11th hour push Flashcards
Metformin and Rosaglitazone are contraindicated in the presence of:
CHF
70/30 insulin is used to tx:
T2DM
What oral medications should be avoided in patients with DM and renal disease?
Metformin;
Glyburide (sulfonylureas)
T/F: Monotherapy with metformin or glyburide improves overall glycemia to an approximately equal extent.
True
A 50-year-old female complains of bone pain, most severely in the hips. Blood work is normal except for severely elevated alkaline phosphatase. X-ray indicates a thickening of the cortex, increased trabecular markings and expansion in the size of the bone, with variable degrees of gross bone deformity. Bone scans indicated increased bone metabolism. Dx?
Paget’s disease
Alkaline phosphatase and hydroxyproline elevations indicate:
bone loss
A 48 year-old male complains of tiredness, thirst, constipation and polyuria. Blood work indicates anemia, increased BUN and a large increase in creatinine and alkaline phosphatase, with normal glucose. Serum calcium and vitamin D are reduced, while phosphate and PTH are elevated. Upon Xray, there are indications of osteopenia and nephrocalcinosis. What is the most likely diagnosis?
Secondary hyperparathyroidism due to renal insufficiency—elevated PTH due to hypocalcemia, increased bone resorption leads to osteopenia, elevated plasma phosphate inhibits conversion of 25-hydroxycholecalciferol (liver), thereby reducing vitamin D thereby reducing intestinal calcium absorption. Elevated phosphate in presence of high PTH indicates primary renal compromise.
Class: Alendronate
bisphosphonate
used to prevent fractures in osteoporosis
What is PTHrP?
PTHrP (PTH related peptide) is a humoral marker released in malignancy that works like PTH to raise calcium levels.
Class: Raloxifene
selective estrogen receptor modulator
Use: Raloxifene
Raloxifene is a selective estrogen receptor modulator and currently only used to treat osteoporosis in women.
What thioamide blocks conversion of T4 to T3?
PTU
Excess secretion of aldosterone causes:
HTN and hypokalemia
Late onset congenital adrenal hyperplasia due to 21-hydroxylase deficiency would be associated with:
hirsutism and glucocorticoid as well as mineralocorticoid deficiency.
T/F: Patients with DKA have a significant volume deficit of 7-12L of fluid
True
You admit two patients to the hospital. One patient has DKA (diabetic ketoacidosis) and the other has HHS (hyperosmolar hyperglycemic state). Which statement would best describe the patient with HHS?
Higher serum glucose
Greater acidemia
Type 1 diabetes mellitus
Patients with HHS generally have type 2 diabetes and will generally present with a higher serum glucose and osmolality. Patients with DKA are acidotic with elevated ketones, and decreased bicarbonate and an associated decreased pH. Because of symptoms associated with the acidemia, i.e. vomiting, abdominal pain, etc, they may present early with only sightly elevated glucose levels.
T/F: Patients with HHS (hyperosmolar, hyperglycemic state) have a fluid deficit.
True
Where does craniopharynioma originate?
Above the sella turcicia
destruction of posterior pituitary
no ADH –> DI
Functional lactotrope adenomas lead to:
ammenorhhea;
galactorrhea;
infertility
If the tumor is small enough, tx with dopamine agonist like bromocriptine to inhibit prolactin secretion
MG cases often involve:
thymic hyperplasia, thymoma;
tx with thymectomy
How does goiter cause hoarseness?
Laryngeal nerve impingement
What drug can cause nontoxic goiter?
Lithium
Why can male patients with acromegaly from a pituitary adenoma have ED?
Excess prolactin secretion in a mixed somatotroph-lactotroph adenoma
What is P450C21?
CAH, 21-hydroxylase deficiency pathway from cholesterol to cortisol virilization of female neonate genitalia continuous secretion of ACTH by pituitary adrenal glands greatly enlarged
How does Albright hereditary osteodystrophy cause hypocalcemia?
End organ unresponsiveness to PTH (pseudohypoparathyroidism)
short stature, obesity, mental retardation, congenital abnormalities of the bone etc.
Mutations in what protooncogene are responsible for MEN syndromes?
RET
Diffuse nontoxic goiter is found in:
Adolescents;
Pregnancy
Nodular nontoxic goiter is found in:
Older folks
Plummer disease
This “toxic” nodule has acquired growth and functional characteristics similar to a benign neoplasm, such as a follicular adenoma, but one that is functional.
A hyperplastic and vascular thyroid is found in:
Graves disease
Nontoxic goiter that causes hyperthyroidism does NOT cause what symptom, seen in Graves disease?
Exopthalmous
Orphan Annie, or ground gladd, nuclei are seen in what neoplasm?
Papillary carcinoma of the thyroid
What causes the granulomatous reaction seen in DeQuervain thyroiditis?
Destruction of follicles –> release of colloid
What antibodies are found in Graves disease?
Stimulating IgG antibodies
A conspicuous feature of MTC is:
Stromal amyloid (deposition of procalcitonin)
Patients with MTC often have what paraneoplastic syndromes?
Carcinoid syndrome;
Cushing syndrome
Watery diarrhea in MTC is caused by:
VIP secretion
Where does neuroblastoma originate?
Adrenal medulla or sympathetic ganglia;
pseudorosettes around small vessels;
urinary VMA
N-myc amplification
Absolute lymphopenia is seen in what endocrine disorder?
Cushing syndrome
Dexamethasone suppresses:
the pituitary secretion of ACTH (corticotropin)
if positive –> pituitary adenoma
if negative –> adrenal source
Cushing syndrome from an adrenal cortex would involve what layer of cells?
Fasiculata
Conn syndrome is aka
primary hyperaldosteronism, adrenal adenoma
Hypernatremia, HTN
potassium depletion causes muscle weakness and fatigue
Pheochromocytoma involves what cells?
Chromaffin cells
Why can somatotroph adenomas and acromegaly cause DM?
GH opposes insulin
What is empty sella syndrome?
herniation of the arachnoid through the diaphragma sellae. Although the increased pressure can lead to reduction in pituitary tissue through compression atrophy, there is typically adequate functional anterior pituitary to prevent hypopituitarism. This herniation can cause a “stalk section” effect, however, with loss of prolactin inhibition and hyperprolactinemia.
How does the anterior pituitary infarct in Sheehan syndrome?
Hypotensive events, like bleeding, cause hypoperfusion –> infarction
Hurthle cell metaplasia is characteristic of:
Hashimoto thyroiditis
A PAX8-PPARG fusion gene is found in certain:
follicular carcinomas of the thyroid
A 46-year-old woman has a one-year history of a skin disease. At the time of initial diagnosis, she was antinuclear antibody (ANA) positive. The patient’s disease course since then has been characterized by rapidly progressive skin thickening and tightening, gastroesophageal reflux disease with diffuse esophageal dysmotility, and Raynaud phenomena. Now she is admitted to the hospital for a new-onset seizure. On admission, her blood pressure was 192/132 mm Hg with a creatinine of 1.3 mg/dL, which was elevated from a baseline of 0.9 mg/dL.
Scleroderma - thrombotic microangiopathy
An 8-year-old girl developed watery diarrhea which turned bloody 2 days later. On the second day of hospitalization, she became anuric and progressively encephalopathic. On admission, laboratory testing showed azotemia (BUN 67 mg/dL, creatinine 5.1 mg/dL), anemia (hemoglobin 9.1 g/dL) with schistocytes on the blood smear, neutrophilic leukocytosis (white blood cell count 17,000/ mm3) and thrombocytopenia (platelet count 59,000/ mm3). Prothrombin time was 18 seconds (elevated) and D-dimer > 20 (elevated). Initial CT scan showed low density areas centered within the basal ganglia, thalami, and the cerebral hemispheres, all consistent with infarctions.
HUS - Thrombotic microangiopathy
56-year-old woman received a renal allograft from a deceased donor. On day 3 after renal transplantation, recurrent proteinuria developed, which increased over the next few months (see figure). The patient was treated with rituximab in addition to a standard transplant immunosuppressive regimen. Anti–PLA2R (phospholipase A2 receptor)-specific antibody titers were measured in serum that had been obtained from the patient before and after renal transplantation, as well as after rituximab therapy.
Subepithelial immune complexes without significant glomerular hypercellularity
A previously healthy 6-year-old girl has polyuria, polydipsia, dry mouth with rampant dental caries, grittiness of eyes, and recurrent painful swelling of parotid glands. The Schirmer tear test is abnormal and Pertechnetate scintigraphy (99mTc) of the salivary glands revealed no detectable salivary flow. She has hyperchloremic, normal anion gap metabolic acidosis. ANA, Rheumatoid factor and Ro are positive. La is negative. Complement C’3 and C’4 were normal. There is hyposthenuria, which did not resolve after water deprivation and administration of vasopressin. The urine pH did not go lower than 7.0 and study of the fractional excretion of bicarbonate was normal.
Interstitial nephritis
Kidney biopsy in Alport syndrome would show
Thin lamina densa of the glomerular basement membranes diffusely
T1DM often coincides with another acute illness.
True
What is the cause of MCD?
The most likely cause of foot process fusion is a primary injury to visceral epithelial cells caused by T cell–derived cytokines.
Corticosteroid-resistant hematuria and proteinuria leading to hypertension and renal failure is typical for
FSGS
