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175 Cards in this Set

  • Front
  • Back
very dry tongue, thirst, polyuria, dec'd BP, tachycardia, inc'd RR, vomitting, abd pain, diaphoresis
DKA
fatigue, weight loss, excessive urination, polyuria, polydipsia, polyphagia
DM
fingerstick, UA, CBC, C7, Ha1c, fasting lipids, EKG
Dx of DM
Malignant Otitis Externa, Emphysematousis pyelonephritis, retinopathy, foot complications, CAD, MI, CVA, PVD
Manifestations of DM
antiestrogens x 3 months or surgery
Tx of gynecomastia
serum LH, FSH, testosterone
semen analysis
dec'd testosterone
dec'd Gonadotropin
inc'd FSH
dec'd NL sperm
Dx of Testicular Feminization
Phenotypic female
fetus- L-S folds don't fuse= short vagina
breat enlargement
inc'd LH
Testicular Feminization
remains prepubital
small testes
rubbery testes
lack testosterone
see endocrinologist
Kallmas Syndrome
XXY
gynecomastia
small firm testes
azoospermia
euchnoidal skeletal proportions
elevated FSH and LH
Kleinfelter Syndrome
testosterone therapy
GnRH
surgery
Tx for infertililty
surgical excision
alpha blockade by phentolamine
beta blockade
Epi= alpha and beta
Tx of Pheochromocytoma
24 hr urinary catecholamines or metabolites
VMA
Plasma catechols inc'd during HTN
MRI or CT of adrenals
Dx of Pheochromocytoma
HTN- not controlled by meds
flushing
anxiety
nausea
weakness
weight loss
looks like a thyroid problem
Pheochromocytoma
correct electrolyte abNL
spirolactone
ACEi
Angioplasty in Renal Artery Stenosis
Tx of hyperaldosterone
document HTN and hypokalemia
hypoMg
EKG changes
CT/MRI of adrenals
Serum/Urine Aldosterone Level
Plasma renin levels
Serum ACTH
Dx of hyperaldosteronism
HTN
hypokalemia
absent or decreased DTR
proximal muscle weakness and fatigue
parasthesias
Hyperaldosteronism
Exogenous- dec steroid dose
Endogenous- surgery for pit or lung Ca, Radiation of Chemo, unilateral adrenalectomy or radiation
Cushing's Syndrome
24 hour UFC- 1st
serum cortisol
serum ACTH
high dose dexamethasone suppression test
MRI gadolinium of pituitary
MRI of adrenals
CXR
DEXA
Dx of Cushing's
hyperglycemia
inc'd protien and muscle breakdown
central obesity
poor wound healing
virilizing of women
HTN
osteoporosis
Cushing's Syndrome
prolactin secreting pit tumors
drugs effecting CNS
OCP and HRT
hypo/hyperthyroidism
breast stimulation
chest wall injury
spinal cord injury
Causes of Galactorrhea
Pituitary Surgery
Tx for acromegaly
macroadenomas
metalstatic carcinoma
germinomas
craniopharyngiomas
Causes of Hypopituitarism
h/a
bilateral visual fiels effects
dec'd GH
dec'd GnRH
dec'd libido
Mass Effects of Pituitary Tumors
Transsphenoidal surgery or suppressio of prolactin by bromocroptine
Tx for Prolactinoma
most common secretory adenoma
commonly amenorrhea and galactorrhea
excess PRL
men--> dec libido, oligospermia, dec'd testosterone
Prolactinoma
>1cm in diameter
endocrine inactive tumor
mass effect
sellar enlargement
deviation of the pituitary stalk
displace optic chiasm
bitemporal visual fiels cuts
Pituitary Macroadenoma
<1cm
does not cause sellar enlargement, structural problems, hypopituitarism
Pituitary Microadenoma
MRI w/ gadolinium
Dx test done for pituitary tumor found before death
Pituitary insufficiency
Nonfunctional adenomas
incidental finding on autopsy
Pituitary Tumor
address dysrhythmias, seizures
IV Mg
ID cause
Tx of HypoMg
GI loss
malnutrition
renal loss
Rx
Causes of HypoMg
NM irritability
hyperreactive DTR
muscle cramps
muscle fibrillation
CNS hyperexcitability
irritability and combativeness
disorientation
psychodid
ataxia, vertigo, nystagmus, seizures
Cardia Arrhythmias
HypoMg
Stop any exogenous source of Mg
IV fluids to dilute Mg
diuretics to increase excretion Mg
IV Ca
Tx for HyperMg
N/V
weakness
skin flushing
lightheadedness
disappearance of DTR
hypotn
arrhythmia
Intraventriculat conduction delay
asystole
ventilatory failure
muscle weakness
vasodilation
heart block
stupor or coma
DEATH
HyperMg
large doses of Vit D and Ca
Tx for Hyperparathyroidism
hypernatremia
hyperkalemia
eosinophilia
metabolic acidosis
cortisol and aldosterone levels
ACTH or corticotropin stim. tests
Adrenal Imaging on CT and MRI
Adrenal Ab
Dx of Addisons
Vomitting
dehydration
hypoglycemia
hypotension
ACUTE Addisons Dz
Fasting hypoglycemia
inc'd pigmentation
inability to respond to stress
aldosterone lack
weight loss
fatigue
vomitting
women- lack axillary and pubic hair and dec'd hair on extremities
Addisons Dz
insufficient PTH produced
depressed reabsorption of Ca from bones
low serum Ca
tetany sxs
carpopedal spasm
Hypoparathyroidism
Surgical removal by standard surgery or MIRP
Tx of hyperparathyroidism
inc'd parathyroid hormone
inc'd serum Ca
Dx of Hyperparathyroidism
50% asx
renal stones
emotional disorders
renal insufficiency
pancreatitis
hypercalciuria
osteoporosis
PUD
Primary hyperparathyroidism
After pt with CRF receives a renal transplant, the parathyoirs remain overactive even though new kidneys are fx well
Tertiary Hyperparathyroidism
compensatory inc in fx due to renal, GI or bone dz
Secondary hyperparathyroidism
unknown cause
benign or malignant
single or multiglandular involvement
Primary Hyperparathyroidism
lack of cortisol, aldosterone and androgen
autoimmune
80-90% of gland has to be destroyed before sx occur
Addison's dz
inc'd ACTH
hyperplasia of ZF and ZR
lack of cortisol or aldosterone
inc'd adrenal androgens
shunting to biosynthesis of androgens and 17 ketosteroids
Congenital Adrenal Hyperplasia
dec'd aldosterone
dec'd cortisone
inc'd 17-hydroxyprogesterone
inc'd progesterone
check plasma 17 hydroxyprogesterone excess
Congenital Adrenal Hyperplasia
Androgens only- hirsutism and amenorrhea
Virilizing of Adrenocortical or Ovarian Tumors
Androgens + Cortisol secretions
Mixed virilizing of Adrenocortical or Ovarian Tumors
hirsutism
infertility
amenorrhea
obesity
enlarged ovaries
Polycystic Ovary Syndrome
Femal fetus- enlargement of clitoris and labial fusion
Female pseudohermaphrodism @ birth
hirsutism @ puberty
Excess Androgens
Fludrocortisone
Lasix
Tx of Hyporeninemic Hypoaldosteronism
dec'd renin
dec'd AT I
Dec'd ATII
dec'd Aldosterone
hyperkalemia
hyponatremia
Hyporeninemic Hypoaldosteronism
Lifeling replacement of glucose and mineralcorticoids
Tx of Secondary Adrenal Insufficiency
Failure of Standing dehydration test
Dx of Secondary Adrenal Insufficiency
exogenous steroids
infiltrative- sarcoidosis
tumors- pituitary/ hypothalmic
post partum pituitary necrosis
head trauma
pituitary surgery/ irradiation
Causes of Secondary Adrenal Insufficiency
Autoimmune- Addisons
Infectious- TB, HIV
Infiltrative Disorders- Sarcoid, Amyloid
Hemmorhage. thrombosis
Metastasis
Causes of Adrenal Insufficiency
panhypopituitarism or sudden withdrawal of steroids
dec'd ACTH
NL aldosterone
Secondary Adrenal Insufficiency
inc'd ACTH
inc'd renin
dec'd cortisol
dec'd aldosterone
dec'd urinary 17 hydroxycorticosteroids
unresponsive adrenals
IV infusion does not cause a rise in cortisol
Primary Adrenal Insufficiency
usually found after metastasis
poor prognosis
fatal weeks--> months
Anaplastic Thyroid Carinoma
Complete Thyroid removal PLUS a dissection to remove the lymph nodes of the front and side of the neck
Tx for Medullary Ca
most common and most curable type of thyroid ca
Follicular and Papillary Ca
complete removal of the lobe that harbors the ca PLUS almost all of the other lobe
SYNTHROID THERAPY
Tx of Follicaular and Papillary Ca
Small- levothyroxine
Large- surgery
Tx of Goiters
single
fixed
hard
associated with lyphadenopathy
cold on I123 scan
Criteria that makes a nodule seem Malignant
Synthroid and monitoring
Tx of hypothroidism
dec'd T4 and inc'd TSH
Primary Hypothyroidism
dec'd T4 and dec'd TSH
Secondary Hypothyroidism
fatigue, weakness,
course dry hair
constipation
delayed DTR
dry rough pale skin
cold intolerance/hypothermia
depression
bradycardia
weight gain
myalgias
arthralgias
irritability
lethargy
puffy looking
amenorrhea
heart blocks
Hypothyroidism
poor feeding
hypotonia
inactivity
edema of hands and feet
Hypothyroid in Infants
short stature
delayed puberty
MR
development delays
Hypothyroid in children
hypothermia
stupor
extreme weakness
hypoventilation
hypoglycemia
Myxedema coma
most common permanent tx of hyperthyroidism
Radioactive I
PTU/ Methimazole
Antithyroid Drugs
Radioactive Iodine
Surgery
Beta Blockers
Ablative therapy with RAI
Tx of Hyperthyroidism
dec'd I uptake
Dx of Thyroiditis
TSH receptor Ab
inc'd I uptake
toxic adenoma
Dx of Graves Dz
inc'd free T4
dec'd TSH
Dx of hyperthyroidism
Ingestion of excessive amounts of thyoxine
thyroxicosis factitia
thyroid swells rapidly and is painful and tender
Gland is producing thyroid hormone but quits taking up I
resolves over a few weeks
NSAIDS and Bed Rest
DeQuervains Thyroiditis
in late stages...
inc'd TSH
dec'd T4 and T3
Hashimotos Thyroiditis
inflammation of thyrois is always enlarged
Thyroid is inefficient in converting I into thyroid hormone and compensates by enlarging
Hashimotos Thyroiditis
cause of hyperthyroid
thyrois nodules produce excess amounts of thyroid hormones
palpable goiter
Solitary Toxic Nodule
Autoimmune
goiter
women 8:1
hyperthyroid eye dz
thyroid dermopathy
check for antithyroglobin and antihyroperoxidase Ab
Graves Dz
Most common cause of hyperthyroid
autoAb attach to activating sites on the thyroid which stimulates hormone synthesis
Graves Dz
precipitated by stressor--> surgery
acute infection, MI, uncontrolled DM, radioactive iodine therapy
Thyroid Storm
coma
marked hyperpyrexia
diaphoresis
tachycardia
a-fib
cardiac failure
N/V
diarrhea
agitation
delerium
Thyroid Storm
thyrotoxicosis
tachycardia
muscle weakness
hair loss
fine tremor
diaphoresis
staring gaze
weight loss
tactile temp
palpitations
a-fib
insomnia
light or absent menses
heat intolerance
breathlessness
nervousness
diarrhea
fatigue
bulging eyeballs
pretibial edeam
palmar erythema
Hyperthyroidism
elevated circulating thyroid hormone
not increades thyroid activity
source either pit or hypothalmus
Hyperthyroidism
loss of one, all or a combination of AP hormones
Anterior Hypopituitarism
hypogonadism and infertility
LH and FSH deficiency
central diabetes inspidis with polyuria and polydipsia, and hypernatremia
ADH deficiency
painless swelling in region of thyroid
TFT NL
irradiation to head and neck
+ thyroid needle aspirations
Thyroid Ca
NL WBC
inc'd sed rate
+ RF- doesn't rule this out
Xray
OA
APAP
NSAIDS
Capsaicin cream (Zostrix)
Oral Chondroitin sulfate or glucosamine
Intraarticular steroid injection
Intraarticular Hyaluronic acid derrivatives
Surgery
Tx of OA
BC +
dec'd glu
inc'd protein and lactate
WBC count>10K
Septic Arthritis
Treat empirically w/ abx against gonoccal, staph, pneumococcai and GN orgs
Rochephin
Naphcillin + Gent
Tx of Septic Arthritis
no viable organisms
inc'd sed rate and CRP
turbid fluid
WBC count >5K
low viscosity
glu not greatly reduced
Reiter's Syndrome (Reactive Arthritis)
NSAIDS and exercise
DMARDS
Tx of Reiter's Syndrome
rare
inc'd chylomicrons
extremely increased TG
NL VLDL and LDL
risk of pancreatitis
Type 1 Lipoprotein Disorder
xanthomas in homozygous
marked inc LDL
NL VLDL
Total Cholesterol >500
Vascular Dz in Children
Type 2a Lipoprotein Disorder
Inc'd VLDL
inc'd LDL
mixed hyperlipidemia
inc'd TG
TC 250-500
Type 2b Lipoprotein Disorder
dysbetalipoproteinemia
inc'd VLDL
NL LDL
inc'd TG
inc'd TC
Type 3 Lipoprotein Disorders
inc'd VLDL
inc'd TG
familial hypertriglyceridemia
NL LDL
inc'd risk of CAD
Type 4 Lipoprotein Disorders
inc'd TC
NL LDL
Inc'd VLDL
TG>1000
Type 5 Lipoprotein Disorders
lifestyle change
smoking cessation
inc fiber
dec saturated fats
statings
bile acid sequest.
fibrates
niacin
Tx of Lipoprotein Disorders
hyponatremia
hypotoxicity
euvolemia
NL renal, thyrois and adrenal fx
Uosm <100
inc'd Una
SIADH
confusion
coma
N/V
h/a
weakness
psychosis
pitting edema
peripheral edema absent
SIADH
Na>135
NL BG
Sosm <280
CXR
CBC
C7
Lytes
Amy
Lip
UA
CT-head
Dx of SIADH
mild- mod--> HOH restriction and good workup
ABCs first
consider glu, narcan and thiamine
thypotension or hypovolemia--> NSS bolus
watch rate of Na--> pontine myelinosis
Tx of SIADH
can't concentrate urine
dilute urine
dec'd Uosm
NL--> high plasma osm
Diabetes Inspidis
HOH depletion test--> continue to make dilute urine
Dx of DI
Psychogenic--> tx psych dz
central or neuro--> synthetic ADH (DDAVP)
Nephrogenic--> tx renal dz
tx of DI
malaise
weakness
polyuria
polydipsia
dehydration
nephrolithiasis
HTN
muscle weakness
hyporeflexia
EKG changes
hypotn
tremor
lethargy
confusion
stupor
coma
Hypercalcemia
weight loss
loss of appetite
weakness
pain
easily fx bones
KIDS- deformities ar epi plates
ADULTS- softening- bending on long bones
Primary Osteoporosis
inc'd alk phos
Dx of Primary Osteoporosis
Vit D x 6 weeks
Tx of Primary Osteoporosis
dec'd height
curved upper back
back pain
vertebral fx
wrist, tibial, hip and humoral fx
Secondary Osteoporosis
XR- prominent vertebral end plates
Dx of Secondary Osteoporosis
Ca/Vit D supplements
Calcitonin
Weight bearing exercise
Tx of Osteroporosis
dull ache pain, 1+ jts, worse w/ activity, AM, cold, improves with rest, stiffness
OA
PIP, DIP of hand and feet, crepitus, warm, red, effusion, swell, Heberden's DIP, Bouchard
OA
WBC 2000
no infx
ESR NL
CT/MRI- disc stenosis
Dx of OA
Low exercise, weight loss, steroids, brace
OA
ulner deviation, hammer finger, boutonneire deformity, swam neck, vasculitis, sjogrens nodules, bakers cyst, CTS, symmetrical swelling
RA
wrist, hands, AM stiffness, 3+ jts (at least one jt: wrist, MCP, PIP, Boutonniere's, swan neck)
RA
RF+
Dx of RA
NSAIDS
ASA
methrotrexate
antimalarial
PCN
low dose steroids
Tx of RA
inflammation of sacroilitis, sponylitis jts, adn uveitis, pencil in cup deformity, acro-osteolysis, Joint space loss
Psoriatic Arthritis
Chlamydial infx
Psoriatic Arthritis
HLA B27 allele
XR- sacrilitis
osteophytes
bamboo spine
Psoriatic Arthritis
very local spasm, neck, shoulder, intercapsular muscle, lower back, butt
reproducable on palpation
Mypcascial Trigger Points
ACAP, ASA, NSAID, lidocaine/steroid injection
Tx of Mypcascial Trigger Points
low dose amitrip muscle relaxer, low exercise, SSRI, antidepressants
Ts of a fake dz
pain, siff, cervical , 10-20% temporal arteritis
Poly Rheumatica
inc'd ESR
anemia
inc'd LFT
Dx of Poly Rheumatica
low dose steroids
Tx of Poly Rheumatica
ice, rest, remove agent, antiinflammatory, steroids
Tx of -itises
trauma, inflammation, pain, limited motion of biceps or supraspinatous tendon
Capulitis, bursitis of shoulder
pain over wrist extensor inserts on lateral epicondyle, tennis elbow
epicondylitis
extensor/abd tendon sheaths in wrist, inflamm disease or repetitive trauma
Tenosynovitis
pain in PM in wrist/hand--> numbness in thumb/index
CTS
ice, rest, remove agent, antiinflamm, steroids
Tx of CTS, Dupuytren's contracture, IT band, Trochanteric bursitis, plantar fascitis
fibrosis/shortening of 1+ flexor tendons of hand--> deformity
Dupuytren's contracture
fascial strain over extensor hip--> pain down side of leg
IT Band
Local Pain over great trochanter--> diff to walk
Trochanteric bursitis
S. Aureus, suspect cellulitis, erythema, fever, leukocytosis, crystal deposits in bursa
Septic Bursitis
Aspirate bursa fluid, cell count, cx, crystal exam
Dx of Septic Bursitis
drai, ABX
Tx of Septic Bursitis
overuse injury, subacromial shoulder, trochant
Nonseptic bursitis
rest, ice, NSAIDS, steroids, don't aspirate iliopsoas bursa
Tx of Nonseptic Bursitis
Low Back pain,
Spinal Dz
rapid, PM pain, podagra, skin inflamm, warm, hot jts, pain w. movement, hurts to put clothes on,
GOUT
Negative Birefringent needle shapped crystals
GOUT
knee, wrist, pubic sym.
psuedogout
positive birefringent rhomboid shaped crystals, athrocentesis
Dx of pseudogout
Colchicine, methyl/prednisone, intercrit, alopurinol
Tx of Gout
NSAIDS, Roids: intracrticular and oral
Tx of Psuedogout
h/a, scalp tenderness, visual disturbances, monocular blindness
Giant cell arteritis
inc'd ESR
anemia
fever
Dx of Giant cell arteritis
hight dose steroids
Tx for giant cell arteritis
pulseless disease, claudication, leads to MI
Tx. Roids
Takayasu Arteritis
associated with hep b/c, involves medium vessels, segmental nec lesion
Polyarteritis Nodusa
Biopsy/ Angiography of vessel
Dx of Polyarteritis Nodusa
asthma, pulm infiltrates, eosinophilia, skin, peripheral nerves, GI, allergic granulomatos adn angitis
Churg- Straus
fuliment alveolar hemm, rapid GN, tissue Bx, lung, kidney, sinuses
Wegner Granulomatosis
small children, young adults, palpable purpuram arthalgia, abd pain, fever, GN
Henoch-Schonlein Purpura
100% mortal w/o tx
Weg. Gran.
Roids and immunosuppressant
Tx of Weg Gran
Roids and NSAIDS
Tx. of H-S Pupura
inc'd serum CPK-MM
inc'd aldolase
inc'd ALT and AST
inc'd LDH
inc'd sed rate
urine + for hemoglobin
Polymyositis
Steroids and DMARDS
Tx of Polymyositis
45 XO, short stature, hypogonadism, webbed neck, hypertension, reanl abNL,
Turner's Syndrome
daily injections of GH
Tx of Turners
surgery, parathyrois resection, bisphosphantes
Tx of MEN 1 wermer's Syndrome