USMLE Internal Medicine Review 10 08 Findings – Cardiac, Cardio and Respiration

USMLE Internal Medicine Review 10 08 Findings – Cardiac, Cardio and Respiration

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Let’s start our USMLE Review with Hypothyroidism and Hyperthyroidism from the Gold Standard USMLE Foundations of Medicine Audio Review program.

 

Play USMLE Audio MP3 10 08 Findings – Cardiac, Cardio and Respiration Below

 

Begin 10 08 Findings – Cardiac, Cardio and Respiration Transcription

What is characteristic of the respirations of the adult hypothyroid patient?

  • The adult hypothyroid patient usually has shallow and slow respirations.

He or she will also have impaired ventilatory responses to which two pulmonary conditions?

  • Impaired ventilatory responses to hypercapnia and hypoxia.

What is hypercapnia?

  • Hypercapnia is abnormally increased arterial carbon dioxide tension.

And what is hypoxia?

  • Hypoxia is decreased levels of oxygen in inspired gases, arterial blood or tissue, but not to the point of anoxia.

Student doctor please pause the tape and summarize for pulmonary problems with adult hypothyroidism.

  • The adult hypothyroid patient usually has shallow and slow respirations and impaired ventilatory responses to hypercapnia and hypoxia. Hypercapnia is abnormally increased arterial carbon dioxide tension. And, hypoxia is decreased levels of oxygen in inspired gases, arterial blood or tissue, but not to the point of anoxia.

Intestinal peristalsis is markedly slowed in the adult hypothyroid patient resulting in which gastrointestinal complaint? Chronic constipation and occasionally severe fecal impaction or ileus.

Renal function is also impaired in adult hypothyroidism with decreased glomerular filtration rate and impaired ability to perform what simple function?

  • Impaired ability to excrete a water load.

This inability to excrete water properly predisposes the myxedematous patient to what condition, if excessive free water is administered?

  • Water intoxication.

Student doctor please pause the tape and summarize for intestinal peristalsis and renal function in the adult hypothyroid patient.

  • Intestinal peristalsis is markedly slowed in the adult hypothyroid patient resulting in chronic constipation and occasionally severe fecal impaction or ileus. Renal function is also impaired in adult hypothyroidism with decreased glomerular filtration rate and impaired ability to excrete a water load. This inability to excrete water properly predisposes the myxedematous patient to water intoxication if excessive free water is administered.

Anemia may also be a complication for hypothyroid patients. We’ll name four mechanisms which may contribute to anemia in this setting.

First, impaired hemoglobin synthesis as a result of what L-isomer deficiency?

  • Anemia in hypothyroid patients may be due to impaired hemoglobin synthesis resulting from Thyroxine or T4 deficiency.

Second, iron deficiency from which two causes? Just list them please.

  • Iron loss from menorrhagia or from impaired intestinal absorption of iron.

Third, folate deficiency from which cause?

  • Folate deficiency from impaired intestinal absorption of folic acid.

And fourth, pernicious anemia in the hypothyroid patient, especially which variety?

  • Vitamin B12 deficient megaloblastic anemia.

What type of cell is a megaloblast? Please pause the tape for this.

  • A megaloblast is a large nucleated embryonic type of cell which is a precursor of erythrocytes in an abnormal erythropoietic process seen in pernicious anemia.

Student doctor please pause the tape and summarize four mechanisms which may contribute to anemia as a complication with adult hypothyroidism.

  • Mechanisms contributing to anemia as often experienced by the hypothyroid patient include impaired hemoglobin synthesis resulting from Thyroxine  T4 deficiency, iron deficiency from menorrhagia or impaired iron absorption in the intestines, folate deficiency from impaired intestinal absorption of folic acid, and pernicious anemia of a vitamin B12 deficient megaloblastic variety.

****END OF TRANSCRIPTION****

 

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