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