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78 Cards in this Set
- Front
- Back
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Turner
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45X0
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Primary amenorrhea with web neck, short stature, low set ears, intact smull, rudimentary ovaries
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Turner
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Primary amenorrhea with no vagina, no uterus, ovaries ok, breast normal
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46XX (Rokitansky-Kuster-Hauser syndrome)
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primary amenorrhea with acne, clitoromegaly, hirsutism, no ovaries, no breasts
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46XY (gonadal dysgenesis)
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primary amenorrhea with atrophic vagina, no cervix, has breasts, no pubic or axillary hair
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androgen insensitivity syndrome
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primary amenorrhea with anosmia, low LH/FSH
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Kallman syndrome
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name the primary amenorrhea cases
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Turner, 46XX, gonadal dysgenesis, androgen insensitivity syndrome, Kallman syndrome
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Hypothalamus-pituitary-gonadal axis immaturity
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17y/o with amenorrhea, given progesterone and then got her periods; reassure
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patient stopped oral contraceptives, still no menses, pregnancy test negatiuve, LH FSH normal, estrogen challenge with no bleed, diagnosis?
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Asherman's syndrome or uterine synechiae
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mechanism of amenorrhea in young marathon runner with only a couple of periods the past year
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excessive exercise inhibits LHRH release
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cushing disease
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increased ACTH, increased cortisol, increased 17 hydroxy keto steroids
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adrenal carcinoma
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increased cortisol, increased 17 hydroxy keto steroids decreased ACTH
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congenital adrenal hyperplasia
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decreased cortisol, increased 17 hydroxy keto steroids increased 17 hydroxy progesterone decreased ACTH
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tests for hirsutism
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testosterone level, DHEA (17 hydroxy ketosteroids) urine free cortisol
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conditions that can produce gynecomastia
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cirrhosis, germ cell tumors, Klinefelter's syndrome
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treatment for premature ejaculation
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SSRIs or sildenafil
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test that differentiates between psychogenic vs organic impotence
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nocturnal penile tumescence
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differential diagnosis if patient has organic impotence
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vascular insufficiency, nerves (DM neuropathy), central (HP gonadal axis problem, prolactinoma), hypothyroidism
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patient on tadalafil, given nitrates, blood pressure drops, what to do next?
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fluids, trendelenburg, phenylephrine (not norepinephrine)
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conditions with increased RAIU
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Graves, toxic adenoma, MNG
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conditions with decreased RAIU
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thyroiditis (SAT, postpartum) exogenous T3 T4
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two medications for osteoporosis that is indicated for EVERYTHING (prevention and treatment of postmenopausal osteoporosis, osteo in men; prevention and treatment of CS-induced osteoporosis)
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risedronate and zoledronate
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when is free testosterone indicated?
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when SHBG is increased (aging) or decreased (obesity) and total testosterone can be inaccurate
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MOA of sulfonylureas
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increase release of insulin from B cells (thereby causing weight gain)
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why is repaglinide the drug of choice in renal insufficiency?
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excreted through bile
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MOA repaglinide / meglitiniides
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increase release of insulin from B cells (like sulfonylureas)
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how does metformin work?
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decreases hepatic gluconeogenesis, decreases weight and triglycerides
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mechanism of action of alpha glucosidase inhibitors / acarbose
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inhibits breakdown of carbohydrates
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mechanism of action of thiazolidinediones or glitazones
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binds PPAR receptors, increases glucose transport and decreases insulin resistance
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side effects of glitazones
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lower triglycerides and increases HDL but also increases LDL
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mechanism of action of incretin mimetics (Exanitide or Byetta)
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decreases hepatic gluconeogenesis
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DPP4 inhibitors
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sitagliptin / Januvia
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all diabetic treatments cause weight gain except for
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metformin, incretin, amyulin
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the new diabetic drugs
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RAID - repaglinide, amylin analogue, incretin mimetics, DPP4 inhibitors
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GLP1 agonists
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exanatide / incretin mimetics
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PPAR receptor binders
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glitazones
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when is metformin contraindicated?
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creatinine more than 1.4 in men or 1.5 in women; advance CHF
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need for iodine during pregnancy / lactation
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increased by 50% during pregnancy and 100% during lactation
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best test to follow hypothyroidism treatment
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TSH
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best test to follow hyperthyroidism treatment
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FT4
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antithyroid drug for pregnant
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PTU
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treatments used in hyperthyroidism
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PTU/MMZ; RAI; ASA (for thyroiditis); prednisone / propranolol / hydrocortisone (for storm) plus Surgery
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the only form of hyperthyroidism with increased TSH
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pituitary adenoma
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what is a normal radioactive iodine uptake?
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more than 35% is normal; less that 5% is decreased
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findings in RAI uptake scan (4)
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diffuse for Grave's, focal for toxic nodule; areas of increased and decreased uptake for MNTG and decreased uptake for thyroiditis
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how to differentiate between factitious thyrotoxicosis and thyroiditis?
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both will have increased FT4 T3 and low TSH plus low RAIU; check thyroglobin levels which will be low in factitious thyrotoxicosis
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these three contidions present the same way: high FT4 T3, low TSH and increased RAIU
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Grave's, toxic nodule; MNTG (RAIU to differentiate between the three)
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antibodies to differentiate thyroiditis from Grave's
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anti TSH receptor antibodies (not anti TPO)
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post partum thyroiditis
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chronic lymphocytic thyroiditis
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half life of levothyroxine
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7 days
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leading cause of hypothyroidism
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Hashimoto's
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history of Hashimoto's now with enlarging goiter, what is the diagnosis?
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B cell lymphoma
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after nuclear explosion, what to give for prophylaxis?
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potassium iodide
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vitamin D levels
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less than 20 is deficiency; less than 30 is insufficiency; more than 30 is normal
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treatment of Vitamin D deficiency
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50K IU per week x 8 weeks then 1-2K/day
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treatment of vitamin D insufficiency
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1 to 2 thousand per day
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vitamin D supplement
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600 IU per day if less than 70 years old; 800 IU per day if more than 70 years old
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when to check 25 hydroxy vitamin D 3
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if considering vitamin d deficiency or intoxication
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when to check 1, 25 hydroxy vitamin D 3
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sarcoidosis
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action of PTH
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on kidney - increases calcium absorption and increases phosphate excretion
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action of vitamin D
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increases intestinal calcium and phosphate absorption
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lab findings in sarcoidosis / vitamin D intoxication
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increased calcium and phosphate, low PTH
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lab findings in hyperparathyroidism
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increased PTH, calcium, low phosphate
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lab findings in malignancy / milk alkali syndrome
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increased calcium, low PTH, low PO4
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MEN 1
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pituitary, pancreatic (ZES, insulinoma), parathyroid
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MEN 2a
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parathyroid, pheochromocytoma, medullary thyroid cancer
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MEN 2b
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pheochromocytoma, medullary thyroid cancer, neuromas
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spectrum of MEN
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pituitary, pancreatic, parathyroid, pheo, medullary thyroid, neuromas; PETER PAN PARA FEOLI MEDED NEUROMEDED (PETER PAN PARA, PARA FEOLI MEDED, FEOLI MEDED NEUROMEDED)
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how to screen family members of patient diagnosed with medullary thyroid cancer?
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check calcitonin levels and RET proto oncogene
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in hyperparathyroidism, when is surgery indicated?
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age less than 50, calcium 11.5 or more; renal stones, symptomatic
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in hyperparathyroid patient refusing surgery, what next?
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start cinacalcet
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patient with dyspepsia develops hypercalcemia
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milk alkalil syndrome
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lab findings in pseudohypo parathyroidism
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high PTH, low calcium, high phosphate
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pathophysiology of pseudo hypo parathyroidism
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abnormal G protein attached to PTH receptor, PTH binds to receptor but there is no effect
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treatment of osteoporosis
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bisphosphonates, calcitonin for pain, Vitamin D and calcium, raloxifene, teriparatide
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patient comes in to renew estrogen for osteoporosis treatment
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stop the estrogen and start bisphosphonates, vitamin D and calcium
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medication that decreases mortality in patients with osteoporosis
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zoledronate
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most common side effect of zoledronate
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fever and myalgias
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