AMEDEX MIX Flashcards
pituitary adenomas (micro or macro) - disruption of stalk
causes of hyperprolactinaemia
hypothalams tumors (craniopharyngioma, glioma), infiltration (sarcoidosis), irradiation
causes of hyperprolactinaemia
drug-induced cimetidine, methyldopa, metodopramide, phenothizine, risperidone, other neuroleptics, SSRIs, TCAs, opiates and marijuana
causes of hyperprolactinaemia
systemic pregnancy, hypothyroidism, renal
failure, liver disease, polycystic ovarian
syndrome, epileptic seizures
causes of hyperprolactinaemia
neurogenic breast stimulation, chest wall trauma
or lesion, stress
causes of hyperprolactinaemia
prolactin level as high as 7845 mU/L, the most likely cause would be a
prolactin secreting pituitary adenoma (prolactinoma).
A prolactin level of above 5000 mU/L is more
likely to have been caused by a
prolactinoma
Although drugs such as risperidone are a potential cause of hyperprolactinemia, the
prolactin levels are expected to be below
5000 mU/L.
In children with type I diabetes mellitus, _____________is the most common encountered
complication
hypoglycemia
hypoglycemia may lead to _________and loss of consciousness
seizures
In childhood (other than neonatal period), \_\_\_\_\_\_\_\_\_is defined as a blood glucose level of <2.6 mmol/L.
hypoglycaemia
The most appropriate treatment of severe hypoglycemia when the
patient is unconscious and unable to take oral glucose is with a bolus of __________________10%, 2.5 to 5 mL/Kg followed by 0.03 to 0.05 mL/Kg/minute until the patient is
stable
intravenous
dextrose
In adults with hypoglycemia, _____% glucose solution is used for treatment of severe
hypoglycemia
50
This solution is not recommended for children because it can result in serum
hyperosmolarity and death.
50% glucose solution is used for treatment of severe
hypoglycemia
In a conscious and cooperative child, oral route is preferred.
In childhood (other than neonatal period), hypoglycaemia
________neuropathy is one of the complications of diabetes mellitus. Diabetic autonomic
neuropathy is common and often a debilitating condition
Autonomic
Skin - dry skin (due to lack of sweating), or excessive sweating in defined areas
• Eye - poor dark adaptation, sensitivity to bright lights
• Cardiovascular - postural lightheadedness, fainting, orthostatic tachycardia,
orthostatic bradycardia and orthostatic hypotension
• Urinary - urgency, incontinence, dribbling, and bladder emptying abnormalities
• Gastrointestinal - diarrhea, constipation, nausea and vomiting
• Sexual - erectile dysfunction and ejaculatory failure in men, loss of ability to reach
sexual climax in women
Clinical manifestations of
diabetic autonomic neuropathy
Diabetic foot ulcers have a
different pathophysiology, mostly including peripheral neuropathy and ischemia from
________________
peripheral vascular disease
Poor resistance against infections is also a contributing factor.
Diabetic foot ulcers
First is the feeling of ‘always
afraid that something bad is going to happen soon’. This subjective feeling also described as
‘impending doom’ often indicates the presence of anxiety and can be seen during a panic attack
in patients with pheochromocytoma, and in those with hyperthyroidism and __________
thyrotoxicosis
Increased perspiration and palpitation are features seen almost in every hypermetabolic and
________________state
hypersympathetic
___________ blood pressure on examination goes against generalized anxiety
disorder (option D) and panic disorder (option B), making these two less likely, but still
possible
Elevated
The
most common presentation of ______________is with episodic headache, tachycardia,
hypertension, anxiety and sweating
pheochromocytoma
Although some patients with pheochromocytoma appears
to have sustained increased blood pressure, the absence of _____________, which is one of the
components of the classic triad of the disease (headache, palpitation, and diaphoresis), makes
pheochromocytoma (option C) less likely
headache
The most frequent symptoms of hyperthyroidism are nervousness (anxiety), ________________,
palpitations, and fatigue and weight loss.
heat intolerance
Common signs on examination include agitation, sinus
tachycardia, elevated systolic blood pressure, fine tremors and hyper-reflexia
hyperthyroidism
The low BMI of this woman, as well as being a professional athlete makes _________________ a very likely diagnosis
anorexia nervosa
AN
If the diagnosis is AN, it is most likely to be of restricting type,
where the patients reduces weight through restricted calorie intake or _________________.
excessive exercise
one thing is certain: this woman is at increased risk of
osteopenia/osteoporosis due to ________________ and prolonged menopause and the DEXA
scan proves that osteoporosis of the vertebral column ans osteopenia of the hip have
already occured.
low body weight
. All patients with AN should be started on calcium (1200-1600mg,
daily) and vitamin D. Calcium and vitamin D, will not restore the bone density, but they
prevent further ___________.
bone loss
Alendronate and other bisphosphonates are first-line treatment for
postmenopausal women with established ______________.
osteoporosis
In women of reproductive age,
bisphosphonates should not be used routinely as they are ____________and may remain in
the body for long periods
teratogenic
Weight-bearing exercises have been shown equivocal results in bone ______________ to date.
mass
restoration
Furthermore, excessive exercise can be associated with more
probability of ___________fractures in a osteopenic/osteoporotic woman
traumatic
Androgens, in any form, have shown no benefit in treatment of AN-related
__________________.
osteoporosis
Osteoporosis is one of the significant complications of anorexia nervosa (AN) seen in at
least _________% of female patients.
30
Osteoporosis is associated with risk of ________.
fractures
Osteoporosis in AN is characterized by increased bone resorption without concomitant
increased _________formation
bone
Trabecular bone, found in the spine and hips, is affected more
than cortical bone.
Osteoporosis
. The most severely affected site is the lumbar spine. Bone loss occurs at
a rate of 4% to 10% per year.
Osteoporosis
Peak bone mass is generally acquired
during adolescence and young adulthood, which frequently coincides with the onset of AN.
The peak bone mass acquired by a patient with AN depends on the time of onset and
duration of the eating disorder, the degree of nutritional depletion, and changes in body
composition.
factors contribute to osteoporosis in AN
