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108 Cards in this Set
- Front
- Back
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Most common tumor of the pituitary?
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prolactinoma
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How can a prolactinoma cause visual complaints?
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if its an adenoma (> 10mm), it can impinge on the optic chiasm and cause bitemporal heteronymous hemianopsia
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Buffalo hump, moon facies, violaceous striae, truncal obesity, HTN, hyperglycemia, osteoporosis, poor wound healing.
These are all signs of _____ which is due to ______ |
Cushing's disease
due to overproduction of cortisol, from overproduction of ACTH in the ant pit |
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Why do Cushings pts have striae and poor wound healing?
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bc cortisol inhibits connective tissue production
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An adult who has outgrown rings and hats and has developed course facial features suggests what?
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Acromegaly due to ant pit adenoma
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In PCOS:
____ is overproduced, causing stimulation of _____ cells which produce androstenedione and testosterone which go to the fat cells to be converted to _____ by _____. This creates a neg feedback to inhibit _____ secretion. Decreased ______ secretion causes anovulation |
LH is overproduced, causing stimulation of theca cells which produce androstenedione and testosterone, which go to the fat cells to be converted to estrone by aromatase. This creates a neg feedback to inhibit FSH secretion. Decreased FSH secretion causes anovulation
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What LH:FSH ratio is diagnostic for PCOS?
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2:1 or more
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This is caused by ovarian failure and destroys the neg feedback system, so ____ and ____ are high in the blood
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FSH and LH
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What do labs look like in menopause?
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low estrogen, progesterone
hi FSH, LH |
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This syndrome causes excessive water reabsorption at the kidney, causing HTN, hypokalemia and cerebral edema
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SIADH- excess ADH secretion from post pit
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What disease can SIADH occur concurrently with?
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SIADH commonly shows up with small cell lung cancer as a paraneoplastic syndrome
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Sheehan's syndrome is...
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postpartum pituitary necrosis
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Central Diabetes Insipidus is caused by...
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post pit inability to make ADH, so you pee out all the water (polyuria and polydipsia)
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How does nephrogenic DI differ?
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kidney doesnt respond to ADH but causes sim sx
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In Conn syndrome, this hormone is overproduced, causing hypokalemia and hypernatremia
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aldosterone
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Screening test for Cushings?
Confirmatory test? |
24 hour urine cortisol
confirm with dexamethasone suppresion test |
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5 P's of Pheochromocytomas?
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Pressure (HTN)
Pain (HAs) Perspiration Palpitation (tachy) Palor |
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What is a pheo?
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tumor of the adrenal medulla that secretes norepi +/- epi causing HTN
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Best lab value to dx pheo?
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24 hr VMA > 24 hr metanephrines > 24hr urinary catecholamines
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Rule of 10s with Pheos?
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10% bilateral
10% malignant 10% children 10% extra-adrenal 10% calcify |
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What hormone does a neuroblastoma produce in excess?
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malignant tumor of adrenal medulla producing excess norepi
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This dz features decreased Aldosterone production causing hypotension, hyponatremia, hyperkalemia, skin hyperpigmentation....
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Addisons disease
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In primary hyperthyroidism, you will have ____ T3/4 and ____ TSH
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high T3/4 and low TSH
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In secondary hyperthyroidism, you have _____ T3/4 and _____ THS
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high T3/4 BECAUSE OF HIGH TSH
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What is the most common type of hyperthyroidism in the US?
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Graves dz, where pt has anti-TSH receptor antibodies that activate the receptor
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What is dermopathy in Graves?
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It is pretibial myxedema, or non-pitting edema bc it is not due to excess water but tissue
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Why are pregnant women euthyroid even though they make excess thyroid hormone?
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because they also make excess TBG
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Diff bt Graves and Plummers disease (nodular toxic goiter)
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Plummer's dz is focal areas of thyroid. No systemic effect of hyperthyroid, BUT the excess T3/4 does affect ant pit, inhibiting TSH release and decrease thyroid stim
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Diffuse simple goiter is due to ______
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iodine def
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In ________ disease, anti-microsomal ABs destroy thyroid gland and hypothyroid sx develop. Treat with levothyroxine
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Hashimotos thyroiditis
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Why is it a bad idea to keep patients on Ergots for migraines for more than 6mos for a lifetime?
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because they increase the risk for Riedel's thyroiditis, where thyroid gland fibroses and becomes nonfxnal
Tx = levothyroxine |
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This transient and temporary form of thyroiditis, a viral infection triggers thyroid to dump its stores leading to hyperthyroid, then hypothyroid
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DeQuervain's thyroiditis
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There are many variants of sick euthyroid syndrome, but all of them have:
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NORMAL TSH
Due to severe illness, trauma, physiologic stress |
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This type of thyroid nodule is more likely to be malignant ______ because:
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cold nodules because they do not need iodine since they are not making thyroid hormone.
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This is the most common thyroid cancer and has the best prognosis:
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papillary ca
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This type of thyroid ca has psammoma bodies:
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papillary ca
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This thyroid ca has the worst prognosis:
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Anaplastic ca- VERY aggressive, by time of dx it has infiltrated entire neck
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What do parafollicular C cells of the thyroid make?
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calcitonin
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Medullary thyroid ca causes hypocalcemia bc:
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it is a tumor of parafollicular C cells of the thyroid which manufacture calcitonin which is produced in excess
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What does the PTH do?
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1) activates osteoclasts
2) increases Ca reabsorption in the renal tubule 3) increase GI absorption of Ca 4) increase vit D conversion to 1,25-dihydroxyvitamin D in the kidney 5) increases renal phosphate excretion |
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What does 1,25-dihydroxyvitamin D3 do in terms of Ca and P absorption?
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increases Ca and P absorption increasing blood levels
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What are labs like in Hyperparathyroidism?
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hi PTH, hi Ca, low Phos
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Most common cause of hypoparathyroidism?
Labs? |
parathyroid removal during thyroidectomy
low PTH, low Ca, hi Phos |
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What is Pseudohypoparathyroidism?
Labs? |
Nothing wrong with parathyroid gland, problem is with tissue receptors!
Hi PTH, low Ca, hi Phos due to lack of response |
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What is pseudopseudohypoparathyroidism?
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PTH receptors on tissue are fine but 2nd messenger system in tissues is defective, making response slow but possible
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How does renal osteodystrophy occur?
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in kidney failure, you have decreased active Vit D production, leading to hypocalcemia. This increases PTH, which increases bone demineralization, causing osteodystrophy (osteomalacia)
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This type of DM has a ketoacidosis risk...
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Type I
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What are Type II Diabetics at risk for developing that is extremely dangerous?
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hyperosmolar nonketotic coma- blood becomes hyperosmolar due to elevated glucose levels, causing water to be drawn into the vasculature, dessicating the brain and causing coma
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Which type of DM has an HLA association? Which HLA?
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DM type I is a/w HLA-DR3, -DR2
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Which type of DM has antibodies and which antibodies are they?
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Type I has anti-Beta islet cell ABs which destroy the cells that produce insulin
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What exacerbates Gestational Diabetes?
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human placental lactogen (hPL) a product of the placenta which causes mild insulin resistance
Screened by the Glucola test |
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This type of DM is due to a glucokinase defect...
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MODY (maturity onset diabetes of the young)
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For MENs, type I's shape is ____
type II's shape is ______ type IIa's shape is ______ |
Type 1 is a diamond
Type II is a rectangle Type IIa is a Triangle |
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What is the inheritance pattern for MENs?
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Auto Dom
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Another name for MEN type I is
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Wermer's syndrome
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Another name for MEN type II is
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Sipples syndrome
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Another name for MEN type IIA is
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MEN type III
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GpIb binds _____
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vWF
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GpIIbIIIa binds _______
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other platelets
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ASA inhibits platelets from making _____
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thromboxane
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Sulfinpyrazone inhibits ______ and _______ release
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degranulation and TXA release
No longer used |
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Which drug is a PDE inhibitor that increases cAMP, which inhibits TXA2?
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Dipyridamole
-also used in cardiac imaging. In nuclear imaging, healthy parts of the heart "light up" |
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It is standard practice that all patients that receive stents be put on _______
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clopidogrel
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What type of drug is abciximab?
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it blocks GpIIbIIIa receptors which normally aid in plt to plt aggregation
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What does heparin bind to and how does it work?
How long does it take to start working? |
it binds to Antithrombin III, enhancing its activity. ATIII normally binds to and inhibits clotting factors II, IX, X, XI, XII
Given IV, works in minutes |
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To monitor heparin therapy, which pathway is monitored and which clotting test is done?
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Intrinsic pathway, PTT
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What is the convenient thing about LMWH?
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do not need to follow up with coag studies
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These are the factors that need Vit K to mature, and are blocked by coumadin after 3 days...
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X, IX, VII, II
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This drug is like heparin but is synthetic
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Fondaparinux
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Why do you need to give heparin upon starting coumadin therapy?
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Bc proteins C+S are Vit K dependent. They inhibit Factors V and VIII. They have a 24 hour half life, so after 24 hrs coumadin will inhibit them, so patient will become HYPERCOAGULABLE
SO need heparin to prevent clotting |
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What are some uses for thrombolytics?
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P.E
MI DVT |
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Streptokinase and urokinase both activate ______ while tPA binds _______
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plasminogen
plasmin that is already bound to fibrin tPA is targeted tissue tx; wont affect clots that are made after its administration |
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pneumonic for Anti-arrythmics?
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Silly Bunnies Punch Cats
Sodium blockers, beta blockers, potassium blockers, CCBs |
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Which anti-arrythmic has elevated risk of lupus like syndrome?
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procainamide
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What is the basic mechanism of the gylcosides?
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inhibit the Na-K pump. Na builds inside the cell. Rising Na levels inhibit Na-Ca exchanger and Ca builds in the cell. Ca is taken to sarcoplasmic reticulum
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Downsides of gylcosides?
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therapeutic is low, needs regular monitoring
can cause objects to look yellow |
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Which is the DOC for cardiogenic shock?
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Dobutamine- it is a B1 agonist that activates the second messenger system to eventually phosphorylate Ca channels allowing them to permit entry of Ca
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Why is dopamine given with dobutamine?
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because it prevents reflex vasodilation by stimulating alpha1 receptors causing vasoconstriction
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Prophylaxis of asthma can be achieved by giving _____ which is a _______
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cromolyn
mast cell stabilizer |
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Corticosteroids inhibit _______ to inhibit the release of leukotrienes and prostaglandins
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Phospholipase A2
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Some other actions of corticosteroids:
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decrease mphage, T cell, and eosinophil activation
decrease capillary permeability |
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What do leukotrienes do?
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cause vasoconstriction and bronchoconstriction
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Examples of some leukotriene inhibitors?
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zileuton, zafirlukast, montelukast
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Omalizumab is an AB to _________
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IgE
only reserved for most serious cases of severe persistent asthma |
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the supraspinatous is involved in the first ______ of abduction
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90 degrees
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These two SITS muscles eternally rotate the arm:
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Infraspinatous
Teres Minor |
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Subscapularis does ______
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internal rotation
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What is the primary flexor of the shoulder?
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anterior deltoid
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What are the primary extensors of the shoulder?
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post deltoid
teres major lat dorsi |
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The brachial plexus runs through the _____ and _____ scalenes medially and _______ the clavicle laterally
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ant and middle scalenes
underneath the clavicle |
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The brachioradialis reflex tests nerve root ____
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C6
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the interossei are innervated by ____
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T1
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most common brachial plexus injury is ____
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Erb-Duchenne C5-6
causes waiters tip |
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Klumpkes palsy is due to
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C8-T1 injury
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How do you test for a winged scapula?
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have pt push against the wall, if scapula pops out then the long thoracic n. is injured, serratus anterior m isnt working
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Sign of bicipital tenosynovitis is
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pain at the bicipital groove
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Primary flexor of the forearm is?
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brachioradialis
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Primary supinators?
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biceps, supinator
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What does the Allen's test look for?
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radial and ulnar aa patency before ABGs
release ulnar artery and see if hand pinks up, then do same with radial |
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This test tests for DeQuervain's tenosynovitis...
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Finkelsteins- make a tight fist with the thumb tucked into the fist, and induce adduction of wrist. Pos test is pain over tendons at the wrist
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Damage to the ______ nerve causes wrist drop deformity
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radial
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The dorsal interossei _____ the fingers and the palmar interossei _____ the fingers
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dorsal abduct (DAB)
palmar adduct (PAD) |
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Swan neck deformity and Bouteniere deformity are a/w:
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RA
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"Swans flex the DIP"
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Imagine a swan flexing and chewing DIP
Flexion of the DIP |
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Claw hand deformity is from _____ nerve damage
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ulnar
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Ape hand deformity is from ______ nerve damage
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median
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Dupuytren's contracture is from ___
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palmar fascia contracture
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Bishops deformity can either be from _____ damage or _____ damage
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medial or ulnar
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