level. Hyperaldosteronism would give you low K, as can RAS.

 

[BrooklynDO]

and the potassiums have it!

my reasoning was a lot murkier than either of yours tho... it went something like :hmm sodium is the thing causeing the htn essentially, so thats what youre treating...now, most meds are dangerous with either K wasting, or Ca wasting/buildup. of the two I decided that problems with potassium were a lot more commonly seen.
but eh, tommorow i would have gotten it wrong

 

[BrooklynDO]

Your first afternoon appointment is a patient who had been initially diagnosed with depression but was recently documented to be in a full manic phase. This visit was scheduled to discuss the treatment options for the new diagnosis. You tell your patient that lithium is often used in treating patients with bipolar disorder, mania, and hypomania. Which of the following statements is true concerning lithium salts?

A. Lithium salts are effective in only a small percentage of patients and are rarely used.

B. Lithium's mode of action is clearly defined as a stabilization of the cellular membrane.

C. Lithium salts are nontoxic and very safe.

D. Lithium causes no noticeable effect on normal individuals.

E. Lithium is classified as a depressive agent.

answer supposedly D, however, im sure i heard something about DI, and hypothyroidism

 

[Resident Alien]

If we assume D is right, then I think the question-writers meant that Lithium does not have an affect on the mood of normal individuals.

 

[BrooklynDO]

If we assume D is right, then I think the question-writers meant that Lithium does not have an affect on the mood of normal individuals.

ofcourse, its just that being psychic wasnt in the entrance requirements for med school 🙄
I initially put down E as it was the only factoid that I wasnt completely sure about.

 

[Gauss]

potassium first
always
then sodium and calcium
hyperkalemia is an emergency
mg is an oddball, something to consider once everything else is ruled out


Lithium has no effect on the mood of someone who is not bipolar (manic or depressed) i.e. 'normal'
yes, eventually you'll see hypothyroidism, diabetes insipidus, weight gain with longterm use
nevertheless, lithium is a VERY good med for bipolar patients

 

[optiplex]

heads up on lithium...very low therapeutic window...if you get dehydrated...say you are bipolar decided to go for a run on a hot day, or say, if you are having diarrhea...losing a lot of fluid would increase Li concentration and give you kidney probelm. I think renal tox is one of the limiting factors for this med.

 

[Idiopathic]

You are always most concerned with K+, if asked.