Sweet Ketone o' mine
What is the criteria in diagnosing diabetes? State any 2 out of 4 criteria
Diagnosis of Diabetes with any of :
Fasting glucose ≥ 7mmol/L (Prediabetes: 6.1-6.9)
HbA1c ≥ 6.5% (Prediabetes: 6.0-6.4%)
2h 75g OGTT ≥ 11.1 mmol/L (Impaired glucose tolerance: 7.8-11.0)
Random glucose ≥ 11.1 mmol/L
What is the first laboratory test to order when evaluating hyponatremia, and what does it differentiate?
→ Serum osmolality — distinguishes true hypotonic hyponatremia from pseudohyponatremia (e.g., hyperglycemia, hyperlipidemia, or mannitol use) .
According to CCS 2023, what drug or drugs have mortality benefit in HFrEF.
→ ARNI/ACEi/ARB (neurohormonal modulation), β-blocker (↓sympathetic tone), MRA (aldosterone blockade), SGLT2 inhibitor (↓HF hospitalization, improves diuresis and remodeling).
Name This Pattern
Microcytic anemia with ↓ serum iron, ↓ TIBC, ↑ ferritin.
→ Anemia of chronic disease (functional iron deficiency).
who opened the Chamber of Secrets?
Ginny Weasley
What is the diagnostic criteria for DKA
Arterial pH is ≤7.3
• bicarbonate ≤15 mmol/L
• anion gap is >12 mmol/L
• +Ketones (serum/urine)
Glucose is usually ≥14.0 mmol/L
A patient has Na 120, serum Osm 280, glucose 30 mmol/L.What is the cause of this hyponatremia?
→ Pseudohyponatremia secondary to hyperglycemia; osmotic shift of water from intracellular to extracellular space dilutes serum sodium.
Based on the CCS guidelines, which drug or drugs have mortality benefit in HFpEF
SGLT2 inhibitors (empagliflozin, dapagliflozin)
Trials: EMPEROR-Preserved and DELIVER
Findings: Significant reduction in HF hospitalizations, no proven mortality benefit.
Guideline stance: Strong CCS 2022 recommendation to use in all HFpEF patients (LVEF >40%, NYHA II-IV) to reduce HF admissions
Limitations: Not indicated for T1DM, dialysis, or severe renal impairment (eGFR <20-25).
What formula is used to estimate total iron deficit when planning IV iron replacement?
The Ganzoni equation — used to calculate total parenteral iron requirement
What is veritaserum?
This potion forces the drinker to tell the truth
According to guidelines, what can decrease A1c with no increase in hypoglycemia and increase quality of life?
Benefits of Adding CGM to BBI or CSII
Adding Continuous Glucose Monitoring (CGM) with high sensor adherence can
– ↓ A1C with no increase in hypoglycemia
– ↑ QOL, diabetes distress, fear of hypoglycemia and treatment satisfaction
Note: Benefits of CGM are only seen when patients are actually wearing the sensor/CGM at all times = high sensor adherence (>70% in 14d period)
How quickly can you correct chronic and acute hyponatremia?
→ Risk of osmotic demyelination from rapid rise in serum osmolality;
4-6mmol/L in 24hours - chronic
8-10mmol/L in 24hours - acute
When are ARNIs contraindicated?
contraindicated if history of hereditary (familial) or idiopathic angioedema
A patient with macrocytosis, elevated LDH, low reticulocyte count, and hypersegmented neutrophils.
→ Megaloblastic anemia due to B12 or folate deficiency (impaired DNA synthesis).
What are the deathly hallows?
Elder wand, Invisibility cloak, Resurrection stone
when do you give bicarbonate?
Only indicated if pH < 6.9 and there is hemodynamic instability or life-threatening hyperkalemia; otherwise, it delays ketone clearance and increases risk of cerebral edema
What is the hyponatremia correction formula?
Volume infusate to give = (TBW x (desired Na – Serum Na)) / [Na] infusate
Indications for ICD for primary prevention in a patient with CHF?
CCS 2017 HF Guidelines
- ICM, NYHA II-IV, LVEF ≤ 35%
- ICM, NYHA I, LVEF ≤ 30%
- NICM, NYHA II-III, LVEF ≤ 35%
What are the three key steps in the structured workup of normocytic or unexplained anemia, and what information does each step provide?
Reticulocyte count – distinguishes production failure (low retic; marrow/aplastic/renal) from destruction/loss (high retic; hemolysis or bleeding).
Peripheral blood smear – assesses morphology (schistocytes, spherocytes, target cells, blasts, rouleaux) to direct toward specific mechanisms.
Iron studies, B12/folate, and renal function – identify nutritional deficiencies or chronic disease as reversible causes before invasive testing.
What was Harry Potter's Patronus?
a stag
18 yo with T1DM (diagnosed 3 years ago and out of their honeymoon phase) is now requiring MDI regimen with glargine 18u HS and aspart 6 u with meals. They previously had lower insulin requirements and is just starting to be adherent with bolus insulin.
What do you recommend as next best step?
a) Insulin pump therapy
b) Increase glargine to 20 u, and aspart 7u ac breakfast and supper.
c) Increase glargine to 20 u and aspart to 8u ac all meals
d) Advise carb ratio 1:5 with each meal (give 1 u insulin for every 5g carb)
b) Increase glargine to 20 u, and aspart 7u ac breakfast and supper.
A 45 year old female recently had a showering of strokes from
infective endocarditis. A few days later you notice sodium trending
up to 155. You initiate increased po intake of water but her sodium
won’t improve. Urine osm is 100. What is the next best step?
a) Water deprivation test
b) DDAVP trial
c) ½ NS @ 45 cc/hour
d) Supportive care
b) DDAVP trial
A 65M with dilated cardiomyopathy (LVEF 32%) and history of familial angioedema presents in clinic with NYHA class II dyspnea after a recent hospitalization for CHF. He has been on Bisoprolol 10 mg OD, Candesartan 32 mg OD, and Spironolactone 50 mg OD, apixaban 5mg bid for 4 months.
Labs show Normal CBC. K 4.2, Cr 102 (CrCl 55). A1C 5.5%, LDL 1.5. His ECG shows atrial fibrillation with a HR of 74 bpm and QRS duration of 125 ms in RBBB morphology.
Which of the following would you recommend next to reduce risk of cardiovascular mortality?
A) Change Candesartan to Sacubitril/Valsartan
B) Add Ivabradine to current therapies
C) Add Dapagliflozin to current therapies
D) Add amiodarone to current therapies
E) Continue current medical therapy, refer for CRT
C) Add Dapagliflozin to current therapies
Note FAMILIAL ANGIOEDEMA = synonymous with HEREDITARY ANGIOEDEMA DAPA is now in the guidelines for non diabetic w EF <40%. Pt is in afib so ivabradine not appropriate, and RBBB w QRS <150 w AFIB so CRT unlikely to confer mortality benefit.
A 19-year-old female presents with 3-week history of worsening bruising and menorrhagia. She has also noticed increased fatigue with dyspnea on exertion. No recent infectious symptoms. Examination is notable for sporadic ecchymoses. Hb 84, WBC 1.2, PLT 44, Neutrophils 0.6, reticulocytes 5, Vitamin B12 400, ferritin 50. No palpable hepatosplenomegaly or lymphadenopathy. What is the most likely diagnosis?
a) Pure red cell aplasia
b) Parvovirus B19 infection
c) Hodgkin lymphoma
d) Aplastic anemia
aplastic anemia
pancytopenia with severe reticulocytopenia in an otherwise young, healthy patient suggests a bone marrow failure syndrome. Isolated anemia and severe reticulocytopenia may be in keeping with PRCA (primary or secondary to parvovirus B19 infection) but would not affect other lineages. Hodgkin lymphoma often presents with lymphadenopathy and constitutional symptoms but not pancytopenia.
Who was Voldemort's Grandfather?
Marvolo Gaunt