HY USMLE Q #503 – Endocrine — Transcript

Full transcript

1. 0:00how's it going guys it is 3 46 a.m
2. 0:02friday june 10 2022 here in japan and we
3. 0:04have a past little question for step one
4. 0:06and two uh this is going to be a very
5. 0:08short clip it's going to drive home an
6. 0:10important factoid that students [ __ ] up
7. 0:12quite frequently so before we start
8. 0:14please subscribe my channel i really
9. 0:15appreciate it good video like i really
10. 0:16appreciate it find me on instagram at
11. 0:18melbourne underscore medical i'm ehlman
12. 0:20underscore medical links down below find
13. 0:21me on telegram links to telegram group
14. 0:23and channel are down below and not start
15. 0:24the clip 54 old woman two week history
16. 0:26of increased thirst urination 12 pound
17. 0:28weight loss during this time she has
18. 0:29hypertension hypercholesterolemia bmi is
19. 0:3135. question wants to know what's most
20. 0:33likely to be seen in this patient so
21. 0:34diagnosis here is acute type 2 diabetes
22. 0:37mellitus overweight patient increased
23. 0:39thirst urination metabolic syndrome you
24. 0:41can get weight loss and acute type 2.
25. 0:42okay that might sound a little bit weird
26. 0:44because patients overweight but you can
27. 0:45get weight loss all right so
28. 0:47as i said this is going to be a very
29. 0:49short clip you need to know dka diabetic
30. 0:51ketoacidosis versus hhs hyperketotic
31. 0:55hyperosmolar syndrome okay so dka type 1
32. 1:00hhs type 2.
33. 1:02so the key here i'm just jumping right
34. 1:04out of the gates all right the key you
35. 1:06need to know
36. 1:07is that you only get ketones in type 1
37. 1:11diabetes you don't [ __ ] get ketones
38. 1:13in type 2 okay so a lot of students will
39. 1:16see a question like this they see the
40. 1:18the ketone area and they choose it it's
41. 1:19the wrong [ __ ] answer okay you're
42. 1:21only going to get this in type 1 in dka
43. 1:23you don't get ketones in type 2 and the
44. 1:25reason you don't get ketones and type 2
45. 1:27is because there is not an insulin
46. 1:29deficiency in type 2 diabetes oneness we
47. 1:31have insulin resistance now patients of
48. 1:34course can go on to ultimately get
49. 1:36pancreatic burnout insulin deficiency
50. 1:38but initially in type 2 we have high
51. 1:41insulin levels the answer here is
52. 1:42hyperinsulinemia we have insulin
53. 1:44resistance we have hypertrophy of the
54. 1:46beta islet cells and i've actually seen
55. 1:48that as a separate answer for an nvme
56. 1:50question we have hypertrophy of the beta
57. 1:52isos hyperinsulinemia
58. 1:54insulin inhibits ketone production
59. 1:57okay so insulin will stimulate fatty
60. 2:00acid synthesis
61. 2:01and we can get malonyl coa that shuts
62. 2:04off the carnitine shuttle which is
63. 2:06required for bringing fatty acids from
64. 2:08the cytosol into the mitochondria for
65. 2:10beta oxidation which will you're going
66. 2:13to be cleaving off acetyl coas which you
67. 2:15put two acetyl coa's together and you're
68. 2:17ultimately going to get your ketogenesis
69. 2:19okay so if we have insulin we can't get
70. 2:21ketogenesis that's why we have
71. 2:24fairly absent absent or minimal ketones
72. 2:27in hhs
73. 2:28okay so keonaria wrong answer it's
74. 2:30hyperinsulinemia so
75. 2:33let me just whip through the other ants
76. 2:34choices real quick you need to know that
77. 2:36in dka for type 1 you're going to have
78. 2:39decreased total body potassium total
79. 2:41body potassium can be decreased in hhs
80. 2:44as well or normal according to the
81. 2:46literature
82. 2:47serum ph is going to be under 7.30 in
83. 2:50dka normal range 7.35 to 45 but the
84. 2:53liter we're talking a literature
85. 2:55just low ph in dka hhs it can be normal
86. 2:59and serum glucose is often greater than
87. 3:02600 in hhs
88. 3:04it's often greater than 250 in dka don't
89. 3:07worry for us similarly i'm just whipping
90. 3:09through why the other answers are wrong
91. 3:11here and bicarbonate
92. 3:13usually under 18 in dka normal range 22
93. 3:16to 28 and it's greater than 18 in hhs so
94. 3:21look once again just recapitulating you
95. 3:24don't get [ __ ] ketones in type 2
96. 3:26diabetes among us
97. 3:27okay you get ketones only in type 1.
98. 3:30you know the deal to make more content
99. 3:32if you like my stuff subscribe my
100. 3:33channel i appreciate your time that's it