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329 Cards in this Set

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Panhyopituitarism. Etiology?
Panhyopituitarism. Etiology - 1 Compression, or 2 Damages of Pituitary glands. Tumors (1 Metastatic cancer, 2 Adenoma, 3 Rathke Cleft Cysts, 4 Meningiomas, 5 Craniopharyngiomas, 6 Lymphoma.) Trauma and Radiation are damaging to pituitary. Conditions (Hemochromatosis, Sarcoidosis, Histiocytosis X, or Infection with Fungi, TB, and Parasites infiltrate Pitutary, destroying its function. Autoimmune and Lymphocytic infiltration can damage the gland.
Panhyopituitarism. Px?
Panhyopituitarism. Px - symptoms of panhypopituitarism based on deficiencies of specific hormone.
Prolactin Deficiency. Px?
Prolactin Deficiency. Px - Only in Women - No Lactation After Childbirth. Prolactin means In Favor of or Pro Lactation.
No Lactation After Childbirth - What deficiency?
Prolactin Deficiency. Px - Only in Women - No Lactation After Childbirth. Prolactin means In Favor of or Pro Lactation.
Luteinizing Hormone and Follicle-Stimulating Hormone Deficiency. Px?
Luteinizing Hormone LH and Follicle-Stimulating Hormone FSH Deficiency. Px - Women will Not be Able to Ovulate or Menstruate (Amenorrheic). Men will Not make Testosterone or Sperm. Both will have Decreased Libido and Decreased Axillary, Pubic, and Body Hair. Men will have Erectile Dysfunction and Decreased Muscle Mass.
Women will Not be Able to Ovulate or Menstruate (Amenorrheic). Men will Not make Testosterone or Sperm. Both will have Decreased Libido and Decreased Axillary, Pubic, and Body Hair. Men will have Erectile Dysfunction and Decreased Muscle Mass. What deficiency?
Luteinizing Hormone LH and Follicle-Stimulating Hormone FSH Deficiency. Px - Women will Not be Able to Ovulate or Menstruate (Amenorrheic). Men will Not make Testosterone or Sperm. Both will have Decreased Libido and Decreased Axillary, Pubic, and Body Hair. Men will have Erectile Dysfunction and Decreased Muscle Mass.
Women will Not be Able to Ovulate or Menstruate (Amenorrheic), Decreased Libido and Decreased Axillary, Pubic, and Body Hair. Also affect men differently. What deficiency?
Luteinizing Hormone LH and Follicle-Stimulating Hormone FSH Deficiency. Px - Women will Not be Able to Ovulate or Menstruate (Amenorrheic). Men will Not make Testosterone or Sperm. Both will have Decreased Libido and Decreased Axillary, Pubic, and Body Hair. Men will have Erectile Dysfunction and Decreased Muscle Mass.
Men will Not make Testosterone or Sperm, Decreased Libido and Decreased Axillary, Pubic, and Body Hair, Erectile Dysfunction and Decreased Muscle Mass. Also affect women differently. What deficiency?
Luteinizing Hormone LH and Follicle-Stimulating Hormone FSH Deficiency. Px - Women will Not be Able to Ovulate or Menstruate (Amenorrheic). Men will Not make Testosterone or Sperm. Both will have Decreased Libido and Decreased Axillary, Pubic, and Body Hair. Men will have Erectile Dysfunction and Decreased Muscle Mass.
What is Kallman Syndrome?
Kallman Syndrome (KAL - Kidney, Anosmia, LH) is 1 Decreased FSH and LH from Decreased GnRH, 2 Anosmia, 3 Renal Agenesis in 50 perc.
Growth Hormone Deficiency in Children Px? Adult Px?
Growth Hormone GH Deficiency in Children Px - Short Stature and Dwarfism. Adult Px - Few Symptoms (Catecholamines, Glucagon, and Cortisol act as Stress Hormones.) Adult have Subtle findings 1 Central Obesity, 2 Increased LDL and Cholesterol levels, 3 Reduced Lean muscle mass.
What is a general Endocrine pathway?
A General Endocrine Pathway is HAT (HPA axis) - 1 HypoThalamus, 2 Pituitary (Anterior, or Posterior), 3 Gland (Thyroid, Adrenal, etc).
What are the Hormones secreted by Antior Pituitary? Function?
The Hormones secreted by Antior Pituitary is FLAT PG - 1 FSH, 2 LH, 3 ACTH, 4 TSH, 5 Prolatin, 6 GH
What are secreted by Posterior Pituitary? Function?
Posterior Pituitary secrete OA - 1 Oxytoxin (Uterine contraction during Delivery), 2 ADH (Conserve Water)
What are secreted by Hypothalamus?
Hypothalamus secrete - 1 GnRH (Inhibit by Prolactin), 2 CRH, 3 TRH, 4 Dopamine (Inhibit Prolactin), 5 GHRH, 6 Somatostatin (Inhibit GH)
What is a common reason for Prolactinemia?
Common reason for Prolactinemia is HypoThyroidism. TRH Activate Prolactin.
What is function of HypoThalamus' Dopamine?
Function of HypoThalamus' Dopamine - Inhibit Prolactin release in Anterior Pituitary.
What is function of HypoThalamus' Somatostatin?
Function of HypoThalamus' Somatostatin - Inhibit GH release in Anterior Pituitary
What is the Imaging studies of Anterior Pituitary?
Imaging studies of Anterior Pituitary - MRI
What is the Imaging studies of Adrenal gland?
Imaging studies of Adrenal gland - CT
In Panhypopituitarism, what deficiency has HypoNatremia?
In Panhypopituitarism, HypoNatremia due to deficiency - 1 Thyroid (Hypothyroidism - Low TSH), 2 Glucocorticoids (Low ACTH)
Panhypopituitarism, Lx?
Panhypopituitarism, Lx - 1 HypoNatremia (HypoThyroidism, and Isolated Glucocorticoid Underproduction). 2 FLAT - FSH_LH_Testoterone Decreased, AdrenoCorticotropic_ACTH_Cortisol Decreased, Thyroid-Stimulating Hormone_TSH_Thyroxine Decreased. Low ACTH and Low TSH can be Confirmed (Cosyntropin_CRH_Cortisol, TRH). Metyrapone Decreases Cortisol Output, and Increases ACTH. Insulin Stimulation causes Decreased Glucose Levels, and Increased GH.
Low TSH and Low Thyroxine levels. How to Confirm abnormality?
Low TSH and Low Thyroxine levels. Confirm abnormality - TRH stimulate Decreased TSH.
Low ACTH and Low Cortisol levels. How to Confirm abnormality?
Low ACTH and Low Cortisol levels. Confirm abnormality - Cosyntropin stimulate Normal Response. Cortisol Rise (Normal Adrenal) in Recent Disease, (Adrenal is Abnormal) in Chronic Disease due to Adrenal Atrophy. CRH stimulate No Response_Rise in ACTH. An Elevated Baseline Cortisol Level Excludes Pituitary Insufficiency (HypoThalamus Problem)
What is Cosyntropin?
Cosyntropin is Synthetic ACTH. It test function of Adrenal Gland to produce Cortisol.
What Hormone has Pulsatile release?
Hormone has Pulsatile release - GH - at midnight
What is Addison Disease?
Addison Disease - Chronic Adrenal Insufficiency.
What name is Chronic Adrenal Insufficiency?
Addison Disease - Chronic Adrenal Insufficiency.
Contrast Addison Disease vs PanHypopituitarism?
Addison Disease (Adrenal Insufficiency) vs PanHypopituitarism (Pituitary Insufficiency - Acute. Adrenal Insufficiency - Chronic).
What is function of Metyrapone?
Metyrapone Inhibits 11-Beta Hydroxylase to Decrease Adrenal Gland output of Cortisol, and Increase ACTH. It test Anterior Pituitary function to produce ACTH.
What is function of Insulin Stimulation?
Insulin Stimulation Decreases Glucose level, and Increases GH level. It test Anterior Pituitary function to produce GH.
Panhypopituitarism, Tx?
Panhypopituitarism, Tx (Cortisone and Thyroxine most Important) - 1 Cortisone, 2 Thyroxine, 3 Testosterone and Estrogen, 4 Recombinant Human Growth Hormone
What is name for ADH Deficiency?
ADH Deficiency - Central Diabetes Insipidus
What is name for Central Diabetes Insipidus?
ADH Deficiency - Central Diabetes Insipidus
What is Vasopressin? Function?
Vasopressin is Nasal ADH. It is used in Central Diabetes Insipidus Tx.
Extremely High Volume Urine, Excessive Thirst, Disorientation. Dx? Etiology? Lx? Tx?
Extremely High Volume Urine, Excessive Thirst, Disorientation (Confusion, Lethargy, Seizures and Coma). Dx - Diabetes Insipidus (Volume Depletion and HyperNatremia). Diabetes Insipidus can be due to Decreased ADH from Pituitary (Central DI), or Decreased ADH effect on Kidney (Nephrogenic DI). Etiology - CDI from brain destruction (Stroke, Tumor, Trauma, Hypoxia, Infiltration of gland from Sarcoidosis or Infection). NDI - 1 Kidney diseases (Chronic Pyelonephritis, Amyloidosis, Myeloma, or Sickle Cell Disease), 2 HyperCalcemia (HyperParathyroidism), 3 HypoKalemia, 4 Lithium. Lx - Serum Sodium Elevated (Oral Replacement Insufficient), Urine Osmolality and Urine Sodium Decreased, Serum Osmolality (Serum Sodium) Elevated, Urine Volume is Enormous. Difference between CDI and NDI determined by Response to Vasopressin (ADH) - CDI Responsive. Tx - CDI - Desmopressin (Long-term Vasopressin), NDI - 1 Correct Underlying Cause (eg HypoKalemia, or HyperCalcemia), 2 HydroChloroThiazide, 3 Amiloride (K Sparing Diuretic - use for Lithium Induce DI), and 4 Prostaglandin Inhibitors (NSAIDs - Indomethacin).
Extremely High Volume Urine, Excessive Thirst, Disorientation. Dx?
Extremely High Volume Urine, Excessive Thirst, Disorientation (Confusion, Lethargy, Seizures and Coma). Dx - Diabetes Insipidus (Volume Depletion and HyperNatremia). Diabetes Insipidus can be due to Decreased ADH from Pituitary (Central DI), or Decreased ADH effect on Kidney (Nephrogenic DI).
Extremely High Volume Urine, Excessive Thirst, Disorientation. Dx? Etiology?
Extremely High Volume Urine, Excessive Thirst, Disorientation (Confusion, Lethargy, Seizures and Coma). Dx - Diabetes Insipidus (Volume Depletion and HyperNatremia). Diabetes Insipidus can be due to Decreased ADH from Pituitary (Central DI), or Decreased ADH effect on Kidney (Nephrogenic DI). Etiology - CDI from brain destruction (Stroke, Tumor, Trauma, Hypoxia, Infiltration of gland from Sarcoidosis or Infection). NDI - 1 Kidney diseases (Chronic Pyelonephritis, Amyloidosis, Myeloma, or Sickle Cell Disease), 2 HyperCalcemia (HyperParathyroidism), 3 HypoKalemia, 4 Lithium.
CDI cause?
Etiology - CDI from brain destruction (Stroke, Tumor, Trauma, Hypoxia, Infiltration of gland from Sarcoidosis or Infection). NDI - 1 Kidney diseases (Chronic Pyelonephritis, Amyloidosis, Myeloma, or Sickle Cell Disease), 2 HyperCalcemia (HyperParathyroidism), 3 HypoKalemia, 4 Lithium.
NDI cause?
Etiology - CDI from brain destruction (Stroke, Tumor, Trauma, Hypoxia, Infiltration of gland from Sarcoidosis or Infection). NDI - 1 Kidney diseases (Chronic Pyelonephritis, Amyloidosis, Myeloma, or Sickle Cell Disease), 2 HyperCalcemia (HyperParathyroidism), 3 HypoKalemia, 4 Lithium.
What Med can cause DI? Tx?
NDI - 1 Kidney diseases (Chronic Pyelonephritis, Amyloidosis, Myeloma, or Sickle Cell Disease), 2 HyperCalcemia (HyperParathyroidism), 3 HypoKalemia, 4 Lithium. Lx - Serum Sodium Elevated (Oral Replacement Insufficient), Urine Osmolality and Urine Sodium Decreased, Serum Osmolality (Serum Sodium) Elevated, Urine Volume is Enormous. Difference between CDI and NDI determined by Response to Vasopressin (ADH) - CDI Responsive. Tx - CDI - Desmopressin (Long-term Vasopressin), NDI - 1 Correct Underlying Cause (eg HypoKalemia, or HyperCalcemia), 2 HydroChloroThiazide, 3 Amiloride (K Sparing Diuretic - use for Lithium Induce DI), and 4 Prostaglandin Inhibitors (NSAIDs - Indomethacin).
Extremely High Volume Urine, Excessive Thirst, Disorientation. Dx? Tx?
Extremely High Volume Urine, Excessive Thirst, Disorientation (Confusion, Lethargy, Seizures and Coma). Dx - Diabetes Insipidus (Volume Depletion and HyperNatremia). Diabetes Insipidus can be due to Decreased ADH from Pituitary (Central DI), or Decreased ADH effect on Kidney (Nephrogenic DI). Etiology - CDI from brain destruction (Stroke, Tumor, Trauma, Hypoxia, Infiltration of gland from Sarcoidosis or Infection). NDI - 1 Kidney diseases (Chronic Pyelonephritis, Amyloidosis, Myeloma, or Sickle Cell Disease), 2 HyperCalcemia (HyperParathyroidism), 3 HypoKalemia, 4 Lithium. Lx - Serum Sodium Elevated (Oral Replacement Insufficient), Urine Osmolality and Urine Sodium Decreased, Serum Osmolality (Serum Sodium) Elevated, Urine Volume is Enormous. Difference between CDI and NDI determined by Response to Vasopressin (ADH) - CDI Responsive. Tx - CDI - Desmopressin (Long-term Vasopressin), NDI - 1 Correct Underlying Cause (eg HypoKalemia, or HyperCalcemia), 2 HydroChloroThiazide, 3 Amiloride (K Sparing Diuretic - use for Lithium Induce DI), and 4 Prostaglandin Inhibitors (NSAIDs - Indomethacin).
Lithium Induced Diabetes Insipitus Tx?
Lithium Induced Diabetes Insipitus Tx - Amiloride (K Sparing Diuretic)
What are synthetic ADH?
Synthetic ADH - Desmopressin (Long-term Vasopressin), Vasopressin
What electrolyte abnormality will inhibit ADH effect on kidney?
Electrolyte abnormality will inhibit ADH effect on kidney (cause NDI) - 1 HyperCalcemia (HyperParathyroidism), 2 HypoKalemia.
What can cause Severe HyperNatremia? What is Severe HyperNatremia Px?
Severe HyperNatremia cause by Diabetes Insipidus (Serum Osmolarity More than 300, and Urine Osmolarity Less than 300). Severe HyperNatremia Px - Neurological - Confusion, Disorientation, Lethargy, and eventually Seizures and Coma.
What is Acromegaly? Cause? Association with another disorder? Acromegaly Px? Lx? Tx?
Acromegaly is OverProduction of Growth Hormone leading to Soft Tissue OverGrowth throughout the body. Association with another disorder - Multiple Endocrine Neoplasias (1 Pituitary Adenoma, 2 Parathyroid, 3 Pancreatic Dirsorders (aaa Gastrinoma or bbb Insulinoma). Acromegaly Px - 1 Hat_Ring_Shoe Size Increased, 2 Carpal Tunnel Syndrome and Obstructive Sleep Apnea, 3 Body Odor from Sweat Gland Hypertrophy, 4 Coarsening Facial Features and Teeth Widening from Jaw Growth, 5 Deep Voice and Macroglossia (Big Tongue), 6 Colonic Polyps and Skin Tags, 7 Arthralgias from Joints Growing Out of Alignment, 8 Hypertension for Unclear Reasons in 50 perc, 9 Cardiomegaly and CHF (cause of Death), 10 Erectile Dysfunction (male - Increased Prolactin Cosecreted with Pituitary Adenoma. female - Amenorrhea). Lx (shows Glucose Intolerance and HyperLipidemia) - Best initial - Insulinelike Growth Factor level (IGF). Most Accurate - Glucose Suppression Test (Normal - Glucose should Suppress Growth Hormone levels). MRI should be done Only After lab Identificatin of Acromegaly. Prolactin Levels are tested because of Cosecretion with Growth Hormone. Tx - 1 Surgery (TranSphenoidal Resection of Pituitary. Larger Adenomas are Harder to cure). 2 Medications - aaa Cabergoline (Dopamine will Inhibit GH release), bbb Octreotide or Lanreotide (Somatostatin Inhibits GH release), ccc Pegvisomant (GH receptor Antagonist, it Inhibits IGF release from the Liver). 3 Radiotherapy (Radiation only not respond to surgery or medications).
What is Acromegaly? Cause?
Acromegaly is OverProduction of Growth Hormone leading to Soft Tissue OverGrowth throughout the body.
What is Acromegaly Association with another disorder?
Acromegaly Association with another disorder - Multiple Endocrine Neoplasias (1 Pituitary Adenoma, 2 Parathyroid, 3 Pancreatic Dirsorders (aaa Gastrinoma or bbb Insulinoma).
Acromegaly Px?
Acromegaly Px - 1 Hat_Ring_Shoe Size Increased, 2 Carpal Tunnel Syndrome and Obstructive Sleep Apnea, 3 Body Odor from Sweat Gland Hypertrophy, 4 Coarsening Facial Features and Teeth Widening from Jaw Growth, 5 Deep Voice and Macroglossia (Big Tongue), 6 Colonic Polyps and Skin Tags, 7 Arthralgias from Joints Growing Out of Alignment, 8 Hypertension for Unclear Reasons in 50 perc, 9 Cardiomegaly and CHF (cause of Death), 10 Erectile Dysfunction (male - Increased Prolactin Cosecreted with Pituitary Adenoma. female - Amenorrhea).
Acromegaly Lx?
Acromegaly Lx (shows Glucose Intolerance and HyperLipidemia) - Best initial - Insulinelike Growth Factor level (IGF). Most Accurate - Glucose Suppression Test (Normal - Glucose should Suppress Growth Hormone levels). MRI should be done Only After lab Identificatin of Acromegaly. Prolactin Levels are tested because of Cosecretion with Growth Hormone.
Acromegaly Tx?
Acromegaly Tx - 1 Surgery (TranSphenoidal Resection of Pituitary. Larger Adenomas are Harder to cure). 2 Medications - aaa Cabergoline (Dopamine will Inhibit GH release), bbb Octreotide or Lanreotide (Somatostatin Inhibits GH release), ccc Pegvisomant (GH receptor Antagonist, it Inhibits IGF release from the Liver). 3 Radiotherapy (Radiation only not respond to surgery or medications).
What is Cabergoline Drug Class? Function? Disorder Tx?
Acromegaly Medications - aaa Cabergoline - better than Bromocriptine (Dopamine will Inhibit GH release), bbb Octreotide or Lanreotide (Somatostatin Inhibits GH release), ccc Pegvisomant (GH receptor Antagonist, it Inhibits IGF release from the Liver). 3 Radiotherapy (Radiation only not respond to surgery or medications).
What is Bromocriptine Drug Class? Function? Disorder Tx?
Acromegaly Medications - aaa Cabergoline - better than Bromocriptine (Dopamine will Inhibit GH release), bbb Octreotide or Lanreotide (Somatostatin Inhibits GH release), ccc Pegvisomant (GH receptor Antagonist, it Inhibits IGF release from the Liver). 3 Radiotherapy (Radiation only not respond to surgery or medications).
What is Octreotide Drug Class? Function? Disorder Tx?
Acromegaly Medications - aaa Cabergoline (Dopamine will Inhibit GH release), bbb Octreotide or Lanreotide (Somatostatin Inhibits GH release), ccc Pegvisomant (GH receptor Antagonist, it Inhibits IGF release from the Liver). 3 Radiotherapy (Radiation only not respond to surgery or medications).
What is Lanreotide Drug Class? Function? Disorder Tx?
Acromegaly Medications - aaa Cabergoline (Dopamine will Inhibit GH release), bbb Octreotide or Lanreotide (Somatostatin Inhibits GH release), ccc Pegvisomant (GH receptor Antagonist, it Inhibits IGF release from the Liver). 3 Radiotherapy (Radiation only not respond to surgery or medications).
What is Pegvisomant Drug Class? Function? Disorder Tx?
Acromegaly Medications - aaa Cabergoline (Dopamine will Inhibit GH release), bbb Octreotide or Lanreotide (Somatostatin Inhibits GH release), ccc Pegvisomant (GH receptor Antagonist, it Inhibits IGF release from the Liver). 3 Radiotherapy (Radiation only not respond to surgery or medications).
What is TranSphenoidal Resection Function? Disorder Tx?
Acromegaly Tx - 1 Surgery (TranSphenoidal Resection of Pituitary. Larger Adenomas are Harder to cure).
Compare Growth Hormone and Insulin.
Compare Growth Hormone and Insulin. Growth Hormone is AntiInsulin (on Glucose). Growth Hormone makes InsulinLike Growth Factors - Only effect on Proteins and Amino Acids is InsulinLike.
What are Dopamine Agonist med? Disorder Tx?
Acromegaly Medications - aaa Cabergoline - better than Bromocriptine (Dopamine will Inhibit GH release), bbb Octreotide or Lanreotide (Somatostatin Inhibits GH release), ccc Pegvisomant (GH receptor Antagonist, it Inhibits IGF release from the Liver). 3 Radiotherapy (Radiation only not respond to surgery or medications).
What are Somatostatin med? Disorder Tx?
Acromegaly Medications - aaa Cabergoline (Dopamine will Inhibit GH release), bbb Octreotide or Lanreotide (Somatostatin Inhibits GH release), ccc Pegvisomant (GH receptor Antagonist, it Inhibits IGF release from the Liver). 3 Radiotherapy (Radiation only not respond to surgery or medications).
What are GH receptor Antagonist med? Disorder Tx?
Acromegaly Medications - aaa Cabergoline (Dopamine will Inhibit GH release), bbb Octreotide or Lanreotide (Somatostatin Inhibits GH release), ccc Pegvisomant (GH receptor Antagonist, it Inhibits IGF release from the Liver). 3 Radiotherapy (Radiation only not respond to surgery or medications).
What is HyperProlactinemia Etiology? Px? Lx? Tx?
HyperProlactinemia Etiology - 1 Other Anterior Pituitary Hormone Abnormality (aaa Prolactin can be CoSecreted wtih Growth Hormone in Acromegaly, Extremely High TRH levels Stimulate Prolactin Release in HypoThyroidism), 2 Physiologic Causes (aaa Pregnancy, bbb Intense Exercise, ccc Increased Chest Wall Stimulation. ddd Cutting Pituitary Stalk Eliminates Dopamine Delivery to Anterior Pituitary. Dopamine Inhibits Prolactin Release. Prolactin Inhibit GnRH release.), 3 Drugs (aaa AntiPsychotic Medications - Rispiridone, bbb MethylDopa, ccc Metoclopromide, ddd Opioids, eee Tricyclic Antidepressants, fff SSRI.) Px - Women - 1 Galactorrhea, 2 Amenorrhea, 3 Infertility. Men - 1 Erectile Dysfunction, 2 Decreased Libido. Lx - (After Prolactin level found to be High) - 1 Thyroid Function Tests, 2 Pregnancy test (Always Exclude Pregnancy First in any Woman with High Prolactin level), 3 BUN over Creatinine (Kidney Disease Elevates Prolactin), 4 Liver Function tests (Cirrhosis Elevates Prolactin). MRI Done After 1 High Prolactin Level Confirmed, 2 Secondary Causes (Medications, etc.) Excluded, 3 Not Pregnant. Tx - 1 Dopamine Agonists (Cabergoline - Initial Tx) is Better Tolerated than Bromocriptine. 2 Transphenoidal Surgery (Not responding to medications), 3 Radiation Rarely Needed.
Medication that can cause HyperProlactinemia?
HyperProlactinemia Etiology - 1 Other Anterior Pituitary Hormone Abnormality (aaa Prolactin can be CoSecreted wtih Growth Hormone in Acromegaly, Extremely High TRH levels Stimulate Prolactin Release in HypoThyroidism), 2 Physiologic Causes (aaa Pregnancy, bbb Intense Exercise, ccc Increased Chest Wall Stimulation. ddd Cutting Pituitary Stalk Eliminates Dopamine Delivery to Anterior Pituitary. Dopamine Inhibits Prolactin Release. Prolactin Inhibit GnRH release.), 3 Drugs (aaa AntiPsychotic Medications - Rispiridone, bbb MethylDopa, ccc Metoclopromide, ddd Opioids, eee Tricyclic Antidepressants, fff SSRI.)
What is HyperProlactinemia Etiology?
HyperProlactinemia Etiology - 1 Other Anterior Pituitary Hormone Abnormality (aaa Prolactin can be CoSecreted wtih Growth Hormone in Acromegaly, Extremely High TRH levels Stimulate Prolactin Release in HypoThyroidism), 2 Physiologic Causes (aaa Pregnancy, bbb Intense Exercise, ccc Increased Chest Wall Stimulation. ddd Cutting Pituitary Stalk Eliminates Dopamine Delivery to Anterior Pituitary. Dopamine Inhibits Prolactin Release.), 3 Drugs (aaa AntiPsychotic Medications - Rispiridone, bbb MethylDopa, ccc Metoclopromide, ddd Opioids, eee Tricyclic Antidepressants, fff SSRI.)
What is HyperProlactinemia Px?
HyperProlactinemia Px - Women - 1 Galactorrhea, 2 Amenorrhea, 3 Infertility. Men - 1 Erectile Dysfunction, 2 Decreased Libido (Prolactin Inhibit GnRH release).
What is HyperProlactinemia Lx?
HyperProlactinemia Lx - (After Prolactin level found to be High) - 1 Thyroid Function Tests, 2 Pregnancy test (Always Exclude Pregnancy First in any Woman with High Prolactin level), 3 BUN over Creatinine (Kidney Disease Elevates Prolactin), 4 Liver Function tests (Cirrhosis Elevates Prolactin). MRI Done After 1 High Prolactin Level Confirmed, 2 Secondary Causes (Medications, etc.) Excluded, 3 Not Pregnant.
What is HyperProlactinemia Tx?
HyperProlactinemia Tx - 1 Dopamine Agonists (Cabergoline - Initial Tx) is Better Tolerated than Bromocriptine. 2 Transphenoidal Surgery (Not responding to medications), 3 Radiation Rarely Needed.
What is Hypothyroidism Etiology? Px? Lx? Tx?
Hypothyroidism Etiology - 1 Hashimoto Thyroiditis (Failure of Throid gland from Burnt-Out), 2 Agenesis of Thyroid, 3 Dietary Deficiency of Iodine, 4 Amiodarone, 5 Lithium. Remember LA - Lithium and Agenesis. Px - Hypothyroidism is Almost all bodily processes Slowed, except Menstrual Flow Incrased. SS - 1 Bradycardia, 2 Constipation, 3 Weight Gain, 4 Fatigue, Lethargy, Coma, 5 Reflexes Decreased, 6 Cold Intolerance, 7 Hypothermia, 8 Hair Loss, Edema. Important Contrast to Hyperthyroidism - 5 Reflexes Decreased, 6 Cold Intolerance, 7 Hypothermia. Lx - Initial - TSH level. Low TSH level, then Measure T4 levels. TSH levels are Markedly Elevated if Gland has Failed. Tx - Replacing Thyroid Hormone with Thyroxine (Synthroid)
What is Hypothyroidism Etiology?
Hypothyroidism Etiology - 1 Hashimoto Thyroiditis (Failure of Throid gland from Burnt-Out), 2 Agenesis of Thyroid, 3 Dietary Deficiency of Iodine, 4 Amiodarone, 5 Lithium. Remember LA - Lithium and Agenesis.
What is Hypothyroidism Px?
Hypothyroidism Px - Hypothyroidism is Almost all bodily processes Slowed, except Menstrual Flow Incrased. SS - 1 Bradycardia, 2 Constipation, 3 Weight Gain, 4 Fatigue, Lethargy, Coma, 5 Reflexes Decreased, 6 Cold Intolerance, 7 Hypothermia, 8 Hair Loss, Edema. Important Contrast to Hyperthyroidism - 5 Reflexes Decreased, 6 Cold Intolerance, 7 Hypothermia.
What is Hypothyroidism Lx?
Hypothyroidism Lx - Initial - TSH level. Low TSH level, then Measure T4 levels. TSH levels are Markedly Elevated if Gland has Failed.
What is Hypothyroidism Tx?
Hypothyroidism Tx - Replacing Thyroid Hormone with Thyroxine (Synthroid)
Contrast Hypothyroidism and Hyperthyroidism.
Contrast Hypothyroidism and Hyperthyroidism. Hypothyroidism (Slow) - Bradycardia, Constipation, Weight Gain, Fatigue, Lethargy, Coma, Reflexes Decreased, Cold Intolerance, Hypothermia (Hair Loss, edema). Hyperthyroidism (Fast) - Tachycardia, Palpitations, Arrhythmia (Atrial Fibrillation), Diarrhea (HyperDefecation), Weight Loss, Anxiety, Nervousness, Restlessness, HyperReflexia, Heat Intolerance, Fever.
What is Synthroid? Disorder Tx?
Synthroid is Thyroxine - Tx Hypothroidism.
Unique Feature - Proptosis and Skin finding. Dx?
Unique Feature - Proptosis and Skin finding. Dx? Graves Disease
Unique Feature - Tender Thyroid. Dx?
Unique Feature - Tender Thyroid. Dx? Subacute Thyroiditis.
Unique Feature - Recent Viral Infection and Tender Thyroid. Dx?
Unique Feature - Recent Viral Infection and Tender Thyroid. Dx? Subacute Thyroiditis.
Unique Feature - Nontender Thyroid, Normal exam results. Dx?
Unique Feature - Nontender Thyroid, Normal exam results. Dx? Painless Silent Thyroiditis.
Unique Feature - Involuted neck gland is Not palpable. Dx?
Unique Feature - Involuted neck gland is Not palpable. Dx? Exogenous Thyroid Hormone Use.
Unique Feature - High TSH level. Dx?
Unique Feature - High TSH level. Dx? Pituitary Adenoma.
Unique Feature - TSI. Dx?
Unique Feature - TSI. Dx? Only Graves Disease has Thyroid Stimulating Immunoglobulin TSI or TSH Receptor Antibodies.
Graves Disease. Unique Feature?
Graves Disease. Unique Feature? Proptosis and Skin finding. Only Graves Disease has Thyroid Stimulating Immunoglobulin TSI or TSH Receptor Antibodies
Subacute Thyroiditis.. Unique Feature?
Subacute Thyroiditis.. Unique Feature? Recent Viral Infection and Tender Thyroid.
Painless Silent Thyroiditis.. Unique Feature?
Painless Silent Thyroiditis. Unique Feature? Nontender Thyroid, Normal exam results.
Exogenous Thyroid Hormone Use.. Unique Feature?
Exogenous Thyroid Hormone Use.. Unique Feature? Involuted neck gland is Not palpable.
Pituitary Adenoma. . Unique Feature?
Pituitary Adenoma. . Unique Feature? High TSH level.
What is another name for Silent Thyroiditis?
Another name for Silent Thyroiditis is Painless Thyroiditis
What is Proptosis? Cause? Dx?
Proptosis is lid retraction due to Lymphocyte Infiltration in ExtraOcular Muscle. Graves Disease.
Does Thyroid Moves with Swallowing?
Does Thyroid Moves with Swallowing? Yes.
What moves up with Tongue Protrusion?
What moves up with Tongue Protrusion? Thyroglossal Cyst.
What disorder has RAIU Elevated?
RAIU Radio Active Iodine Uptake Elevated in Graves Disease
What cause of Hyperthyroidism has High TSH?
What cause of Hyperthyroidism has High TSH? Pituitary Adenoma.
What is Hashimoto Thyroiditis? Complication of Hashimoto Thyroiditis?
Hashimoto Thyroiditis - HypoThyroidism. Complication of Hashimoto Thyroiditis - Lymphoma.
Contrast Graves Disease, Subacute Thyroiditis, Painless Thyroiditis, Exogenous Thyroid use, Pituitary Adenoma. Px? Lx? Tx?
Contrast Graves Disease, Subacute Thyroiditis, Painless Thyroiditis, Exogenous Thyroid use, Pituitary Adenoma. Px? Lx? Tx? Graves Disease (Proptosis, Elevated RAIU, Positive Antibody - TSI or TSH Antibody, Tx Radioactive Iodine), Subacute Thyroiditis - De Quervain (Recent Viral Infection, Tender, Tx Aspirin), Painless Silent Thyroiditis, Exogenous Thyroid use, Pituitary Adenoma (High TSH level, Lx MRI, Tx Surgery).
What is De Quervain?
De Quervain is Subacute Thyroiditis with Tenderness.
HyperThermia, Delirium, Coma, A Fib. Dx?
Thyroid Storm Px - 1 HyperThermia, 2 Delirium, 3 Coma, 4 A Fib, 5 Nausea and Vomiting, 6 Tremor, 7 Increase or Decrease Bp. Tx - Supportive (Saline, Hydration, Steroids, Oxygen, Cooling blanket)
Delirium, Coma, A Fib, Nausea and Vomiting, Tremor, Increase Bp. Dx?
Thyroid Storm Px - 1 HyperThermia, 2 Delirium, 3 Coma, 4 A Fib, 5 Nausea and Vomiting, 6 Tremor, 7 Increase or Decrease Bp. Tx - Supportive (Saline, Hydration, Steroids, Oxygen, Cooling blanket)
Acute Hyperthyroidism and Thyroid Storm Tx?
Acute Hyperthyroidism and Thyroid Storm Tx - 1 Propranolol (blocks target organ effect, Inhibits Peripheral conversion of T4 to T3), 2 Thiourea drugs (Methimazole and Propylthiouracil. PTU safe for pregnancy. They blocks hormone production), 3 Iodinated Contrast material (Iopanoic acid and Ipodate. They blocks Peripheral conversion of T4 to More active T3. They blocks release of Existing hormone). 4 Steroids (Hydrocortisone). 5 Radioactive Iodine (Ablates the gland for a Permanent cure. Initial, Long Term curative).
What are Thiourea drugs? Disorder Tx?
Thiourea drugs - Methimazole and Propylthiouracil. Disorder Tx - they treat Acute Hyperthyroidism and Thyroid Storm. PTU safe for Pregnancy. They blocks hormone production. They can cause Tremor or Atrial fibrillation (delete Thyroid hormone first)
What is Methimazole? Disorder Tx?
Thiourea drugs - Methimazole and Propylthiouracil. Disorder Tx - they treat Acute Hyperthyroidism and Thyroid Storm. PTU safe for Pregnancy. They blocks hormone production.
What is Propylthiouracil? Disorder Tx?
Thiourea drugs - Methimazole and Propylthiouracil. Disorder Tx - they treat Acute Hyperthyroidism and Thyroid Storm. PTU safe for Pregnancy. They blocks hormone production. Can cause Tremor or Atrial fibrillation (delete Thyroid hormone first).
What are Iodinated Contrast material? Disorder Tx?
Iodinated Contrast material (Iopanoic acid and Ipodate). Disorder Tx - Acute Thyroidism and Thyroid Storm. They blocks Peripheral conversion of T4 to More active T3. They blocks release of Existing hormone
What blocks T4 to T3 conversion?
Blocks T4 to T3 conversion - 1 Dexamethasone, 2 Iodinated Contrast (Iopanoic acid and Ipodate), 3 Propranolol, 4 Thiourea (Methimazole and PTU).
What is Iopanoic? Disorder Tx?
Iodinated Contrast material (Iopanoic acid and Ipodate). Disorder Tx - Acute Thyroidism and Thyroid Storm. They blocks Peripheral conversion of T4 to More active T3. They blocks release of Existing hormone
What is Ipodate? Disorder Tx?
Iodinated Contrast material (Iopanoic acid and Ipodate). Disorder Tx - Acute Thyroidism and Thyroid Storm. They blocks Peripheral conversion of T4 to More active T3. They blocks release of Existing hormone
What is Proptosis Tx?
Proptosis is Graves Ophthalmopathy in Hyperthyroidism. Tx - Initial - Steroids. Radiation if unresponsive to Steroids. Severe cases needs Decompressive Surgery.
What thyroid disorder causes Lymphoma?
Thyroid disorder causes Lymphoma - Hashimoto Thyroiditis..
What thyroid disorder has antibody to Thyroperoxidase enzyme?
Thyroid disorder has antibody to Thyroperoxidase enzyme - Hashimoto Thyroiditis.
What is the cause of Proptosis in Graves disease?
Cause of Proptosis in Graves disease - Lymphocytic infiltration of extra ocular muscle. Tx - Steroids.
RAIU Contraindication?
RAIU Radio Active Iodine Uptake Elevated in Graves Disease. RAIU Contraindicated in 1 Pregnancy, 2 Severe Ophthalmopathy (Tx Steroids).
Thyroid Storm Px? Tx?
Thyroid Storm Px - 1 HyperThermia, 2 Delirium, 3 Coma, 4 A Fib, 5 Nausea and Vomiting, 6 Tremor, 7 Increase or Decrease Bp. Tx - Supportive (Saline, Hydration, Steroids, Oxygen, Cooling blanket)
What is different types of MEN syndrome?
MEN (Multiple Endocrine Neoplasia) syndrome types - MEN1 (3P) - 1 Pituitary, 2 Parathyroid, 3 Pancreas (Gastrinoma Zollinger Ellison Syndrome, Insulinoma). MEN2a - 1 Medullary Thyroid Cancer (Family Hx positive, DNA testing for RET gene and Total Thyroidectomy if RET positive. C Cell hyperplasia Increase Calcitonin), 2 Pheochromocytoma, 3 Primary Parathyroid Hyperplasia. MEN2b - 1 Medullary Thyroid Cancer, 2 Pheochromocytoma, 3 Marfanoid Habitus or Mucosal Neuroma (Tongue, Lip, Eye lid, GI)
What is MEN1 syndrome?
MEN1 syndrome? MEN1 (3P) - 1 Pituitary, 2 Parathyroid, 3 Pancreas (Gastrinoma Zollinger Ellison Syndrome, Insulinoma). MEN2a - 1 Medullary Thyroid Cancer (Family Hx positive, DNA testing for RET gene and Total Thyroidectomy if RET positive. C Cell hyperplasia Increase Calcitonin), 2 Pheochromocytoma, 3 Primary Parathyroid Hyperplasia. MEN2b - 1 Medullary Thyroid Cancer, 2 Pheochromocytoma, 3 Marfanoid Habitus or Mucosal Neuroma (Tongue, Lip, Eye lid, GI)
What is MEN2a syndrome?
MEN2a syndrome? MEN1 (3P) - 1 Pituitary, 2 Parathyroid, 3 Pancreas (Gastrinoma Zollinger Ellison Syndrome, Insulinoma). MEN2a - 1 Medullary Thyroid Cancer (Family Hx positive, DNA testing for RET gene and Total Thyroidectomy if RET positive. C Cell hyperplasia Increase Calcitonin), 2 Pheochromocytoma, 3 Primary Parathyroid Hyperplasia. MEN2b - 1 Medullary Thyroid Cancer, 2 Pheochromocytoma, 3 Marfanoid Habitus or Mucosal Neuroma (Tongue, Lip, Eye lid, GI)
What is MEN2b syndrome?
MEN2b syndrome? MEN1 (3P) - 1 Pituitary, 2 Parathyroid, 3 Pancreas (Gastrinoma Zollinger Ellison Syndrome, Insulinoma). MEN2a - 1 Medullary Thyroid Cancer (Family Hx positive, DNA testing for RET gene and Total Thyroidectomy if RET positive. C Cell hyperplasia Increase Calcitonin), 2 Pheochromocytoma, 3 Primary Parathyroid Hyperplasia. MEN2b - 1 Medullary Thyroid Cancer, 2 Pheochromocytoma, 3 Marfanoid Habitus or Mucosal Neuroma (Tongue, Lip, Eye lid, GI)
What thyroid cancer has hematogenous spread?
Thyroid cancer has hematogenous spread - Follicular carcinoma is most Severe.
What thyroid cancer is most severe?
Thyroid cancer has hematogenous spread - Follicular carcinoma is most Severe.
What is Calcitonin function?
Calcitonin Decrease Calcium in blood. Calcitonin is Opposite of PTH.
What is PTH function?
PTH (Parathyroid Hormone) Increase Calcium in blood. PTH oppose Calcitonin.
What lung cancer has Hypercalcemia?
Lung cancer has Hypercalcemia - Squamous cell cancer - PTHrP - Smokers
What lung cancer has ACTH and ADH?
Lung cancer has ACTH and ADH - Small Cell cancer.
What lung cancer has hypertropic osteorthropathy?
Lung cancer has hypertropic osteorthropathy - Adenocarcinoma of lung - Non-Smokers
Contrast Primary Parathyroidism, Renal Failure, Lung Cancer, and Plasma Cell in Bone marrow.
Contrast Primary Parathyroidism, Renal Failure (Secondary Hyperparathyroidism), Lung Cancer (Squamous cell - Smoker), and Plasma Cell in Bone marrow (multiple myeloma). Levels - PTH, Serum Calcium, and Serum Phosphate. Primary Parathyroidism (High PTH, High Calcium), Renal Failure (Secondary Hyperparathyroidism - High PTH, Low Calcium) , Lung Cancer (Squamous cell - Smoker - High PTH, High Calcium), and Plasma Cell in Bone marrow (multiple myeloma - Low PTH, High Calcium). Primary Parathyroidism and Squamous Lung Cancer have High PTH and High Calcium.
High PTH, High Calcium, Low Phosphate. Dx?
Contrast Primary Parathyroidism, Renal Failure (Secondary Hyperparathyroidism), Lung Cancer (Squamous cell - Smoker), and Plasma Cell in Bone marrow (multiple myeloma). Levels - PTH, Serum Calcium, and Serum Phosphate. Primary Parathyroidism (High PTH, High Calcium), Renal Failure (Secondary Hyperparathyroidism - High PTH, Low Calcium) , Lung Cancer (Squamous cell - Smoker - High PTH, High Calcium), and Plasma Cell in Bone marrow (multiple myeloma - Low PTH, High Calcium). Primary Parathyroidism and Squamous Lung Cancer have High PTH and High Calcium.
What is Calcitriol? Function?
Calcitriol is Vitamin D. Function - Increase Calcium and Phosphorus in blood
Thyroid Nodule in relation to Thyroid Gland function?
Thyroid Nodule in relation to Thyroid Gland function - Normal or Hypo functioning (Never HyperThyroidism for cancer)
What is the Most Common Thyroid nodule?
Most Common Thyroid nodule - Colloid nodule.
Asymptomatic Thyroid nodule. Next Step?
Asymptomatic Thyroid nodule. Next Step - get TSH and T4.
Asymptomatic Thyroid nodule. Normal TSH and T4. Next Step?
Asymptomatic Thyroid nodule. Normal TSH and T4. Next Step - Thyroid Biopsy with Fine Needle Aspiration.
Thyroid Nodule. Management?
Thyroid Nodule. Management - 1 Perform Thyroid Function tests (TSH and T4). 2 If test is Normal, Biopsy the gland with FNA.
Thyroid nodule, normal thyroid function, Fine-Needle Aspirate gives Indeterminant for Follicular Adenoma. Next Step?
Thyroid nodule, normal thyroid function, Fine-Needle Aspirate gives Indeterminant for Follicular Adenoma. Next Step - Surgical Removal (Excisional Biopsy)
Hypercalcemia Etiology? Px? Tx?
Hypercalcemia Etiology (Normal Calcium 8-10) - MCC - Primary HyperParathyroidism (PTH) - Asymptomatic. Severe Acute Symptomatic Hypercalcemia - 1 Cancer and 2 Hypercalcemia of Malignancy from PTH-like particle. 3 Vitamin D Intoxication, 4 Sarcoidosis and other Granulomatous Diseases, 5 Thiazide Diuretics, 6 HyperThyroidism, 7 Metastases to Bone and Multiple Myeloma. Px - Acute Symptomtic Hypercalcemia (Psychic Moan, Stone, Bone, Abdominal Groan) - 1 Confusion, 2 Stupor, 3 Lethargy, 4 Constipation. 5 CVS (CAL toe - high Ca low QT) - Short QT Syndrome and Hypertension. 6 Bone - Osteoporosis. 7 Renal - Nephrolithiasis, Diabetes Insipidus, Renal Insufficiency. Tx - 1 Acute - Saline Hydration at high volume with Loop diuretic (Furosemide), 2 Chronic - Bisphosphonates (Pamidronate, Zoledronic Acid. Decrease Resorption of Bone). 3 Calcitonin (Oppose PTH, Decrease Calcium, Inhibit Osteoclasts).
Hypercalcemia Etiology?
Hypercalcemia Etiology (Normal Calcium 8-10) - MCC - Primary HyperParathyroidism (PTH) - Asymptomatic. Severe Acute Symptomatic Hypercalcemia - 1 Cancer and 2 Hypercalcemia of Malignancy from PTH-like particle. 3 Vitamin D Intoxication, 4 Sarcoidosis and other Granulomatous Diseases, 5 Thiazide Diuretics, 6 HyperThyroidism, 7 Metastases to Bone and Multiple Myeloma.
Hypercalcemia Px?
Hypercalcemia Px - Acute Symptomtic Hypercalcemia (Psychic Moan, Stone, Bone, Abdominal Groan) - 1 Confusion, 2 Stupor, 3 Lethargy, 4 Constipation. 5 CVS (CAL toe - high Ca low QT) - Short QT Syndrome and Hypertension. 6 Bone - Osteoporosis. 7 Renal - Nephrolithiasis, Diabetes Insipidus, Renal Insufficiency.
Hypercalcemia Tx?
Hypercalcemia Tx - 1 Acute - Saline Hydration at high volume with Loop diuretic (Furosemide), 2 Chronic - Bisphosphonates (Pamidronate, Zoledronic Acid. Decrease Resorption of Bone). 3 Calcitonin (Oppose PTH, Decrease Calcium, Inhibit Osteoclasts).
Hypercalcemia Etiology - MCC?
Hypercalcemia Etiology - MCC - Primary HyperParathyroidism (PTH) - Asymptomatic. Severe Acute Symptomatic Hypercalcemia - 1 Cancer and 2 Hypercalcemia of Malignancy from PTH-like particle. 3 Vitamin D Intoxication, 4 Sarcoidosis and other Granulomatous Diseases, 5 Thiazide Diuretics, 6 HyperThyroidism, 7 Metastases to Bone and Multiple Myeloma.
Moan, Stone, Bone, Groan. Dx?
Hypercalcemia Px - Acute Symptomtic Hypercalcemia (Psychic Moan, Stone, Bone, Abdominal Groan) - 1 Confusion, 2 Stupor, 3 Lethargy, 4 Constipation. 5 CVS (CAL toe - high Ca low QT) - Short QT Syndrome and Hypertension. 6 Bone - Osteoporosis. 7 Renal - Nephrolithiasis, Diabetes Insipidus, Renal Insufficiency. Tx - 1 Acute - Saline Hydration at high volume with Loop diuretic (Furosemide), 2 Chronic - Bisphosphonates (Pamidronate, Zoledronic Acid. Decrease Resorption of Bone). 3 Calcitonin (Oppose PTH and Decrease Calcium).
Confusion, Stupor, Lethargy, Constipation. Electrolyte abnormality. Dx?
Confusion, Stupor, Lethargy, Constipation. Electrolyte abnormality. Dx - Hypercalcemia Px - Acute Symptomtic Hypercalcemia (Psychic Moan, Stone, Bone, Abdominal Groan) - 1 Confusion, 2 Stupor, 3 Lethargy, 4 Constipation. 5 CVS (CAL toe - high Ca low QT) - Short QT Syndrome and Hypertension. 6 Bone - Osteoporosis. 7 Renal - Nephrolithiasis, Diabetes Insipidus, Renal Insufficiency. Tx - 1 Acute - Saline Hydration at high volume with Loop diuretic (Furosemide), 2 Chronic - Bisphosphonates (Pamidronate, Zoledronic Acid. Decrease Resorption of Bone). 3 Calcitonin (Oppose PTH and Decrease Calcium).
Short QT Syndrome. Dx?
Hypercalcemia Px - Acute Symptomtic Hypercalcemia (Psychic Moan, Stone, Bone, Abdominal Groan) - 1 Confusion, 2 Stupor, 3 Lethargy, 4 Constipation. 5 CVS (CAL toe - high Ca low QT) - Short QT Syndrome and Hypertension. 6 Bone - Osteoporosis. 7 Renal - Nephrolithiasis, Diabetes Insipidus, Renal Insufficiency. Tx - 1 Acute - Saline Hydration at high volume with Loop diuretic (Furosemide), 2 Chronic - Bisphosphonates (Pamidronate, Zoledronic Acid. Decrease Resorption of Bone). 3 Calcitonin (Oppose PTH and Decrease Calcium).
Thiazide. AE?
Thiazide (Hydrochlorothiazide - HCTZ). AE (5 Hyper, 2 Hypo) - 5 Hyper - 1 HyperCalcemia, 2 HyperGlycemia (Glucose high), 3 HyperLipidemia, 4 HyperUrecemia (Protein breakdown), 5 HyperSensitivity. 2 Hypo - 1 HypoNatremia, 2 HypoKalemia.
Multiple Myeloma Mnemonic?
Multiple Myeloma Mnemonic (CRAB) - 1 HyperCalcemia, 2 Renal, 3 Anemia, 4 Bone Lesion.
Diuretic effect on electrolytes?
Diuretic effect on electrolytes - All Diuretics (Except Spironolactone) - 1 Decrease Na (HypoNatremia), 2 Decrease K (HypoKalemia)
What are potassium sparing diuretics?
Potassium (K) sparing diuretics - do Not cause HypoKalemia - 1 Spironolactone, 2 Eplerenone, 3 Amiloride, 4 Triamterine. Aldosterone Antagonist - 1 Spironolactone, 2 Eplerenone
Long QT Syndrome. Dx?
Long QT Syndrome. Dx - HypoCalcemia
What is Bisphosphonates? Tx of Disorder?
Hypercalcemia Tx - 1 Acute - Saline Hydration at high volume with Loop diuretic (Furosemide), 2 Chronic - Bisphosphonates (Pamidronate, Zoledronic Acid. Decrease Resorption of Bone). 3 Calcitonin (Oppose PTH and Decrease Calcium).
What is Pamidronate? Tx of Disorder?
Hypercalcemia Tx - 1 Acute - Saline Hydration at high volume with Loop diuretic (Furosemide), 2 Chronic - Bisphosphonates (Pamidronate, Zoledronic Acid. Decrease Resorption of Bone). 3 Calcitonin (Oppose PTH and Decrease Calcium).
What is Zoledronic Acid? Tx of Disorder?
Hypercalcemia Tx - 1 Acute - Saline Hydration at high volume with Loop diuretic (Furosemide), 2 Chronic - Bisphosphonates (Pamidronate, Zoledronic Acid. Decrease Resorption of Bone). 3 Calcitonin (Oppose PTH and Decrease Calcium).
What is Calcitonin? Tx of Disorder?
Hypercalcemia Tx - 1 Acute - Saline Hydration at high volume with Loop diuretic (Furosemide), 2 Chronic - Bisphosphonates (Pamidronate, Zoledronic Acid. Decrease Resorption of Bone). 3 Calcitonin (Oppose PTH, Decrease Calcium, Inhibit Osteoclasts).
What disease is Tx with Hydration?
Disease is Tx with Hydration - 1 HyperCalcemia, 2 DM, 3 Acute Pancreatitis, 4 Sickle Cell Anemia (After hydration, give Hydroxyurea)
What is the cause of HyperCalcemia due to Metastatic Breast Cancer? Tx?
What is the cause of HyperCalcemia due to Metastatic Breast Cancer - Cytokines causing Osteoclastic Lesion. Tx - Bisphosphonates (Pamidronate, Zoledronic Acid)
HyperCalcemia due to Sarcoidosis. Tx?
HyperCalcemia due to Sarcoidosis or any Granulomatous disease. Tx - Steroids
Cinacalcet function?
Cinacalcet function - Inhibit PTH release.
Parathyroid gland function mnemonics?
Parathyroid gland function mnemonics - Butterfly shape Thyroid gland with Ca in 4 corners for PTH function. PTH Increase Calcium in blood.
Hyperparathyroidism Etiology? Px? Lx? Tx?
Hyperparathyroidism Etiology - 1 Solitary Adenoma, 2 Hyperplasia of All four glands (MEN1 and MEN2a symptom association), 3 Parathyroid Malignancy. Px - Asymptoomatic Elvation in Calcium levels. Rarely, Symptoms - Acute Severe Hypercalcemia. Slower Px - 1 Osteoporosis, 2 Nephrolithiasis and Renal Insuficiency, 3 Muscle Weakness, Anorexia, Nausea, Vomiting, and Abdominal pain, 4 Peptic Ulcer Disease (Calcium Stiulates Gastrin). Lx - 1 High Calcium, 2 High PTH level, 3 Low Phosphate level, 4 High Chloride, 5 EKG with Short QT, 6 Elevated BUN and Creatinine. 7 Alkaline Phosphatase (Bone and Biliary Tree problem) maybe Elevated - PTH on Bone (DEXA densitometry for Osteoporosis). Tx - Surgical Removal (Do Sonography or Nuclear Scanning with Sesamibi before Surgery).
Hyperparathyroidism Etiology?
Hyperparathyroidism Etiology - 1 Solitary Adenoma, 2 Hyperplasia of All four glands (MEN1 and MEN2a symptom association), 3 Parathyroid Malignancy.
Hyperparathyroidism Px?
Hyperparathyroidism Px - Asymptoomatic Elvation in Calcium levels. Rarely, Symptoms - Acute Severe Hypercalcemia. Slower Px - 1 Osteoporosis, 2 Nephrolithiasis and Renal Insuficiency, 3 Muscle Weakness, Anorexia, Nausea, Vomiting, and Abdominal pain, 4 Peptic Ulcer Disease (Calcium Stiulates Gastrin).
Hyperparathyroidism Lx?
Hyperparathyroidism Lx - 1 High Calcium, 2 High PTH level, 3 Low Phosphate level, 4 High Chloride, 5 EKG with Short QT, 6 Elevated BUN and Creatinine. 7 Alkaline Phosphatase (Bone and Biliary Tree problem) maybe Elevated - PTH on Bone (DEXA densitometry for Osteoporosis). Tx - Surgical Removal (Do Sonography or Nuclear Scanning with Sesamibi before Surgery).
Hyperparathyroidism Tx?
Hyperparathyroidism Tx - Surgical Removal (Do Sonography or Nuclear Scanning with Sesamibi before Surgery).
High Alkaline Phosphatase. What problem?
High Alkaline Phosphatase. Problem - 1 Bone and 2 Biliary Tree problem.
Hypercalcemia, High PTH, Low Phosphates. Dx?
Hypercalcemia, High PTH, Low Phosphates. Dx - Primary Hyperparathyroidism.
Hypocalcemia, High PTH, High Phosphates. Dx?
Hypocalcemia, High PTH, High Phosphates. Dx - Secondary Hyperparathyroidism (Renal Failure or Pseudohypoparathyroidism - PTH Resistance).
What is Pseudohypoparathyroidism? Lx result?
Pseudohypoparathyroidism - PTH Resistance - Secondary Hyperparathyroidism. Lx result - High PTH, Hypocalcemia, High Phosphates - same result as Renal Failure.
Hypocalcemia Etiology? Px? Lx? Tx?
Hypocalcemia Etiology - 1 Primary Hypoparathyroidism (Complication of Prior Neck Surgery - Thyroidectomy). 2 HypoMagnesemia (Mg needed for PTH release from gland, and Increase Urinary loss of calicium). 3 Renal Failure (Unable to make Vitamin D Active). 4 Vitamin D Deficiency, 5 Genetic Disorder, 6 Fat Malabsorption, and 7 Low Albumin States - Liver Cirrhosis (Normal Albumin 3 - 5. One Point Decrease in Albumin is 0.8 Decrease in Total Calcium). Px (Neural Hyperexcitability in Hypocalcemia) - 1 Chvostek sign (Facial Nerve Hyperexcitability), 2 Carpopedal Spasm, 3 Perioral Numbness, 4 Mental Irritability, 5 Seizures, 6 Tetany (Trousseau sign). Lx - 1 EKG - Prolonged QT (CAL toe) - may lead to Arrhythmia, 2 Slit lamp - Early Cataracts. Tx - Replace Calcium and Vitamin D. Oral - Mild or absent, IV - Severe symptoms.
Hypocalcemia Etiology?
Hypocalcemia Etiology - 1 Primary Hypoparathyroidism (Complication of Prior Neck Surgery - Thyroidectomy). 2 HypoMagnesemia (Mg needed for PTH release from gland, and Increase Urinary loss of calicium). 3 Renal Failure (Unable to make Vitamin D Active). 4 Vitamin D Deficiency, 5 Genetic Disorder, 6 Fat Malabsorption, and 7 Low Albumin States - Liver Cirrhosis (Normal Albumin 3 - 5. One Point Decrease in Albumin is 0.8 Decrease in Total Calcium).
Hypocalcemia Px?
Hypocalcemia Px (Neural Hyperexcitability in Hypocalcemia) - 1 Chvostek sign (Facial Nerve Hyperexcitability), 2 Carpopedal Spasm, 3 Perioral Numbness, 4 Mental Irritability, 5 Seizures, 6 Tetany (Trousseau sign).
Hypocalcemia Lx?
Hypocalcemia Lx - 1 EKG - Prolonged QT (CAL toe) - may lead to Arrhythmia, 2 Slit lamp - Early Cataracts. Tx - Replace Calcium and Vitamin D. Oral - Mild or absent, IV - Severe symptoms.
Hypocalcemia Tx?
Hypocalcemia Tx - Replace Calcium and Vitamin D. Oral - Mild or absent, IV - Severe symptoms.
What is normal Albumin level? How does Low Albumin States affect blood Calcium level? What causes Low Albumin level? - Liver Cirrhosis (Normal Albumin 3 - 5. One Point Decrease in Albumin is 0.8 Decrease in Total Calcium).
Normal Albumin 3 - 5. Low Albumin Decrease Total Calcium. One Point Decrease in Albumin is 0.8 Decrease in Total Calcium. Causes Low Albumin level - Liver Cirrhosis.
Low Calcium and High Calcium symptom in general?
Low Calcium (Twitchy and Hyperexcitable). High Calcium symptom (Lethargic and Slow).
What does Hypomagnesemia cause?
Hypomagnesemia cause - Hypocalcemia (Mg needed for PTH release from gland, and Increase Urinary loss of calicium).
What is Cushing Syndrome?
Cushing Syndrome - HyperCortisolism.
What is Cushing Disease?
Cushing Disease - Pituitary Overproduction of ACTH.
Hypercortisolism Etiology? Px? Lx? Tx?
Hypercortisolism Etiology - 1 Pituitary ACTH (Cushing Disease), 2 Adrenals, 3 Ectopic ACTH (Cancer, Carcinoid), 4 Unknown source of ACTH. Px - 1 Fat Redistribution (Moon Face, Truncal Obesity, Buffalo Hump, Thin Extremitites, Increased Abdominal fat). 2 Skin (Striae, Easy Bruising, Decreased Wound Healing, and Thinning of Skin). 3 Osteoporosis. 4 Hypertension (Increae Na reabsorption in Kidney. Increased Vascular Reactivity). 5 Menstrual Disorders in Women. Erectile Dysfunction in Men. 6 Cognitive Disturbance (Decreased Concentration to Psychosis). 7 Polyuria (Hyperglycemia and Increased Free water clearance). Lx - General (1 Establish Presence of Hypercortisolism. 2 Establish Cause of Hypercortisolism). 1 Establish Presence (aaa Best Initial Lx - 24 Hour Urine Cortisol - Confirmatory. bbb 1 mg Low Dose Overnight Dexamethasone Suppression Test (Normal - Suppress Morning Cortisol level. False Positive for 1 mg Overnight Dexamethasone Suppression test - bbbb1 Depression, bbbb2 Alcoholism, bbbb3 Obesity)). 2 Establish Cause of Hypercortisolism (aaa Best Initial Lx - ACTH testing [Elevated ACTH - Pituitary or Ectopic in Lung Cancer or Carcinoid. Decreased ACTH means Adrenal Source.], bbb MRI, ccc Inferior Petrosal Sinus Venous Drainage for ACTH sample after CRH Stimulation, ddd Scan Chest for ACTH source. Confirm Source of Hypercortisolism with Biochemical tests before Performing Imaging studies. Other Lx - Cortisol is Stress Hormone (Anti-Insulin, Aldosterone-Like effect - Excrete Potassium and Hydrogen Ion). Hypercortisolism effects - 1 Hyperglycemia, 2 Hyperlipidemia, 3 Hypokalemia, 4 Metabolic Alkalosis, 5 Leukocytosis (Demargination of WBC). Tx - Surgery (Transsphenoidal for Pituitary sources. Laparoscopic removal for Adrenal sources). Evaluate Adrenal Incidentaloma (1 Pheochromocytoma - Metanephrines of Blood or Urine, 2 Hyperaldosteronism - Renin and Aldosterone levels, 3 Hypercortisolism - 1 mg Overnight Dexamethasone Suppression test)
Hypercortisolism Etiology?
Hypercortisolism Etiology - 1 Pituitary ACTH (Cushing Disease), 2 Adrenals, 3 Ectopic ACTH (Cancer, Carcinoid), 4 Unknown source of ACTH.
Hypercortisolism Px?
Hypercortisolism Px - 1 Fat Redistribution (Moon Face, Truncal Obesity, Buffalo Hump, Thin Extremitites, Increased Abdominal fat). 2 Skin (Striae, Easy Bruising, Decreased Wound Healing, and Thinning of Skin). 3 Osteoporosis. 4 Hypertension (Increae Na reabsorption in Kidney. Increased Vascular Reactivity). 5 Menstrual Disorders in Women. Erectile Dysfunction in Men. 6 Cognitive Disturbance (Decreased Concentration to Psychosis). 7 Polyuria (Hyperglycemia and Increased Free water clearance).
Hypercortisolism Lx?
Hypercortisolism Lx - General (1 Establish Presence of Hypercortisolism. 2 Establish Cause of Hypercortisolism). 1 Establish Presence (aaa Best Initial Lx - 24 Hour Urine Cortisol - Confirmatory. bbb 1 mg Overnight Dexamethasone Suppression Test (Normal - Suppress Morning Cortisol level. False Positive for 1 mg Overnight Dexamethasone Suppression test - bbbb1 Depression, bbbb2 Alcoholism, bbbb3 Obesity)). 2 Establish Cause of Hypercortisolism (aaa Best Initial Lx - ACTH testing [Elevated ACTH - Pituitary or Ectopic in Lung Cancer or Carcinoid. Decreased ACTH means Adrenal Source.], bbb MRI, ccc Inferior Petrosal Sinus Venous Drainage for ACTH sample after CRH Stimulation, ddd Scan Chest for ACTH source. Confirm Source of Hypercortisolism with Biochemical tests before Performing Imaging studies. Other Lx - Cortisol is Stress Hormone (Anti-Insulin, Aldosterone-Like effect - Excrete Potassium and Hydrogen Ion). Hypercortisolism effects - 1 Hyperglycemia, 2 Hyperlipidemia, 3 Hypokalemia, 4 Metabolic Alkalosis, 5 Leukocytosis (Demargination of WBC).
Hypercortisolism Tx?
Hypercortisolism Tx - Surgery (Transsphenoidal for Pituitary sources. Laparoscopic removal for Adrenal sources). Evaluate Adrenal Incidentaloma (1 Pheochromocytoma - Metanephrines of Blood or Urine, 2 Hyperaldosteronism - Renin and Aldosterone levels, 3 Hypercortisolism - 1 mg Overnight Dexamethasone Suppression test)
Evaluate Adrenal Incidentaloma
Evaluate Adrenal Incidentaloma (1 Pheochromocytoma - Metanephrines of Blood or Urine, 2 Hyperaldosteronism - Renin and Aldosterone levels, 3 Hypercortisolism - 1 mg Low Dose Overnight Dexamethasone Suppression test)
Hypercortisolism Lx - General?
Hypercortisolism Lx - General (1 Establish Presence of Hypercortisolism. 2 Establish Cause of Hypercortisolism). 1 Establish Presence (aaa Best Initial Lx - 24 Hour Urine Cortisol - Confirmatory. bbb 1 mg Overnight Dexamethasone Suppression Test (Normal - Suppress Morning Cortisol level. False Positive for 1 mg Overnight Dexamethasone Suppression test - bbbb1 Depression, bbbb2 Alcoholism, bbbb3 Obesity)). 2 Establish Cause of Hypercortisolism (aaa Best Initial Lx - ACTH testing [Elevated ACTH - Pituitary or Ectopic in Lung Cancer or Carcinoid. Decreased ACTH means Adrenal Source.], bbb MRI, ccc Inferior Petrosal Sinus Venous Drainage for ACTH sample after CRH Stimulation, ddd Scan Chest for ACTH source. Confirm Source of Hypercortisolism with Biochemical tests before Performing Imaging studies. Other Lx - Cortisol is Stress Hormone (Anti-Insulin, Aldosterone-Like effect - Excrete Potassium and Hydrogen Ion). Hypercortisolism effects - 1 Hyperglycemia, 2 Hyperlipidemia, 3 Hypokalemia, 4 Metabolic Alkalosis, 5 Leukocytosis (Demargination of WBC).
Hypercortisolism Lx algorithm - General?
Hypercortisolism Lx algorithm - General - 1 Overnight Low Dose Dexamethasone Supression test (Screening), 2 24-Hour Urinary Cortisol (Confirm), 3 High-Dose Dexamethasone Suppression, 4 ACTH level, 5 PreSurgery - CT
Hypercortisolism Lx - Establish Presence?
Hypercortisolism Lx - General (1 Establish Presence of Hypercortisolism. 2 Establish Cause of Hypercortisolism). 1 Establish Presence (aaa Best Initial Lx - 24 Hour Urine Cortisol - Confirmatory. bbb 1 mg Overnight Dexamethasone Suppression Test (Normal - Suppress Morning Cortisol level. False Positive for 1 mg Overnight Dexamethasone Suppression test - bbbb1 Depression, bbbb2 Alcoholism, bbbb3 Obesity)). 2 Establish Cause of Hypercortisolism (aaa Best Initial Lx - ACTH testing [Elevated ACTH - Pituitary or Ectopic in Lung Cancer or Carcinoid. Decreased ACTH means Adrenal Source.], bbb MRI, ccc Inferior Petrosal Sinus Venous Drainage for ACTH sample after CRH Stimulation, ddd Scan Chest for ACTH source. Confirm Source of Hypercortisolism with Biochemical tests before Performing Imaging studies. Other Lx - Cortisol is Stress Hormone (Anti-Insulin, Aldosterone-Like effect - Excrete Potassium and Hydrogen Ion). Hypercortisolism effects - 1 Hyperglycemia, 2 Hyperlipidemia, 3 Hypokalemia, 4 Metabolic Alkalosis, 5 Leukocytosis (Demargination of WBC).
Hypercortisolism Lx - Establish Cause?
Hypercortisolism Lx - General (1 Establish Presence of Hypercortisolism. 2 Establish Cause of Hypercortisolism). 1 Establish Presence (aaa Best Initial Lx - 24 Hour Urine Cortisol - Confirmatory. bbb 1 mg Overnight Dexamethasone Suppression Test (Normal - Suppress Morning Cortisol level. False Positive for 1 mg Overnight Dexamethasone Suppression test - bbbb1 Depression, bbbb2 Alcoholism, bbbb3 Obesity)). 2 Establish Cause of Hypercortisolism (aaa Best Initial Lx - ACTH testing [Elevated ACTH - Pituitary or Ectopic in Lung Cancer or Carcinoid. Decreased ACTH means Adrenal Source.], bbb MRI, ccc Inferior Petrosal Sinus Venous Drainage for ACTH sample after CRH Stimulation, ddd Scan Chest for ACTH source. Confirm Source of Hypercortisolism with Biochemical tests before Performing Imaging studies. Other Lx - Cortisol is Stress Hormone (Anti-Insulin, Aldosterone-Like effect - Excrete Potassium and Hydrogen Ion). Hypercortisolism effects - 1 Hyperglycemia, 2 Hyperlipidemia, 3 Hypokalemia, 4 Metabolic Alkalosis, 5 Leukocytosis (Demargination of WBC).
False Positive for 1 mg Overnight Dexamethasone Suppression test?
False Positive for 1 mg Overnight Dexamethasone Suppression test - bbbb1 Depression, bbbb2 Alcoholism, bbbb3 Obesity
What is 24 Hour Urine Cortisol Lx? for what disorder?
Hypercortisolism Lx - General (1 Establish Presence of Hypercortisolism. 2 Establish Cause of Hypercortisolism). 1 Establish Presence (aaa Best Initial Lx - 24 Hour Urine Cortisol - Confirmatory. bbb 1 mg Overnight Dexamethasone Suppression Test (Normal - Suppress Morning Cortisol level. False Positive for 1 mg Overnight Dexamethasone Suppression test - bbbb1 Depression, bbbb2 Alcoholism, bbbb3 Obesity)). 2 Establish Cause of Hypercortisolism (aaa Best Initial Lx - ACTH testing [Elevated ACTH - Pituitary or Ectopic in Lung Cancer or Carcinoid. Decreased ACTH means Adrenal Source.], bbb MRI, ccc Inferior Petrosal Sinus Venous Drainage for ACTH sample after CRH Stimulation, ddd Scan Chest for ACTH source. Confirm Source of Hypercortisolism with Biochemical tests before Performing Imaging studies. Other Lx - Cortisol is Stress Hormone (Anti-Insulin, Aldosterone-Like effect - Excrete Potassium and Hydrogen Ion). Hypercortisolism effects - 1 Hyperglycemia, 2 Hyperlipidemia, 3 Hypokalemia, 4 Metabolic Alkalosis, 5 Leukocytosis (Demargination of WBC).
What is 1 mg Overnight Dexamethasone Suppression test? for what disorder?
Hypercortisolism Lx - General (1 Establish Presence of Hypercortisolism. 2 Establish Cause of Hypercortisolism). 1 Establish Presence (aaa Best Initial Lx - 24 Hour Urine Cortisol - Confirmatory. bbb 1 mg Low Dose Overnight Dexamethasone Suppression Test (Normal - Suppress Morning Cortisol level. False Positive for 1 mg Low Dose Overnight Dexamethasone Suppression test - bbbb1 Depression, bbbb2 Alcoholism, bbbb3 Obesity)). 2 Establish Cause of Hypercortisolism (aaa Best Initial Lx - ACTH testing [Elevated ACTH - Pituitary or Ectopic in Lung Cancer or Carcinoid. Decreased ACTH means Adrenal Source.], bbb MRI, ccc Inferior Petrosal Sinus Venous Drainage for ACTH sample after CRH Stimulation, ddd Scan Chest for ACTH source. Confirm Source of Hypercortisolism with Biochemical tests before Performing Imaging studies. Other Lx - Cortisol is Stress Hormone (Anti-Insulin, Aldosterone-Like effect - Excrete Potassium and Hydrogen Ion). Hypercortisolism effects - 1 Hyperglycemia, 2 Hyperlipidemia, 3 Hypokalemia, 4 Metabolic Alkalosis, 5 Leukocytosis (Demargination of WBC).
What is ACTH testing? for what disorder?
Hypercortisolism Lx - General (1 Establish Presence of Hypercortisolism. 2 Establish Cause of Hypercortisolism). 1 Establish Presence (aaa Best Initial Lx - 24 Hour Urine Cortisol - Confirmatory. bbb 1 mg Overnight Dexamethasone Suppression Test (Normal - Suppress Morning Cortisol level. False Positive for 1 mg Overnight Dexamethasone Suppression test - bbbb1 Depression, bbbb2 Alcoholism, bbbb3 Obesity)). 2 Establish Cause of Hypercortisolism (aaa Best Initial Lx - ACTH testing [Elevated ACTH - Pituitary or Ectopic in Lung Cancer or Carcinoid. Decreased ACTH means Adrenal Source.], bbb MRI, ccc Inferior Petrosal Sinus Venous Drainage for ACTH sample after CRH Stimulation, ddd Scan Chest for ACTH source. Confirm Source of Hypercortisolism with Biochemical tests before Performing Imaging studies. Other Lx - Cortisol is Stress Hormone (Anti-Insulin, Aldosterone-Like effect - Excrete Potassium and Hydrogen Ion). Hypercortisolism effects - 1 Hyperglycemia, 2 Hyperlipidemia, 3 Hypokalemia, 4 Metabolic Alkalosis, 5 Leukocytosis (Demargination of WBC).
Hypercortisolism. ACTH testing - Low. Dx?
Hypercortisolism. Confirmatory Lx finding for difference Sources (Adrenal, Pituitary, Ectopic). Lx - 1 ACTH testing, 2 Petrosal Sinus testing, 3 High Dose (8 mg) Dexamethasone Suppression test. Adrenal (1 ACTH level - LOW - the only one). Pituitary (2 Petrosal Sinus testing - High ACTH, and 3 High Dose Dexamethasone - Suppression). Ectopic ACTH (2 Petrosal Sinus testing - Low ACTH, and 3 High Dose Dexamethasone - NO Suppression)
Hypercortisolism. ACTH testing - High. Dx?
Hypercortisolism. Confirmatory Lx finding for difference Sources (Adrenal, Pituitary, Ectopic). Lx - 1 ACTH testing, 2 Petrosal Sinus testing, 3 High Dose (8 mg) Dexamethasone Suppression test. Adrenal (1 ACTH level - LOW - the only one). Pituitary (2 Petrosal Sinus testing - High ACTH, and 3 High Dose Dexamethasone - Suppression). Ectopic ACTH (2 Petrosal Sinus testing - Low ACTH, and 3 High Dose Dexamethasone - NO Suppression)
What is Inferior Petrosal Sinus sample testing? for what disorder?
Hypercortisolism Lx - General (1 Establish Presence of Hypercortisolism. 2 Establish Cause of Hypercortisolism). 1 Establish Presence (aaa Best Initial Lx - 24 Hour Urine Cortisol - Confirmatory. bbb 1 mg Overnight Dexamethasone Suppression Test (Normal - Suppress Morning Cortisol level. False Positive for 1 mg Overnight Dexamethasone Suppression test - bbbb1 Depression, bbbb2 Alcoholism, bbbb3 Obesity)). 2 Establish Cause of Hypercortisolism (aaa Best Initial Lx - ACTH testing [Elevated ACTH - Pituitary or Ectopic in Lung Cancer or Carcinoid. Decreased ACTH means Adrenal Source.], bbb MRI, ccc Inferior Petrosal Sinus Venous Drainage for ACTH sample after CRH Stimulation, ddd Scan Chest for ACTH source. Confirm Source of Hypercortisolism with Biochemical tests before Performing Imaging studies. Other Lx - Cortisol is Stress Hormone (Anti-Insulin, Aldosterone-Like effect - Excrete Potassium and Hydrogen Ion). Hypercortisolism effects - 1 Hyperglycemia, 2 Hyperlipidemia, 3 Hypokalemia, 4 Metabolic Alkalosis, 5 Leukocytosis (Demargination of WBC).
Hypercortisolism. Presence Confirmatory lx? Source Confirmatory lx?
Hypercortisolism. Presence Confirmatory lx - 24 Hour Urine Cortisol level. Source Confirmatory lx - 1 Petrosal Sinus Venous Sampling, 2 High Dose (8 mg) Dexamethasone Suppression testing.
Hypercortisolism. Confirmatory Lx finding for difference Sources?
Hypercortisolism. Confirmatory Lx finding for difference Sources (Adrenal, Pituitary, Ectopic). Lx - 1 ACTH testing, 2 Petrosal Sinus testing, 3 High Dose (8 mg) Dexamethasone Suppression test. Adrenal (1 ACTH level - LOW - the only one). Pituitary (2 Petrosal Sinus testing - High ACTH, and 3 High Dose Dexamethasone - Suppression). Ectopic ACTH (2 Petrosal Sinus testing - Low ACTH, and 3 High Dose Dexamethasone - NO Suppression)
Contrast Cushing Syndrome and Cushing Disease.
Contrast Cushing Syndrome (any Hypercortisolism, including Cushing Disease) and Cushing Disease (Pituitary ACTH overproduction).
Hypercortisolism. ACTH testing - High. Petrosal Sinus Sample - High. Dx?
Hypercortisolism. Confirmatory Lx finding for difference Sources (Adrenal, Pituitary, Ectopic). Lx - 1 ACTH testing, 2 Petrosal Sinus testing, 3 High Dose (8 mg) Dexamethasone Suppression test. Adrenal (1 ACTH level - LOW - the only one). Pituitary (2 Petrosal Sinus testing - High ACTH, and 3 High Dose Dexamethasone - Suppression). Ectopic ACTH (2 Petrosal Sinus testing - Low ACTH, and 3 High Dose Dexamethasone - NO Suppression)
Hypercortisolism. ACTH testing - High. Petrosal Sinus Sample - Low. Dx?
Hypercortisolism. Confirmatory Lx finding for difference Sources (Adrenal, Pituitary, Ectopic). Lx - 1 ACTH testing, 2 Petrosal Sinus testing, 3 High Dose (8 mg) Dexamethasone Suppression test. Adrenal (1 ACTH level - LOW - the only one). Pituitary (2 Petrosal Sinus testing - High ACTH, and 3 High Dose Dexamethasone - Suppression). Ectopic ACTH (2 Petrosal Sinus testing - Low ACTH, and 3 High Dose Dexamethasone - NO Suppression)
Hypercortisolism. ACTH testing - High. High Dose Dexamethasone - Supression. Dx?
Hypercortisolism. Confirmatory Lx finding for difference Sources (Adrenal, Pituitary, Ectopic). Lx - 1 ACTH testing, 2 Petrosal Sinus testing, 3 High Dose (8 mg) Dexamethasone Suppression test. Adrenal (1 ACTH level - LOW - the only one). Pituitary (2 Petrosal Sinus testing - High ACTH, and 3 High Dose Dexamethasone - Suppression). Ectopic ACTH (2 Petrosal Sinus testing - Low ACTH, and 3 High Dose Dexamethasone - NO Suppression)
What is name for Chronic Hypoadrenalism?
Name for Chronic Hypoadrenalism - Addison Disease (Add K - HyperKalemia. Low Blood Pressure) - Decrease Cortisol.
What is name for Acute Hypoadrenalism?
Name for Acute Hypoadrenalism (Adrenal Insufficiency) - Adrenal Crisis
Electrolyte inbalance in Primary Hyperaldosterone?
Electrolyte inbalance in Primary Hyperaldosterone - (Absence - HypoKalemia. High Blood Pressure).
Blood Pressure and electrolyte relation?
Blood Pressure and electrolyte relation - Body Increase Sodium (Na) to Increase Blood Pressure, and Decrease Potassium (K). Aldosterone Increase Sodium (Na) and Decrease Potassium (K).
Hypoadrenalism. Etiology? Px? Lx? Tx?
Hypoadrenalism. Etiology - Addison disease (Chronic Hypoadrenalism) cause by - 1 Autoimmune Destruction of gland, 2 Infection (Tb), 3 Adrenoleukodystrophy (X-linked Recessive, Children, HypoAdrenalism, UMN lesion - Spasticity, Hearing Loss, School Performance Decrease), 4 Metastatic Cancer to Adrenal Gland. Acute Adrenal Crisis (Acute Adrenal Insufficiency) caused by - 1 Hemorrhage, 2 Surgery, 3 Hypotension, 4 Trauma that Rapidly Destroys gland, 5 Chronic High Dose Prednisone (Steroid) use Sudden Removal, 6 Loss of Pituitary (Rare) - Aldosterone is not controlled by ACTH. Px - 1 Weakness, 2 Fatigue, 3 Altered Mental Status, 4 Nausea and Vomiting, 5 Anorexia, 6 Hypotension, 7 Hyponatremia (Decrease Aldosterone), 8 Hyperkalemia (Metabolic Acidosis). They present in both Acute and Chronic. 9 Hyperpigmentation from Chronic Adrenal Insufficiency - a longer period. Acute Adrenal Crisis - 1 Profound Hypotension, 2 Fever, 3 Confusion, and 4 Coma. Lx (Cortisol, Glucose, Sodium go same direction) - 1 HypoGlycemia, 2 HyperKalemia, 3 Metabolic Acidosis, 4 Hyponatremia, 5 High BUN. Hypoadrenalism - Pituitary Failure - ACTH Low. Hypoadrenalism - High ACTH - Adrenal Insufficiency (Primary Adrenal Failure). 6 Cosyntropin Stimulation Test (Cosyntropin is Synthetic ACTH. Normal - Cosyntropin Increase Cortisol.) 7 Eosinophilia is common in Hypoadrenalism. Tx (Tx is more important than testing in Acute Adrenal Crisis) - 1 Replace Steroids with Hydrocortisone IV (Glucocorticoid. Life Saver), 2 Fludrocortisone (Steroid Hormone High in Mineralocorticoid or Aldosterone-like Effect. Use in Postural Instability. Mineralocorticoid supplements should be used in Primary Adrenal Insufficiency when pt is on Oral Steroids such as Cortisone.)
Hypoadrenalism. Etiology?
Hypoadrenalism. Etiology - Addison disease (Chronic Hypoadrenalism) cause by - 1 Autoimmune Destruction of gland, 2 Infection (Tb), 3 Adrenoleukodystrophy (X-linked Recessive, Children, HypoAdrenalism, UMN lesion - Spasticity, Hearing Loss, School Performance Decrease), 4 Metastatic Cancer to Adrenal Gland. Acute Adrenal Crisis (Acute Adrenal Insufficiency) caused by - 1 Hemorrhage, 2 Surgery, 3 Hypotension, 4 Trauma that Rapidly Destroys gland, 5 Chronic High Dose Prednisone (Steroid) use Sudden Removal, 6 Loss of Pituitary (Rare) - Aldosterone is not controlled by ACTH.
Hypoadrenalism. Px?
Hypoadrenalism. Px - 1 Weakness, 2 Fatigue, 3 Altered Mental Status, 4 Nausea and Vomiting, 5 Anorexia, 6 Hypotension, 7 Hyponatremia (Decrease Aldosterone), 8 Hyperkalemia (Metabolic Acidosis). They present in both Acute and Chronic. 9 Hyperpigmentation from Chronic Adrenal Insufficiency - a longer period. Acute Adrenal Crisis - 1 Profound Hypotension, 2 Fever, 3 Confusion, and 4 Coma.
Hypoadrenalism. Lx?
Hypoadrenalism. Lx (Cortisol, Glucose, Sodium go same direction) - 1 HypoGlycemia, 2 HyperKalemia, 3 Metabolic Acidosis, 4 Hyponatremia, 5 High BUN. Hypoadrenalism - Pituitary Failure - ACTH Low. Hypoadrenalism - High ACTH - Adrenal Insufficiency (Primary Adrenal Failure). 6 Cosyntropin Stimulation Test (Cosyntropin is Synthetic ACTH. Normal - Cosyntropin Increase Cortisol.) 7 Eosinophilia is common in Hypoadrenalism.
Hypoadrenalism. Tx?
Hypoadrenalism. Tx (Tx is more important than testing in Acute Adrenal Crisis) - 1 Replace Steroids with Hydrocortisone IV (Glucocorticoid. Life Saver), 2 Fludrocortisone (Steroid Hormone High in Mineralocorticoid or Aldosterone-like Effect. Use in Postural Instability. Mineralocorticoid supplements should be used in Primary Adrenal Insufficiency when pt is on Oral Steroids such as Cortisone.)
Describe Adrenoleukodystrophy
Adrenoleukodystrophy (X-linked Recessive, Children, HypoAdrenalism, UMN lesion - Spasticity, Hearing Loss, School Performance Decrease
UMN lesion general?
UMN lesion - Spasticity
LMN lesion general?
LMN lesion - Flaccid, Weakness
What is Hydrocortisone? Disorder Tx?
Hypoadrenalism. Tx (Tx is more important than testing in Acute Adrenal Crisis) - 1 Replace Steroids with Hydrocortisone IV (Glucocorticoid. Life Saver), 2 Fludrocortisone (Steroid Hormone High in Mineralocorticoid or Aldosterone-like Effect. Use in Postural Instability. Mineralocorticoid supplements should be used in Primary Adrenal Insufficiency when pt is on Oral Steroids such as Cortisone.)
What is Fludrocortisone? Disorder Tx?
Hypoadrenalism. Tx (Tx is more important than testing in Acute Adrenal Crisis) - 1 Replace Steroids with Hydrocortisone IV (Glucocorticoid. Life Saver), 2 Fludrocortisone (Steroid Hormone High in Mineralocorticoid or Aldosterone-like Effect. Use in Postural Instability. Mineralocorticoid supplements should be used in Primary Adrenal Insufficiency when pt is on Oral Steroids such as Cortisone - older Hydrocortisone.)
Medication with High Glucocorticoid activity? Disorder Tx?
Hypoadrenalism. Tx (Tx is more important than testing in Acute Adrenal Crisis) - 1 Replace Steroids with Hydrocortisone IV (Glucocorticoid. Life Saver), 2 Fludrocortisone (Steroid Hormone High in Mineralocorticoid or Aldosterone-like Effect. Use in Postural Instability. Mineralocorticoid supplements should be used in Primary Adrenal Insufficiency when pt is on Oral Steroids such as Cortisone - older Hydrocortisone.)
Medication with High Mineralocorticoid activity? Disorder Tx?
Hypoadrenalism. Tx (Tx is more important than testing in Acute Adrenal Crisis) - 1 Replace Steroids with Hydrocortisone IV (Glucocorticoid. Life Saver), 2 Fludrocortisone (Steroid Hormone High in Mineralocorticoid or Aldosterone-like Effect. Use in Postural Instability. Mineralocorticoid supplements should be used in Primary Adrenal Insufficiency when pt is on Oral Steroids such as Cortisone - older Hydrocortisone.)
What is Primary Adrenal Failure? Lx?
Primary Adrenal Failure - Adrenal gland problem - 1 High ACTH, 2 Pigmentation. Secondary Adrenal Insufficiency - Pituitary Failure - 1 Low ACTH, 2 No Pigmentation. Tertiary Adrenal Insufficiency - Hypothalamus Failure - 1 Low ACTH, 2 No Pigmentation
What is Secondary Adrenal Failure? Lx?
Primary Adrenal Failure - Adrenal gland problem - 1 High ACTH, 2 Pigmentation. Secondary Adrenal Insufficiency - Pituitary Failure - 1 Low ACTH, 2 No Pigmentation. Tertiary Adrenal Insufficiency - Hypothalamus Failure - 1 Low ACTH, 2 No Pigmentation
What is Tertiary Adrenal Failure? Lx?
Primary Adrenal Failure - Adrenal gland problem - 1 High ACTH, 2 Pigmentation. Secondary Adrenal Insufficiency - Pituitary Failure - 1 Low ACTH, 2 No Pigmentation. Tertiary Adrenal Insufficiency - Hypothalamus Failure - 1 Low ACTH, 2 No Pigmentation
What is Adrenal Gland Failure? Lx?
Primary Adrenal Failure - Adrenal gland problem - 1 High ACTH, 2 Pigmentation. Secondary Adrenal Insufficiency - Pituitary Failure - 1 Low ACTH, 2 No Pigmentation. Tertiary Adrenal Insufficiency - Hypothalamus Failure - 1 Low ACTH, 2 No Pigmentation
What is Pituitary Failure for hypoadrenalism? Lx?
Primary Adrenal Failure - Adrenal gland problem - 1 High ACTH, 2 Pigmentation. Secondary Adrenal Insufficiency - Pituitary Failure - 1 Low ACTH, 2 No Pigmentation. Tertiary Adrenal Insufficiency - Hypothalamus Failure - 1 Low ACTH, 2 No Pigmentation
What is Hypothalamus Failure for hypoadrenalism? Lx?
Primary Adrenal Failure - Adrenal gland problem - 1 High ACTH, 2 Pigmentation. Secondary Adrenal Insufficiency - Pituitary Failure - 1 Low ACTH, 2 No Pigmentation. Tertiary Adrenal Insufficiency - Hypothalamus Failure - 1 Low ACTH, 2 No Pigmentation
Why does Hydrocortisone Increase blood pressure?
Hydrocortisone Increase blood pressure - Permissive Effect of Glucocorticoids on Vascular Reactivity effect of Catecholamines. BP comes up fast with steroids because norepinephrine will be more effective in Constricting blood vessels.
What is name for Primary Hyperaldosteronism?
Name for Primary Hyperaldosteronism - Conn's Syndrome
What is name for Conn's Syndrome?
Name for Primary Hyperaldosteronism - Conn's Syndrome
Primary Aldosteronism. Etiology? Px? Lx? Tx?
Primary Aldosteronism. Etiology - Autonomous Overproduction of 1 Aldosterone Despite a 2 High Pressure with 3 Low Renin Activity (Renin Secreting Tumore has High Renin) cause by - 1 Solitary Adenoma (Tx Surgery), 2 Bilateral Hyperplasia (Tx Spironolactone), 3 Rarely Malignant. Px - 1 High Blood Pressure - Secondary Hypertension (1 Under 30 or Over 60 year age, 2 Uncontrolled with Two Antihypertensive medications, 3 Characteristics finding on Hx, Physical, or Lx), 2 Low Potassium - HypoKalemia (Symptom - 1 Muscular Weakness, or 2 Diabetes Insipidus from HypoKalemia). High Blood Pressure + HypoKalemia is Primary Hyperaldosteronism. Lx - Best Initial - 1 Measure Ratio of Plasma Aldosterone to Plasma Renin (Elevated Plasma Renin Excludes Primary Hyperaldosteronism). Most Accurate - Confirm Presence of Unilateral Adenoma - Sample of Venous Blood Draining the Adrenal - High Aldosterone Level. (High Aldosterone - with Salt Loading Normal Saline). CT scan After Biochemical testings confirms (1 Low Potassium, 2 High Aldosterone despite a High-Salt diet, 3 Low Plasma Renin level). Tx - 1 Unilateral Adenoma - Resect by Laparoscopy, 2 Bilateral Hyperplasia - Eplerenone or Spironolactone. Spironolactone AE - Gynecomastia and Decreased Libido because it is AntiAndrogenic.
Primary Aldosteronism. Etiology?
Primary Aldosteronism. Etiology - Autonomous Overproduction of 1 Aldosterone Despite a 2 High Pressure with 3 Low Renin Activity (Renin Secreting Tumore has High Renin) cause by - 1 Solitary Adenoma (Tx Surgery), 2 Bilateral Hyperplasia (Tx Spironolactone), 3 Rarely Malignant.
Primary Aldosteronism. Px?
Primary Aldosteronism. Px - 1 High Blood Pressure - Secondary Hypertension (1 Under 30 or Over 60 year age, 2 Uncontrolled with Two Antihypertensive medications, 3 Characteristics finding on Hx, Physical, or Lx), 2 Low Potassium - HypoKalemia (Symptom - 1 Muscular Weakness, or 2 Diabetes Insipidus from HypoKalemia). High Blood Pressure + HypoKalemia is Primary Hyperaldosteronism.
Primary Aldosteronism. Lx?
Primary Aldosteronism. Lx - Best Initial - 1 Measure Ratio of Plasma Aldosterone to Plasma Renin (Elevated Plasma Renin Excludes Primary Hyperaldosteronism). Most Accurate - Confirm Presence of Unilateral Adenoma - Sample of Venous Blood Draining the Adrenal - High Aldosterone Level. (High Aldosterone - with Salt Loading Normal Saline). CT scan After Biochemical testings confirms (1 Low Potassium, 2 High Aldosterone despite a High-Salt diet, 3 Low Plasma Renin level).
Primary Aldosteronism. Tx?
Primary Aldosteronism. Tx - 1 Unilateral Adenoma - Resect by Laparoscopy, 2 Bilateral Hyperplasia - Eplerenone or Spironolactone. Spironolactone AE - Gynecomastia and Decreased Libido because it is AntiAndrogenic.
What is Ratio of Plasma Aldosterone to Renin? For what disorder?
Primary Aldosteronism. Lx - Best Initial - 1 Measure Ratio of Plasma Aldosterone to Plasma Renin (Elevated Plasma Renin Excludes Primary Hyperaldosteronism). Most Accurate - Confirm Presence of Unilateral Adenoma - Sample of Venous Blood Draining the Adrenal - High Aldosterone Level. (High Aldosterone - with Salt Loading Normal Saline). CT scan After Biochemical testings confirms (1 Low Potassium, 2 High Aldosterone despite a High-Salt diet, 3 Low Plasma Renin level).
What is Sample of Venous Blood Draining the Adrenal with Salt Loading Normal Saline? For what disorder?
Primary Aldosteronism. Lx - Best Initial - 1 Measure Ratio of Plasma Aldosterone to Plasma Renin (Elevated Plasma Renin Excludes Primary Hyperaldosteronism). Most Accurate - Confirm Presence of Unilateral Adenoma - Sample of Venous Blood Draining the Adrenal - High Aldosterone Level. (High Aldosterone - with Salt Loading Normal Saline). CT scan After Biochemical testings confirms (1 Low Potassium, 2 High Aldosterone despite a High-Salt diet, 3 Low Plasma Renin level).
Low Potassium, High Aldosterone despite a High-Salt diet, Low Plasma Renin level. Dx?
Primary Aldosteronism. Lx - Best Initial - 1 Measure Ratio of Plasma Aldosterone to Plasma Renin (Elevated Plasma Renin Excludes Primary Hyperaldosteronism). Most Accurate - Confirm Presence of Unilateral Adenoma - Sample of Venous Blood Draining the Adrenal - High Aldosterone Level. (High Aldosterone - with Salt Loading Normal Saline). CT scan After Biochemical testings confirms (1 Low Potassium, 2 High Aldosterone despite a High-Salt diet, 3 Low Plasma Renin level).
What is Aldosterone Antagonist medication?
Primary Aldosteronism. Bilateral Hyperplasia - Aldosterone Antagonist (Eplerenone or Spironolactone). Spironolactone AE - Gynecomastia and Decreased Libido because it is AntiAndrogenic.
What is Eplerenone? Disorder Tx?
Primary Aldosteronism. Bilateral Hyperplasia - Aldosterone Antagonist (Eplerenone or Spironolactone). Spironolactone AE - Gynecomastia and Decreased Libido because it is AntiAndrogenic.
What is Spironolactone? AE? Disorder Tx?
Primary Aldosteronism. Bilateral Hyperplasia - Aldosterone Antagonist (Eplerenone or Spironolactone). Spironolactone AE - Gynecomastia and Decreased Libido because it is AntiAndrogenic.
How to know Secondary Hypertension?
Primary Aldosteronism. Secondary Hypertension (1 Under 30 or Over 60 year age, 2 Uncontrolled with Two Antihypertensive medications, 3 Characteristics finding on Hx, Physical, or Lx), 2 Low Potassium - HypoKalemia (Symptom - 1 Muscular Weakness, or 2 Diabetes Insipidus from HypoKalemia). High Blood Pressure + HypoKalemia is Primary Hyperaldosteronism.
What is RAA pathway?
RAA pathway is 1 Renin, 2 AngiotensinII (ACEI works on this step), 3 Aldosterone to Increase Blood Pressure
Hypokalemia, Metabolic Alkalosis, Hyperaldosterone. Causes?
Hypokalemia, Metabolic Alkalosis, Hyperaldosterone. Causes - 1 Diuretic Use, 2 Vomiting, 3 Primary HyperAldosteronism, 4 Barter Syndrome, 5 Renin Secreting Tumor.
Contrast Diuretic Use, Vomiting, Bartter Syndrome, Renin Secreting Tumor, Primary Hyperaldosteronism.
Lx - Blood Pressure, Sodium, Renin, Urine Chloride. Contrast Diuretic Use (High Renin, Urine Chloride Greater than 20), Vomiting (High Renin, Urine Chloride LESS than 10 - the only one), Bartter Syndrome (High Renin, Urine Chloride Greater than 40 - Very High), Renin Secreting Tumor (HTN, Sodium Greater than 140, High Renin, Urine Chloride Greater than 40 - Very High), Primary Hyperaldosteronism(HTN, Sodium Greater than 140, LOW Renin - the only one, Urine Chloride Greater than 40 - Very High).
High Blood Pressure, Hypokalemia. Dx?
High Blood Pressure, Hypokalemia. Dx - Primary Aldosteronism.
Hypokalemia symptom - general?
Hypokalemia symptom - general - Low Potassium - HypoKalemia Symptom - 1 Muscular Weakness, or 2 Diabetes Insipidus from HypoKalemia
What is Metanephrines? In what disorder?
Pheochromocytoma - Metanephrines of Blood or Urine, 2 Hyperaldosteronism - Renin and Aldosterone levels, 3 Hypercortisolism - 1 mg Overnight Dexamethasone Suppression test)
Renin and Aldosterone levels. Dx?
Pheochromocytoma - Metanephrines of Blood or Urine, 2 Hyperaldosteronism - Renin and Aldosterone levels, 3 Hypercortisolism - 1 mg Overnight Dexamethasone Suppression test)
1 mg Overnight Dexamethasone. Dx?
Pheochromocytoma - Metanephrines of Blood or Urine, 2 Hyperaldosteronism - Renin and Aldosterone levels, 3 Hypercortisolism - 1 mg Overnight Dexamethasone Suppression test)
Lx - Blood Pressure - Low, Sodium - Low, Renin - High, Urine Chloride - 22. Dx?
Lx - Blood Pressure, Sodium, Renin, Urine Chloride. Contrast Diuretic Use (High Renin, Urine Chloride Greater than 20), Vomiting (High Renin, Urine Chloride LESS than 10 - the only one), Bartter Syndrome (High Renin, Urine Chloride Greater than 40 - Very High), Renin Secreting Tumor (HTN, Sodium Greater than 140, High Renin, Urine Chloride Greater than 40 - Very High), Primary Hyperaldosteronism(HTN, Sodium Greater than 140, LOW Renin - the only one, Urine Chloride Greater than 40 - Very High).
Lx - Blood Pressure - Normal, Sodium - Low, Renin - High, Urine Chloride - 8. Dx?
Lx - Blood Pressure, Sodium, Renin, Urine Chloride. Contrast Diuretic Use (High Renin, Urine Chloride Greater than 20), Vomiting (High Renin, Urine Chloride LESS than 10 - the only one), Bartter Syndrome (High Renin, Urine Chloride Greater than 40 - Very High), Renin Secreting Tumor (HTN, Sodium Greater than 140, High Renin, Urine Chloride Greater than 40 - Very High), Primary Hyperaldosteronism(HTN, Sodium Greater than 140, LOW Renin - the only one, Urine Chloride Greater than 40 - Very High).
Lx - Blood Pressure - Low, Sodium - Normal, Renin - High, Urine Chloride - 42. Dx?
Lx - Blood Pressure, Sodium, Renin, Urine Chloride. Contrast Diuretic Use (High Renin, Urine Chloride Greater than 20), Vomiting (High Renin, Urine Chloride LESS than 10 - the only one), Bartter Syndrome (High Renin, Urine Chloride Greater than 40 - Very High), Renin Secreting Tumor (HTN, Sodium Greater than 140, High Renin, Urine Chloride Greater than 40 - Very High), Primary Hyperaldosteronism(HTN, Sodium Greater than 140, LOW Renin - the only one, Urine Chloride Greater than 40 - Very High).
Lx - Blood Pressure - High, Sodium - 143, Renin - High, Urine Chloride - 42. Dx?
Lx - Blood Pressure, Sodium, Renin, Urine Chloride. Contrast Diuretic Use (High Renin, Urine Chloride Greater than 20), Vomiting (High Renin, Urine Chloride LESS than 10 - the only one), Bartter Syndrome (High Renin, Urine Chloride Greater than 40 - Very High), Renin Secreting Tumor (HTN, Sodium Greater than 140, High Renin, Urine Chloride Greater than 40 - Very High), Primary Hyperaldosteronism(HTN, Sodium Greater than 140, LOW Renin - the only one, Urine Chloride Greater than 40 - Very High).
Lx - Blood Pressure - High, Sodium - 141, Renin - Low, Urine Chloride - 41. Dx?
Lx - Blood Pressure, Sodium, Renin, Urine Chloride. Contrast Diuretic Use (High Renin, Urine Chloride Greater than 20), Vomiting (High Renin, Urine Chloride LESS than 10 - the only one), Bartter Syndrome (High Renin, Urine Chloride Greater than 40 - Very High), Renin Secreting Tumor (HTN, Sodium Greater than 140, High Renin, Urine Chloride Greater than 40 - Very High), Primary Hyperaldosteronism(HTN, Sodium Greater than 140, LOW Renin - the only one, Urine Chloride Greater than 40 - Very High).
NonMalignant lesion of Adrenal Medulla. Produce Catecholamines despite High blood pressure. Dx?
NonMalignant lesion of Adrenal Medulla. Produce Catecholamines despite High blood pressure. Dx - Pheochromocytoma
What is Pheochromocytoma?
NonMalignant lesion of Adrenal Medulla. Produce Catecholamines despite High blood pressure. Dx?
Pheochromocytoma. Px? Lx? Tx?
Pheochromocytoma. NonMalignant lesion of Adrenal Medulla. Produce Catecholamines despite High blood pressure. Px - 1 Hypertension - Episodic, 2 Headache, 3 Sweating or Diaphoresis, 4 Palpitations and Tremor. Lx - Best Initial - 1 Free Metanephrines in Plasma. 2 Confirm - 24 Hour Urine Metanephrines (More Sensitive than 3 Urine Vanillylmandelic Acid level.) 4 Direct measurement of Epinephrine and Norepinephrine are useful as well. Most Accurate - 5 Imaging of Adrenal Glands with aaa CT or bbb MRI (after biochemical testing). 6 MIBG Scanning (MetaIodoBenzylGuanidine. Nuclear Isotope detects Outside of Adrenal Gland - Occult Lesion). Tx - Best Initial - 1 Phenoxybenzamine (Irreversible Alpha Blocker). 2 Calcium Channel Blocker and 3 Beta Blockers are used afterwards. 4 Surgery (Only after blood pressure Stabilization) or 5 Laparoscopy.
Pheochromocytoma. Px?
Pheochromocytoma. NonMalignant lesion of Adrenal Medulla. Produce Catecholamines despite High blood pressure. Px - 1 Hypertension - Episodic, 2 Headache, 3 Sweating or Diaphoresis, 4 Palpitations and Tremor.
Pheochromocytoma. Lx?
Pheochromocytoma. Lx - Best Initial - 1 Free Metanephrines in Plasma. 2 Confirm - 24 Hour Urine Metanephrines (More Sensitive than 3 Urine Vanillylmandelic Acid level.) 4 Direct measurement of Epinephrine and Norepinephrine are useful as well. Most Accurate - 5 Imaging of Adrenal Glands with aaa CT or bbb MRI (after biochemical testing). 6 MIBG Scanning (MetaIodoBenzylGuanidine. Nuclear Isotope detects Outside of Adrenal Gland - Occult Lesion).
Pheochromocytoma. Tx?
Pheochromocytoma. Tx - Best Initial - 1 Phenoxybenzamine (Irreversible Alpha Blocker). 2 Calcium Channel Blocker and 3 Beta Blockers are used afterwards. 4 Surgery (Only after blood pressure Stabilization) or 5 Laparoscopy.
Free Metanephrines in Plasma. Dx?
Pheochromocytoma. Lx - Best Initial - 1 Free Metanephrines in Plasma. 2 Confirm - 24 Hour Urine Metanephrines (More Sensitive than 3 Urine Vanillylmandelic Acid level.) 4 Direct measurement of Epinephrine and Norepinephrine are useful as well. Most Accurate - 5 Imaging of Adrenal Glands with aaa CT or bbb MRI (after biochemical testing). 6 MIBG Scanning (MetaIodoBenzylGuanidine. Nuclear Isotope detects Outside of Adrenal Gland - Occult Lesion).
24 Hour Urine Metanephrines. Dx?
Pheochromocytoma. Lx - Best Initial - 1 Free Metanephrines in Plasma. 2 Confirm - 24 Hour Urine Metanephrines (More Sensitive than 3 Urine Vanillylmandelic Acid level.) 4 Direct measurement of Epinephrine and Norepinephrine are useful as well. Most Accurate - 5 Imaging of Adrenal Glands with aaa CT or bbb MRI (after biochemical testing). 6 MIBG Scanning (MetaIodoBenzylGuanidine. Nuclear Isotope detects Outside of Adrenal Gland - Occult Lesion).
Urine Vanillylmandelic Acid level. Dx?
Pheochromocytoma. Lx - Best Initial - 1 Free Metanephrines in Plasma. 2 Confirm - 24 Hour Urine Metanephrines (More Sensitive than 3 Urine Vanillylmandelic Acid level.) 4 Direct measurement of Epinephrine and Norepinephrine are useful as well. Most Accurate - 5 Imaging of Adrenal Glands with aaa CT or bbb MRI (after biochemical testing). 6 MIBG Scanning (MetaIodoBenzylGuanidine. Nuclear Isotope detects Outside of Adrenal Gland - Occult Lesion).
Direct measurement of Epinephrine and Norepinephrine. Dx?
Pheochromocytoma. Lx - Best Initial - 1 Free Metanephrines in Plasma. 2 Confirm - 24 Hour Urine Metanephrines (More Sensitive than 3 Urine Vanillylmandelic Acid level.) 4 Direct measurement of Epinephrine and Norepinephrine are useful as well. Most Accurate - 5 Imaging of Adrenal Glands with aaa CT or bbb MRI (after biochemical testing). 6 MIBG Scanning (MetaIodoBenzylGuanidine. Nuclear Isotope detects Outside of Adrenal Gland - Occult Lesion).
MIBG test. Dx?
Pheochromocytoma. Lx - Best Initial - 1 Free Metanephrines in Plasma. 2 Confirm - 24 Hour Urine Metanephrines (More Sensitive than 3 Urine Vanillylmandelic Acid level.) 4 Direct measurement of Epinephrine and Norepinephrine are useful as well. Most Accurate - 5 Imaging of Adrenal Glands with aaa CT or bbb MRI (after biochemical testing). 6 MIBG Scanning (MetaIodoBenzylGuanidine. Nuclear Isotope detects Outside of Adrenal Gland - Occult Lesion).
Metaiodobenzylguanidine test. Dx?
Pheochromocytoma. Lx - Best Initial - 1 Free Metanephrines in Plasma. 2 Confirm - 24 Hour Urine Metanephrines (More Sensitive than 3 Urine Vanillylmandelic Acid level.) 4 Direct measurement of Epinephrine and Norepinephrine are useful as well. Most Accurate - 5 Imaging of Adrenal Glands with aaa CT or bbb MRI (after biochemical testing). 6 MIBG Scanning (MetaIodoBenzylGuanidine. Nuclear Isotope detects Outside of Adrenal Gland - Occult Lesion).
Alpha Blockers? Tx of disorder?
Alpha Blockers (Phenoxybenzamine - Irreversible. Phentolamine - Reversible). Tx of disorder - Phenoxybenzamine for Pheochromocytoma.
What is Phenoxybenzamine? Tx of disorder?
Alpha Blockers (Phenoxybenzamine - Irreversible. Phentolamine - Reversible). Tx of disorder - Phenoxybenzamine for Pheochromocytoma.
What is Phentolamine? Tx of disorder?
Alpha Blockers (Phenoxybenzamine - Irreversible. Phentolamine - Reversible). Tx of disorder - Phenoxybenzamine for Pheochromocytoma.
How is Diabetes Mellitus defined?
Diabetes Mellitus defined as Persistently High Fasting Glucose levels Greater than 125 on at Least 2 Separate Occasions.
Contrast DM1 and DM2.
DM1 (1 Onset - Childhood, 2 Insulin Dependent from Early Age, 3 NOT related to Obesity, 4 Insulin Deficiency, 5 Complication - DKA). DM2 (1 Onset - Adulthood, 2 Directly related to Obesity, 3 Insulin Resistance).
Onset - Childhood. What DM type?
DM1 (1 Onset - Childhood, 2 Insulin Dependent from Early Age, 3 NOT related to Obesity, 4 Insulin Deficiency, 5 Complication - DKA). DM2 (1 Onset - Adulthood, 2 Directly related to Obesity, 3 Insulin Resistance).
Insulin Dependent. What DM type?
DM1 (1 Onset - Childhood, 2 Insulin Dependent from Early Age, 3 NOT related to Obesity, 4 Insulin Deficiency, 5 Complication - DKA). DM2 (1 Onset - Adulthood, 2 Directly related to Obesity, 3 Insulin Resistance).
NOT related to Obesity. What DM type?
DM1 (1 Onset - Childhood, 2 Insulin Dependent from Early Age, 3 NOT related to Obesity, 4 Insulin Deficiency, 5 Complication - DKA). DM2 (1 Onset - Adulthood, 2 Directly related to Obesity, 3 Insulin Resistance).
Insulin Deficiency. What DM type?
DM1 (1 Onset - Childhood, 2 Insulin Dependent from Early Age, 3 NOT related to Obesity, 4 Insulin Deficiency, 5 Complication - DKA). DM2 (1 Onset - Adulthood, 2 Directly related to Obesity, 3 Insulin Resistance).
Onset - Adulthood. What DM type?
DM1 (1 Onset - Childhood, 2 Insulin Dependent from Early Age, 3 NOT related to Obesity, 4 Insulin Deficiency, 5 Complication - DKA). DM2 (1 Onset - Adulthood, 2 Directly related to Obesity, 3 Insulin Resistance).
Directly related to Obesity. What DM type?
DM1 (1 Onset - Childhood, 2 Insulin Dependent from Early Age, 3 NOT related to Obesity, 4 Insulin Deficiency, 5 Complication - DKA). DM2 (1 Onset - Adulthood, 2 Directly related to Obesity, 3 Insulin Resistance).
Insulin Resistance. What DM type?
DM1 (1 Onset - Childhood, 2 Insulin Dependent from Early Age, 3 NOT related to Obesity, 4 Insulin Deficiency, 5 Complication - DKA). DM2 (1 Onset - Adulthood, 2 Directly related to Obesity, 3 Insulin Resistance).
DKA. What DM type?
DM1 (1 Onset - Childhood, 2 Insulin Dependent from Early Age, 3 NOT related to Obesity, 4 Insulin Deficiency, 5 Complication - DKA). DM2 (1 Onset - Adulthood, 2 Directly related to Obesity, 3 Insulin Resistance).
Dibetes Mellitus. Definition? Types? Px? Lx? Tx?
Diabetes Mellitus Defined as Persistently High Fasting Glucose levels Greater than 125 on at Least 2 Separate Occasions. Types - DM1 (1 Onset - Childhood, 2 Insulin Dependent from Early Age, 3 NOT related to Obesity, 4 Insulin Deficiency). DM2 (1 Onset - Adulthood, 2 Directly related to Obesity, 3 Insulin Resistance). Px - 1 Polyuria, 2 Polyphagia, 3 Polydipsia. DM1 - 4 Thinner, 5 DKA, 6 Polyphagia. Both types - 7 Decreased Wound Healing. Lx - 1 Two Fasting Blood Glucose Greater than 125 mg per dL, 2 Single Glucose level About 200 mg per dL with Symptoms, 3 Increased Glucose Level on Oral Glucose Tolerance Testing (greater than 200). 4 Hemoglobin A1c Greater than 6.5 percent (Best test to Follow Response to Therapy over last Several months). Tx - 1 Diet, Exercise, and Weight Loss - control 25 perc of DM2 without medications (Decreasing amount of Adipose Tissue helps Decrease Insulin Resistance.) Exercising Muscle does Not need Insulin. 2 Oral Hypoglycemia Medications - Best Initial - aaa MetfoRmin (Blocks Gluconeogenesis. Contraindicated in Renal Dysfunction because it Accumulate and Cause Metabolic Acidosis.), bbb Sulfonylureas (Increase Insulin Release from Pancreas - Drives Glucose and Increase Obesity), ccc Thiazoladinediones - Glitazones (No Clear Benefit over hypoglycemic medications. Relatively Contraindicated in CHF because Increase Fluid Overload). ddd Nateglinide and repaglinide - similar to Sulfonylureas without Sulfa (Stimulate Insulin Release, similar to Sulfonylureas). eee Alpha Glucosidase Inhibitors - Acarbose, Miglitol (Block Glucose Absorption in Bowel. Add about Half a point Decrease in HgA1c. Cause Flatus, Diarrhea, and Abdominal Pain). fff Incretins - Exenatide, Sitagliptin (Part of mechanism by which Oral Glucose Normally produce a Rise in Insulin and Decrease Glucagon levels. Decrease Gastric Motility and Help in Weight Loss, Decreasing DM2. Exenatide may cause Pancreatitis). ggg Pramlintide (Analog of Amylin protein Secreted Normally with Insulin. Amylin Decreases Gastric Emptying, Decreases Glucagon levels, and Decreases Appetite). hhh Insulin - Glargine [Steady insulin level Entire Day.], NPH [Dose Twice a day] - (Added if Not controlled with oral Hypoglycemia agents). Long Acting Insulin (Glargine, NPH) is combined with Short acting (Lispro, Aspart, Glulisine, Regular insulin). Regular Insulin is Sometimes Used as Short-acting insulin.
Dibetes Mellitus. Px?
Diabetes Mellitus Px - 1 Polyuria, 2 Polyphagia, 3 Polydipsia. DM1 - 4 Thinner, 5 DKA, 6 Polyphagia. Both types - 7 Decreased Wound Healing.
Dibetes Mellitus. Lx?
Diabetes Mellitus Lx - 1 Two Fasting Blood Glucose Greater than 125 mg per dL, 2 Single Glucose level About 200 mg per dL with Symptoms, 3 Increased Glucose Level on Oral Glucose Tolerance Testing (greater than 200). 4 Hemoglobin A1c Greater than 6.5 percent (Best test to Follow Response to Therapy over last Several months).
Dibetes Mellitus. Tx?
Diabetes Mellitus Tx - 1 Diet, Exercise, and Weight Loss - control 25 perc of DM2 without medications (Decreasing amount of Adipose Tissue helps Decrease Insulin Resistance.) Exercising Muscle does Not need Insulin. 2 Oral Hypoglycemia Medications - Best Initial - aaa MetfoRmin (Blocks Gluconeogenesis. Contraindicated in Renal Dysfunction because it Accumulate and Cause Metabolic Acidosis.), bbb Sulfonylureas (Increase Insulin Release from Pancreas - Drives Glucose and Increase Obesity), ccc Thiazoladinediones - Glitazones (No Clear Benefit over hypoglycemic medications. Relatively Contraindicated in CHF because Increase Fluid Overload). ddd Nateglinide and repaglinide - similar to Sulfonylureas without Sulfa (Stimulate Insulin Release, similar to Sulfonylureas). eee Alpha Glucosidase Inhibitors - Acarbose, Miglitol (Block Glucose Absorption in Bowel. Add about Half a point Decrease in HgA1c. Cause Flatus, Diarrhea, and Abdominal Pain). fff Incretins - Exenatide, Sitagliptin (Part of mechanism by which Oral Glucose Normally produce a Rise in Insulin and Decrease Glucagon levels. Decrease Gastric Motility and Help in Weight Loss, Decreasing DM2. Exenatide may cause Pancreatitis). ggg Pramlintide (Analog of Amylin protein Secreted Normally with Insulin. Amylin Decreases Gastric Emptying, Decreases Glucagon levels, and Decreases Appetite). hhh Insulin - Glargine [Steady insulin level Entire Day.], NPH [Dose Twice a day] - (Added if Not controlled with oral Hypoglycemia agents). Long Acting Insulin (Glargine, NPH) is combined with Short acting (Lispro, Aspart, Glulisine, Regular insulin). Regular Insulin is Sometimes Used as Short-acting insulin.
Dibetes Mellitus. Tx - Medications?
Diabetes Mellitus Tx - 2 Oral Hypoglycemia Medications - Best Initial - aaa MetfoRmin (Blocks Gluconeogenesis. Contraindicated in Renal Dysfunction because it Accumulate and Cause Metabolic Acidosis.), bbb Sulfonylureas (Increase Insulin Release from Pancreas - Drives Glucose and Increase Obesity), ccc Thiazoladinediones - Glitazones (No Clear Benefit over hypoglycemic medications. Relatively Contraindicated in CHF because Increase Fluid Overload). ddd Nateglinide and repaglinide - similar to Sulfonylureas without Sulfa (Stimulate Insulin Release, similar to Sulfonylureas). eee Alpha Glucosidase Inhibitors - Acarbose, Miglitol (Block Glucose Absorption in Bowel. Add about Half a point Decrease in HgA1c. Cause Flatus, Diarrhea, and Abdominal Pain). fff Incretins - Exenatide, Sitagliptin (Part of mechanism by which Oral Glucose Normally produce a Rise in Insulin and Decrease Glucagon levels. Decrease Gastric Motility and Help in Weight Loss, Decreasing DM2. Exenatide may cause Pancreatitis). ggg Pramlintide (Analog of Amylin protein Secreted Normally with Insulin. Amylin Decreases Gastric Emptying, Decreases Glucagon levels, and Decreases Appetite). hhh Insulin - Glargine [Steady insulin level Entire Day.], NPH [Dose Twice a day] - (Added if Not controlled with oral Hypoglycemia agents). Long Acting Insulin (Glargine, NPH) is combined with Short acting (Lispro, Aspart, Glulisine, Regular insulin). Regular Insulin is Sometimes Used as Short-acting insulin.
What is Metformin? Function? Tx of Disorder? AE?
Diabetes Mellitus Tx - 2 Oral Hypoglycemia Medications - Best Initial - aaa MetfoRmin (Blocks Gluconeogenesis. Contraindicated in Renal Dysfunction because it Accumulate and Cause Metabolic Acidosis.), bbb Sulfonylureas (Increase Insulin Release from Pancreas - Drives Glucose and Increase Obesity), ccc Thiazoladinediones - Glitazones (No Clear Benefit over hypoglycemic medications. Relatively Contraindicated in CHF because Increase Fluid Overload). ddd Nateglinide and repaglinide - similar to Sulfonylureas without Sulfa (Stimulate Insulin Release, similar to Sulfonylureas). eee Alpha Glucosidase Inhibitors - Acarbose, Miglitol (Block Glucose Absorption in Bowel. Add about Half a point Decrease in HgA1c. Cause Flatus, Diarrhea, and Abdominal Pain). fff Incretins - Exenatide, Sitagliptin (Part of mechanism by which Oral Glucose Normally produce a Rise in Insulin and Decrease Glucagon levels. Decrease Gastric Motility and Help in Weight Loss, Decreasing DM2. Exenatide may cause Pancreatitis). ggg Pramlintide (Analog of Amylin protein Secreted Normally with Insulin. Amylin Decreases Gastric Emptying, Decreases Glucagon levels, and Decreases Appetite). hhh Insulin - Glargine [Steady insulin level Entire Day.], NPH [Dose Twice a day] - (Added if Not controlled with oral Hypoglycemia agents). Long Acting Insulin (Glargine, NPH) is combined with Short acting (Lispro, Aspart, Glulisine, Regular insulin). Regular Insulin is Sometimes Used as Short-acting insulin.
What is Sulfonylureas? Function? Tx of Disorder? AE?
Diabetes Mellitus Tx - 2 Oral Hypoglycemia Medications - Best Initial - aaa MetfoRmin (Blocks Gluconeogenesis. Contraindicated in Renal Dysfunction because it Accumulate and Cause Metabolic Acidosis.), bbb Sulfonylureas (Increase Insulin Release from Pancreas - Drives Glucose and Increase Obesity), ccc Thiazoladinediones - Glitazones (No Clear Benefit over hypoglycemic medications. Relatively Contraindicated in CHF because Increase Fluid Overload). ddd Nateglinide and repaglinide - similar to Sulfonylureas without Sulfa (Stimulate Insulin Release, similar to Sulfonylureas). eee Alpha Glucosidase Inhibitors - Acarbose, Miglitol (Block Glucose Absorption in Bowel. Add about Half a point Decrease in HgA1c. Cause Flatus, Diarrhea, and Abdominal Pain). fff Incretins - Exenatide, Sitagliptin (Part of mechanism by which Oral Glucose Normally produce a Rise in Insulin and Decrease Glucagon levels. Decrease Gastric Motility and Help in Weight Loss, Decreasing DM2. Exenatide may cause Pancreatitis). ggg Pramlintide (Analog of Amylin protein Secreted Normally with Insulin. Amylin Decreases Gastric Emptying, Decreases Glucagon levels, and Decreases Appetite). hhh Insulin - Glargine [Steady insulin level Entire Day.], NPH [Dose Twice a day] - (Added if Not controlled with oral Hypoglycemia agents). Long Acting Insulin (Glargine, NPH) is combined with Short acting (Lispro, Aspart, Glulisine, Regular insulin). Regular Insulin is Sometimes Used as Short-acting insulin.
What is Thiazoladinediones medications? Function? Tx of Disorder? AE?
Diabetes Mellitus Tx - 2 Oral Hypoglycemia Medications - Best Initial - aaa MetfoRmin (Blocks Gluconeogenesis. Contraindicated in Renal Dysfunction because it Accumulate and Cause Metabolic Acidosis.), bbb Sulfonylureas (Increase Insulin Release from Pancreas - Drives Glucose and Increase Obesity), ccc Thiazoladinediones - Glitazones (No Clear Benefit over hypoglycemic medications. Relatively Contraindicated in CHF because Increase Fluid Overload). ddd Nateglinide and repaglinide - similar to Sulfonylureas without Sulfa (Stimulate Insulin Release, similar to Sulfonylureas). eee Alpha Glucosidase Inhibitors - Acarbose, Miglitol (Block Glucose Absorption in Bowel. Add about Half a point Decrease in HgA1c. Cause Flatus, Diarrhea, and Abdominal Pain). fff Incretins - Exenatide, Sitagliptin (Part of mechanism by which Oral Glucose Normally produce a Rise in Insulin and Decrease Glucagon levels. Decrease Gastric Motility and Help in Weight Loss, Decreasing DM2. Exenatide may cause Pancreatitis). ggg Pramlintide (Analog of Amylin protein Secreted Normally with Insulin. Amylin Decreases Gastric Emptying, Decreases Glucagon levels, and Decreases Appetite). hhh Insulin - Glargine [Steady insulin level Entire Day.], NPH [Dose Twice a day] - (Added if Not controlled with oral Hypoglycemia agents). Long Acting Insulin (Glargine, NPH) is combined with Short acting (Lispro, Aspart, Glulisine, Regular insulin). Regular Insulin is Sometimes Used as Short-acting insulin.
What is Glitazones? Function? Tx of Disorder? AE?
Diabetes Mellitus Tx - 2 Oral Hypoglycemia Medications - Best Initial - aaa MetfoRmin (Blocks Gluconeogenesis. Contraindicated in Renal Dysfunction because it Accumulate and Cause Metabolic Acidosis.), bbb Sulfonylureas (Increase Insulin Release from Pancreas - Drives Glucose and Increase Obesity), ccc Thiazoladinediones - Glitazones (No Clear Benefit over hypoglycemic medications. Relatively Contraindicated in CHF because Increase Fluid Overload). ddd Nateglinide and repaglinide - similar to Sulfonylureas without Sulfa (Stimulate Insulin Release, similar to Sulfonylureas). eee Alpha Glucosidase Inhibitors - Acarbose, Miglitol (Block Glucose Absorption in Bowel. Add about Half a point Decrease in HgA1c. Cause Flatus, Diarrhea, and Abdominal Pain). fff Incretins - Exenatide, Sitagliptin (Part of mechanism by which Oral Glucose Normally produce a Rise in Insulin and Decrease Glucagon levels. Decrease Gastric Motility and Help in Weight Loss, Decreasing DM2. Exenatide may cause Pancreatitis). ggg Pramlintide (Analog of Amylin protein Secreted Normally with Insulin. Amylin Decreases Gastric Emptying, Decreases Glucagon levels, and Decreases Appetite). hhh Insulin - Glargine [Steady insulin level Entire Day.], NPH [Dose Twice a day] - (Added if Not controlled with oral Hypoglycemia agents). Long Acting Insulin (Glargine, NPH) is combined with Short acting (Lispro, Aspart, Glulisine, Regular insulin). Regular Insulin is Sometimes Used as Short-acting insulin.
What is Nateglinide? Function? Tx of Disorder? AE?
Diabetes Mellitus Tx - 2 Oral Hypoglycemia Medications - Best Initial - aaa MetfoRmin (Blocks Gluconeogenesis. Contraindicated in Renal Dysfunction because it Accumulate and Cause Metabolic Acidosis.), bbb Sulfonylureas (Increase Insulin Release from Pancreas - Drives Glucose and Increase Obesity), ccc Thiazoladinediones - Glitazones (No Clear Benefit over hypoglycemic medications. Relatively Contraindicated in CHF because Increase Fluid Overload). ddd Nateglinide and repaglinide - similar to Sulfonylureas without Sulfa (Stimulate Insulin Release, similar to Sulfonylureas). eee Alpha Glucosidase Inhibitors - Acarbose, Miglitol (Block Glucose Absorption in Bowel. Add about Half a point Decrease in HgA1c. Cause Flatus, Diarrhea, and Abdominal Pain). fff Incretins - Exenatide, Sitagliptin (Part of mechanism by which Oral Glucose Normally produce a Rise in Insulin and Decrease Glucagon levels. Decrease Gastric Motility and Help in Weight Loss, Decreasing DM2. Exenatide may cause Pancreatitis). ggg Pramlintide (Analog of Amylin protein Secreted Normally with Insulin. Amylin Decreases Gastric Emptying, Decreases Glucagon levels, and Decreases Appetite). hhh Insulin - Glargine [Steady insulin level Entire Day.], NPH [Dose Twice a day] - (Added if Not controlled with oral Hypoglycemia agents). Long Acting Insulin (Glargine, NPH) is combined with Short acting (Lispro, Aspart, Glulisine, Regular insulin). Regular Insulin is Sometimes Used as Short-acting insulin.
What is Repaglinide? Function? Tx of Disorder? AE?
Diabetes Mellitus Tx - 2 Oral Hypoglycemia Medications - Best Initial - aaa MetfoRmin (Blocks Gluconeogenesis. Contraindicated in Renal Dysfunction because it Accumulate and Cause Metabolic Acidosis.), bbb Sulfonylureas (Increase Insulin Release from Pancreas - Drives Glucose and Increase Obesity), ccc Thiazoladinediones - Glitazones (No Clear Benefit over hypoglycemic medications. Relatively Contraindicated in CHF because Increase Fluid Overload). ddd Nateglinide and repaglinide - similar to Sulfonylureas without Sulfa (Stimulate Insulin Release, similar to Sulfonylureas). eee Alpha Glucosidase Inhibitors - Acarbose, Miglitol (Block Glucose Absorption in Bowel. Add about Half a point Decrease in HgA1c. Cause Flatus, Diarrhea, and Abdominal Pain). fff Incretins - Exenatide, Sitagliptin (Part of mechanism by which Oral Glucose Normally produce a Rise in Insulin and Decrease Glucagon levels. Decrease Gastric Motility and Help in Weight Loss, Decreasing DM2. Exenatide may cause Pancreatitis). ggg Pramlintide (Analog of Amylin protein Secreted Normally with Insulin. Amylin Decreases Gastric Emptying, Decreases Glucagon levels, and Decreases Appetite). hhh Insulin - Glargine [Steady insulin level Entire Day.], NPH [Dose Twice a day] - (Added if Not controlled with oral Hypoglycemia agents). Long Acting Insulin (Glargine, NPH) is combined with Short acting (Lispro, Aspart, Glulisine, Regular insulin). Regular Insulin is Sometimes Used as Short-acting insulin.
What is Alpha Glucosidase Inhibitors medications?? Function? Tx of Disorder? AE?
Diabetes Mellitus Tx - 2 Oral Hypoglycemia Medications - Best Initial - aaa MetfoRmin (Blocks Gluconeogenesis. Contraindicated in Renal Dysfunction because it Accumulate and Cause Metabolic Acidosis.), bbb Sulfonylureas (Increase Insulin Release from Pancreas - Drives Glucose and Increase Obesity), ccc Thiazoladinediones - Glitazones (No Clear Benefit over hypoglycemic medications. Relatively Contraindicated in CHF because Increase Fluid Overload). ddd Nateglinide and repaglinide - similar to Sulfonylureas without Sulfa (Stimulate Insulin Release, similar to Sulfonylureas). eee Alpha Glucosidase Inhibitors - Acarbose, Miglitol (Block Glucose Absorption in Bowel. Add about Half a point Decrease in HgA1c. Cause Flatus, Diarrhea, and Abdominal Pain). fff Incretins - Exenatide, Sitagliptin (Part of mechanism by which Oral Glucose Normally produce a Rise in Insulin and Decrease Glucagon levels. Decrease Gastric Motility and Help in Weight Loss, Decreasing DM2. Exenatide may cause Pancreatitis). ggg Pramlintide (Analog of Amylin protein Secreted Normally with Insulin. Amylin Decreases Gastric Emptying, Decreases Glucagon levels, and Decreases Appetite). hhh Insulin - Glargine [Steady insulin level Entire Day.], NPH [Dose Twice a day] - (Added if Not controlled with oral Hypoglycemia agents). Long Acting Insulin (Glargine, NPH) is combined with Short acting (Lispro, Aspart, Glulisine, Regular insulin). Regular Insulin is Sometimes Used as Short-acting insulin.
What is Acarbose? Function? Tx of Disorder? AE?
Diabetes Mellitus Tx - 2 Oral Hypoglycemia Medications - Best Initial - aaa MetfoRmin (Blocks Gluconeogenesis. Contraindicated in Renal Dysfunction because it Accumulate and Cause Metabolic Acidosis.), bbb Sulfonylureas (Increase Insulin Release from Pancreas - Drives Glucose and Increase Obesity), ccc Thiazoladinediones - Glitazones (No Clear Benefit over hypoglycemic medications. Relatively Contraindicated in CHF because Increase Fluid Overload). ddd Nateglinide and repaglinide - similar to Sulfonylureas without Sulfa (Stimulate Insulin Release, similar to Sulfonylureas). eee Alpha Glucosidase Inhibitors - Acarbose, Miglitol (Block Glucose Absorption in Bowel. Add about Half a point Decrease in HgA1c. Cause Flatus, Diarrhea, and Abdominal Pain). fff Incretins - Exenatide, Sitagliptin (Part of mechanism by which Oral Glucose Normally produce a Rise in Insulin and Decrease Glucagon levels. Decrease Gastric Motility and Help in Weight Loss, Decreasing DM2. Exenatide may cause Pancreatitis). ggg Pramlintide (Analog of Amylin protein Secreted Normally with Insulin. Amylin Decreases Gastric Emptying, Decreases Glucagon levels, and Decreases Appetite). hhh Insulin - Glargine [Steady insulin level Entire Day.], NPH [Dose Twice a day] - (Added if Not controlled with oral Hypoglycemia agents). Long Acting Insulin (Glargine, NPH) is combined with Short acting (Lispro, Aspart, Glulisine, Regular insulin). Regular Insulin is Sometimes Used as Short-acting insulin.
What is Miglitol? Function? Tx of Disorder? AE?
Diabetes Mellitus Tx - 2 Oral Hypoglycemia Medications - Best Initial - aaa MetfoRmin (Blocks Gluconeogenesis. Contraindicated in Renal Dysfunction because it Accumulate and Cause Metabolic Acidosis.), bbb Sulfonylureas (Increase Insulin Release from Pancreas - Drives Glucose and Increase Obesity), ccc Thiazoladinediones - Glitazones (No Clear Benefit over hypoglycemic medications. Relatively Contraindicated in CHF because Increase Fluid Overload). ddd Nateglinide and repaglinide - similar to Sulfonylureas without Sulfa (Stimulate Insulin Release, similar to Sulfonylureas). eee Alpha Glucosidase Inhibitors - Acarbose, Miglitol (Block Glucose Absorption in Bowel. Add about Half a point Decrease in HgA1c. Cause Flatus, Diarrhea, and Abdominal Pain). fff Incretins - Exenatide, Sitagliptin (Part of mechanism by which Oral Glucose Normally produce a Rise in Insulin and Decrease Glucagon levels. Decrease Gastric Motility and Help in Weight Loss, Decreasing DM2. Exenatide may cause Pancreatitis). ggg Pramlintide (Analog of Amylin protein Secreted Normally with Insulin. Amylin Decreases Gastric Emptying, Decreases Glucagon levels, and Decreases Appetite). hhh Insulin - Glargine [Steady insulin level Entire Day.], NPH [Dose Twice a day] - (Added if Not controlled with oral Hypoglycemia agents). Long Acting Insulin (Glargine, NPH) is combined with Short acting (Lispro, Aspart, Glulisine, Regular insulin). Regular Insulin is Sometimes Used as Short-acting insulin.
What is Incretins medications? Function? Tx of Disorder? AE?
Diabetes Mellitus Tx - 2 Oral Hypoglycemia Medications - Best Initial - aaa MetfoRmin (Blocks Gluconeogenesis. Contraindicated in Renal Dysfunction because it Accumulate and Cause Metabolic Acidosis.), bbb Sulfonylureas (Increase Insulin Release from Pancreas - Drives Glucose and Increase Obesity), ccc Thiazoladinediones - Glitazones (No Clear Benefit over hypoglycemic medications. Relatively Contraindicated in CHF because Increase Fluid Overload). ddd Nateglinide and repaglinide - similar to Sulfonylureas without Sulfa (Stimulate Insulin Release, similar to Sulfonylureas). eee Alpha Glucosidase Inhibitors - Acarbose, Miglitol (Block Glucose Absorption in Bowel. Add about Half a point Decrease in HgA1c. Cause Flatus, Diarrhea, and Abdominal Pain). fff Incretins - Exenatide, Sitagliptin (Part of mechanism by which Oral Glucose Normally produce a Rise in Insulin and Decrease Glucagon levels. Decrease Gastric Motility and Help in Weight Loss, Decreasing DM2. Exenatide may cause Pancreatitis). ggg Pramlintide (Analog of Amylin protein Secreted Normally with Insulin. Amylin Decreases Gastric Emptying, Decreases Glucagon levels, and Decreases Appetite). hhh Insulin - Glargine [Steady insulin level Entire Day.], NPH [Dose Twice a day] - (Added if Not controlled with oral Hypoglycemia agents). Long Acting Insulin (Glargine, NPH) is combined with Short acting (Lispro, Aspart, Glulisine, Regular insulin). Regular Insulin is Sometimes Used as Short-acting insulin.
What is Exenatide? Function? Tx of Disorder? AE?
Diabetes Mellitus Tx - 2 Oral Hypoglycemia Medications - Best Initial - aaa MetfoRmin (Blocks Gluconeogenesis. Contraindicated in Renal Dysfunction because it Accumulate and Cause Metabolic Acidosis.), bbb Sulfonylureas (Increase Insulin Release from Pancreas - Drives Glucose and Increase Obesity), ccc Thiazoladinediones - Glitazones (No Clear Benefit over hypoglycemic medications. Relatively Contraindicated in CHF because Increase Fluid Overload). ddd Nateglinide and repaglinide - similar to Sulfonylureas without Sulfa (Stimulate Insulin Release, similar to Sulfonylureas). eee Alpha Glucosidase Inhibitors - Acarbose, Miglitol (Block Glucose Absorption in Bowel. Add about Half a point Decrease in HgA1c. Cause Flatus, Diarrhea, and Abdominal Pain). fff Incretins - Exenatide, Sitagliptin (Part of mechanism by which Oral Glucose Normally produce a Rise in Insulin and Decrease Glucagon levels. Decrease Gastric Motility and Help in Weight Loss, Decreasing DM2. Exenatide may cause Pancreatitis). ggg Pramlintide (Analog of Amylin protein Secreted Normally with Insulin. Amylin Decreases Gastric Emptying, Decreases Glucagon levels, and Decreases Appetite). hhh Insulin - Glargine [Steady insulin level Entire Day.], NPH [Dose Twice a day] - (Added if Not controlled with oral Hypoglycemia agents). Long Acting Insulin (Glargine, NPH) is combined with Short acting (Lispro, Aspart, Glulisine, Regular insulin). Regular Insulin is Sometimes Used as Short-acting insulin.
What is Sitagliptin? Function? Tx of Disorder? AE?
Diabetes Mellitus Tx - 2 Oral Hypoglycemia Medications - Best Initial - aaa MetfoRmin (Blocks Gluconeogenesis. Contraindicated in Renal Dysfunction because it Accumulate and Cause Metabolic Acidosis.), bbb Sulfonylureas (Increase Insulin Release from Pancreas - Drives Glucose and Increase Obesity), ccc Thiazoladinediones - Glitazones (No Clear Benefit over hypoglycemic medications. Relatively Contraindicated in CHF because Increase Fluid Overload). ddd Nateglinide and repaglinide - similar to Sulfonylureas without Sulfa (Stimulate Insulin Release, similar to Sulfonylureas). eee Alpha Glucosidase Inhibitors - Acarbose, Miglitol (Block Glucose Absorption in Bowel. Add about Half a point Decrease in HgA1c. Cause Flatus, Diarrhea, and Abdominal Pain). fff Incretins - Exenatide, Sitagliptin (Part of mechanism by which Oral Glucose Normally produce a Rise in Insulin and Decrease Glucagon levels. Decrease Gastric Motility and Help in Weight Loss, Decreasing DM2. Exenatide may cause Pancreatitis). ggg Pramlintide (Analog of Amylin protein Secreted Normally with Insulin. Amylin Decreases Gastric Emptying, Decreases Glucagon levels, and Decreases Appetite). hhh Insulin - Glargine [Steady insulin level Entire Day.], NPH [Dose Twice a day] - (Added if Not controlled with oral Hypoglycemia agents). Long Acting Insulin (Glargine, NPH) is combined with Short acting (Lispro, Aspart, Glulisine, Regular insulin). Regular Insulin is Sometimes Used as Short-acting insulin.
What is Pramlintide? Function? Tx of Disorder? AE?
Diabetes Mellitus Tx - 2 Oral Hypoglycemia Medications - Best Initial - aaa MetfoRmin (Blocks Gluconeogenesis. Contraindicated in Renal Dysfunction because it Accumulate and Cause Metabolic Acidosis.), bbb Sulfonylureas (Increase Insulin Release from Pancreas - Drives Glucose and Increase Obesity), ccc Thiazoladinediones - Glitazones (No Clear Benefit over hypoglycemic medications. Relatively Contraindicated in CHF because Increase Fluid Overload). ddd Nateglinide and repaglinide - similar to Sulfonylureas without Sulfa (Stimulate Insulin Release, similar to Sulfonylureas). eee Alpha Glucosidase Inhibitors - Acarbose, Miglitol (Block Glucose Absorption in Bowel. Add about Half a point Decrease in HgA1c. Cause Flatus, Diarrhea, and Abdominal Pain). fff Incretins - Exenatide, Sitagliptin (Part of mechanism by which Oral Glucose Normally produce a Rise in Insulin and Decrease Glucagon levels. Decrease Gastric Motility and Help in Weight Loss, Decreasing DM2. Exenatide may cause Pancreatitis). ggg Pramlintide (Analog of Amylin protein Secreted Normally with Insulin. Amylin Decreases Gastric Emptying, Decreases Glucagon levels, and Decreases Appetite). hhh Insulin - Glargine [Steady insulin level Entire Day.], NPH [Dose Twice a day] - (Added if Not controlled with oral Hypoglycemia agents). Long Acting Insulin (Glargine, NPH) is combined with Short acting (Lispro, Aspart, Glulisine, Regular insulin). Regular Insulin is Sometimes Used as Short-acting insulin.
What is Insulin types? Function?
Diabetes Mellitus Tx - 2 Oral Hypoglycemia Medications - hhh Insulin - Glargine [Steady insulin level Entire Day.], NPH [Dose Twice a day] - (Added if Not controlled with oral Hypoglycemia agents). Long Acting Insulin (Glargine, NPH) is combined with Short acting (Lispro, Aspart, Glulisine, Regular insulin). Regular Insulin is Sometimes Used as Short-acting insulin.
What is Glargine? Function? Tx of disorder? AE?
Diabetes Mellitus Tx - 2 Oral Hypoglycemia Medications - hhh Insulin - Glargine [Steady insulin level Entire Day.], NPH [Dose Twice a day] - (Added if Not controlled with oral Hypoglycemia agents). Long Acting Insulin (Glargine, NPH) is combined with Short acting (Lispro, Aspart, Glulisine, Regular insulin). Regular Insulin is Sometimes Used as Short-acting insulin.
What is NPH? Function? Tx of disorder? AE?
Diabetes Mellitus Tx - 2 Oral Hypoglycemia Medications - hhh Insulin - Glargine [Steady insulin level Entire Day.], NPH [Dose Twice a day] - (Added if Not controlled with oral Hypoglycemia agents). Long Acting Insulin (Glargine, NPH) is combined with Short acting (Lispro, Aspart, Glulisine, Regular insulin). Regular Insulin is Sometimes Used as Short-acting insulin.
What is Lispro? Function? Tx of disorder? AE?
Diabetes Mellitus Tx - 2 Oral Hypoglycemia Medications - hhh Insulin - Glargine [Steady insulin level Entire Day.], NPH [Dose Twice a day] - (Added if Not controlled with oral Hypoglycemia agents). Long Acting Insulin (Glargine, NPH) is combined with Short acting (Lispro, Aspart, Glulisine, Regular insulin). Regular Insulin is Sometimes Used as Short-acting insulin.
What is Aspart? Function? Tx of disorder? AE?
Diabetes Mellitus Tx - 2 Oral Hypoglycemia Medications - hhh Insulin - Glargine [Steady insulin level Entire Day.], NPH [Dose Twice a day] - (Added if Not controlled with oral Hypoglycemia agents). Long Acting Insulin (Glargine, NPH) is combined with Short acting (Lispro, Aspart, Glulisine, Regular insulin). Regular Insulin is Sometimes Used as Short-acting insulin.
What is Glulisine? Function? Tx of disorder? AE?
Diabetes Mellitus Tx - 2 Oral Hypoglycemia Medications - hhh Insulin - Glargine [Steady insulin level Entire Day.], NPH [Dose Twice a day] - (Added if Not controlled with oral Hypoglycemia agents). Long Acting Insulin (Glargine, NPH) is combined with Short acting (Lispro, Aspart, Glulisine, Regular insulin). Regular Insulin is Sometimes Used as Short-acting insulin.
What is DKA? What disorder? Px? Lx? Tx?
DKA (diabetic KetoAcidosis - 2K [HyperKalemia, Increase Ketone], 3A [Acidosis, Increase Anion Gap, Acetone]) is more common in DM1. Px - 1 Hyperventilation, 2 Possibly Altered Mental Status, 3 Metabolic Acidosis with Increased Anion Gap, 4 Hyperkalemia in Blood, but Decreased Total Body Potassium because of Urine Spillage, 5 Increased Anion Gap on Blood Testing, 6 Serum is Positive for Ketone, 7 Nonspecific Abdominal Pain, 8 Acetone Odor on Breath, 9 Polydipsia, Polyuria. Tx - 1 Large-Volume Saline and 2 Insulin Replacement. 3 Replace Potassium when Potassium level comes down to a level Approaching Normal. 4 Correct Underlying Cause (aaa Noncompliance with medications, bbb Infections, ccc Pregnancy, or ddd Any Serious Illness).
What is the measure of Severity of DKA?
Measure of Severity of DKA - Serum Bicarbonate level (Low Becarb mean High Anion Gap).
DM Health Maintenance? Exam? Lx? Tx?
DM Health Maintenance (RBC Gu) - Respiratory (1 Pneumococcal). B - Neuro - Eye (2 Retinopathy - Laser), Foot (3 Neuropathy and Ulcers). Cardio - 4 LDL Greater than (Statins), 5 Blood Pressure Greater than 130 over 80 (ACEI), 6 Aspirin. Gu - Renal - 7 Microalbuminuria (ACEI).
Complications of DM? Lx? Tx?
Complications of DM - 1 Cardiovascular, 2 Dibetic Nephropathy, 3 Gastroparesis, 4 Retinopathy, 5 Neuropathy. 1 Cardiovascular (Increased Risk of MI, Stroke, and CHF from Atherosclerotic disease. aaa Blood pressure Goal Below 130 over 80. DM is Eqivalent of CAD for Tx of bbb LDL - Goal Less than 100 to Initiate Statins), 2 Dibetic Nephropathy (ccc Microalbuminuria - Albumin between 30 and 300 mg per 24 Hours - ACEI. Dipstick for Urine becomes Trace Positive at 300 mg of Protein per 24 hours.), 3 Gastroparesis (DM Decreases Ability of Gut to Sense Stretch of Walls of Bowel. Stretch is Main Stimulant to Gastric Motility. Gastroparesis is Immobility of Bowels - Bloating, Constipation, Early Satiety, Vomiting, Abdominal Discomfort - Tx Metoclopromide and Erythromycin - Increase Gastric Motility), 4 Retinopathy (Manage Nonoproliferative Retinopathy with Tighter Control of Glucose. Neovascularization and Vitreous Hemorrhages - Proliferative Retinopathy - Tx Laser PhotoCoagulation - retards Progression to Blindness), 5 Neuropathy (Damage Vasonervorum surrounding Large Peripheral nerves - Decreased Sensation in Feet - Skin Ulcers leads to Osteomyelitis. Neuropathy Pain - Tx Pregabalin, Gabapentin, or TCA.
Complications of DM general?
Complications of DM - 1 Cardiovascular, 2 Dibetic Nephropathy, 3 Gastroparesis, 4 Retinopathy, 5 Neuropathy. It takes over 10 years after Diabetes Mellitus.
Complications of DM - Cardiovascular. Lx? Tx?
Complications of DM - 1 Cardiovascular, 2 Dibetic Nephropathy, 3 Gastroparesis, 4 Retinopathy, 5 Neuropathy. 1 Cardiovascular (Increased Risk of MI, Stroke, and CHF from Atherosclerotic disease. aaa Blood pressure Goal Below 130 over 80. DM is Eqivalent of CAD for Tx of bbb LDL - Goal Less than 100 to Initiate Statins), 2 Dibetic Nephropathy (ccc Microalbuminuria - Albumin between 30 and 300 mg per 24 Hours - ACEI (Use Hydralazine in Pregnant). Dipstick for Urine becomes Trace Positive at 300 mg of Protein per 24 hours.), 3 Gastroparesis (DM Decreases Ability of Gut to Sense Stretch of Walls of Bowel. Stretch is Main Stimulant to Gastric Motility. Gastroparesis is Immobility of Bowels - Bloating, Constipation, Early Satiety, Vomiting, Abdominal Discomfort - Tx Metoclopromide and Erythromycin - Increase Gastric Motility), 4 Retinopathy (Manage Nonoproliferative Retinopathy with Tighter Control of Glucose. Neovascularization and Vitreous Hemorrhages - Proliferative Retinopathy - Tx Laser PhotoCoagulation - retards Progression to Blindness), 5 Neuropathy (Damage Vasonervorum surrounding Large Peripheral nerves - Decreased Sensation in Feet - Skin Ulcers leads to Osteomyelitis. Neuropathy Pain - Tx Pregabalin, Gabapentin, or TCA.
Complications of DM - Dibetic Nephropathy. Lx? Tx?
Complications of DM - 1 Cardiovascular, 2 Dibetic Nephropathy, 3 Gastroparesis, 4 Retinopathy, 5 Neuropathy. 1 Cardiovascular (Increased Risk of MI, Stroke, and CHF from Atherosclerotic disease. aaa Blood pressure Goal Below 130 over 80. DM is Eqivalent of CAD for Tx of bbb LDL - Goal Less than 100 to Initiate Statins), 2 Dibetic Nephropathy (ccc Microalbuminuria - Albumin between 30 and 300 mg per 24 Hours - ACEI (Use Hydralazine in Pregnant). Dipstick for Urine becomes Trace Positive at 300 mg of Protein per 24 hours.), 3 Gastroparesis (DM Decreases Ability of Gut to Sense Stretch of Walls of Bowel. Stretch is Main Stimulant to Gastric Motility. Gastroparesis is Immobility of Bowels - Bloating, Constipation, Early Satiety, Vomiting, Abdominal Discomfort - Tx Metoclopromide and Erythromycin - Increase Gastric Motility), 4 Retinopathy (Manage Nonoproliferative Retinopathy with Tighter Control of Glucose. Neovascularization and Vitreous Hemorrhages - Proliferative Retinopathy - Tx Laser PhotoCoagulation - retards Progression to Blindness), 5 Neuropathy (Damage Vasonervorum surrounding Large Peripheral nerves - Decreased Sensation in Feet - Skin Ulcers leads to Osteomyelitis. Neuropathy Pain - Tx Pregabalin, Gabapentin, or TCA.
Complications of DM - Gastroparesis. Lx? Tx?
Complications of DM - 1 Cardiovascular, 2 Dibetic Nephropathy, 3 Gastroparesis, 4 Retinopathy, 5 Neuropathy. 1 Cardiovascular (Increased Risk of MI, Stroke, and CHF from Atherosclerotic disease. aaa Blood pressure Goal Below 130 over 80. DM is Eqivalent of CAD for Tx of bbb LDL - Goal Less than 100 to Initiate Statins), 2 Dibetic Nephropathy (ccc Microalbuminuria - Albumin between 30 and 300 mg per 24 Hours - ACEI (Use Hydralazine in Pregnant). Dipstick for Urine becomes Trace Positive at 300 mg of Protein per 24 hours.), 3 Gastroparesis (DM Decreases Ability of Gut to Sense Stretch of Walls of Bowel. Stretch is Main Stimulant to Gastric Motility. Gastroparesis is Immobility of Bowels - Bloating, Constipation, Early Satiety, Vomiting, Abdominal Discomfort - Tx Metoclopromide and Erythromycin - Increase Gastric Motility), 4 Retinopathy (Manage Nonoproliferative Retinopathy with Tighter Control of Glucose. Neovascularization and Vitreous Hemorrhages - Proliferative Retinopathy - Tx Laser PhotoCoagulation - retards Progression to Blindness), 5 Neuropathy (Damage Vasonervorum surrounding Large Peripheral nerves - Decreased Sensation in Feet - Skin Ulcers leads to Osteomyelitis. Neuropathy Pain - Tx Pregabalin, Gabapentin, or TCA.
Complications of DM - Retinopathy. Lx? Tx?
Complications of DM - 1 Cardiovascular, 2 Dibetic Nephropathy, 3 Gastroparesis, 4 Retinopathy, 5 Neuropathy. 1 Cardiovascular (Increased Risk of MI, Stroke, and CHF from Atherosclerotic disease. aaa Blood pressure Goal Below 130 over 80. DM is Eqivalent of CAD for Tx of bbb LDL - Goal Less than 100 to Initiate Statins), 2 Dibetic Nephropathy (ccc Microalbuminuria - Albumin between 30 and 300 mg per 24 Hours - ACEI. Dipstick for Urine becomes Trace Positive at 300 mg of Protein per 24 hours.), 3 Gastroparesis (DM Decreases Ability of Gut to Sense Stretch of Walls of Bowel. Stretch is Main Stimulant to Gastric Motility. Gastroparesis is Immobility of Bowels - Bloating, Constipation, Early Satiety, Vomiting, Abdominal Discomfort - Tx Metoclopromide and Erythromycin - Increase Gastric Motility), 4 Retinopathy (Manage Nonoproliferative Retinopathy with Tighter Control of Glucose. Neovascularization and Vitreous Hemorrhages - Proliferative Retinopathy - Tx Laser PhotoCoagulation - retards Progression to Blindness), 5 Neuropathy (Damage Vasonervorum surrounding Large Peripheral nerves - Decreased Sensation in Feet - Skin Ulcers leads to Osteomyelitis. Neuropathy Pain - Tx Pregabalin, Gabapentin, or TCA.
Complications of DM - Neuropathy. Lx? Tx?
Complications of DM - 1 Cardiovascular, 2 Dibetic Nephropathy, 3 Gastroparesis, 4 Retinopathy, 5 Neuropathy. 1 Cardiovascular (Increased Risk of MI, Stroke, and CHF from Atherosclerotic disease. aaa Blood pressure Goal Below 130 over 80. DM is Eqivalent of CAD for Tx of bbb LDL - Goal Less than 100 to Initiate Statins), 2 Dibetic Nephropathy (ccc Microalbuminuria - Albumin between 30 and 300 mg per 24 Hours - ACEI (Use Hydralazine in Pregnant). Dipstick for Urine becomes Trace Positive at 300 mg of Protein per 24 hours.), 3 Gastroparesis (DM Decreases Ability of Gut to Sense Stretch of Walls of Bowel. Stretch is Main Stimulant to Gastric Motility. Gastroparesis is Immobility of Bowels - Bloating, Constipation, Early Satiety, Vomiting, Abdominal Discomfort - Tx Metoclopromide and Erythromycin - Increase Gastric Motility), 4 Retinopathy (Manage Nonoproliferative Retinopathy with Tighter Control of Glucose. Neovascularization and Vitreous Hemorrhages - Proliferative Retinopathy - Tx Laser PhotoCoagulation - retards Progression to Blindness), 5 Neuropathy (Damage Vasonervorum surrounding Large Peripheral nerves - Decreased Sensation in Feet - Skin Ulcers leads to Osteomyelitis. Neuropathy Pain - Tx Pregabalin, Gabapentin, or TCA.
DM Blood pressure Goal?
Complications of DM - 1 Cardiovascular, 2 Dibetic Nephropathy, 3 Gastroparesis, 4 Retinopathy, 5 Neuropathy. 1 Cardiovascular (Increased Risk of MI, Stroke, and CHF from Atherosclerotic disease. aaa Blood pressure Goal Below 130 over 80. DM is Eqivalent of CAD for Tx of bbb LDL - Goal Less than 100 to Initiate Statins), 2 Dibetic Nephropathy (ccc Microalbuminuria - Albumin between 30 and 300 mg per 24 Hours - ACEI (Use Hydralazine in Pregnant). Dipstick for Urine becomes Trace Positive at 300 mg of Protein per 24 hours.), 3 Gastroparesis (DM Decreases Ability of Gut to Sense Stretch of Walls of Bowel. Stretch is Main Stimulant to Gastric Motility. Gastroparesis is Immobility of Bowels - Bloating, Constipation, Early Satiety, Vomiting, Abdominal Discomfort - Tx Metoclopromide and Erythromycin - Increase Gastric Motility), 4 Retinopathy (Manage Nonoproliferative Retinopathy with Tighter Control of Glucose. Neovascularization and Vitreous Hemorrhages - Proliferative Retinopathy - Tx Laser PhotoCoagulation - retards Progression to Blindness), 5 Neuropathy (Damage Vasonervorum surrounding Large Peripheral nerves - Decreased Sensation in Feet - Skin Ulcers leads to Osteomyelitis. Neuropathy Pain - Tx Pregabalin, Gabapentin, or TCA.
DM LDL Goal? DM and Hypertension LDL Goal? Tx?
DM LDL Goal - 1 Cardiovascular (Increased Risk of MI, Stroke, and CHF from Atherosclerotic disease. aaa Blood pressure Goal Below 130 over 80. DM is Eqivalent of CAD for Tx of bbb LDL - Goal Less than 100 to Initiate Statins). DM and Hypertension (or MI, or Stroke), LDL goal is Less than 70.
DM Eqivalent of CAD for?
Complications of DM - 1 Cardiovascular, 2 Dibetic Nephropathy, 3 Gastroparesis, 4 Retinopathy, 5 Neuropathy. 1 Cardiovascular (Increased Risk of MI, Stroke, and CHF from Atherosclerotic disease. aaa Blood pressure Goal Below 130 over 80. DM is Eqivalent of CAD for Tx of bbb LDL - Goal Less than 100 to Initiate Statins), 2 Dibetic Nephropathy (ccc Microalbuminuria - Albumin between 30 and 300 mg per 24 Hours - ACEI (Use Hydralazine in Pregnant). Dipstick for Urine becomes Trace Positive at 300 mg of Protein per 24 hours.), 3 Gastroparesis (DM Decreases Ability of Gut to Sense Stretch of Walls of Bowel. Stretch is Main Stimulant to Gastric Motility. Gastroparesis is Immobility of Bowels - Bloating, Constipation, Early Satiety, Vomiting, Abdominal Discomfort - Tx Metoclopromide and Erythromycin - Increase Gastric Motility), 4 Retinopathy (Manage Nonoproliferative Retinopathy with Tighter Control of Glucose. Neovascularization and Vitreous Hemorrhages - Proliferative Retinopathy - Tx Laser PhotoCoagulation - retards Progression to Blindness), 5 Neuropathy (Damage Vasonervorum surrounding Large Peripheral nerves - Decreased Sensation in Feet - Skin Ulcers leads to Osteomyelitis. Neuropathy Pain - Tx Pregabalin, Gabapentin, or TCA.
What is Microalbuminuria? In what Disorder? Tx?
Complications of DM - 1 Cardiovascular, 2 Dibetic Nephropathy, 3 Gastroparesis, 4 Retinopathy, 5 Neuropathy. 1 Cardiovascular (Increased Risk of MI, Stroke, and CHF from Atherosclerotic disease. aaa Blood pressure Goal Below 130 over 80. DM is Eqivalent of CAD for Tx of bbb LDL - Goal Less than 100 to Initiate Statins), 2 Dibetic Nephropathy (ccc Microalbuminuria - Albumin between 30 and 300 mg per 24 Hours - ACEI. Dipstick for Urine becomes Trace Positive at 300 mg of Protein per 24 hours.), 3 Gastroparesis (DM Decreases Ability of Gut to Sense Stretch of Walls of Bowel. Stretch is Main Stimulant to Gastric Motility. Gastroparesis is Immobility of Bowels - Bloating, Constipation, Early Satiety, Vomiting, Abdominal Discomfort - Tx Metoclopromide and Erythromycin - Increase Gastric Motility), 4 Retinopathy (Manage Nonoproliferative Retinopathy with Tighter Control of Glucose. Neovascularization and Vitreous Hemorrhages - Proliferative Retinopathy - Tx Laser PhotoCoagulation - retards Progression to Blindness), 5 Neuropathy (Damage Vasonervorum surrounding Large Peripheral nerves - Decreased Sensation in Feet - Skin Ulcers leads to Osteomyelitis. Neuropathy Pain - Tx Pregabalin, Gabapentin, or TCA.
When is Dipstick for Urine becomes Trace Positive?
Complications of DM - 1 Cardiovascular, 2 Dibetic Nephropathy, 3 Gastroparesis, 4 Retinopathy, 5 Neuropathy. 1 Cardiovascular (Increased Risk of MI, Stroke, and CHF from Atherosclerotic disease. aaa Blood pressure Goal Below 130 over 80. DM is Eqivalent of CAD for Tx of bbb LDL - Goal Less than 100 to Initiate Statins), 2 Dibetic Nephropathy (ccc Microalbuminuria - Albumin between 30 and 300 mg per 24 Hours - ACEI (Use Hydralazine in Pregnant). Dipstick for Urine becomes Trace Positive at 300 mg of Protein per 24 hours.), 3 Gastroparesis (DM Decreases Ability of Gut to Sense Stretch of Walls of Bowel. Stretch is Main Stimulant to Gastric Motility. Gastroparesis is Immobility of Bowels - Bloating, Constipation, Early Satiety, Vomiting, Abdominal Discomfort - Tx Metoclopromide and Erythromycin - Increase Gastric Motility), 4 Retinopathy (Manage Nonoproliferative Retinopathy with Tighter Control of Glucose. Neovascularization and Vitreous Hemorrhages - Proliferative Retinopathy - Tx Laser PhotoCoagulation - retards Progression to Blindness), 5 Neuropathy (Damage Vasonervorum surrounding Large Peripheral nerves - Decreased Sensation in Feet - Skin Ulcers leads to Osteomyelitis. Neuropathy Pain - Tx Pregabalin, Gabapentin, or TCA.
What is Gastroparesis? Why? In what disorder? Px? Tx?
Complications of DM - 1 Cardiovascular, 2 Dibetic Nephropathy, 3 Gastroparesis, 4 Retinopathy, 5 Neuropathy. 1 Cardiovascular (Increased Risk of MI, Stroke, and CHF from Atherosclerotic disease. aaa Blood pressure Goal Below 130 over 80. DM is Eqivalent of CAD for Tx of bbb LDL - Goal Less than 100 to Initiate Statins), 2 Dibetic Nephropathy (ccc Microalbuminuria - Albumin between 30 and 300 mg per 24 Hours - ACEI (Use Hydralazine in Pregnant). Dipstick for Urine becomes Trace Positive at 300 mg of Protein per 24 hours.), 3 Gastroparesis (DM Decreases Ability of Gut to Sense Stretch of Walls of Bowel. Stretch is Main Stimulant to Gastric Motility. Gastroparesis is Immobility of Bowels - Bloating, Constipation, Early Satiety, Vomiting, Abdominal Discomfort - Tx Metoclopromide and Erythromycin - Increase Gastric Motility), 4 Retinopathy (Manage Nonoproliferative Retinopathy with Tighter Control of Glucose. Neovascularization and Vitreous Hemorrhages - Proliferative Retinopathy - Tx Laser PhotoCoagulation - retards Progression to Blindness), 5 Neuropathy (Damage Vasonervorum surrounding Large Peripheral nerves - Decreased Sensation in Feet - Skin Ulcers leads to Osteomyelitis. Neuropathy Pain - Tx Pregabalin, Gabapentin, or TCA.
What is Gastroparesis Px? Tx?
Complications of DM - 1 Cardiovascular, 2 Dibetic Nephropathy, 3 Gastroparesis, 4 Retinopathy, 5 Neuropathy. 1 Cardiovascular (Increased Risk of MI, Stroke, and CHF from Atherosclerotic disease. aaa Blood pressure Goal Below 130 over 80. DM is Eqivalent of CAD for Tx of bbb LDL - Goal Less than 100 to Initiate Statins), 2 Dibetic Nephropathy (ccc Microalbuminuria - Albumin between 30 and 300 mg per 24 Hours - ACEI (Use Hydralazine in Pregnant). Dipstick for Urine becomes Trace Positive at 300 mg of Protein per 24 hours.), 3 Gastroparesis (DM Decreases Ability of Gut to Sense Stretch of Walls of Bowel. Stretch is Main Stimulant to Gastric Motility. Gastroparesis is Immobility of Bowels - Bloating, Constipation, Early Satiety, Vomiting, Abdominal Discomfort - Tx Metoclopromide and Erythromycin - Increase Gastric Motility), 4 Retinopathy (Manage Nonoproliferative Retinopathy with Tighter Control of Glucose. Neovascularization and Vitreous Hemorrhages - Proliferative Retinopathy - Tx Laser PhotoCoagulation - retards Progression to Blindness), 5 Neuropathy (Damage Vasonervorum surrounding Large Peripheral nerves - Decreased Sensation in Feet - Skin Ulcers leads to Osteomyelitis. Neuropathy Pain - Tx Pregabalin, Gabapentin, or TCA.
What is Metoclopromide? Tx what disorder?
Metoclopromide is Dopamine Antagonist - 3 Gastroparesis (DM Decreases Ability of Gut to Sense Stretch of Walls of Bowel. Stretch is Main Stimulant to Gastric Motility. Gastroparesis is Immobility of Bowels - Bloating, Constipation, Early Satiety, Vomiting, Abdominal Discomfort - Tx Metoclopromide and Erythromycin - Increase Gastric Motility). Metoclopromide AE - Prolactinemia.
What is Erythromycin? Tx what disorder?
Complications of DM - 1 Cardiovascular, 2 Dibetic Nephropathy, 3 Gastroparesis, 4 Retinopathy, 5 Neuropathy. 1 Cardiovascular (Increased Risk of MI, Stroke, and CHF from Atherosclerotic disease. aaa Blood pressure Goal Below 130 over 80. DM is Eqivalent of CAD for Tx of bbb LDL - Goal Less than 100 to Initiate Statins), 2 Dibetic Nephropathy (ccc Microalbuminuria - Albumin between 30 and 300 mg per 24 Hours - ACEI (Use Hydralazine in Pregnant). Dipstick for Urine becomes Trace Positive at 300 mg of Protein per 24 hours.), 3 Gastroparesis (DM Decreases Ability of Gut to Sense Stretch of Walls of Bowel. Stretch is Main Stimulant to Gastric Motility. Gastroparesis is Immobility of Bowels - Bloating, Constipation, Early Satiety, Vomiting, Abdominal Discomfort - Tx Metoclopromide and Erythromycin - Increase Gastric Motility), 4 Retinopathy (Manage Nonoproliferative Retinopathy with Tighter Control of Glucose. Neovascularization and Vitreous Hemorrhages - Proliferative Retinopathy - Tx Laser PhotoCoagulation - retards Progression to Blindness), 5 Neuropathy (Damage Vasonervorum surrounding Large Peripheral nerves - Decreased Sensation in Feet - Skin Ulcers leads to Osteomyelitis. Neuropathy Pain - Tx Pregabalin, Gabapentin, or TCA.
Tx of Nonoproliferative Retinopathy ? in what disorder?
Complications of DM - 1 Cardiovascular, 2 Dibetic Nephropathy, 3 Gastroparesis, 4 Retinopathy, 5 Neuropathy. 1 Cardiovascular (Increased Risk of MI, Stroke, and CHF from Atherosclerotic disease. aaa Blood pressure Goal Below 130 over 80. DM is Eqivalent of CAD for Tx of bbb LDL - Goal Less than 100 to Initiate Statins), 2 Dibetic Nephropathy (ccc Microalbuminuria - Albumin between 30 and 300 mg per 24 Hours - ACEI (Use Hydralazine in Pregnant). Dipstick for Urine becomes Trace Positive at 300 mg of Protein per 24 hours.), 3 Gastroparesis (DM Decreases Ability of Gut to Sense Stretch of Walls of Bowel. Stretch is Main Stimulant to Gastric Motility. Gastroparesis is Immobility of Bowels - Bloating, Constipation, Early Satiety, Vomiting, Abdominal Discomfort - Tx Metoclopromide and Erythromycin - Increase Gastric Motility), 4 Retinopathy (Manage Nonoproliferative Retinopathy with Tighter Control of Glucose. Neovascularization and Vitreous Hemorrhages - Proliferative Retinopathy - Tx Laser PhotoCoagulation - retards Progression to Blindness), 5 Neuropathy (Damage Vasonervorum surrounding Large Peripheral nerves - Decreased Sensation in Feet - Skin Ulcers leads to Osteomyelitis. Neuropathy Pain - Tx Pregabalin, Gabapentin, or TCA.
What is Proliferative Retinopathy? In what disorder? Tx?
Complications of DM - 1 Cardiovascular, 2 Dibetic Nephropathy, 3 Gastroparesis, 4 Retinopathy, 5 Neuropathy. 1 Cardiovascular (Increased Risk of MI, Stroke, and CHF from Atherosclerotic disease. aaa Blood pressure Goal Below 130 over 80. DM is Eqivalent of CAD for Tx of bbb LDL - Goal Less than 100 to Initiate Statins), 2 Dibetic Nephropathy (ccc Microalbuminuria - Albumin between 30 and 300 mg per 24 Hours - ACEI. Dipstick for Urine becomes Trace Positive at 300 mg of Protein per 24 hours.), 3 Gastroparesis (DM Decreases Ability of Gut to Sense Stretch of Walls of Bowel. Stretch is Main Stimulant to Gastric Motility. Gastroparesis is Immobility of Bowels - Bloating, Constipation, Early Satiety, Vomiting, Abdominal Discomfort - Tx Metoclopromide and Erythromycin - Increase Gastric Motility), 4 Retinopathy (Manage Nonoproliferative Retinopathy with Tighter Control of Glucose. Neovascularization and Vitreous Hemorrhages - Proliferative Retinopathy - Tx Laser PhotoCoagulation - retards Progression to Blindness), 5 Neuropathy (Damage Vasonervorum surrounding Large Peripheral nerves - Decreased Sensation in Feet - Skin Ulcers leads to Osteomyelitis. Neuropathy Pain - Tx Pregabalin, Gabapentin, or TCA.
Neuropathy Pain in what disorder? Tx?
Complications of DM - 1 Cardiovascular, 2 Dibetic Nephropathy, 3 Gastroparesis, 4 Retinopathy, 5 Neuropathy. 1 Cardiovascular (Increased Risk of MI, Stroke, and CHF from Atherosclerotic disease. aaa Blood pressure Goal Below 130 over 80. DM is Eqivalent of CAD for Tx of bbb LDL - Goal Less than 100 to Initiate Statins), 2 Dibetic Nephropathy (ccc Microalbuminuria - Albumin between 30 and 300 mg per 24 Hours - ACEI. Dipstick for Urine becomes Trace Positive at 300 mg of Protein per 24 hours.), 3 Gastroparesis (DM Decreases Ability of Gut to Sense Stretch of Walls of Bowel. Stretch is Main Stimulant to Gastric Motility. Gastroparesis is Immobility of Bowels - Bloating, Constipation, Early Satiety, Vomiting, Abdominal Discomfort - Tx Metoclopromide and Erythromycin - Increase Gastric Motility), 4 Retinopathy (Manage Nonoproliferative Retinopathy with Tighter Control of Glucose. Neovascularization and Vitreous Hemorrhages - Proliferative Retinopathy - Tx Laser PhotoCoagulation - retards Progression to Blindness), 5 Neuropathy (Damage Vasonervorum surrounding Large Peripheral nerves - Decreased Sensation in Feet - Skin Ulcers leads to Osteomyelitis. Neuropathy Pain - Tx Pregabalin, Gabapentin, or TCA.
Pregabalin Tx of what disorder?
Complications of DM - 1 Cardiovascular, 2 Dibetic Nephropathy, 3 Gastroparesis, 4 Retinopathy, 5 Neuropathy. 1 Cardiovascular (Increased Risk of MI, Stroke, and CHF from Atherosclerotic disease. aaa Blood pressure Goal Below 130 over 80. DM is Eqivalent of CAD for Tx of bbb LDL - Goal Less than 100 to Initiate Statins), 2 Dibetic Nephropathy (ccc Microalbuminuria - Albumin between 30 and 300 mg per 24 Hours - ACEI. Dipstick for Urine becomes Trace Positive at 300 mg of Protein per 24 hours.), 3 Gastroparesis (DM Decreases Ability of Gut to Sense Stretch of Walls of Bowel. Stretch is Main Stimulant to Gastric Motility. Gastroparesis is Immobility of Bowels - Bloating, Constipation, Early Satiety, Vomiting, Abdominal Discomfort - Tx Metoclopromide and Erythromycin - Increase Gastric Motility), 4 Retinopathy (Manage Nonoproliferative Retinopathy with Tighter Control of Glucose. Neovascularization and Vitreous Hemorrhages - Proliferative Retinopathy - Tx Laser PhotoCoagulation - retards Progression to Blindness), 5 Neuropathy (Damage Vasonervorum surrounding Large Peripheral nerves - Decreased Sensation in Feet - Skin Ulcers leads to Osteomyelitis. Neuropathy Pain - Tx Pregabalin, Gabapentin, or TCA.
Gabapentin Tx of what disorder?
Complications of DM - 1 Cardiovascular, 2 Dibetic Nephropathy, 3 Gastroparesis, 4 Retinopathy, 5 Neuropathy. 1 Cardiovascular (Increased Risk of MI, Stroke, and CHF from Atherosclerotic disease. aaa Blood pressure Goal Below 130 over 80. DM is Eqivalent of CAD for Tx of bbb LDL - Goal Less than 100 to Initiate Statins), 2 Dibetic Nephropathy (ccc Microalbuminuria - Albumin between 30 and 300 mg per 24 Hours - ACEI. Dipstick for Urine becomes Trace Positive at 300 mg of Protein per 24 hours.), 3 Gastroparesis (DM Decreases Ability of Gut to Sense Stretch of Walls of Bowel. Stretch is Main Stimulant to Gastric Motility. Gastroparesis is Immobility of Bowels - Bloating, Constipation, Early Satiety, Vomiting, Abdominal Discomfort - Tx Metoclopromide and Erythromycin - Increase Gastric Motility), 4 Retinopathy (Manage Nonoproliferative Retinopathy with Tighter Control of Glucose. Neovascularization and Vitreous Hemorrhages - Proliferative Retinopathy - Tx Laser PhotoCoagulation - retards Progression to Blindness), 5 Neuropathy (Damage Vasonervorum surrounding Large Peripheral nerves - Decreased Sensation in Feet - Skin Ulcers leads to Osteomyelitis. Neuropathy Pain - Tx Pregabalin, Gabapentin, or TCA.
TCA Tx of what non psychiatric disorder?
Complications of DM - 1 Cardiovascular, 2 Dibetic Nephropathy, 3 Gastroparesis, 4 Retinopathy, 5 Neuropathy. 1 Cardiovascular (Increased Risk of MI, Stroke, and CHF from Atherosclerotic disease. aaa Blood pressure Goal Below 130 over 80. DM is Eqivalent of CAD for Tx of bbb LDL - Goal Less than 100 to Initiate Statins), 2 Dibetic Nephropathy (ccc Microalbuminuria - Albumin between 30 and 300 mg per 24 Hours - ACEI. Dipstick for Urine becomes Trace Positive at 300 mg of Protein per 24 hours.), 3 Gastroparesis (DM Decreases Ability of Gut to Sense Stretch of Walls of Bowel. Stretch is Main Stimulant to Gastric Motility. Gastroparesis is Immobility of Bowels - Bloating, Constipation, Early Satiety, Vomiting, Abdominal Discomfort - Tx Metoclopromide and Erythromycin - Increase Gastric Motility), 4 Retinopathy (Manage Nonoproliferative Retinopathy with Tighter Control of Glucose. Neovascularization and Vitreous Hemorrhages - Proliferative Retinopathy - Tx Laser PhotoCoagulation - retards Progression to Blindness), 5 Neuropathy (Damage Vasonervorum surrounding Large Peripheral nerves - Decreased Sensation in Feet - Skin Ulcers leads to Osteomyelitis. Neuropathy Pain - Tx Pregabalin, Gabapentin, or TCA.
High Glucocorticoid affect on CBC?
High Glucocorticoid affect on CBC - 1 High Neutrophile, 2 Low Eosinophil, 3 Low Lymphocytes.
High Neutrophile, Low Eosinophil, Low Lymphocytes. Dx?
High Glucocorticoid affect on CBC - 1 High Neutrophile, 2 Low Eosinophil, 3 Low Lymphocytes.
Dibetes Mellitus - Pregnant. When to do? Lx?
Dibetes Mellitus - Pregnant. Do - Gestation 24 - 28 weeks. Lx - 1 Two Fasting Blood Glucose Greater than 90 mg per dL, 2 1-Hour 50 g Oral Glucose Tolerance Testing (greater than 140) - Screening, 3 3-Hour 100 g Oral Glucose Tolerance Testing (greater than 140) - Confirm, 4 Post Partum - 2-Hour 75 g Oral Glucose Tolerance Testing (greater than 140).
Contrast - Dibetes Mellitus - Normal and Pregnant. Lx?
Diabetes Mellitus - Normal - Lx - 1 Two Fasting Blood Glucose Greater than 125 mg per dL, 2 Single Glucose level About 200 mg per dL with Symptoms, 3 Increased Glucose Level on Oral Glucose Tolerance Testing (greater than 200). 4 Hemoglobin A1c Greater than 6.5 percent (Best test to Follow Response to Therapy over last Several months). Dibetes Mellitus - Pregnant. Do - Gestation 24 - 28 weeks. Lx - 1 Two Fasting Blood Glucose Greater than 90 mg per dL, 2 1-Hour 50 g Oral Glucose Tolerance Testing (greater than 140) - Screening, 3 3-Hour 100 g Oral Glucose Tolerance Testing (greater than 140) - Confirm, 4 Post Partum - 2-Hour 75 g Oral Glucose Tolerance Testing (greater than 140).
Contrast - Dibetes Mellitus - Normal and Pregnant. Lx - Fasting Glucose?
Contrast - Dibetes Mellitus - Normal and Pregnant. Lx - Fasting Glucose - Normal (125), Pregnant (90)
Contrast - Dibetes Mellitus - Normal and Pregnant. Lx - Oral Glucose Tolerance Testing?
Contrast - Dibetes Mellitus - Normal and Pregnant. Lx - Oral Glucose Tolerance Testing - Normal 2-Hour 75 g OGTT (200). Post Partum - 2-Hour 75 g OGTT (140). Pregnant - Gestation 24 - 28 weeks. 1 1-Hour 50 g Oral Glucose Tolerance Testing (greater than 140) - Screening, 2 3-Hour 100 g Oral Glucose Tolerance Testing (greater than 140) - Confirm. Lower level for pregnancy.
Dibetes Mellitus Lx - HgA1c? How often to test?
Dibetes Mellitus Lx - HgA1c - Greater than 6.5 How often to test - Every Quarter.
DKA general Px?
DKA general Px - 1 metabolic Acidosis, 2 Anion gap (Bicarb Less than 15), 3 Ketone body, 4 Glucose More than 250
Metabolic Acidosis, Bicarb - 15, Ketone in Urine, Glucose More than 251. Dx?
Metabolic Acidosis, Bicarb - 15, Ketone in Urine, Glucose More than 251. Dx - DKA general Px - 1 metabolic Acidosis, 2 Angion gap (Bicarb Less than 15), 3 Ketone body, 4 Glucose More than 250
How to calculate Anion Gap? Normal?
Calculate Anion Gap. AG is Na - (Bicarb + Chloride). Normal less than 12