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416 Cards in this Set
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Q001. What are the corresponding blood glucose levels to HbA1c of: ; 1. 6; 2. 7; 3. 8; 4. 9
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A001. 1. 120; 2. 150; 3. 180; 4. 210
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Q002. Definition: Hyperglycemia resulting from the autoimmune distruction of the insulin-producing beta cells of the pancreas
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A002. DM-1
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Q003. most common HLA genotypes in DM-1; (2)
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A003. HLA DR3; HLA DR4
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Q004. Dx: woman has a recurrent vaginal candidiasis that is refractory to treatment; what test should be done?
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A004. Diabetes mellitus; Get a blood glucose
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Q005. Antibody types for DM-1; (2)
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A005. Anti-cytoplasmic Ab against: Beta cells; and Glutamic Acid Carboxylate (GAD)
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Q006. (2) environmental factors that may play a role in the etiology of DM-1
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A006. Viral infection; Exposure to cow's milk during infancy
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Q007. (3) Viral infections that may play a role in the etiology of DM- 1
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A007. Congenital Rubella; Mumps; Coxsackie B
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Q008. Dx: polyuria, polydipsia, weight loss, dehydration, blurred vision, fatigue
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A008. DM-1
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Q009. Dx tests for Diabetes; (3)
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A009. 1. Fasting glucose > 126; 2. Random plasma glucose > 200; 3. HbA1c > 7%
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Q010. (4)* Bugs that occur in DM patients due to their decreased efficacy of granulocytes
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A010. MA and PA:; Mucormycoses;; Actinomycoses;; Pseudomonas;; Aspergillosis (pneumonia)
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Q011. How do you determine the time the daily dose of insulin (NPH or 70/30 preparations) is given for a DM-1 patient?
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A011. Give 2/3 daily dose before breakfast; Give 1/3 daily dose before dinner
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Q012. How should new DM-1 patients monitor their glucose?
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A012. Finger-stick levels 5 times a day: morning fasting;; breakfast postprandial;; lunch postprandial;; dinner postprandial;; before bed
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Q013. Which insulin preparation is considered "Rapid-acting" and used right before meals?; (2); List: Onset of action; Peak action; Duration of action
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A013. Humalog or Lispro; Onset of action = 15 min; Peak action = 60 min (ave 30-90 min); Duration of action = 3 hr (ave 2-4 hr)
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Q014. Regular insulin: Onset of action; Peak action; Duration of action
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A014. Onset of action = 30-60 min; Peak action = 2-4 hr; Duration of action = 6-8 hr
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Q015. (2) Intermediate-acting Insulin preparations; List: Onset of action; Peak action; Duration of action
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A015. NPH and Lente; Onset of action = 1-3 hr; Peak action = 6-12 hr; Duration of action = 18-26 hr
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Q016. (2) Long-Acting Insulin preparations; List: Onset of action; Peak action; Duration of action
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A016. Ultralente and PZI; Onset of action = 4-8 hr; Peak action = 14-24 hr; Duration of action = 24+
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Q017. Longest acting Insulin preparation; (2 names); List: Onset of action; Peak action; Duration of action
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A017. Glaragine (Lantus); Onset of action = 1 hr; Peak action = no peak; Duration of action = 24+
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Q018. Definition: exaggeration of the normal tendancy of plasma glucose to rise in the early morning hours before breakfast; what may it be caused by?; First step in Tx?
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A018. Dawn phenomenon; By: inc in GH secretion; Tx: move nighttime insulin closer to bedtime
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Q019. what is "postprandial"?
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A019. 2 hours after meal
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Q020. Definition: nighttime hypoglycemia followed by dramatic inc in fasting glucose levels and inc plasma ketones; what confirms dx?; Tx?
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A020. Somogyi Effect; confirms: Hypoglycemia at 3am; Tx: give Long-acting insulin at bedtime (instead of NPH)
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Q021. Dx: patient presents with persistent morning hyperglycemia, despite increasing his nighttime NPH insulin dose. He complains of frequent nightmares and his wife witnessed him having a seizure in the middle of the night
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A021. Somogyi effect
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Q022. MC negative complication with: 1. DM-1; 2. DM-2
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A022. 1. DKA; 2. Non-Ketonic Hyperglycemic Hyperosmolar Coma (NKHC); [either can occur with either DM]
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Q023. What type of immunity is impaired with diabetes?; what type of infections can this lead to?
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A023. Cell-mediated immunity; leads to: Fungal infections
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Q024. What should be done if the am finger-sticks show hypoglycemia?
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A024. decrease the bedtime NPH even if the bedtime finger-sticks are high
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Q025. (3) causes of DM-2 hyperglycemia
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A025. 1. Impaired secretion of Insulin; 2. Decreased insulin effectiveness at glucose uptake; 3. Impaired inhibition of hepatic gluconeogenesis
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Q026. How can hyperglycemia cause further glucose intolerance?; (2)
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A026. 1. it Decreases insulin sensitivity; 2. it Increases hepatic glucose production
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Q027. Drug class of Metformin; MOA (3); AE
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A027. Biguanides; MOA: sensitizes skeletal muscle and fat to insulin; Dec hepatic gluconeogenesis; Dec GIT absorption; AE: Lactic Acidosis
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Q028. (4)* drugs in Sulfonylurea class
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A028. Goes To Cancel Glucose:; Glyburide;; Tolbutamide;; Chlorpropamide;; Glipizide
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Q029. MOA of Sulfonylureas; AE
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A029. MOA: increase postprandial insulin secretion from beta cells; AE: Hypoglycemia
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Q030. (3) drugs in the Thiazolidinediones class
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A030. GLITAZONES: Troglitazone;; Rosiglitazone;; Pioglitazone
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Q031. (2) MOA of the Thiazolidinediones; AE
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A031. MOA: Reduces insulin resistance; dec. hepatic glucose output; AE: Hepatotoxicity
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Q032. Example of an Alpha-glucosidase inhibitor; MOA; AE
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A032. Example: Acarbose; MOA: inhibits monosaccharides and oligosaccharide hydrolysis in the small intestines; AE: Diarrhea and nausea (and farting)
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Q033. MC combination of DM oral drugs; (plus 2 drugs in it)
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A033. Glucovance; (Metformin + Glyburide)
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Q034. Basic Etiology behind DKA
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A034. Severe insulin deficiency causes body to switch from metabolizing carbs to metabolizing and oxidizing lipids
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Q035. What (2) ketones are produced with DKA?; what is normal raio of these two?; ratio in DKA?
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A035. Beta-hydroxybutyric Acid (BOH); Acetoacetic Acid; Normal ratio: 3:1; DKA ratio: 8:1
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Q036. Pathophysiology of DKA and how it leads to "fruity breath"; (4)
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A036. 1. insulin deficiency causes hyperglycemia -> osmotic diuresis; 2. loss of fluids, Na and K; 3. inhibition of FFA oxidation in liver -> ketosis; 4. Met Acidosis results in respiratory compensation and blowing off of breakdown products (acetone)
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Q037. Dx: dehydration, polyuria, N/V, rapid deep (Kussmal) breathing, + anion gap, scent to breath
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A037. DKA
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Q038. (3) main parts of Dx DKA
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A038. D: high glucose (400-800 mg); K: + Ketones; A: pH < 7.3 (inititially casues K to rise)
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Q039. (3) Tx rules for DKA
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A039. 1. Hydrate (usu 3-4L loss): replace with NS; 2. Insulin (and glucose if pt becomes normoglycemic); 3. Replace K
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Q040. Causes of death with DKA; (3)
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A040. circulatory failure;; HypoK;; Infection
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Q041. MC DM-2 patient profile to get Nonketotic Hyperosmolar Coma
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A041. DM-2 nursing home patient
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Q042. Etiology of Nonketotic Hyperosmolar Coma; (4--2 are drugs)
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A042. Sepsis;; Dehydration;; Diuretics;; Glucocorticoids
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Q043. Sx: Altered mental status, signs of profound dehydration, neurologic deficits, DM-2
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A043. Nonketotic Hyperosmolar Coma
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Q044. What is serum glucose levels for Nonketotic Hyperosmolar Coma?; serum Osmolarity?; what is the other indicator, with relation to the kidneys?
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A044. glucose > 1000 mg/dL; serum osmloarity around 385 mOsm/kg; Pre-renal Azotemia: BUN/creatinine levels are increased
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Q045. Tx for Nonketotic Hyperosmolar Coma; (3)
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A045. 1. Expand IV volume: infuse 2-3L NS over 1-2hrs; 2. K replacement; 3. withhold insulin therapy for up to 1 hour (to help with IV osmolality)
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Q046. Whipple's triad of Hypoglycemia
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A046. 1. plasma glucose < 60mg/dL; 2. Sx of hypoglycemia; 3. improvement of Sx with Glucose
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Q047. MCC of altered mental status in Healthcare environments
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A047. Hypoglycemia
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Q048. Etiology of Hypoglycemia; (6)*
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A048. DIAL HI:; 1. Drug induced; 2. Islet cell tumor/adenoma; 3. Adrenal insufficiency; 4. Liver/renal Dz (severe); 5. Hypopituitarism from low GH and cortisol; 6. Insulin receptor Ab
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Q049. Dx: possible History of insulin or sulfonylurea Tx, adrenergic Sx (diaphoresis, anxiety, tremor, hunger, palpitations); confusion, inappropriate behavior, mistaken for alcohol intoxication
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A049. Hypoglycemia
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Q050. Dx Tests for Hypoglycemia; (2)
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A050. 1. Low serum glucose < 50mg/dL; 2. ask lab to test C-peptide to distinguish b/t Endogenous insulin (high C-peptide) or Exogenous insulin(low)
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Q051. If alcoholism or nutritional deficiency is a suspected reason for hypoglycemia, what should be placed with the IV of dextrose?; Why?
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A051. Thiamine to prevent Wernicke's encephalopathy
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Q052. Hospital Tx for Hypoglycemia; (3 steps)
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A052. 1. IV amp of 50% dextrose; 2. if no improvement, give a second amp; 3. continue to infuse 10% dextrose until serum glucose is > 100mg/dL
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Q053. if hypoglycemia is refractory after Tx and there are associated signs of adrenal insufficiency, what is Tx?
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A053. give Hyrdocortisone 100-200mg IV
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Q054. what is used to resuscitate hypoglycemic coma?; what type of patient will this Tx not work on?
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A054. Glucagon IM; won't work on Alcoholic with liver failure
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Q055. What does a glucagonoma present with?; (3)
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A055. 1. new-onset DM; 2. weight loss; 3. characteristic rash (necrolytic migratory erythema)
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Q056. How is insulin related to Catecholamines?; (2)
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A056. 1. Inc insulin leads to hypoglycemia, leading to tachycardia, sweating and anxiety; 2. Pheochomocytoma patient have inc risk of hyperglycemia and DM
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Q057. How does Cortisol relate to glucose levels?; (2)
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A057. 1. Too much cortisol (Cushings) leads to hyperglycemia and DM; 2. Too little cortisol (Addisons) leads to hypoglycemia
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Q058. How does GH relate to glucose levels?; (2)
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A058. 1. high GH in acromegaly, leads to hyperglycemia and DM; 2. neonatal hypoglycemia is a cardinal sign of GH deficiency
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Q059. List the 5 signs (any 3 of which can confirm Dx) to properly Dx Metabolic syndrome
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A059. 1. Fasting glucose > 110 mg/dL; 2. Abdominal obesity; 3. Serum TG > 150 mg/dL; 4. HDL-C < 40 in men and < 50 in women; 5. Blood Pressure > 130/85 (or on BP meds)
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Q060. (3) causes of Macroglossia
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A060. Acromegaly;; Myxedema;; Amyloidosis
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Q061. Definition: Increased synthesis and secretion of free thyroid hormones resulting in hypermetabolism
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A061. Hyperthyroidism
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Q062. Etiology of Hyperthyroidism; (4)
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A062. Grave's Dz;; Toxic Nodular Goiter;; Plummer's Dz (toxic adenoma);; Subacute thyroiditis
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Q063. Dx: heat intolerance, sweating, palpitations, weight loss, tremor, nervousness, weakness, hyperdefication
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A063. Hyperthyroidism
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Q064. When is the only time TSH is increased and TRH is decreased?
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A064. Pituitary tumor (secretes TSH)
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Q065. When is the only time TSH and TRH are both increased (with T3 and T4 decreased)?
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A065. Primary Hypothyroidism
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Q066. Definition: A medical emergency consisting of an exaggerated manifestation of hyperthyroidism
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A066. Thyroid Storm
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Q067. Etiology of a Thyroid Storm; (4)
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A067. 1. Trauma, infection;; 2. DKA;; 3. MI, CVA, PE;; 4. Withdrawl from anti-hyperthyroid meds
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Q068. Dx: fever, tachycardia, high-output CHF and volume depletion, exhaustion, diarrhea, abdominal pain, agitation and confusion, possible jaundice
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A068. Thyroid Storm
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Q069. What is the BP change with hyperthyroidism?
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A069. Isolated systolic HTN
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Q070. (4) Primary stabilization Tx for a Thyroid Storm
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A070. Airway protection;; Oxygenation;; Assess circulation and BP;; IV hydration
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Q071. Aside from primary stabilization, how is a Thyroid Storm treated?; (4 together)
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A071. 1. Beta-blocker - block adrenergic effects;; 2. Acetaminophen - fever;; 3. PTU - block new thyroid hormones; 4. Iodine - 1.5 hrs after PTU to decrease release of preformed thyroid hormones
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Q072. Definition: Autoimmune Dz causing hyperthyroidism due to Ab, which stimulates TSH receptor
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A072. Graves Dz
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Q073. Dx: diffusely enlarged thyroid, exopthalamos, pretibial myxedema, tachycardia
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A073. Graves Dz
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Q074. Dx tests for Graves Dz; (4)
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A074. 1. High radioactive iodine uptake; (if present but low, then Dx is thyroiditis); 2. high Free thyroid hormones;; 3. Undetectable TSH levels;; 4. High thyroglobulin levels
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Q075. what is the Long-term anti-thyroid therapy?; complication?
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A075. PTU; complication: Leukopenia
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Q076. what is the preferred Tx for Graves Dz?; AE?
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A076. Radioactive Iodine Ablation Therapy; AE: can result in Hypothyroidism over time
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Q077. what should be used as adjunctive therapy for Graves Dz?
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A077. Adrenergic Antagonist: Propranolol
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Q078. Definition: TSH levels are more then twice the upper limit of normal
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A078. Hypothyroidism
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Q079. Etiology of Primary Hypothyroidism; (5)
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A079. Hashimoto's thyroiditis;; Radiation to neck;; Subacute thyroiditis;; Iodine deficiency (or excess);; Medications: Lithium
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Q080. Etiology of Secondary Hypothyroidism; (3)
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A080. Secondary = Pituitary problem: Sheehan's syndrome;; Pituitary neoplasm;; Infiltrating Dz (TB) causing TSH deficiency
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Q081. Etiology of Tertiary Hypothyroidism; (3)
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A081. Tertiary = Hypothalamic problem: Granuloma;; Neoplasm;; Radiation
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Q082. Dx: fatigue, lethargy, weakness, weight gain, constipation, cold intolerance, slow speech, dry skin, brittle hair, delayed deep tendon reflexes
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A082. Hypothyroidism
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Q083. Because muscle weakness and cramps are associated with both hyper and hypothyroidism, how can you tell the difference with CPK level?
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A083. Hyper: CPK is normal; Hypo: CPK is elevated
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Q084. what additional lab tests may be elevated or decreased with hypothyroidism?; (4 categories)
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A084. Increased: 1. Cholesterol and TG; 2. LFTs: LDH, AST, ALT, MM of CPK; Decreased: 3. Hct and Hb; 4. serum sodium
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Q085. If a patient presents with high cholesterol, what should you consider testing?
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A085. thyroid function tests; (since high cholesterol is a sign of hypothyroidism)
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Q086. what test is useful from distinguishing secondary from tertiary hypothyroidism?; what are the results of each?
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A086. TRH stimulation test: Secondary: Low; Tertiary: normal
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Q087. Tx for Hypothyroidism; How often do you check meds?; How is therapy monitored (b/t primary and secondary hypothyroidism)?
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A087. Low-dose Levothyroxine (increase dose every 6 to 8 weeks, depending on patient's response); Primary: measure TSH levels; Secondary: measure T-4 levels
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Q088. Definition: elevated TSH with normal thyroid hormone levels in the absence of overt clinical symptoms; what are the (2) possible prognosis?
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A088. Subclinical Hypothyroidism; 1. can become Primary Hypothyroidism; 2. become Euthyroid
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Q089. Tx parameters for replacement therapy for Subacute Hypothyroidism; (3)
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A089. 1. All patients with TSH > 10; 2. Patients with TSH > 5 and Goiter or Anti-thyroid Ab; 3. All patients with History of Iodine therapy
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Q090. (2) Antibody tests that are positive in Hashimoto's thyroiditis
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A090. Anti-thyroglobulin; Anti-microsomal
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Q091. Definition: Life-threatening complication of Hypothyroidism with profound lethargy or worse, usually assoc. with hypothermia
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A091. Myxedema Coma
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Q092. Etiology of Myxedema coma; (4)
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A092. Sepsis;; Prolonged exposure to cold weather;; CNS depressants;; Trauma/surgery
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Q093. Dx: hypothermia with rectal temp < 95; bradycardia or circulatory collapse; severe lethargy; delayed relaxation of DTR or Areflexia
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A093. Myxedema Coma
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Q094. Tx for Myxedema coma (in order); (5)
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A094. 1. Airway management; 2. Prevent further heat loss; 3. Glucocorticoids; 4. IV Levothyroxine; 5. IV hydration (D5 1/2 NS)
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Q095. Why are glucocorticoids given before levothyroxine in the Myxedema patient?
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A095. due to the concern that the patient may have associated Addison's Dz. Giving only thyroxine could initiate an Addisonian crisis
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Q096. In Hashimoto's Thyroiditis, what destroys the thyroid?
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A096. CD-4 lymphocytes
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Q097. What PE finding distinguishes Hashimoto's from other forms of Thyroiditis?
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A097. Thyroid is not tender
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Q098. Etiology of Thyroiditis types: 1. Subacute; 2. Silent; 3. Suppurative; 4. Riedel's
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A098. 1. Subacute: Post-viral (usu a UTI); 2. Silent: Postpartum (autoimmune); 3. Suppurative: Bacterial or fungal (commonly seen with PCP in HIV pt); 4. Riedel's: Fibrous infiltration of unknown etiology
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Q099. Dx: 35-yo female with History of hyperthyroidism and recent flu presents with neck pain and elevated ESR
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A099. Subacute Thyroiditis
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Q100. Dx: tender, enlarged thyroid, fever and signs of hyperthyroidism; jaw or tooth pain; hypothyroidism may develop; what other Dx is similar to this without tenderness?
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A100. Subacute Thyroiditis; other: Silent thyroiditis
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Q101. Dx: fever with severe neck pain, focal tenderness of involved portion of thyroid
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A101. Suppurative Thyroiditis
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Q102. Dx: slowly enlarging rock hard mass in anterior neck, tight and stiff neck, fibrosis of mediastinum
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A102. Riedel's Thyroiditis
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Q103. what labs allow you to distinguish b/t Subacute, Silent and suppurative thyroiditis?
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A103. Silent: high serum Thyroglobulin levels only (and possible Antimicrosomal Ab); Subacute: high serum Thyroglobulin levels and WBC left shift; Suppurative: WBC with left shift only
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Q104. What is Tx for: 1. Pain from Subacute thyroiditis; 2. Suppurative thyroiditis; what should never be given to any thyroiditis patient?
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A104. 1. NSAIDs (or steroids); 2. IV Abx and drainage of abscess; Never give PTU to thyroiditis
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Q105. *Best test to evaluate a thyroid nodule
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A105. Fine-needle aspiration
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Q106. If thyroglobulin levels return to normal after a thyroidectomy, what does that suggest?
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A106. Absence of metastatic thyroid tissue
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Q107. what test distinguishes b/t Hot and Cold thyroid nodules?; what is the difference b/t them?; which is more likely malignant?
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A107. Thyroid Scan with t-99; Hot: Hyperfunctioning thyroid; less likely malignancy; Cold: Hypofunctioning thyroid; more likely malignant
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Q108. (4) Types of thyroid Cancer; which is most common?; has best prognosis?; worst prognosis (0% survival in 5 yrs)?; Seen in MEN II and III?
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A108. 1. Papillary - MC; best prognosis; 2. Follicular; 3. Anaplastic - worst prognosis; 4. Parafollicular (Medullary) - in MEN II and III
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Q109. Thyroid CA: ground-glass "Orphan Annie" nuclei and psammoma bodies
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A109. Papillary
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Q110. Thyroid CA: good prognosis but commonly bloodborne mets to bone and lungs
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A110. Follicular
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Q111. Thyroid CA: cancer of the "C" cells, derived from branchial pouch 5 and secretes Calcitonin; (2 names)
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A111. Parafollicular; (Medullary thyroid CA)
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Q112. Tx for any thyroid CA; (2)
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A112. Thyroidectomy; Oral thyroxine supplements after surgery
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Q113. Definition: hypersecretion of PTH by the parathyroid gland
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A113. Primary Hyperparathyroidism
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Q114. Definition: Glandular hyperplasia and elevated PTH in an inappropriate response to hypocalcemia
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A114. Secondary Hyperparathyroidism
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Q115. Definition: continued elevation of PTH after the disturbance causing secondary hyperparathyroidism has been corrected
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A115. Tertiary Hyperparathyroidism
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Q116. Etiology of Hyperparathyroidism; (3)
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A116. Hyperplasia of all 4 glands;; Adenoma/carcinoma;; MEN II and III
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Q117. Pathophysiology of the parathyroid gland; (4 ways to increase Calcium)
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A117. PTH increases serum Ca levels: 1. stimulates renal hydroxylation of Vit-D (needed for GI to absorb Ca); 2. Increases renal resorption of Ca; 3. Decreases renal resorption of phosphorus;; 4. Increases Osteoclastic resorption of bone (via osteoblast receptors)
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Q118. what do lab tests show to Dx Hyperparathyroidism?; (3)
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A118. high serum calcium (low phos);; high serum PTH;; hypercalciuria
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Q119. what are the indications for surgery with Dx of hyperparathyroidism?; (2)
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A119. Adenomas should be removed;; Hyperplasia of all four glands: remove and reinsert a small portion of one on the SCM so that it is accessable if problems arise
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Q120. Emergent measures taken (PRN) with hyperparathyroidism; (3)
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A120. 1. Hydration with Lasix; 2. Bisphosphonates to block bone resorption; 3. Calcitonin
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Q121. When is Mg deficiency seen?; (3)
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A121. SAP: SIADH;; Alcoholism;; Pancreatitis
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Q122. Etiology of Hypoparathyroidism; (3)*
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A122. HID Parathyroids: Hypomagnesium;; Infiltrative CA / Irradiation;; DiGeorge Syndrome;; Post-surgical
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Q123. Dx: 30-yo woman presents with perioral paresthesia and long QT interval. She recently had surgery on her goiter.
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A123. Hypoparathyroidism
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Q124. Dx: seizures, perioral paresthesia, tetany, fasciculations, muscle weakness, CNS depression, faint heart sounds, bronchospasm
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A124. Hypoparathyroidism
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Q125. What is seen in hypoparathyroidism on the EKG?
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A125. QT prolongation
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Q126. Tx for hypoparathyroidism; (life-threatening versus maintenance)
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A126. Life-threatening: IV Calcium; Maintenance: Calcitriol and oral calcium
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Q127. Dx: Similar characteristics to Hypoparathyroidism, but tissue is resistant to PTH, causing an INCREASE in serum PTH
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A127. Pseudohypoparathyroidism
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Q128. What is pseudohypoparathyroidism assoc with?
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A128. Albright's hereditary osteodystrophy
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Q129. If you suspect over-the-counter thyroid hormone abuse, TSH is low and T4 is high, what other lab test can you check?
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A129. Thyroglobulin levels will be low.
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Q130. Radioactive iodine uptake scan is increased in (3)
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A130. Graves' disease; toxic adenoma/toxic nodules; multinodular goiter
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Q131. Radioactive iodine uptake scan is decreased in (4)
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A131. subacute thyroiditis (hyperthyroid stage),; hashimotos thyroiditis (hypothyroid stage),; exogenous T3/T4/levo,; postpartum thyroiditis
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Q132. In which conditions are thyroglobulin levels high?
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A132. Thyroiditis,; iodine-induced thyrotoxicosis,; amiodarone-induced thyrotoxicosis
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Q133. Medications that increase the need for thyroid hormone are (4)
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A133. estrogen,; rifampin,; carbamazepine,; phenytoin
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Q134. TSH and Free T4 are both decreased in these two conditions:
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A134. pituitary hypothyroidism,; hypothalamic hypothyroidism
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Q135. Most cases of hyperthyroidism can be treated with (2)
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A135. propylthiouracil or methimazole. Severe cases require radioactive ablation.
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Q136. Why can't you give methimazole during pregnancy to treat hyperthyroidism?
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A136. It can cause aplasia cutis in the fetus
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Q137. Another name for Primary Adrenal insufficiency
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A137. Addison's Dz
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Q138. Dx: shock, dehydration, confusion, vomiting, hyperK and Hypoglycemia; What are the (3) causes?
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A138. Addisonian (or adrenal) crisis causes: Hemorrhage;; Sepsis;; Trauma
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Q139. (2) main causes of Addison's Dz
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A139. Autoimmune (80%);; TB (15%)
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Q140. MCC of Secondary adrenal insufficiency; (2) other causes
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A140. MCC: Exogenous steroid drugs others: Sheehan's syndrome;; Pituitary infarct
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Q141. How is Aldosterone made?; (2) functions
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A141. Angiotensin II acts on the zoNa glomerulosa to convert cortisone to aldosterone Functions: Increase sodium reabsorption;; secretion of K+ and H+
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Q142. What does a deficiency in aldosterone cause with electrolytes?; (2)
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A142. HyperK; HypoN
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Q143. Dx: 18-yo man with hemophilia A who was recently mugged (receiving multiple blows to head and abdomen) is now complaining of dizziness, abdominal pain, dark patches on his elbows and knees, and uncontrollable cravings for pizza and french fries
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A143. Primary Adrenal Insufficiency; (Addison's Dz)
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Q144. How is secondary insufficiency distinguished from Addison's Dz?; (3)
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A144. No hyperpigmentation;; Normal aldosterone secretion;; Signs of hypopituitarism (hypothyroidism or hypogonadism)
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Q145. What is Cortisol's relation to glucose?; (2)
|
A145. Stimulates gluconeogenesis by increasing protein and fat catabolism;; Decreases utilization of glucose and sensitivity to insulin
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Q146. How does cortisol promote an anti-inflammatory state?; (3)
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A146. Inhibits Arachidonic Acid;; Inhibits IL-2 production;; Inhibits release of histamine from Mast cells
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Q147. Definition: Hemorrhagic necrosis of the adrenal medulla during the course of meningococcemia
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A147. Waterhouse-Friderichsen Syndrome
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Q148. Dx: hyperpigmentation, salt cravings, orthostatic hypotension, amenorrhea
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A148. Addison's Dz; (primary adrenal insufficiency)
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Q149. Describe the ACTH (Cortrosyn) test to Dx Adrenal insufficiency etiology; How does it distinguish b/t primary and secondary?
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A149. Give ACTH and measure at zero and 30 minutes. A level of < 18 at 30 = adrenal insufficiency; Measure plasma ACTH after test: Primary = high ACTH; Secondary = low ACTH
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Q150. Tx for adrenal insufficiency; what additional Tx for Addison's only?
|
A150. Tx: Glucocorticoid replacement (especially at times of stress); additional for Addisons: Mineralcorticoid replacement
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Q151. What disease presents with the exact opposite of Addison's?
|
A151. Cushing's Dz
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Q152. Definition: Symptoms of excess Cortisol production
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A152. Cushing's syndrome
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Q153. Definition: Cushing's syndrome caused by excess ACTH secretion of pituitary
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A153. Cushing's disease
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Q154. What lung cancer is associated with ectopic ACTH production?
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A154. Small (Oat) cell lung CA
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Q155. Etiology of Cushing's syndrome (Adrenal excess); (3)
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A155. Exogenous corticosteroid therapy;; Adrenal neoplasm;; Ectopic ACTH production
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Q156. Dx: HTN, hair loss, central obesity, hump on the back of neck, abdominal purplish striae, hirsuitism, proximal muscle weakness, osteoporosis
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A156. Cushing's syndrome
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Q157. How is the ectopic ACTH Sx different from the ACTH Sx released directly from the adrenals?; Why?
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A157. Ectopic ACTH Sx: Weight gain and proximal muscle weakness only; B/c: the ACTH in ectopic from is usually the inactive form.
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Q158. How can Cushing's Dz be distinguished from Cushing's Syndrome?
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A158. Cushing's Dz: presence of Hyperpigmentation
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Q159. Dx: 42-yo woman on long-term steroids for asthma has excess adipose tissue in her neck and upper trunk, a wide "moon face", and very fine hair
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A159. Cushing's Syndrome
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Q160. (2) main lab tests to Dx Cushing's Syndrome; which is more specific as to finding the etiology?
|
A160. Overnight Dexamethasone Suppression test; High-Dose Dexamethasone Suppression test (more specific)
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Q161. Describe the Overnight Dexamethasone test
|
A161. 1 mg of dexamethasone is given at night, then plasma cortisol is measured in the morning. if < 5ug/100mL, it EXCLUDES Cushing's as the Dx
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Q162. What are the 3 Dx from Dexamethasone Suppression test & ACTH that follows?; (3 results from test)
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A162. Give 8 mg dexamethasone, then measure ACTH: 1. If ACTH is decreased or undetectable with no supression = Adrenal etiology; 2. ACTH is Normal or Increased with no supression = Ectopic ACTH etiology; 3. ACTH is High with partial supression = Pituitary etiology
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Q163. What are the electrolyte (Cl, K and Na) findings with Cushing's syndrome?; (3); What is found in urine?
|
A163. Hypochloremia;; HypoK;; HyperN; In Urine: 24-hour Urinary free cortisol > 100 ug/24hr
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Q164. Tx of Cushing's from Pituitary adenomas
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A164. Transsphenoidal surgery; (radiation for children and refractory to surgery)
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Q165. Tx of Cushing's from Adrenal Adenoma
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A165. Unilateral resection, followed by 3 to 12 months of glucocorticoid replacement (until normal adrenal comes out of suppression)
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Q166. Tx of Cushing's from Bilateral Adrenal Hyperplasia
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A166. Bilateral resection and lifelong replacements of glucocorticoids and mineralcorticoids
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Q167. Tx of Cushing's from Ectopic ACTH production
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A167. Remove source of neoplasm
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Q168. Definition: Isolated excess production of Aldosterone; Another name for it?
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A168. Hyperaldosteronism; "Conn's syndrome"
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Q169. Etiology of Conn's syndrome; (2); Which is MCC?
|
A169. 1. Unilateral aldosterone-producing Adenoma (MCC); 2. Bilateral hyperplasia of ZoNa Glomerulosa (idiopathic)
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Q170. Dx: HTN, signs of HyperK (muscle cramps, palpitations), signs of glucose intolerance (polyuria, polydipsia); may also be asymptomatic
|
A170. Conn's syndrome
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Q171. Dx test for Conn's syndrome
|
A171. Measure plasma aldosterone to plasma renin activity ratio; a ratio > 20 = Conn's syndrome (hyperaldosteronism)
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Q172. Dx: 44-yo woman has HTN, muscle cramps and excessive thirst
|
A172. Hyperaldosteronism; (Conn's syndrome)
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Q173. What is the Tx for Conn's syndrome if it is due to hyperplasia?; (2)
|
A173. 1. Spirolactone or ACEi to control BP; 2. Low-sodium diet
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Q174. Definition: tumor of the adrenal medulla resulting in the intermittent release of catecholamine excess
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A174. Pheochromocytoma
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Q175. (4) Disease Etiologies of Pheochromocytomas
|
A175. MEN II: (Pheochromocytoma, PTH tumor, medullary thyroid CA);; MEN III: (Pheochromocytoma, PTH tumor, mucosal Neuromas);; Neurofibromatosis;; Von Hippel-Lindau Dz
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Q176. Dx: Pheochromocytoma, retinal angioma, CNS hemangioblastomas, renal cell CA, pancreatic pseudocysts, ependymal cystenoma
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A176. Von Hippel-Lindau Dz
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Q177. Dx: 38-yo woman on labetalol presents with poorly controlled hypertension, frequent headaches and palpitations
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A177. Pheochromocytoma
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Q178. what are the 5 "H" Sx of pheochromocytoma?
|
A178. HA;; HTN;; Hot (diaphoretic);; Heart palpitations;; Hyperhidrosis (hand sweating)
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Q179. Dx test for Pheochromocytoma
|
A179. Elevated urine Vanillylmandelic Acid; (urine catecholamines)
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|
Q180. Tx for pheochromocytoma; (2)
|
A180. Surgical resection of mass;; Alpha-adrenergic blocker (may also add B-blocker)
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|
Q181. What is a possible misdiagnosis of Pheochromocytoma?
|
A181. Anxiety disorder
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Q182. What Dx is known for the "Rule of 10s": 10% are extra- adrenal; 10% are bilateral; 10% are malignant; 10% are familial; 10% are pediatric; 10% calcify; 10% recur after resection
|
A182. Pheochromocytoma
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Q183. Where is the anterior pituitary derived from?
|
A183. Rathke's pouch
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Q184. Where is the posterior pituitary derived from?
|
A184. Hypothalamic neuronal axon terminals of the brain
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|
Q185. what multiendocrine problem includes pituitary tumors?
|
A185. MEN-1; (pituitary, pancreas, parathyroid)
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|
Q186. where is the site of the primary tumors of the pituitary?
|
A186. Anterior pituitary only; (none in posterior)
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Q187. MC pituitary tumor, it presents with glactorrhea and amenorrhea; Tx?
|
A187. Prolactinoma; Tx: Bromocriptine (DA agonist)
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|
Q188. Dx: pituitary tumor that presents with visual changes or slightly high prolactin levels; Tx?
|
A188. Nonfunctioning Tumor; Tx: surgery
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|
Q189. Definition: MC tumor of the suprasellar region in children that arises from the remnants of Rathke's pouch and is solid or cystic; usually calcified
|
A189. Craniopharyngioma
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|
Q190. Dx: HA, compression of optic chiasm "tunnel vision", signs of increased intracranial pressure
|
A190. Craniopharyngioma
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|
Q191. Dx Test for Craniopharayngioma; (3)
|
A191. X-ray - shows enlarged sella; CT / MRI; Hormone studies: excess deficiencies
|
|
Q192. Tx for craniopharyngioma; (3 together)
|
A192. 1. Surgery; 2. Hormone replacement; 3. Dopamine agonist if prolactin-related Sx are noticed
|
|
Q193. specific Etiology of Acromegaly
|
A193. pituitary Somatotrophic Adenoma secreting GH
|
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Q194. Dx: progressive enlargement of the peripheral body parts, particularly head, hands, and feet; decreased glucose tolerance; hyperphosphatemia
|
A194. Acromegaly
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|
Q195. Acromegaly in children
|
A195. Gigantism
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|
Q196. What hormone in excess is related to acromegaly?
|
A196. GH
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|
Q197. Dx tests that confirm Acromegaly; (3)
|
A197. 1. Serum GH levels - measured in bed in am; 2. Lack of GH suppression by glucose; 3. Elevated serum IGF-I levels
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|
Q198. Aside from surgery and radiation, what is the medicine used to Tx Acromegaly?
|
A198. GH receptor blocker: Pegvisomant (Somavert)
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|
Q199. Dx: 29-yo woman with inability to lactate after childbirth. Delivery was complicated by blood loss and hypotension
|
A199. Sheehan's syndrome
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|
Q200. Etiology of Hypopituitraism; (3)
|
A200. Tumors;; Medical/surgical destruction;; Sheehan's syndrome
|
|
Q201. Dx: 36-yo woman complains of amenorrhea for 1 year, increasingly bad HA, clumsiness and sporadic nipple discharge; beta-hCG levels are normal
|
A201. Prolactinoma
|
|
Q202. Drugs that inhibit DA and as a result, cause hyperprolactinemia; (6)*
|
A202. The Prolactin Has Magnified My C-cups: TCAs;; Prochlorperazine;; Haloperidol;; Methyldopa;; Metoclopramide: Cimetidine
|
|
Q203. Difference b/t Central DI and Nephrogenic DI with respect to ADH
|
A203. Central DI: inadequate pituitary secretion of ADH; Nephrogenic DI: lack of renal response to ADH
|
|
Q204. Etiology of Central DI; (4, 3 are systemic)
|
A204. PENS:; 1. Posterior pituitary damage (tumor, trauma, etc); 2. Encephalitis;; 3. Neurosyphillis;; 4. Sarcoidosis
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|
Q205. Dx: Psychiatric disorder of compulsive water drinking common in young to middle aged women; polyuria and dilute urine. How is it distinguished from DI?
|
A205. Psychogenic Polydipsia; difference with DI: PP has a low plasma osmolality
|
|
Q206. Etiology of Nephrogenic DI aside from Drugs, renal Dz and electrolyte disorders
|
A206. Sickle cell
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|
Q207. (3) Drugs that can cause nephrogenic DI
|
A207. "Liquid DM": Lithium;; Demeclocycline;; Methoxyflurane
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|
Q208. Dx: polyuria (3-15 L/day); thirst; dilute urine (sp gravity < 1.005)
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A208. DI
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|
Q209. Dx test for DI; (3)
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A209. 1. plasma Osmolality: High; 2. Exogenous ADH: leads to Water deprivation; 3. Infusion of hypertonic saline: no response
|
|
Q210. Compare the urine osmolality before and after the infusion of exogenous ADH in: 1. Normal patient; 2. Central DI patient; 3. Nephrogenic DI patient
|
A210. Normal: High urine Osm -> high urine Osm; Central DI: Low urine Osm -> high urine Osm; Nephrogenic DI: Low urine Osm -> low urine Osm
|
|
Q211. Tx for Central DI
|
A211. Desmopressin (DDAVP)
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|
Q212. Tx for Nephrogenic DI
|
A212. Thiazide Diuretics
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|
Q213. Definition: Excess production of ADH
|
A213. SIADH
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|
Q214. basic Etiology of SIADH; (3)
|
A214. PIE:; Pharmacologic stimulation of hypo-pit axis;; Idiopathic overproduction of axis;; Ectopic production from tumors
|
|
Q215. what (2) tumors cause SIADH?
|
A215. Small cell lung CA; Pancreatic CA
|
|
Q216. what are the Idiopathic causes of the overproduction of ADH in SIADH?; (5 in 2 categories)
|
A216. CNS: encephalitis, trauma, stroke; Pulmonary Dz: TB, pneumonia; *any problem to Lungs or Brain (+ Pancreatic CA) can cause SIADH!
|
|
Q217. (4) Pharmacologic causes of SIADH
|
A217. Carbamazepine;; Chlorpropamide;; Clofibrate;; Vincristine
|
|
Q218. (4)* other causes, aside from small cell and pancreatic cell cancer, of ADH secretion
|
A218. Adrenal failure;; Renal failure;; Edema;; Fluid loss
|
|
Q219. Dx: hyponatremia; low serum osmolality; high urinary sodium; urine osmolality > serum
|
A219. SIADH
|
|
Q220. Tx for SIADH; (2 with fluids, 1 drug)
|
A220. Fluid restriction;; Hypertonic saline in severe HypoN;; Demeclocycline (lowers CD response to ADH)
|
|
Q221. Definition: Disease of impaired bone mineralization
|
A221. Osteomalacia; (Mineralization = Malacia)
|
|
Q222. Osteomalacia in children
|
A222. Rickets
|
|
Q223. Basic etiology of Osteomalacia; (4)
|
A223. Decreased Calcium absorption;; Dietary Calcium deficiency;; Vitamin D deficiency;; Hypophosphatemia
|
|
Q224. Causes of dietary Calcium deficiency; (3)*
|
A224. Malabsorption syndromes;; Gastrectomy;; Dumping syndrome
|
|
Q225. Main Causes of Vitamin D deficiency; (2)
|
A225. Hepatobiliary and Pancreatic diseases (loss of bile acids or pancreatic lipase reduce absorption of fat-soluble vitamins);; Renal Osteodystrophy
|
|
Q226. Causes of Hypophosphatemia; (2)
|
A226. Renal Tubular Acidosis;; Falconi's syndrome
|
|
Q227. Dx: Bone pain, weakness, difficulty walking: broad-based waddling gait with short strides; thoracic kyphosis
|
A227. Osteomalacia; (Rickets in children)
|
|
Q228. What do blood tests show to Dx Osteomalacia?; (3)
|
A228. Labs:; 1. Low - nml Calcium;; 2. Low - nml Phosphate;; 3. High Alk-phos (possible high PTH)
|
|
Q229. Tx for Osteomalacia; (2)
|
A229. Tx underlying disorder;; Calcium and Vitamin D supplements
|
|
Q230. Definition: Systemic disorder resulting in a reduction of bone mass that leads to increased risk of fracture
|
A230. Osteoporosis
|
|
Q231. Risk factors for Osteoporosis; (6)
|
A231. Elderly Female;; Post-menopause;; Family Hx;; Smoking;; Thin body;; Sedentary lifestyle
|
|
Q232. Pathophysiology of Osteoporosis
|
A232. Reduction of bone mass occurs due to an imbalance b/t bone acquisition and bone reabsorption;; without change in the ratio of mineral to organic bone
|
|
Q233. Histology of Osteoporosis
|
A233. Decreased cortical thickness and number (and size) of cancellous bone trabeculae; (especially horizontal)
|
|
Q234. When does osteoporosis usually become symptomatic?; (2) types
|
A234. when Fracture occurs:; Vertebral body fracture;; Hip fracture
|
|
Q235. Dx lab blood test results for Osteoporosis
|
A235. Everything is normal: Serum Ca++ and PO4- are usu normal;; Alk-phos is normal unless there is a fracture, then it's increased
|
|
Q236. How is bone mineral density measured?; (2) Dx results
|
A236. Dual X-ray Absorptiometry (DEXA) scan; T-score < -2.5 = Osteoporosis; T-score -2.5 to -1 = Osteopenia
|
|
Q237. Differential in Osteoporosis; (4)*
|
A237. Malignancy;; Hyperparathyriodism;; Osteomalacia;; Padget's disease of the bone
|
|
Q238. Prevention and Tx for Osteoporosis; (4)
|
A238. Dietary Calcium and Weight-bearing exercises;; Estrogen replacement therapy;; Calcitonin;; Bisphosphonates (Alendronate) with Vitamin D and Calcium supplements
|
|
Q239. Definition: Chronic Dz of adult bone in which localized areas of bone becomes hyperactive, and the normal bone matrix is replaced by softened and enlarged bone
|
A239. Padget's Disease of the bone
|
|
Q240. If Alkaline Phos is elevated, what is the next step?; (2)
|
A240. Send GGT to determine if it is Hepatic (elevated GGT) or bone (not elevated); or Check to see if it is heat-labile (Bone), where hepatic is not
|
|
Q241. Histology: Hyperactive bone turnover with enlarged multinucleated osteoclasts
|
A241. Padgets Disease of the bone
|
|
Q242. Dx: 45-yo male is found to have an elevated alkaline phosphatase during a routine blood test. No other abnormalities were found. Further workup reveals the enzyme to be heat labile
|
A242. Padget's Disease of the bone
|
|
Q243. Radiologic finding: area of hyperlucency of the bone surrounded by a hyperdense border
|
A243. Padget's Disease of the bone
|
|
Q244. Tx for Padget's Disease of the Bone for: 1. Pain relief; 2. Anatomic deformity or impingement; 3. to Decrease bone reabsorption; 4. to assist with cardiac failure or neurologic deficits
|
A244. 1. Pain = Indomethacin; 2. Deformity = Osteotomy of the bone; 3. Decrease Reabsorption = Bisphosphonates; 4. Assist in CardiacNeuro = Calcitonin
|
|
Q245. What is the Normal serum Calcium range?
|
A245. 8.5 - 10.2 mg/dL
|
|
Q246. Etiology of Hypocalcemia; (8)*
|
A246. IV STRAP:; Insufficient PTH;; Vitamin D deficiency;; Sepsis / Severe Mg deficiency;; Toxins;; Rhabdomyolysis;; Albright's Osteodystrophy (Pseudohypoparathyroidism);; Pancreatitis
|
|
Q247. Osteoporosis Risk factors; (8)*
|
A247. FACELESS:; Family history;; Alcohol;; Corticosteroids;; Elderly Female;; Low Calcium;; Estrogen low (Menopause);; Smoking;; Sedentary lifestyle
|
|
Q248. First sign/Sx of Hypocalcemia; Name and describe (2) other common signs seen in PE
|
A248. first sign:; Circumoral Paresthesia; Chvostek's sign: Facial muscle spasm with tapping of the facial nerve; Trousseau's sign: Carpal spasm after occluding blood flow in forearm with BP cuff
|
|
Q249. What is seen with EKG for Hypocalcemia?
|
A249. Prolonged QT and ST intervals; (also peaked T-waves can be seen as in HyperK)
|
|
Q250. How can Calcium correct for Hypoalbuminemia?
|
A250. Adjust Calcium upward by 0.8mg/dL for each 1.0g/dL of albumin below normal
|
|
Q251. Toxins that cause low calcium; (5)*
|
A251. Can Produce A Calcium Fall:; Cimetidine;; Phenytoin;; Alcohol;; Citrate;; Fluoride
|
|
Q252. Etiology of Hypercalcemia; (14)*
|
A252. CHIMPANZEES:; Calcium supplementation;; Hyperparathyroidism / Hyperthyroidism;; Immobility;; Meds / Multiple Myeloma;; Padget's Dz;; Addison's Dz / Acromegaly;; Neoplasm metastasis;; Zollinger-Ellison syndrome;; Excess Vit-A;; Excess Vit-D;; Sarcoidosis or TB (granulomatous dz)
|
|
Q253. MCC of hypercalcemia; MCC for inpatient?
|
A253. Primary Hyperparathyroidism; Inpatient: Malignancy
|
|
Q254. Dx: malaise, HA, diffuse aches, dehydration, N/V, nodules on skin, cornea, conjunctiva and kidneys
|
A254. Hypercalcemia; (nodules are calcifications)
|
|
Q255. Drugs that cause Hypercalcemia; (5)*
|
A255. C-TALE:; Calcium supplementation;; Thiazides;; Antacid abuse;; Lithium;; Excess Vitamin D
|
|
Q256. Dx: "Stones, bones, groans and psychiatric overtones"
|
A256. Hyperparathyroidism
|
|
Q257. Tx for Primary Hyperparathyroidism patient with underlying cardiac failure; (drug and maintenance)
|
A257. Lasix to maintain diuresis; and Pulmonary artery pressure monitoring to avoid volume overload
|
|
Q258. Pathophysiology behind Renal Osteodystrophy
|
A258. Nephron loss reduces phosphate excretion, causing hyperphosphatemia, which lowers serum calcium and increases PTH secretion; (secondary parahyperthyroidism)
|
|
Q259. (3) Bone lesions assoc with Secondary Hyperparathyroidism
|
A259. Osteitis Fibrosa Cystica;; Adynamic Bone Dz;; Osteomalacia
|
|
Q260. Definition: Normal bone is replaced by fibrous tissue, primitive woven bone and cysts
|
A260. Osteitis Fibrosa Cystica
|
|
Q261. Dx: bone pain, proximal muscle weakness, pruritis, soft- tissue ulcerations, diffuse soft-tissue calcifications
|
A261. Secondary Hyperparathyroidism; (Renal Osteodystrophy)
|
|
Q262. Goal and Tx for Secondary Hyperparathyroidism /; Renal Osteodystrophy; (2 drugs and 2 if drugs dont work)
|
A262. Goal:; Normalize calcium-phos balance Tx:; 1. Aluminum-containing antacids: reduce GI absorpt of PO4-; 2. Vit-D with Calcitrol: inc serum Ca++ and reverse bone damage; 3. Subtotal parathyroidectomy; 4. Renal transplant
|
|
Q263. If patient has hypocalemia or hypophosphatemia (or both) what is the next step?
|
A263. Check for Hypomagnesemia:; Ca++ and PO4- will not elevate if Magnesium is low
|
|
Q264. Dx: Rapid transfer of Calcium into bones following removal of hyperactive parathyroid; What electolyte disorder can it cause?
|
A264. Hungry Bone syndrome; can cause: Hypomagnesemia
|
|
Q265. parasellar sx
|
A265. headache; changes in vision
|
|
Q266. do men or women have a higher rate of parasellar sx associated w prolactinomas
|
A266. men
|
|
Q267. tx of prolactinoma
|
A267. bromocriptine x 2yrs; or cabergoline (both are DA agonists); surgery if no response to medication
|
|
Q268. dx of acromegaly
|
A268. incresaed igf 1; the do glucose suppresion test (glucose normally supresses gh)
|
|
Q269. how should random gh level testing be done
|
A269. it shouldn't be done... it's not useful
|
|
Q270. associated sx (aside from teh obvious) of acromegaly
|
A270. increased glucose, tg, po4, and prl levels
|
|
Q271. causes of central DI
|
A271. sarcoid; TB; syphilis; encephalopathy
|
|
Q272. causes of nephrogenic DI
|
A272. lithium; hypokalemia; hypercalcemia
|
|
Q273. tx of central DI
|
A273. DDAVP; chlopromide (increases ADH secretion and enhances ADH effects)
|
|
Q274. tx of nephrogenic DI
|
A274. HCTZ (works by depleting body of Na --> reabsorption of Na and water in proximal tubules)
|
|
Q275. why is there no edema in SIADH
|
A275. natriuresis also occurs b/c the body senses increased blood volume, and secretes ANP, causing natriuresis; decreased proximal tubule reabsorption of Na b/c of increased volume; RAAS is inhibited
|
|
Q276. tx of SIADH
|
A276. if no sx: water restriction or ns + loop diuretic; if sx: water restriction + isotonic saline
|
|
Q277. difference between cushing syndrome and cushing dz
|
A277. syndrome = increased gc; dz = increased acth from pit
|
|
Q278. effect of hypocalcemia on reflexes
|
A278. increased
|
|
Q279. pseudohypoparathyroid
|
A279. end organ doesn't respond to pth
|
|
Q280. T3 functions
|
A280. 4 B's; brain maturation,; bone growth,; b-adrenergic,; BMR; also diabetogenic and lipolytic
|
|
Q281. Cortisol functions
|
A281. diabetogenic; liplolytic; proteolytic; osteolytic; anti-inflammatory; maintains bp
|
|
Q282. How is cortisol anti-inflammatory?
|
A282. induces lipocortin, which inhibits phospholipase A2; inhibits IL2; inhibits histamine, 5ht release
|
|
Q283. Sympathetic effect on Insulin release?
|
A283. B-adrenergic causes increased release; a2 stimulation inhibits insulin release
|
|
Q284. Steroid Receptors
|
A284. PET CAT; progesteron; estrogen; testosterone; cortiol; aldosterone; thyroid hormone; also Vit D
|
|
Q285. IP3 receptors
|
A285. TO GAG; TRH; Oxytocin; GnRH; ADH (V1); GHRH
|
|
Q286. Conn's Syndrome
|
A286. primary hyperaldosteronism (tumor) (low renin)
|
|
Q287. Addison's Disease
|
A287. primary adrenocortical insufficiency
|
|
Q288. Waterhouse-Friderichsen Syndrome
|
A288. acute adrenocortical insufficiency; adrenal hemorrhage syndrome assoc with meningococcal septicemia
|
|
Q289. MEN syndromes: inheritance, gene assoc, symptoms
|
A289. MenI=pancreas, pituitary, parathyroid; MenII=parathyroid, pheochromocytoma, medullary ca of thyroid; MenIII=pheochromocytoma, medullary ca of thyroid; all auto-dominant, and II and III associated with ret gene
|
|
Q290. MEN syndromes
|
A290. Men I=pancreas, pituitary, parathyroid; Men II=parathyroid, pheochromocytoma, medullary ca of thyroid; Men III=pheochromocytoma, medullary ca of thyroid, and mucosal neuromas (oral and intestinal); all auto-dominant, and II and III associated with ret gene
|
|
Q291. Myxedema
|
A291. glycosaminoglycan deposition in dermis; related to both hypothyroidism and grave's hypertyroidism; pretibial only in graves
|
|
Q292. Subacute Thyroiditis (de Quervain)
|
A292. self limited hypothyroidism (can be hyper early on) following flulike illness; elevated ESR, tender thyroid gland; granulomatous inflammation
|
|
Q293. Thyroid Cancers
|
A293. Papillary=groundglass, orphan annie, psammoNa bodies, most common, excellent prognosis; Follicular=good prognosis, uniform cells; Medullary=parafollicular C cells, calcitonin, sheets of cells in amyloid stroma (calcitonin becomes amyloid); lymphoma assoc with Hashimoto's
|
|
Q294. Test for acromegaly?
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A294. oral glucose tolerance test (GH excess causes insulin resistance)
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|
Q295. Osteitis Fibrosa Cystica
|
A295. cystic bone spaces filled with brown fibrous tissue; bone pain; associated with primary hyperparathyroidism
|
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Q296. Primary Hyperparathyroidism
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A296. stones, bones, groans; stones=renal stones due to hypercalciuria; bones=osteitis fibrosa cystica. often see subperiosteal resorbtion with cystic degeneration, salt/pepper calcarium; groans=weakness/constipation
|
|
Q297. Secondary Hyperparathyroidism
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A297. due to low Ca, usually due to chronic renal disease (renal osteodystrophy); high phosphate!
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|
Q298. acid/base and calcium relationship
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A298. with alkalosis, there is less free ionized Ca2+ so you can get tetany
|
|
Q299. HLA assoc with Hashimotos
|
A299. B5, DR5
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Q300. HLA assoc with DM
|
A300. type 1 = DR3, DR4; none for type 2; although type has a stonger genetic predisposition
|
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Q301. Insulin action
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A301. tyr kinase receptor; glucose uptake; anabolic for fat; K+ uptake
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Q302. AE of metformin
|
A302. lactic acidosis; contrainidcated with renal disease
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Q303. AE of glitazone
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A303. weight gain; edema; hepatotoxic
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|
Q304. Vitamin deficiency: Night blindness; dry skin; impaired immune response; squamous metaplasia of trachea and hair follicles
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A304. Vitamin A
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|
Q305. Vitamin deficiency (and Dx): polyneuritis, high-output cardiac failure, dilated cardiomyopathy, and edema; MCC of deficiency?
|
A305. B1 – Thiamine (Wet beri-beri); MCC - alcoholism
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Q306. Vitamin deficiency: Cheilosis, angular stomatitis, Corneal vascularization, glossitis, seborrheic dermatitis
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A306. Vit B2 - Riboflavin; (2 C's)
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Q307. Vitamin deficiency (and Dx): diarrhea, dermatitis, dementia, beefy glossitis
|
A307. Vit B3 - Niacin; (Pellagra)
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Q308. Vitamin deficiency: Dermititis, enteritis, alopecia, adrenal insufficiency
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A308. B5 - Pantothenate
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Q309. Vitamin deficiency: Convulsions, hyperirritibility, glossitis, peripheral neuropathy, sideroblastic anemia with ringed sideroblasts
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A309. Vit B6 - Pyridoxine
|
|
Q310. Nutrient deficiency: Dermatitis, enteritis; cause?; what is its use?
|
A310. Biotin (from Avidin in raw eggs or antibiotics); Use: Carboxylation rxns
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Q311. Vitamin deficiency: megaloblastic anemia
|
A311. Folic acid
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Q312. Vitamin deficiency: anemia, optic neuropathy, subacute combined degeneration, paresthesia, glossitis; MMC of deficiency?; What test for Dx confirmation?
|
A312. B12 - Cobalamin; MMC - pernicious anemia (also fish tapeworm); Shilling's test
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|
Q313. Vitamin deficiency (and Dx): swollen gums, bruising, anemia, poor wound healing, perifollicular hemorrhage; what NT is it a cofactor for?
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A313. Vitamin C - Ascorbic Acid (Scurvy); cofactor for NE
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|
Q314. Vitamin deficiency: Bending bones, soft bones, hypocalcemic tetany; What other effect is seen only in kids?; What is the most common cause of the deficiency?
|
A314. Vitamin D; kids - soft spots in skull; MCC - chronic renal failure
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|
Q315. Vitamin deficiency: Neonatal hemorrhage, increased PT, increased PTT, normal bleed time; How is it made?; Most common cause of deficiency?
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A315. Vitamin K; made by colonic bacteria; MCC - broad spectrum Ab in hospital
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|
Q316. Nutrient deficiency: Poor wound healing, dissecting aortic anuerysm, skin depigmentation
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A316. Copper
|
|
Q317. Nutrient deficiency: rash; dysgeusia; growth retardation; poor wound healing; hypogonadism, decreased adult hair
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A317. Zinc
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Q318. Vitamin deficiency (and Dx): polyneuritis, muscle wasting, demyelination syndromes, distal sensorimotor neuropathy
|
A318. Vitamin B1 – Thiamine (Dry beri beri)
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|
Q319. Dx: retarded growth and loss of muscle and sub-q fat;; "wasting away"
|
A319. Marasmus
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Q320. Dx: retarded growth and loss of muscule but retained sub-q fat, fatty liver, severe edema, anemia
|
A320. Kwashiorkor; [MEAL = Malabsorption, Edema, Anemia, Liver fat]
|
|
Q321. vitamin required for Transamination reactions
|
A321. Pyridoxine (Vit B-6)
|
|
Q322. (3)* causes of Pellagra
|
A322. HIC: Hartnup Dz (low Tryptophan);; INH (low Vit B-6);; Carcinoid syndrome (high Tryptophan metabolism)
|
|
Q323. what NT and vitamin is Niacin derived from?
|
A323. Tryptophan; Vit B6
|
|
Q324. Dx: Alopecia, fatigue, HA, hepatocellular damage, sore throat, skin changes
|
A324. Vit A toxicity (Retinol)
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|
Q325. Vitamin deficiency: increased fragility of RBC
|
A325. Vitamin E [E = Erythrocytes]
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|
Q326. Dx: hypercalciuria, nephrocalcinosis, renal calculi; (in children: growth retardation)
|
A326. Excess Vitamin D
|
|
Q327. What are the causes of zinc deficiency?
|
A327. 1. alcoholism; 2. DM; 3. chornic diarrhea; 4. Acrodermatitis enteropathica--which is an autosomal recessive disease
|
|
Q328. This is the clinical presentation of what condition?; poor wound healing, can't taste or smell, perioral rash; Children--hypogonadism, growth retardation
|
A328. zinc deficiency
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|
Q329. What is the function of zinc in the body?
|
A329. cofactor for many enzymes including collagenase in wound remodeling
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|
Q330. Name this vitamin toxicity: too much of this vitamin results in papilledema and seizures due to an increased intracranial pressure and can present with bone pain due to periosteal proliferation
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A330. vitamin A
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Q331. Name this vitamin toxicity: hypercalcemia with metastatic calcification and renal calculi
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A331. vitamin D
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Q332. Name this vitamin toxicity: decreased synthesis of vitamin K-dependent porcoagulatn factors; can also have a synergistic effect with warfarin anticoagulation
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A332. vitamin E
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Q333. Name this vitamin toxicity: over dose of this vitamin results in hemolytic anemia and jaundice in newborns if the mother has had too much of this vitamin
|
A333. vitamin K
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Q334. these symptoms are due to what vitamin deficiency?; impaired night vision; blindness; penumonia; growth retardation; loss of sebaceous gland function; renal calculi
|
A334. vitamin A deficiency
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Q335. these symptoms are due to what vitamin deficiency?; CNS bleeding (newborns); bruising; GI bleeding; prolonged prothrombin time
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A335. vitamin K deficiency
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Q336. these symptoms are due to what vitamin deficiency?; hemolytic anemia; peripheral neuropathy; poor joint sensation; ataxia b/c spinocerebellar tract degeneration
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A336. vitamin E deficiency
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Q337. these symptoms are due to what vitamin deficiency?; pathologic fractures, bowed legs, rickets, osteomalacia; continuous muscle contraction (tetany)
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A337. vitamin D deficiency
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Q338. these symptoms are due to what vitamin deficiency?; peripheral neuropathy; ataxia; confusion; amnesia; congestive cardiomyopathy
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A338. Thiamine (b1) deficiency
|
|
Q339. these symptoms are due to what vitamin deficiency?; corneal neovascularization, glositis, fissuring at the angles of the mouth, cheilosis (cracked lips)
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A339. riboflavin (b2) deficiency
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Q340. these symptoms are due to what vitamin deficiency?; pellagra: diarrhea, dermatitis, dementia, death
|
A340. niacin (b3) deficiency
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|
Q341. these symptoms are due to what vitamin deficiency?; weak capillaries and venules; skin ecchymoses, ring of hemoorrhage around hair follicles, bleeding gums, anemia, poor wound healing
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A341. ascorbic acid (C) deficiency
|
|
Q342. these symptoms are due to what vitamin deficiency?; neuropathy; nausea; GI cramps; restlessness; hypoglycemia
|
A342. pantothenic acid (b5) deficiency
|
|
Q343. these symptoms are due to what vitamin deficiency?; sideroblastic anemia; confulsions; peripheral neuropathy
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A343. pyridoxine (b6) deficiency
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|
Q344. these symptoms are due to what vitamin deficiency?; depression; lethargy; hallucinations; numbness/tingling; red scaly rash on face; hair loss
|
A344. biotin (b7) deficiency
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|
Q345. these symptoms are due to what vitamin deficiency?; megaloblastic anemia; no neurologic pathology other than during pregnancy; glottitis red tongue
|
A345. folic acid (b9) deficiency
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|
Q346. these symptoms are due to what vitamin deficiency?; megaloblastic anemia; posterior cloumn an dlateral corticospinal tract demyelination **neuro disease**; glotssitis; *triad of weakness, sore tonge, parasthesis*
|
A346. cobalamin (b12) deficiency
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|
Q347. A mother brings her 3 year old son to the doc after severe bouts of vomiting and diarrhea for the past 2 days. The diarrhea is water, though the mother denies seeing any blood in it. The doctor makes a diagnosis by ELISA on the child's stool and assures the mother that he will be fine with good rehydration---whats the microbe?
|
A347. rotavirus; reoviridae rotavirus
|
|
Q348. What's the clinical presentation of rotavirus?
|
A348. gastroenteritis
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|
Q349. What is the pathogenesis of rotavirus?
|
A349. fecal-oral route....infects villus cells of proximal small intestine and replicates within and lyses the cell resulting in impaired absorption of carbohydrates and other nutrients; vomiting followed by watery diarrhea
|
|
Q350. How is a diagnosis of rotavirus made?
|
A350. symptoms; stool specimen immunoassay for virus assays
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|
Q351. What is the treatment for rotavirus?
|
A351. rehydration!; or a live oral attenuated vaccine is available
|
|
Q352. Mesalamine; Sulfasalazine (or -azine, -azide); class; MOA
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A352. Mesalamine; *5-Aminosalicytes; MOA: inhibits prostaglandin synthesis and the migration of leukotrines into the bowel wall; *topical effect; and scavenges superoxide-free radicals
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|
Q353. Mesalamine; Sulfasalazine (or -azine, -azide); clinical uses
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A353. inflammatory bowel disease--mild to moderate; UC
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Q354. Mesalamine; Sulfasalazine (or -azine, -azide); adverse effects
|
A354. due to sulfapyridine released; 1. dose dependent; nausea, vomiting, headache, malaise, male infertitlity; 2. hypersensitivity: fever, skin rash, hemolytic anemia, agranulocytosis, hepatitis
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|
Q355. Infliximab; Adalimumab; Certolizumab pegol; class; MOA
|
A355. Infliximab; Adalimumab; Certolizumab pegol; *Biological response modifiers; MOA: binds to membrane bound TNF-alpha on macrophages or activated T cells to induce cell death
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Q356. Infliximab; Adalimumab; Certolizumab pegol; clinical uses
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A356. moderate to severe Chron's; induce and maintain remission; Moderate to severe UC (Infliximab); induce and maintain remission
|
|
Q357. Type I; Hyperchylomicronemia
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A357. Increase: chylomicrons; elevated: TG; Lipoprotein lipase def OR altered apolipoprotein C-II
|
|
Q358. Type IIa; Hypercholesterolemia
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A358. Increased: LDL; elevated: cholesterol; Decreased LDL rec
|
|
Q359. Type IIb; Combined hyperlipidemia
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A359. AKA Hyperbetalipidemia; Inc: LDL, VLDL; Elev: TG, cholesterol; Hepatic inc synthesis of VLDL
|
|
Q360. Type III; Dysbetalipoproteinemia
|
A360. Increase: IDL, VLDL; elevated: TG, cholesterol; Altered apolipoprotein E; Accumulation of chylomicron remnants in blood
|
|
Q361. Type IV; Hypertriglyceridemia
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A361. Increased: VLDL; elevated: TG; Hepatic overproduction of VLDL
|
|
Q362. Type V; Mixed Hypertriglyceridemia
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A362. Increased: VLDL, chylomicrons; elevated: TG, cholesterol; Inc production and decreased clearance of VLDL and chylomicrons
|
|
Q363. Increase in serum LDL above 190mg/dl; Acquired causes; primary hypothyroidism; Nephrotic syndrome
|
A363. type II
|
|
Q364. A type II, familial lipoprotein disorder; Autosomal dominate; Defiency in LDL receptors
|
A364. familial hypercholesterolemia
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|
Q365. A..Famial dysbetalipoproteinemia (remnant disease); B. Defiency of apolipoprotein E; 1) Decreased liver uptake of chylomicron remants and IDL; Increased serum chlesterol and triglycerides
|
A365. Type 3 .Famial dysbetalipoproteinemia (remnant disease)
|
|
Q366. a. increase in VLDL due to increase in synthesis or decreased catabolism; b. Acquired causes: Excess alcohol, progesterone OC, DM; c. Familial. Autosomal dominate
|
A366. Type 4, most common
|
|
Q367. a) Autosomal dominant; b) defiency in apolipoprotein B-48 and B-100 1) Defiency in chylomicrons, VLDL, and LDL 2) Decrease in serum cholestorl and triglycerides.
|
A367. Apolipoprotein B deficiency (abetalipoprteinemia) Type 5; Characterized by malabsorption, vitamin E defiency; ataxia, hemolytic anemia with thory RBCs (acanthocytes.
|
|
Q368. Von Gierke's disease; Deficient enzyme
|
A368. glucose-6-phosphatase
|
|
Q369. Von Gierke's disease; Findings
|
A369. Type I glycogen storage disease; Severe fasting hypoglycemia, increased glycogen in liver, increased blood lactate, hepatomegaly
|
|
Q370. Pompe's disease; Deficient enzyme
|
A370. Lysosomal alpha-1-4-glucosidase (acid maltase)
|
|
Q371. Pompe's disease; Findings
|
A371. Type II glycogen storage disease; Cardiomegaly and systemic findings leading to early death; Pompe's trashes the Pump (heart, liver and muscle)
|
|
Q372. Cori's disease; Deficient enzyme
|
A372. Debranching enzyme, alpha-1,6-glucosidase
|
|
Q373. Cori's disease; Findings
|
A373. milder form of type I (Von Gierke's disease) with normal blood lactate levels; Gluconeogenesis is intact
|
|
Q374. McArdle's disease; Deficient enzyme
|
A374. Skeletal muscle glycogen phosphorylase
|
|
Q375. McArdle's disease; Findings
|
A375. increased glycogen in muscle, but cannot break it down, leading to painful muscle cramps, myoglobinuria with strenuous exercise; McArdles: think MUSCLE
|
|
Q376. Fabry's disease; Deficient enzyme
|
A376. Sphingolipidoses; alpha-galactosidase A; X-linked recessive!
|
|
Q377. Fabry's disease; accumulated substrate
|
A377. ceramide trihexoside; X-linked recessive!
|
|
Q378. Fabry's disease; Findings
|
A378. peripheral neuropathy of hands/feet, angiokeratomas, cardiovascular/renal disease; X-linked recessive!
|
|
Q379. Gaucher's disease; Deficient enzyme
|
A379. beta-glucocerebrosidase!; AR
|
|
Q380. Gaucher's disease; Accumulated substrate
|
A380. Glucocerebroside
|
|
Q381. Gaucher's disease; Findings
|
A381. AR!; hepatosplenomegaly, aseptic necrosis of the femur, bone crises; Gaucher's cells (macrophages that look like crumpled paper)
|
|
Q382. Niemann-Pick disease; Deficient enzyme
|
A382. Sphingomyelinase
|
|
Q383. Niemann-Pick disease; Accumulated substrate
|
A383. Sphingomyelin; AR
|
|
Q384. Niemann-Pick disease; Findings
|
A384. progressive neurodegeneration, hepatosplenomegaly, cherry-red-spot (on macula), foam cells; AR!
|
|
Q385. Tay-Sachs disease; Deficient enzyme
|
A385. hexosaminidase
|
|
Q386. Tay-Sachs disease; Accumulated substrate
|
A386. GM2 ganglioside; AR
|
|
Q387. Tay-Sachs disease; Findings
|
A387. progressive neurodegeneration, developmental delay, cherry-red spot, lysosomes with onion skin!!
|
|
Q388. Krabbe's disease; Deficient enzyme
|
A388. Galactocerebrosidase; AR
|
|
Q389. Krabbe's disease; Accumulated substrate
|
A389. galactocerebroside
|
|
Q390. Krabbe's disease; Findings
|
A390. peripheral neuropathy,; developmental delay,; optic atrophy,; globoid cells
|
|
Q391. Metachromic leukodystrophy; Deficient enzyme
|
A391. Arylsulfatase A
|
|
Q392. Metachromic leukodystrophy; Accumulated substrate
|
A392. Cerebroside sulfate
|
|
Q393. Metachromic leukodystrophy; Findings
|
A393. Central and peripheral demyelination with ataxia, dementia
|
|
Q394. Mucopolysaccharidoses
|
A394. Hurler's syndrome and Hunter's syndrome
|
|
Q395. Hurler's syndrome; Deficient enzyme
|
A395. alpha-L-iduronidase
|
|
Q396. Hurler's syndrome; accumulated substrate
|
A396. heparan sulfate,; dermatan sulfate
|
|
Q397. Hurler's syndrome; Findings
|
A397. developmental delay,; gargoylism,; airway obstruction,; corneal clouding,; hepatosplenomegaly
|
|
Q398. Hunter's syndrome; Deficient enzyme
|
A398. Mucopolysaccharidoses; iduronate sulfatase
|
|
Q399. Hunter's syndrome; Accumulated substrate
|
A399. heparan sulfate, dermatan sulfate
|
|
Q400. Hunter's syndrome; Findings
|
A400. XR!; mild-Hurler's (developmental delay, gargoylism, airway obstruction, corneal clouding, hepatosplenomegaly) with aggressive behavior, NO corneal clouding
|
|
Q401. Peripheral neuropathy with pain in extremities; Angiokeratomas; Death from kidney or heart failure
|
A401. Fabry's (X-linked recessive)
|
|
Q402. Ceramide trihexosides (α-galactosidase)
|
A402. Fabry's (X-linked recessive)
|
|
Q403. Hepatosplenomegaly; Macrophage accumulation in liver, spleen; Bone involvement with fractures and pain; "Crinkled Paper" macrophages; Compatible with life
|
A403. Gaucher's, adult (AR)
|
|
Q404. Glucocerebrosides (Β-glucocerebrosidase)
|
A404. Gaucher's, adult (AR)
|
|
Q405. Progressive psychomotor retardation; Abnormal myelin; Large "globoid bodies" in white matter of brain; Fatal early in life
|
A405. Krabbe's (AR)
|
|
Q406. Galactocerebrosides (Β-galactocerebrosidase)
|
A406. Krabbe's (AR)
|
|
Q407. Ataxia; Dementia; Seizures; Death withi first 10 years
|
A407. Metachromatic leukodystrophy (AR)
|
|
Q408. Sulfatides (arylsulfatase A)
|
A408. Metachromatic leukodystrophy (AR)
|
|
Q409. Hepatosplenomegaly; Mental Retardation; Microcephaly; Foamy macrophages; Fatal early in life
|
A409. Niemann-Pick (AR)
|
|
Q410. Sphingomyelin (sphingomyelinase)
|
A410. Niemann-Pick (AR)
|
|
Q411. Muscle weakness & flaccidity; Blindness, cherry-red macular spot; No hepatosplenomegaly; Occurs primarily in Eastern Ashkenazi Jews; Fatal at early age
|
A411. Tay-Sachs (AR)
|
|
Q412. GM2 gangliosides (hexoaminidase A)
|
A412. Tay-Sachs (AR)
|
|
Q413. Gargoyle facies; Corneal clouding; Hepatosplenomegaly; Skeletal deformities; Upper airway obstruction; Recurrent ear infections; Hearing loss; Hydrocephalus; Mental retardation; Death <10 yrs
|
A413. Hurler's (AR)
|
|
Q414. dermatan sulfate, heparan sulfate (α-L-iduronidase)
|
A414. Hurler's (AR)
|
|
Q415. Mild and severe forms; Severe like Hurler but retinal degeneration instead of corneal clouding; Aggressive behavior; Death <15 yrs; Mild compatible with long life
|
A415. Hunter's (X-linked recessive)
|
|
Q416. Dermatan sulfate, heparan sulfate (L-iduronate-2-sulfatase)
|
A416. Hunter's (X-linked recessive)
|