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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
A001. 1. 120; 2. 150; 3. 180; 4. 210
Q002. Definition: Hyperglycemia resulting from the autoimmune distruction of the insulin-producing beta cells of the pancreas
A002. DM-1
Q003. most common HLA genotypes in DM-1; (2)
A003. HLA DR3; HLA DR4
Q004. Dx: woman has a recurrent vaginal candidiasis that is refractory to treatment; what test should be done?
A004. Diabetes mellitus; Get a blood glucose
Q005. Antibody types for DM-1; (2)
A005. Anti-cytoplasmic Ab against: Beta cells; and Glutamic Acid Carboxylate (GAD)
Q006. (2) environmental factors that may play a role in the etiology of DM-1
A006. Viral infection; Exposure to cow's milk during infancy
Q007. (3) Viral infections that may play a role in the etiology of DM- 1
A007. Congenital Rubella; Mumps; Coxsackie B
Q008. Dx: polyuria, polydipsia, weight loss, dehydration, blurred vision, fatigue
A008. DM-1
Q009. Dx tests for Diabetes; (3)
A009. 1. Fasting glucose > 126; 2. Random plasma glucose > 200; 3. HbA1c > 7%
Q010. (4)* Bugs that occur in DM patients due to their decreased efficacy of granulocytes
A010. MA and PA:; Mucormycoses;; Actinomycoses;; Pseudomonas;; Aspergillosis (pneumonia)
Q011. How do you determine the time the daily dose of insulin (NPH or 70/30 preparations) is given for a DM-1 patient?
A011. Give 2/3 daily dose before breakfast; Give 1/3 daily dose before dinner
Q012. How should new DM-1 patients monitor their glucose?
A012. Finger-stick levels 5 times a day: morning fasting;; breakfast postprandial;; lunch postprandial;; dinner postprandial;; before bed
Q013. Which insulin preparation is considered "Rapid-acting" and used right before meals?; (2); List: Onset of action; Peak action; Duration of action
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)
Q014. Regular insulin: Onset of action; Peak action; Duration of action
A014. Onset of action = 30-60 min; Peak action = 2-4 hr; Duration of action = 6-8 hr
Q015. (2) Intermediate-acting Insulin preparations; List: Onset of action; Peak action; Duration of action
A015. NPH and Lente; Onset of action = 1-3 hr; Peak action = 6-12 hr; Duration of action = 18-26 hr
Q016. (2) Long-Acting Insulin preparations; List: Onset of action; Peak action; Duration of action
A016. Ultralente and PZI; Onset of action = 4-8 hr; Peak action = 14-24 hr; Duration of action = 24+
Q017. Longest acting Insulin preparation; (2 names); List: Onset of action; Peak action; Duration of action
A017. Glaragine (Lantus); Onset of action = 1 hr; Peak action = no peak; Duration of action = 24+
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?
A018. Dawn phenomenon; By: inc in GH secretion; Tx: move nighttime insulin closer to bedtime
Q019. what is "postprandial"?
A019. 2 hours after meal
Q020. Definition: nighttime hypoglycemia followed by dramatic inc in fasting glucose levels and inc plasma ketones; what confirms dx?; Tx?
A020. Somogyi Effect; confirms: Hypoglycemia at 3am; Tx: give Long-acting insulin at bedtime (instead of NPH)
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
A021. Somogyi effect
Q022. MC negative complication with: 1. DM-1; 2. DM-2
A022. 1. DKA; 2. Non-Ketonic Hyperglycemic Hyperosmolar Coma (NKHC); [either can occur with either DM]
Q023. What type of immunity is impaired with diabetes?; what type of infections can this lead to?
A023. Cell-mediated immunity; leads to: Fungal infections
Q024. What should be done if the am finger-sticks show hypoglycemia?
A024. decrease the bedtime NPH even if the bedtime finger-sticks are high
Q025. (3) causes of DM-2 hyperglycemia
A025. 1. Impaired secretion of Insulin; 2. Decreased insulin effectiveness at glucose uptake; 3. Impaired inhibition of hepatic gluconeogenesis
Q026. How can hyperglycemia cause further glucose intolerance?; (2)
A026. 1. it Decreases insulin sensitivity; 2. it Increases hepatic glucose production
Q027. Drug class of Metformin; MOA (3); AE
A027. Biguanides; MOA: sensitizes skeletal muscle and fat to insulin; Dec hepatic gluconeogenesis; Dec GIT absorption; AE: Lactic Acidosis
Q028. (4)* drugs in Sulfonylurea class
A028. Goes To Cancel Glucose:; Glyburide;; Tolbutamide;; Chlorpropamide;; Glipizide
Q029. MOA of Sulfonylureas; AE
A029. MOA: increase postprandial insulin secretion from beta cells; AE: Hypoglycemia
Q030. (3) drugs in the Thiazolidinediones class
A030. GLITAZONES: Troglitazone;; Rosiglitazone;; Pioglitazone
Q031. (2) MOA of the Thiazolidinediones; AE
A031. MOA: Reduces insulin resistance; dec. hepatic glucose output; AE: Hepatotoxicity
Q032. Example of an Alpha-glucosidase inhibitor; MOA; AE
A032. Example: Acarbose; MOA: inhibits monosaccharides and oligosaccharide hydrolysis in the small intestines; AE: Diarrhea and nausea (and farting)
Q033. MC combination of DM oral drugs; (plus 2 drugs in it)
A033. Glucovance; (Metformin + Glyburide)
Q034. Basic Etiology behind DKA
A034. Severe insulin deficiency causes body to switch from metabolizing carbs to metabolizing and oxidizing lipids
Q035. What (2) ketones are produced with DKA?; what is normal raio of these two?; ratio in DKA?
A035. Beta-hydroxybutyric Acid (BOH); Acetoacetic Acid; Normal ratio: 3:1; DKA ratio: 8:1
Q036. Pathophysiology of DKA and how it leads to "fruity breath"; (4)
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)
Q037. Dx: dehydration, polyuria, N/V, rapid deep (Kussmal) breathing, + anion gap, scent to breath
A037. DKA
Q038. (3) main parts of Dx DKA
A038. D: high glucose (400-800 mg); K: + Ketones; A: pH < 7.3 (inititially casues K to rise)
Q039. (3) Tx rules for DKA
A039. 1. Hydrate (usu 3-4L loss): replace with NS; 2. Insulin (and glucose if pt becomes normoglycemic); 3. Replace K
Q040. Causes of death with DKA; (3)
A040. circulatory failure;; HypoK;; Infection
Q041. MC DM-2 patient profile to get Nonketotic Hyperosmolar Coma
A041. DM-2 nursing home patient
Q042. Etiology of Nonketotic Hyperosmolar Coma; (4--2 are drugs)
A042. Sepsis;; Dehydration;; Diuretics;; Glucocorticoids
Q043. Sx: Altered mental status, signs of profound dehydration, neurologic deficits, DM-2
A043. Nonketotic Hyperosmolar Coma
Q044. What is serum glucose levels for Nonketotic Hyperosmolar Coma?; serum Osmolarity?; what is the other indicator, with relation to the kidneys?
A044. glucose > 1000 mg/dL; serum osmloarity around 385 mOsm/kg; Pre-renal Azotemia: BUN/creatinine levels are increased
Q045. Tx for Nonketotic Hyperosmolar Coma; (3)
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)
Q046. Whipple's triad of Hypoglycemia
A046. 1. plasma glucose < 60mg/dL; 2. Sx of hypoglycemia; 3. improvement of Sx with Glucose
Q047. MCC of altered mental status in Healthcare environments
A047. Hypoglycemia
Q048. Etiology of Hypoglycemia; (6)*
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
Q049. Dx: possible History of insulin or sulfonylurea Tx, adrenergic Sx (diaphoresis, anxiety, tremor, hunger, palpitations); confusion, inappropriate behavior, mistaken for alcohol intoxication
A049. Hypoglycemia
Q050. Dx Tests for Hypoglycemia; (2)
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)
Q051. If alcoholism or nutritional deficiency is a suspected reason for hypoglycemia, what should be placed with the IV of dextrose?; Why?
A051. Thiamine to prevent Wernicke's encephalopathy
Q052. Hospital Tx for Hypoglycemia; (3 steps)
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
Q053. if hypoglycemia is refractory after Tx and there are associated signs of adrenal insufficiency, what is Tx?
A053. give Hyrdocortisone 100-200mg IV
Q054. what is used to resuscitate hypoglycemic coma?; what type of patient will this Tx not work on?
A054. Glucagon IM; won't work on Alcoholic with liver failure
Q055. What does a glucagonoma present with?; (3)
A055. 1. new-onset DM; 2. weight loss; 3. characteristic rash (necrolytic migratory erythema)
Q056. How is insulin related to Catecholamines?; (2)
A056. 1. Inc insulin leads to hypoglycemia, leading to tachycardia, sweating and anxiety; 2. Pheochomocytoma patient have inc risk of hyperglycemia and DM
Q057. How does Cortisol relate to glucose levels?; (2)
A057. 1. Too much cortisol (Cushings) leads to hyperglycemia and DM; 2. Too little cortisol (Addisons) leads to hypoglycemia
Q058. How does GH relate to glucose levels?; (2)
A058. 1. high GH in acromegaly, leads to hyperglycemia and DM; 2. neonatal hypoglycemia is a cardinal sign of GH deficiency
Q059. List the 5 signs (any 3 of which can confirm Dx) to properly Dx Metabolic syndrome
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)
Q060. (3) causes of Macroglossia
A060. Acromegaly;; Myxedema;; Amyloidosis
Q061. Definition: Increased synthesis and secretion of free thyroid hormones resulting in hypermetabolism
A061. Hyperthyroidism
Q062. Etiology of Hyperthyroidism; (4)
A062. Grave's Dz;; Toxic Nodular Goiter;; Plummer's Dz (toxic adenoma);; Subacute thyroiditis
Q063. Dx: heat intolerance, sweating, palpitations, weight loss, tremor, nervousness, weakness, hyperdefication
A063. Hyperthyroidism
Q064. When is the only time TSH is increased and TRH is decreased?
A064. Pituitary tumor (secretes TSH)
Q065. When is the only time TSH and TRH are both increased (with T3 and T4 decreased)?
A065. Primary Hypothyroidism
Q066. Definition: A medical emergency consisting of an exaggerated manifestation of hyperthyroidism
A066. Thyroid Storm
Q067. Etiology of a Thyroid Storm; (4)
A067. 1. Trauma, infection;; 2. DKA;; 3. MI, CVA, PE;; 4. Withdrawl from anti-hyperthyroid meds
Q068. Dx: fever, tachycardia, high-output CHF and volume depletion, exhaustion, diarrhea, abdominal pain, agitation and confusion, possible jaundice
A068. Thyroid Storm
Q069. What is the BP change with hyperthyroidism?
A069. Isolated systolic HTN
Q070. (4) Primary stabilization Tx for a Thyroid Storm
A070. Airway protection;; Oxygenation;; Assess circulation and BP;; IV hydration
Q071. Aside from primary stabilization, how is a Thyroid Storm treated?; (4 together)
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
Q072. Definition: Autoimmune Dz causing hyperthyroidism due to Ab, which stimulates TSH receptor
A072. Graves Dz
Q073. Dx: diffusely enlarged thyroid, exopthalamos, pretibial myxedema, tachycardia
A073. Graves Dz
Q074. Dx tests for Graves Dz; (4)
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
Q075. what is the Long-term anti-thyroid therapy?; complication?
A075. PTU; complication: Leukopenia
Q076. what is the preferred Tx for Graves Dz?; AE?
A076. Radioactive Iodine Ablation Therapy; AE: can result in Hypothyroidism over time
Q077. what should be used as adjunctive therapy for Graves Dz?
A077. Adrenergic Antagonist: Propranolol
Q078. Definition: TSH levels are more then twice the upper limit of normal
A078. Hypothyroidism
Q079. Etiology of Primary Hypothyroidism; (5)
A079. Hashimoto's thyroiditis;; Radiation to neck;; Subacute thyroiditis;; Iodine deficiency (or excess);; Medications: Lithium
Q080. Etiology of Secondary Hypothyroidism; (3)
A080. Secondary = Pituitary problem: Sheehan's syndrome;; Pituitary neoplasm;; Infiltrating Dz (TB) causing TSH deficiency
Q081. Etiology of Tertiary Hypothyroidism; (3)
A081. Tertiary = Hypothalamic problem: Granuloma;; Neoplasm;; Radiation
Q082. Dx: fatigue, lethargy, weakness, weight gain, constipation, cold intolerance, slow speech, dry skin, brittle hair, delayed deep tendon reflexes
A082. Hypothyroidism
Q083. Because muscle weakness and cramps are associated with both hyper and hypothyroidism, how can you tell the difference with CPK level?
A083. Hyper: CPK is normal; Hypo: CPK is elevated
Q084. what additional lab tests may be elevated or decreased with hypothyroidism?; (4 categories)
A084. Increased: 1. Cholesterol and TG; 2. LFTs: LDH, AST, ALT, MM of CPK; Decreased: 3. Hct and Hb; 4. serum sodium
Q085. If a patient presents with high cholesterol, what should you consider testing?
A085. thyroid function tests; (since high cholesterol is a sign of hypothyroidism)
Q086. what test is useful from distinguishing secondary from tertiary hypothyroidism?; what are the results of each?
A086. TRH stimulation test: Secondary: Low; Tertiary: normal
Q087. Tx for Hypothyroidism; How often do you check meds?; How is therapy monitored (b/t primary and secondary hypothyroidism)?
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
Q088. Definition: elevated TSH with normal thyroid hormone levels in the absence of overt clinical symptoms; what are the (2) possible prognosis?
A088. Subclinical Hypothyroidism; 1. can become Primary Hypothyroidism; 2. become Euthyroid
Q089. Tx parameters for replacement therapy for Subacute Hypothyroidism; (3)
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
Q090. (2) Antibody tests that are positive in Hashimoto's thyroiditis
A090. Anti-thyroglobulin; Anti-microsomal
Q091. Definition: Life-threatening complication of Hypothyroidism with profound lethargy or worse, usually assoc. with hypothermia
A091. Myxedema Coma
Q092. Etiology of Myxedema coma; (4)
A092. Sepsis;; Prolonged exposure to cold weather;; CNS depressants;; Trauma/surgery
Q093. Dx: hypothermia with rectal temp < 95; bradycardia or circulatory collapse; severe lethargy; delayed relaxation of DTR or Areflexia
A093. Myxedema Coma
Q094. Tx for Myxedema coma (in order); (5)
A094. 1. Airway management; 2. Prevent further heat loss; 3. Glucocorticoids; 4. IV Levothyroxine; 5. IV hydration (D5 1/2 NS)
Q095. Why are glucocorticoids given before levothyroxine in the Myxedema patient?
A095. due to the concern that the patient may have associated Addison's Dz. Giving only thyroxine could initiate an Addisonian crisis
Q096. In Hashimoto's Thyroiditis, what destroys the thyroid?
A096. CD-4 lymphocytes
Q097. What PE finding distinguishes Hashimoto's from other forms of Thyroiditis?
A097. Thyroid is not tender
Q098. Etiology of Thyroiditis types: 1. Subacute; 2. Silent; 3. Suppurative; 4. Riedel's
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
Q099. Dx: 35-yo female with History of hyperthyroidism and recent flu presents with neck pain and elevated ESR
A099. Subacute Thyroiditis
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?
A100. Subacute Thyroiditis; other: Silent thyroiditis
Q101. Dx: fever with severe neck pain, focal tenderness of involved portion of thyroid
A101. Suppurative Thyroiditis
Q102. Dx: slowly enlarging rock hard mass in anterior neck, tight and stiff neck, fibrosis of mediastinum
A102. Riedel's Thyroiditis
Q103. what labs allow you to distinguish b/t Subacute, Silent and suppurative thyroiditis?
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
Q104. What is Tx for: 1. Pain from Subacute thyroiditis; 2. Suppurative thyroiditis; what should never be given to any thyroiditis patient?
A104. 1. NSAIDs (or steroids); 2. IV Abx and drainage of abscess; Never give PTU to thyroiditis
Q105. *Best test to evaluate a thyroid nodule
A105. Fine-needle aspiration
Q106. If thyroglobulin levels return to normal after a thyroidectomy, what does that suggest?
A106. Absence of metastatic thyroid tissue
Q107. what test distinguishes b/t Hot and Cold thyroid nodules?; what is the difference b/t them?; which is more likely malignant?
A107. Thyroid Scan with t-99; Hot: Hyperfunctioning thyroid; less likely malignancy; Cold: Hypofunctioning thyroid; more likely malignant
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?
A108. 1. Papillary - MC; best prognosis; 2. Follicular; 3. Anaplastic - worst prognosis; 4. Parafollicular (Medullary) - in MEN II and III
Q109. Thyroid CA: ground-glass "Orphan Annie" nuclei and psammoma bodies
A109. Papillary
Q110. Thyroid CA: good prognosis but commonly bloodborne mets to bone and lungs
A110. Follicular
Q111. Thyroid CA: cancer of the "C" cells, derived from branchial pouch 5 and secretes Calcitonin; (2 names)
A111. Parafollicular; (Medullary thyroid CA)
Q112. Tx for any thyroid CA; (2)
A112. Thyroidectomy; Oral thyroxine supplements after surgery
Q113. Definition: hypersecretion of PTH by the parathyroid gland
A113. Primary Hyperparathyroidism
Q114. Definition: Glandular hyperplasia and elevated PTH in an inappropriate response to hypocalcemia
A114. Secondary Hyperparathyroidism
Q115. Definition: continued elevation of PTH after the disturbance causing secondary hyperparathyroidism has been corrected
A115. Tertiary Hyperparathyroidism
Q116. Etiology of Hyperparathyroidism; (3)
A116. Hyperplasia of all 4 glands;; Adenoma/carcinoma;; MEN II and III
Q117. Pathophysiology of the parathyroid gland; (4 ways to increase Calcium)
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)
Q118. what do lab tests show to Dx Hyperparathyroidism?; (3)
A118. high serum calcium (low phos);; high serum PTH;; hypercalciuria
Q119. what are the indications for surgery with Dx of hyperparathyroidism?; (2)
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
Q120. Emergent measures taken (PRN) with hyperparathyroidism; (3)
A120. 1. Hydration with Lasix; 2. Bisphosphonates to block bone resorption; 3. Calcitonin
Q121. When is Mg deficiency seen?; (3)
A121. SAP: SIADH;; Alcoholism;; Pancreatitis
Q122. Etiology of Hypoparathyroidism; (3)*
A122. HID Parathyroids: Hypomagnesium;; Infiltrative CA / Irradiation;; DiGeorge Syndrome;; Post-surgical
Q123. Dx: 30-yo woman presents with perioral paresthesia and long QT interval. She recently had surgery on her goiter.
A123. Hypoparathyroidism
Q124. Dx: seizures, perioral paresthesia, tetany, fasciculations, muscle weakness, CNS depression, faint heart sounds, bronchospasm
A124. Hypoparathyroidism
Q125. What is seen in hypoparathyroidism on the EKG?
A125. QT prolongation
Q126. Tx for hypoparathyroidism; (life-threatening versus maintenance)
A126. Life-threatening: IV Calcium; Maintenance: Calcitriol and oral calcium
Q127. Dx: Similar characteristics to Hypoparathyroidism, but tissue is resistant to PTH, causing an INCREASE in serum PTH
A127. Pseudohypoparathyroidism
Q128. What is pseudohypoparathyroidism assoc with?
A128. Albright's hereditary osteodystrophy
Q129. If you suspect over-the-counter thyroid hormone abuse, TSH is low and T4 is high, what other lab test can you check?
A129. Thyroglobulin levels will be low.
Q130. Radioactive iodine uptake scan is increased in (3)
A130. Graves' disease; toxic adenoma/toxic nodules; multinodular goiter
Q131. Radioactive iodine uptake scan is decreased in (4)
A131. subacute thyroiditis (hyperthyroid stage),; hashimotos thyroiditis (hypothyroid stage),; exogenous T3/T4/levo,; postpartum thyroiditis
Q132. In which conditions are thyroglobulin levels high?
A132. Thyroiditis,; iodine-induced thyrotoxicosis,; amiodarone-induced thyrotoxicosis
Q133. Medications that increase the need for thyroid hormone are (4)
A133. estrogen,; rifampin,; carbamazepine,; phenytoin
Q134. TSH and Free T4 are both decreased in these two conditions:
A134. pituitary hypothyroidism,; hypothalamic hypothyroidism
Q135. Most cases of hyperthyroidism can be treated with (2)
A135. propylthiouracil or methimazole. Severe cases require radioactive ablation.
Q136. Why can't you give methimazole during pregnancy to treat hyperthyroidism?
A136. It can cause aplasia cutis in the fetus
Q137. Another name for Primary Adrenal insufficiency
A137. Addison's Dz
Q138. Dx: shock, dehydration, confusion, vomiting, hyperK and Hypoglycemia; What are the (3) causes?
A138. Addisonian (or adrenal) crisis causes: Hemorrhage;; Sepsis;; Trauma
Q139. (2) main causes of Addison's Dz
A139. Autoimmune (80%);; TB (15%)
Q140. MCC of Secondary adrenal insufficiency; (2) other causes
A140. MCC: Exogenous steroid drugs others: Sheehan's syndrome;; Pituitary infarct
Q141. How is Aldosterone made?; (2) functions
A141. Angiotensin II acts on the zoNa glomerulosa to convert cortisone to aldosterone Functions: Increase sodium reabsorption;; secretion of K+ and H+
Q142. What does a deficiency in aldosterone cause with electrolytes?; (2)
A142. HyperK; HypoN
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
A143. Primary Adrenal Insufficiency; (Addison's Dz)
Q144. How is secondary insufficiency distinguished from Addison's Dz?; (3)
A144. No hyperpigmentation;; Normal aldosterone secretion;; Signs of hypopituitarism (hypothyroidism or hypogonadism)
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
Q146. How does cortisol promote an anti-inflammatory state?; (3)
A146. Inhibits Arachidonic Acid;; Inhibits IL-2 production;; Inhibits release of histamine from Mast cells
Q147. Definition: Hemorrhagic necrosis of the adrenal medulla during the course of meningococcemia
A147. Waterhouse-Friderichsen Syndrome
Q148. Dx: hyperpigmentation, salt cravings, orthostatic hypotension, amenorrhea
A148. Addison's Dz; (primary adrenal insufficiency)
Q149. Describe the ACTH (Cortrosyn) test to Dx Adrenal insufficiency etiology; How does it distinguish b/t primary and secondary?
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
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
Q151. What disease presents with the exact opposite of Addison's?
A151. Cushing's Dz
Q152. Definition: Symptoms of excess Cortisol production
A152. Cushing's syndrome
Q153. Definition: Cushing's syndrome caused by excess ACTH secretion of pituitary
A153. Cushing's disease
Q154. What lung cancer is associated with ectopic ACTH production?
A154. Small (Oat) cell lung CA
Q155. Etiology of Cushing's syndrome (Adrenal excess); (3)
A155. Exogenous corticosteroid therapy;; Adrenal neoplasm;; Ectopic ACTH production
Q156. Dx: HTN, hair loss, central obesity, hump on the back of neck, abdominal purplish striae, hirsuitism, proximal muscle weakness, osteoporosis
A156. Cushing's syndrome
Q157. How is the ectopic ACTH Sx different from the ACTH Sx released directly from the adrenals?; Why?
A157. Ectopic ACTH Sx: Weight gain and proximal muscle weakness only; B/c: the ACTH in ectopic from is usually the inactive form.
Q158. How can Cushing's Dz be distinguished from Cushing's Syndrome?
A158. Cushing's Dz: presence of Hyperpigmentation
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
A159. Cushing's Syndrome
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)
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
Q162. What are the 3 Dx from Dexamethasone Suppression test & ACTH that follows?; (3 results from test)
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
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
Q164. Tx of Cushing's from Pituitary adenomas
A164. Transsphenoidal surgery; (radiation for children and refractory to surgery)
Q165. Tx of Cushing's from Adrenal Adenoma
A165. Unilateral resection, followed by 3 to 12 months of glucocorticoid replacement (until normal adrenal comes out of suppression)
Q166. Tx of Cushing's from Bilateral Adrenal Hyperplasia
A166. Bilateral resection and lifelong replacements of glucocorticoids and mineralcorticoids
Q167. Tx of Cushing's from Ectopic ACTH production
A167. Remove source of neoplasm
Q168. Definition: Isolated excess production of Aldosterone; Another name for it?
A168. Hyperaldosteronism; "Conn's syndrome"
Q169. Etiology of Conn's syndrome; (2); Which is MCC?
A169. 1. Unilateral aldosterone-producing Adenoma (MCC); 2. Bilateral hyperplasia of ZoNa Glomerulosa (idiopathic)
Q170. Dx: HTN, signs of HyperK (muscle cramps, palpitations), signs of glucose intolerance (polyuria, polydipsia); may also be asymptomatic
A170. Conn's syndrome
Q171. Dx test for Conn's syndrome
A171. Measure plasma aldosterone to plasma renin activity ratio; a ratio > 20 = Conn's syndrome (hyperaldosteronism)
Q172. Dx: 44-yo woman has HTN, muscle cramps and excessive thirst
A172. Hyperaldosteronism; (Conn's syndrome)
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
Q174. Definition: tumor of the adrenal medulla resulting in the intermittent release of catecholamine excess
A174. Pheochromocytoma
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
Q176. Dx: Pheochromocytoma, retinal angioma, CNS hemangioblastomas, renal cell CA, pancreatic pseudocysts, ependymal cystenoma
A176. Von Hippel-Lindau Dz
Q177. Dx: 38-yo woman on labetalol presents with poorly controlled hypertension, frequent headaches and palpitations
A177. Pheochromocytoma
Q178. what are the 5 "H" Sx of pheochromocytoma?
A178. HA;; HTN;; Hot (diaphoretic);; Heart palpitations;; Hyperhidrosis (hand sweating)
Q179. Dx test for Pheochromocytoma
A179. Elevated urine Vanillylmandelic Acid; (urine catecholamines)
Q180. Tx for pheochromocytoma; (2)
A180. Surgical resection of mass;; Alpha-adrenergic blocker (may also add B-blocker)
Q181. What is a possible misdiagnosis of Pheochromocytoma?
A181. Anxiety disorder
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
Q183. Where is the anterior pituitary derived from?
A183. Rathke's pouch
Q184. Where is the posterior pituitary derived from?
A184. Hypothalamic neuronal axon terminals of the brain
Q185. what multiendocrine problem includes pituitary tumors?
A185. MEN-1; (pituitary, pancreas, parathyroid)
Q186. where is the site of the primary tumors of the pituitary?
A186. Anterior pituitary only; (none in posterior)
Q187. MC pituitary tumor, it presents with glactorrhea and amenorrhea; Tx?
A187. Prolactinoma; Tx: Bromocriptine (DA agonist)
Q188. Dx: pituitary tumor that presents with visual changes or slightly high prolactin levels; Tx?
A188. Nonfunctioning Tumor; Tx: surgery
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
Q190. Dx: HA, compression of optic chiasm "tunnel vision", signs of increased intracranial pressure
A190. Craniopharyngioma
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
Q194. Dx: progressive enlargement of the peripheral body parts, particularly head, hands, and feet; decreased glucose tolerance; hyperphosphatemia
A194. Acromegaly
Q195. Acromegaly in children
A195. Gigantism
Q196. What hormone in excess is related to acromegaly?
A196. GH
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
Q198. Aside from surgery and radiation, what is the medicine used to Tx Acromegaly?
A198. GH receptor blocker: Pegvisomant (Somavert)
Q199. Dx: 29-yo woman with inability to lactate after childbirth. Delivery was complicated by blood loss and hypotension
A199. Sheehan's syndrome
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
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
Q207. (3) Drugs that can cause nephrogenic DI
A207. "Liquid DM": Lithium;; Demeclocycline;; Methoxyflurane
Q208. Dx: polyuria (3-15 L/day); thirst; dilute urine (sp gravity < 1.005)
A208. DI
Q209. Dx test for DI; (3)
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)
Q212. Tx for Nephrogenic DI
A212. Thiazide Diuretics
Q213. Definition: Excess production of ADH
A213. SIADH
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?
A294. oral glucose tolerance test (GH excess causes insulin resistance)
Q295. Osteitis Fibrosa Cystica
A295. cystic bone spaces filled with brown fibrous tissue; bone pain; associated with primary hyperparathyroidism
Q296. Primary Hyperparathyroidism
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
A297. due to low Ca, usually due to chronic renal disease (renal osteodystrophy); high phosphate!
Q298. acid/base and calcium relationship
A298. with alkalosis, there is less free ionized Ca2+ so you can get tetany
Q299. HLA assoc with Hashimotos
A299. B5, DR5
Q300. HLA assoc with DM
A300. type 1 = DR3, DR4; none for type 2; although type has a stonger genetic predisposition
Q301. Insulin action
A301. tyr kinase receptor; glucose uptake; anabolic for fat; K+ uptake
Q302. AE of metformin
A302. lactic acidosis; contrainidcated with renal disease
Q303. AE of glitazone
A303. weight gain; edema; hepatotoxic
Q304. Vitamin deficiency: Night blindness; dry skin; impaired immune response; squamous metaplasia of trachea and hair follicles
A304. Vitamin A
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
Q306. Vitamin deficiency: Cheilosis, angular stomatitis, Corneal vascularization, glossitis, seborrheic dermatitis
A306. Vit B2 - Riboflavin; (2 C's)
Q307. Vitamin deficiency (and Dx): diarrhea, dermatitis, dementia, beefy glossitis
A307. Vit B3 - Niacin; (Pellagra)
Q308. Vitamin deficiency: Dermititis, enteritis, alopecia, adrenal insufficiency
A308. B5 - Pantothenate
Q309. Vitamin deficiency: Convulsions, hyperirritibility, glossitis, peripheral neuropathy, sideroblastic anemia with ringed sideroblasts
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
Q311. Vitamin deficiency: megaloblastic anemia
A311. Folic acid
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
Q313. Vitamin deficiency (and Dx): swollen gums, bruising, anemia, poor wound healing, perifollicular hemorrhage; what NT is it a cofactor for?
A313. Vitamin C - Ascorbic Acid (Scurvy); cofactor for NE
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
Q315. Vitamin deficiency: Neonatal hemorrhage, increased PT, increased PTT, normal bleed time; How is it made?; Most common cause of deficiency?
A315. Vitamin K; made by colonic bacteria; MCC - broad spectrum Ab in hospital
Q316. Nutrient deficiency: Poor wound healing, dissecting aortic anuerysm, skin depigmentation
A316. Copper
Q317. Nutrient deficiency: rash; dysgeusia; growth retardation; poor wound healing; hypogonadism, decreased adult hair
A317. Zinc
Q318. Vitamin deficiency (and Dx): polyneuritis, muscle wasting, demyelination syndromes, distal sensorimotor neuropathy
A318. Vitamin B1 – Thiamine (Dry beri beri)
Q319. Dx: retarded growth and loss of muscle and sub-q fat;; "wasting away"
A319. Marasmus
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)
Q325. Vitamin deficiency: increased fragility of RBC
A325. Vitamin E [E = Erythrocytes]
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
Q329. What is the function of zinc in the body?
A329. cofactor for many enzymes including collagenase in wound remodeling
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
A330. vitamin A
Q331. Name this vitamin toxicity: hypercalcemia with metastatic calcification and renal calculi
A331. vitamin D
Q332. Name this vitamin toxicity: decreased synthesis of vitamin K-dependent porcoagulatn factors; can also have a synergistic effect with warfarin anticoagulation
A332. vitamin E
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
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
Q335. these symptoms are due to what vitamin deficiency?; CNS bleeding (newborns); bruising; GI bleeding; prolonged prothrombin time
A335. vitamin K deficiency
Q336. these symptoms are due to what vitamin deficiency?; hemolytic anemia; peripheral neuropathy; poor joint sensation; ataxia b/c spinocerebellar tract degeneration
A336. vitamin E deficiency
Q337. these symptoms are due to what vitamin deficiency?; pathologic fractures, bowed legs, rickets, osteomalacia; continuous muscle contraction (tetany)
A337. vitamin D deficiency
Q338. these symptoms are due to what vitamin deficiency?; peripheral neuropathy; ataxia; confusion; amnesia; congestive cardiomyopathy
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)
A339. riboflavin (b2) deficiency
Q340. these symptoms are due to what vitamin deficiency?; pellagra: diarrhea, dermatitis, dementia, death
A340. niacin (b3) deficiency
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
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
A343. pyridoxine (b6) deficiency
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
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
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
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
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
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
A352. Mesalamine; *5-Aminosalicytes; MOA: inhibits prostaglandin synthesis and the migration of leukotrines into the bowel wall; *topical effect; and scavenges superoxide-free radicals
Q353. Mesalamine; Sulfasalazine (or -azine, -azide); clinical uses
A353. inflammatory bowel disease--mild to moderate; UC
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
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
Q356. Infliximab; Adalimumab; Certolizumab pegol; clinical uses
A356. moderate to severe Chron's; induce and maintain remission; Moderate to severe UC (Infliximab); induce and maintain remission
Q357. Type I; Hyperchylomicronemia
A357. Increase: chylomicrons; elevated: TG; Lipoprotein lipase def OR altered apolipoprotein C-II
Q358. Type IIa; Hypercholesterolemia
A358. Increased: LDL; elevated: cholesterol; Decreased LDL rec
Q359. Type IIb; Combined hyperlipidemia
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
A361. Increased: VLDL; elevated: TG; Hepatic overproduction of VLDL
Q362. Type V; Mixed Hypertriglyceridemia
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
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)