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55 Cards in this Set
- Front
- Back
headache, palpitations, abdominal pain, nausea & vomiting w/increased urinary vanillylmandelic acid Tx? |
Pheochromocytoma alpha-blocker first then beta-blockers - blocking just beta-receptors causes unopposed stimulation of a alpha-receptors and increased BP |
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Polyuria + polydipsia in normal individual
1. causes (2) 2. How to distinguish |
1. Primary polydipsia vs diabetes insipidus
2. Water deprivation test - increased urine osmolality after water deprivation suggest primary polydipsia |
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ammenorrhea w/galactorrhea Treatment? |
Prolactinoma dopamine agonists (bromocriptine, cabergoline) |
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Metabolic syndrome Define Cause? |
At least 3 of 5 criteria: 1. Increase BP (hypertension) 2. Hypertriglycerides 3. Decreased HdL 4. fasting glucose > 100 5. Abdominal obesity Insulin resistance |
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How does hyperventilation affect calcium? |
Hyperventilation -> Decreased PaCO2 -> Repiratory alkalosis -> Increased H+ dissociation from albumin -> increased Ca2+ bound to albumin -> decreased ionized Ca2+ and hypocalcemia |
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best long-term therapy for graves disease? contraindictions? |
Radioactive iodine ablation pregnancy and severe ophthalmopathy |
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Causes of thyrotoxicosis with low radioactive iodine uptake (4) |
- thyroiditis (inflammation causes leakage of hormones) iodine-induced thyroid toxicosis levothyroxine overdose struma ovarii |
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Tight glycemic control in diabetes decreases risk of what? |
microvascular complications (retinopathy, nephropathy) |
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Hyperpigmentation Hyponatremia Hyperkalemia Hypotension |
Adrenal insufficiency (autoimmune) |
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Estrogen replacement or pregnancy in a pt w/hypothyroidism do what? Why? |
Increased L-thyroxine dose Estrogen increases levels of thyroxine-binding globulin so more hormone is required to saturate these sites |
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Steatorrhea causes what vitamin deficiency |
Vit. D deficiency |
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How to distinguish between follicular cancer and follicular adenoma? |
follicular cancer invades tumor capsule and surrounding blood vessels |
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Constipation, abdominal pain polyuria, polydipsia |
Vitamin D toxicity |
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Fatigue, proximal muscle weakness, increased CK, sluggish ankle reflex First step? |
Get TSH and Free T4 |
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Diabetes Insipidus 1. Kinds - define 2. How to distinguish |
1. Central - Decreased ADH secretion Nephrogenic - ADH resistance 2. Desmopressin test - Increased urine osmolality s/p desmopressin means central DI |
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Pt w/AMS, wt loss, polydipsia and polyuria next step? |
DKA Fingerstick glucose |
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Most common type of neuropathy in diabetics? |
Symmetrical distal polyneuropathy |
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Gynecomastia w/testicular nodule negative beta-HCG and AFP |
Leydig tumor (increased testosterone and estrogen) |
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Impotence and absent morning erections Cause? |
Neurogenic |
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Swollen hands/feet and coarse facial features. 1. Common cause of death 2. Next step in dx |
Acromegly 1. Cardiovascular disease 2. Measure IGF-1 level |
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fever/sore throat in a pt on propylthiouracil or methimazole next step |
Stop antithyroid drugs and check WBC count for agranulocytosis |
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Hypoalbuminemia Effect of calcium? |
40-55% of calcium is bound to albumin so decreased albumin can cause decreased total calcium but normal ionized calcium |
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headache, deafness, back pain in an elderly 1. Mechanism 2. Labs show what? 3. Tx |
Paget's Disease 1. Increased bone remodeling (disorganized) 2. Increased Alk phos but normal calcium, phosphorus, etc. 3. Bisphosphonates |
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Screening recommendations for diabetes |
Screen if BP > 135/80 and consider if >45 y.o. w/risk factors: ethnicity, hyperlipidemia, increased BMI, FH, cardiovascular ds, etc |
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Vipoma 1. Symptoms 2. Common location |
1. Watery diarrhea, muscle weakness/cramps (from hypokalemia) 2. Pancreatic tail |
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Non-hormonal cause of hypercalcemia Treatment |
Immobilization Hydration & bisphosphonates |
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Treatment of choice for diabetic neuropathy Alternative? |
TCAs gabapentin |
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What vitamin deficiency w/carcinoid syndrome? |
Niacin (Pellagra)
Carcinoid uses up tryptophan |
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Hirsutism + menstrual irregularities in an overweight female Tx? Do what screening test? |
Polycystic ovarian syndrome Weight loss, oral estrogen/progestin contraceptive Oral glucose tolerance test b/c of increased likelihood of having T2 diabetes |
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How to reduce progression of diabetic nephropathy? 1. Goal? 2. Drugs |
Hypertension control 1. < 130/80 2. ACE inhibitors |
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Increased blood glucose, hypertension, and weight gain 1. Other signs/symptoms 2. Most common cause |
Cushings 1. Obesity, striae, proximal muscle weaknesses, and psychiatric disturbances 2. Excess glucocorticoid intake |
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Graves Disease 1. Mechanism 2. Mechanism of exophtalmos |
1. autoantibodies to TSH receptors stimulate thyroid hormone production 2. Retro-orbital tissue expansion |
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What lab is specific for androgen-producing adrenal tumors? |
DHEA-S Dehydroepiandrosterone - sulfate |
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Primary hyperaldosteronism 1. another name 2. common causes 3. Labs - renin, Na, K, bicarb 4. Tx |
1. Conn's syndrome 2. Adrenal adenoma or bilateral adrenal hyperplasia 3. Decreased renin, increased Na, decreased K, increased bicarb 4. Surgery if unilateral adrenal adenoma spironalactone/eplerenone for all else |
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Medullary thyroid cancer secretes what? |
Calcitonin |
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pts w/Hashimoto's thyroiditis are at increased risk of developing what cancer? |
Thyroid Lymphoma |
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Explain paradoxical hyperkalemia |
Increased K+ 2/2 extracellular shift in DKA |
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Calcification of both adrenal glands Most common cause of AI in the US |
Tuberculosis causing adrenal insufficiency -> most common in developing countries Autoimmune adrenalitis |
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Evaluation of thyroid nodule
1. First step 2. Fine needle biopsy if? 3. Radionucleotide scan if? |
1. TSH and thyroid ultrasound 2. Increased TSH or abnormal US findings 3. Decreased TSH hot nodule = hyperthyroidism cold nodule = FNA |
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Psammoma bodies What disease? |
Papillary thyroid cancer |
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Hypothyroidism causes what lab changes? (3) |
hyperlipidemia (increased cholesterol, increased triglycerides) hypertransaminases (increased ALT, increased AST) elevated creatine kinase |
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Diabetic med that causes weight loss What side-effects? |
GLP-1 agonist (glucagon-like peptide 1) -> exenatide, liraglutide acute pancreatitus |
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Fatigue, hypotension, hyperpigmentation
1. Lab findings 2. Dx tests |
Primary adrenal insufficiency (Addison's)
1. Decreased Na, Increased K, eosinophillia
2. Morning ACTH (high is diagnostic) and low cortisol cosyntropin stimulation (ACTH analog) -> should not increase cortisol |
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Anorexia, early satiety and vomiting in a diabetic Treatment? |
Gastroparesis frequent small meals, metoclopramide/erythromycin |
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Hyperosmolar Hyperglycemia 1. Complication of what disease 2. Signs/symptoms 3. Labs: glucose? anion gap? Ketones? |
1. Diabetes, type 2 2. AMS, weakness 3. Very high glucose, normal anion gap (unlike DKA), and normal or slightly elevated ketones |
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alcholic w/hypocalcemia cause? mechanism? |
Hypomagnesemia Decreased PTH release and increased PTH resistance |
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Thyroid function test in a sick patient disease name |
Decreased T3, normal T4 and TSH Euthyroid sick syndrome |
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Continuous urinary dribbling in a diabetic with high post void bladder volume |
Neurogenic bladder dysfunction |
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Best marks of DKA resolution (2) |
Serum anion gap
Beta-hydroxybutyrate |
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What treatment for Graves disease is associated with development or worsening opthalmopathy? |
Radioactive iodine |
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What drug slows down diabetic nephropathy? |
ACE inhibitors
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Headache, loss of libido, erectile dysfunction and visual disturbances |
Prolactinoma |
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Hyperthyroidism + warm nodule Potential complications if untreated? (2) |
Thyroid adenoma Bone loss, a-fib |
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Young pt w/hypertension that doesn't resolve with low-dose hydrochlorothiazide and hypokalemia next step |
Primary hyperaldosteronism morning aldosterone: renin ratio |
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diabetes, wt loss, erythematous plaques, diarrhea, anemia |
glucagonoma |