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88 Cards in this Set

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which HLA types is type I DM associated with?
HLA DR3 and DR4
treatment for 'dawn phenomenon'
move PM insulin closer to bedtime
when does diabetic retinopathy appear?
when DM has been present for at least 3-5 years
how do you prevent diabetic retinopathy?
control of hyperglycemia and HTN and laser photocoagulation therapy for retinal neovascularization
how is diabetic nephropathy characterized?
glomerular hyperfiltration and microalbinuria
goal BP for a diabetic?
<130/<75
goal LDL for diabetic
<100
goal triglycerides for diabetic?
<150
when do you test people for DM?
every three years starting at 45
what is considered impaired fasting glucose?
>100 but <126
diagnosis of metabolic syndrome
must meet 3/5 criteria:
abdominal obesity
triglycerides >150
HDL <40 (men), <50 (women)
BP> 130/85 or on antihypertensives
fasting glucose >110
treatment for metabolic syndrome
aggressive weight loss, cholesterol lowering, and BP control
side effects of sulfonylureas (glipizide, glyburide)
hypoglycemia & weight loss
how do sulfonylureas and meglitinides work?
insulin secretagogues
how does metformin work?
inhibits hepatic gluconeogenesis; increases peripheral sensitivity to insulin
side effects of metformin
weight loss, GI upset, lactic acidosis
in whom is metformin contraindicated?
elderly (>80) and patients with renal disease
how do thiazolidinediones work?
increased insulin sensitivity
side effects of thiazolidinediones
weight gain, edema, potential hepatotoxicity
how do alpha glucosidase inhibitors work
decrease intenstinal absorption of carbohydrates
single best test for thyroid function
TSH
high TSH
primary hypothyroidism
low TSH
primary hyperthyroidism
preferred screening test for thyroid hormone levels
free T4
in what disease are exophthalmos and pretibial myxedema seen?
only in Grave's
what causes Grave's disease?
TSH receptor antibodies
most common cause of hypothyroidism
hashimotos't thyroiditis
antibodies in hashimoto's?
anti-TPO; anti-microsomal
treatment for subacute thyroiditis?
usually self-limited; treat wtih NSAIDs or oral steroids for severe cases
severe hypothyroidism with decreased mental status, hypothermia, and other symptoms
myxedema coma
treatment for myxedema coma
IV levothyroxine and IV hydrocortisone (unless adrenal insufficiency hasn't been excluded)
typical pattern of thyroiditis
hyperthyroidism followed by hypothyroidism with decreased uptake on RAIU
treatment for hyperthyroidism thyroiditis
B blockers
treatment for hypothyroidism thyroiditis
levothyroxine
hyperfunctioning thyroid nodule, local symptoms, with + family history
think of medullary thyroid cancer
with which MEN syndromes is medullary thyroid cancer associated?
MEN II and III
characteristics of LNs in carcinoma
firm, fixed, nontender
treatment for hot nodules
never cancerous; should not be biopsied
most common thyroid neoplasm
papillary
psammoma bodies and orphan annie nuclei
papillary thyroid cancer
MEN I
Wermer's syndrome: pancreatic syndrome (Z-E, insulinomas, VIPomas), parathyroid, and pituitary tumors
MEN II
sipple's syndrome: medullary carcinoma of thyroid, pheochromocytoma, parathyroid gland hyperplasia
MEN III
medullary thyroid cancer, pheochromocytoma, oral and intestinal ganglioneuromas (mucosal neuromas), marfanoid habitus
most common cause of pathologic fractures in elderly thin women
osteoporosis
what is associated with an increased risk of osteoporosis?
smoking, excessive caffeine intake, history of amenorrhea, and steroid use
what is Paget's disease?
characterized by an increased rate of bone turnover; excessive resorption and formation of bone
mosaic lamellar bone pattern
Paget's disease
cause of Paget's disease
thought to be due to viral infection &/or genetic factors
symptoms of Paget's
usually asymptomatic, but may present with aching bone or joint pain, HAs, skull deformities, fractures, nerve entrapment, which can lead to hearing loss
most sensitive test for Paget's
radionuclide bone scan
treatment for Paget's
majority of patients are asymptomatic and require no treatment; bisphosphonates and calcitonin can be used to slow osteoclastic resorption
what are most cases of hyperparathyroidism due to?
single adenoma; 15% due to parathyroid hyperplasia
symptoms of hyperparathyroidism
stones, bones, groans, psychiatric overtones
hypercalcemia, hypophosphatemia, hypercalciuria
hyperparathyroid
treatmtne for acute hypercalcemia
IV fluids with loop diuretic if heart or renal failure, IV bisphosphonate, calcitonin
what is cushing's syndrome most commonly due to?
hypersecretion of ACTH, usually due to a pituitary tumor
ectopic ACTH secretion from neoplasia
carcinoid tumor, small cell lung CA
screening tests for cushing's syndrome
24 hour free urine cortisol (will be elevated); low-dose dexamethasone test (AM cortisol will be persistently elevated)
dagnostic test for cushings
high-dose dexamethasone suppression test- cortisol suppressed only in patients with cushing's disease
drugs that can be used in cushing's
blockers of adrenal steroidogenesis - ketoconazole, metyrapone
what visual disturbance can a pituitary tumor cause?
bitemporal hemianopsia (compression of optic chiasm)
medical treatment for prolactinoma
dopamine agonists: cabergoline, bromocriptine, or pergolide
addison's disease
primary adrenal insufficiency casued by autoimmune adrenal cortical destruction, which leads to deficiencies of mineralocorticoids and glucocorticoids
secondary adrenal insufficiency
caused by decreased ACTH production from pituitary, most often due to abrupt cessation of chronic glucocorticoid treatment
weakness, fatigue, anorexia with weight loss, hyperpigmentation
addison's disease
electrolyte disturbances in addison's disease
hyponatremia, hyperkalemia
low plasma cortisol levels during a period of high physiologic stress
adrenal insufficiency
results of synthetic ACTH stimulation test in adrenal insufficiency
plasma cortisol less than 20
treatment for primary adrenal insufficiency
glucocorticoid and mineralocorticoid replacement
with which MEN syndromes is pheochromocytoma associated?
MEN II/III
diagnostic tests for suspected pheo?
plasma free metanephrines or 24-hr urinary metaneprhines
treatment for pheo
surgical resection - first alpha blockade to decrease incidence of intraop HTN, then B blockade to control tachycardia
Conn's syndrome
adrenal adenoma - secretes excessive aldosterone from zona glomerulosa of adrenal cortex
hypertension, HA, polyuria, muscle weakness; hypokalemia, mild hypernatremia
hyperaldosteronism
renin level in conn's syndrome
low
treatment for bilateral adrenal hyperplasia
sprionolactone
what does 21-hydroxylase deficiency cause?
decreased cortisol production
how is 21-hydroxylase deficiency inherited?
autosomal recessive
ambiguous genitalia, virilization (if later in life), macrogenitosomia in male infants
congenital adrenal hyperplasia, most likely caused by 21-hydroxylase deficiency
diagnosis of CAH
high levels of cortisol precursors and androgens in blood and urine
treatment for CAH
cortisol administration to decrease ACTH and adrenal androgens; fludrocortisone for severe 21 hydroxylase deficiency
loose zones, pseudofractures, blurring of spine seen in what?
osteomalacia
lab findings in osteomalacia
low/nl calcium, low phos, increased PTH
most commmon neuropathy in diabetics
symmetrical distal polyneuropathy; stocking glove pattern
what is found in 80% of diabetics with foot ulcers?
neuropathy
what lab value should you follow when monitoring effects of treatment of DKA?
anion gap
treatment of choice in hypotensive, severely dehydrated patietn with DI
normal saline
most common cause of thyroid nodule
benign colloid nodule