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90 Cards in this Set
- Front
- Back
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differential diagnosis for increased blood glucose (DM)
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pancreatic disease (chronic pancreatitis), glucagonoma, Cushing's disease, iatrogenic (corticosteroids), gestational DM, diabetes insipidus
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Describe the honeymoon period in type 1 DM
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a remission phase seen in type 1 DM days after initiation of insulin therapy, where they have decreased insulin requirements for several months
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pathophysiology of type 1 DM
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autoimmune destruction of beta cells
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pathophysiology of type 2 DM
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insulin resistance and inadequate insulin secretion by pancreas
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in which type of DM are classic symptoms more common?
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type 1 DM
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differential diagnosis for increased blood glucose (DM)
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pancreatic disease (chronic pancreatitis), glucagonoma, Cushing's disease, iatrogenic (corticosteroids), gestational DM, diabetes insipidus
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genetic predisposition of type 1 DM
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weak, polygenic in type 1, with association to HLA DR3 and DR4; strong polygenic in type 2 with no HLA association
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Describe the honeymoon period in type 1 DM
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a remission phase seen in type 1 DM days after initiation of insulin therapy, where they have decreased insulin requirements for several months
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common regimen of type 1 DM
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MDI regimen (premeal HR and bedtime glargine)
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pathophysiology of type 1 DM
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autoimmune destruction of beta cells
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short-acting insulin
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Lispro or Aspart
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pathophysiology of type 2 DM
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insulin resistance and inadequate insulin secretion by pancreas
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frequency of HbA1c checkups
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every 3 months
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in which type of DM are classic symptoms more common?
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type 1 DM
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HbA1C goal
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<7
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genetic predisposition of type 1 DM
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weak, polygenic in type 1, with association to HLA DR3 and DR4; strong polygenic in type 2 with no HLA association
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common regimen of type 1 DM
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MDI regimen (premeal HR and bedtime glargine)
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short-acting insulin
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Lispro or Aspart
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frequency of HbA1c checkups
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every 3 months
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HbA1C goal
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<7
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when to obtain baseline ECG in type 1 DM patients?
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if with heart disease or is <35 y/o
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typical stepwise pharmacologic management of type 2 DM
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metformin, a glitazone, and a sulfonylurea (glyburide); if inadequate on 3 drugs, replace glyburide with NPH or glargine insulin at bedtime; if more intense therapy needed, split/mixed regimen of HR and NPH
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symptoms and diagnostic findigns in DKA
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fruity breath odor, Kussmaul hyperpnea, DHN, abdominal pain, increased AG, hyperkalemia, hyperglycemia, ketones in blood and urine
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criteria for HHNK
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glu >600; pH <7.3; bicarb >15, AG < 14, osmolality >310
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types of DM retinopathy
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nonproliferative and proliferative
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describe nonproliferative DM retinopathy
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retinal vascular microaneurysms, blot hemorrhages, cotton wool spots, macular edema
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describe proliferative retinopathy
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neovascularization in response to retinal hypoxia
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diagnostic findings in kidney biopsy in DM
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Kimmelstiel-Wilson lesions (nodular glomerulosclerosis)
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treatment of nephropathy
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patients with microalbuminuria or proteinuria should be started on ACEi to achieve BP of <125/75
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treatment of neurpopathy
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stict glycemic control improves nerve conduction; TCAs and carbamazepine for sensory dysfunction
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describe myxedema coma
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a form of severe hypothyroidism characterized by AMS and hypothermia
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describe thyroid storm
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a form of severe hyperthyroidism characterized by high fever, DHN, tachycardia, coma and high-output cardiac failure
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diagnostic tests for patients with decreased TSH
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order RAIU scan, TG antibody and thyroid-stimulating Ig assays
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diagnostic tests for patients with increased TSH
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order anti-thyroid peroxidase antibody assay
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symptomatic treatment of hyperthyroidism
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propranolol, hydration, rest, adequate nutrition, cooling measures if severe hyperthermia
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pharmacologic treatment of hyperthyroidism
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PTU or methimazole; severe cases require RAI thyroid ablation; thyroidectomy
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indications for thyroidectomy
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large goiters, pregnanat patients, obstruction of trachea
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pharmacologic treatment of hypothyroidism
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levothyroxine; IV levothyroxine and IV hydrocortisone for myxedema coma patients
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most common cause of primary hyperparathyroidism
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parathyroid adenoma
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common fractures seen in osteoporotic patients
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hip fractures, vertebral compression fractures, distal radius fractures following minimal trauma
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who should be screened for osteoporosis?
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all patients >65 y/o; patients 40-60 y/o with at least 1 RF for osteoporotic fractures after menopause
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screening test for osteoporosis
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DEXA scan of spine and hip
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interpretation of Dexa scan
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take the lowest T-score between spine and hip; if -1 to -2.5 diagnosis is osteopenia; if </= 2.5 diagnosis is osteoporosis
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secondary causes of osteoporosis
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smoking, alcoholism, renal failure, hyperthyroidism, MM, primary hyperparathyroidism, vitamin D deficiency, hypercortisolism, heparin use, chronic steroid use
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when to start treatment in osteoporosis
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if T-score is <-2; of <-1.5 with RF for fractures
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DOC for osteoporosis, in order of efficacy
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bisphosphonates, teriparatide, SERMs, intranasal calcitonin
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bisphosphonates
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alendronate, etidronate, ibandronate
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SERMs
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selective estrogen receptor modulators (raloxifene)
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how often should DEXA scans be repeated
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every 1-2 years after initiation of drug therapy; if worsened T-scores, start combination therapy or change drug
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what is Cushing's disease
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Cushing's syndrome caused by hypersecretion of ACTH from pituitary adenoma
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etiologies of hypercortisolism
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adrenal (adenoma, carcinoma),"", pituitary adenoma, ectopic (lung CA), exogenous (CS administration)
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symptoms of Cushing's disease
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truncal obesity, moon facies, buffalo hump; psych disturbances, HTN, impotence, oligomenorrhea, growth retardation, hirsutism, easy bruisability, purple stria
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diagnostic for Cushing's syndrome
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increased 24-hour urine cortisol
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algorithm for Cushing's syndrome (increased 24 h urine cortisol)
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check AM serum ACTH; if <5, give exogenous steroids or obtain adrenal CT or MRI; if >5, give high-dose dexa suppression test
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interpretation of high-dose dexamathasone suppression test
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suppressed = cushing's disease (confirm with pituitary MRI); nonsuppressed = ectopic ACTH producing tumor (carcinoid tumors, small cell lung CA)
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What is Addison's diseas
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primary adrenal insufficiency
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when is DHEA most elevated
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adrenal carcinoma
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etiologies of primary adrenal insufficiency
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autoimmune, metastatic tumor, hemorrhagic infarction, adrenalectomy, granulomatous disease (TB, sarcoid)
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etiologies of secondary adrenal insufficiency
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withdrawal of steroids, hypothalamic or pituitary pathology (tumor, infarct, trauma, infection, iatrogenic)
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symptoms of adrenal insuff
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weakness, anorexia, weight loss, N/V, postural hypotension, diarrhea, abdominal pain, myalgias, arthralgias
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symptoms of addisonian crisis
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symptomatic adrenal insufficiency, confusion, vasodilatory shock
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diagnostic of adrenal insuff
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AM serum cortisol <5 or <20 after ACTH stimulation test or <9 increase after same test
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nonspecific lab findings for adrenal insufficiency
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hyponatremia, hyperkalemia, eosinophilia
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how to differnetiate primary from secondary adrenal insufficiency based on diagnostic tests
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ACTH increased in primary and decreased in secondary; cortisol after ACTH challenge decreases in primary and increases in secondary
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treatment of adrenal insufficiency
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glucocorticoids and mineralocorticoids
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DOC for adrenal insufficiency
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hydrocortisone
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treatment of OH/hyponatremia, hyperkalemia in adrenal insufficiency
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fludrocortisone
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most common functional pituitary tumor
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prolactinoma
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lab findings in prolactinoma
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increased prolactin, decreased LH and FSH; MRI to confirm tumor
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traetment of prolactinoma
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dopamin agonist (bromocriptine or cabergoline); transsphenoidal surgery ffd by irradiation if tumor is large or medical therapy not tolerated
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MEN type 1
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Wermer's syndrome; pituitary adenoma; parathyroid hyperplasia; pancreatic islet cell tumor
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MEN Type 2a
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Sipple's syndrome; parathyroid hyperplasia; thryoid medullary cancer, pheochromocytoma
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MEN Type 2b
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thyroid medullary cancer, pheochromocytoma, mucocutaneous neuromas, ganglioneuromatosis of colon, Marfan-like habitus
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symptoms of hyperparathyroidism
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fatigue, constipation, polyuria, polydipsia, bone pain, nausea
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diagnostic findings in primary hyperparathyroidism
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increased calcium and PTH, low PO4
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diagnostic findings in hypercalcemia not due to primary hyperparathyroidism
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increased calcium, low or normal PTH, sometimes increased PO4
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treatment of primary hyperparathyroidism
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surgical removal or parathyroid glands; hydrate, furosemide after deficit corrected, bisphophonates for severe hypercalcemia
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complications of primary hyperparathyroidism
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nephrolithiasis, nephrocalcinosis, osteopenia, osteoporosis, pancreatitis, cardiac valve calcifications
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pathophysiology of Grave's disease
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Ab to TSH receptor
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pathophysiology of subacute thyroiditis
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viral infection (mumps or coxsackievirus)
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pathophysiology of Hashimoto's thyroiditis
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autoimmune
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diagnostic findings in Grave's disease
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decreased RAIU scan, (+) Thyroid-stim Ig; (+) Thyroglobulin Ab
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diagnostic findings in subacute thyroiditis
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increased RAIU scan; (+) Thyroglobulin Ab, high ESR
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diagnostic findings in Hashimoto's thyroiditis
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(+) anti-TPO Ab
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treatment of Grave's
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PTU, methimazole, thyroid ablation
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treatment of subacute thyroiditis
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NSAIds, steroids for severe pain; self-limited
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treatment of Hashimoto's thyroiditis
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levothyroxine
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painless thyroid enlargement
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Hashimoto's thyroiditis
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hyperthyroidism --> hypothyroidism; tender thyroid
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subacute thyroiditis
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diffuse painless goiter with eye signs, pretibial myxedema and hyperthyroidism
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Grave's disease
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